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The Impact of Domestic Violence on
Children’s Functioning: Care Planning
Approaches to
Foster Trauma-Informed Care
www.int...
Children’s Mental Health in Ontario
• Clinicians, educators and school personnel want
to play a crucial role in the identi...
Impacts of Trauma
• Children who experience domestic violence and abuse are at a higher risk
of experiencing:
 physical h...
The interRAI Trauma-Informed Care Project
Gain a comprehensive understanding
of the mental health dynamics of
individuals ...
interRAI
interRAI is an international collaborative to improve the quality of life of vulnerable
persons through a seamles...
How do interRAI instruments help children,
youth, and their families?
• Improving early identification of mental health an...
Lifespan Approach
Through the use of an integrated suite of setting- and sector-specific
assessments, the child/youth suit...
interRAI Child and Youth Suite
School Community HospitalJusticeHome
Examples of Manuals in Children and Youth
Instruments
What sets interRAI Instruments Apart?
One assessment…multiple applications
CAPs
• Collaborative Action Plans are documents containing current evidence-informed approaches to guide
interventions in ...
Safety
CAPs
Services
and
Supports
CAPs
Functional
Status
CAPs
Family Life
and Social
Integration
CAPs
Health
Promotion
CAP...
Using the results
Results of interRAI Assessment Youth Profile
=
47
Support
referrals
Track
change
Support
planning
Assist...
Implementation of trauma informed care using the interRAI Child and Youth Mental
Health instrument (ChYMH) Collaborative A...
Goals of the Current Project
• Determine the needs of children who have been exposed to domestic violence (DV)
• Identify ...
Participants
• Recruited from over 70 schools,
secure custody sites and mental health
facilities in Ontario, Canada
• Engl...
Child and Youth Mental Health Instrument
• Comprehensive assessment system
• Approximately 60-90 minutes for
completion
• ...
Measures
Domestic Violence Trauma - 6 questions:
Victim of: sexual abuse, physical abuse,
emotional abuse; witness of dome...
Poly-Victimization and Types of trauma
0.0
10.0
20.0
30.0
40.0
50.0
60.0
None 1
trauma
type
2
trauma
types
3
trauma
types
...
Externalizing and Internalizing Problems
0.0
5.0
10.0
15.0
DABS Internalizing
symptoms
Externalizing
symptoms
4.1
9.2
3.8
...
Family Factors
0.0
20.0
40.0
60.0
80.0
100.0
Caregiver distress Effective
communication
Disruptions in care
28.1
97.3
3.4
...
Medical Conditions
0.0
2.0
4.0
6.0
8.0
10.0
12.0
Diabetes Epilepsy FASD Migraine Traumatic
brain
injury
Asthma
No DV traum...
0.0
10.0
20.0
30.0
40.0
50.0
60.0
No DV trauma DV Trauma
35.6
57.6
Percent
Victim of Bullying
History of Needs Met (yes)
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Physical needs met Safety needs met
Perc...
Summary of Results
• 25.8% of children and youth who had witnessed DV have experienced multiple forms
of trauma
• Children...
How do youth in secure custody compare to
inpatient and outpatient youth with respect
to trauma?
N= 755 youth
Age 16 to 19...
Measures
Traumatic Life Events
Abuse: Victim of: sexual violence, physical abuse, emotional abuse, bullying
Family Factors...
Traumatic Experiences: Abuse
30
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Victim of Sexual
Violence
Physical Abuse Emotional
Abuse...
Traumatic Experiences: Family Factors
31
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Percent
Trauma Type
YJ
Inpat...
Traumatic Events: Neighbourhood Factors
32
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Violent Neighborhood
Victim of Crime
Percent
...
Internalizing Problems:
Anxiety, Social Disengagement and Depressive
Symptoms
33
0
2
4
6
8
10
12
Anxiety
Social
Disangagem...
Disruptive Behaviour Problems
34
0
0.5
1
1.5
2
2.5
3
YJ
Inpatient
Outpatient
MeanScore
Disruptive Behaviour Symptoms
Hyperactivity and Distractibility
35
0
1
2
3
4
5
6
7
8
YJ
Inpatient
Outpatient
Mean-Distractibility/Hyperactivity
Case Typ...
Aggressive Behaviour
36
0
0.5
1
1.5
2
2.5
3
YJ
Inpatient
Outpatient
Mean-AggressiveBehaviour
Case Type
Males
Femailes
Care Planning:
Trauma
37
0
5
10
15
20
25
30
35
40
Reduce the impact of prior
traumatic life events
Address immediate safet...
Care Planning:
Harm to Others and Self-Harm
38
0
5
10
15
20
25
30
Moderate risk of
harm to others
High risk of harm
to oth...
