This document discusses innovative approaches to supporting homeless people with complex needs. It covers topics like complex trauma, psychologically informed environments, trauma-informed care, housing first, and the adverse childhood experiences study. Housing first is described as an approach that offers permanent housing with no preconditions, along with flexible, client-centered support. Trauma-informed care aims to help clients feel safe and in control of their recovery without being retraumatized by services. The document also provides a case study of how understanding trauma helped improve a client's engagement and behavior.
An invited presentation to the The Compassion and Social Justice Lecture Series on Courageous Leadership in a Crisis
"This event explores the courage required when leading in a crisis and making important decisions without precedence. Given the global impact of COVID, leaders are being tested daily. Hear perspectives from two global leaders and learn from their courageous leadership during the historical HIV/AIDS crisis and the more current COVID pandemic."
Speakers:https://beholdvancouver.org/events/courageous-leadership-in-a-crisis
Family Matters: Homeless Youth & Eva’s Initiative’s Family Reconnect ProgramTheHomelessHub
Young people become homeless largely because of challenges they experience within their families. We know well that conflicts within family - whether related to abuse, mental health, or addictions issues of either young people themselves or other family members – often lead young people to the streets. Because of this, most street youth serving agencies largely ignore the potential role of family members in helping people make the transition to adulthood. There are some exceptions, and one of these is the Family Reconnect program of Eva’s Initiatives in Toronto. In the report, Family Matters, this program is examined to evaluate how reconnecting with family may help some young people avoid long term homelessness. In doing this review, the authors raise some important questions about the Canadian response to youth homelessness. They argue for a rather radical transformation of this response, one that reconsiders the role of strengthened family (and community) relations in preventing and responding to youth homelessness.
An invited presentation to the The Compassion and Social Justice Lecture Series on Courageous Leadership in a Crisis
"This event explores the courage required when leading in a crisis and making important decisions without precedence. Given the global impact of COVID, leaders are being tested daily. Hear perspectives from two global leaders and learn from their courageous leadership during the historical HIV/AIDS crisis and the more current COVID pandemic."
Speakers:https://beholdvancouver.org/events/courageous-leadership-in-a-crisis
Family Matters: Homeless Youth & Eva’s Initiative’s Family Reconnect ProgramTheHomelessHub
Young people become homeless largely because of challenges they experience within their families. We know well that conflicts within family - whether related to abuse, mental health, or addictions issues of either young people themselves or other family members – often lead young people to the streets. Because of this, most street youth serving agencies largely ignore the potential role of family members in helping people make the transition to adulthood. There are some exceptions, and one of these is the Family Reconnect program of Eva’s Initiatives in Toronto. In the report, Family Matters, this program is examined to evaluate how reconnecting with family may help some young people avoid long term homelessness. In doing this review, the authors raise some important questions about the Canadian response to youth homelessness. They argue for a rather radical transformation of this response, one that reconsiders the role of strengthened family (and community) relations in preventing and responding to youth homelessness.
Dementia friendly communities - my talk this eveningshibley
This is the talk I gave on dementia friendly communities this evening at BPP Law School. It is part of a public lecture series for raising awareness about English dementia policy for the general public. The lectures are provided completely free of charge.
Zero Suicide in Healthcare International Declaration (March 2016)David Covington
A diverse group of 50 peer leaders, government policy makers, and healthcare providers from 13 countries convened for Atlanta 2015: An International Declaration and Social Movement. Invited guests included “Zero Suicide” advocates and pioneers as well as others committed to suicide prevention and better healthcare.
This workshop brought together, for the first time, the pioneers and the partner organisations of the Integrated Care and Support programme. It focused on building a learning community that will help develop, share and spread knowledge and solutions at scale and pace across the country.
