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National Evaluation of 2 day Trauma Informed Practice & Skills Development Pilot: 2 day course. April to September 2018 “The training evidences the huge need for TIP training across all levels of social work and the need to change our practice. This may actually give our clients the
chance to progress”
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Contents Page Introduction 3 Evaluation Process 4 Section 1 – Evaluation of course content 5 Section 2 – Pre and post course evaluation findings 12 Section 3 – Discussion and conclusion 17 Section 4 – Conclusion 20 Appendix 1 – Trauma Informed Training Enhanced Level (3) Outcomes 21 Appendix 2 -Transforming Psychological Trauma Framework Outcomes 23 Appendix 3 – Additional Comments from participants on training 54 Appendix 4 – Survey Monkey results 56 Introduction
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From a national strategic and policy perspective there was a number of key drivers inviting services to consider adverse childhood experiences and the need for well-designed trauma informed and responsive Justice Services. This is encapsulated in: • The Mental Health Strategy (2017-2027) and Justice Strategy (2017) which acknowledges the need to ensure that interventions for victims and offenders are informed by understanding of the impact of trauma." • The Justice in Scotland (Vision and Priorities July 2017) highlights "The population in contact with the criminal justice system is a vulnerable one in health and well-being terms, with people experiencing high levels of mental health problems, trauma, learning difficulties (sometimes undiagnosed) and challenges with problem alcohol and substance use”. • Community Justice Scotland national body which “aims to be an outcomes focused organisation…. We are trauma-informed, with a public health perspective recognising that poor health and trauma, in particular adverse experiences in childhood, impact on life chances and future behaviours”. Evaluation Process
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A Scottish local authority co-designed a 2 day trauma informed training input with a Health professional consultant trained in Forensic Psychology and specialist in trauma informed service design and intervention1. Four pilot courses in Trauma Informed Practice were held in authorities in the north Strathclyde region and elsewhere. Participants were comprised of Social Workers (Criminal Justice and Children and Families), Senior Social Workers, and Support Workers and Service coordinators. In 2017 Community Justice Scotland undertook an informal scoping exercise to assess demand from key stakeholders for new learning products within the field of community justice. One of the consistently articulated requests was for training around trauma informed practice. With this in mind Community Justice Scotland devised a framework to assess the suitability of course content of any products purporting to meet this requirement. The framework was based on the NHS Education Scotland Knowledge and Skills Framework and required products to meet certain standards and deliver learning outcomes. The East Dunbartonshire Trauma Informed Practice training met the criteria and Community Justice Scotland were invited to formally evaluate the course. The course ran for two days. All four courses were evaluated at the end of the second day. We evaluated the content of the course and also provided a survey monkey questionnaire for participants to measure pre and post course levels of knowledge and understanding of Trauma Informed Practice. 52 participants from 4 local authorities took part in the training. We evaluated the course in alignment with the outcomes for the course, provided by the trainers (see appendix). This course was developed in line with the National Framework for Transforming Psychological Trauma. The outcomes were aligned with those at Trauma Enhanced level (3) (see appendix 4).
Section 1: Evaluation of course content
1 Dr Dawn Harris and Alex O’Donnell
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Course evaluation: We measured the expectations of the participants, the sections of the course that participants found most useful, things that could be improved and finally how they were going to put their learning in to practice. All 52 participants expectations were met (49 fully met and 3 somewhat met) 49 participants stated that the training provided “valuable learning and/or development” and 3 participant stated that it was a “much needed reminder” of Trauma Informed Practice. a) The sections of the course that participants found most useful and enjoyed can be broken down in to 4 main categories: (in brackets are the percentage of participants who have cited this element)
Practical tools, skills practice e.g. The Zones and the Window of opportunity and mindfulness. (76.9%)
Style of delivery, tools used to deliver training and trainer knowledge (76.9% )
Adverse Childhood Experiences; Where Adverse Childhood Experiences fit in to LS-CMI, Looking at the person who has experienced
trauma, triggers and case studies. (48%)
Neurobiology and Brain structure – the impact of trauma. (44.2%)
There were substantially less improvements cited than elements of the course that were enjoyed and considered useful. The elements that the participants thought could be improved were:
Having the accompanying training manual before the training/more handouts (15%)
More time/another day to share practice (15%)
More time on vicarious trauma/self-care/practising mindfulness (9%)
More time to go over content/to process information – a lot covered in 2 days (7%
Skills practice (role play suggested) (7%)
Greater emphasis on impact of trauma – on offending/criminal behaviour/custody (3%)
More understanding of neuroscience (3%)
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Some other points made by individual participants were: More interaction from facilitators during group work, Information on further available training, more visual information i.e. short videos, Managers being present, how to support clients after they have disclosed, more multi-disciplinary audience (Health and Education). Other factors such as larger print on handouts, mixing up the groups and more interaction were also cited As part of this evaluation we required participants to state how they were going to put this learning in to practice (the intention is to follow up with participants a few months following the completion of the course): b) Responses to this question can be grouped in to 5 main categories: Some responses from participants are included underneath the headings. 1) Having the confidence to ask service-users about part trauma without fear of re-traumatising. Using the ACE screening tool as part of
this:
“The ACE screening and strengths based approach will help me ask the questions as I don’t need to be scared of trauma, now I have
some confidence”
“Will feel more confident and competent to work with people (not scared to open “that can of worms)”
“I think I will feel more confident helping clients understand their own feelings & behaviours and in my ability to support them to regulate.
I will be less nervous about talking about trauma”
“I now feel confident around talking about the trauma and not being scared about re-traumatisation and having a better understanding
of interventions and breathing exercises”
2) How to apply the learning, using skills and tools gained from training in everyday practice with service users:
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“I have women with PD and underlying trauma and men with a similar MO. This training will help me – the zones to understand
emotional regulation and techniques to manage this”
“In all my work with people. Trauma informed knowledge will help me to understand the impact of a person’s trauma (definition,
neurobiology, ACE). Practice skills (guided imagery, breathing, setting, survival kit) will help me work in a trauma informed way. These
skills are so needed in CJSW”
“This training has given me the opportunity to reflect upon my current practice and to look at ways of doing things differently i.e.
working from a trauma based perspective and moving away from practices I usually use”
“I will include the knowledge and tools I learned into my everyday practice, particularly the Zone tool which I found really useful. I
believe that I would benefit from more formal training in relation to work with clients with trauma”
“I will be prepared for working with service users with experience of trauma. I will use theory e.g. zones and window of tolerance to
support service users to better understand what they have experienced and how it is affecting them now – and support them to
identify strategies to manage this e.g. grounding techniques, guided imagery”
“I feel that I shall be able to better understand and respond to “red zone” responses. I shall be sharing this will my CPD colleagues”
“This will allow me to be more aware of traumas which will have occurred in client’s background. I will be more informed of the
behaviours, moods clients present with. An understanding of the zones, clients can be in and how to deal with this”
“A large proportion of clients have/are experiencing trauma and this course has raised my awareness of it can impact on my work with
them and their ability to engage. I found information about zones particularly interesting”
“Going to apply this within my practice, within my reports. This will help the service support service users in a therapeutic, understood
and supported manner”
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“It has given me so much to think about in terms of making sense/understanding clients behaviours and attitudes. Also helped me to
consider how best to respond to their needs”
“I will use this training in a number of my sessions with clients to help them understand how and why they react the way they do. I have
found the training fascinating which will enhance my practice and skills”
“Working within women’s team so will be extremely relevant for most of my caseload:
I will most certainly utilise my learning and knowledge base of trauma informed practice in my relationships with the women and
children I am working with – domestic abuse generates a trauma response and using breathing and grounding and understanding of
bodily reactions/brain function to support client’s journey”
“I have some very practical tools that I can take away and use in session (e.g. high/low road); information will change my approach to
and analysis of assessment and ongoing work; I will give greater weight to the physical interactions I have with clients; Use of the
excellent tips and guidance from the end of the day”
“Already thinking about some clients and doing the high/low road stuff with them to create a safe, shared language; I also want to
adjust my practice for all my clients and be more trauma informed in general”
“I will be thinking about ACE’s primarily at the CJSW report interview stage, and in the process of building up rapport with service user,
if they subsequently come on a CPO supervision requirement, I will be trying to take this forward to the case management plan “special
responsivity issues”. I think this will give me much greater awareness of the difficulties perhaps faced by those who have suffered
trauma. In line with E. Dun, I believe it would be a good timescale to work on the initial themes before consolidating them prior to the
initial 3 month CPO review”
3) Following on from this the next area is that of using knowledge gained around ACE’s and the Impact of trauma on people involved in CJ,
having a better understanding of service users. Also applying this knowledge when writing court reports.
