Agenda item

To update the Board on the Mental Wellbeing theme of the Health and Wellbeing Strategy priorities.

Contact:  Rebecca Elliott, Public Health Manager

Rebecca Elliott, Public Health Manager, along with colleagues from a range of organisations, and services, advised the Board, that the update would be on the Mental Wellbeing priority of the Health and Wellbeing Strategy. The particular focus will be on the trauma informed approaches being taken across the Kirklees system. There are a number of speakers from across the Kirklees place who will contribute to the discussion, sharing some examples of the trauma informed approaches that are already happening.

The Board was informed that trauma is a public health issue, and research suggests that people who experience adverse childhood experiences are more likely to use alcohol, smoke, develop chronic diseases, and trauma can happen at anytime during the life course. Therefore, it is important to think about trauma informed approaches across the full life course. People are also more likely to develop mental health conditions and it is important to think about how trauma informed organisations are,  and how trauma responsive they are. Not only in respect of the local population, but also for the people employed.

The Board was directed to a slide which outlined a pledge that the Director of Public Health, Rachel Spencer-Henshall, agreed to last year.

‘Kirklees is committed to reducing health inequalities across the life course and tackling the risk factors that contribute towards adversity and trauma. Now more than ever, we are focused on working at place level and working with communities to really understand how we can build upon local assets and enhance protective factors for resilience. I pledge to support the ambition for West Yorkshire to be trauma informed and responsive by 2030, by sharing best practice and working in an integrated way to support those facing multiple disadvantages in the best way possible’.

Emm Irving, Head of Population Health from West Yorkshire Integrated Care Board (ICB), gave an overview of the West Yorkshire programme that supports the programmes already being undertaken in place. The Board was informed that currently in the world there is a great deal going on that is causing trauma and adversity for the population, therefore, instead of talking about what  could be done, it is important to talk about what happens if nothing is done. There is likely to be an increase in the number of children born into poverty, an increase in children and adults in the criminal justice system, an increase in violence, health harming behaviours and disease, therefore it is important to act.

The programme across West Yorkshire, looks at how to work together as a system, all organisations, the entire workforce and the population to be trauma informed. It is an iterative journey, and it does not end and therefore, the aim is to get to a position where organisations and people are trauma informed, responding and constantly learning. The West Yorkshire programme is around supporting capacity, capability and intelligence across the system including place, providing resources, training and expertise around the subject area, also working with the large West Yorkshire organisations such as, West Yorkshire Police, the Acute Trusts and the ICB. There is then support down to place where this can be enacted in Kirklees to become a trauma informed, responsive place.

There are programmes in every place, all at different stages, and a maturity matrix shows where organisations all are in the journey and how to start working together. More importantly how to change the narrative from West Yorkshire driving it, to place driving it and West Yorkshire being there as a support mechanism.

Alastair Christie, Joanne Watkinson and Tom Bevan, Calderdale and Huddersfield Foundation Trust, provided an update on the BLOSM Service. The Board was informed that the service has been funded by both the West Yorkshire Health & Care Partnership and the West Yorkshire Violence Reduction Partnership to introduce the principles of Trauma Informed Practice into our Emergency Departments at Calderdale and Huddersfield NHS Foundation Trust (CHFT).

The service has introduced Youth Navigators into the emergency departments to proactively engage with young people who may be at risk of exploitation, criminal activity or involved in serious violence. It is based on Navigator Services, which are run across the country, however, the focus at CHFT is young people who have a history of trauma, ensuring that identification and support, is given to those young people appropriately and make those onward referrals into community services.

Another priority has been how to integrate the principles of trauma informed practice to the clinical staff. For the last two years a module has been delivered on trauma informed practice to all Emergency Departments (ED), nursing staff, and from next month that will be delivered to clinicians across ED also. There has already been a difference in the culture within the departments and how staff are recognising people who have had previous trauma.

The current challenges – (Resources, Budget, Timescales)

-      Securing longer term funding past our current funding model which ends in March 2025

-      Current financial challenges within the Trust and across local authorities impacting on the day to day running of the service

-      The impact year on year funding has had on retention of staff who have received the training and the need to recruit and retrain new starters

Katerina Westwood, Senior Advanced Nurse Practitioner, Southwest Yorkshire Foundation Trust (SWYFT), informed the Board that a change management approach is used in SWYFT to become a trauma informed organisation, which was endorsed by the Executive Management Team, in September 2022. This has involved working with Experts by Experience, moving into year 3 of the programme where SWYFT continues the journey to become a trauma informed organisation, which underpins all the work undertaken. The core principles of trauma informed have been adopted within the strategic objectives in priority programmes as well as across the Trust.

Phase 3 of the programme will focus on supporting sustainable changes to behaviours and practice, by continuing the operationalisation of the evaluated framework and ensuring the ‘golden thread’ is woven throughout everything. There will be a wider emphasis on staff support and wellbeing.