Care Planning: Interpersonal Conflict
39
0
5
10
15
20
25
30
35
40
45
50
Reduce conflict within a
specific domain
Reduce wi...
Care Planning: Substance and Tobacco Use
40
0
20
40
60
80
100
YJ Inpatient Outpatient
Percent
Substance Use CAP
0
5
10
15
...
Care Planning – Other CAPs
41
0
10
20
30
40
50
60
70
Percent
Triggered CAPs
YJ
Inpatient
Outpatient
Conclusions: Comparison of Patient
Groups
• Trauma rates were found to be higher for the YJ group.
• Females experienced h...
Dr. Shannon L. Stewart, Associate Professor
Director of Clinical Training
Faculty of Education, Western University
Interna...
ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma...
ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma...
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ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care

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The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care

Shannon Stewart, Yasmin Garad, Natalia Lapshini

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ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care

  1. 1. The Impact of Domestic Violence on Children’s Functioning: Care Planning Approaches to Foster Trauma-Informed Care www.interrai.org Shannon L. Stewart, Yasmin Garad, Natalia Lapshina
  2. 2. Children’s Mental Health in Ontario • Clinicians, educators and school personnel want to play a crucial role in the identification of students struggling  One in five students experiences mental health issues  Yet only about 25% receive the treatment needed  50-75% of adult mental health issues persist from school-age years • Highly predictive of  Impaired social and emotional functioning  Poor academic achievement  School absenteeism  Substance abuse  Academic failure and drop out in both elementary and secondary schools
  3. 3. Impacts of Trauma • Children who experience domestic violence and abuse are at a higher risk of experiencing:  physical health issues  mental health problems  social skills deficits  academic underachievement and school dropout  underemployment  poverty  pre/postnatal exposure to drugs, alcohol, and toxins  parental substance abuse • Placement instability exacerbates this risk for mental and physical health, and socio-emotional problems
  4. 4. The interRAI Trauma-Informed Care Project Gain a comprehensive understanding of the mental health dynamics of individuals exposed to DVA Improve outcomes and enhance early intervention for mental health, behavioural and socio-emotional problems Improve understanding Early intervention Strengthen capacity at community level to address the health of victims of DVA using trauma- informed care Enhance multi-agency collaboration and improve continuity of care to better meet the needs of clients who have experienced DVA Strengthen Capacity Multi-agency Collaboration Project Objectives www.interrai.org
  5. 5. interRAI interRAI is an international collaborative to improve the quality of life of vulnerable persons through a seamless comprehensive assessment system. Our consortium strives to promote evidence-informed clinical practice and policy decision making through the collection and interpretation of high-quality data about the characteristics and outcomes of persons served across a variety of health, school and social services settings
  6. 6. How do interRAI instruments help children, youth, and their families? • Improving early identification of mental health and substance use across service sectors • Enhancing access to mental health care services • Improve transitions • Contributing to increased evidence-informed care planning to improve the functionality of mental health services across multiple service sectors
  7. 7. Lifespan Approach Through the use of an integrated suite of setting- and sector-specific assessments, the child/youth suite delivers comprehensive information about children and youth that can support them from birth through to adulthood and beyond.
  8. 8. interRAI Child and Youth Suite School Community HospitalJusticeHome
  9. 9. Examples of Manuals in Children and Youth Instruments
  10. 10. What sets interRAI Instruments Apart? One assessment…multiple applications
  11. 11. CAPs • Collaborative Action Plans are documents containing current evidence-informed approaches to guide interventions in target areas. • Case finding methodology • CAPs target to those who may benefit from an intervention • Enable service providers to use time efficiently • Decision-support tools to inform interactions between service providers and individuals with identified needs • A triggered CAP will highlight child or youth needs and appropriate interventions in that area. Judgement is required to determine clinician ability and availability. • 29 ChYMH CAPs available; 30 ChYMH-DD CAPs; 17 0-3 CAPs; 29 Youth Justice CAPS Example:
  12. 12. Safety CAPs Services and Supports CAPs Functional Status CAPs Family Life and Social Integration CAPs Health Promotion CAPs interRAI ChYMH Collaborative Action Plans (CAPs) Functional Status CAPs Communication, Life Skills Family Life and Social Integration CAPs Attachment, Caregiver Distress, Interpersonal Conflict, Parenting, Social and Peer Relationships Safety CAPs Control Interventions, Criminality Prevention, Harm to Others Hazardous Fire Involvement, Sexual Behaviour, Suicidality and Purposeful Self-Harm, Traumatic LifeEvents Services and Supports CAPs Education, Informal Support, Readmission, Support Systems for Discharge,Transitions Health Promotion CAPs Caffeine Use, Gambling, Medication Adherence, Medication Review, Physical Activity, Sleep Disturbance, Strengths, Substance Use, Tobaccoand Nicotine Use, Video Gaming, Weight Management www.interrai.org
  13. 13. Using the results Results of interRAI Assessment Youth Profile = 47 Support referrals Track change Support planning Assist triage decisions
  14. 14. Implementation of trauma informed care using the interRAI Child and Youth Mental Health instrument (ChYMH) Collaborative Action Plans (CAPs) www.interrai.org The interRAI Trauma-Informed Care Project Training staff at participating agencies on the use of the interRAI ChYMH CAPs using a trauma-informed lens Assessing the impact of implementing interRAI ChYMH Collaborative Action Plans from a trauma-informed perspective
  15. 15. Goals of the Current Project • Determine the needs of children who have been exposed to domestic violence (DV) • Identify specific developmental, behavioural, and emotional problems of this sub- population • Engage diverse team of knowledge-users, research, and decision-makers • Strengthen the delivery of mental health care for children and youth
  16. 16. Participants • Recruited from over 70 schools, secure custody sites and mental health facilities in Ontario, Canada • English-speaking children and youth • N = 8924 • No DV trauma n= 4764 • DV trauma n= 4160 No DV trauma DV trauma Age (M, SD) 11.56 (3.59) 12.54 (3.50) Gender Males (%) 61.4 54.6 Females (%) 38.6 45.4
  17. 17. Child and Youth Mental Health Instrument • Comprehensive assessment system • Approximately 60-90 minutes for completion • Semi-structure interview of individual needs • Well established reliability and validity of psychometric properties • A wide range of domains are possible needs are evaluated including:  Substance Abuse  Social Relationships  Environmental Issues  Medical Issues • Applications are included to support decisions related to care planning and outcome measurement
  18. 18. Measures Domestic Violence Trauma - 6 questions: Victim of: sexual abuse, physical abuse, emotional abuse; witness of domestic violence; physical neglect, emotional neglect Dichotomized 0 = Never, 1= Present in last 3 days- 1 year ago Combined into a cumulative trauma variable (range: 0-6) Dichotomized into 0= no DV trauma, 1 = yes Medical diagnosis: asthma, diabetes, epilepsy, FASD, traumatic brain injury, migraines Family factors: family dysfunction, caregiver distress, communication with the child, frequent disruptions in care Peer relationships: victim of bullying Externalizing / internalizing symptoms scales Disruptive and Aggressive Behaviour scale
  19. 19. Poly-Victimization and Types of trauma 0.0 10.0 20.0 30.0 40.0 50.0 60.0 None 1 trauma type 2 trauma types 3 trauma types 4 trauma types 5 trauma types 6 trauma types 52.9 16.3 10.6 7.6 3.8 2.8 1.0 Percent 0 10 20 30 40 50 60 70 WDV Emotional abuse Physical abuse Emotional neglect Sexual abuse Physical neglect 62.4 59.8 40 27.7 22.1 19.4 Percent
  20. 20. Externalizing and Internalizing Problems 0.0 5.0 10.0 15.0 DABS Internalizing symptoms Externalizing symptoms 4.1 9.2 3.8 5.6 11.1 5.6 MeanScore No DV trauma DV trauma
  21. 21. Family Factors 0.0 20.0 40.0 60.0 80.0 100.0 Caregiver distress Effective communication Disruptions in care 28.1 97.3 3.4 57.8 91.1 28.3 Percent No DV trauma DV trauma 0.0 0.5 1.0 1.5 2.0 2.5 No DV trauma DV trauma MeanFamilyDysfunction Family functioning
  22. 22. Medical Conditions 0.0 2.0 4.0 6.0 8.0 10.0 12.0 Diabetes Epilepsy FASD Migraine Traumatic brain injury Asthma No DV trauma 0.7 1.2 0.8 1.4 0.6 7.5 DV trauma 0.6 1.6 3.1 2.4 0.7 10.5 Percent No DV trauma DV trauma
  23. 23. 0.0 10.0 20.0 30.0 40.0 50.0 60.0 No DV trauma DV Trauma 35.6 57.6 Percent Victim of Bullying
  24. 24. History of Needs Met (yes) 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Physical needs met Safety needs met Percent No DV trauma DV Trauma
