The Bare Necessities for creating trauma informedmental health inpatient services          Toni Ashmore          24 June 2...
Trauma informed care                provision• The provider acknowledges and understands the effects  of violence and trau...
We recognise we need     to do somethingdifferent.. BUT WHAT?                    3
It was crucial for „becoming trauma- informed‟ to grow and spread based on  self-identified needs rather than a top-down a...
Interagency           Trauma included in                Engagement                                                  collab...
Trauma included in                                                                        national knowledge              ...
Nowhere to                                                              Psychiatrists                                     ...
The current big picture• Trauma not recognized as a central problem• No accepted definition of what trauma  informed care ...
Can we get really get it together?                                     9
“Above All, Do No Harm”  “dealing with…primary pain without unnecessarily inflicting secondary pain  experiences on the re...
What‟s needed• A systematic approach to culture  change• Administrative commitment to change  at all levels
National Action Plan                          Community                                 Knowledge                         ...
National Action PlanNational          Definition                                 Community                                ...
GoalsWe will know that we have accomplished our missionwhen every organization within our system of care• has fully integr...
National Action PlanNational            Definition                                   Community                            ...
National Action PlanNational                                                Definition                                    ...
Local Policy and Procedures Vulnerable        Restraint and    Universal screening                                        ...
National Action PlanNational                                                Definition                                    ...
“How do I understand     this person?”       rather than“How do I understand this problem or symptom?”
Foundation training• Broaden understanding of trauma• Recognize trauma-related symptoms as     adaptive responses to overw...
Qualities and characteristics ofstaff that are essential for trauma           informed care•   Empathic•   Able to talk op...
Qualities and characteristics cont.• Willingness to connect emotionally  with the trauma survivors experience• Willingness...
Workforce Development      Working with Trauma          Sexual Safety            Assessment          Engagement     Dealin...
National Action PlanNational                                                Definition                                    ...
Supervision    Individual and group         MentoringPositive promotion of supervision                                    25
Supervision• Vicarious trauma normative in mental  health• Staff own history of trauma• Transference and countertransferen...
National Action PlanNational                                                Definition                                    ...
Keys to culture success           • Consistent message              • Shared values• Support and commitment of management ...
National Action PlanNational                                                Definition                                    ...
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Toni Ashmore presentation

  1. 1. The Bare Necessities for creating trauma informedmental health inpatient services Toni Ashmore 24 June 2011 Sydney 1
  2. 2. Trauma informed care provision• The provider acknowledges and understands the effects of violence and trauma on those whom they work. This is evidenced by the fact that they:• Integrate an understanding of trauma throughout their program• Review policies and procedures to ensure prevention of re-traumatisation• Involve trauma survivors in designing and evaluating services• Place priority on trauma survivors safety, choice and control 2 Klinic, 2008
  3. 3. We recognise we need to do somethingdifferent.. BUT WHAT? 3
  4. 4. It was crucial for „becoming trauma- informed‟ to grow and spread based on self-identified needs rather than a top-down approach of mandating, forcing or flooding. The latter approach creates resistance, whereas the former engenders receptivity, empowerment and choice ~ the very same principles from which trauma-informed services are sourced.
  5. 5. Interagency Trauma included in Engagement collaboration national knowledge and skills framework TIC included in New Grad Vulnerable MH Increase inWomen‟s Space programme community Sensory programmes Modulation for BPD Restraint and Seclusion Assessment of DV routine sexual safety Screening Discharge Sexual Safety Asking about Trauma 5
  6. 6. Trauma included in national knowledge Engagement Interagency and skills time collaboration framework Sensory Vulnerable Women‟s Space Trauma Modulation Informed Care Restraint and DV routine Seclusion Principles Screening Increase in communityTIC included programmesin New Grad Sexual MH Safety Discharge programme planning Admission Planning 6
  7. 7. Nowhere to Psychiatrists Assessment of Not all on the refer to in the dependance on the sexual safety same page community medical model TIC included Trauma included in in New Grad Interagency national knowledge Engagement MH collaboration and skills framework programme Increase in Lack of community No set Vulnerable screening tools programmes definition of Lack of training Women‟s Space TIC on TIC Challenging Sensory building No practice Modulation descigns guidelines Restraint and Seclusion Staff unsure how to DV routine engage with Screening consumersRisk Aversion Discharge Lack of referral priority Sexual pathways with Safety community Admission programmes Planning 7
  8. 8. The current big picture• Trauma not recognized as a central problem• No accepted definition of what trauma informed care means for an inpatient setting• Little information accessible on implementation in an inpatient setting• Vicarious Traumatization not seen as normative in mental health system• Emotional and Physical Safety are a Priority?
