Mapping Of Professional Qualification Routes and Continuous Professional Learning Opportunities relating to Psychological Trauma, in the Children and Families Workforce

7. Additional Findings

7.1 Themes in this section have emerged through conversations and exchanges with key stakeholders across all five areas of work, from educators and senior leaders to managers and frontline practitioners. These themes relate to all areas of work, and therefore have not been included in the above sections.

7.2 In some instances, findings in this section have been accompanied with recommendations. These recommendations have been suggested by the contractor as potential options for follow on work, building on the learning outcomes from this research.

The limits of ‘one-off’ training

7.3 Several accounts across all five areas of work confirm a similar pattern of trauma informed training. Typically, trauma informed training is offered as a ‘one-off,’ in the form of a session or a short course, which, once complete, offers no follow-up materials or mechanisms to support meaningful ongoing development of trauma informed practice at an individual or organisational level. Even in instances where initial training was described as effective, in-depth, or well-rounded, the lack of sustained follow-on training was described as limiting and resulted in challenges scaling the impact of trauma informed approaches beyond specific individuals or teams, to workforces or organisations.

Recommendation: Offer resources to support ongoing learning

7.4 Support organisations in the implementation journey of trauma informed practice, raising awareness of resources that encourage ongoing learning and discussion around trauma informed approaches. This could be realised in various ways, for instance:

• Raising awareness of existing conversation guides which help teams to reflect on trauma informed approaches periodically.
• By highlighting existing resources or offering new ones that could underpin yearly top-up training.
• By supporting coaching into practice of their learning and supervision and reflective practice where appropriate.

Workplace Culture Around Training

7.5 Across all five areas of work, regulatory bodies (the NMC or the SSSC) require evidence of a certain level of continued professional learning for workers to remain on their registers through a renewal or revalidation process. The subject of learning covered in such continued professional development is highly flexible and broadly defined by both the NMC and SSSC as anything that supports a worker to learn more about their role:

“We leave it up to you to decide what activity is most useful for your development as a professional” (NMC, 2021).

7.6 With such flexibility in the specific learning focus(es) of continued professional learning, workplace culture plays a significant role in impacting what training is promoted, and whether the need for training is followed up in practice.

Recommendation: Focus on managers, supervisors, and team leaders

7.7 Recognise the significant role managers, supervisors and team leaders have in influencing the focus of their team's continued professional learning. Place resource towards targeting them with the NTTP resources and give context to the critical value of trauma informed approaches.

Child Protection — a common thread across all areas of work

7.8 Across all five areas of work, ‘Child Protection’ is a notable reoccurring training. All five areas of work complete some degree of Child Protection training. Child Protection is mandated locally and therefore training is provided locally which includes face-to-face learning, single and multi-agency learning, and eLearning. In addition, there are formal academic programmes through Higher Education Institutions in relation to Child Protection. Those we spoke to indicated that the Child Protection training they had encountered had limited inclusion of issues relating to trauma informed practice, and that it covers topics which are analogous to trauma informed practice such as how to support and protect vulnerable young people and identifying different types of abuse.

Recommendation: Explore how to align Child Protection with trauma informed principles

7.9 Explore how to embed trauma informed principles across all levels of Child Protection in Scotland. This might involve adapting the Knowledge and Skills framework for a Child Protection context and raise awareness of the importance of a trauma informed approach within Child Protection practices.

Trauma Informed Workplace, not just a Workforce

7.10 A trauma informed workplace means that everyone within a workplace is aware of the impact of trauma, and that systems have been designed to be considerate to the needs of someone who has had experience of trauma. A trauma informed workplace, and not just a workforce, was often emphasised as an important factor in ensuring that children and families who have experienced trauma are engaged with in a trauma informed way. It is also important for ensuring that the systems supporting them are flexible to their needs and that frontline workers assisting them through potentially traumatising situations are appropriately supported too.

7.11 Many frontline workers described the importance of a trauma informed workplace in terms of interactions with the team working around them. To them, it is particularly important that members of a team can support each other to make the right decisions for a young person, with the knowledge that everyone is aware of trauma and the way it can impact one’s actions. It is also important for all grades of staff to be reminded of the kinds of experiences that frontline workers might be managing. In this way, supervisors and team leaders would have the right tools to be sensitive to the vicarious trauma or secondary trauma that frontline workers may have experienced and can provide meaningful support to mitigate the impact that this could have.

