National Trauma Transformation Programme - local authority delivery trials: follow-up evaluation - final report

Executive Summary

The National Trauma Transformation Programme (NTTP) is a major and long-term change programme delivered as a partnership between the Scottish Government, COSLA, NHS Education for Scotland (NES), the Improvement Service and Resilience Learning Partnership.

The NTTP (formerly known as the National Trauma Training Programme) was established in 2018 with an initial investment of £1.35 million over three years and a goal to deliver trauma training to 5,000 frontline workers over three years. In 2019, three local delivery trial sites in Argyll & Bute, Glasgow and Midlothian were established through the NTTP, with each area awarded £40,000 funding to support the work. This aspect of the NTTP aimed to test various approaches to delivering high-quality and sustainable trauma training and implementation support in differing contexts. It is worth noting that delivery of the trial in each area took place during the COVID-19 pandemic.

Over time the Programme has steadily grown and evolved in response to feedback and in 2023 was rebranded to the National Trauma Transformation Programme to reflect the need for a whole system approach towards trauma-informed culture, attitudes, policies and practice across the workforce, which requires long-term, transformational change.

The Lines Between was commissioned by the Scottish Government to deliver a follow-up evaluation of the delivery trial sites. The evaluation aims were to explore progress in the sites since 2019, identify the challenges and enablers, and capture learning and reflections to inform the future delivery of the programme. Qualitative interviews with 30 key stakeholders and staff across the pilot sites were undertaken.

Enablers and barriers to programme delivery

Each pilot area has made clear progress in the implementation and delivery of the NTTP, and each has had a different focus and taken different approaches. One area focussed on delivering training that equipped staff to implement trauma-informed approaches in their practice; and another on leadership activity that would support the wider development of trauma-informed services. The third area took a combined approach, which involved training frontline staff and engaging and supporting leaders.

The focus and approach of each area, as well as the progress that has been made, have been influenced by each area’s operating context, systems, resources, capacity and aims and priorities. Despite this, there was consistency in the various factors that were identified as helping or hindering implementation and delivery activity.

Critical enablers to the successful implementation and delivery of programme activity were identified, which included:

• A dedicated lead to drive and co-ordinate activity, who is supported in an environment of shared responsibility and ownership.
• The wider involvement of stakeholders and partners, and critically, those with lived experience of trauma, working together collaboratively.
• Sustained input and support for those involved in training and service redesign activity.
• Effective sharing of learning, and recognising and celebrating the successes.
• Strategic and operational planning and effective governance.
• Leadership support and involvement, as well as buy-in and engagement from staff at every level of organisations and services.

Where challenges and barriers to implementation and delivery were observed by delivery leads and stakeholders, these often related to a gap in one or more of those enabling factors. However, other challenges were also experienced:

• Resource constraints and limited capacity, making staff engagement problematic.
• Identifying and accessing trainers that can deliver higher levels of trauma-informed practice training.
• Ensuring staff received appropriate levels of training and have access to the necessary support to work in a trauma-informed way and ensure staff wellbeing.
• A lack of integration, joined-up working and cohesion across services and partners locally, and also across the national landscape in terms of policy and strategy.
• The impact of the COVID-19 pandemic on working practices, resource and capacity.

Outcomes and benefits

While staff and stakeholders acknowledged the long-term nature of embedding trauma-informed approaches and developing trauma-informed services, several examples of the benefits and early outcomes of NTTP activity were provided.

Stakeholders perceive that the programme has contributed to increased trauma-related knowledge and skills among staff, and a more trauma-aware and trauma-informed workforce overall. Programme activity was also seen to have increased awareness and led to more conversations about the impact of vicarious trauma, compassion fatigue and burnout, bringing a focus on staff wellbeing.

Some stakeholders discussed how service review and redesign activity undertaken through the programme has improved accessibility, and helped to ensure services are less judgemental, more nurturing, asset-based and relationship-based. Others discussed organisational changes which have made services more responsive and person-centred, for example the removal of structural barriers, better interagency working and a shift towards more holistic, wraparound support for those accessing services.

The programme was also perceived to have contributed to a greater appreciation of the value, and focus on, the involvement of those with lived experience of trauma in developing trauma-informed services. This has led to examples of meaningful involvement activity in the review and re-design of services.

Some stakeholders also perceive that activity delivered through the programme is beginning to generate benefits for vulnerable adults, children and families, with people accessing services having more positive and supportive interactions due to the trauma-informed approach to service design and a trauma-informed approach taken by the workforce.

Sustainability and the future

Most participants, emphasised that they were at the beginning of what would be a long journey and strongly support and are committed to further roll out of NTTP activity beyond the initial scope of the trial. They explained that there is still much to do to fully embed the work undertaken to date and to ensure sustainability of what has been implemented.

Participants across all three local authority areas identified potential threats to the sustainability and further embedment and roll-out of trauma-informed practice. Most commonly, they highlighted pressures facing public service staff - such as high workloads, understaffing, recruitment and retention difficulties, stressful work environments and competing policy workstreams.

Overarching conclusion

The trial has been an effective catalyst for trauma-informed training and transformation, with each area having developed a solid foundation to further build on and enhance implementation and delivery activity. However, there is also recognition and acknowledgement of the long-term nature of fully realising trauma-informed organisations and services, and developing a trauma-informed workforce. Therefore, ensuring the sustainability and embedding of what has been implemented and achieved to date will require sustained and ongoing investment and support.