More information: http://www.nhsiq.nhs.uk/news-events/events/integrated-care-and-support-pioneers-inaugural-workshop.aspx
More about the integrated care and support pioneers programme: http://www.nhsiq.nhs.uk/7862.aspx
Alzheimer Europe talk 2015 Dr Shibley Rahmanshibley
These are the slides for the presentation I will give this year at the Alzheimer Europe conference in Ljubljana in Slovenia. It's survey based research on the importance of clinical nursing specialists in dementia.
Learning Disabilities: Dynamic Registers Webinar – 14 December 2016NHS England
Specific challenges in working with dynamic registers: Kevin Elliott, Clinical Lead (Policy & Strategy), Transforming Care Programme, NHS England
Sarah Jackson, Strategic Case Manager (North),Children and Young People, Learning Disabilities and/or Autism Workstream, NHS England
Topics covered:
- Risk stratification
- Consent
- Children and Young People
- People with autism and no learning disability
Ending the Cycle: Taking a Stand Against Domestic Violence.pdfWhalley Law
Domestic violence is a pervasive issue that affects individuals and families across the globe. It thrives in silence, behind closed doors, perpetuating a cycle of fear, pain, and trauma. However, by raising awareness, advocating for change, and providing support to survivors, we can collectively take a stand against domestic violence and work towards creating a safer and more compassionate society. This article aims to shed light on the importance of ending the cycle of domestic violence and offers insights into how individuals and communities can actively contribute to this vital cause.
Understanding Domestic Violence
Domestic violence encompasses a range of abusive behaviors that occur within intimate relationships, including physical, emotional, sexual, and financial abuse. It affects people of all genders, ages, races, and socioeconomic backgrounds. The consequences of domestic violence are far-reaching, impacting the physical and mental health, well-being, and overall quality of life of survivors and their families.
Breaking the Silence
One of the most significant barriers in addressing domestic violence is the silence that shrouds it. Many survivors hesitate to come forward due to fear, shame, or a lack of resources and support. By breaking this silence, we can create an environment where survivors feel empowered to share their stories, seek help, and access the support they need. It is crucial to cultivate a culture of empathy, non-judgment, and active listening, so survivors feel safe and validated when disclosing their experiences.
Raising Awareness and Education
Raising awareness about domestic violence is key to creating societal change. Educational initiatives can help dispel myths and misconceptions, challenge victim-blaming attitudes, and promote healthy relationship dynamics based on respect, equality, and consent. Schools, workplaces, community organizations, and media platforms all play a vital role in providing accurate information, promoting prevention strategies, and offering resources to those affected by domestic violence.
Supporting Survivors
Supporting survivors is essential in their journey towards healing and rebuilding their lives. Here are some ways individuals and communities can provide support:
Empathy and Validation: Offer a listening ear and provide validation to survivors by believing their experiences and validating their feelings. Show empathy and compassion, emphasizing that the abuse is not their fault.
Safety Planning: Help survivors develop safety plans tailored to their specific circumstances. Safety plans involve identifying resources, creating escape routes, and establishing communication networks to ensure their safety during and after leaving an abusive relationship.
Referral to Support Services: Connect survivors with local domestic violence shelters, helplines, counseling services, and legal aid organizations that can provide specialized assistance and guidance.
Improving the health and wellbeing of students and universitiesDr Justin Varney
A presentation I gave on improving the health and wellbeing of students and staff in higher education at a conference on Protecting and Supporting Students: Promoting Wellbeing, Confronting Harassment and Preventing Extremism
Dementia friendly communities - my talk this eveningshibley
This is the talk I gave on dementia friendly communities this evening at BPP Law School. It is part of a public lecture series for raising awareness about English dementia policy for the general public. The lectures are provided completely free of charge.
Zero Suicide in Healthcare International Declaration (March 2016)David Covington
A diverse group of 50 peer leaders, government policy makers, and healthcare providers from 13 countries convened for Atlanta 2015: An International Declaration and Social Movement. Invited guests included “Zero Suicide” advocates and pioneers as well as others committed to suicide prevention and better healthcare.
