Read Standard 1: Trauma informed care and shared decision making

Standard statement

People can access information and services that are right for them and are supported to participate in decisions about their care.

Rationale

It is essential that services take a trauma-informed approach when people experience a traumatic event such as rape, sexual assault or child sexual abuse.⁹ People report positive experiences and outcomes when they are fully informed and involved in shared decision making. People are empowered when they are supported to describe what matters to them and when they are respected and listened to.

Trauma-informed care builds on and adds to the principles of person-centred²² and age-appropriate care. Services and staff should recognise and adapt to the specific ways in which the experience of trauma can negatively affect people's experience of care, support and interventions.

People should be given choice and control over decisions to enhance their feelings of safety and trust.⁹ Trauma-informed care should be at the centre of any communications with or about the person. People should be fully informed throughout all stages of their care, including any delays or limitations to their care. This should be discussed with them at the earliest opportunity and communicated in a way that meets their individual needs. The person’s care partner or trusted representative should be appropriately supported. The person should be advised that they can bring a care partner or trusted representative with them to any appointments, particularly for medical examinations. The person’s care partner or trusted representative should be appropriately supported.

A person-centred approach to service delivery includes being responsive to people’s individual needs. This includes taking into account their preferences, wellbeing and wider social and cultural background. NHS boards and partners should consider potential barriers to accessing care. Children and young people may miss school or college. People living in island or remote and rural communities may have to travel to access specialist care and support, including a SARCS. Local protocols should be developed to support people to access services. These may include, but are not limited to, coordinating travel to appointments and access to interpreters.²³

Information should be provided in a range of formats and languages which reflect the needs of the person. The format should take account of the persons’ age, psychological, social, cultural and spiritual factors. Information should be appropriate, inclusive, evidence-informed and easily accessible. Information and discussions should be delivered in a way that is inclusive of everyone. Information should include all aspects of the person’s care, including any onward referrals or procedures.

Services and staff should work collaboratively to provide timely access to information on available options, services and care. This information should focus on the person’s choices, needs and preferences.^8,24 People should have the opportunity to ask any questions they may have.

Staff should work to reduce re-traumatisation and distress. People should be seen in a trauma-informed environment.⁹^,25 This includes minimising any factors that may trigger a trauma response, such as particular sights, sounds or smells.

Trauma informed services are informed by people with lived experience of trauma. Feedback and improvement are essential components to delivering a service which is trauma informed.9 A national feedback form is in place so that people who access forensic medical examinations at a SARCS can provide information about their experience if they wish to do so. NHS boards should collect and review this data to identify actions required for quality improvement and assurance of services (see Standard 2).

Information about a person’s care should only be shared with their consent and in accordance with relevant legislation and guidance.⁵^,²⁶^,27 In some circumstances, professional judgement may determine that information should be shared without the person’s consent, if this is deemed necessary to protect them or other people from harm.²⁸^{, 29} If this is necessary, the person should be informed so that they understand the reason for this decision.

Criteria

1.1

People are:

fully informed
listened to and taken seriously
involved and supported through all stages of their care.

1.2

Staff will support people to help them feel safe.

1.3

People receive information on all aspects of their care, which includes any onward referrals. The information is timely, relevant, and in a language and format that is right for them.

1.4

People have access to timely and age-appropriate services that are person-centred and responsive to the person’s needs, choices and circumstances.

1.5

There is a trauma informed response to people who have experienced rape, sexual assault or child sexual abuse that:

recognises and avoids the risk of re-traumatisation or adverse health effects caused by medical treatment
avoids where possible the need for repeated accounts of traumatic events
maximises opportunities to empower a person to collaborate and have control over their healthcare, examination and follow up
meets the aims of the trauma informed justice knowledge and skills framework.⁸

1.6

People can discuss with kind, empathetic, well-informed, compassionate and unbiased staff:

their needs, concerns and care
their readiness to access services.

1.7

People are offered support and information, in a format appropriate to their age and needs, about:

their immediate clinical needs
their immediate and follow-up healthcare, including safety planning
referral to other healthcare or support services as appropriate
any delays or limitations to their care
the consent process including where information may be shared without their consent
how and when information will be shared with other services.

1.8

NHS boards ensure that people have access to timely and high-quality services that are provided as close to home as possible.

1.9

Where specialist services are not available locally, NHS boards ensure robust pathways are in place to access national, regional or suitable alternative local provision.

1.10

NHS boards provide clear, accessible and fair policies for reimbursement of reasonable expenses where a person must travel to access services.²³

1.11

People are asked their preferred method of communication and this is supported, where possible. This includes alternative languages, translation or easy read.

1.12

The person’s care partner or representative is involved in discussions and decisions with the person’s consent and where appropriate.

1.13

NHS boards actively enable and support people to provide meaningful feedback using age-appropriate, person-centred and trauma-informed approaches and can demonstrate where this feedback has resulted in change.

What does this standard mean for...

What does the standard mean for people receiving care and support?

You will be listened to and taken seriously.
Staff will support you to feel safe and able to trust everyone involved in your care.
Your care and support will be clearly explained. You will know what will be happening. You can stop or pause at any time.
You will be empowered to have a sense of choice and control over your healthcare. Your healthcare will be delivered in collaboration with you.
The impact of any trauma you experienced and any psychological needs you have as a consequence will be recognised. Your recovery will be supported.
Information will be provided at the right time, right pace and in a language and format that is right for you.
Your privacy is important and will be respected. Staff will explain if information is being shared about you and why.
You will have the opportunity to provide feedback to services about your experiences of care.
Your care partner or representative will be supported as much as possible.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

listen and actively engage with people to understand their needs and preferences including social and cultural experiences that may impact care
take a person-centred and trauma informed approach to planning healthcare that facilitates informed and shared decision making
provide person-centred care that meets the aims of trauma-informed services and information for all people who have experienced rape, sexual assault and child sexual abuse
have the knowledge and skills to provide care and services that meet the aims of the trauma-informed framework.²⁴ This includes the provision of support to enhance recovery from the psychological impact of trauma in line with guidance.³⁰
provide opportunities for people to ask questions about their care
provide empathetic, respectful and compassionate support and recognise the importance of people feeling safe
have knowledge of policies, pathways and services to inform people of the options available to them
signpost people to current information and support appropriate to their individual needs.

What does the standard mean for the NHS board?

NHS boards:

provide person-centred and trauma-informed services that meet the aims of national trauma informed framework.
ensure the staff are trained in person-centred care and to the appropriate trauma-informed practice level⁹
have systems and processes in place to provide services that are responsive and support fully informed and shared decision making in line with national guidance
ensure the availability of appropriate, inclusive, easily accessible and timely information and support
have mechanisms to record and act upon feedback from people, their care partners and representatives and staff
work with partners including the third sector, to ensure people are supported in their decision making
ensure that staff have time and resources to support and care for people.

Examples of what meeting this standard might look like

Information and support are available and provided in a format that is age-appropriate, including easy read and alternative languages.
Access to interpretation services.
Demonstration of a trauma-informed approach to design of services and environment, including provision of safe spaces.²⁵
Feedback from service users about their experiences using the national qualitative feedback form to help inform the continuous improvement of services.
Evidence of acting upon feedback, given by people who access the services, to help ensure a trauma-informed approach to the continuous improvement of service design and environment. For example, information videos about what to expect from the service.