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

Conclusions and recommendations

This report sets out how each trial area approached the implementation of trauma-informed practice and the development of trauma-informed services, as well as the progress made.

One trial 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. There were some differences in implementation and delivery across services, and variation in starting points linked to awareness and exposure to trauma-informed practice.

Differences in approach and progress were influenced by each area’s operating context, systems, resources, capacity and aims and priorities. Despite the different approaches taken, we identified consistent influencing factors across areas. Delivery during the trial period has generated valuable learning about the enablers and challenges that have helped or hindered progress, and garnered qualitative evidence about the difference that the activity to date has made.

Clear progress has been made in each trial area, which is commendable given the challenging operating environment. A large part of the trial took place during the COVID-19 pandemic and associated restrictions; this affected working practices, resource and capacity. The trial has been an effective catalyst for trauma-informed training and transformation, with each area having a solid foundation to further develop 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.

Consideration of how to build on what has worked well, and maximising the enabling factors, while addressing barriers, will be a critical aspect in the progress of each area. A range of enablers that are critical to the success of implementation and delivery activity were identified across the three areas, which included:

• A dedicated lead, though supported in an environment of shared responsibility and ownership;
• The wider involvement of stakeholders and partners, and critically, those with lived experience of trauma;
• Sustained support for those involved in training and service redesign activity;
• 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 gaps existed in these enabling factors, delivery leads and other stakeholders involved experienced challenges and barriers to implementation and delivery. Additional challenges were also observed, including: resource constraints and available capacity, access to trainers that could deliver higher levels of trauma-informed practice training, ensuring staff received appropriate levels of training and have access to support structures that ensure staff wellbeing, a lack of integration and COVID-19. At a national level, the strategy and policy environment can be complex, with many competing priorities. However, it also offers opportunities to take a more cohesive and coherent approach where a single area of activity can contribute to different areas of policy and strategy.

The evaluation has identified several examples of achievements which demonstrate the difference that the implementation and delivery activity during the trial period has made. Areas of the workforce have participated in training that has enhanced their awareness, knowledge, and skills in relation to trauma and trauma-informed practice. The activity has also resulted in a greater understanding of, and focus on, staff wellbeing and the support they need to work in a trauma-informed way safely and effectively. However, some challenges in creating effective structures and support have been identified, and it is critical that these be addressed.

Involvement in the trial has resulted in 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 meaningful involvement activity in the review and design of services. Examples of quick wins and positive changes in service development activity in some areas have been identified. Collectively, these achievements have combined to generate benefits for people who access services in relation to accessibility and their experiences of engaging with services and the way in which support is provided.

The work during the trial, and the activity subsequently delivered, is starting to influence the cultural change required to underpin trauma-informed organisations and services. While this is largely contained to teams and services that have been involved, and not yet fully embedded, it is a positive indicator of what can be achieved.

Ensuring the sustainability and embedding of what has been delivered and achieved to date requires a sustained and ongoing investment. Aligned with this, recognition and acknowledgement of the time needed to realise the ambitions of the programme will be required at a national and local level. All three trial areas hope to build on and embed their achievements, and they intend to expand implementation beyond their initial areas of focus.

Recommendations:

While every local authority area in Scotland has its own unique context, they will likely face many of the same challenges and rely on the same enablers and critical success factors. At a national level we would make the following six recommendations for the NTTP:

1. To act as a convener and facilitator in gathering and sharing learning and good practice. This could include the creation of a repository that includes best practice examples of trauma-informed policies, monitoring and evaluation tools, meaningful engagement of people with lived experience of trauma, and other helpful resources.

2. To demonstrate how the achievement of trauma-informed transformation contributes to other policy priorities and strategies to help avoid duplication of effort and add to the significance of this work and the wider impact it can have.

3. To advocate and influence for the continuation of financial support for local areas to support the ongoing and long-term work that is required, while demonstrating a national leadership commitment to the trauma-informed agenda. Aligned to this, to support longer term planning, system change, and sustainability at a local level, a move away from the existing annual funding model should be considered.

4. To provide support with monitoring and evaluation activity to ensure consistent and reliable measurement of the contribution that programme activity is making to outcomes and impacts, as well as the capturing of learning that can be shared.

5. To help to ensure appropriate training resource and capacity are available to support the rollout of training delivery, particularly at the higher levels of trauma-informed practice. Furthermore, steps should be taken to ensure that any training, and training providers, used to support the upskilling of staff meets a minimum set of national standards.

6. To continue to work in collaboration with national and local partners, to develop options which support meaningful and proportionate accountability and reporting, using the Roadmap as a guiding framework.