  9. 9. Can we get really get it together? 9
  10. 10. “Above All, Do No Harm” “dealing with…primary pain without unnecessarily inflicting secondary pain experiences on the residents throughpunitive or controlling reactions”(Anglin, 2002, p. 55)
  11. 11. What‟s needed• A systematic approach to culture change• Administrative commitment to change at all levels
  12. 12. National Action Plan Community Knowledge Integrated Building RedefiningNational Definition and NGO resourcing Response Design Base Research DiagnosisFramework Consumer Leadership Minimum Standard Workforce Development Undergraduate/ Funding Forum Post Graduate Advisory Group Education/VTA 12
  13. 13. National Action PlanNational Definition Community and NGO resourcing Integrated Response Building Design Knowledge Base Trauma Diagnosis ResearchFramework Consumer Workforce Development Undergraduate/ Minimum Funding Forum Leadership Standard Post Graduate Advisory Group Education/VTAB Advisory MinimumState-wide Action Plan Advisory Group Consumer Group Rep Goals Policy Standards Funding Accountability Structures Accreditation Data collection on Trauma history IIMS OV Audit 13
  14. 14. GoalsWe will know that we have accomplished our missionwhen every organization within our system of care• has fully integrated trauma-informed services into their service provision, policies and procedures• evidenced by trauma-informed materials made readily available to clients, consistently applied trauma informed• lens when discussing clients and implementation of routine program procedures such as trauma• screening, trauma-informed assessments and stage matched interventions. San Mateo County 14
  15. 15. National Action PlanNational Definition Community and NGO resourcing Integrated Response Building Design Knowledge Base Trauma Diagnosis ResearchFramework Consumer Workforce Development Undergraduate/ Minimum Funding Forum Leadership Standard Post Graduate Advisory Group Education/VTAB AdvisoryState-wide Action Plan Group Consumer Rep Goals Policy Minimum Standards Funding Accountability Structures ResourceClinical Guidelines and Policy development Accreditation Data collection on Trauma history IIMS OV Audit 15
  16. 16. National Action PlanNational Definition Community and NGO resourcing Integrated Response Building Design Knowledge Base Trauma Diagnosis ResearchFramework Consumer Workforce Development Undergraduate/ Minimum Funding Forum Leadership Standard Post Graduate Advisory Group Education/VTAB AdvisoryState-wide Action Plan Group Consumer Rep Goals Policy Minimum Standards Funding Accountability Structures ResourceClinical Guidelines and Policy development Accreditation Data collection on Trauma history Local Policy and Procedures IIMS UniversalVulnerable Restraint screening SensoryWomen‟s and (i.e. DV, Modulation Space Seclusion CSA) OV Audit Incident Sexual Interagency Discharge Review Safety collaboration Planning Procedures Admission Engagement Planning 16
  17. 17. Local Policy and Procedures Vulnerable Restraint and Universal screening Sensory ModulationWomen‟s Space Seclusion (i.e. DV, CSA) Incident ReviewSexual Safety Interagency collaboration Discharge Planning Procedures Engagement Admission Planning 17
  18. 18. National Action PlanNational Definition Community and NGO resourcing Integrated Response Building Design Knowledge Base Trauma Diagnosis ResearchFramework Consumer Workforce Development Undergraduate/ Minimum Funding Forum Leadership Standard Post Graduate Advisory Group Education/VTAB AdvisoryState-wide Action Plan Group Consumer Rep Goals Policy Minimum Standards Funding Accountability Structures ResourceClinical Guidelines and Policy development Accreditation Data collection on Trauma history Local Policy and Procedures Workforce Development IIMS Universal Working with TraumaVulnerable Restraint screening SensoryWomen‟s and Sexual Safety (i.e. DV, Modulation Space Seclusion CSA) Assessment OV Audit Engagement Incident Dealing with Disclosures Sexual Interagency Discharge Review Safety collaboration Planning De-escalation Procedures Vicarious Trauma / Self Care Promoting Safe Environments Admission Psycho-education Engagement Planning 18
  19. 19. “How do I understand this person?” rather than“How do I understand this problem or symptom?”
