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

Impact

This chapter sets out findings about the impact of the NTTP trial sites. Stakeholders engaged in the evaluation shared extensive examples of the benefits of NTTP activity; such as an upskilled and trauma-informed workforce, improvements in service design and delivery, and positive impacts for those accessing services.

However, some participants acknowledged the difficulties in isolating the direct impact of NTTP due to a wider strategic trauma agenda and other initiatives targeted at building a trauma-informed workforce. Others considered it too early to comment on impact, reflecting on the long-term nature of embedding trauma-informed approaches within services, and the time required to redesign services through a trauma-informed lens.

“I think potentially the attitudes that they encounter might feel different because of a greater level of awareness and stuff um but I would say that generally you know things like the environment all of these things take a lot longer and it's a cultural change, it's a real shift that's required in a lot of instances and sometimes a bit of investment, so some services will have taken it on and embraced it really quickly or some parts of services will have taken it on and embraced it really quickly and those service users will see a marked change I would say. But I don't think that that would be reflective of the broader range of services that people are interacting with. It's still too early doors and it's going to take five to ten years I would say before you can consistently walk through a service and feel that it is trauma-informed.”

Impact on workforce

Stakeholders reflected on how NTTP activity has led to a more trauma-aware and trauma-informed workforce. Across all three delivery trial sites, there was articulation of increased trauma-related knowledge and skills among staff at different levels and grades including administrative staff, practitioners and senior leadership.

“The biggest impact seen by our service users is the front door access. So not necessarily the CPN or a psychologist or a social worker, it's actually reception staff that have a renewed sense of understanding so that the very first step in the door, and we have a no wrong door approach, particularly in [service name], has been much more positive for people.”

“I would say from the staff that attended the training and from the feedback that we've had from them I think there would be positive benefits, you know I can see that and I've had staff come back to me and say how they've used it in practice.”

“There's more discussion about it, there's more awareness. It's more part of the kind of like discussions that people have about cases and how we do things and what the environments are like. Like it definitely is more present, definitely.”

Some described a greater understanding of the impact of trauma among the workforce, and others identified ways that learning and resources from training modules have been directly applied. For example, one discussed how the Window of Tolerance has been integrated into activities with children and families to facilitate discussion and monitor progress, and others had incorporated strategies such as the PACE approach and the trauma lens in their practice.

“I really like the trauma lens tool, where you look at the environment through a trauma lens. I've got a lot from that, just thinking about small modifications that you can make just to be more trauma aware, things that you maybe don't even think of.”

A few felt that trauma-informed training had positively affected staff wellbeing due to increased awareness and more conversations about the impact of vicarious trauma, compassion fatigue and burnout and strategies to manage these.

Impact on the design and delivery of services

A key area of impact has been an increase in awareness and understanding among the workforce of the benefits of delivering services in a trauma-informed way. Participants discussed the greater value attached to trauma-informed practice as a result of the programme, and reflected on how this has started to influence the design and delivery of services. For example, one participant noted that trauma-informed practice had been introduced as a criterion in the procurement and commissioning of services in the area. Another pointed to a recent service development where the standard operating procedures had been changed to ensure it aligned with trauma-informed principles.

“One good example of this is a revision of the previous "limited access clinic" model. This was a clinic where people displaying "difficult to manage behaviours" were transferred to for a period of assessment. The standard operating procedure is being revised to incorporate a more trauma-informed approach, hopefully supporting service users to engage more effectively.”

Some stakeholders discussed how NTTP activity has led to services being redesigned to improve accessibility, making delivery less judgemental, more nurturing, asset-based and relationship-based. For example, participants noted differences in how practitioners approach cases, placing more focus on an individual’s background and the wider circumstances of a referral, as opposed to the immediate cause or catalyst. Others described smaller, quick wins that made services more trauma-informed, such as changes in the letters sent to those who access the service.

“I can hear people have had training or are trying to understand it more than just the behaviour, you know, they're trying to think what's gone on for somebody. So that heartens me a lot and I hear that a lot in my work, in the clinical work particularly.”

“I think there's a real wider understanding now in that kind of non-judgmental culture, understanding processes of shame, where does responsibility lie, the kind of behavioural consequences model. There's a real understanding within, certainly within education, I presume across other teams of the real importance of looking compassionately at where a child's coming from and thinking with them about next steps.”

