National Trauma Training Programme - local delivery trials: interim evaluation

Conclusions

By March 2020 the three NES/SG funded Delivery Trial Sites had made progress in many areas including:

• establishing multi-partner steering/ implementation groups
• conducting needs assessments and workforce mapping
• designing training content
• progressing leadership training - STILT and roadshows (high volume awareness raising events)
• identifying inhouse and/or commissioning trainers to deliver at level 1, 2 and 3
• progressing monitoring and evaluation plans.

The main variations in approaches between sites were in relation to whether they targeted all agencies within their HSCP/Local Authority or focused on specific target groups or geographical localities. Other variations existed in terms of their approaches to project management and involvement of people with lived experience and third sector partners. These variations and outputs such as the carers’ training module may lead to useful learning once delivery is complete and outcomes measured.

Training for senior leaders and managers was delivered in 2 out of 3 sites. Unfortunately due to the Coronavirus pandemic training of frontline staff was organised and advertised but unable to proceed. Given this, the process evaluation was unable to report on the reach and early outcomes from frontline training.

The support via the NTTP from NES was viewed positively and STILT training and e-learning resources and tools were valued. More specific guidance from NES/SG on ways in which third sector agencies and people with lived experience could/should be engaged in co-production and delivery were suggested improvements. An additional suggested improvement was further consideration on the timing of the release of new content and tools when local agreements on these had already been made. A final issue was ensuring that e-learning did not reduce attendance at face to face training where this was available.

The learning and feedback gathered from the process evaluation is limited as it focused only on early planning for the role out of training – only one aspect of the plans. Lessons from the wider literature suggest there are a number of necessary conditions which when aligned with training will create a sufficient package of interventions to achieve TIP. A recent realist informed systematic review of trauma informed care in youth inpatient psychiatric treatment settings ^[26] highlights this by concluding that:

“Five factors were instrumental in implementing trauma informed care across a spectrum of initiatives: senior leadership commitment, sufficient staff support, amplifying the voices of patients and families [people with lived experience], aligning policy and programming with trauma informed principles, and using data to help motivate change”

Further lessons from the process review and literature that may be important for future roll out of the NTTP are that:

• developing a Trauma informed organisation needs long-term action. The timeframe needed when working across partnerships such as integrated HSCPs which contain many agencies and organisations may therefore take even longer than for single organisations
• no one size fits all solutions exist and the varied partnership contexts will need tailored approaches. Recent literature ^13,14 and learning from the process evaluation indicate that many contextual factors will impact on implementation such as geography, socio-economic, political, organisational, local networks etc.^13,14
• numerous mechanisms (e.g. trusting relationships, open communication, effective staff supervision and support, empowerment of and coproduction with staff and people with lived experience, choice and collaboration) are all likely necessary for practice and service changes to occur and for subsequent impact to be achieved^8,9
• monitoring and evaluation should be integrated at the planning stage and needs to be pragmatic and proportionate to the scale of programmes and resources. There are many existing audit tools and measurement scales used in TIP worldwide^6,7,8,18. These can be used to enhance future planning and evaluation within the local and national roll out of the NTTP. Where resources allow, further validation of these tools and measure is needed to inform more consistent use across interventions and allow more robust analysis. This in turn will help inform issues such as optimum length of training course, and necessary packages of intervention to maximise positive impacts on individuals, partnership and people with lived experience.