Bringing Trauma Informed Care Training to our Teams
This case study was created by Kirstie Wright, Ani Zavody, Lorraine Gordon, Andrew Ware and lived experience worker Aurora Todisco.
A group of clinicians and a lived experience consultant within the Trust have been working collaboratively to increase our knowledge of Trauma Informed Care (TIC).
This partnership brings together professional expertise and the invaluable insights of those with lived experience, ensuring that trauma-informed practices are not only clinically sound but also deeply empathetic.
By integrating these perspectives, the initiative aims to create a more compassionate and effective approach to care, where understanding the root causes of behaviour leads to more supportive interventions, reducing the need for restraint and helping promote recovery.
Context behind this change
The initial aim of the trauma informed steering group was to reduce restrictive practice and restraint on the wards. As a Trust, we have achieved an 88% reduction in the use of prone restraints since 2020 with year-on-year decreases, but we still have a way to go.
Through this change in approach, we aim to help clinicians understand that aggressive responses may be a response to current and past trauma and how restraint can contribute to re-traumatisation. This includes helping clinicians to:
- Consider how past experiences of a service user could be leading to aggression
- Understand how aggression can be a response to trauma
- Identify what triggers for the trauma response might be
- Think about how we can support the individual without using restraint.
We also aim to increase knowledge of Trauma Informed Care in Community Mental Health Teams.
Delivering training to a variety of teams
We have developed two trainings on trauma informed care that have been carried out on the wards and in the Community.
The trainings consider how many of the people that use our services have experienced trauma and how experiencing trauma can lead people to be hypervigilant for threats, leaving them to view the world through a lens of danger.
The training focuses on helping staff understand people’s behaviour through the lens that patients in distress have been through trauma. This may be contributing to a trauma response that could include a variety of responses eg becoming non-responsive; hearing voices; and/or aggressive behaviour. The training also asks staff to think about the way services could be triggering for service users and helps participants reflect on current practice to mitigate these kinds of experiences.
So far, the training has been offered to various teams including Community Mental Health Teams (CMHTs), inpatient wards and Home Treatment Teams, and more. The active discussion of participants during these training sessions about their own services helps us to tailor Trauma Informed Care training to specific settings. The number of sessions and content is adapted to the particular challenges teams may face regarding implementation of TIC.
When developing training, the following needs to be thought of: agreeing a time between multiple facilitators & teams, ensuring all teams members have protected time to attend and stay for the duration and that feedback is collected on the training. Things that might help with this are If P&P staff already have relationship with a team they can offer training to P&P staff in that team only to create a train the trainer model, offering it in person only.
The impact on staff and service users so far
Measures of staff satisfaction on the training and whether people feel more confident following the training, have been implemented but as a majority of measurement is around culture change, it can be difficult to quantify.
Nevertheless there are some new validated and reliable measures that we will be using such as the ARTIC (Attitudes Relating to Trauma Informed Care) Using the ARTIC showed a noteworthy increase in better staff attitudes to trauma informed care following the training.
Verbal feedback from teams who have received the training has demonstrated that people were appreciative of the training. A particular theme that came up was that it was good to have a space to think about a service user’s history of trauma, the impact it has on them and others and interventions that can soothe both service user and staff’s trauma responses.
Other feedback expressed the benefit of space to think about all the different types of trauma (e.g. generational, systemic, organisational) and enhance awareness of the way that microaggressions can cause/trigger a traumatic experience.
It is hard to measure the impact this training has had on restraint use on the ward as changes in staff perception, and wider culture change, take time and use of restraint is also influenced by other factors.
Co-Production
Co-production is central to our efforts in advancing trauma-informed care at South London and Maudsley NHS Foundation Trust. Through collaborative partnerships between clinicians, administrators, and individuals with lived experience, we have forged a transformative path towards more compassionate and effective mental health services.
Our co-production work stemmed from a recognition of the invaluable insights that patients and the public bring to the table and our commitment to inclusivity and collaboration. Their lived experiences not only enrich our understanding of trauma but also guide us in tailoring our services to meet the diverse needs of our community. Feedback from individuals involved in our co-production efforts echoes the sentiment that their contributions are valued and meaningful.
One participant said: "Being part of the co-production process has empowered me to have a voice in shaping the services that directly impact my mental health journey. It's incredibly validating to know that my experiences are being listened to and acted upon."
Another shared: "Through co-production, I've felt a sense of belonging and agency that I haven't experienced elsewhere in the healthcare system. It's reassuring to know that my perspective is valued and respected."
By amplifying the voices of those with lived experience, we not only improve the effectiveness of our care but also cultivate a sense of dignity and hope for individuals and communities affected by trauma.
What’s next?
We have found that there is a need for Trauma Informed training and the training that has been given has been well received, with requests for more training received from all teams where the training has been provided, and positive results on the ARTIC questionnaire. This demonstrates there is a need for training in Trauma Informed Care. The training aligns with existing initiatives such as the Patient Carer Race Equality Framework (PCREF).
Due to Trauma Informed Care being a collective approach, we have found that it is important and vital to link up with other clinicians doing related work across the Trust. This joint working with other clinicians will ensure that the culture moves to one of Trauma Informed Care. Recent initiatives include a two-year project focused on embedding trauma-informed care on adult inpatient wards across the Trust.
The training has proved very popular, and we are now working toward supporting teams to deliver the training independently and offering support to team-member facilitators who can offer the training as needed and champion trauma informed care. This change in direction would also ensure the trainings are available for new starters, which would mean the training is available even if there is high staff turnover. This will support with further embedding trauma-informed care in teams.
There is more work to be done but we’re pleased to see the impact it is already having on making our Trust a more trauma informed place so we can care for those in need with kindness and respect. Please contact Kirstie.wright@slam.nhs.uk for further information on this project.
