1 Executive Summary
1.1 This research was commissioned in 2022 by the Scottish Government, as part of the National Trauma Transformation Programme, to an independent research contractor called ‘Andthen’.
1.2 The aim of this study was to map the learner journeys of five areas of work from the Children and Families workforce. Within these learner journeys, the study explored the extent to which learning around psychological trauma was already included or where there is potential for the National Trauma Transformation Programme (NTTP) ‘Level 1: Trauma Informed’ and ‘Level 2: Trauma Skilled’ practice level resources to be further incorporated. The five areas of work covered by this study are School Nursing, Health Visiting, Children and Families Social Work, Residential Childcare and Secure Care. Their learning journeys have been summarised, and relevant education materials and standards have been analysed to determine if and where trauma or trauma informed practice is included.
1.3 There are some limits to this study, notably, many participants were self-selecting and therefore may have had prior awareness or interest in psychological trauma or trauma informed practice. It is also worth noting that the learning materials analysed throughout this report are a mixture of publicly available materials (such as module descriptions and learning objectives) and materials shared by relevant individuals from institutions. In cases where publicly available materials were analysed, it is important to note the limitations of such analysis — publicly available materials such as module descriptors and learning objectives are often high-level and may not cover the full detail of what is included in learning materials themselves. While psychological trauma and trauma-informed practice may not be mentioned in publicly available materials, these topics still may be included within learning materials.
School Nurses and Health Visitors
1.4 Across the five areas of work covered in this study, Health Visitors and School Nurses have the most straightforward education pathway — with limited options for learner journeys into these respective areas of work. Health Visitors and School Nurses must complete Undergraduate level Nursing or Midwifery education (referred to a pre-registration education), before registering with the Nursing and Midwifery Council (NMC), and then specialising through a Specialist Community Health Public Nursing (SCPHN) programme in Health Visiting or School Nursing (referred to a post-registration education).
1.5 The NMC set specifications for both pre and post-registration education, which must be adhered to by all educational programmes. In both cases, there is limited requirement for learning about the impact of psychological trauma and trauma informed practice — both pre and post-registration standards include requirements which only partially cover topics outlined in Level 1: Trauma Informed. The standards analysed in this report are from 2022 and all institutions must align to these standards by 2024.
1.6 Most Nursing Undergraduate Degrees include components of learning about the impact of psychological trauma and trauma informed practice and are teaching up to the equivalent of Level 1: Trauma Informed. However, this is not the case across Midwifery Undergraduate Degrees, in which there is minimal focus on psychological trauma, instead focussing on physical trauma. Most SCPHN programmes have little visible inclusion of information about trauma or trauma informed approaches in their materials.
1.7 The NMC sets mandatory CPL requirements for School Nurses and Health Visitors, however the content of such CPL is flexible, and tends to be highly dependent on the needs of individuals, managers or team leaders.
Children and Families Social Workers
1.8 There are a few different journeys into this area of work, although these are overseen by the Scottish Social Services Council (SSSC) and are still relatively formalised. The SSSC sets out standards for social work education, which sets the foundation for qualifications and training programmes required to become a Children and Families Social Worker and to register with the SSSC. All of these standards include some elements of the topics outlined in Level 1: Trauma Informed, but do not cover all topics, and typically do not use the terms ‘trauma’ or ‘trauma informed,’ instead using terms like ‘abuse’ and ‘vulnerable/vulnerability’ to refer to similar themes.
1.9 Individuals must complete a Post Graduate Diploma (PGDip), Undergraduate Bachelors degree (BA, BA (Hons)), or a full-time postgraduate Masters degree (MSc, MSW) in order to qualify for this role. Content for these programmes varies, and there are some examples of programmes where material goes beyond the requirements outlined in SSSC specifications, and covers the equivalent Level 1: Trauma Informed, and Level 2: Trauma Skilled, although other courses provide no evidence that they cover Level 1. Stakeholder engagements highlighted that programme content in these instances is highly influenced by the interests and knowledge of programme designers or academic staff.
1.10 The SSSC also sets requirements for CPL — Newly Qualified Social Worker must complete 144 hours of CPL, within 12 or 18 months of joining register (depending on whether they are working full or part time), and then must complete 90 hours of CPL every 3 years. In most part, the content of this training is up to the individual, with 30 hours focusing on working effectively with colleagues and other professionals to identify, assess and manage risk to vulnerable groups. Typically, Children and Families Social Workers have access to Knowledge and Skills Framework Level 1 and Level 2 resources, however engaging with these resources is not mandatory, and depends on the personal interest of managers and practitioners.
1.11 In practice, Children and Families Social Workers have challenges when conducting training due to high case load numbers — time can be very difficult to protect for education and training, particularly if the training is more advanced, in-depth or requires additional funding. Stakeholders engaged argued that trauma informed practice needs to gain respect throughout local council Social Work departments in order for it to be prioritised.