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“I have many service users who have experienced trauma and whom would benefit from TIP. I am now more knowledgeable in TIP and
believe that I can now offer them a better service. I will in particular consider the ACE questionnaire, the three zones and how certain
parts of the brain affect actions/body”
“I will use this learning in practice on a daily basis given the client group I work with and the high volume of those who have suffered
from trauma”
“I will be more aware and informed of the impact of trauma and will be able to use this with clients. Linking TIP into everyday work will
be invaluable. About how you think about the person – to what plans (working together), some of the lessons will cross over to non-
traumatised clients too”
“It will always be at the forefront when a new order is allocated. I will be thinking about the potential trauma which is making the
person the way they are. The breathing techniques will allow me to ensure that individuals are not in a state of hyper/hypo arousal
before leaving the room. I will always bring my whole self to the room and be conscious of when I am not in the body for speaking to
people”
“Will use in my own practice and support team in enhancing their practice”
“I would use breathing techniques, window of tolerance and zones to understand my own and my client’s feelings, thoughts and
behaviours. I would like to develop my knowledge of and use of self-compassion and the idea that while people may do “bad” things
they are not bad and will have good qualities that can be identified and built on using a strength based approach”
4) The next area involves educating and working with others around Trauma Informed Practice – either in the participants wider team, or
the wider community/criminal justice community.
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“Work with senior management team to discuss implementing a trauma informed service for all service users”
“I think it is essential that TIP be introduced to daily practice A>S>A>P. Training needs to be extended to all practitioners. TIP awareness
for other connected staff and agencies.”
“To influence practice within EAC and across partners”
“As TIP is a relatively new concept in practice my colleagues and I will take this book to our team via development sessions in order for
it to inform all future practice”
“I aim to initially instil the practice during discussion at team meetings and individual supervisions. Overview of content/assessment
within LSCMI and discussions surrounding responsivity/referrals/action plans. On-going peer research at team meetings – further
exploration of the various texts identified during the 2 days”
“I will have oversight of cases and therefore in supervision we will discuss trauma informed P and methods that workers will employ in
formulating case management plans. Welfare issues will require to be addressed first prior to working on offending issues.”
“I will use my learning from today in all future work which I undertake. I will also discuss training t next team meeting to allow wider
team the opportunity to benefit from this knowledge”
“Learning to be used to inform current practice in a Children and Families setting, Learning will be rolled out to the team to ensure their
engagement and practice with families is informed by their knowledge of trauma and how to adapt their interactions to best engage
service users”
“I am going to re-write child protection reports. I am going to evaluate and look at how to do it in a new way”
“I will spend time at work to develop a strategy, 6 week plan of how I will use this learning and pass this to clients. I will also continue to
push management about the importance of TI service and push for change”
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5) The next area is specific to working in a custodial setting
“This learning will be invaluable to my everyday practice and approach with individuals within the prison setting, this learning will also
inform my practice when advocating for individuals within the prison setting. It will allow me to identify and recognise when someone
may be in a hyper or hypo state of arousal and I am now better informed and equipped to support those in that moment”
“Good visual ideas to 1:1 work with individuals re zones, thoughts on early years (ACE’s); in induction, in supervision with all guys/SPS
staff and colleagues. ICMS/interviews as a tool for supporting affect regulation/and focus. ACE’s in report and in supporting this
individuals sentence management, RA and progression planning”
Section 2: Pre and post course evaluation findings
We also conducted a pre and post training evaluation using survey monkey to assess learner’s level of understanding of Trauma Informed
Practice. We also used to it to ascertain whether workers were putting their learning in to practice.
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It was possible to see an improvement in almost all elements of understanding further to completing the course, there was a slight anomaly
which we will discuss later in the report.
Adverse Childhood Experiences
In regard to levels of understanding of Adverse Childhood Experiences, prior to participating in the course 9.7% of participants rated their
understanding as “excellent” this moved to 19.4% post participation. 29.4% rated their understanding as “good” pre course and 75% post
course, a clear improvement. Prior to attendance 35.2% rated their understanding as “satisfactory” and 28.3% as “poor”, after participation
this changed to 5.5% “satisfactory” and 0% rated their understanding as poor. We can see that there is a clear improvement in levels of
understanding of Adverse Childhood Experiences. Participants were able to name 3 Adverse Childhood Experiences pre course and post course
– although there was more variety of answers post course, demonstrating again an improvement in their levels of understanding.
Table 1
Trauma and complex trauma
We measured participants understanding of different kinds of trauma before and after participation in the course.
Pre course Post Course Excellent 9.7% → 19.4% Good 29.4% → 75% Satisfactory 35.2% → 5.5% Poor 28.3% → 0%
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Again we can see a marked improvement in levels of understanding of trauma pre and post attendance on the course. Prior to participating in
the course 0% of participants rated their understanding of different kinds of trauma as “excellent” this moved to 9.7% post participation. 40%
rated their understanding as “good” pre course and 59.9% post course, a clear improvement. Prior to attendance 60% rated their understanding
as “satisfactory” after participation this changed to 21.4% “satisfactory”. All participants had some understanding of trauma prior to attending
(as you would expect from this workforce). We can see that there is a clear improvement in levels of understanding of different kinds of trauma,
although less marked that that of Adverse Childhood Experiences.
Table 2
We asked participants to describe complex trauma and the impact of trauma on the brain, prior to and post attendance on the course.
Prior to the course most participants were able to describe complex trauma to a degree, however post course all participants were able to
describe complex trauma and in more detail. The same results were found for the impact of trauma on neurobiology, the answers were fuller
and more detailed after attendance on the course and more participants were able to answer the question.
Adverse Childhood Experiences and Health
Pre course Post Course Excellent 0% → 9.7% Good 40% → 59.9% Satisfactory 60% → 21.4% Poor 0% → 0%
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We also wanted to measure participants understanding of the health impacts of having an Adverse Childhood Experiences score of 3 or more,
pre and post course. Prior to the course most participants were able to name some of the impacts but mostly relating to mental health. Post
course there was a wider variety of answers also taking in to account the physical health impacts of adversity.
All participants were able to name protective factors prior to and post training.
Trauma and behaviour
We measured participants levels of understanding of the impact trauma has on behaviour and ultimately why this behaviour might be hard to
change. We also asked them to provide some examples of these behaviours. The results regarding the improvements in learning are discussed
later. All participants were able to give examples of behaviours associated with trauma and difficulties changing these behaviours.
We also wanted to measure participants understanding of “Dissociation”. We asked participants to explain its meaning. Most participants
answered pre course, but post course, more people answered the question and the answers were fuller and more descriptive.
We measured participant’s levels of understanding of the links between trauma and offending behaviour.
We can see a clear (table below) improvement in levels of understanding of the links.
Table 3
Trauma Informed Practice
Pre course Post Course Excellent 0% → 8.3% Good 46.6% → 77.7% Satisfactory 43.3% → 13.8% Poor 0% → 0%
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We then asked a number of questions specifically pertaining to Trauma Informed Practice. We measured levels of understanding of Trauma
Informed Practice prior to and post attendance. Those that rated their understanding as “excellent” prior to the course showed no change,
however those who rated their understanding as “good” improved significantly. Those that rated “satisfactory” dropped by 40% and “poor” by
38.8%, demonstrating a clear improvement.
Table 4
We asked participants to rate their confidence in working using a Trauma informed framework organisationally and at an individual level.
Table 5
We can see a marked improvement in confidence in working from a trauma informed way.
Vicarious trauma
Pre course Post Course Excellent 5.5% → 5.5% Good 0% → 78.8% Satisfactory 55.5% → 15.5% Poor 38.8% → 0%
Pre course Post Course Excellent 0% → 19% Good 20% → 55% Satisfactory 46.6% → 16.6% Poor 33.3% → 8%
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We measured participants understanding of Vicarious Trauma, this was an important element of the course and we wanted to raise awareness
of this and to encourage self-care. Participants were asked to rate whether they agreed or disagreed that they understood the meaning of
vicarious trauma. We can see that there was a marked in improvement in participants understanding.
Table 6
Self-care
Nearly 90% of participants knew where to seek help and support if required.
We again asked participants to commit to applying the learning from this course to the workplace. Some examples of this can be found in the
appendix and will be followed up.
