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

Leadership

Leadership at all levels is seen as vital for developing and maintaining TI Practice. Leaders support staff in understanding the role of TI Practice for delivering the organisation’s purpose as well as individual, team and service outcomes and wider national impacts such as those relating to inequalities and human rights. Leaders help to establish the environment, infrastructure and ways of working which support TI Practice. Leaders can help to manage staff workload and capacity. They can put mechanisms in place to ensure accountability for TI change and to embed it in future processes and services. Leaders can also model trauma-informed approaches in their behaviour and facilitate power sharing with staff and people with lived experience of trauma across the organisation.

Challenges in the Pathfinder areas

The time-constrained nature of the pathfinders meant that ongoing relationship building and developing senior leadership buy in for the project was limited, although there was some continuity provided through the local Transforming Psychological Trauma Implementation Coordinator (TPTIC) who organised trauma training for senior management staff. Senior managers in the pathfinder areas were often under significant pressure and therefore had limited capacity to focus on the pathfinder work or indeed their own health and wellbeing.

Enablers in the Pathfinder areas

As highlighted previously, service leads were under enormous pressure due to a variety of factors which often meant they were operating out with their Window of Tolerance. STILT^[9] training was attended by some pathfinder service leads and team managers, who reported finding it helpful. Individual coaching worked particularly well for one service lead, where a reflective space was provided to apply some of the learning from STILT and from trauma training. Over the course of the pathfinder project, there was evidence of changes such as increased modelling the importance of self-care, likely due to attendance at STILT.

A key part of being a transformational leader is empowering others to share their thoughts and views towards services, and to be able to instil change behaviours. There were emerging findings from the pathfinders to show that staff felt more empowered to make changes as part of the TI Practice implementation.

Pathfinder Recommendations relating to Trauma-Informed Leadership

• Visible and transparent support from leaders for TI Practice implementation is important for staff motivation and buy in, for example the production of a TI Practice mission statement can reinforce this as a long-term priority for the service.
• Trauma training with senior management is beneficial in helping everyone at all levels of an organisation to understand what TI Practice requires and the importance of trauma-informed leadership.
• HR is key to the implementation of TI Practice as they are often the gatekeepers for crucial policies which impact on culture (for example Staff Mental Health and wellbeing policies), and recruitment (qualities of staff being recruited, and recruitment policies).
• It may be beneficial to put in place pathways for the TIPIG to feedback information on the drafted implementation plan and the progress of this plan to senior management. This ensures actions can be taken at the senior management level to address issues included in the plan, including issues with staffing, wider challenges with service design, development of HR policies, facilities acquisition and wider resourcing issues.
• The management of the pathfinders found STILT valuable. Additional training to further support leaders in transformational change should be considered.
• The qualities needed for trauma-informed leaders should be taken into account when recruiting staff into management roles. HR buy in to implementing a trauma-informed approach can help to ensure necessary amendments are made to recruitment practices, inductions and training.
• Leadership coaching was a valued part of the pathfinder project, giving a manager the opportunity to have a reflective space to discuss the challenges they face in a confidential environment, and with the support to apply a TI lens to their behaviours (as well as those of their staff). Consideration should be given to the support already available to managers, and if there is a suitable existing person (in an addictions service team) who could offer this support to leaders.