In the period from 2021–24, CAST has undertaken and delivered a range of projects and programmes to meet the needs of specific populations and clients who work with them. 

CAST offers expert consultancy and training around mental health, incident planning, and emergency response. CAST can develop and deliver bespoke training sessions to organisations, including on how to recognise and manage trauma and potentially traumatic stress. Contact us at [email protected] to enquire. 

Training  

We aim to improve the knowledge and skills of not only healthcare staff but also professionals working for other agencies. Providing training for non-specialists will help integrate trauma awareness into everyday practice. 

Whilst much attention has been paid to training specialist therapists to treat PTSD and other trauma spectrum disorders, most of the response to major incidents is delivered by non-specialists (e.g. emergency services, law enforcement) – and the scale of many major incidents means it is unrealistic to have a response based only on trauma specialists. Building knowledge of how to respond to and manage trauma into the everyday skills of non-specialists has to be a central aim of healthcare systems. 

CAST has delivered specialist training and consultancy in the areas of anxiety, stress and trauma to provide organisations with the skills and confidence they need. We have provided training to professionals working in health and care, the emergency services, and also the private sector. CAST tailors training content and delivery methods to a client’s needs and can cover subjects ranging across anxiety, stress, trauma, burnout, and staff wellbeing. CAST has delivered: 

Bridging Support and Skill Development for Non-Clinical Groups 

  • Training for Crest Advisory Ltd (2021–22), an organisation supporting the media and communications around public inquiries. 
  • Training and workshop sessions for Catch22 (2022–23), a social business which delivers a UK-wide wellbeing programme to people on probation, commissioned by the Ministry of Justice (MoJ). 
  • Consultancy and design of a programme to train Trauma Support Volunteers within London Fire Brigade (2022–present). 
  • CAST staff have provided training for ‘blue light’ emergency services in issues around trauma. 

Psychoeducation for health and care professionals 

Dr Jai Shree Adhyaru has delivered trauma awareness workshops to a wide audience including psychiatrists, nurses, and social workers. The half-day Trauma Awareness Workshop was developed in the context of crisis response, wherein many people from a range of services may need to work with those who experienced a traumatic event. The interactive workshop focuses on the concept and definition of trauma, the signs, symptoms and impact of trauma in adults and children, cultural understandings and the different treatments available. 

Individual support for trauma-affected workers 

We also provided individual support to people involved in delivering services to those affected by the Grenfell Tower event from a wide range of services including, amongst others, the London Metropolitan Police (MPS). During the response we worked closely with – and supported – the Family Liaison Officers (FLOs) and are therefore very familiar with their work and the challenges of their role. Psychoeducation training led to an uptake in screening for MPS staff and we fed the learning into the re-licensing programmes for search officers and neighbourhood response teams.  

In 2022, Dr Sarah Heke and colleagues received commendations from the MPS for their work supporting traumatised police officers, which were awarded “to recognise the professionalism, empathy, sincerity and caring nurturing way” in which their first responders had been supported. 

Training for statutory and voluntary sector organisations impacted by a local tragedy 

Training was provided to a large range of statutory and voluntary sector organisations including local authority, central government departments, third sector organisations and community groups impacted by the Grenfell Tower Fire. We have trained non-therapists in trauma-informed approaches, to help to improve community collaboration and engagement, and also in traumatic bereavement; all of this learning has led to us honing training to new professional groups.? 

CAST is currently designing bespoke programmes of training to: 

  • London Ambulance Service staff, including call handlers. 
  • Operation Northleigh officers at the London Metropolitan Police Service (MPS). 
  • The government in Jersey and staff there who responsed to a number of potentially traumatising major incidents. 

Consultancy  

CAST brings together wide range of trauma expertise into a consultancy offer to the wider healthcare system and to organisations outside healthcare, both in the UK and internationally. We can offer expert advice and guidance on addressing the mental health and wellbeing needs of individuals and communities; contact us at [email protected] to enquire. 