Pre course Post Course Strongly Agree 10% → 16.6% Agree 40% → 77.7% Neutral 16.6% → 5.5% Disagree 13.3% → 0% Strongly Disagree 0% → 0%
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Section 3
Discussion
Analysis of the evaluation demonstrates that the Key training objectives relating to, the prevalence of trauma, the neurobiological effects of trauma and a greater understanding of the Adverse Childhood Experiences and their impact on health and inequalities were met as evidenced in section 1 and section 2, Table 1 and 2; Adverse Childhood Experiences, Adverse Childhood Behaviours and Health, and Trauma and Complex Trauma. There was a clear improvement in levels of understanding after completing the course. Analysis of the evaluation demonstrates that the Key training objectives relating to understanding the link between trauma and offending were met as evidenced in section 2, Table 3; Trauma and Behaviour, there was a clear improvement in levels of understanding of the link, also all participants were able to explain dissociation after completing the course. Analysis of the evaluation demonstrates that the Key training objectives relating to Trauma Informed Practice (informed), as we have a commitment from participants that the learning and concepts will be incorporated in to everyday practices as evidenced by Section 2, Table 4 and 5, we can see an improvement in levels of understanding of the concepts of Trauma Informed Practice as well as confidence in using the approach. Practitioner skills were enhanced as a result of the theoretical tools introduced (zones, window of tolerance) to improve their practice as evidenced in section 1, b, 1 & 2.
“I will be prepared for working with service users with experience of trauma. I will use theory e.g. zones and window of tolerance to
support service users to better understand what they have experienced and how it is affecting them now – and support them to identify
strategies to manage this e.g. grounding techniques, guided imagery”
“Good visual ideas to 1:1 work with individuals re zones, thoughts on early years (ACE’s); in induction, in supervision with all guys/SPS
staff and colleagues. ICMS/interviews as a tool for supporting affect regulation/and focus. ACE’s in report and in supporting this
individual’s sentence management, RA and progression planning”
Practitioner’s confidence when working with people affected by trauma was increased in alignment with the NES National Trauma Framework (see introduction and appendix 2) evidenced in section 2, table 5 and Section 1, b, 1 & 2.
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“Will feel more confident and competent to work with people (not scared to open “that can of worms)”
“I think I will feel more confident helping clients understand their own feelings & behaviours and in my ability to support them to regulate.
I will be less nervous about talking about trauma”
Practitioners demonstrated that they had developed a capacity for self-reflection and trauma informed practice as evidenced throughout the evaluation but particularly in section 2, b, 2-4, and also in appendix 3 and 4. “This training has given me the opportunity to reflect upon my current practice and to look at ways of doing things differently i.e. working from a trauma based perspective and moving away from practices I usually use”
“It will always be at the forefront when a new order is allocated. I will be thinking about the potential trauma which is making the person
the way they are. The breathing techniques will allow me to ensure that individuals are not in a state of hyper/hypo arousal before leaving
the room. I will always bring my whole self to the room and be conscious of when I am not in the body for speaking to people”
However, there were two anomalies in the results which appear to contradict the rest of the results of our survey.
The first anomaly is in regard to levels of understanding of the impact of trauma on behaviour: Prior to participating in the course 26.6% of
participants rated their understanding as “excellent” this moved to 15.5% post participation. 73.3% rated their understanding as “good” pre
course and 74.4% post course. Prior to attendance 0% rated their understanding as “satisfactory” and 0% as “poor”, after participation this
changed to 10% “satisfactory” and 0% rated their understanding as poor. Clearly those who rated their understanding as “good” has remained
broadly the same but there was a move from those rating their understanding as excellent downwards towards either “good” or “satisfactory”.
However one participant has cited “I will be more understanding of client’s background and how this is impacting on them at the present time”.
Another anomaly in the results was that of measuring participants understanding of trauma in the prison population. The results are less
marked than the previous question on the impact of trauma on behaviour, however are still surprising. We questioned whether participants
agree with the statement that there is a “high prevalence of trauma amongst the prison population”:
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Pre training 73.3% strongly agreed with this statement, 16.6% agreed and 10% were neutral; Post training 68.5% strongly agreed, 27.7%
agreed and a small number (1.8%) strongly disagreed with this statement. The number of participants who have strongly agreed has lessened
and there is now a small percentage who strongly disagree.
Limitations to evaluation:
All measurements in survey monkey are self- measurements and are subjective. We asked participants to give examples in some of the questions
in order for us to substantiate their answers.
It may be that participants are thinking more about their answers post training and are taking more time to answer, this could lead to rumination
and lower marking. The two questions that are anomalous are questions about personal attitude/views rather than those about knowledge per
se. It could also be that with greater insight following the training people tend to revaluate their learning and realise they still have significant
room for development.
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Section 4
Conclusion
In conclusion, the pilot of Trauma Informed Practice has been a success. All participants found the course valuable and learned from the two
days, this is evidenced by the improvement in knowledge and confidence in almost all areas of the evaluation. There is a clear message that
practitioners want to continue to use the knowledge and skills gained; there is a desire to share this knowledge with their teams and the wider
workforce. There appears to be a momentum that has been created by attending the course.
“I would like to see a rolling programme of TIP events and training. It allows me to be the compassionate and skilled worker that I always aspired
to be, thank you it has been a great training.”
The challenge now is to support participants to move forward and allow them to continue to work in a trauma informed way.
Appendix 1
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Trauma Informed Training Outcomes – 2018 Aims of Course Wider Aims For workers to better understand:
• trauma and its impact
• the relationship between trauma and offending
• the obstacles to engagement with services
All workers can:
• relate to people they come into contact with using trauma‑informed principles regardless of whether a history of trauma is known or
identified.
All managers can: • begin to plan and implement trauma‑informed service systems and procedures
• ensure effective support for staff
All workers and managers consistently demonstrate their application of this knowledge and understanding in practices and processes Specific Aims Trauma To develop an understanding of trauma and its prevalence To be able to define trauma and different types of trauma To gain and understanding of the neurobiological effects of trauma (including vicarious trauma) To be familiar with the ACE study To Understand the impact of ACE’s on health and inequalities Trauma and behaviour
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To develop an understanding of the impact of trauma on behaviour (particularly amongst offenders) To develop an understanding of the behaviour patterns of traumatised people, and why these are hard to change Trauma and Offending To understand the link between trauma and offending To gain an understanding of the prevalence of trauma amongst the prison population To gain an understanding of recent research in to trauma informed treatment of offenders Trauma Informed Practice To use the above learning outcomes to work with service users from a trauma informed framework; To integrate the learning and concepts into every day practices and incorporate into established risk assessments and formulation To provide an opportunity to enhance practical skills in working with people who have been traumatised. To be more confident in working within a framework of trauma-informed care at an individual and organisational level. Develop a capacity for trauma-informed and self-reflection To develop an awareness of when to refer/signpost to specialist services and what services exist Appendix 2 – Transforming Psychological Practice – Enhanced Level Outcomes (Level 3)
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For workers to better understand:
• trauma and its impact
• the relationship between trauma and offending
• the obstacles to engagement with services
All workers can:
• relate to people they come into contact with using trauma‑informed principles regardless of whether a history of trauma is known or
identified.
All managers can:
• begin to plan and implement trauma‑informed service systems and procedures
• ensure effective support for staff
All workers and managers consistently demonstrate their application of this knowledge and understanding in practices and processes Practice level 3: Trauma enhanced practice:
1. Understanding trauma (Level 3)
2. Good self-care
3. Trauma informed practice and systems
4. Trauma-informed risk assessment and management
5. Routine enquiry and supporting disclosure
6. Working with interpersonal difficulties in the context of trauma
7. Assessing people with trauma-related difficulties
8. Delivering interventions for people with trauma-related difficulties
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9. Recovery and connection
Trauma-informed leadership
Trauma Enhanced Practice level: knowledge and skills for staff with regular and intense contact with people affected by trauma and who have a specific remit to respond by providing support, advocacy or specific psychological interventions to protocol, and/or staff with responsibility for directly managing care and/or services for those affected by trauma.
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Outcome What workers know (knowledge) What workers are able to do (capability/skill/ability)
1. The impact of trauma on people is recognised and understood. The impact of trauma on people is recognised and understood. The impact of trauma on people is recognised and understood.