7.12 Additionally, for Residential and Secure Care, it is important for a workplace to have a deep and shared understanding of what a trauma informed practice is in order to support each other to maintain this way of working strongly as a team, and to be able to articulate and pass on the practice to new members of the team.

Trauma informed training needs to be delivered in different ways

7.13 Of all the areas of work, those in Secure Care and Residential Care most strongly emphasised the need for whole teams to be trained in approaches to trauma together, citing the highly collaborative, team-oriented style of work. However, these two areas of work experience significant capacity challenges when it comes to training — they must maintain 24/7 services across 365 days of the year, making it near impossible to send full teams away for training.

7.14 One service provider, historically sent employees to conduct training in small groups unrelated to the teams they were working in. They found that this was unsuccessful in embedding a trauma informed practice across their services as only the odd employee would theoretically understand the impacts of trauma and might only theoretically know the best approach to support, thus it was not successful in embedding a practical approach to trauma. Currently, they ensure that full houses obtain training together over a series of four days through intense planning and bringing in a substitute team to take over a house. This has meant that team understanding of a trauma informed practice has been embedded into the way they work.

7.15 For Social Work, Health Visiting and School Nursing, training needs to be delivered throughout the organisation and to the Enhanced level for frontline staff. It is important that peer learning and critical discussion are supported across all types of roles.

Buzzwords and Knowledge Trends

7.16 There is some caution and hesitancy around the terms ‘trauma’ or ‘trauma informed’. Although the importance of trauma informed approaches was not lost on most of those we spoke to, some had concerns that these terms were becoming ‘buzzwords’ or ‘knowledge trends’ used too casually or without appropriate rigour or definition.

7.17 Often, standards and training material used analogous or else broader terms to refer to similar themes. The terms ‘abuse’ and ‘vulnerable’ are most often used to refer to similar themes relating to psychological trauma, for example, standards outline requirements to “understand the needs of vulnerable children” or “recognise different types of abuse.”

7.18 In these instances, while it is clear that the language is making reference to subject matter that overlaps with that of a trauma informed approach, the lack of the explicit use of the term ‘trauma’ results in omission of certain key elements of a trauma informed approach — for instance ‘avoiding re-traumatisation.’

It is challenging to change entrenched practices

7.19 The NTTP Knowledge and Skills Framework for Psychological Trauma provides a clear, straightforward learning framework for trauma informed practice, which is a useful tool to structure learning across an education pathway for new learners. However, much of the workforce that this research consulted with, felt they have already gained significant experience supporting those who have experienced trauma and developed their own informal ways of supporting or coping with trauma-experienced people. It was suggested that it may be difficult to change this group’s approach, as their self-developed ways of doing are deeply ingrained.

Trauma informed training is often theoretical

7.20 Frontline workers who only had access to Levels 1 or 2 of the framework and are dealing with people who have experienced trauma daily often referred to Trauma Informed training as theoretical. They spoke about the training feeling good and important to learn about, but hard to translate into their practice without further support.

7.21 The five areas of work which are covered in this research involve roles that must regularly support those who have experienced trauma, and as a result must regularly deal with complex situations. Frontline workers and their managers describe the importance of understanding how to manage complex experiences such as dealing with vicarious trauma, being able to reconcile between a child’s and an adult’s perspective on a traumatic experience when working with families and dealing with multiple family members who have experienced trauma:

“The messiness of the job isn’t really provisioned for in training. Social workers are supporting trauma-experienced children but are also supporting adoptive or kinship carers and other staff who may be experiencing second or third-hand trauma. The key problem here is that the training social workers get tends to provide a textbook understanding of what trauma is, but doesn’t really clearly explain what to do about it in terms that are actually useful on a day-to-day.”

—Community Placement Service Manager

7.22 Where training materials included information on how to respond to trauma in practice, it was typically criticised for being theoretical, and not context-specific enough for the complexity of experiences that workers were dealing with on a day-to-day basis. This was often compounded by the format of the training — it was suggested that online, or video-based training provides no opportunities for detailed discussion about how to practically implement a trauma informed approach with a knowledgeable expert that has frontline experience. This format had the following negative implications:

• Some social workers reported experiencing anxiety as they did not feel properly trained to deal with trauma.
• Assumptions were formed across social work, health visiting and school nursing that they would always need to refer trauma-experienced children onto specialist support services.
• Assumptions were formed that any future trauma informed training would also be highly theoretical, and therefore of limited value.

7.23 One Residential Care service described a positive experience of receiving training which was delivered as a mixture of online and in-person learning, and the team participated as a group where they engaged in reflective discussion. This was described as highly effective, as the material triggered memories and grounded the learning in examples that were specific and relatable to the team.

