In 2021, Fife Trauma Training Collaborative developed a set of Quality Standards (Transforming Psychological Trauma; Quality Standards for Fife) to encourage and support teams, services and wider organisations, with implementation, improvement planning and progress measurement for their work to embed trauma-informed and responsive practice. Whilst these Quality Standards were developed prior to the publication of the Roadmap for Creating Trauma-Informed and Responsive Change, they reflect many of the key messages and drivers outlined in the Roadmap to support organisations, systems and workforces in embedding a trauma-informed and responsive approach.
The Women’s Justice Team (WJT), a multi-agency group, volunteered to pilot the accompanying Quality Improvement Tool to support with identifying strengths and areas for development in trauma-informed and responsive practice.
The challenge
Trauma experiences are widespread across populations, but disproportionately affects individuals in the criminal justice system. For women in particular, the majority have experienced some form of trauma. Recognising this, the WJT sought to better understand and improve their work to embed a trauma-informed approach to ensure service provision for women accessing the service was responsive, supportive, and effective.
Outline of project
The Quality Improvement Tool was developed by the local trauma steering group and offered to teams for piloting. The WJT was a natural fit due to its multi-agency partnership approach which included professionals from justice, health, social work, and third-sector organisations.
A diverse working group, representing a range of different service areas and job roles, was established and met monthly to work through the tool’s quality standards. These were not tackled in a fixed order but based on relevance and team capacity. Early sessions focused on more tangible, operational standards (e.g., communication, accessibility), while more complex areas (e.g., policy, finance) were addressed later.
The team highlighted that whilst the tool initially felt overwhelming due to its breadth, breaking it down into manageable sections enabled them to build confidence and maintain momentum. To this end, the process was iterative and adopted a collaborative approach informed by the knowledge and expertise of all multi-agency partners on the group.
Results
There were a number of early outcomes as a result of the project. These included:
Communications improvements
Communication gaps were identified as part of the project, and this led to the creation of a digital skills post in June 2024 to improve accessibility of information for women engaging with justice services. The post holder has been involved in various media projects with the Women’s Justice Team, including filming at Fife Connect groups, capturing moments from the cooking module, and from UPW projects. The digital skills role also supports the wider service in creating a range of videos aimed at reducing anxiety and setting clear expectations for service users. The role is also working alongside a neurodiversity and accessibility initiative that is currently in development.
Digital communications were developed to reduce anxiety for women by clearly explaining processes such as unpaid work and court appearances, and walk-throughs of physical spaces. This benefited the women’s team, the wider service, as well as women accessing the service who highlighted that these communications helped to alleviate their concerns as they had a better understanding of the processes that they were engaging with from the start. In addition, all written correspondence from NHS professionals within the team was reviewed and updated to ensure trauma-informed language was used.
Embedding the voices of those with lived experience
Following the audit, a strategy was developed which focused on embedding lived experience voices into service design and delivery.
There are several improvement initiatives currently underway across the Service aimed at enhancing opportunities for individuals who have used or
are using services to contribute meaningfully to their design and delivery. This includes the introduction of a new automated feedback process, ensuring that everyone who engages with services has the opportunity to share their experience. Additionally, the team are collaborating with the Quality Assurance (QA) team, who are conducting thematic feedback work with various teams.
Cultural shifts
This exercise supported trauma-informed language and principles becoming embedded in team conversations, referral processes and communications (such as letters to those accessing services).
Staff reported a shift in perception; from other services viewing the women’s service as “soft touch” to recognising the value of trauma-informed and responsive approaches.
Recruitment practices focused on prioritising values and trauma-informed and responsive understanding over experience alone.
Focus on engagements with women accessing the service changed from “what is wrong with you/ what have you done” to reframing in as “what has happened to you” and taking a trauma-informed and responsive approach to engagements and understanding of offending. This has also been reflected in conversations across the team and in the referrals received by health services.
Staff care, support and wellbeing
The team developed informal support mechanisms and re-considered how workload and cases were distributed in recognition of the emotional and mental demands of the work. This supported embedding a trauma-informed and responsive culture across the service by acknowledging staff care, support and wellbeing as a priority.