All workers understand: • that trauma can impact on the individual in different ways depending on a range of factors, including: the developmental stage at which the trauma occurred; the type(s) of trauma experienced; the frequency with which the trauma was experienced; availability (for children) of a good‑enough functioning adult; and the individual’s cultural background. • that childhood trauma and adversity (“adverse childhood experiences”) has been found to be associated with poorer longer‑term physical and mental health outcomes and early mortality
All workers can: recognise and acknowledge the contribution trauma may have made to the development of a person's mental or physical health difficulties • recognise where trauma has led to missed developmental opportunities. • build trust and engage the person within a working context by being consistent, trustworthy, collaborative and non‑judgemental. • develop clear but flexible boundaries with the person.
•
2 All workers understand: • the ways in which childhood trauma and abuse can impact neurologically, socially, emotionally, cognitively and developmentally, and can therefore have implications for learning and social and emotional development. • that trauma has the potential to impact on the ability to form and maintain relationships, tolerate emotions and maintain a stable and positive sense of self.
All workers can: • recognise where the experience of trauma is having an effect on a person's relationship with a worker or service, and adapt accordingly. • help people recognise links between current difficulties or needs and past experiences of trauma. • normalise and make sense of (where possible) current difficulties as adaptive
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• the importance of giving the message “it’s what happened to you, not what’s wrong with you” in enabling individuals to feel safe within themselves and build a positive sense of self.
and understandable responses to overwhelming threat and its impact
3 All workers understand: • the potential for people affected by trauma to experience distress when memories of the trauma are triggered by circumstances/relationships/situations that bear some similarity to previous trauma. • that trauma can cause individuals to feel overwhelmed and become over or under (hyper‑ or hypo) aroused in situations that remind them of past trauma and/or where they perceive the current risk to themselves to be high. This is known as exceeding the “window of tolerance”. • that the individual who is hypo‑aroused(dissociated) can look disconnected/ unconcerned. • the importance of enabling the individual, where possible, to stay within the window of tolerance. • the importance of providing safety and building trust, giving choice and control, and engaging collaboratively with the individual to reduce the likelihood of triggering trauma related distress.
All workers can: • recognise when a person is overwhelmed by trauma related symptoms or responses (distressed/hyper‑ aroused or dissociating) and collaboratively support the person to use a range of grounding and other individually tailored techniques to enable them to return to within their window of tolerance. • recognise triggers to dissociation/hyper‑arousal and avoid, where possible exposing the person to situations which exceed the 'window of tolerance'. • advocate on behalf of a person to ensure that where possible systems and procedures do not trigger trauma related memories that lead to distress and/ or re‑traumatisation. • acknowledge the link between past trauma and current coping strategies and collaboratively consider the ways in which strategies may no longer be helpful / have become actively unhelpful.
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4 The impact of trauma on people is
recognised and understood All workers understand: • that symptoms and difficulties (such as dissociation, risky sexual behaviour, self‑harm and substance misuse) can be reactions to trauma which have emerged as attempts to cope with and/or adapt to the experience of trauma in the past. • that, in addition to PTSD and complex PTSD, trauma is a recognised factor contributing to the development of a range of other mental health diagnoses and difficulties, including depression, eating disorders, psychosis, anxiety, personality disorders, self‑harm, suicidality, substance misuse, dissociation and risky sexual behaviour.
All workers can: • acknowledge the link between past trauma and current coping strategies and collaboratively consider the ways in which strategies may no longer be helpful / have become actively unhelpful. • work collaboratively, as far as possible in responding to immediate needs for safety. Managers can: • develop and support trauma‑informed systems and procedures within services to address the immediate safety needs of those affected by trauma, recognise and reduce risk of re‑traumatisation and support staff well‑being.
5 The impact of trauma on people is recognised and understood
All workers understand: • the need for awareness of possible red flags for different types of current or ongoing trauma and abuse (such as for human trafficking and domestic violence). • the potential for minority and marginalised groups, and those with protected characteristics, to be disproportionately affected by trauma. • the potential for discrimination against minority and marginalised groups to result in and compound the effects of trauma.
All workers can: • recognise the red flags associated with different types of trauma and abuse and respond appropriately. • recognise where factors linked to membership of a particular minority or marginalised group are relevant to understanding risk of trauma and/or a person's trauma‑related difficulties.
people affected by trauma and their dependents have their immediate
All workers understand: All workers can:
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needs for safety identified at the earliest possible opportunity so they can be protected from further harm.
• the importance of holding the safety needs of the person and their dependents in mind at all times. • the importance of recognising signs and symptoms which are indicative of ongoing trauma and abuse. • risk‑screening/risk‑assessment tools relevant to own area of practice and to role. • that achieving objective and emotional safety is part of the phased model of recovery from trauma and an essential stage in recovery.
• recognise signs and symptoms which are indicative of ongoing trauma and abuse. • use relevant risk screening tools. • appropriately respond to manage risk.
6. People affected by trauma and their dependents have their immediate needs for safety identified at the earliest possible opportunity so they can be protected from further harm.
All workers understand: • that individuals with a history of previous trauma are at increased risk of experiencing further trauma, called re‑ victimisation. .
All workers can: • recognise where a person may be at risk of re‑victimisation, and respond to support the person to minimise risk as far as possible
7 People affected by trauma and their dependents have their immediate needs for safety identified at the earliest possible opportunity so they can be protected from further harm.
All workers understand: • that the risk of experiencing further trauma / re‑ victimization can be linked to a combination of external risk factors (such as debt, poverty or gang involvement), internal risk factors (including poor sense of self‑worth) and relational risk factors (e.g. a coercive and controlling partner). • that difficulties which may raise safety concerns, such as self‑harm and substance misuse, may have developed as a means of coping with the impact of trauma. • the importance of ensuring interventions for substance misuse and the consequences of trauma
All workers can: • recognise when complex risks are present and when it would be helpful to consult with specialists with relevant expertise in managing risks, or to refer for specialist risk assessment, where appropriate. • recognise when trauma reactions are compromising the safety of the individual and/or the safety of others, and respond accordingly to mitigate any risks and, in collaboration with the individual develop safety.
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are, where possible, delivered simultaneously rather than consecutively, recognising the links between trauma substance misuse and mental health.
8 People affected by trauma are supported to safely disclose trauma, where appropriate.
All workers understand: • that trauma can be disclosed spontaneously, in a planned way (e.g. through a witness statement), or in response to routine enquiry.
All workers can: • recognise and safely respond to a spontaneous disclosure of abuse and trauma.
9 People affected by trauma are supported to safely disclose trauma, where appropriate
All workers understand: • in many services, spontaneous disclosures of trauma are relatively unusual and routine enquiry has been found to support disclosure. • the importance of supporting individuals affected by trauma to disclose, where this is appropriate to service context, the worker’s role and where this is likely to be beneficial to the individual. • their own service’s/agency’s policy on routine enquiry. • that the way in which trauma affects the individual and is disclosed can vary depending on a range of factors, including the individual’s developmental age at the time of trauma and at disclosure, his or her levels of verbal ability and emotional awareness, and cultural factors. • the risks associated with routine enquiry (including presence/awareness of potential abuser). • the responsibility to document disclosure and take appropriate action in line with local, national and/or
All workers can: • where deemed appropriate to service context and role, sensitively and empathically routinely enquire about trauma and abuse using appropriate and unambiguous language, and ensure a confidential space and suitable follow‑ up where necessary. • tailor the language of routine enquiry to the individual. • recognise when routine enquiry carries potential risks and take steps to reduce risk and/or make a plan for follow‑up and/or referral. • recognise that where details of trauma experiences are required to be disclosed in a legal context as evidence, it is important to take trauma reactions into account when taking witness statements.
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professional risk‑management policies and procedures, depending on service context.
• prioritise the individual’s health and well‑being over the needs of systems and procedures. • respond to disclosure in a way that recognises and responds to a person's needs while balancing respect for the right to autonomy, choice and control.
10 People affected by trauma are supported to safely disclose trauma, where appropriate.
Managers understand: • the importance of ensuring that the practice of routine enquiry is adopted service‑wide and is supported by a clearly specified and trauma‑informed service‑level response protocol to ensure that emerging needs for safety/support and/or therapeutic interventions are recognised and appropriately addressed.
Managers can: • ensure that staff are informed and trained in the use of service protocols for supporting and responding to disclosure.
11 People affected by trauma are signposted/referred to appropriate services to ensure needs are met following disclosure, where appropriate.
