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

Workforce Care, Support and Wellbeing

Workforce wellbeing is critical for TI Practice. Staff cannot deliver trauma-informed services if they themselves do not feel safe, supported and well. It is also important to recognise that staff and volunteers as well as people who use the services, may also have experience of trauma.

Wellbeing is key for any workforce but is even more important where staff are directly supporting others with experience of trauma or are in roles where they themselves may be exposed to traumatic experiences and, or vicarious trauma. Staff in such roles are more likely to experience moral injury or compassion fatigue than others in non-front facing roles. For staff dealing with these circumstances and contexts the provision of both proactive support (e.g., supervision, reflective practice) and reactive support (e.g., action plan for responding to critical events) is vital to prevent staff feeling disconnected from their practice values and suffering burnout.

Challenges in the Pathfinder areas

As outlined previously, staff health and wellbeing in pathfinder services was a concern due to the impact of COVID, staffing pressures and often low staff morale, evidenced by high levels of staff sickness and/or staff attrition. There was no baseline measure of staff wellbeing currently in place in either pathfinder area and not all staff had access to clinical supervision or reflective practice.

Wider issues relating to staffing levels and service structures at a national level, as well as difficulties in recruiting for posts also substantially impacted on staff wellbeing. This situation was likely amplified in rural and island communities and may act as a barrier to implementing TI Practice. Staffing levels also need to be sufficient to complete the review of policies, guidance, and documents necessary to fully implement TI Practice.

Adequate staff facilities are important for staff wellbeing. In areas where office spaces were overcrowded, with little space for staff to take time to be able to look after themselves, this can also impact on staff wellbeing.

Enablers in the Pathfinder areas

For both pathfinder areas, staff wellbeing was the initial focus on the training plan using existing NTTP resources (which included staff completing an individualised Wellbeing Plan) and discussions began on how wellbeing can be improved in the service. Initiating these discussions helped de-stigmatise the subject of wellbeing.

Staff buy in for TI Practice was improved due to the focus on health and wellbeing. Proactive prevention for staff wellbeing was welcomed by staff, for example soothing boxes for staff to help regulate emotional arousal were provided in one pathfinder area.

It was clear from the pathfinders that having adequate levels of staffing was essential to staff wellbeing, so staff did not feel overloaded and were able to take the time they needed to look after themselves. If caseloads are too high, staff are not able to attend training nor have the time to implement trauma-responsive approaches with people who use the services. This has further impact on staff wellbeing as staff cannot provide the service that they understand the people they are working with need. Skills such as Safety and Stabilisation^[10] are likely to have additional importance in the case of supporting people who use Buprenorphine, discussed in the later section on service delivery.

Pathfinder Recommendations relating to Workforce Care, Support and Wellbeing

• Any assessment of readiness for TI Practice should ensure that staff wellbeing is recognised as a priority issue and is being supported.
• Consideration should be given to investigating suitable measures of staff wellbeing, which can then be fed into a wider system of tailored actions for improvement.
• TI leaders need also be aware of the importance of staff wellbeing and the importance of role-modelling positive approaches. Small differences such as ensuring managers leave work on time, not sending emails out of working hours, and taking time out for self-care (such as taking a lunch break, or space to regulate their emotions when necessary) can make a difference in service culture.
• Services should have access to clinical supervision and/or Reflective Practice Groups facilitated by someone with the appropriate level of knowledge, skills and experience.
• Staff facilities should be adequate to help staff (and people who use the services) to feel emotionally safe.