CAST can offer advice and guidance on preparing for and coordinating the mental health response to major incidents and health emergencies. CAST draws expertise from the development and delivery of mental health services and support following major incidents, and also of responding to health emergencies, including the HIV/AIDS crisis and most recently the COVID-19 pandemic. 

We can assist organisations in the UK and internationally to develop frameworks for incident preparedness and for coordination and delivery of care, including by first responders and non-specialists. 

Specialist supervision  

CAST has also offered specialist supervision to organisations that work with distressed or traumatised people. For those working with people who have witnessed or experienced traumatic events, specialist supervision can be helpful in mitigating against the impact of vicarious trauma. 

Programmes for Emergency Services 

CAST has also provided screening for trauma spectrum disorders to emergency services staff affected by the Grenfell Tower Fire and, where appropriate, treatment (2017 – 2024). 

Programme to support refugee nurses  

CAST designed and delivered a Refugee Nurse Support programme (2021–22) to assist cohorts of trained nurses relocating to the UK from refugee settings, and to proactively screen them for trauma spectrum disorders and other mental health needs. 

Over a year-long period, CAST helped support the psychological wellbeing of almost 100 nurses (across three different cohorts) with proactive screening, pastoral support, and confidential advice. CAST clinicians used a standard measure to ascertain traumatic experiences and all nurses we spoke with had several severely adverse past experiences, given the countries and situations they were leaving. Our clinicians offered follow-ups and brokered onward referral to local services wherever needed. 

CAST worked in partnership with the commissioner, NHS England (NHSE), and partners including Liverpool John Moores University (LJMU), Reset, and Talent Beyond Boundaries to deliver the programme. 

CAST is fortunate in having staff and associates with experience in international relocation work, and some with personal experience as migrants (including some as refugees). This contributed to successful delivery of the programme, with outcomes reported to NHSE to help inform future recruitment and support of overseas health professionals. 

The wider initiative by NHSE supported refugee nurses in coming to the UK, securing employment with NHS hospitals, and going through the necessary procedures to obtain registration. We know that integration of refugees into their host communities is a key factor in supporting their emotional and physical wellbeing and gaining meaningful employment is one key way to promote such integration. 

This was a very successful pilot in bringing much-needed nurses, who are of a very high standard, into the UK health service; it is a program which benefits everyone.  

Five of the refugee nurses joined CNWL Trust in November 2021. Read more?here. 

Programmes to screen and support refugees and asylum seekers 

CAST has designed and delivered targeted support for refugees and displaced people in London and supported the responses to major incidents and health emergencies. 

Afghan Evacuee Response (2021–23) 

CAST convened a team of outreach staff from across CNWL to undertake face-to-face screening and support for Afghan evacuees arriving in north west London and temporarily accommodated in ‘bridging’ hotels. This programme was commissioned by North West London ICB, following initial work by NHS staff to offer screening and support to evacuees arriving at Heathrow airport. 

The project was led by Dr Jai Adhyaru and coordinated through close working with the local authorities and a range of third sector providers. The team convened by CAST sought to address the mental health and wellbeing needs of Afghan evacuees but also picked up more general issues around wellbeing and signposted evacuees to a range of other services which could help their quality of life and integration into UK society.  

The outreach team worked to proactively engage with and speak to as many evacuees residing in hotels as possible (most evacuees arrived at hotels in Kensington and Chelsea and Westminster). We used a standardised interview schedule to ensure all relevant issues were covered and equipped the team with screening tools translated into relevant languages, in addition to involving interpreters in the team. 

From November 2021 to August 2022, the programme approached over 700 evacuees residing in hotels, conducted 432 completed screening conversations, created 699 records on SystmOne, and made 57 referrals to specialist mental health services (with a further 24 offered referral but not taken up). 

Since outreach screening was completed, the emphasis switched from screening to meeting the ongoing needs of those residents who have not yet been relocated, working closely with the local authority and other agencies. 