All workers understand: • that people affected by trauma and their dependents can have a range of possible needs which can include a need for: § objective safety § practical and emotional support, (including counselling and advocacy) and for children educational support § physical and/or mental healthcare and therapeutic services. • the importance of completing an individualised needs assessment to identify a persons' needs and desired personal outcomes, and to inform a plan to ensure that needs can be met/personal outcomes realised.
All workers can: • in collaboration with the person affected by trauma, carry out an evaluation of their needs in terms of safety/risk, practical and emotional support, physical and mental healthcare and therapeutic resources. • enable the person to identify personally valued outcomes. • recognise when an individual has unmet needs linked to trauma and would benefit from onward referral or additional care, support or interventions.
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• the importance of ensuring the person affected by trauma is signposted/referred to the relevant service to ensure that needs can be met and that multi‑agency input is co‑ ordinated. • The importance of ensuring, where necessary, that interlinking trauma‑related needs are met simultaneously rather than sequentially (for example interventions for substance misuse and trauma related mental health)
• enable the person to access care, support and/or therapeutic interventions, as appropriate. • act as a keyworker to the person to co‑ordinate appropriate input and onward referral to ensure needs for care, support and intervention are met
TRAUMA ENHANCED PRACTICE LEVEL | BEING ABLE TO COPE
12 People affected by trauma experience a consistent, respectful and professional relationship to engender trust.
All workers understand: • that interpersonal difficulties are a normal and predictable reaction to the experience of having lived through trauma and adversity. • the range of ways in which interpersonal difficulties that arise as a result of trauma may affect the therapeutic relationship between a person affected by trauma and a worker. • that interpersonal difficulties can be understood within an attachment framework and can manifest as a difficulty trusting others/having poorer ability to judge who is trustworthy and/or a fear of being abandoned in the context of difficulties in managing intense emotions.
All workers can: • skillfully and reflectively respond to different interpersonal styles and ways of being while remaining person‑centred and trauma‑informed. • be aware that their interpersonal style may be influenced by early adverse experience and be able to take that into account in dealing with relationship difficulties or ruptures. • develop a plan for contact that is developed collaboratively, based on shared decision‑making, is clear and specific, and has a specified time frame. • acknowledge and help the individual to cope with the end of the relationship in advance of finishing contact.
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13 People affected by trauma experience a consistent, respectful and professional relationship to engender trust.
All workers understand: • the importance of collaboratively negotiating a clearly specified and time‑framed plan for contact to create and foster predictability and trust. • the importance of preparing the individual for the point when contact will end, recognising the loss that this can represent
14 Natural recovery is optimised and the individual’s strengths are recognised and supported
All workers understand: • the importance of recognising and supporting the resilience, positive roles and strengths held by the person affected by trauma. • the importance of the person connecting with existing emotional supports and social networks following trauma, where these are available, safe and appropriate
All workers can: • recognise the positive roles and strengths held by a person affected by trauma, in the face of what can sometimes seem overwhelming difficulties • frame current difficulties as understandable and adaptive coping responses to experiences of trauma and overwhelming threat and its consequences. • involve the individual in identifying and reflecting on his or her strengths and skills and in thinking about how these might be used to cope with current difficulties
15 Natural recovery is optimised and the individual’s strengths are recognised and supported.
All workers can: • incorporate the individual’s strengths and skills into support/treatment plans. • advocate for and support the individual to connect with existing emotional supports and social networks, where possible.
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16 Current distress and difficulties are recognised and understood
All workers understand: • the normal basis for trauma‑related reactions (e.g. fight, flight, freeze). • the fundamentals of the neurobiological basis of trauma symptoms, including hypervigilance and re‑experiencing. • the ideas and concepts behind the "window of tolerance". • that trauma memories are frequently triggered by situations which bear some resemblance to elements of previous trauma. • that as well as being seen and heard, trauma memories can be felt in the body. • the role of avoidance in maintaining trauma related difficulties.
All workers can: • provide psychoeducation, which explains the initially adaptive and protective function of trauma reactions • explain the role of trigger avoidance in maintaining trauma symptoms. • be sensitive to trauma triggers in the service context.
17 People affected by trauma receive the level of care/support and/or intervention that matches the level of need.
All workers understand: • the importance of assessing the individual’s level of need so care/support/intervention can be matched to need. • that support should be provided to facilitate natural recovery that recognises and builds on strengths. • that professional support and advocacy should be provided when individuals don’t have safe or supportive networks or are unable to use existing supports. • that selective and targeted therapeutic interventions should be provided for persons who appear to be showing signs of longer‑term mental health difficulties.
All workers can: • carry out a person‑centred needs assessment that takes into account age, life stage and cultural background. • draw up a care plan that articulates how needs will be met and by which service(s). • provide care, support and/or intervention to meet identified needs and/or make onward referrals, where appropriate.
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• the range of services available locally to meet the individual’s needs.
18 People affected by trauma receive effective professional support and/ or advocacy in line with needs.
When directly providing support, all workers understand: • best practice guidance and evidence relating to working with individuals affected by trauma (such as WHO guidance on interviewing women affected by sexual violence). • the importance of support work being informed by a needs assessment which identifies specific needs for practical and/or emotional support, and/or advocacy, and/or skills acquisition or consolidation. • the importance of support work being conducted with an empowering and enabling focus recognising and working with strengths and positive adaptations.
All workers can: • respond to the person's needs in line with best practice guidance and best evidence. • discern the appropriate focus for support work. • work in collaboration with the person to address practical and emotional support needs. • demonstrate skills relevant to providing practical and emotional support, including the ability to: a) support and enable effective problem‑solving b) communicate a normalising explanation of the effects of trauma and trauma reactions using psychoeducation; c) respond empathically and non‑judgementally using relevant psychosocial skills, including active and reflective listening
19 People affected by trauma receive effective professional support and/ or advocacy in line with needs.
When directly providing support, all workers understand: • the importance of providing practical support to address current stressors and immediate needs, (e.g. housing and finance), where appropriate. • the importance of providing emotional support, where appropriate.
All workers can: • empower people affected by trauma through advice and advocacy where appropriate. • offer advice to enable and support the individual to use adaptive coping strategies to manage stress and distress.
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• the importance of enabling the individual to identify and address gaps in skills. • the potential for trauma to impact on parenting. • local knowledge of services/resources/courses to support skills development and social connectedness.
• enable/support the person to identify strengths and gaps in skills and roles. • offer support to help him or her access relevant services/courses to address the gaps and build on the strengths (e.g. confidence‑building, literacy or parenting). • hold the needs of family members and dependents in mind, especially those who are vulnerable, when directly providing support. • provide information, where appropriate.
20 People affected by trauma are supported to make a legal disclosure, where appropriate.
All workers understand: • the range of factors that can interfere with a person’s willingness and ability to be a witness for the purpose of prosecution of offences that may have been committed against them in the course of their traumatic experience(s). • the importance of supporting and enabling a person who has been a victim of crime to legally disclose these experiences in a legal context, where appropriate and in the interests of the person.
All workers can: • gauge whether the person wishes to consider making a legal disclosure. • provide, where appropriate, information about the process of making a legal disclosure. • support the person to access relevant information in order to make a decision about making a formal legal disclosure.
21 People affected by trauma are supported to make a legal disclosure, where appropriate.
All workers can: • provide or refer/ signpost to appropriate emotional and practical supports necessary to facilitate the process of legal disclosure and engagement in the prosecution process.
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• be mindful of the risk of re-traumatisation and exceeding the window of tolerance throughout the process of disclosure of traumatic events in the context of providing evidence. • advocate for the individual involved in a legal process so that his or her needs are central considerations at all points during legal disclosure/ evidence‑giving.
21 People with mild– moderate mental health difficulties linked to trauma receive evidence based psychological interventions in line with protocol to promote coping with trauma reactions and current stressors.
All workers understand: • the range of evidence and protocol‑based psychological interventions currently available and designed to support key aspects of coping with the impacts of trauma (such as skills in regulating emotions, increasing activity and in reducing avoidance). • the importance of undertaking appropriate training and gaining skills and experience to develop competence in delivering protocol‑based psychological interventions.
All workers can: • discuss key areas of current difficulty with the individual and collaboratively identify where he or she is using coping strategies likely to be problematic over the longer term (such as situational avoidance). • provide psychoeducation around trauma symptoms and reactions
22 People with mild– moderate mental health difficulties linked to trauma receive evidence based psychological interventions in line with protocol to promote coping with trauma reactions and current stressors.
