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…