Residential and Secure Care
1.12 There is a diversity of qualification pathways which allow someone to work in, and progress through roles within Residential and Secure Care. Qualifications can be achieved in College or University, as well as on the job through In-Work Qualifications and Apprenticeships. The qualification programmes for these roles are highly standardised, as the content for them is dictated by the Scottish Qualifications Authority (SQA). The learning content for these qualifications, as outlined by the SQA includes limited information about trauma or trauma informed approaches, and none of them include material which satisfies Level 1: Trauma Informed.
1.13 Residential and Secure Care organisations have different approaches to CPL and what knowledge is required of their workforce. While all Residential and Secure Care providers engaged in this study saw the importance of a trauma informed workforce, they were all at different stages of delivering trauma informed training and are taking different approaches to implementation.
1.14 The relevant stakeholders engaged noted several barriers towards embedding trauma informed practice in this area of work. Firstly, the complex qualification landscape makes it difficult to embed standard practice. Secondly, those working in this area learn about trauma to a great extent through experience, and therefore they often consider that they are already working in a trauma informed way and may not be aware of the opportunities available for further training. Finally, Residential Childcare and Secure Care frontline workers can qualify on the job therefore are always learning from placements and the other people working around them, again making it difficult to roll out standard practice.
Across all areas of work
1.15 The following is an outline of observations gained from conversations and engagements with stakeholders which are relevant to all areas of work covered in this study. Some are accompanied by recommendations, which are suggestions from the contractor for follow on work which could build on the learning outcomes of this study.
1.16 ‘One-off’ trauma informed training has limits — for a workforce to truly build trauma informed capability, it needs to have sustained engagement with the topic, through mechanisms like top-up training or discussion groups.
1.17 Recommendation: Support organisations in the implementation journey of trauma informed practice, raising awareness of resources that encourage ongoing learning and discussion around trauma informed approaches.
1.18 The content of required CPL for every area of work is not yet specified, therefore typically this is heavily influenced by employers, team leaders, managers as well as individuals.
1.19 Recommendation: Focus on managers, supervisors and team leaders with the Knowledge and Skills Framework to help communicate the critical value of trauma informed approaches.
1.20 All roles across these five areas of work have one common piece of training — Child Protection. This is delivered by a range of providers, however, typically has limited inclusion of issues relating to trauma informed practice.
1.21 Recommendation: Explore ways of embedding trauma informed principles across all levels of Child Protection in Scotland. For example, through adapting the Knowledge and Skills Framework for a Child Protection context.
1.22 It is important to have a trauma informed workplace and not just a workforce, to ensure not only that children and families are appropriately supported by individuals but by the structures of the support organisations they are dealing with, and that frontline workers who are experiencing second-hand or third-hand trauma are supported too.
1.23 Training needs to be delivered with considerations to the context of the work environment. For example, with residential and secure care, training needs to be delivered to whole teams at a time which incurs challenges around keeping a 24/7 service running.
1.24 There is some caution and hesitancy around the terms ‘trauma’ or ‘trauma informed’ — some had concerns that these terms were becoming ‘buzzwords’ or ‘knowledge trends,’ used too casually or without appropriate rigour or definition.
1.25 Many in the existing children and families workforce have already built up significant experience supporting those who have experienced trauma and developed their own informal ways of supporting or coping with trauma-experienced people. The Knowledge and Skills Framework resources are of least impact for this group, due to the challenges of changing ingrained practice.
1.26 Those that had experienced trauma informed training often described the training as theoretical, and difficult to translate into action. This led to individuals either dismissing training as too theoretical, developing anxiety (i.e., ‘I can now see the problem, but I don’t know what to do about it’), or building assumptions that they would always have to refer trauma-experienced individuals to specialist service. This was specifically expressed by people working closest with people who have experiences of trauma.
1.27 Recommendation: Recognise the significant role academic staff have in influencing the focus of their curriculum and provide support on how to use and teach the Knowledge and Skills Framework in an educational setting.
1.28 Recommendation: Continue to support group-based learning and continue to explore other ways to help learners tailor their learning to their context.
1.29 Regulatory bodies play a key role within the learner journeys explored in this report as every area of work must adhere to their standards. The standards that are set by the NMC and the SSSC help to shape these job roles, the way that these practitioners practice and what they learn to a certain extent. Currently the NMC and SSSC do not have robust requirements that entirely cover trauma informed practice in their standards despite some efforts to include elements of learning about trauma.
1.30 Recommendation: Dedicate resource to influencing and supporting regulatory bodies to embed the Knowledge and Skills Framework for Psychological Trauma in their standards. This should be the responsibility of a full-time staff member, who can focus on championing the nuances and benefits of trauma informed practice.
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