All workers understand: • the need for protocol‑based psychological interventions to be practised under an appropriately‑trained supervisor. • the need to identify key areas of current difficulty and current strategies used to cope with emotions and stress when providing psychological interventions to protocol. • that trauma can affect the ability to tolerate and manage the expression of difficult
All workers can: • teach and encourage practice of key skills to enhance emotion regulation (such as brief breathing exercises, relaxation, mindfulness and/or grounding exercises). • provide advice to address poor sleep and sleep hygiene. • intervene to encourage activities to overcome avoidance, and improve mood
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emotions, particularly in interpersonal contexts. • that symptoms and difficulties may have emerged as attempts to cope with or adapt to trauma.
by increasing social contact and engagement in meaningful activity. • effectively deliver evidence‑based psychological interventions to address trauma related difficulties in line with protocol, where appropriately trained and supervised
23 People with mild– moderate mental health difficulties linked to trauma receive evidence based psychological interventions to protocol to promote coping with trauma reactions and current stressors
All workers understand: • when moderate to severe mental health difficulties linked to trauma emerge, that these may require high‑intensity psychological therapy provided by a Tier 4 psychological therapist, and the importance of timely referral.
All workers can: • recognise when the psychological interventions being provided are not effective and/or when an individual requires high‑intensity psychological therapy provided by a Tier 4 psychological therapist. • enable the individual to access, or refer the individual to, high‑intensity psychological therapy, where appropriate.
24 The professional needs of workers responding to the impact of trauma are recognised and addressed in the workplace.
All workers understand: • the importance of engaging in regular clinical supervision to ensure that clinical practice is safe and effective. Managers understand: • the ethical and professional obligation to ensure that workers are appropriately trained and are working within the limits of professional competences. • the different training routes and requirements to provide psychological interventions or practice as a psychological therapist in Scotland.
The worker can: • regularly access and use clinical supervision. Managers can: • select appropriate staff to work with those affected by trauma on the basis of the training and qualifications required to provide relevant interventions (for example psychological interventions) or to practice in the role
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25 People affected by trauma benefit from a sharing of trauma understanding and expertise across the workforce.
All workers understand: • the importance of educating the workforce about trauma and its impact, and about factors that support recovery and enhance personal outcomes.
The worker can: • provide education about trauma and recovery that is specific to the worker’s area of expertise. • deliver education around best practice in a range of settings. • make complex ideas about trauma and the effects it has on people, both short and long term, understandable and relevant to a given audience, informed by the best available evidence.
Stage of recovery: processing and making sense of trauma. Individuals affected by trauma can emotionally process the memory, meaning and losses associated with past traumatic events to experience a reduction in psychological distress and recover psychologically.
26 People affected by trauma experience a consistent and respectful working relationship to set the conditions for disclosure of trauma and abuse, where appropriate
All workers understand: • the importance of attending to professional working relationships with people affected by trauma at all points in contact.
All workers can: • recognise where there are potential difficulties with boundaries in relationships with those affected by trauma, and use supervision to manage these.
27 Natural recovery following trauma exposure is optimised and the person’s strengths and resources recognised and supported. in the individual’s recovery journey.
All workers understand: that processing and making sense of past trauma
is an ongoing process not restricted to a
particular point
All workers can: • encourage the person affected by trauma to use existing relationships to discuss traumatic experiences, where safe and appropriate.
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28 People experiencing high distress
linked to the memory of past trauma are enabled, where possible, to safely disclose and process trauma memories.
All workers understand: • the importance of communicating a willingness and capacity to actively hear a spontaneous or planned disclosure of trauma if the person wishes to disclose. • that the wish to disclose trauma and abuse can be understood as a need to process and make sense of trauma
All workers can: • communicate a willingness and ability to hear a disclosure/discuss trauma and abuse if the individual wishes to disclose. • support the individual to make an active choice about whether to discuss the details of past trauma or not. • provide an empathic, non‑blaming and trauma informed response to a planned or spontaneous disclosure of trauma and abuse.
29 The needs of people affected by trauma are prioritised over systems and procedures to reduce risk of re-traumatisation.
All workers understand: • the potential for tension between the individual’s recovery needs and the needs of systems for statements and testimony (e.g. for court systems, trafficking and asylum systems). • the potential for the individual to experience distress associated with trauma memories and re-traumatisation in these contexts.
All workers can: • use professional knowledge and skills to advocate for the needs of individuals engaged with complex systems, in order to reduce negative impact of re-traumatisation and ensure needs are met appropriately and timeously.
30 People affected by trauma are enabled to access timely care, support and treatment, where appropriate
All workers understand: • that trauma is considered unprocessed/unresolved if the individual continues to experience intrusive memories, flashbacks and/or nightmares, experiences a negative view of themselves and/or others, and/or has difficulty establishing or maintaining relationships. • that where significant distress and intrusions persist beyond one month following a single trauma
All workers can: • recognise when an individual is presenting with clinically significant mental health difficulties linked to unresolved trauma. • recognise when the individual would potentially benefit from trauma‑processing therapy.
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and/or significant distress is present linked to cumulatively experienced trauma, referral for formal trauma‑focused therapy should be considered in line with guidance.
• collaboratively discuss with the individual the option and possible impact of referral for trauma‑memory‑ focused therapy. • link the individual with the appropriate mental health service, either through direct referral or by supporting the individual to speak to the GP.
31 The needs of workers exposed directly to traumatic events or to the details of trauma experienced by others is recognised and addressed in the workplace
All workers understand: • the importance of using regular professional support and supervision to cope with exposure to traumatic material encountered in the course of work. • the potential for working with individuals affected by trauma to impact emotionally on the worker, and the place of professional supervision that is distinct from line management in ensuring continuing effective practice.
The worker can: • make appropriate use of professional support and supervision. • recognise the need for, and seek, appropriate peer support and/or professional supervision when experiencing significant professional or personal demands. • ensure that professional supervision meets the requirements of professional bodies where relevant.
32 The needs of workers exposed directly to traumatic events or to the details of trauma experienced by others is recognised and addressed in the workplace
Managers understand: • the importance of effective and timely access to supervision that is distinct from line management. .
Managers can: • recognise the importance of workers feeling safe to speak openly in supervision about the interaction between the personal and the professional and the value of supervision structures that separate professional from line‑management supervision
Stage of recovery: living the life you choose. The individual affected by trauma can feel hopeful, envisage a life he or she chooses, connected to
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others and using skills and strengths to move towards goals and participate in roles that are meaningful, culturally relevant and personally valued.
33 People affected by trauma can access timely care, support and treatment, where appropriate.
All workers understand: • the importance of reviewing the need for different types of care, support and treatment, particularly at times of transition or crisis. • the importance of collaboratively developing care plans that are recovery‑focused. • the importance of care plans incorporating personally valued goals, roles and personal outcomes.
The worker can: • recognise when an individual might need additional, ongoing or reduced care, support and/or treatment. • develop a recovery‑focused care plan which emphasises valued goals, roles and personal outcomes.
34 People affected by trauma can engage in and maintain safe, sustaining and supportive relationships and social networks.
All workers understand: • the importance of safe relationships and culturally relevant social networks and connections to good mental health and well‑being. • the importance of skills training, where needed, to enable the individual to build on and develop essential interpersonal skills. • that due to effects of trauma on attachment and interpersonal abilities, ending supportive relationships benefits from careful planning.
The worker can: • recognise the impact of social isolation in maintaining trauma related difficulties and support the individual to build safe, sustaining and supportive relationships and culturally‑relevant social networks. • offer support to link the person into classes to build and develop relevant interpersonal skills, where appropriate (e.g. parenting skills, personal safety, and confidence building classes). • consolidate what has been beneficial from the support received and support the person to replicate and generalise these benefits to other parts of their life.
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35 People affected by trauma can recognise and build on own strengths, skills and resources to live a personally valued life
All workers understand: • the importance of enabling the person to recognize that they can build on their own strengths, skills, roles and resources to allow them to live a personally valued life.
The worker can: • enable the individual to identify and build on their own strengths, skills and resources.
36 People affected by trauma can address missed developmental opportunities.
All workers understand: • that where trauma happens at developmentally important times, it can result in missed developmental opportunities, including those that are educational and social.
All workers can: • recognise where, due to the impact of trauma, the individual has missed out on opportunities to develop skills and knowledge, and support the individual to access opportunities and supports to develop valued and essential skills and knowledge.
