Item 11 - Implementation of National Trauma Framework
North Lanarkshire Council · 17 May 2023
Back to Health and Social Care Integration Joint Board — 17 May 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 11 SUBJECT: Implementation of the National Trauma Framework for North Lanarkshire TO: Integrated Joint Board Lead Officer for Report: Alison Gordon, Chief Social Work Officer (Children, Families, Justice and Integrated Practice) Author(s) of Report Margaret Flavell, Senior Manager Adult Social Work Services DATE: 17 May 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☒ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☐ Reviewed By: ☐ Endorsed By: ☐ 3. RECOMMENDATIONS IJB Committee: (1) Endorse the approach to the implementation of Trauma Informed Practice across the Health and Social Care Partnership as set out in this report. (2) Agree that the workforce should be trained at the ‘informed level’ as part of the suite of mandatory training. (3) Consider IJB members and/or Health Board members being a Trauma Informed Champion
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Summary 5.1.1 The Transforming Psychological Trauma: Knowledge and Skills Framework (The Framework) has been developed by NHS Education Scotland (NES) to support the delivery of Scottish Government and COSLA’s joint policy intention to create a trauma- informed workforce. 5.1.2 Being trauma-informed is about long-term culture and system change across the Health and Social Care Partnership (HSCP) and the Council to create the conditions in which staff feel supported to care for and respond to citizens in ways that recognise the impacts of trauma and create relationships that heal and resist re-traumatisation. It will support the delivery of the ambitions of the Strategic Commissioning Plan and changes within the Council’s new Programme of Work. 5.1.3 The purpose of this paper is to set out for the Integrated Joint Board the actions being taken to embed the Framework in North Lanarkshire, highlight areas of practice where a trauma informed approach is already making a positive difference for children and individuals and outlining next steps, in ensuring North Lanarkshire becomes a leading trauma informed HSCP and council. 5.2 Background 5.2.1 Evidence of the full impact of trauma, particularly adverse childhood experiences (ACES) has been emerging now for some time, establishing beyond doubt that its effects can be wide-ranging, substantial, long-lasting, and costly (NHS Education for Scotland, 2021). In response to this Scottish Government established a National Trauma Training Programme, led by NHS Education for Scotland (NES) to support the ambition, agreed with COSLA, to create trauma-informed and trauma-responsive workforce and services across Scotland. 5.2.2 In 2019 the Scottish Government published the Scottish Psychological Trauma Training Plan (Trauma Training Plan) to support the local implementation of Transforming Psychological Trauma: Knowledge and Skills framework for the Scottish Workforce (The Trauma Framework). Working with COSLA, the commitment to the implementation of The Trauma Framework was reiterated in the Programme for Government 2021-22 along with the initiation of a Leadership Pledge of Support for Trauma Informed Practice to raise the standard of support across public and third sector organisations. COSLA and several local authorities and HSPCs have signed this pledge, including North Lanarkshire HSCP. See Leadership Pledge Signatories. Yes ☐ No ☒ N/A ☐
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3 5.2.3 The Trauma Framework outlines the importance of creating a trauma-informed system and organisation that supports the workforce engage with citizens in a trauma-informed way. This is reflected in 5-key drivers for trauma-informed practice which emphasise the importance of leadership and the wellbeing of the workforce: 1. Leadership and management 2. Workforce wellbeing 3. Workforce knowledge and skills 4. Experts by experience 5. Data and feedback loops 5.2.4 Being ‘Trauma Informed’, both at the practitioner and organisational level means being able to recognise when someone may be affected by trauma, taking this into account, and responding in a way that supports recovery, does no harm, and recognises and supports people's resilience. To achieve this, a trauma informed approach comprises 5 key principles: Safety, Trust, Choice, Empowerment, and Collaboration (see Appendix A). 5.2.5 The Trauma Training Plan, developed by NES, tailors training to the type of role and function performed by staff across 4 practice levels: trauma informed; trauma skilled; trauma enhanced, and trauma specialist (see Appendix B). 5.2.6 Being trauma-informed as an organisation has significant benefits for staff and the people they serve. Services are organised in ways that promote safety and trust to prevent re-traumatisation, and this is effective in preventing concerns and difficulties escalate, which in turn have a human and economic cost. The approach is about addressing inequality by ensuring that those affected by trauma (staff or those they serve) do not experience barriers to life chances and choice as a result of trauma and that trauma is recognised and responded to in order to support recovery. Becoming a trauma-informed organisation is not simply about doing what we already do better, rather it is transformative in the way services are organised and delivery and therefore requires to be key part of the delivery of the ambitions of the Strategic Commissioning Plan. 5.3 Report 5.3.1 Scottish Government and COSLA asked all local authorities and health boards to appoint trauma champions to ‘oversee, encourage and raise awareness of trauma informed and trauma responsive practice across all services within their area’. The champions have a specific responsibility to influence local leaders to embed the five key drivers of trauma-informed practice (as detailed in 1.3) across their area. 5.3.2 The North HSCP nominated Margaret Flavell, Senior Manager Adult Social Work as the champion. As requested by COSLA and Scottish Government, Ministers have been advised of this, who are working with national leads in Scottish Government and the Improvement Service, as well as local leads in NHS Lanarkshire in relation to implementation.