Action planning
A detailed action plan was created, outlining the short and long-term goals, those responsible for taking forward actions, and relevant associated timescales.
Trauma-informed and responsive practice became a standing agenda item in team meetings, ensuring a continued, ongoing focus and accountability and maintaining momentum throughout the project.
Learning
There were a range of key learning points which emerged from the project, including:
- Coordination support: Having a dedicated person coordinating this work helped to manage the process, identify actions, ensure consistency of messaging and maintain momentum throughout the process.
- Start small: Beginning with the more manageable and tangible quality standards made the Quality Improvement tool feel less overwhelming, helped build team confidence and enabled the group to take forward learning as they explored more complex standards further on in the project.
- Multi-agency collaboration: The diversity of the team ensured a holistic approach and shared ownership kept the project grounded and contained. Whilst considering policies, procedures and processes from across different multi-agency teams added a level of complexity, it was very important to have the collaborative approach and expansive knowledge base to help inform the development of the project.
In addition, having the work and relevant learning shared beyond the working group helped to influence the wider service. This was enabled by having a multi-agency partnership approach and promoting the work on a wider service level. - Leadership buy-in: Support from leadership enabled responsive resource allocation and reinforced the value of a trauma-informed and responsive approach within the service.
- Lived experience involvement: Plans were developed to conduct focus groups with women to explore their experiences of service contact, communication, support, and endings. Lived experience involvement was highlighted as a key action within the action plan and it is anticipated that this will support in identifying potential gaps, highlight areas of good practice and inform future improvements. In turn, focus groups have been developed and the results and learning from these will help inform a review of service provision in the Women’s Justice Team. Furthermore, the information collated from the focus groups, particularly in relation to environments, will be applicable to the wider justice service and organisation as a whole. Focus groups participants were compensated for their time to recognise the value of their insight and contributions, and the learning from the focus groups will provide a springboard for further ideas and creative approaches for lived experience involvement.
- Shared learning: It is anticipated that the learning from the approach could be taken and applied to other services, such as unpaid work in the men’s service, and making cultural and contextual adjustments as needed to meet the needs of those accessing the wider justice service.
- Opportunities for reflection: While the specific tool was helpful, the value lay in the team having structured opportunities for reflection and action-planning to support with further development and identifying areas for improvement.
Evaluation approaches and learning
Evaluation and progress monitoring and quality assurance were built into the process as part of the quality assurance tool. Using a structured tool to take stock of progress has enabled the service to reflect on the journey to date, celebrate good practice and inform actions for ongoing development to continue this journey.
Measuring impact of a trauma-informed approach can be challenging. It often involves lots of small changes, which makes it hard to quantify the impact of trauma-informed culture change. The learning and messages from the WJT around this include:
- Having a structured tool (regardless of which one!) and approach, with multi-agency buy in and engagement and having a named person coordinating this work, are key enablers for taking a structured approach to evaluation. Leadership and engagement with the process are more important than the specific tool itself.
- Importance of both qualitative and quantitative data: The importance of having qualitative data, such as identifying and sharing stories from people with lived experience of trauma, as well as statistical data as part of the evaluation plan was highlighted as a key enabler for this work. Qualitative data, for example completion rates, can help tell a story, and can be a powerful tool for getting leadership buy-in, however qualitative feedback and lived experience engagement are key to understanding the real impact behind the numbers.
- Importance of embedding feedback loops and lived experience engagement: involving people accessing the service to understand their experience of engaging with the service and how they ‘move through the service’ can support with telling the story of change and illustrating the impact of ‘small’ changes.
- Having a baseline for comparison against is not always possible, especially where development has been ongoing for a long time through an iterative process. Being creative with how we can still capture impact of changes that have taken place, to tell the story of where we started from and where we have got to is important. This might involve thinking about how we can use existing data sources and documentation, even if created for different purposes, to show how changes have taken place over time.
- Adaptability: adapting the approach and expectations to the service context helps to keep this manageable.
Sarah Woodburn, Service Manager – Quality Improvement
sarah.woodburn@fife.gov.uk
Seonaid Peddie, NHS Fife
seonaid.peddie@nhs.scot
Kate Campbell, NHS Fife
kate.campbell2@nhs.scot