This workshop brought together, for the first time, the pioneers and the partner organisations of the Integrated Care and Support programme. It focused on building a learning community that will help develop, share and spread knowledge and solutions at scale and pace across the country.
More information: http://www.nhsiq.nhs.uk/news-events/events/integrated-care-and-support-pioneers-inaugural-workshop.aspx
More about the integrated care and support pioneers programme: http://www.nhsiq.nhs.uk/7862.aspx
Alzheimer Europe talk 2015 Dr Shibley Rahmanshibley
These are the slides for the presentation I will give this year at the Alzheimer Europe conference in Ljubljana in Slovenia. It's survey based research on the importance of clinical nursing specialists in dementia.
Learning Disabilities: Dynamic Registers Webinar – 14 December 2016NHS England
Specific challenges in working with dynamic registers: Kevin Elliott, Clinical Lead (Policy & Strategy), Transforming Care Programme, NHS England
Sarah Jackson, Strategic Case Manager (North),Children and Young People, Learning Disabilities and/or Autism Workstream, NHS England
Topics covered:
- Risk stratification
- Consent
- Children and Young People
- People with autism and no learning disability
Ending the Cycle: Taking a Stand Against Domestic Violence.pdfWhalley Law
Domestic violence is a pervasive issue that affects individuals and families across the globe. It thrives in silence, behind closed doors, perpetuating a cycle of fear, pain, and trauma. However, by raising awareness, advocating for change, and providing support to survivors, we can collectively take a stand against domestic violence and work towards creating a safer and more compassionate society. This article aims to shed light on the importance of ending the cycle of domestic violence and offers insights into how individuals and communities can actively contribute to this vital cause.
Understanding Domestic Violence
Domestic violence encompasses a range of abusive behaviors that occur within intimate relationships, including physical, emotional, sexual, and financial abuse. It affects people of all genders, ages, races, and socioeconomic backgrounds. The consequences of domestic violence are far-reaching, impacting the physical and mental health, well-being, and overall quality of life of survivors and their families.
Breaking the Silence
One of the most significant barriers in addressing domestic violence is the silence that shrouds it. Many survivors hesitate to come forward due to fear, shame, or a lack of resources and support. By breaking this silence, we can create an environment where survivors feel empowered to share their stories, seek help, and access the support they need. It is crucial to cultivate a culture of empathy, non-judgment, and active listening, so survivors feel safe and validated when disclosing their experiences.
Raising Awareness and Education
Raising awareness about domestic violence is key to creating societal change. Educational initiatives can help dispel myths and misconceptions, challenge victim-blaming attitudes, and promote healthy relationship dynamics based on respect, equality, and consent. Schools, workplaces, community organizations, and media platforms all play a vital role in providing accurate information, promoting prevention strategies, and offering resources to those affected by domestic violence.
Supporting Survivors
Supporting survivors is essential in their journey towards healing and rebuilding their lives. Here are some ways individuals and communities can provide support:
Empathy and Validation: Offer a listening ear and provide validation to survivors by believing their experiences and validating their feelings. Show empathy and compassion, emphasizing that the abuse is not their fault.
Safety Planning: Help survivors develop safety plans tailored to their specific circumstances. Safety plans involve identifying resources, creating escape routes, and establishing communication networks to ensure their safety during and after leaving an abusive relationship.
Referral to Support Services: Connect survivors with local domestic violence shelters, helplines, counseling services, and legal aid organizations that can provide specialized assistance and guidance.
Improving the health and wellbeing of students and universitiesDr Justin Varney
A presentation I gave on improving the health and wellbeing of students and staff in higher education at a conference on Protecting and Supporting Students: Promoting Wellbeing, Confronting Harassment and Preventing Extremism
The ppt is prepared to serve the need of curriculum for post graduate students interested in learning about the counselling for terminal disease esp. HIV/AIDS.
There are many misconceptions about harm reduction. In this presentation, we will debunk the myths, explain what harm reduction is and provide examples of harm reduction in action throughout our province and nation. This presentation also includes how individuals can become volunteers with our agency.