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4 5.3.3 Two steering groups have been established, one that is Pan Lanarkshire and a north operations group of staff from the HSCP and North Lanarkshire officers from Education and Families, Enterprise and Communities, People Resources with the purpose of providing strategic direction and coordination of support and training to promote the implementation of Trauma-Informed Practice. The Scottish Government has made £100K available to all local authorities over two years to support the implementation of Trauma-Informed Practice. An officer was therefore appointed in January 2023, to lead on the implementation of Trauma Informed Practice and build on, and add pace to, the work started to integrate the Trauma Training Programme with current training plans in place to deliver The Plan for North Lanarkshire. Additionally there are 2 Health and Wellbeing officers being employed for the HSCP to support staff wellbeing that will be aligned with the outlined Trauma Informed Practice approach. 5.4 Trauma Informed Practice across the HSCP 5.4.1 The importance of being trauma-informed in our approach to support citizens has been recognised by services across the partnership. The Strategic Commissioning Plan, is underpinned by the strategy to develop a trauma skilled work force, building on established work around nurture, resilience and other approaches based on forming strong relationships with children and families. Awareness about the importance of trauma recovery has been integrated into the delivery of nurture and resilience work and critical incidents; this is evident in Adult Protection practice. 5.4.2 The importance of being trauma-informed also underpins the Partnership’s longstanding investment in prevention and early intervention work with our existing workforce and our third sector partners with its principles incorporated within the multiagency adult protection training, domestic abuse training and others although this requires further development. 5.4.3 The housing service is working to embed trauma-informed understanding of working with people through its implementation of the Solihull approach across the service. Other initiatives such as psychologically informed environments, ‘Family Plus’ and ‘Forever Homes’ have been piloted with housing and partners recognising the importance of trauma-informed approaches on improving outcomes. The Local Housing Strategy (2021-2026) and the Rapid Rehousing Transition Plan also set out how a trauma-informed workforce will improve outcomes for people in need of support with housing. Work is also underway to help identify the barriers and enablers for adopting a trauma-informed approach within housing to inform the actions and support required to embed trauma-informed practice in housing practice. 5.4.4 An awareness of the impact of trauma is now also embedded into the approach to the design and development of North Lanarkshire’s community hub programme. Working with the Promise Development team and Council equalities officer we applied a ‘trauma lens’ using the Scottish Government toolkit and identified a number of improvement actions e.g. paint colours, signage, seating, layouts and signposting to supports and services. This work will continue as our new community hubs are introduced and through tests of
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5 change to address the barriers that those affected by trauma can experience while accessing supports and services. This work will be further developed through existing workplaces across the partnership by teams applying a ‘trauma lens’ to their working environments. 5.4.5 The Council’s Equalities Delivery Board also has Trauma Informed Practice firmly sitting within its strategy, delivery framework and five objectives to ‘ensure that local public services are responsive to different needs and treat users with dignity and respect’. 5.5 Training 5.5.1 The North steering group is developing a strategy to use the national Trauma Training Plan to support implementation across the HSCP and North Lanarkshire. An e-learning module at the ‘informed level’ (see Appendix B) is in development for all staff in the Council and committee is asked to approve its inclusion within the mandatory suite of training for Council employees. The Health Board is asked to consider this also for NHSL staff. Beyond this, an assessment tool is being developed for services to identify at what level groups staff need training across the continuum of informed to specialist and training plans will be built around analysis of need, integrating trauma informed practice wherever possible. A specific training offer for education staff has been developed in collaboration with Education Scotland to enhance understanding of trauma responsive strategies, aligned with the outcomes within the Roadmap to Recovery. 