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

Context

Medication Assisted Treatment (MAT) Standards

Prior to the start of the Pathfinders, the Scottish Drugs Deaths Taskforce and Public Health Scotland (PHS) developed and published evidence-based Medication Assisted Treatment (MAT) standards to enable the consistent delivery of safe, accessible, high-quality drug treatment across Scotland. They were developed by a diverse group, including those who will deliver care and those who will benefit from that care with input from individuals and families with experience of harmful drug use.

The MAT standards have been a priority focus of substance use services throughout Scotland and are a key part of the context within which the substance use trauma-informed pathfinders have been delivered. There are 10 MAT standards, two of which directly overlap with trauma-informed care:

• Standard 6: the system that provides MAT is psychologically and trauma-informed (Tier 1); routinely delivers evidence based low intensity psychosocial interventions (Tier 2) and supports the development of social networks; and
• Standard 10: All people receive Trauma-Informed Care.

It is important to highlight that the remaining standards, whilst some are more medically oriented, are still influenced by, or relevant to TI Practice, such as treatment choice, mental health, shared care, and primary care. The MAT Standards are available online.

PHS published a National benchmarking report in June 2023 which shows progress towards implementing the standards. PHS has recommended that all 10 standards should be fully implemented by April 2025.

National Trauma Transformation Programme

The Scottish Government and COSLA have a shared ambition for a trauma-informed and trauma-responsive workforce and services across all sectors of the workforce in Scotland. Since 2018, the Scottish Government has invested over £9.6 million in a National Trauma Transformation Programme (NTTP). This includes a total of £1.6 million each year since 2021/22 shared equally across all 32 local authorities to work with community planning partners to further progress trauma-informed services, systems and workforces.

Scotland was one of the first countries in the world to publish a knowledge and skills framework for psychological trauma, developed by NHS Education for Scotland (NES). This framework sets out the knowledge and skills needed by everyone in the Scottish workforce to be able to recognise where an individual may be affected by trauma and to adapt their practice accordingly in order to minimise distress and support recovery through a safe and compassionate response.

The NTTP provides accessible, evidence-based trauma training resources developed by NES and informed by experts by experience, including a trauma-informed leaders component. Support for training and implementation, across all sectors of the workforce, is provided by a team of Transforming Psychological Trauma Implementation Co-Ordinators (TPTICs) based in every Health Board in Scotland. A network of ‘Trauma Champions’ has also been established. Supported by the Improvement Service, this network includes senior leaders from across local authorities, health boards and key community planning partners who work collaboratively to influence change across local areas.

A ‘Roadmap for Creating Trauma-Informed and Responsive Change: Guidance for Organisations, Systems and Workforces in Scotland’ has been developed by the Improvement Service in collaboration with partners and will be available on the NTTP website. This resource is designed to help services and organisations identify and reflect on progress, strengths and opportunities for embedding a trauma-informed and responsive approach across policy and practice.

Trauma-Informed Practice

Being ‘trauma-informed’ means being able to recognise when someone may be affected by trauma, collaboratively adjusting ways of working to take this into account and responding in ways that support recovery, does no harm and recognises and supports people's resilience. A trauma-informed organisation will reduce barriers to accessing services, recognising that experiences of trauma can create barriers to engagement in services.

Being ‘trauma-informed’ involves:

• Realising how common experiences of trauma, adversity and adverse childhood experiences (ACEs) are
• Recognising the different ways that trauma can affect people
• Responding to support recovery
• Resisting re-traumatisation
• Recognising the central importance of Relationships

The evidence is growing that TI Practice can both improve outcomes for people using services and support the wellbeing of the workforce. Five key principles underlie TI Practice: safety, trust, choice, collaboration, and empowerment. The development of TI Practice requires services, organisations and systems to be aligned with these five principles. implementation of TI Practice is often described as an ‘ongoing process of change’ or a ‘continuum of implementation’. This requires us to take a whole system approach, moving beyond a sole focus on staff training to allow for a wider understanding of all aspects of an organisation’s culture and practice delivery, viewed through a trauma-informed lens.

The importance of involving people with experience of trauma and adversity is essential in developing trauma-informed approaches. It is also acknowledged that members of the workforce can also be affected by trauma, through their own personal experience and, in many cases, ‘vicariously’ in the course of their work. Workforce wellbeing is therefore fundamental to a trauma-informed approach.

Being trauma-informed is not about providing treatment for trauma related difficulties, although some people may benefit from specialist evidence based psychological treatment options. It is about enabling the workforce to address barriers that people affected by trauma can experience when accessing the care, support and treatment they require. It also involves preventing trauma related distress that can be triggered for service users when in contact with staff and services (i.e., re-traumatisation^[1]).