7.24 Social Workers, and those working in Residential or Secure Care also noted that they were typically offered training which contained materials that were broadly aligned with Levels 1 and 2 of the Knowledge and Skills Framework, however, Levels 3 and 4 were much more appropriate for the challenges they were typically faced with.

“A short course on what trauma is and a basic approach on how to respond to it isn’t really helpful.”

—Residential Care worker

Recommendations: Support higher education institutions to deliver trauma-informed education

7.25 Recognise the significant role academic staff have in influencing the focus of their curriculum and provide support on how to use and teach the Knowledge and Skills Framework resources in an educational setting. Focus on developing their understanding of the value of trauma informed approaches, and their confidence in teaching this to others. There is also an opportunity here to support the development of cross-institutional peer support and knowledge-sharing groups by hosting cross-institutional training sessions.

Recommendation: Help practitioners tailor the Knowledge and Skills Framework to their specific needs

7.26 Continue to support group-based learning and continue to explore other ways to help learners tailor their learning to their context. For example, by:

• Supporting open forums for specific areas of work.
• Raising awareness of existing case studies which provide examples of what trauma informed practice looks like in action.
• Raising awareness of existing resources for managers and team leaders to host group discussions about trauma informed training.

Regulatory bodies require support to embed new schools of thought

7.27 Regulatory bodies play a key role within the learner journeys explored in this report as every area of work must adhere to their standards. The standards that are set by the NMC and the SSSC help shape these job roles, both in terms of what practitioners learn and how they practice alongside education institutions and employers. Currently, the NMC and SSSC do not have robust requirements that entirely cover trauma informed practice in their standards, despite some efforts to include elements of learning about trauma. In particular, the SSSC who are working on a number of different things including looking at how their CPL requirements can direct people towards certain topics such as trauma.

7.28 In order to successfully work to embed trauma informed practice into standards, there are certain things to consider. For example, the timelines that the SSSC and the NMC work towards are long term. This means that any significant changes to materials need to have longevity and fit into a ten-year plan. Additionally, the regulatory bodies are stretched in resources and often feel that new schools of thought are not able to be considered because the resources available tend to cover maintaining the existing frameworks rather than taking on new schools of thought, their nuances and how they impact the wider landscape of required education.

7.29 An example of the resources provided to embed specific training into an organisation was given by the SSSC, which had a full-time employee responsible for the roll-out of the Dementia Framework into social care standards. They were able to demonstrate the value of the framework across the organisation and appropriately embed specifications in relevant learning materials.

Recommendation: Influence and support regulatory bodies to embed the NES Knowledge and Skills Framework for Psychological Trauma

7.30 One of the ways to influence learning across these five areas of work involves working with regulatory bodies (the NMC and the SSSC) to embed specifications set out in the NTTP’s knowledge and skills framework in their standards. Such work is already underway — for instance, there was significant consultation across the 4 countries for the NMC’s recent post-registration standards. For the SCPHN Health Visiting and School Nursing, this did result in the inclusion (and recognition) of trauma. Also from the SSSC who are exploring how to bring in topics such as trauma through CPL requirements and certain standards such as NOS.

7.31 This should be the responsibility of a full-time staff member, exclusively focussed on championing the benefits of trauma informed practice to regulatory bodies and offering support on how to embed appropriate learning specifications in the standards, when standards are being reviewed. The relevant standards that should be targeted are listed below.

Table 8: Relevant Standards

Regulatory Body

NMC

Standard

Standards of proficiency for registered nurses, 2018

Regulatory Body

NMC

Standard

Standards of proficiency for registered midwives, 2019

Regulatory Body

NMC

Standard

Standards of proficiency for specialist community public health nurses, 2022

Core Competencies

Regulatory Body

NMC

Standard

Standards of proficiency for specialist community public health nurses, 2022

Health Visitors

Regulatory Body

SSSC

Standard

Newly Qualified Social Worker Standards, Early Implementation Version, 2022

Regulatory Body

SSSC

Standard

Standards in Social Work Education (SiSWE)

Regulatory Body

SSSC

Standard

National Occupation Standards, SVQ at SCQF Level 7, Practitioner, Core Units CCLD 301 HSC 032 HSC 033 HSC 034

Regulatory Body

SSSC

Standard

National Occupation Standards, SVQ at SCQF Level 9, Lead Practitioner / Manager, Core Units CCLD 401 HSC 042 HSC 043 HSC 044