Commissioned as part of the National Trauma Transformation Programme (NTTP), the Scottish Government funded four pathfinder projects with a focus on two priority sectors: maternity and substance use services. This report presents a summary of learning from the two substance use pathfinders which were based in Dumfries and Galloway and Orkney. The pathfinders took place over a 15-month period from January 2022 to March 2023.
These highlights are intended to support services across Scotland to consider the opportunities and challenges of planning for, developing and implementing sustainable trauma-informed (TI) practice, care and systems. A key aim of the pathfinders was to share learning which would further support substance use services in particular to implement and embed the Medication Assisted Treatment (MAT) Standards, and in particular, MAT Standard 10 (Trauma-Informed Care) as well as supporting the Scottish Government and Convention of Scottish Local Authorities (COSLA) shared ambition for a trauma-informed and responsive workforce and services across Scotland.
The two substance use pathfinder areas were provided with approximately 40 days of dedicated support across the two areas from a specialist in TI Practice (who was also a Clinical Psychologist), as well as support from a Monitoring and Evaluation specialist. The substance use pathfinders followed three phases:
1. Understanding service context and readiness for TI Practice.
2. Improvement planning, informed by Phase 1.
3. Implementation of agreed priority areas.
Summary of Key Learning
From the outset of the pathfinders, it was recognised that services were already progressing many aspects of trauma-informed work, often without realising it. It is important that these actions are explicitly recognised as positive progress on an organisation’s journey to becoming trauma-informed and responsive. The pathfinders also supported the development of a number of practical recommendations in relation to embedding the core components of a trauma-informed approach, including:
Organisational Culture : Each organisation’s culture will look and feel different, but it is important to consider how TI principles, values and ways of working are embedded within the culture of an organisation. Practical approaches such as completing an organisational assessment tool and service-specific lens walkthrough, using supporting resources provided through the NTTP, can support teams/ services and organisations to reflect on strengths, challenges and opportunities across strategic and operational aspects.
Leadership: Visible and transparent support from leaders for TI Practice implementation is important for staff motivation and buy in, for example the production of a TI Practice mission statement can reinforce this as a long-term priority for the service. Attendance at Scottish Trauma Informed Leaders Training (STILT), provided through the NTTP is beneficial in helping everyone at all levels of an organisation to understand what TI Practice requires and the importance of trauma-informed leadership.
Workforce Care, Support and Wellbeing : Any assessment of readiness for TI Practice should ensure that staff wellbeing is recognised as a priority issue and is being supported. Consideration should be given to investigating suitable evaluation measures of staff wellbeing, which can then be fed into a wider system of tailored actions for improvement. Services should also have access to clinical supervision where required and/or reflective practice groups facilitated by someone with the appropriate level of knowledge, skills and experience.
Power-Sharing with Experts by Experience of Trauma : Planning for power sharing with people with lived experience should happen in the early stages of implementation of TI Practice to ensure people who use the services are included in the process from beginning to end in a meaningful way. This may include setting up a service user group, or an advisory group from people further along in their recovery journey, or potentially engaging with people with lived experience from existing psychosocial groups run either within the service or with third sector colleagues.
Workforce Knowledge, Skills and Confidence : Consideration should be given by services as to how to incorporate the NTTP resources into their own tailored training plans, which can be particularly useful for induction of new staff and ensures the training plan becomes sustainable and integrated into training provision. Scaffolding or coaching post training, where capacity allows can support staff to implement knowledge and skills.
Data, Feedback Loops and Continuous Improvement : Developing a longer-term implementation plan (longer than 1 year) is likely useful for services, so staff understand all that is involved in implementing TI Practice and have a clear plan (with accountability) as to how actions can be taken forward.
Policies and Processes : Human Resources (HR) staff play a key role managing NHS wide policies. Consideration should be given to providing trauma training for HR staff alongside senior managers to ensure HR have the knowledge and support to apply a TI lens when reviewing policies. Creating working groups to review existing service documentation and guidance appears to be a sensible way forward for progressing the organisational capacity and catalyst necessary to facilitate change.
Budgets : Budget needs to be considered and reviewed when drafting a TI implementation plan to identify in/direct costs and resources required to implement and sustain these changes. This is a further reason for ensuring senior management are involved in the drafting and progress on implementation plans.
Service Design and Delivery : Where possible, whoever is leading the implementation of TI Practice should have a good knowledge of the team, to facilitate some of the potentially difficult conversations and reflections which may need to happen to implement TI Practice. This will support implementation planning with sufficient depth and specificity.
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