The Future of Australian Housing Conference Qld …qshelter.asn.au/.../2017/06/MHCC-Trauma-Informed-Care.pdfThe Future of Australian Housing Conference Qld 2017 Trauma-informed Care

The Future of Australian Housing Conference Qld 2017

Trauma-informed Care and Practice in Homeless Services: towards a shift in service delivery culture

Who is MHCC?

• Peak body representing CMOs in NSW

• Members deliver a range of psychosocial disability support

programs with a focus on trauma-informed recovery oriented

practice

• Services include: housing, employment and social inclusion

activities; clinical and peer supported services & primary health

care (PHNs)

• Member orgs also provide: advocacy, education, training and

professional development and information services

MENTAL HEALTH COORDINATING COUNCIL

Our Vision

That people experiencing mental health conditions are supported to

live meaningful lives in the communities of their choice


Strategic priorities

Policy Leadership, Influence and Reform

Sector Development

Research and Development

Organisational Development


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“Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life”

Judith Herman 1992, Trauma and Recovery: The Aftermath of Violence: from Domestic Abuse to Political Terror, New York: Basic Books.


Safety First


Trauma and Homelessness


An inescapably stressful event that overwhelms people's coping mechanisms

Bessel Van der Kolk

What is trauma?

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“Failure to acknowledge the reality of trauma and abuse in the lives of children, and the long-term impact this can have in the lives of adults, is one of the most significant clinical and moral deficits of current mental health approaches.

Trauma in the early childhood shapes brain and psychological development, it sets up vulnerability to stress and to the range of mental health problems.”

Professor Louise Newman, Psychiatrist and Director

Centre for Developmental Psychiatry and Psychology, Monash University


The consequences of complex trauma and adaptations to cope with it, often lead to a number of mental health and related problems, e.g.:

• poor mental and physical health

• substance abuse and misuse

• eating disorders

• self-harming behaviours

• suicidality

• dysfunctional relationships and poor self-esteem

• poor educational outcomes, poverty, homelessness

• and contact with the criminal justice system

Impacts of Trauma

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Single events – accidents, natural disasters

Type I Trauma - associated with development of disorders e.g., PTSD, depression and anxiety

Interpersonal trauma - enduring and prolonged

Type 11 Trauma/Complex Trauma - complex psychosocial and mental health problems, high rates of psychiatric disorders such as post-traumatic stress disorder, substance use disorders and depression

Trauma Experiences

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“Complex Trauma occurs as a result of traumatic stressors that are interpersonal – premeditated, planned and perpetrated by one human being on another. It is particularly damaging if it occurs in childhood.

These actions can be both violating and exploitative of another person”

Courtois, C A & Ford, J D (eds), 2009,

Treating Complex Trauma: An Evidence-Based Guide, New York, The Guildford Press

Complex Trauma

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Australian Research


• Both Type I and Type II trauma were experienced by the majority of participants

• Consistent with previous research, outcomes for the 60% of participants exposed to Type II trauma included high levels of difficulties with:

• emotional regulation (62%)

• maintaining social relationships (93%)

• managing risk taking behaviour (41%)

• suicidal ideation (19%)

• dissociative experiences (72%)

• holding negative perceptions of the world and self (66%)

Participants who had experienced multiple Type I traumas also reported increased difficulties with relationships, memory and dissociative difficulties, negative views, self-harming behaviours and suicidal ideation

Effects of Trauma


• Majority of participants (88%) met criteria for at least one current mental health diagnosis.

• These included:• current posttraumatic stress disorder (PTSD; 73%)• current depression (54%)• alcohol abuse disorder (49%) • alcohol dependence disorder (43%)• substance abuse disorder (51%)• substance dependence disorder (44%)• and current psychotic disorder (33%)

PTSD was found to be highly comorbid with other disorders

Study data

• Women and men who experienced physical abuse

before the age of 15 10% (779,500) and 9.4%

(702,400) respectively

• 12% (956,600) women reported that they had been

sexually abused before the age of 15 compared of

to 4.5% (337,400) of men

Australian Bureau of Statistics

• An Australian initiated study of over 21,000 older

Australians found that over 13% of those surveyed

reported having been either physically or sexually

abused in childhood or both

• Draper et al, 2008


Prevalence


Trauma rates are higher in vulnerable groups who experience discrimination and stigma:

• Women

• Elderly people

• Homeless people

• People with a disability

• People in the criminal justice system

• Aboriginal and Torres Strait Islander people

• Refugees and culturally diverse people

• People with a mental health condition

• GLBTIQ

Vulnerable groups

• Physical – jumpy, easily startled or ‘shut down’, hard to ‘get going’

• Cognitive – thoughts, memories, beliefs

• Emotional – strong, fluctuating, overwhelming or numb and distant

• Behavioural – attempts to manage memory and emotion, and to avoid being overwhelmed

• Spiritual – loss of connectedness, faith in others

High degrees of attachment may become untenable for partners, friends and family


Signs of exposure to trauma


Safety is necessary for healing

Safety should be considered :

• Within the body• In relationships• In environments• In systems


• We need to acknowledge the deficits in MH and human service systems – people not having needs met, often re-traumatised by the services themselves;

• their presentation misunderstood, i.e. ending up with multiple diagnoses

• What we now term as a Trauma-Informed Care & Practice is a key element of best practice recovery orientation

It requires a fundamental shift in philosophy, culture, and practice .

The Imperative for Change


• Evidence based, best practice approach that fosters opportunities for survivors to rebuild a sense of control and empowerment

• Involves not only changing assumptions about how we organise and provide services, but creates organisational cultures that are personal, holistic, creative, open, and therapeutic

• A practice that can be utilised to support service providers in moving from a caretaker to a collaborator role

So what is Trauma- informed Care & Practice ?


Principles of Trauma-informed Care & practice


Benefits of Trauma-informed Care & Practice


• Your values and attitudes

• Your behaviours and choices

• Your knowledge and awareness

Recognise * Reflect * Respond

How can you assist ?


• Reduce the possibilities for re-traumatisation and harm

• Trauma- informed recovery must be integrated into a philosophy of practice and set of working principles

• Embedded across systems and services - working with other practitioners across service settings

Minimise barriers to recovery

A worker :

• is approachable and understanding

• has an open, honest and transparent professional agenda

• is an interested and engaged professional

• provides a supportive safe environment

• is willing to listen non-judgementally to disclosures of trauma and abuse

• receives the client’s story calmly and does not dramatise or treat the story as unspeakable

• maintains confidentiality


Safety to disclose


Ensure a safe place

Use yourself as therapeutic tool

Employ empathic attunement

Be self-aware

Think about neurobiology

Think about the ‘window of tolerance ‘

Make safety plans – identify triggers, preferences, choices

for treatment

Understand ‘problem’ behaviours as adaptations

Focus on strengths

Alarm minimisation

What can you do?


Don’t• Force the person to talk if they don’t want to• Don’t interrupt • Don’t tell someone what to feel, think or do• Don’t try to solve the person’s problems for them• Minimise the person’s feelings or problems• Touch or get too close without their permission• Use judgemental language even to colleagues• Describe them by their behaviours or symptoms• Don’t perpetuate us and them • Use guilt to try to stop the person self-harming• Give ultimatums


Trauma-Informed Care & Practice Organisation Toolkit (TICPOT) : a quality improvement change resource

Supporting organisational change

Stage 1


TICPOT has been mapped against national standards

TICPOT


TICPOT assists services review every aspect of their organisation’s structure including:

• Governance, Management and Leadership

• Policies and structure,• A healthy and effective workforce• Consumer and carer/family

participation• direct service delivery• information and education • Outcomes and evaluation

Planning for organisationalchange


Stage 2 Supporting Organisational Change


MHCC Learning and DevelopmentAward-winning Mental health professional

development for everyone.


Other TICP resources from MHCC

THANK YOU

Corinne HendersonPrincipal Advisor| Policy & Legislative Reform [email protected]

Documents

The Future of Australian Housing Conference Qld …qshelter.asn.au/.../2017/06/MHCC-Trauma-Informed-Care.pdfThe Future of Australian Housing Conference Qld 2017 Trauma-informed Care