Why do some individuals develop addictive disorders while others don’t? The relationship between trauma and addiction can provide valuable insight. The adverse childhood experiences (ACES) study helped define and shape our understanding of this complex issue and research demonstrates that higher ACE scores are linked with higher rates of future substance use. It is critical that the health care workforce understand the impact of trauma on addiction and how this relationship impacts treatment and recovery. Explore what it means to be trauma-informed and how providers can integrate trauma-informed care into recovery services and other work with individuals who experience addictive disorders.
Midwifery 101 by Corrine Clarkson and Morag Forbes lnnmhomeless
What to worry about and how to help when presented with complex pregnant women in your practice. A presentation to the London Network of Nurses and Midwives Conference 2016
Topic The Care Act: Implications for Homeless Health Care
Presenter Karl Mason
Social Work Lead - Trauma, Emergency and Acute Medicine Kings Lead KHP Homeless Pathway Team Kings
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. www.homeless.org.uk Let’s end homelessness together
Jo Prestidge
Innovation and Good Practice Project Manager
Homeless Link
Innovative approaches to
supporting homeless people
with complex needs
2. www.homeless.org.uk Let’s end homelessness together
• Complex needs and homelessness
provision
• Complex needs and complex
trauma
• Psychologically Informed
Environments
• Trauma Informed Care
• Housing First
In this workshop….
3. www.homeless.org.uk Let’s end homelessness together
Amicus Horizon
What we know…
• Rough sleeping has increased by 51% in last two years
• 47% of accommodation projects report reduced funding, number of bed
spaces declining
• 33% living in accommodation projects have complex needs, 32%
affected by mental health problems and 31% affected by drug problems
and 23% alcohol problems.
• 73% of accommodation projects turned people away because their
needs were too high or too high risk to staff and residents (67%)
• Risk to self, non-engagement, balance with other clients (reasons for
refusal)
4. Question…
www.homeless.org.uk Let’s end homelessness together
What is your experience of working
with people with multiple and complex
needs?
How do they present to your service?
5. Complex needs
Hard Edges (2015) – 85% of those in touch with
criminal justice, substance misuse and
homelessness services in the UK have
experienced trauma as children (not
representative of women).
‘Women with extensive experience of physical
and sexual violence are far more likely to
experience disadvantage in many other areas of
their lives, including disability and ill health,
substance dependence, poverty and debt, poor
living conditions, homelessness and
discrimination’. Hidden Hurt, Agenda (2016)
www.homeless.org.uk Let’s end homelessness together
6. Trauma and Homelessness
www.homeless.org.uk Let’s end homelessness together
• Goodman et al (1991) – psychological trauma and homelessness is linked.
Losing one’s home, living in the ‘shelter system’ or experiencing trauma
(particularly women) before homelessness. Homeless people display two of
the symptoms of PTSD; social disaffiliation and learned helplessness.
• Nick Maguire et al (literature review) – strong link between homelessness
and complex trauma. Makes the argument that psychological interventions
are needed.
• ‘People with a history of complex trauma, including the chronically homeless,
may behave in a range of ways that suggest underlying difficulties with
trusting relationships, and with managing their own emotions in the face of
perceived adversity’. (PIE good practice guide, CLG, 2012)
7. Trauma:
www.homeless.org.uk Let’s end homelessness together
1. Trauma is pervasive
2. The impact of trauma is very broad and touches many life
domains
3. The impact of trauma is often deep and life-shaping
4. Violent trauma is often self-perpetuating
5. Trauma is insidious and preys particularly on the more vulnerable
among us
6. Trauma affects the way people approach potentially helpful
relationships
7. Trauma has often occurred in the service context itself
8. Trauma affects staff members as well as consumers
Fallot and Harris 2009
8. Psychologically Informed Environments (PIE)
www.homeless.org.uk Let’s end homelessness together
• Recognition high levels of personality disorder
and complex trauma in homeless population
• Royal College of Psychiatry
• Enabling Environments and PIPEs
• DCLG guidance 2012
• Framework for use by homelessness services
• A service which considers the emotional and
psychological needs of their clients
9. PIE framework
www.homeless.org.uk Let’s end homelessness together
Managing
relationships
Environment
and spaces
Training
and support
Psychological
framework
Monitoring
outcomes
Reflective
Practice
10. Use of PIE
www.homeless.org.uk Let’s end homelessness together
Waterloo project
St Mungos
Newcastle and Gateshead
St Basils
Commissioners
PIE Link
PIE training
11. Me, PIE and the big apple
www.homeless.org.uk Let’s end homelessness together
• Pan London Personalised Budgets
project for entrenched street homeless
people
• Go into crisis once housed
• Challenging and destructive
behaviour
• Won’t engage at all
• Tons of training, totally missing
something!?