You can read more about this project here

Also: https://www.cnwl.nhs.uk/news/cnwl-heathrow-airport-helping-refugees-afghanistan 

Ukrainian Evacuee Response (2022–present) 

CAST collaborated with colleagues in the local authorities and other agencies to develop a programme that would assess the needs of incoming Ukrainian evacuees arriving in London following the invasion of Ukraine by Russia. This programme was commissioned by Westminster City Council (WCC) for an initial pilot period and subsequently extended and adapted as population needs became more apparent.  

The programme was developed with three main aims: 

  1. To assess the level of trauma symptoms in Ukrainian refugee children and to identify those who needed further input. 
  1. To introduce Teaching Recovery Techniques (TRT), a group intervention for children developed jointly by Kings College London and Children and War UK which is now widely used internationally by the Children and War Foundation. A recent review found it significantly reduced symptoms of PTSD (Alzaghoul, McKinley and Archer, British Journal of Psychiatry 2022). The intervention was specifically developed so that it could be taught to non-specialists. 
  1. To advise on children with complex mental health problems and to broker referrals into the healthcare system where appropriate. 

The intention was not to replace business as usual (BAU) services provided by CAMHS services or other agencies but to provide a “front end” service which would ensure that children were being offered screening; try to reduce the number of children reaching secondary care mental health services; and provide first language interventions in Ukrainian and Russian. 

Although the initial target population had been Ukrainian children, inevitably parents – many of whom are likely to be traumatised themselves – came into scope. Particularly with younger children the family is a key unit of intervention. 

CAST also collated a range of resources in key languages to support professionals in health and care and beyond with recognising and addressing the needs of people arriving into the UK from Ukraine. CAST made available, via its website plus partner communications, three types of material:? 

  • materials for those helping refugees, including professionals and third sector volunteers;
  • materials that can be given to people affected by traumatic events to help them understand how they are feeling; and  
  • screening questionnaires, intended for use by health and social care professionals and others with experience in mental health work. 

Specialist input for public inquiries 

CAST and its people have provided specialist input for emergency services, public inquiries, and major incidents, drawing on extensive experience working with ‘blue light’ services and responding to major incidents such as the Ladbroke Grove rail crash (1999) and the Grenfell tower fire (2017), as well as health emergencies including the HIV/AIDS crisis and most recently the COVID-19 pandemic. 

Supporting the Grenfell Inquiry 

Giving and listening to evidence can have an emotional impact on those involved. CAST has been providing support for witnesses and members of the public attending, or giving evidence at, the public inquiry (2017–23). People at the inquiry often hear distressing material which can have an adverse effect on their wellbeing. Provision of psychological support contributed to the effective delivery of the inquiry. 

CAST staff, led by Dr Heke, provided psychological support to witnesses at the Grenfell Tower Public Inquiry on a contract from the Inquiry (2017–present). The Inquiry and the accompanying police investigation are likely to result in criminal prosecutions. Dr Heke & Dr Green have experience as expert witnesses in criminal cases, including giving evidence in court under cross-examination, and are therefore familiar with the investigatory and inquisitorial processes. 

Specialist input for major incident planning 

CAST’s Director, Dr John Green, was the head of CNWL’s Grenfell response (2017–2020 and establishment of the Grenfell Health & Wellbeing Service (GHWS). Some team members also had experience of responding to previous mass casualty events including managing the response to the Ladbroke Grove rail crash (1999).  

A large part of the Grenfell work was direct work with traumatised people and bereaved families. Additionally, a significant aspect of the work was training other organisations to understand and deal with traumatised people. CAST team members are therefore extensively experienced in dealing with highly distressed, and sometimes very angry, victims of incidents and accidents as well as with their families. 

With their experience in major incident response and planning, CAST staff have participated in workshops and events to aid future planning, including in intensive exercises held by the London Resilience to convene major agencies from across emergency services, health, and government. 

Supporting school staff following critical incidents 

CAST staff have offered guidance to schools on how to communicate information and work with those most directly impacted, as well as the impact on the wider school system. 

Contact

If you have a question or would like to work with CAST email us at [email protected]

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