37 People affected by trauma can identify and move towards goals and participate in roles that are culturally relevant and personally valued.
All workers understand: • the importance of enabling the individual affected by trauma to identify and move towards culturally relevant, achievable and personally valued goals.
All workers can: • enable the individual to identify and move towards culturally relevant, achievable and personally valued goals. • identify where the individual would benefit from support, advocacy and information to achieve goals.
38 The needs of workers exposed directly to traumatic events or the details of trauma experienced by others is recognised and addressed in the workplace.
All workers understand: • the importance of negotiating a clear focus and clear timescales for professional contact. • the importance of planning for the end of contact. • that withdrawing support /ending contact may evoke strong feelings in the staff member.
All workers can: • negotiate a clear focus and timescales for professional contact and compassionately and professionally manage the end of contact. • utilise supervision/management to supporting reflective practise and decision making around support coming to an end.
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CJS Outcomes
Outcome All workers understand: What workers are able to do (capability/skill/ability)
CJS 6 Trauma Better understand the neurological explanation for flashbacks, trauma memories, confusion over past and present To gain and understanding of the neurological effects of trauma (including vicarious trauma)
• explain why people have flashbacks • define trauma memory and explain why it is
different to other memories • explain the difficulty faced by people who
have been traumatised in differentiating between the past and present
• list useful actions and responses to support someone who is experiencing a flashback
• explain the differences between a flashback and an intrusive memory
demonstrate active listening skills when a person speaks about his or her experiences of trauma and/or abuse.
• formulate empathetic and neutral responses to the traumatised person avoiding criticism or blame. • offer appropriate support to the person by asking what help (if any) he or she needs. • analyse whether a person’s behaviour or reactions might be trauma related and practise how to respond.
CJS 7 Trauma and Offending To better understand the link between trauma and offending To gain an understanding of the prevalence of trauma amongst the prison population To gain an understanding of recent research in to trauma informed treatment of offenders
Explain how subcortical parts of the brain drives individuals so they function on automatic pilot with no conscious knowledge of why they behave as they do
Explain how brain changes due to trauma are linked to offending and risk factors such as impulsivity, emotional dysregulation, attachment problems, aggression etc.
Explain a structured psycho-educational approach
practise responding to a client with the understanding and knowledge of brain changes to help formulate an individual’s difficulties.
Practise explaining to individuals how to understand themselves from a neurobiological perspective.
Demonstrate that you can explain to individual’s why they react to particular
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(Understand the neurobiology of trauma and how this impacts on development and presentation)
behaviours/comment using a neurobiological approach.
Discuss/analyse current and past cases from using a neuro-biological approach to develop knowledge in this area.
CJS 8 Trauma and Offending To understand the link between trauma and offending To gain an understanding of the prevalence of trauma amongst the prison population To gain an understanding of recent research in to trauma informed treatment of offenders To understand dissociation and how this can impact on someone’s presentation to be able to understand the concept of
dissociation
to be able to know the link between dissociation and trauma
to understand the neurobiological underpinnings of dissociation
to understand the link between dissociation and offending
define the concept of dissociation
explain the link between dissociation and trauma
summarise the neurobiological underpinnings of dissociation
be able to spot the signs of someone who is dissociated
explain the link between dissociation and offending
Identify characteristics of dissociation in a case study of violent or sexual offending
Identify an appropriate point to refer on to a specialist service
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CJS 9 Trauma To gain and understanding of the neurobiological effects of trauma Trauma and behaviour To develop an understanding of the impact of trauma on behaviour (particularly amongst offenders) Better understand the somatic and cognitive distress and difficulties of people affected by trauma Better understand the typical distress and difficulties faced by those who have experienced trauma (Current distress and difficulties are recognised and understood.)
list the effects of trauma on the mind and body and the fight/flight/freeze/submit response to trauma.
describe coping strategies, including substance misuse, self‑harm, aggression, anger, violence, sexualised behaviour (offending and non-offending) and, emotional disconnection (“dissociation”)
define dissociated violence
justify that an offence can itself be traumatic for the perpetrator
explain the role of trigger avoidance in maintaining trauma symptoms.
• analyse whether a person’s behaviour or reactions might be trauma related and practise how to respond. demonstrate active listening skills when a person speaks about his or her experiences of trauma and/or abuse. • formulate empathetic and neutral responses to the traumatised person avoiding criticism or blame. • offer appropriate support to the person by asking what help (if any) he or she needs.
CJS 10 Trauma To gain and understanding of the neurobiological effects of trauma Trauma and behaviour To develop an understanding of the impact of trauma on behaviour (particularly amongst offenders)
list the effects of trauma on the mind and body and the fight/flight/freeze/submit response to trauma.
describe coping strategies, including substance misuse, self‑harm, aggression, anger, violence, sexualised behaviour (offending and non-offending) and, emotional disconnection (“dissociation”)
demonstrate active listening skills when a person speaks about his or her experiences of trauma and/or abuse.
• formulate empathetic and neutral responses to the traumatised person avoiding criticism or blame. • offer appropriate support to the person by asking what help (if any) he or she needs.
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To develop an understanding of the behaviour patterns of traumatised people, and why these are hard to change Trauma and Offending To understand the link between trauma and offending To gain an understanding of the prevalence of trauma amongst the prison population (The current distress and difficulties of people affected by trauma from both a somatic and cognitive perspective are recognised and understood.) Better understand the typical distress and difficulties faced by those who have experienced trauma
define dissociated violence
justify that an offence can itself be traumatic for the perpetrator
Explain the role of trigger avoidance in maintaining trauma symptoms
• identify the normal basis for trauma‑related reactions (e.g. fight, flight, and freeze).
• summarise the fundamentals of the neurobiological basis of trauma symptoms, including hypervigilance and re‑experiencing.
• define the "window of tolerance". • explain the role of trigger avoidance in
maintaining trauma symptoms.
define concepts of denial and shame from a trauma perspective
List information on relevant local services that offer advice or support skills and training, where appropriate to role.
CJS 11 Trauma and behaviour To develop an understanding of the impact of trauma on behaviour (particularly amongst offenders) To develop an understanding of the behaviour patterns of traumatised people, and why these are
• summarise the different personality disorders and how the symptoms of each may overlap with traumatic responses
• analyse personality disorders and links to response to traumatic experiences
• explain that not everyone with a PD will have a history of trauma.
• practise responding to someone with a personality disorder as you would to someone who is traumatised.
• practise responding with compassion and empathy whilst
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hard to change Better understand the links between personality disorders and trauma (To develop an awareness of how different personality disorders are underpinned by trauma)
• justify behaviour as a survival mechanism or coping strategy.
• discuss current and past cases to further
develop appropriate working practices
maintaining appropriate boundaries.
• practise communicating with people who have a diagnosis of personality disorder to further develop their awareness of their behaviours as survival and coping mechanisms
CJS 12 Trauma and behaviour To develop an understanding of the impact of trauma on behaviour (particularly amongst offenders) To develop an understanding of the behaviour patterns of traumatised people, and why these are hard to change Trauma and Offending To understand the link between trauma and offending
justify the importance of trauma informed services, systems and organisations to reduce the risk of trauma related distress
analyse how a traumatic past can impact on an individual’s ability to engage with treatment.
explain obstacles to engagement such as denial or lack of motivation in terms of response trauma.
summarise key literature on neuro-processing obstacles that impact on engagement in treatment
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Better understand how trauma can impact on ability to remain within treatment
list the limitations of purely cognitive focussed interventions
analyse aspects of own practice that may be triggering to a service user that has experienced trauma.
CJS 13 Trauma and Offending To understand the link between trauma and offending To gain an understanding of the prevalence of trauma amongst the prison population To gain an understanding of recent research in to trauma informed treatment of offenders (Identify that trauma within the forensic field is common and that workers will come into contact with people who have been traumatised.)
