Medication Assisted Treatment (MAT) standards: access, choice, support

Standard 10 Trauma Informed Care

All people receive trauma informed care.

The treatment service people use recognises that many people who use their service may have experienced trauma, and that this may continue to impact on them in various ways.

The services available and the people who work there, will respond in a way that supports people to access, and remain in, services for as long as they need to, in order to get the most from treatment. They will also offer people the kind of relationship that promotes recovery, does not cause further trauma or harm, and builds resilience.

Rationale

The majority of people accessing MAT services are likely to have extensive histories of complex trauma, the consequences of which may be intrinsically linked to the individual's drug use. Unaddressed trauma related issues are a significant barrier to people accessing, and benefitting, from MAT services. Providing trauma-informed services can promote recovery and improve outcomes for individuals, their families, staff and services.

Psychological trauma is everyone's business. We all have a part to play in understanding and responding to people recovering from trauma. It is the Scottish Government's ambition to have a trauma informed and trauma responsive workforce, who ensure all services are delivered in ways that prevent harm or further trauma, and promote recovery.

Trauma informed care reflects a model that is grounded in, and directed by, a complete understanding of how trauma affects service user's neurological, biological, psychological and social development.

Five key principles underlie trauma informed care: safety, trust, choice, collaboration and empowerment. Service delivery and the care provided should align with these principles, and drive change when necessary. Trauma informed care can only be delivered as part of a wider system of psychologically informed care. Local substance use psychology services can support implementation of this standard.

Criteria

10.1 MAT services should have an explicit delivery plan in place for delivering trauma

informed care that takes into account the 5 key drivers for organisational change recognised by NHS Education for Scotland: engagement with people with lived and living experience of trauma in all aspects of service delivery, evaluation and improvement planning, developing trauma-informed leadership, growing workforce knowledge and skills, promoting workforce wellbeing, and collecting data and information to evaluate services.

Delivery plans should:

a) be informed by a baseline assessment of current trauma informed care delivery.
A tool that can support this process is the Trauma-informed Care and Practice Organisational Toolkit (TICPOT);

b) consider the physical environment in which MAT is delivered;

c) include mechanisms to maximise staff wellbeing and reduce the risk of secondary traumatisation, burnout and compassion fatigue - such as policies for regular supervision;

d) include people with lived and living experience of trauma and their family member or nominated person(s) in all aspects of service delivery, evaluation and improvement planning (where the person wishes this);

e) ensure that the knowledge and skills of the MAT workforce (including senior leaders) are aligned to the Transforming Psychological Trauma: Knowledge & Skills Framework;

f) ensure alignment of practice with MAT Standard 6 Psychological support and the use of validated tools for routine trauma screening;

g) ensure that service evaluation and continuous quality improvement is underpinned by the principles of trauma informed care.

10.2 A steering group should be established to oversee the development and implementation of trauma informed care across MAT services.

Further Support from National Trauma Training Programme

The Trauma Informed Practice Toolkit for Scotland is a freely available resource that can support your service to undertake this journey towards delivering trauma-informed care.

Further information and resources are also available from the National Trauma Training Programme (NTTP).