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Trauma-Informed Care: What is it really and how should it be practiced in youth mental health settings?
Sarah Bendall, Senior Research Fellow and Clinical Psychologist
Overview
─ Why do we need trauma-informed care?
─ What is trauma-informed care?
─ What does/should trauma-informed care look like in youth health settings?
─ Practical example: Trauma-Informed Psychotherapy for Psychosis (TRIPP) implementation in WA headspace Youth Early Psychosis Project
Trauma and young people
What is trauma?
Trauma in headspace services –801 young people
Trauma present (%)
Childhood sexual abuse 18
Childhood physical abuse 68
Childhood emotional abuse 32
Childhood physical neglect 55
Childhood emotional neglect 35
Any childhood trauma 84
Trauma
Alcohol & substance problems
Suicide-related
behaviour
Anxiety Depression
Psychosis
Personality disorders
Self-harm
Eating disorders
Trauma is more than PTSD…
Trauma-informed care in mental health services- principles
A system that is trauma-informed:
Realizes the widespread impact of trauma and understands potential paths for recovery
Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system
Responds by fully integrating knowledge about trauma into policies, procedures, and practices
Seeks to actively resist re-traumatization
Substance Abuse and Mental Health Services Administration (SAMHSA)
Trauma-informed care in mental health services- practice
BUT! What does that actually mean for practice??
─ Definition needs be “high level”
─ Sectors need to make their own operational definitions and practices
─ No clearly defined consensus in Youth Mental Health
─ Review of the national and international literature
─ Surveying service providers
─ Asking about young people’s experience
─ Ongoing research
What trauma-informed youth mental health services DON’T look like - Roxxanne's story
What trauma-informed youth mental health services COULD look like - Roxxanne's story
Focus of trauma-informed care in youth mental health settings
Focus of trauma-informed care in Youth Health Settings
Trauma-informed care in early psychosis services
Key features of TRauma- Informed Psychotherapy for Psychosis (TRIPP)
─ Early psychosis clinicians avoided talking about trauma with their clients because they were worried that it would exacerbate psychotic symptoms.
─ Collaboration between researchers and clinicians at EPPIC
─ Addressing PTSD (51%), dissociation (60%) and hallucinations and delusions if appropriate
─ Addressing safety
─ Conducted within ongoing case management by clinical psychologists/social workers/occupational therapists
─ Designed to be conducted within existing service resources
Formulation
Timeline
Psycho-education
Safety
Screening
Choice and autonomy
Strengths-based approach
Formulation
Timeline
Psycho-education
Safety
Screening
Choice and autonomy
Strengths-based approach
Brief, non-invasive. Trauma experience; PTSD;
dissociative symptoms.
Qualitative analysis of Internet forum threads of young people talking about their experiences of trauma
"I was abused and haven't told my psychologist or psychiatrist. I don't
know how to bring it up”
“There's only one teacher I'd be comfortable telling, but I have no idea how to start a conversation with her
about it”
Formulation
Timeline
Psycho-education
Safety
Screening
Choice and autonomy
Strengths-based approach
Identifying distress using distress thermometer;
teaching distress management; safety planning.
Qualitative interviews with TRIPP participants
“She introduced like a thermometer where um, if it got
too high my emotions, we’d stop and take a break...that
was helpful because she knew how I was thinking so
we were communicating, cos she’d ask every once in a
while to make sure I was OK… [My case manager also]
introduced this thing to do when I was having my
episodes. Listing two things I could smell, two things I
could see... All that sort of stuff. And I do use that when
I do have episodes, kind of pulls me back into the
reality”
Distress thermometer
─“How distressed are you right now from 0-10?”
─Building awareness of distress
-Building ability to communicate distress with clinician-If distress is high, coping resources used─ Young person is in charge
of how much they talk about trauma memories or other distressing material
www.docstoc.com
Formulation
Timeline
Psycho-education
Safety
Screening
Choice and autonomy
Strengths-based approach
Trauma experiences; PTSD; dissociative symptoms; other
symptoms; positive events/protective
factors
Safety/Coping
Formulation
Timeline
Psycho-education
Safety
Screening
Choice and autonomy
Strengths-based approach
“What is trauma?”; fight/flight/freeze; PTSD
intrusions and avoidance; dissociative processes
Formulation
Timeline
Psycho-education
Safety
Screening
Choice and autonomy
Strengths-based approachShared understanding of the relationship between trauma, PTSD, dissociation and hallucinations and delusions, and other symptoms. Written if possible.
“At the start I was having hallucinations, seeing shadows, hearing voices in my head and wanted to die. I was fearful all the time and never went out the house unless I was forced to do so.”“You taught me that I had a trunk of memories that I found bad or embarrassing or both and that the trunk was flowing over so much that it made me remember the bad events that happened in the past. I was very disconnected from life that all I wanted was to go to my “land of better things”. This did not help me because the only way forward is to go back to the past and ‘sort the laundry out’ so to speak, even though it was painful I soldiered on and with your help sorted most of my laundry and now I am ready to live my life”
Hannah
TRIPP Implementation Evaluation Project
─ Western Australia headspace Youth Early Psychosis Project
─ Goal- build a more trauma-informed service delivery model for the young people with early psychosis
─ WA Primary Health Alliance funded comprehensive implementation and evaluation
─ Currently in implementation phase after 2-day trainings for all staff in Feb 2019
Logic model
Safety/Coping
orygen.org.auSearch for “trauma”
orygen.org.auSearch for “trauma”
“I am strong, cheeky, caring, intelligent, selfless, good at knitting, good at strategy, love making people laugh, love animals, friendly, full of life, generous and so much more!”
Hannah again…