Background and approach
This report presents the main findings from an online survey of the Scottish workforce exploring awareness and attitudes to psychological trauma and trauma-informed practice. The survey was carried out by the Improvement Service on behalf of the Scottish Government and NHS Education for Scotland and took place over a two-week period from 19 February to 5 March 2021.
The aim of this research was to measure self-assessed levels of confidence, knowledge, skills and understanding across different sectors of the workforce of psychological trauma and trauma-informed practice. It also explored uptake and awareness of the National Trauma Training Programme.
The survey was issued through multiple digital channels and networks and was targeted across the whole workforce within the public and third sectors, as well as those working in the private social care sector.
A total of 3553 responses were received. Within this, responses were received from all thirty two local authority areas; from the public, private and third sectors; from a wide range of service areas including children and families, mental health, and social care and social work; and from multiple job roles and responsibilities including senior staff, elected officials and practitioners.
Self-assessed confidence and experience
Respondents were asked to assess their own confidence against four statements related to psychological trauma and trauma-informed practice. 43.5% of respondents reported that they were extremely or very confident in their understanding of the concept of psychological trauma. A similar proportion reported confidence in relation to understanding of the impact of psychological trauma at 45.7%. There were lower levels of confidence in understanding of the principles of trauma-informed practice and applying these principles at 30.7% and 26.7% respectively.
Self-Assessed Confidence Statements
1. Understanding of the concept of psychological trauma.
2. Understanding of the impact of psychological trauma.
3. Understanding of the principles of trauma-informed practice.
4. Confidence in applying the principles of trauma-informed practice in your work.
Responses varied by sector with those working in the third sector significantly more confident, and those in the public sector less confident, across all four statements. Responses also varied by service area with significantly higher levels of confidence among those working in mental health and alcohol and drugs. Among job roles, senior managers tended to report higher levels of confidence across all of the statements, but otherwise results did not vary by job role.
Trauma-informed organisations and services
There were a variety of responses in relation to respondents' views of how trauma-informed their organisations are. Six statements were asked about respondents' workplaces and whether they agreed that the key drivers of trauma-informed practice were embedded within the organisation or service. While there was a high level of agreement that wellbeing is prioritised and that staff are encouraged to undertake training to develop their skills, knowledge and confidence in trauma-informed practice, the remaining four statements had relatively low agreement levels. In particular, a small proportion, 23.4%, agreed that "data and feedback are regularly collected and used to evaluate and make changes to policy and practice to ensure they are trauma-informed". There were a high number of "don't know" responses across these statements, suggesting a lack of awareness and engagement with some of these topics.
Trauma-Informed Organisations and Services Statements
1. Staff wellbeing is prioritised.
2. People with lived experience of trauma are routinely engaged and consulted with in the development and delivery of policy and practice.
3. Leaders champion trauma-informed practice and policy.
4. Staff are encouraged to undertake training to develop their skills, knowledge and confidence of trauma-informed practice.
5. Appropriate levels of support are in place for staff when implementing trauma-informed practice.
6. Data and feedback are regularly collected and used to evaluate and make changes to policy and practice to ensure they are trauma-informed.
Answers varied in response to this section by sector. As with the previous section, those working in the third sector were significantly more likely to agree with the statements, while those working in the public sector were significantly less likely to agree. The same was true when responses were grouped by service, with respondents working in some service areas, most notably alcohol and drugs and housing and homelessness, more likely to agree than those who worked in others, such as finance and administration. Senior managers were also more likely to agree with the statements than those working in other job roles.
Barriers to trauma-informed practice
Asked to identify the barriers to working in a trauma-informed way, respondents frequently pointed to a lack of time to undertake training and noted that this was often despite encouragement to do so. Time and resources to properly implement the findings of training was also seen as a barrier by many, alongside difficulty prioritising trauma-informed principles among a range of competing demands, including COVID-19. Examples of the barriers identified include:
"Time is always the main barrier. Time to train staff then time to deliver. With so many other priorities particularly at this time it can be difficult to firstly recognise or pick up when trauma is being experienced and then to have the time to follow up with appropriate supervision."
"We struggle to put the theory into practice."
"Clash of priorities. Trauma is quite a specific field and can get crowded out amongst lots of other concerns. Particularly in current Covid situation."
Uptake of the National Trauma Training Programme
Just under a third of respondents, 31.6%, said that they had been aware of the National Trauma Training Programme (NTTP) prior to completing the survey. A smaller proportion, 22%, had completed at least one NTTP training or information session.
These proportions also differed by sector, service and role. Those from the private sector were less likely to have previously been aware of the NTTP (16.7%) or to have completed a session (12%). On the other hand, those from the third sector were more likely to say that they had heard of the NTTP previously, at 41%, and to have completed NTTP sessions, at around one in three. 31% of public sector employees had heard of the NTTP and 21% had completed a training session.
Employees working within certain service areas were also more likely to have previously heard of and completed NTTP training sessions. In particular, those working in mental health and alcohol and drugs were significantly more likely to have done so. At the other end of the scale, those working in social care and social work, economic development, education, and finance and administration were significantly less likely to have heard of the NTTP previously or to have completed a course.
Senior employees were more likely to say they had heard of the NTTP previously, but there was little difference among other roles, and job role did not correlate with uptake of NTTP sessions.
Impact of the National Trauma Training Programme
There were also significant differences in responses to some areas of the survey based on whether respondents had completed NTTP training or information sessions. This was true for the statements related to confidence in understanding of psychological trauma and trauma-informed practice. The statements related to the extent to which respondents believe that their organisation is trauma-informed also showed significant differences between respondent groups.
Across all statements for self-assessed confidence, those who had completed an NTTP training session were statistically significantly more likely to report high levels of confidence. Those who had completed NTTP training said that they were extremely or very confident in understanding the concept of psychological trauma in 68.7% of cases, compared to 36.3% for those who had not. 69.9% of those with NTTP training said that they understood the impact of trauma compared to 38.8%. 61.8% with training said that they understood the principles of trauma-informed practice compared to 21.9%, and 52.6% that they were confident in applying trauma-informed principles in their work compared to 19.4%.
There were similarly large differences in responses to the statements on whether the respondent's organisation was trauma-informed. In particular, respondents who had undertaken an NTTP session were especially more likely to agree with the statement "staff are encouraged to undertake training to develop their skills, knowledge and confidence of trauma-informed practice" by a margin of 81.9% compared to 45%. There was also a large difference between the percentages agreeing with the statement "leaders champion trauma-informed practice and policy", at 55.4% compared to 32%.