Dr. Rachel Happer and Sonal Raithatha presented on developing a web-based manual to accompany a psycho-education course for adolescents who have experienced complex trauma. They discussed defining complex trauma, its effects, and a 3-stage model of treatment. They piloted a 12-session course called "Survive and Thrive" and aim to supplement it with an online resource covering topics like coping skills, feelings, self-harm, and relationships. Feedback was positive, though some felt content or age ranges could be improved. The web resource may help engage more vulnerable youth and support maintaining progress, but confidentiality and different experience levels pose challenges.

1. Dr. Rachel Happer
Sonal Raithatha
NHS Lothian
Piloting a Psycho-Education Course for
Adolescents who have experienced
complex trauma: Developing a Web-Based
Manual to Accompany the Course

2. Overview of today’s session
 An introduction to complex
trauma
 Introducing a pilot adolescent
psycho-education package for
complex trauma
 The potential of using online
resources to engage a complex
trauma popuation

3. What is complex trauma?
 Multiple traumatic events within a care
giving system
 Repeated events that begin early in
childhood
 All areas of child development affected
 Trauma of an interpersonal nature

4. What is complex trauma?
 Can involve highly invasive traumatic events
but does not have to
 Can involve exposure to repetitive childhood
sexual, physical, and/or sexual abuse
 Not necessarily a consequence of sexual
abuse
 Does not necessarily involve a traumatic
“event”

5. How it presents
 Alterations in relations with others (inability to
trust others and lack of comfort/intimacy in
relationships)
 Somatisation and/or medical conditions
 Alterations in the systems of meaning (sense
of helplessness resulting from the
impossibility of being understood by anyone

6. Some consequences
 Post traumatic adaptation to severe
childhood abuse & attachment trauma can
include:
-Emotional lability
-Poor emotional regulation
-Relational instability
-Impulsivity
-Unstable self-structure

7. Interactions
Absence
of affect regulation
capacities
Tension reduction
behaviours
Abuse related
memories,
cognitions,affect

8. The 3 stage model

9. Using complex trauma as an
organisational framework
 Clients must be able to ‘handle’ any
intervention
 Want to work within the therapeutic window
-The psychological location between
overwhelming exposure and excessive
avoidance
-A hypothetical ‘place’ where intervention is
most effective

10. How do we apply this?
 In small groups spend
some time thinking about
how you can apply an
organisational framework of
complex trauma, to help
inform your understanding
of the case
 Pick 2 key points from your
discussion to feed back

12. Background to ‘Survive and Thrive’
 Gender-based violence strategy NHS –CEL
(2008)
 Trauma informed services agenda
 Central role of trauma in mental
health/routine enquiry
 Lack of confidence expressed by staff
 The Matrix (2011) & evidence base

13. For young people
 Prevalence of trauma in adult populations
 Developmental understanding of complex
trauma
 Potential for early intervention
 Reduce exposure to re-traumatisation
 Target towards a vulnerable developmental
stage for those with trauma histories

14. Survive and Thrive – Under 18s
What is it?
 Encouraging young people to reflect upon
links between their trauma and their
relationships, self-beliefs and coping
strategies
 Stabilization of trauma symptoms
 Better management and regulation of
behaviours and emotions
 Challenging self-blame beliefs

15. Survive and Thrive – Under 18s
How is it structured?
 12 1½ hour sessions:
1. What to expect
2. Strengths and goal setting
3. Survival techniques
4. Avoiding risk and crisis
5. Understanding my feelings
6. Anxiety and Triggers
7. Feeling Angry
8. Understanding my Trauma
9. Being kinder to ourselves
10. Thinking About Me
11. Forming Relationships
12. Moving forwards

16. Survive and Thrive – Under 18s
How was it delivered?
 3 facilitators
 Mix of informational input and interactive
activities, both individual and group
 Practised stabilisation techniques in the
sessions
 Used audio and video clips
 Had slides up in the background

19. Let’s have a go!
 Imagine that you are an
adolescent with a complex
trauma history
 In small groups, use the
relationship diamond to
rank the characteristics in
your given relationship
Most
important
Least
important

20. Some feedback from the pilot group
 Completed outcome measures (YP
Core, DERS, GBO, TSI-A, CHI service
evaluation)
 YP focus group
 Adult survivors group consultation

21. Outcome measures

22. 12

23. DERS
12
Difficulties in Emotion Regulation (DERS) Subscales

24. Some goals identified were:

25. CHI
 All YP felt listened to, taken seriously and
treated well
 Felt the people running the group knew how
to help them and that they were easy to talk
to
 They would all recommend the group to a
friend who was having similar difficulties
 Time and location of appointments could be
improved

26. Some feedback comments

27. YP focus group
 Ownership and personalisation important
 Enjoyed activities, especially mindfulness
 The group environment helped to normalise their
difficulties
 Would have liked the group to last longer – still felt
the had questions but weren’t sure what these were
 Felt there was a lot of content but views were mixed
as to where more/less focus should be.
 All wanted more advice on sleep and self harm

28. Consultation with Adult Survivors
 Valued the importance of the compassionate
approach and being told they were not to
blame.
 Highlighted the value of looking at risky
coping.
 Supported the idea of learning about trauma
from a younger age
 Appreciated the focus on
confusing/contradictory feelings

29. Consultation with Adult Survivors
 More emphasis needed on the normality of
contradictory feelings.
 Different views on mixed gender groups
 Were unsure about the age range
 Felt the messages need to be direct and
specific
 More work on “getting how it is”
 Challenged the occasional use of jargon!

30. Let’s take this online..

31. Plans for the Survive and Thrive –
Under 18s web resource
 Password protected
 Access to weekly group
slides
 Topic areas with
information and audio
 Links to other helpful
websites

32. Topic areas
 Have I Experienced Trauma?
 Understanding my Trauma
 Keeping Myself Safe
 Learning to Cope
 Understanding my feelings
 I’m Worried about my Self Harm
 How I am with Others
 Trouble Sleeping?
 Help Me!

33. Slide of screen shots for topics

34. Slide of screen shots for topics

35. Feedback on this so far
 Is a good way access young people who find
services hard to reach
 Important to strike the right balance of
engaging but not triggering, especially with
regards to images
 Difficulty with when to give them access
 Could be enhanced by rolling support groups
or maintenance sessions?

36. Are web resources a good idea?
 Discuss the value of
supplementing existing
interventions with web
based material
 What is the potential
impact in terms of
engaging service users?
 What are the drawbacks?

37. Now let’s have a go!
 In your small group,
decide how you could
adapt the material you
have been provided with,
to create an engaging
online resource for a
young person with
complex trauma

38. Potential implications of this work
 To reduce vulnerability to further harm in a
vulnerable group?
 Better negotiate a vulnerable developmental
stage
 Help us to reduce risky coping and promote
healthier relationships
 Challenge negative self beliefs and self
blame?
 Support individuals to engage in other
therapeutic work?

39. Potential to apply to LAAC settings
 Vulnerable group, many with complex trauma
histories
 May access skills & self management outside
CAMHS
 May support a moment by moment approach
 Placement breakdown is common at
adolescence

40. Potential Challenges
 Confidentiality
 Young people at different stages
 Non referred young people
 Too challenging in a home environment
 May be better targeting staff or foster carers.

41. Thank you!
Any Questions?
Rachel.Happer@nhslothian.scot.nhs.uk
Sonal.Raithatha@nhslothian.scot.nhs.uk