Archway Glasgow is a specialist service in Glasgow made up of a team of experts experienced in caring for people who have been raped or sexually assaulted within the last seven days.
In addition to the single-event trauma experienced as the result of a recent rape or sexual assault, the service frequently works with people who also have previous experience of trauma and adverse childhood experiences (ACEs). People accessing the service often have multiple and complex needs, in addition to their recent trauma, which require extremely sensitive and nuanced support.
The challenge
For some time, the service has been considering how to gather feedback from people accessing the service and learn more about their experience of the care and support they receive at Archway Glasgow.
In particular, the team wanted to develop snapshots of how it feels to move through the service so they can ensure that people are receiving care and support which is comprehensively trauma-informed. This is necessary due to the highly sensitive nature of the work of the service and the complex needs and trauma experiences of people they are supporting.
Outline of project
In July 2020, a feedback procedure was implemented at Archway Glasgow. A simple paper questionnaire was introduced, containing a mix of scored and narrative questions. These were developed around the five key trauma-informed principles: safety; choice; collaboration; trust; and empowerment. This was devised in consultation with trauma specialists from the National Trauma Training Programme team at NHS Education for Scotland, Glasgow Caledonian University, and Archway Glasgow staff.
The team recognised that it was incredibly important for any evaluation tool to be implemented as sensitively as possible given the levels of distress and vulnerability that people may be experiencing when accessing the service. Initially, the questionnaire was left in consultation rooms for people to fill out at their discretion, in order to not overwhelm or appear to be service- rather than person-centred. However, after a trial period, it was agreed that the staff member providing treatment and support would provide the questionnaire and proactively discuss it with the person they are supporting and offer the choice to provide feedback. If a person wishes to complete the form, they are given the option of filling it out at the time, or taking it away and sending it back. It is made clear that there is no pressure to complete the questionnaire and that it is kept entirely anonymous.
People accessing the Archway Glasgow service for medical examination are offered various options for follow-up support. These support sessions offer further opportunity to obtain feedback from those who didn’t provide feedback immediately after their first attendance at the service.
After six months of the evaluation procedure being in place, the process was reviewed by service leads and specialists who had helped develop the feedback questions. At this point it was agreed that there was a need to include a more open-ended question about the general experience of the service and this was subsequently introduced.
The information collected from the evaluation questionnaires is collated centrally within the service and routinely reviewed by the service manager. Evaluation feedback and data is regularly disseminated to staff via the staff newsletter and annual service reports. Staff also have open access to the feedback data via the centralised system, reinforcing a culture of honesty and transparency.
Feedback data is included in quarterly reports to the Scottish Government and in annual service report across all NHS Boards in the west of Scotland area.
Results
There were some staff anxieties about offering the feedback opportunity at the same visit as the forensic examination. However, uptake by patients was positive and there was a 40% response rate within the first nine months, and a 44% response rate in 2021/22.
The feedback received to date via the evaluation procedure has been predominantly positive which provides evidence to support the continuation of current modes of trauma-informed practice within the service.
Some of the most common words used to describe the experience of the service within the first nine months of the evaluation procedure being in place were “comfortable”, “reassurance”, “kind” and “friendly”. In response to questions around what assisted in creating feelings of safety whilst accessing the service, responses included:
Everything was explained, they were kind and took breaks when I needed to.
Patient, informative, non-judgemental.
Friendly staff, a safe environment, peaceful environment, staff being caring.
Everything was explained to me and I could stop or say no at any time.
Any issues raised in feedback are immediately flagged by the service manager and action is taken to remedy any issues which can feasibly and appropriately be tackled. Some examples of changes which have been implemented as a result of the evaluation feedback are the reintroduction of in-person meetings with nurses prior to medical examination; issues resolved which were associated with a faulty door and noise which was felt as intrusive; and changes to video consultation procedures. As feedback is given anonymously, it is not possible to report back directly to people accessing the service regarding any changes which are made as result of their input. Staff are informed of any changes made to the service via email and clinical room whiteboard communication and also during staff morning meetings.
Learning
There were some initial anxieties amongst staff about seeking feedback from service users during their first visit to the service. Acknowledging staff reservations and ensuring that staff were provided with the reasoning and understanding behind taking this approach helped to build support for implementing the feedback loop.
Incorporating feedback responses into regular staff communications and quarterly reports has also been key to building staff understanding and easing any anxieties. As the majority of feedback gathered through the process has been positive, this has had an uplifting and motivating effect on staff, who see that their efforts in supporting patients at a difficult time has been appreciated.
Dedicated meeting time to discuss the implementation of the feedback process and to fully discuss any future changes has also been key. This helps ensure a considered approach to obtaining feedback and maximising the opportunity to obtain more constructive feedback that might inform future developments.
Resources
The NTTP Knowledge and Skills Framework was helpful in informing the development of the feedback process. The NTTP training resources have also been key to enhancing staff understanding and skills to effectively implement the feedback loop with service users. In particular, the Opening Doors and Sowing Seeds animations and the Trauma Informed Sexual Offences Examination for Forensic Medical Examiners video resource were core to this learning.
Debbie Ambridge – Service Manager
Debbie.Ambridge@ggc.scot.nhs.uk
Deb Wardle – Consultant Clinical Lead
Deborah.Wardle@ggc.scot.nhs.uk