5.5.2 Dr Claire Stark, Lanarkshire Trauma Coordinator, has delivered introductory sessions to 100 plus first line managers across the partnership. There are further planned sessions by Dr Claire Stewart, Lanarkshire Trauma Coordinator to the Strategic Leadership Team to increase leadership understanding, refresh engagement and to agree next steps. Additionally, Dr Claire Stewart has delivered an introduction to The Trauma Framework to the NL Council Corporate Management Team and elected members, which is now available to members digitally. 5.5.3 The principles of being trauma informed underpin and support all work with children, families, and adults. As such, the steering group has coordinated a review of training delivered to social work practitioners, housing staff, within Education and across public protection to identify where the principles of trauma informed practice are embedded in training already. Training packages have been updated to reflect these principles where required. This is required across health staff training and the HSCP Organisational Development lead officer will support this. 5.6 Next Steps 5.6.1 There has been a lot of activity to raise awareness about trauma-informed practice to lay the foundations for a trauma informed workforce through training. However, the success of such initiatives will be limited without clear and unambiguous strategic and organisational support for the approach, which
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6 ensures it ties in with the vision and ambition of the Strategic Commissioning Plan (SCP) and the Plan for North Lanarkshire. We are at the beginning of this process that moves from an organisation that is trauma aware to one that is trauma informed as set out in Appendix C. Particular attention needs to be given to ensuring that we understand the impact and how outcomes for people are being improved through the development of a trauma informed workforce. 5.6.2 Embedding sustainable trauma-informed ways of working is about long-term culture change. The steering group has identified key priorities below linked to the 5 strategic drivers for a Trauma Informed organisation outlined in 1.3: Leadership: Appoint an elected member as Trauma Champion to support the work of the steering group develop plans for North Lanarkshire becoming a trauma-informed Council to support the fulfilment of the ambition of the Plan for North Lanarkshire and the new Programme of work. Health Board members would assist this also. Likewise further SLT to support the SCP ambitions and embed trauma informed practice across the partnership. Re-fresh governance and membership of the of steering group. Workforce Wellbeing: The actions to deliver the NHSL and Council’s Mental Health Strategy for staff are underpinned by the 5 principles of a trauma-informed organisation. Workforce knowledge and skills: Each service across the partnership should assess the level at which staff need training and a base line is established in order to update the training strategy for trauma informed practice. Experts by experience: Individuals, families and communities drive our approach to becoming a trauma informed organisation using existing structures for participation and engagement. Data and Feedback Loops: Base lines and outcome data for trauma informed practice are integrated and aligned with measures of success within the SCP and the Council’s new Programme of Work. 5.7 Leadership Pledge 5.7.1 As set out in the Programme for Government 2021, a Leadership Pledge of Support has been introduced for organisations to demonstrate their commitment to supporting and embedding a trauma informed culture across their workforce and services. Signatories to this pledge agree to: • Work with others to put trauma-informed and responsive practice in place across our workforce and services. • Deliver services that wherever possible are actively informed by people with lived experience of trauma.
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7 • Recognise the central importance of relationships that offer collaboration, choice, empowerment, safety, and trust as part of a trauma-informed approach. • Respond in ways that prevent further harm, and that reduce barriers so that people affected by trauma have equal access to the services they need, when they need it, to support their own journey of recovery. 5.7.2 The IJB are asked to endorse the HSCPs Pledge as a commitment to becoming trauma informed as a way of working and approach in everything it does and its importance for the delivery of high-quality services and support to people in North Lanarkshire. 6. CONCLUSIONS 6.1 The IJB is asked to endorse and promote the implementation of Trauma Improved Practice across the HSCP workforce and subsequently service delivery to our NL citizens. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 7.2.1 Staff are trained in Trauma Informed Practice at the level commensurate with their role. 7.2.2 Improvement action on trauma design of spaces are delivered in line with the implementation of town and community hubs with ongoing learning feeding into future design.
