By Alex Fox Mayday Trust CEO,  Oliver Townsend Platfform’s Head of Connections and Change and Grant Campbell Homeless Network Scotland’s Head of Partnerships & Consulting.

Place-based working: a trauma-informed approach

The New System Alliance core partners, Mayday Trust, Homeless Network Scotland and Platfform share a desire for radical system change which shifts services and public service systems away from being focused on reactive and fixed responses to immediate needs, and towards being led by people, and shaped around their strengths and potential. We believe this is the only way to reverse the growing evidence of inequalities in how people access services and how well they work. It requires a real shift in power away from the people who have traditionally designed services based on a narrow range of life experiences, towards codesigning more people-shaped services which start by forming trusting relationships with people who have lost faith in systems that weren’t helping them.

This is not a new service or intervention, but recognition that for people who are living complex lives and in touch with multiple services, it is the health of the public service system as a whole, and its relationships with people, that creates a good or bad outcome. As a result, the three organisations have all developed place-based working as a core part of demonstrating what whole-system change can look like.

The three organisations have their roots in a specific sector – homelessness or mental health  – but all now see the need to be conveners and partners with a wide range of organisations, if we are to offer and model the more whole-person approaches that we are arguing are needed by the people we were set up to help. Our goals must be grounded in what matters most to people rather than to one organisation. The New System Alliance recently met to share early learning from these approaches, which generated lessons on these three themes:

  • Recognising that trauma-informed practice is not just about the traumas which affect individuals or families, but recognises the traumas inflicted up on whole communities, often across generations
  • Generating learning is a core function of any organisation or place which is seriously engaged with systems-change
  • The transfer of power is central to any system change.

Platfform’s mental health support work has strived to be trauma-informed for some time, but as can be found reflected in the organisation’s recent Manifesto for Change, that understanding of trauma, and how it links to inequalities, is deepening. As well as considering Adverse Childhood Experiences (ACEs) as sources of trauma, Platfform recognises that it will often work with communities experiencing Adverse Community Experiences. These could be large single events like the loss of an industry like mining on which a whole community was reliant, or a series of events, such the grinding impact of racism on a black community. Some communities experience both, such as the Grenfell disaster which was the culmination of decades of exclusion and neglect of a diverse community. These Adverse Community Experiences in turn impact upon the capacity of individuals and families to respond to more personal adversity. So all genuinely trauma-informed mental health work must see people through an inequalities lens or risk ignoring not only the reality of their trauma, but also the potential for organisations to participate in inequalities which form an ongoing source of that trauma.

The three place-based approaches shared a interest in developing learning cycles and learning groups, drawing on the Human Learning Systems approach, to bring people together from different parts of the system, including people using services, or impacted by them, together to design experimental ways of working, with the ambition to embed those changes (rather than the traditional ‘pilot, evaluate, stop’ approach).  Generating and using learning is an idea which appeals to people – it makes sense – but it’s also hard to do practically. It requires finding a willing group from across the system, establishing what their purpose and remit is, and how learning will be generated from individual situations which can result in wider system change.

Homeless Network Scotland is working with Aberdeen Foyer on the question, How do we improve outcomes for young people in the Northfield community of Aberdeen? This project, part of Homeless Network Scotland’s No Wrong Door approach to building more responsive and seamless services with people and communities who experience siloed and fractured services, brings together services, a school and young people to generate learning and new forums for identifying change.

These challenges are intimately connected with the question of who should have power in our public services. Trauma – whether in a relationship or in society – is often the result of the misuse of power. Knowledge is power, so who generates, holds and uses learning is also a question of power. Power is not just about rights: it is the combination of having both the rights and the responsibilities which are so often denied to people who depend most on public services.

Mayday Trust starts its support work and its system change work by finding and forming more equal, trusting relationships with those people are currently the most likely to be failed by or shut out from services, in order to codesign something which works, and from which they and the local area can learn and create wider change. Mayday makes (often small) amounts of money available to people or communities to enable them to share decision making power and responsibility, and pays close attention to the impact of the power imbalances from which no support relationship can escape. For a number of the people with whom Mayday works, being able to take control and responsibility for their own support and life, is the first step of a journey which leads to connecting with others in similar situations, and sometimes to creating new activities or initiatives which enables that person to move from service user to service designer.

Ultimately, these approaches require not just radicalism, but humility from the organisations aiming to pursue them: recognising that we are moving into places and areas of practice we will never be the experts in. All three organisations have recognised the value of starting with small scale changes, even where we are building work with big ambitions. Whether we are working with individuals, organisations or whole public service systems, the approach we are searching for is our role can only be to bring one part of the puzzle, and to create space for new conversations.

Read the Trauma-informed Communities Report
Read ‘Adverse Community Experiences and Resilience: a framework for addressing and preventing community trauma’