• Transatlantic Practice Exchange
• Center for Urban Community Services,
NYC
12. What is Trauma-Informed Care?
www.homeless.org.uk Let’s end homelessness together
SAMHSA Treatment Improvement Protocol 57:
‘TIC is an intervention and organisational approach that focuses on how trauma
may affect an individual's life and his or her response to behavioural health
services from prevention through treatment. There are many definitions of TIC
and various models for incorporating it across organisations, but a “trauma-
informed approach incorporates three key elements:
(1) realising the prevalence of trauma;
(2) recognising how trauma affects all individuals involved with the service,
organisation, or system, including its own workforce; and
(3) responding by putting this knowledge into practice”
(SAMHSA, 2012)’
13. Trauma Informed Care
www.homeless.org.uk Let’s end homelessness together
(Hopper, Bassuk, & Olivet, 2010)
Strengths -
Based
Approach
Emphasis on
Safety
Opportunities
to Rebuild
Control
Trauma
Awareness
14. ACE study
Adverse childhood experiences
Early life trauma events may include one
or more of the following:
Emotional abuse
Physical abuse
Sexual abuse
Emotional neglect
Physical neglect
Domestic violence between parents
Drug/alcohol using parent(s)
Parent(s) with mental illness
Lost parent through separation/divorce
A parent in prison
www.homeless.org.uk Let’s end homelessness together
15. ACE study 1995-1997:
Adverse childhood experiences
As the number of ACEs increases, so does the risk for the following (if 4 or more
ACEs):
7 x more likely to experience alcoholism and/or alcohol abuse
260% more likely to experience chronic obstructive pulmonary disease
460% more likely to experience depression
1220% increased risk of suicide attempts
Health-related quality of life
Illicit drug use
220% more likely to experience Ischemic heart disease
240% higher risk of stroke
240% higher risk of hepatitis - Liver disease
Poor work performance and financial stress
190 % increased risk of cancer
160% increased risk of diabetes
(Info taken from a Nadine Burke-Harris presentation)
www.homeless.org.uk Let’s end homelessness together
16. 2015:
The national survey of ACE Wales
14% had ACE score of 4+ and compared to those with 0 ACE score were…
4 times more likely to be a high-risk drinker
6 times more likely to have had or caused unintended teenage pregnancy
6 times more likely to smoke e-cigarettes or tobacco
6 times more likely to have had sex under the age of 16 years
11 times more likely to have smoked cannabis
14 times more likely to have been a victim of violence over the last 12 months
15 times more likely to have committed violence against another person in the
last 12 months
16 times more likely to have used crack cocaine or heroin
20 times more likely to have been incarcerated at any point in their lifetime
www.homeless.org.uk Let’s end homelessness together
17. Trauma- Informed Support
www.homeless.org.uk Let’s end homelessness together
• A philosophy underpinning organisations and service delivery
• Seeing everything through the lens of trauma
• Not trauma specific – much broader approach
• Creating safety – first stage of trauma recovery (Judith Herman)
• Aims to prevent retraumatisation, ‘do no harm‘ and recognises
widespread impact of trauma (clients and staff)
18. Vicarious Trauma
It is common for support providers to be
impacted when working with survivors of
trauma
Workers may develop symptoms in
response to being exposed to the trauma
This is known as vicarious or secondary
trauma and it can be overwhelming and
lead to burn out
www.homeless.org.uk Let’s end homelessness together
19. The Benefits
For service users:
Feel safe