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8 7.2.3 Staff engagement, retention and wellbeing is improved through the implementation of trauma informed work at a systems level. 7.2.4 HSCP, Council staff, partners, services, and environments recognise the prevalence and impact of trauma, how they may create barriers to support, the key role they play in people’s recovery, and how they can reduce the possibility of re-traumatisation. 7.2.5 Outcomes for children, young people and adults are improved through positive relationships with staff and evidenced in feedback from citizens on their experiences. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.3.1 Cost of the Trauma Informed Practice implementation post (NLC 12) at mid- point including on costs is £58,381. Post is funded from approved carry forward and 2022-23 funding from Scottish Government. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner There are risks to children, individuals and families of re-traumatisation and increased distress if staff are insufficiently trauma- informed in their approach and practice. The roll out of The Training Plan is a national policy priority and the extent to which services have integrated and applied the approach will be subject to external scrutiny, particularly in any joint strategic inspection of children’s or adult services. If our workforce do not recognise trauma as an important factor impacting health throughout a person’s life, there is a risk that we do not enhance the positive impact we are seeking to achieve against our citizens health and wellbeing outcomes. If our physical spaces are not designed and maintained to offer a sense of safety, calmness, dignity, and promoting choice and control it could significantly impact the positive impact and aspiration we have for our town and community hubs. This also Choose an item. Margaret Flavell (HSCP) Yes ☒ No ☐ N/A ☐
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9 extends to an impact on productivity of staff and our ability to provide supports and services that are inclusive and responsive in their delivery. The trauma roadmap applied to our operating model for town and community hubs will address this risk through the improvement action. Attention to the principles of Trauma Informed Practice has now been incorporated into the revised Strategic Policy Framework adopted by the Policy and Strategy Committee on 16 March 2023. Furthermore, Trauma Informed Practice now firmly sits within the objectives of the Council’s Equalities Delivery Board. The steering group is creating a project risk register in line with the development of the implementation plan as outlined in 2.11 which will identify the baseline risk level. 7.5 PEOPLE 7.5.1 Trauma Informed Practice features as a firm commitment within the strategy, delivery framework and objectives of the Equalities Delivery Board. In terms of trauma design of town and community hubs and their spaces, the Council’s Safety and Wellbeing team and Equalities officer are involved in plans and improvement actions. 7.5.2 The TOD team are engaged in training roll out proposals contained in this report and as HR policies are reviewed the impacts of trauma will be considered in development of guidance and toolkits to promote the wellbeing of staff. It is important to note that many staff may have experienced trauma themselves, and some research suggests that those in human services have a higher prevalence of adverse experiences, which means that staff support and strategies to mitigate secondary traumatic stress are crucial (Scottish Government, 2021). 7.5.3 There will be some impact around communication and engagement with communities and with staff if the report is approved. Particular emphasis will need to be given to engagement and communication around the training roll out. In terms of physical design of spaces, environment, and buildings there may be requirements to replace signage and other communications material. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report:
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10 EQIA added to website: 7.6.1 There is a growing body of evidence that impact of adverse childhood experiences and trauma contribute to increased risk of a wide range of physical and mental health conditions and social problems, including involvement in the justice system (Scottish Government, 2018). A trauma-informed approach to the delivery of services mitigates these risks and is an important component in the strategic work to reduce inequalities and delivering priorities within the HSCPs Strategic Commissioning Plan and the Council’s new Programme of Work. 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. 9.1 Appendix A Trauma-Informed System 9.2 Appendix B Trauma Training Plan 9.3 Appendix C Trauma Informed Roadmap 2023-25 9.4 Appendix D The Scottish Psychological Trauma Training Plan trauma-training-plan-final.pdf (transformingpsychologicaltrauma.scot) CHIEF ACCOUNTABLE OFFICER Members seeking further information about any aspect of this report, please contact the following; Margaret Flavell, Senior Manager Adult Social Work Services Yes ☒ No ☐ N/A ☐ Yes ☐ No ☒ N/A ☐
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11 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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12 Appendix A: Trauma-Informed System
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13 Appendix B: Trauma Training Plan
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14 Appendix C: Trauma Informed Roadmap 2023-25