Understanding Trauma-Informed Care in Youth Mental Health Settings

1. 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

2. 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

3. Trauma and young people

4. What is trauma?

5. Trauma in headspace services – 801 young people

6. Trauma is more than PTSD… Alcohol & substance problems Psychosis Eating disorders Trauma Anxiety Depression Self-harm Personality disorders Suicide-related behaviour

7. Trauma-informed care in mental health services- principles

8. 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 resistre-traumatization Substance Abuse and Mental Health Services Administration (SAMHSA)

9. Trauma-informed care in mental health services- practice

10. 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

11. What trauma-informed youth mental health services DON’T look like - Roxxanne's story

12. What trauma-informed youth mental health services COULD look like - Roxxanne's story

13. Focus of trauma-informed care in youth mental health settings

14. Focus of trauma-informed care in Youth Health Settings

15. Trauma-informed care in early psychosis services

16. 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

17. Choice and autonomy Screening Timeline Safety Psycho-education Formulation Strengths-based approach

18. Brief, non-invasive. Trauma experience; PTSD; dissociative symptoms. Choice and autonomy Screening Timeline Safety Psycho-education Formulation Strengths-based approach

19. 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”

20. Choice and autonomy Identifying distress using distress thermometer; teaching distress management; safety planning. Screening Timeline Safety Psycho-education Formulation Strengths-based approach

21. 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”

22. 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

23. Choice and autonomy Screening Trauma experiences; PTSD; dissociative symptoms; other symptoms; positive events/protective factors Timeline Safety Psycho-education Formulation Strengths-based approach

24. Safety/Coping

25. Choice and autonomy Screening Timeline Safety Psycho-education “What is trauma?”; fight/flight/freeze; PTSD intrusions and avoidance; dissociative processes Formulation Strengths-based approach

26. Choice and autonomy Screening Timeline Safety Psycho-education Formulation Strengths-based approach Shared understanding of the relationship between trauma, PTSD, dissociation and hallucinations and delusions, and other symptoms. Written if possible.

27. Hannah “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”

28. 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

29. Logic model Safety/Coping

30. orygen.org.auSearch for “trauma”

31. orygen.org.auSearch for “trauma”

32. Hannah again… “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!”