Findings from a Peer Support and Learning Group pilot to support Trauma Informed Practice in Adult Social Care

2. Methodology

2.1 Sample Composition and Recruitment of Care Homes

2.1.1 Recruitment Strategy

It was suggested that six to eight Care Homes should be included in a PSL Group to support the creation of a psychologically safe and effective learning environment and maximise collaboration between members. Participation was contingent on the ability for each care home to release two members of staff for the duration of the project. This criterion was essential in supporting the beginnings of a 'TIP Implementation Team' in each participating care home, offering a level of resilience both in terms of attendance at PSL Group sessions and the capacity to implement aspects of TIP in their service/organisation. It was also suggested that at least one of the two participants should hold a management role as implementation of TIP requires strategic consideration of policies, systems, environments, and people.

The time limited nature of funding available for this project resulted in a decision being taken to use a combination of purposeful and convenience sampling methods. Recruitment of participating homes was conducted in collaboration with Scottish Care, the Scottish Social Services Council (SSSC), and the Coalition of Care Providers in Scotland (CCPS). Facilitated by Scottish Government, SSSC identified care homes likely to be able to engage with the project, ensuring representation was included from providers with different models of ownership, service size, and models of service provision.

Potential participants were provided with Project Information Sheets to meet the requirement for informed consent and a clear understanding of the purpose of the project and expectation regarding participant commitment. Parties interested in participating in the project were required to provide formal informed consent via a Consent to Participation Form, which also set out agreement to involvement in the Action Research Evaluation of the project.

2.1.2 Sample Composition

Steps were taken to recruit a representative sample by including Care Homes with independent and Local Authority funding models, as well as facilities of different size (see table 1 for a breakdown). Representation was sought from third sector providers; however the identified team were unable to proceed with participation in the project due to staffing capacity pressures. Despite these steps, it was recognised that this methodology likely introduced bias within the sample, with Care Homes already active in the implementation of Person-Centred Care approaches being more likely to be approached regarding involvement in the project. As a result, careful consideration should be taken in generalising findings to the wider population of Care Homes in Scotland.

2.1.3 Table 1 – Characteristics of Participating Care Homes

2.2 Project Model

The offer to Care Homes participating in the project included three components, which were provided by two Project Facilitators:

1. Education regarding TIP and implementation of TIP in practice

2. Monthly PSL Groups

3. Weekly 'drop in' implementation support clinics

2.2.1 Educational Component

The initial component of the project involved the delivery of a three-day training programme designed and delivered by the Project Facilitators. Participants also completed NHS Education for Scotland's 'Trauma Skilled Practice' e-learning module as a pre-requisite requirement for participation in the project. This ensured that the group were commencing the educational component with a minimum level of understanding about psychological trauma and its impact. The three-day programme included the following:

Day 1: Understanding trauma and its impact on older people and people living with dementia

Day 2: Delivering trauma-informed care in the Adult Social Care Sector

Day 3: Implementation of TIP – creating trauma-informed systems and culture in the Adult Social Care Sector

The training programme was evaluated using a participant feedback form designed for the purposes of this project.

2.2.2 The Peer Support Learning (PSL) Groups

Following completion of the educational component, monthly facilitated PSL Groups were provided for a period of six months. Peer Support Groups have been used in various settings including Healthcare, Higher Education and in the Workplace. For this project, they involved 'peers' working in the Care Home sector to come together, learn and support each other over the course of the pilot. Peer Support differs from peer mentoring as in the latter there tends to be more of a hierarchical relationship between participants. These groups were named 'Peer Support and Learning Groups' as it was anticipated peer support would be central to the groups, alongside a learning component through incorporation and discussion of the initial training attended by participants. Sessions were delivered remotely via the Microsoft Teams platform for up to a maximum of 3 hours.

The purpose of the PSL Groups was to support participants to come together and share experiences of implementing TIP, to learn from each other, work together to address common challenges or barriers, and provide peer support. The agenda for each PSL Group session was left open to be determined by group participants.

Initially, the groups were structured to encourage participation and focused on giving all attendees the opportunity to provide a progress report, followed by time to explore reflections or advice from group members, or seek direction or coaching from the project facilitators. Additionally, the PSL Groups also afforded an opportunity for ongoing education and implementation coaching provided by the Project Facilitators. Building on the initial educational component of the project, each group included an additional focus area including:

• Using the educational resources provided by the National Trauma Transformation Plan (NES)
• Utilising implementation tools to support TIP
• Identifying barriers and enablers to implementation of TIP using literature and models from Implementation Science
• Monitoring the implementation of TIP and integration of feedback

This involved dissemination of additional materials developed by the facilitators to support participants in the implementation of TIP in their service or organisation. This 'Implementation Pack' included a brief organisational self-assessment tool specifically tailored for the Care Home sector to support service self-assessment regarding implementation of TIP and associated development planning.^[1]

As detailed below, an action learning approach was adopted, and findings from participants and facilitators were regularly reviewed and fed back into the development of the groups over the course of the project.

2.3 Project Evaluation Model

An action learning approach was considered a good fit for evaluation of this project due to its limited duration and the inclusion of action learning as a key component of the PSL Groups. The purpose of action research is to bring about change in specific contents (Parkin, 2009). In the context of a PSL Group model, it was anticipated that participants and facilitators would contribute knowledge, skills, and experience, supporting a culture of observation and reflection regarding experiences within the group and how they may relate to the wider Adult Social Care Sector. This was monitored throughout the project using a range of methods including:

• Recordings of PSL sessions to prompt reflection and identify key themes
• Review of facilitator notes collected throughout the duration of the project
• The use of focus group and in depth individual interviews methodology after the final PSL Group to gather detailed participant feedback.