“So as I say, once we kind of approve this letter, we will want to consult on it. And we need to consider how we're going to get service user feedback on it to further enhance it or change it or adjust it.”

“We're removing structural barriers and we're removing environmental barriers and we're removing stigmatised barriers which allow people to experience a service in a way that is much more positive than perhaps previously.”

Improvements in service design and delivery included a shift towards less stigmatising and judgemental language in meetings and written records/letters; increased participation opportunities for those with lived experience of trauma; and more nurturing approaches with children and young people. One participant noted how these changes had been recognised in a recent inspection.

“Some of our service areas have seen real change and improvement. Our children’s houses, for example, in their latest inspections, it’s been noted quite prominently that actually some of that trauma-informed work and the trauma-informed training is well evidenced… To actually have that acknowledged as part of an inspection is a testament really to the work that did happen as part of the pilot.”

“Well right away from the very beginning we’ve had service user involvement to look at the trauma, the environment of that and is it trauma-informed? That’s just something that perhaps in the past we might have had to say, you know, I’d have had to put my hand up at a meeting and say, have we thought about this? And now we don’t need to because it’s just, it’s immediately in everybody’s thoughts at the very beginning.”

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 people accessing services.

“We’ve been thinking recently about in particular you know services for women and what they look like and are they trauma-informed and what can we do differently to remove some of the barriers to engagement from a female kind of cohort that engage with services. So it is a regular feature of discussions about how we develop services and how we work with individuals.”

Impact on people who access services

A number of participants shared examples of how NTTP activity has benefitted vulnerable adults, children and families. For example, embedding trauma-informed practice within schools has resulted in a more nurturing and supportive environment for pupils, which supports their engagement with education.

“We can see it clearly at an establishment level, some establishments that are more trauma-informed, that are more nurture aware, you can see the differences in meeting the additional support needs of the kids or in exclusion figures and things like that… we absolutely can see it. … We do see the difference for our children and young people.”

“I think for young people in schools there’s some incredible practice going on that is really trauma-informed… There’s loads of examples of staff really promoting that sense of connection with young people, planning out challenges over the day and what kind of support might the young person need to deal with that. Just being really respectful and non-judgmental and helping a child work through what could be a tricky day at high school… just feeling really supported and calmer and able to engage fully rather than trying to kind of survive the day.”

Others reflected on people who access services having more positive and supportive interactions with those services, due to the trauma-informed approach to service design and a trauma-informed approach taken by the workforce. In these discussions, one argued that a trauma-informed approach had led to better outcomes for children and young people within the justice system.

“We’ve improved our website to make it much easier in relation to service users contacting us before you always needed to be on the phone. Now you can do a referral online, et cetera. So small things that we’re changing that we would hope actually starts to show an effect on people’s use.”

“Families benefit from skilled staff who are considering much more about the story behind the family or the issue. The approaches that we are taking are far more trauma led.”

“I think there has been a significant change in the way that we have discussions with children and young people who, for example, are in conflict with the law. We will use disposals and diversions much more strongly that are much more child-centred than we would ever have done before… And in the past few years, that has seen a reduction in the number of children and young people moving through into a more formal or statutory route. So there is definitely something to be said for capturing things at a very early stage and using that trauma-informed practice to guide responses to children and young people.”

One interviewee discussed how redesigning informational materials with the involvement of someone with lived experience of trauma had led to people accessing the service being more engaged and informed. Another described how newly implemented nurture groups in schools have led to improved familial relationships between some parents and their children.

“We had an information leaflet that didn't really work, so we met with [people with] lived experience [of the justice system] and said, ‘What kind of information leaflet would work? What does it need to look like? What words do you not want us to put in?’ So we have developed just a one-page leaflet that now goes in the prison, and we've actually seen an increase of about 15% straight away of people coming to use the service because the leaflet, we believe is much more in tune to what somebody would look at.”

“In the schools, we have targeted nurture groups and within that there's an element of getting the families involved... I've had a few really lovely examples of where relationships in families have changed because of that support. A real transformation because we were there, we were consistent, we were in unconditional positive regard, we weren't judging.”