Empowered to take control
Increased engagement
Aware that symptoms are a result of trauma
Can begin recovery
Not retraumatised by services
www.homeless.org.uk Let’s end homelessness together
For staff:
Increased understanding
Increased compassion and hope
Increased resilience
More able to cope with
challenges
Don’t see things in such a black
and white way
Reduced burnoutFor organisations:
Clear values and philosophy
Increased retention of service users
Increased engagement
Improved outcomes
Increased retention of staff
Reduced staff sickness and absence
Insightful and compassionate places
to work
20. www.homeless.org.uk Let’s end homelessness together
Amicus Horizon
Case Study:
• Black male, early 40’s
• Accommodated but not complying with rules
• Using numerous services but not allowing people to
support him meaningfully
• Always agitated and verbally aggressive
• Made accusations and threats towards staff and other
service users regularly
• Possible psychosis as delusional ideas
• ‘Victimised’ and defensive
21. www.homeless.org.uk Let’s end homelessness together
Amicus Horizon
Case Study:
• He, I and others were ‘hyper-aroused’
• Quiet safe place to meet
• Grounded him
• Introduced him to a model
• Agreed how behaviour would be managed
• Provided him with resources he could use and refer to in
order to ground himself and process events
• Number of incidents/complaints reduced
22. TIC in England
www.homeless.org.uk Let’s end homelessness together
• TIC and PIE!
• Training the sector
• Women’s criminal justice sector
• Agenda
• Young Minds
• Where else?
23. www.homeless.org.uk Let’s end homelessness together
• Unlike traditional staircase approach
• Permanent offer of a home
• No conditions other than maintaining
tenancy
• Flexible, person-centred support
• International evidence base
What is Housing First?
24. That sounds like floating support..
www.homeless.org.uk Let’s end homelessness together
25. Where is it being used?
www.homeless.org.uk Let’s end homelessness together
• Widely adopted across the US
• Central to national homelessness
strategies in some countries
• Growing in popularity across other
European countries
• A number of services and pilots in
England and devolved nations
• Service models vary depending on
context
26. Support teams structure
www.homeless.org.uk Let’s end homelessness together
• Assertive Community Treatment
- multi-disciplinary
- ‘mini welfare state’
• Intensive Case Management
• Depends on operating context – what
other services are available, funding
streams
• UK – a role for both?
27. The principles
www.homeless.org.uk Let’s end homelessness together
1. People have a right to a home
2. Flexible support is provided for as long as
is needed
3. Housing and support are separated
4. Individuals have choice and control
5. An active engagement approach is used
6. The service is based on people’s
strengths, goals and aspirations
7. Harm reduction approach is used
28. Use in England
www.homeless.org.uk Let’s end homelessness together
33 LA areas
current
Projects in
33 LA areas
50/50
PRS & RSL
Not all for
rough
sleepers
Not all LA
funded
Crisis
feasibility
study
Another 12
planning
(not inc. SIB)
29. Does it work?
www.homeless.org.uk Let’s end homelessness together
• Consistent trends despite
context
• Tenancy sustainment
• Health and wellbeing
• Substance misuse
• Anti Social Behaviour and
ineffective service use
International evidence base:
30. Other things to mention
www.homeless.org.uk Let’s end homelessness together
• Homelessness and mental illness
• Autism
• Acquired Brain Injury
• Supporting drug users
• Homeless Health Needs Audit
• Making Every Adult Matter
• Agenda
31. More Information:
Any questions?