Successes include :

-      the co-designed trauma informed awareness training which was signed off in January 2023 for delivery

-       delivered the Train the Trainer session for staff and Experts by Experience to co-deliver training, trauma informed awareness, May 2024,

-      successfully rolled out the Programme of Community of Practice forums scheduled, March 2024

The current challenges, is again thinking about resources and insufficient time and resource from teams and services to engage and implement any changes viewed as being necessary to support trauma informed developments, which will impact on the success of adoption and spread across the Trust. Lack of engagement from services and support to the changes from internal and external stakeholders and conflicting priorities at the Trust will impact on the success of adoption and spread across the Trust.

Louise Seddon, Youth Justice Specialist Nurse, representing Locala, with a special interest in trauma informed care, informed the Board that it is clear what the research shows regarding adverse childhood experiences and the impact that that has across the life course. This is evident on the frontline of care, there are children and families living in increasing poverty, facing increasing community tensions and increasingly facing the violence within their communities and the exploitation a lot of children and families are faced with. With that, there is a need to consider a trauma informed care approach which needs to run through the whole of the organisation, it is multi-faceted, and the vision focuses on considering the needs of both the client base and staff.

Trauma is considered through the life course, from the start of somebody’s life at conception to the very end of the life. With this approach it is considering the voice of all the clients, their lived experiences and listening with care and compassion and providing staff with the skills to provide trauma informed care. It is considering the client and patients experience from the minute they might enter a health centre. It is having visionaries within the organisation who are willing to drive trauma informed care, its about taking staff on that journey and embedding that within practice and making it non-negotiable.

Successes:

-      Becoming a Trauma Informed Organisation is in the Locala Strategy demonstrating support from the executive structure

-      Work is being undertaken towards a trauma informed culture, committed to developing compassionate leaders and well-being provision is high on the agenda and well underway, e.g. supervision provision and expectations, safe space plans, lead training programme for all managers, personalised approaches, self-management teams, coaching conversations

-      The organisation is invested in listening, co-production and delivery of services that demonstrates trauma informed care, care that is done with, rather than to people

Current Challenges:

-          Still working towards developing a full-time post for the full fruition of TIO work

-          Training provision limited due to capacity in the system of trainers

-          Organisational changes, lack of co-ordination, lack of funding for services

Mary White, Commissioning and Partnerships Manager within Children Services provided the Board with information on services that Children Services have been delivering. The Board was informed that the Educational Psychology Service received some funding through the Alex Timson Programme in 2018, to begin to develop a programme of supporting schools around behavioural problems and adopted a trauma informed approach. As a result of the funding, the service was initially able to develop a whole school programme to support schools to look at their own planning, school populations, wider community issues they might be encountering in the services that sit around them and how they can support children in a trauma informed way. That has been important in a number of schools behavioural policies, to work with children to ask, what has happened to you? What is going on in your life, rather than what’s wrong with you and why are you doing this? It helps to get to some of the roots of the issues and provides a more person-centred, supportive environment for those children and young people. That has been an important pilot funding that has facilitated deep learning to grow that programme across schools in Kirklees, keeping in mind the mental health support model. One of the challenges around that, is sustaining that because of the funding.

Jane Healey, People Services Manager, Employee Healthcare, shared some successes with the Board, advising that a neuro-diversity pathway has been developed, because as an inclusive employer, staff are encouraged to be themselves and to perform to the best of their abilities. Work has been undertaken supporting people with a neurodiverse condition, which has been recognised by the Society of Occupational Medicine. The stress referral pathway, is positive, moving away from the traditional occupational health management referral into the unit, concentrating on having wellbeing conversations and helping people to take care of themselves. The Restorative Team, joined employee healthcare late 2023, and now have listening circles where there are peer-to-peer conversations which helps each other move forward.

Mary White, further informed the Panel that another programme operating in Children’s Services, is a programme called New Beginnings which is an assessment programme, with expectant parents, where there are concerns regarding their children. Previously, there had been a needs based assessment programme and now there is a formulation approach, which is doing a very holistic needs assessment with the parents to be. This is with the support services around them, the wider family and neighbourhoods which is a trauma informed approach, looking at what their needs are, what their support needs will be in the future, to try as far as possible to keep their child safe and the family together and think about what the most appropriate support structures are.

Rebecca Elliott informed the Board that currently things are at the planning and preparation stage of the Council moving towards embarking on the journey to become a trauma informed organisation. The Maturity Matrix is essentially a tool, that work is being undertaken to develop some ownership across the council, to  enable service areas to start to take ownership, and completing this on behalf of their own service area. Officers have attended many different forums and partnership meetings to talk about trauma informed practice and it is always well received and there are pockets and examples of good work that is happening across the Council.

The struggle is with resources to co-ordinate this across the council because it is not a part of one person’s main remit, it is being done in and amongst other work. Another  aspect which is being led at a West Yorkshire level is an organisational toolkit, which is due to be released very soon which will include stages to work through to help on this journey.

The Board was presented with a number of questions with emphasis on:

What do the Board consider to be their role in supporting the commitment and progression of a more joined up way of working? What is the vision from the Board for the progression of this work?

RESOLVED:

That:

i)                 the officers be thanked for providing an up on the Kirklees Health and Wellbeing Strategy Priority on Mental Wellbeing.

ii)               the questions to the Board be considered.