1. Australian WFD and Learning Directions for Achieving Recovery OrientedTrauma Informed Services Trauma Informed Care and Practice: Meeting the Challenge Conference Sydney - 23 & 24 June 2011 Tina Smith, Senior Policy Officer MHCC

2. Why Pursue WFD and Learning Directions? We need to presume the clients we serve have a history of traumatic stress and assume universal precautions by creating systems that are “trauma informed”. (Hodas, 2005)

3. Changing culture requires both …… Organisational change Workforce change “Where will the staff with the rights skills and experience come from to deliver trauma informed services?”

4. Criteria for building a trauma informed MHS system (SAMHSA, 2007) 3/12 criteria relate to WF WF recruitment, hiring and retention of trauma informed staff WF orientation, training, support, job competencies and standards related to trauma Consumer/trauma survivor involvement and trauma informed rights

5. Education and training systems … Accredited (AQTF) Trauma? No University qualifications eg, GP, psychiatry, nursing, psychology, SW, OT Vocational qualifications (CS&H Training Packages) eg, Certificate IV and Diploma in MH and/or AOD, other? MH Peer Worker Competency Development Project Non-accreditedTrauma? Yes Short courses

6. CS&HISC MH Skills Articulation Project Methodology VET/Universities & Mapping Reports Explored MH qualifications and content at Australian universities Policy and Workforce Report Interviews and focus groups about job roles/tasks 79 MHWs (public/community, staff/managers) Diverse qualifications and experience 3 areas (metro, regional, rural)

7. Practice and occupational boundaries in CMH

8. CS&HISC MH Skills Articulation Project Findings (Policy and WF Study) Supported integration across medical, talking and social rehabilitation approaches Identified the need to: “Systematically assess the skills and knowledge required to work effectively in the sector, with a view to developing a unified body of psychosocial practice from which to derive an evidence-based workforce strategy” Filling gaps in knowledge & skills

9. Inclusion of Trauma in MH WFD Directions in Australia Trauma? No National MH Strategy, Plan, Standards COAG NAP MH 2006-2011 National MH WFD Strategy/Plan Health Workforce Australia (HWA) Skills Australia Trauma? Yes CSHISC Environmental Scan 2011/CIP As well as service coordination, PSR & talking therapies to improve responses to people with complex and diverse needs

10. CSHISC Environmental Scan 2011 “Examine expansion of care coordination roles and skills/practices to support increasingly complex needs, including trauma-informed care and talking therapies. Any development of training package content should be addressed in conjunction with broader community MH WFD objectives and identification of a unified body of knowledge/evidence about PSR/recovery-oriented practice”. “This work would inform the existing 2010–2011 work plan proposal: ‘Mental health work – recovery-oriented community mental health and higher-level skills’”. What are the competencies needed to deliver trauma informed services?

11. Trauma competencies Competence - Definition The state or quality of being adequately or well qualified; ability. A specific range of skill, knowledge, or ability. Knowledge- what we know Skills- what we do Attitude- how we do it

12. “Criteria for building a trauma informed MHS system” (SAMHSA, 2007) 3/12 criteria relate to WF WF recruitment, hiring and retention of trauma informed staff WF orientation, training, support, job competencies and standards related to trauma Consumer/trauma survivor involvement and trauma informed rights

13. 1. WF recruitment, hiring and retention of trauma informed staff Prioritize staff with training in and/or lived experience of trauma (eg, job descriptions, “trauma champions”) Outreach to trauma informed/educated employees Advocate for trauma content in education and training Incentives, bonuses and promotions for trauma informed staff Professional development opportunities to become trauma informed Trauma informed/protective OH&S

14. 2. WF orientation, training, support, job competencies and standards related to trauma Trauma informed HR for all employees … that incorporates relevant skill sets and job standards Broad human service involvement (ie, integration & coordination) All staff (admin, direct care, management) To receive basic education about … Prevalence of trauma Traumatic impacts Dynamics of re-traumatization Diversity and trauma

15. 2. WF orientation, training, support, job competencies and standards related to trauma All direct care staff (clinical and non-clinical) Understanding & responding to complex behaviour/s Maintaining boundaries (personal & professional) Trauma dynamics and the avoidance of iatrogenic re-traumatization Relationships between trauma, MH and life problems Vicarious traumatization and self-care Specific traumas (issues & approaches) Trauma techniques (eg, grounding, recovery skills) And … all Training must involve people with lives experience

16. 2. WF orientation, training, support, job competencies and standards related to trauma All clinical staff (including disaster response staff) Evidence based practice in trauma assessment & treatment skills Participation on advanced trauma training For disaster responders – initial assessment through intervention

17. 3. Consumer/trauma survivor involvement and trauma informed rights Involved at all levels of service planning, implementation & evaluation (ie, not just training and peer work roles) Trauma informed ISPs developed collaboratively with every consumer and, where appropriate, their involved family and friends Rights informed participation agenda (ie, discrimination)

18. Implementation plan for the 4th National MH Plan Workforce Development Action 25: Develop and commence implementation of a National Mental Health Workforce Strategy that defines standardized workforce competencies and roles in clinical, community and peer support areas. Action 26: Increase consumer and carer employment in clinical and community support settings.

19. Trauma competencies “Comorbidity Competencies Skills Indicators” (Graham, H. & White, R., 2011) Essential Knowledge Core Practice Skills Specialist Skills/Leadership

20. Trauma competencies Essential Knowledge Knowledge of the impacts of a history of trauma and the various ways it can impact an individual, family and/or community Basic knowledge of impact of childhood abuse and neglect and the links with adult problems. Knows that trauma can be associated with complex and diverse health and social issues and unhelpful coping strategies (suicidality, intoxication/self-medication, dissociation, anxiety, excessive anger, self-harm). Core Practice Skills Specialist Skills/Leadership

21. Trauma competencies Essential Knowledge Core Practice Skills Identifies and responds to mental health issues immediately following a traumatic event, but does not try to engage with the trauma history at this time. Is aware of triggers, vulnerabilities or untimely helping that might contribute to re-traumatisation. Supports consumers who have been through trauma to access MH treatment, rehabilitation and support services, where indicated. Specialist Skills/Leadership

22. Trauma competencies Essential Knowledge Core Practice Skills Specialist Skills/Leadership Actively demonstrates a recovery oriented approach to understanding how trauma affects each individual, helping them to discover their own strategies and goals. Collaborates with other health and community services professionals involved in the persons’s recovery from trauma. Provides education for people seeking healthy coping strategies in response to trauma. Facilitates professional development for services to be more trauma informed.

23. Supervision, coaching & mentorship Professional development Leadership Trauma champions Healing workplaces Organizational/cultural change Trauma informed approaches are Recovery oriented approaches

24. Recovery principles include Hope and faith Meaning, purpose & direction Equality & respect Empowerment & self-determination Social inclusion and connectedness

25. Summation

26. Mental Health Coordinating Council PO Box 668, Rozelle NSW 2039 Cnr. Church & Glover Streets, Callan Park P: (02) 9555 8388 F: (02) 9810 8145 Email:info@mhcc.org.au Website: www.mhcc.org.au Materials available online such as: information; fact sheets; training & workforce development; research publications; the Mental Health Rights Manual; submissions; sector events; current issues and news. www.mhcc.org.au Presenter: Tina Smith tina@mhcc.org.au