Jo Prestidge
joanne.prestidge@homelesslink.org.uk
020 7840 4420
@joanneprestidge
To book the training visit:
http://www.homeless.org.uk/events/training or email
training@homelesslink.org.uk
www.homeless.org.uk Let’s end homelessness together
Editor's Notes
5% of women experience extensive abuse in life course (vs 1% men) – 3% experience extensive physical violence from partner in adulthood
Gender specific services?
Loss of safety/fear of extreme physical harm and loss of control/overpowered and overwhelmed
PTSD main symptoms (from minor affect to disabling):
Avoidance
Nightmares/flashbacks
Hypersensitivity
Dissociation
Rule of 1/3 traumatised:
3 people experience an event. 1 is non-plused, one is ‘life is wonderful’, one is damaged.
Not everyone that experiences early abuse or neglect will present with symptoms of personality disorder/other conditions. This depends on resilience.
Resilience: a secure attachment to someone else, support network, age at onset of trauma and numbers of trauma, what happens when they tell someone of the trauma
Multiagency working group on community mental health – discussions arose
Guidance – PIE to enable people to make changes in their lives, relationships seen as key tool for change
Homelessness staff have most contact but are least qualified
Managing relationships – help staff and clients self manage their emotional and behavioural responses to triggering events
Psych framework – services to have shared understanding of, and response to, the people they support
Training and support – allowing staff to move away from crisis management to working in a planned and therapeutic way
Physical and social environment – adapated to improve space for engagement and support
Eval of outcomes – evaluate effectiveness for ongoing improvement and evidence impact
A philosophy underpinning organisations and service delivery
Seeing everything through the lens of trauma
Not trauma specific – much broader approach
Creating safety – first stage of trauma recovery (Judith Herman)
Aims to prevent retraumatisation, ‘do no harm‘ and recognises widespread impact of trauma (clients and staff)
Researches found these four key themes across trauma-informed homelessness services
There are other principles too – but these are critical.
This research created the definition of TIC.
Trauma awareness – all staff have some understanding of trauma and impact
2. Emphasis on safety – service providers and managers focus on creating safe environments and relationships
3. Opportunities to rebuild control – service users are empowered to take control of their recovery
4. Strengths-based approach – services users are seen as people rather than problems and their strengths are acknowledge and encouraged
The ACE (Adverse Childhood Experience) study involves more than 17,000 Americans who are surveyed through their health insurance company and a gov health organisation
It asks them how many of these things they experienced in childhood and then assesses them against later-life health and wellbeing
It shows that ACEs are a major risk factor for leading causes of illnesses and death in the US. Traumatic experiences are transformed from psychosocial experience into organic disease, social malfunction and mental illness
This study also showed that ACEs are common
Trauma informed support – provides an opportunity to restore balance in a persons life.
This is not about “fixing someone” rather about providing safe space and not re-traumatising the individual
Trauma specific services = psychologist on site
Trauma and psychologically informed services – grounding, CBT etc
Pre-treatment approach – providing safe environment for people. Not responsible for treatment!
Staff and service user wellbeing – supervision; peer support, reflective practice etc (vicarious trauma)
Start of recovery, establishing safety – see your resource pack re Judith Herman book (1992) – Trauma and Recovery Recommend you read this. Defines stages of recovery – safety is the first stage – your key role in services. Ask work to purchase this resource for you!
Secure relationships/secure base
Preparing people to be ready
‘clinical parenting’ – providing the safe relationship that has been missing. Reflect back to this morning!
Focuses on impact on workers too – check in with self too! How am I feeling? How is this impacting on me, my relationships with colleagues and clients?
Ask the group:
What things do humans find traumatising?
Looking for experiences which relate to: abuse, violence, neglect, bereavement, natural disasters
ACTIVITY 2
Looking for discussions around:
The nature of the event
The resilience of the person involved
Natural, manmade, interpersonal
Support worker – secondary trauma
Trauma that sticks: often manmade/interpersonal – what we are talking about today
Natural trauma – no blame/injustice