  20. 20. Foundation training• Broaden understanding of trauma• Recognize trauma-related symptoms as adaptive responses to overwhelming experiences• Develop a shared lens and common language across diverse systems
  21. 21. Qualities and characteristics ofstaff that are essential for trauma informed care• Empathic• Able to talk openly• Self Aware• Flexible• Comfortable with the unknown• Willingness to learn from survivors 21
  22. 22. Qualities and characteristics cont.• Willingness to connect emotionally with the trauma survivors experience• Willingness to step into the world of the survivor• Able to regulate own emotions• Able to treat the survivor as an equal• Good Listener• Willingness to debrief 22
  23. 23. Workforce Development Working with Trauma Sexual Safety Assessment Engagement Dealing with Disclosures De-escalation Vicarious Trauma / Self Care Promoting Safe Environments Psycho-education 23
  24. 24. National Action PlanNational Definition Community and NGO resourcing Integrated Response Building Design Knowledge Base Trauma Diagnosis ResearchFramework Consumer Workforce Development Undergraduate/ Minimum Funding Forum Leadership Standard Post Graduate Advisory Group Education/VTAB AdvisoryState-wide Action Plan Group Consumer Rep Goals Policy Minimum Standards Funding Accountability Structures ResourceClinical Guidelines and Policy development Accreditation Data collection on Trauma Supervision history Local Policy and Procedures Workforce Development Individual and IIMS group Universal Working with TraumaVulnerable Restraint screening SensoryWomen‟s and Sexual Safety (i.e. DV, Modulation Mentoring Space Seclusion CSA) Assessment OV Audit Engagement Incident Dealing with Disclosures Positive Sexual Interagency Discharge promotion of Review Safety collaboration Planning De-escalation Procedures supervision Vicarious Trauma / Self Care Promoting Safe Environments Admission Psycho-education Engagement Planning 24
  25. 25. Supervision Individual and group MentoringPositive promotion of supervision 25
  26. 26. Supervision• Vicarious trauma normative in mental health• Staff own history of trauma• Transference and countertransference• „Have I done the right thing?‟ 26
  27. 27. National Action PlanNational Definition Community and NGO resourcing Integrated Response Building Design Knowledge Base Trauma Diagnosis ResearchFramework Consumer Workforce Development Undergraduate/ Minimum Funding Forum Leadership Standard Post Graduate Advisory Group Education/VTAB AdvisoryState-wide Action Plan Group Consumer Rep Goals Policy Minimum Standards Funding Accountability Structures ResourceClinical Guidelines and Policy development Accreditation Data collection on Trauma Supervision history Local Policy and Procedures Workforce Development Individual and IIMS group Universal Working with TraumaVulnerable Restraint screening SensoryWomen‟s and Sexual Safety (i.e. DV, Modulation Mentoring Space Seclusion CSA) Assessment OV Audit Engagement Incident Dealing with Disclosures Positive Sexual Interagency Discharge promotion of Review Safety collaboration Planning De-escalation Procedures supervision Vicarious Trauma / Self Care Promoting Safe Environments Admission Psycho-education Engagement Planning 27 Local Staff Culture
  28. 28. Keys to culture success • Consistent message • Shared values• Support and commitment of management • Equality of experts • Staff valued • Flexibility • Inclusion • Readiness • Openness
  29. 29. National Action PlanNational Definition Community and NGO resourcing Integrated Response Building Design Knowledge Base Trauma Diagnosis ResearchFramework Consumer Workforce Development Undergraduate/ Minimum Funding Forum Leadership Standard Post Graduate Advisory Group Education/VTAB AdvisoryState-wide Action Plan Group Consumer Rep Goals Policy Minimum Standards Funding Accountability Structures ResourceClinical Guidelines and Policy development Accreditation Data collection on Trauma Supervision history Local Policy and Procedures Workforce Development Individual and IIMS group Universal Working with TraumaVulnerable Restraint screening SensoryWomen‟s and Sexual Safety (i.e. DV, Modulation Mentoring Space Seclusion CSA) Assessment OV Audit Engagement Incident Dealing with Disclosures Positive Sexual Interagency Discharge promotion of Review Safety collaboration Planning De-escalation Procedures supervision Vicarious Trauma / Self Care Promoting Safe Environments Admission Psycho-education Engagement Planning 29 Local Staff Culture
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