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

Background

Scotland has paved the way in creating a vision of a trauma-informed workforce and services, ensuring that services and care are delivered in ways that:

• are informed by people with lived experience
• recognise the importance of wellbeing in the workforce
• recognise where people are affected by trauma and adversity
• respond in ways that prevent further harm
• support recovery
• can address inequalities and improve life chances

This vision is part of the Scottish Government’s commitment to preventing and mitigating psychological trauma and adversity, including Adverse Childhood Experiences (ACEs) and supporting all affected children, young people and adults.

The National Trauma Transformation Programme (formerly known as the National Trauma Training Programme) is a major and long-term change programme, which aims to support this vision. The Programme is delivered as a partnership between the Scottish Government, COSLA, NHS Education for Scotland (NES), the Improvement Service and Resilience Learning Partnership.

The National Trauma Transformation Programme (NTTP) is based on the Knowledge and Skills Framework for Psychological Trauma, which sets out the knowledge and skills needed by everyone in the workforce in Scotland to be able to recognise where an individual may be affected by trauma and to adapt their practice accordingly in order to minimise distress and support recovery through a safe and compassionate response.

The NTTP was established in 2018 with an initial investment of £1.35 million over three years and a goal to deliver trauma training, based on the Knowledge and Skills Framework, to 5,000 frontline workers over three years, with the target being quickly met.

In 2019, three local delivery trial sites in Argyll & Bute, Glasgow and Midlothian were established through the NTTP. This aspect of the programme 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.

Each delivery trial area was provided with one-off Scottish Government funding of £40,000 in 2019/2020 to test different approaches to rolling out trauma training to the local workforce. In addition to the funding, trial areas were supported by the psychological trauma team at NES, and an evaluation specialist who supported each area to develop its local Theory of Change.

Over time the Programme has steadily grown and evolved in response to feedback and to date the Scottish Government has invested over £12 million. It now includes a wide range of learning resources and guidance, alongside a network of Transforming Psychological Trauma Implementation Co-ordinators (TPTICs), Leaders, Trauma Champions and Trauma Lead Officers who are driving forward progress locally and nationally.

In 2023, the NTTP 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.

As part of this move towards supporting transformational change, a Roadmap for Creating Trauma-Informed and Responsive Change has been developed to help services and organisations identify and reflect on progress, strengths and opportunities for embedding a trauma-informed and trauma-responsive approach across policy and practice.

What is meant by psychological trauma?

The term psychological trauma can refer to a wide range of traumatic, abusive or neglectful events or series of events (including Adverse Childhood Experiences (ACEs) and trauma in adulthood) that are experienced as being emotionally or physically harmful or life threatening. Whether an event(s) is traumatic depends not only on our individual experience of the event, but also how it negatively impacts on our emotional, social, spiritual and physical wellbeing. We are all affected by traumatic events in different ways.

In summary, psychological trauma can be understood in terms of the 3 E‘s:

1. the Event

2. how it is Experienced

3. and its Effects

What do we mean by “Trauma-Informed” Practice?

Being ‘Trauma-informed’ means being able to recognise when someone may be affected by trauma, collaboratively adjusting how we work to take this into account and responding in a way that supports recovery, does no harm and recognises and supports people’s resilience.

Being ‘Trauma-informed’ is underpinned by the 5 R’s:

1. Realising how common the experience of trauma and adversity is

2. Recognising the different ways that trauma can affect people

3. Responding by taking account of the ways that people can be affected by trauma to support recovery

4. Opportunities to Resist re-traumatisation and offer a greater sense of choice and control, empowerment, collaboration and safety with everyone that you have contact with

5. Recognising the central importance of Relationships

Evaluation of the trial sites

The Scottish Government commissioned an interim process evaluation of the delivery trial sites in 2019; the findings were published in 2021.

In 2023, social research agency The Lines Between was commissioned 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.

Evaluation activity involved analysis of secondary data collected by the trial sites and qualitative interviews with key stakeholders in each site and staff from NES. In total, 30 evaluation interviews were undertaken; a breakdown of participants is provided in Figure 1.

Interviews explored the activity funded by the programme, governance and decision-making, impact of the funding, key achievements and barriers and challenges which have affected the delivery trial sites.

Each interview was recorded and transcribed. The transcripts were analysed using a coding framework, whereby all qualitative data was coded under different sub-headings that aligned with the core evaluation themes.

Data limitations

While the evaluation provides insight into progress across trial delivery sites, we highlight data limitations to be aware of when interpreting the findings. For example:

• Due to workload and capacity levels, absence and staff turnover, some key stakeholders were not available to be interviewed as part of the evaluation.
• The qualitative data relies on self-reported reflections over a five-year period.

These limitations may have affected the comprehensiveness of the dataset, or resulted in some data gaps, particularly regarding the early stages of the trial sites.

Report Structure

This report is structured as follows:

• Chapter 3 presents the learning on enablers and success factors.
• Chapter 4 covers the challenges and barriers identified in the evaluation.
• Chapter 5 sets outs out the findings on impact and sustainability.
• Chapter 6 presents conclusions and recommendations.
• Appendix 1 provides a summary of the approaches taken, and the progress made, in each trial delivery site.

Illustrative quotes from interviews are included throughout the report.

Role terminology

This report references a range of different roles that have been involved in driving, coordinating, and supporting the delivery of NTTP. Figure 2 provides an overview of each of those roles: