The document outlines the bare necessities for creating trauma-informed mental health inpatient services. It discusses integrating an understanding of trauma throughout programs, policies, and procedures to prevent re-traumatization. It recognizes the need to meaningfully involve trauma survivors in designing services and prioritizing safety, choice, and control. The document also acknowledges that while progress has been made, more work is needed to fully implement trauma-informed practices, such as establishing a shared definition, increasing training, screening for trauma history, and ensuring emotional and physical safety remain top priorities.
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The Bare Necessities for Trauma-Informed Inpatient Mental Health Services
1. The Bare Necessities
for creating trauma informed
mental health inpatient services
Toni Ashmore
24 June 2011
Sydney
1
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
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. Interagency Trauma included in
Engagement
collaboration national knowledge
and skills framework
TIC included
in New Grad
Vulnerable
MH Increase in
Women‟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. 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
community
TIC included
programmes
in New Grad Sexual
MH Safety Discharge
programme planning
Admission
Planning
6
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
consumers
Risk Aversion
Discharge Lack of referral
priority
Sexual pathways with
Safety community
Admission programmes
Planning
7
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?
10. “Above All, Do No Harm”
“dealing with…primary pain without
unnecessarily inflicting secondary pain
experiences on the residents through
punitive or controlling reactions”(Anglin,
2002, p. 55)
11. What‟s needed
• A systematic approach to culture
change
• Administrative commitment to change
at all levels
12. National Action Plan
Community Knowledge
Integrated Building Redefining
National Definition and NGO
resourcing
Response Design Base
Research
Diagnosis
Framework Consumer
Leadership
Minimum
Standard
Workforce
Development
Undergraduate/ Funding
Forum
Post Graduate Advisory Group
Education/VTA
12
13. National Action Plan
National Definition
Community
and NGO
resourcing
Integrated
Response
Building
Design
Knowledge
Base
Trauma
Diagnosis
Research
Framework Consumer
Workforce
Development
Undergraduate/
Minimum
Funding
Forum
Leadership Standard
Post Graduate Advisory Group
Education/VTAB
Advisory
Minimum
State-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. Goals
We will know that we have accomplished our mission
when 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. National Action Plan
National Definition
Community
and NGO
resourcing
Integrated
Response
Building
Design
Knowledge
Base
Trauma
Diagnosis
Research
Framework Consumer
Workforce
Development
Undergraduate/
Minimum
Funding
Forum
Leadership Standard
Post Graduate Advisory Group
Education/VTAB
Advisory
State-wide Action Plan Group
Consumer
Rep
Goals Policy
Minimum
Standards
Funding Accountability
Structures
Resource
Clinical Guidelines and Policy development
Accreditation
Data
collection on
Trauma
history
IIMS
OV Audit
15
16. National Action Plan
National Definition
Community
and NGO
resourcing
Integrated
Response
Building
Design
Knowledge
Base
Trauma
Diagnosis
Research
Framework Consumer
Workforce
Development
Undergraduate/
Minimum
Funding
Forum
Leadership Standard
Post Graduate Advisory Group
Education/VTAB
Advisory
State-wide Action Plan Group
Consumer
Rep
Goals Policy
Minimum
Standards
Funding Accountability
Structures
Resource
Clinical Guidelines and Policy development
Accreditation
Data
collection on
Trauma
history
Local Policy and Procedures
IIMS
Universal
Vulnerable Restraint
screening Sensory
Women‟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. Local Policy and Procedures
Vulnerable Restraint and Universal screening
Sensory Modulation
Women‟s Space Seclusion (i.e. DV, CSA)
Incident Review
Sexual Safety Interagency collaboration Discharge Planning
Procedures
Engagement Admission Planning
17
18. National Action Plan
National Definition
Community
and NGO
resourcing
Integrated
Response
Building
Design
Knowledge
Base
Trauma
Diagnosis
Research
Framework Consumer
Workforce
Development
Undergraduate/
Minimum
Funding
Forum
Leadership Standard
Post Graduate Advisory Group
Education/VTAB
Advisory
State-wide Action Plan Group
Consumer
Rep
Goals Policy
Minimum
Standards
Funding Accountability
Structures
Resource
Clinical Guidelines and Policy development
Accreditation
Data
collection on
Trauma
history
Local Policy and Procedures Workforce
Development IIMS
Universal Working with Trauma
Vulnerable Restraint
screening Sensory
Women‟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. “How do I understand
this person?”
rather than
“How do I understand this
problem or symptom?”
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. Qualities and characteristics of
staff 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. 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. 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. National Action Plan
National Definition
Community
and NGO
resourcing
Integrated
Response
Building
Design
Knowledge
Base
Trauma
Diagnosis
Research
Framework Consumer
Workforce
Development
Undergraduate/
Minimum
Funding
Forum
Leadership Standard
Post Graduate Advisory Group
Education/VTAB
Advisory
State-wide Action Plan Group
Consumer
Rep
Goals Policy
Minimum
Standards
Funding Accountability
Structures
Resource
Clinical Guidelines and Policy development
Accreditation
Data
collection on
Trauma
Supervision history
Local Policy and Procedures Workforce
Development Individual and
IIMS
group
Universal Working with Trauma
Vulnerable Restraint
screening Sensory
Women‟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. Supervision
Individual and group
Mentoring
Positive promotion of supervision
25
26. Supervision
• Vicarious trauma normative in mental
health
• Staff own history of trauma
• Transference and countertransference
• „Have I done the right thing?‟
26
27. National Action Plan
National Definition
Community
and NGO
resourcing
Integrated
Response
Building
Design
Knowledge
Base
Trauma
Diagnosis
Research
Framework Consumer
Workforce
Development
Undergraduate/
Minimum
Funding
Forum
Leadership Standard
Post Graduate Advisory Group
Education/VTAB
Advisory
State-wide Action Plan Group
Consumer
Rep
Goals Policy
Minimum
Standards
Funding Accountability
Structures
Resource
Clinical Guidelines and Policy development
Accreditation
Data
collection on
Trauma
Supervision history
Local Policy and Procedures Workforce
Development Individual and
IIMS
group
Universal Working with Trauma
Vulnerable Restraint
screening Sensory
Women‟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. Keys to culture success
• Consistent message
• Shared values
• Support and commitment of management
• Equality of experts
• Staff valued
• Flexibility
• Inclusion
• Readiness
• Openness
29. National Action Plan
National Definition
Community
and NGO
resourcing
Integrated
Response
Building
Design
Knowledge
Base
Trauma
Diagnosis
Research
Framework Consumer
Workforce
Development
Undergraduate/
Minimum
Funding
Forum
Leadership Standard
Post Graduate Advisory Group
Education/VTAB
Advisory
State-wide Action Plan Group
Consumer
Rep
Goals Policy
Minimum
Standards
Funding Accountability
Structures
Resource
Clinical Guidelines and Policy development
Accreditation
Data
collection on
Trauma
Supervision history
Local Policy and Procedures Workforce
Development Individual and
IIMS
group
Universal Working with Trauma
Vulnerable Restraint
screening Sensory
Women‟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