Understand the link between offending and trauma
identify the frequency of trauma in different
offending populations
identify how trauma manifests in male,
female and young offenders
explain the links between trauma and sexual
or violent behaviours
explain how assessing/acknowledging
trauma contributes to the efficacy of risk
assessment tools such as the LSC-MI
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CJS 20 Trauma Informed Practice To work with service users from a trauma informed framework Better understand the importance of relationships To integrate the learning and concepts into every day practices and incorporate into established risk assessments and formulation To provide an opportunity to enhance practical skills in working with people who have been traumatised. (People affected by trauma experience a consistent and professional relationship that engenders trust)
justify the importance of trust, consistency, and predictability
identify own personal triggers and possible
reactions to traumatized individuals, especially
those who have committed very serious
offences
CJS 21 Trauma Informed Practice Better understand the strategies available to help traumatised people cope more functionally in life To work with service users from a trauma informed framework
List why it is important to work with people to help them stay grounded in the present
Explain how traumatised people are fragmented and need acknowledgment of this
Explain the importance of emotional regulation skills
Explain the critical nature of relationships
summarise emotional regulation and distress
tolerance skills
practise using grounding techniques to help someone stay present
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To integrate the learning and concepts into every day practices and incorporate into established risk assessments and formulation
CJS Trauma Informed Practice To work with service users from a trauma informed framework; To provide an opportunity to enhance practical skills in working with people who have been traumatised. To better understand the importance of relationships
Explain the importance of relationships with people who have been traumatised, including the effects on the nervous system.
Justify the importance of trust, consistency, and predictability
Identify own triggers and possible reactions to traumatized individuals, especially those who have committed very serious offences.
CJS
Trauma Informed Practice Develop a capacity for trauma-informed and self-reflection
for workers to prioritise good self‑care, understand vicarious traumatisation and
make use of support/supervision in the workplace.
to identify ways of developing/maintaining self-care
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To gain and understanding of the neurobiological effects of trauma (including vicarious trauma) (Workers are well supported when responding to trauma.)
For managers to:
to understand the concept of vicarious traumatisation
include awareness of the potential impact of exposure to traumatic incidents in the organisation's Health and Safety protocols. provide access for workers to formal and informal support/supervision in the workplace.
Trauma Informed Practice To integrate the learning and concepts into every day practices and incorporate into established risk assessments and formulation To develop steps to be more trauma-informed in practice and policies
All workers understand:
that trauma and abuse are common in society and that it is highly likely that staff working in services involving contact with the public will meet individuals affected by trauma during their work.
the different forms of trauma, abuse and neglect.
that there are a range of responses to traumatic events, from no effect/resilience through to a significant life‑changing impact across a range of areas of health and well‑being. That people affected by past complex trauma commonly have difficulty managing feelings and find it difficult to trust others.
All workers can: relate to people they come into contact
with using trauma‑informed principles regardless of whether a history of trauma is known or identified.
All managers can: translate an understanding of the
prevalence of trauma into trauma‑informed service systems and procedures and ensure effective support for staff.
Work within their respective community justice partnerships to create cohesive pathways to services aimed at helping
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those in the tertiary stage like criminal justice. To take a preventative approach to minimise the cycle of intergenerational trauma.
3) Organisational trauma informed practice, risk management, trauma informed management and leadership. Trauma informed/psychologically informed environments. All courses should include theory and a practical element to them
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Appendix 3:
Additional remarks from participants
Participants were invited to provide further feedback on the content of the 2 day training.
“Not only was it valuable learning it helped develop skills in responding to trauma with adult group, Excellent training!” “Excellent training – much needed in CJSW – really helped me gain knowledge and practical skills.” “Excellent training which needs to be delivered across agencies and judiciary/systems:” “This was excellent training – wish it could have lasted longer.” “Really brilliant training, not often that training offers theory in conjunction with practical skills which are realistic. I’m leaving feeling very motivated to integrate what I have learned in to practice. It definitely helped with some personal understanding too:” “Training has highlighted very useful techniques and strategies an on how to work with some of our most vulnerable clients. Practice will now be focused on trauma and what interventions will be useful in terms of looking at risks/needs and responsivity issues.” “An excellent 2 days, very well presented which made me more aware of my practice and what I want to change about myself, to help the men I work with. Thank you so much for this great opportunity to change ”
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“The training evidences the huge need for TIP training across all levels of social work and the need to change our practice. This may actually give our clients the chance to progress” “I would like to see a rolling programme of TIP events and training. It allows me to be the compassionate and skilled worker that I always aspired to be, thank you it has been a great training.”
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Appendix 4
Survey Monkey Results:
1) Participants were asked to measure their understanding of Adverse Childhood Experiences prior to and post attending the course: We also
ask participants to name 3 ACE’s:
Pre course level of understanding.
Excellent 9.7%
Good 29.4%
Satisfactory 35.2%
Poor 28.3%
Post course level of understanding
Excellent 19.44%
Good 75%
Satisfactory 5.5%
Poor 0%
1 a) Participants were able to name 3 ACE’s pre course and post course – although there was more variety of answers post course.
2) We asked participants to rate their understanding of different kinds of trauma prior to and post training. We asked them to provide evidence
of their understanding of complex trauma.
Pre course level of understanding of trauma
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Excellent 0%
Good 40%
Satisfactory 60%
Poor 0%
Post course level of understanding of trauma
Excellent 9.7%
Good 59.9%
Satisfactory 21.4%
Poor 0%
3) Pre course participants were asked to describe complex trauma, this was partially answered correctly pre course and post course answers
were fuller and more detailed.
4) Most participants were partially able to describe the impact trauma has on the brain pre course. Post course answers were again fuller and
more detailed.
5) Prior to training most participants were able to name health impacts of having an ACE score of 3 or more, however these were mostly mental
health impacts. Post course there was a wider variety of answers taking in to account the physical health impacts of ACE’s
6) All participants were able to name some protective factors, prior to and post training
5) Participants were asked to rate their understanding of the impact trauma can have on behaviour and their understanding of why this behaviour
is hard to change
Pre course level of understanding
Excellent 26.6%
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Good 73.3%
Satisfactory 0%
Poor 0%
Most participants (60%) were able to give examples of behaviours associated with trauma and difficulties changing this behaviour.
Post course level of understanding
Excellent 15.5%
Good 74.4
%
Satisfactory 10%
Poor 0
All participants were able to give examples of behaviours associated with trauma and difficulties changing this.
6) Pre course all participants were able to explain what dissociation is, post course answers were fuller.
7) Participants were asked to rate their understanding of links between trauma and offending behaviour
Pre course level of understanding
Excellent 0%
Good 46.6%
Satisfactory 43.3%
Poor 0%
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Post course level of understanding
Excellent 8.3%
Good 77.7%
Satisfactory 13.8%
Poor 0%
8) We question whether participants agree with the statement that there is a high prevalence of trauma amongst the prison population
Pre training 73.3% strongly agreed with this statement and 16.6% agreed; and
Post training 25% strongly agreed, 41.66% agreed and 5.55% strongly disagreed with this statement
9) Rate understanding of TIP prior to the 2 day training and post the course
Pre course level of understanding of Trauma Informed Practice
Excellent 5.5%
Good 0%
Satisfactory 55.5%
Poor 38.8%
Post course level of understanding of Trauma Informed Practice
Excellent 5.5%
Good 78.8%
Satisfactory 15.5%
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Poor 0%
10) Participants were asked to rate their confidence in working using a Trauma Informed framework organisationally and at an individual level
Pre course
Strongly agree 0%
Agree 20%
Neutral 46.6%
Disagree 33.3%
Strongly disagree 0%
Post course
Strongly agree 19%
Agree 55%
Neutral 16.6%
Disagree 8%
Strongly disagree
11) Participants were asked to rate their understanding of vicarious trauma
Pre course understanding of vicarious trauma
Strongly agree 10%
Agree 40%
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Neutral 16.6%
Disagree 33.3%
Strongly disagree 0%
Post course understanding of vicarious trauma
Strongly agree 16.65%
Agree 77.78%
Neutral 5.5%
Disagree 0 %
Strongly disagree 0%
Nearly 90% of participants knew where to seek help and support if required.
We asked participants to commit to applying the learning to their workplace. Some examples given were;
“ Build in to the assessment process” “it is a re-focus for me, I will use this in interviews with the individuals who are new to custody” “I will be more understanding of client’s background and how this is impacting on them at the present time” “ Use of the ACE questionnaire” “ I will use this learning to inform parole and LS-CMI assessments” “highlight for onward referrals in the community”
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“carry out ACE questionnaires to understand service users experiences “link in to services and better understanding of people’s difficulties” “Supporting clients to better understand their individual experiences of trauma and the impact this has had on them as adults” “Be more aware of client triggers” “I will use some of the materials from the training (emotional regulation zones) in 1:1 work with clients” “Using the therapeutic relationship and mindfulness techniques in practice” Ensure the room is a safe place with enough space for them to leave the room if they need to” Will discuss at team meeting and keep it on the agenda”
Just over one third of participants had previously attended any training or events relating to TIP