National Trauma Transformation Programme: Trauma-Informed Substance Use Pathfinders – Learning Report

Data, feedback loops and continuous improvement

Service or organisational improvement is dependent on ensuring ongoing discussion and feedback between leaders, staff, partners and people who use the services. All these groups bring varied learning that can be used to enhance service design and delivery. Feedback mechanisms (satisfaction questionnaires, reviews, existing or routine service data, user groups or carers focus groups/interviews, staff feedback, suggestion boxes, etc.) can be set up proactively and used at routine intervals or as a one-off exercise for a specific purpose. Formal and informal data such as these help organisations to understand how to reduce barriers, increase engagement and enhance TI Practice and other outcomes for service users, staff and the organisation. Acting on feedback is key to building safe, trusting relationships and trauma-informed services.

Challenges in the Pathfinder areas

It is important to note the close relationship between trauma-informed organisational culture and feedback loops. If staff do not feel safe feeding back information on how they feel about an organisation, this will impact on the data collected. Another barrier relates to pre-existing feedback mechanisms and (lack of) perceived action in addressing issues raised via these surveys. If staff do not feel feedback is welcomed, meaningfully analysed and informs decision making, they are less likely to take part in the exercise.

Enablers in the Pathfinder areas

Local ToC models were developed for each pathfinder which offered a strategic view of where current activities contributed to interim and longer-term outcomes locally and nationally. The ToC models were intended as planning tools and the activity lists in the models were expanded upon in the full implementation plans.

The ToC models also inform thinking about future ways in which pathfinders can begin to evidence their progress using tools provided as part of the Roadmap for Creating Trauma-Informed and Responsive Change: Guidance for Organisations, Systems and Workforces in Scotland and other possible validated scales for ongoing monitoring and evaluation.

In one pathfinder area, plans had commenced to start using the new community hub to work with people using the services to gather feedback and feed this into service delivery. This pathfinder also reintroduced the Drug and Alcohol Star^[14] within the service, and staff have been trained in its use. This will provide a formal tool to assess service progress for individuals and overall service user progress and provide programme reflection and learning opportunities. The service is reflecting on the future use of a trauma screening questionnaire, which would also provide useful data on trauma experiences of those using the service and may, depending on the measure, support assessment of progress.

Discussion has also taken place about the potential of a 6 month to yearly sample audit of care plans as a means of assessing TI Practice improvement in treatment for example assessing the amount of times ‘trauma’ or ‘Safety and Stabilisation’ are mentioned.

Pathfinder Recommendations relating to Data, Feedback Loops and Continuous Improvement

• Developing a longer-term implementation plan (longer than 1 year) is likely to be useful for services, so they understand all that is involved in implementing TI Practice and have a clear plan (with accountability) as to how actions can be taken forward.
• The utility of an implementation plan is dependent on thoroughness of prior activity (e.g., the TI lens event and organisational assessment). The ToCs set these plans out in relation to interim and long-term outcomes and can help guide future evidencing of progress.
• There is value in staff completing a baseline organisational assessment in addition to the TI lens event. This was apparent in the breadth of the implementation plan. It is also a useful exercise in being able to chart and evidence progress on the implementation of TI Practice.
• Further work would be useful at a national and local level to identify and further test possible validated tools for gathering feedback on the impact on people with experience of trauma who use services as well as the impact on staff health and wellbeing.