  25. 25. Summary of Results • 25.8% of children and youth who had witnessed DV have experienced multiple forms of trauma • Children and youth who had experienced DV trauma were less likely to have their basic needs met in early childhood • Compared to clinically referred children who did not experience DV trauma, those who have experienced DV trauma:  Experience more internalizing, externalizing, disruptive, and aggressive behaviours  Have more problems with family functioning, are less effective communication with parents, experience higher caregiver distress, and more disruptions in care  Experience more medical conditions such as asthma, epilepsy, Fetal Alcohol Syndrome  Experience more bullying by peers
  26. 26. How do youth in secure custody compare to inpatient and outpatient youth with respect to trauma? N= 755 youth Age 16 to 19 (M = 16.76, SD = .81) Subsample Case Type: Secure Custody/Detention N = 90 (11.9%) Inpatient N = 75 (9.9%) Outpatient N = 590 (78.1%) All youth were recruited from facilities in Ontario, Canada
  27. 27. Measures Traumatic Life Events Abuse: Victim of: sexual violence, physical abuse, emotional abuse, bullying Family Factors: Parental addiction, change of legal custodian, abandoned by parent, witness of domestic violence, Neighbourhood Factors: Victim of crime, lived in a violent neighbourhood Dichotomized 0 = Never, 1= in last 3 days- 1 year ago Scales: Social Disengagement (0-16) Depressive Symptoms Scale (0-36) Anxiety (0-28) Aggressive Behaviour (0-16) Hyperactive/Distractible (0-16) Disruptive Behaviour (0-12) 29
  28. 28. Traumatic Experiences: Abuse 30 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Victim of Sexual Violence Physical Abuse Emotional Abuse Victim of Bullying Percent Trauma Type YJ Inpatient Outpatient
  29. 29. Traumatic Experiences: Family Factors 31 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 Percent Trauma Type YJ Inpatient Outpatient
  30. 30. Traumatic Events: Neighbourhood Factors 32 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Violent Neighborhood Victim of Crime Percent Trauma Type YJ Inpatient Outpatient
  31. 31. Internalizing Problems: Anxiety, Social Disengagement and Depressive Symptoms 33 0 2 4 6 8 10 12 Anxiety Social Disangagement Depression MeanScore Intermalizing Symptoms YJ Inpatient Outpatient
  32. 32. Disruptive Behaviour Problems 34 0 0.5 1 1.5 2 2.5 3 YJ Inpatient Outpatient MeanScore Disruptive Behaviour Symptoms
  33. 33. Hyperactivity and Distractibility 35 0 1 2 3 4 5 6 7 8 YJ Inpatient Outpatient Mean-Distractibility/Hyperactivity Case Type Males Femailes
  34. 34. Aggressive Behaviour 36 0 0.5 1 1.5 2 2.5 3 YJ Inpatient Outpatient Mean-AggressiveBehaviour Case Type Males Femailes
  35. 35. Care Planning: Trauma 37 0 5 10 15 20 25 30 35 40 Reduce the impact of prior traumatic life events Address immediate safety concerns Percent Trauma CAP YJ Inpatient Outpatient
  36. 36. Care Planning: Harm to Others and Self-Harm 38 0 5 10 15 20 25 30 Moderate risk of harm to others High risk of harm to others Percent Risk of Harm to Others CAP 0 5 10 15 20 25 30 35 Moderate risk of harm to self High risk of harm to self Percent Suicidality and Purposeful Self-Harm CAP YJ Inpatient Outpatient
  37. 37. Care Planning: Interpersonal Conflict 39 0 5 10 15 20 25 30 35 40 45 50 Reduce conflict within a specific domain Reduce widespread conflict Percent Interpersonal Conflict CAP YJ Inpatient Outpatient
  38. 38. Care Planning: Substance and Tobacco Use 40 0 20 40 60 80 100 YJ Inpatient Outpatient Percent Substance Use CAP 0 5 10 15 20 25 30 35 40 45 50 Reduce or cease daily tobacco use Prevent long-term tobacco use Percent Tobacco Use CAP YJ Inpatient Outpatient
  39. 39. Care Planning – Other CAPs 41 0 10 20 30 40 50 60 70 Percent Triggered CAPs YJ Inpatient Outpatient
  40. 40. Conclusions: Comparison of Patient Groups • Trauma rates were found to be higher for the YJ group. • Females experienced higher rates of sexual violence and emotional abuse compared to males. • Females reported higher depression and anxiety compared to males. • Males reported higher externalizing behaviours than females. • YJ group reported lower levels of depression and anxiety than the two patient groups. • Evidence for differentiated patterns of gender differences for aggression between youth who live in the community and youth either detained in the YJ system or within inpatient mental health care. • No gender differences were found for distractibility and hyperactivity in the YJ group. • Youth involved in the justice system have complex psychosocial issues that require unique interventions. • Current study highlights a need for further research into implementation of trauma-informed care within the justice system.
  41. 41. Dr. Shannon L. Stewart, Associate Professor Director of Clinical Training Faculty of Education, Western University International InterRAI Child and Youth Lead interRAI Fellow sstewa24@uwo.ca

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