The Ayrshire Learning Disabilities Service aimed to develop trauma-informed practices within their services. Funding was provided to develop and deliver trauma training specifically relating to the learning disability population. This case study focusses on how funding was used to develop this.
The challenge
There has been growing recognition that people with learning disabilities are at an increased risk of experiencing trauma. Evidence also shows that there are additional challenges around people with learning disabilities being able to disclose traumatic experiences, and that staff need support in recognising trauma and knowing how best to respond to this.
Outline of activity
Ayrshire and Arran Learning Disability Services received six months of a one-day-a-week post funding from NHS Education Scotland (NES) to focus on developing and delivering training around trauma for staff supporting people with learning disabilities. A further 12-months of one-day-a-week funding for the post was then secured from Ayrshire and Arran Health and Social Care Partnerships’ Mental Health Innovation Fund in order to continue this work. This funding was available until March 2022.
Scoping was carried out to look at what resources were already available, such as the National Trauma Training Programme (NTTP), which provides training resources for various levels of knowledge and skills (trauma-informed, trauma skilled, trauma enhanced and trauma specialist practice levels).
Trauma Skilled Training
The post holder created a tailored ‘trauma skilled’ training package for staff working in Community Learning Disability Teams, drawing on resources that the other Transforming Psychological Training Implementation Coordinators (TPTICs) had already started to develop.
A three and a half hour training package was delivered online to over 110 members of staff within Community Learning Disability Teams across North, East and South Ayrshire. Attendees included nurses, psychologists, psychiatrists, occupational therapists, speech and language specialists, social workers and dietitians. This training package was also initially delivered to two care providers within Ayrshire and Arran.
Trauma Enhanced Training
A smaller number of staff who attended the trauma skilled training were then identified to attend the NES ‘trauma enhanced’ training – Safety and Stabilisation. This three-day training package provides clinicians with the knowledge and skills needed to work within Phase 1 of a phase-based intervention model for the treatment of complex traumatic stress disorders. This training was modified for delivery for staff working within learning disability services.
Trauma Informed Training
A further ‘trauma-informed’ training package was also developed for administrative staff working within learning disability services. It was recognised that this staff group are typically the first point of service contact for people with histories of trauma, and who may be highly distressed. It was noted that administrative staff are vital members of the multi-disciplinary service and ensuring that appropriate training and support is available to this staff group is essential.
Results
The funding for this work was only for a short time but despite this, a lot was achieved, and additional funding was then secured to continue the work.
As the objectives remained consistent throughout the project, there was a continued approach using the NTTP Knowledge & Skills Framework in order to develop training materials and direct these toward the appropriate staff group(s).
Staff working with adults with learning disabilities in Ayrshire and Arran have been exceptionally motivated and willing to engage and results would suggest that their understanding of trauma and confidence in knowing how to respond has increased.
100% of respondents who attended the trauma skilled and trauma informed training packages noted that they would recommend the training to a colleague. All participants who attended the training rated it as either “quite a lot” or “a great deal” useful.
Over 80% of staff attending the trauma skilled and trauma informed training reported that the training had increased their knowledge “quite a lot” or a “great deal”.
Similarity positive feedback from the Safety and Stabilisation training was received, with staff reporting an increase in their knowledge and skills in supporting individuals with a learning disability who have experienced trauma.
Not only was the training well received, but the fact it was adapted for those working with people with learning disabilities was felt to be important and valuable for staff.
Learning
An ‘expert by experience’ supported the development of the training package. This person developed a presentation that was embedded into the training, where she talked about her daughter's experience of trauma and her experiences within education, particularly highlighting her daughter’s experiences, the impact on her behaviour and her mental health.
This was considered a particularly powerful aspect of the training where attendees fed back that:
Hattie’s story provided an excellent example of why trauma principles are so important and understanding how they should be applied.
I liked having the opportunity to hear the lived experience of the mum alongside how the theory behind how we can work better to understand people who have lived experience of trauma. Real life examples always help to make things more relatable. This then made me think more of the people on my own caseload/known to our team and the trauma many of them will have experienced.
The training was three and a half hours, and it was delivered online. In terms of getting a wider reach, online delivery of the trauma skilled level package was crucial. The feedback on the flexibility of delivery style was also positive:
“My first time being involved in online learning, and I felt comfortable with the delivery and in some respects better than being in a room with people talking over or interrupting.”
“The mix between facilitators presenting, the use of videos to consolidate content and learning, and group discussion was really helpful and broke up what could otherwise have felt like a long time on Microsoft Teams. As a result, it did not seem long at all.”
Challenges
Getting staff released for the training was challenging at times. This is a common theme across all services and can be a particular difficulty for staff working in in-patient settings due to the nature of working on wards. This is due to issues in maintaining staffing levels, particularly at times of ward pressures, and accessing technology can be difficult with often more restricted access to laptops.
Resources
Dr Vanessa Watt, Principal Clinical Psychologist
Vanessa.Watt@aapct.scot.nhs.uk
Dr Ken MacMahon
Kenneth.MacMahon@aapct.scot.nhs.uk