The Journey to Social Inclusion (J2SI) program, implementing trauma informed care

Transcription

1 The Journey to Social Inclusion (J2SI) program, implementing trauma informed care Cathy Humphrey, CEO, Sacred Heart Mission Professor Paul Flatau, Director CSI UWA

2 About the J2SI Program Key workers with low case loads responsible for coordinating the full service response Focus on rapid access to safe long term affordable housing and building capacity to sustain long term tenancy An integrated training and skills development program providing participants with interpersonal, practical, tenancy and vocational skills Workers trained in the delivery of therapeutic interventions, receiving supervision and guidance from a clinical consultant. Interventions were tailored to the needs of participants with a focus on the impact of trauma J2SI works in close partnership with other relevant services to ensure that participants are connected to specialist providers to meet their health, housing and other needs

3 The evidence base for trauma informed care Trauma drives homelessness: Traumatic events often occur as a precursor to becoming homeless. Many people left home to avoid ongoing trauma in the form of assault, child abuse and other forms of interpersonal violence. Homelessness drives trauma exposure: Being homeless is a risk for experiencing further trauma. The frequency of trauma exposure escalated when people lost their housing Trauma drives social difficulties: Trauma impacts on an individual s sense of safety and connection with other people Trauma drives mental health problems: Exposure to traumatic events in both childhood and adulthood are associated with Trauma Related Mental Health Disorder

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5 J2SI delivering trauma informed care

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7 What is trauma? DSM-5 criteria for trauma: Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: Directly experiencing the traumatic event(s) Witnessing, in person, the event(s) as it occurred to others. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

8 Symptoms of PTSD DSM-5 criteria for PTSD Symptoms fall into 4 categories: Intrusion symptoms (e.g. intrusive memories or distressing dreams) Avoidance symptoms (e.g. avoiding reminders of the trauma, such as certain people or places) Negative changes in thoughts and mood (e.g. thinking No one can be trusted ) Changes in arousal (e.g. angry outbursts)

9 Baseline Post Traumatic Stress Disorder J2SI Phase 2 Program Participants: Baseline 34.1% of J2SI program participants reported that they had been diagnosed with post traumatic stress disorder by a medical practitioner or a mental health professional.

10 Witnessing Parental/Carer Violence as a Child J2SI Phase 2 Program Participants: Childhood 52.7% had seen their parents/carers throw, hit, kick or smash something in front of the other person. 27.5% reported that they had seen this quite a lot (1) or all the time (2). 50.5% had seen their parents/carers threaten to physically hurt the other person. 27.5% reported that they had seen this quite a lot (1) or all the time (2). 30.8% had seen their parents/carers threaten the other person with a weapon (e.g broken glass, knife, gun). 16.5% reported that they had seen this quite a lot (1) or all the time (2). 47.3% had seen their parents/carers physically hurt or fight with the other person (e.g punch, shove, kick, burn or strangle). 24.2% reported that they had seen this quite a lot (1) or all the time (2).

11 Did the police ever come to your home because of violence (verbal or physical) between your parents/carers? J2SI Phase 2 Program Participants: Childhood 37.4% reported at least one visit from police because of parental/carer violence. Number of times police ever come to the home because of verbal/physical violence between parents/carers 62.6% 6.6% 11.0% 4.4% 15.4% Never Once 2-5 times 6-10 times More than 10 times

12 Did you ever have to leave home (even just for a few hours) because of violence (verbal or physical) between your parents/carers? J2SI Phase 2 Program Participants: Childhood 40.7% reported they had to leave home at least once because of parental/carer violence. 59.3% Number of times had to leave home because of verbal/physical violence between parents/carers 4.4% 15.4% 4.4% 16.5% Never Once 2-5 times 6-10 times More than 10 times

13 How old were you when you first left home because of violence (verbal or physical) between your parents/carers? J2SI Phase 2 Program Participants: Childhood Of all Js, 23.1% had first left home because of parental/carer violence when they were 10 years old or younger. 8.8% said they were 5 years old or younger. Age the first time leaving home because of violence between parents/carers 6.6% 5.5% 4.4% 3.3% 2.2% 2.2% 2.2% 1.1% 1.1% 1.1% 1.1% 1.1% 1.1% 6.6%

14 Post Traumatic Stress Disorder Checklist The 6-item PCL-C is a shortened version of the PTSD Checklist Civilian version (PCL-C). It was developed for use with in primary care or other similar general medical settings (Lang & Stein, 2005). 1. Repeated, disturbing memories, thoughts, or images of a stressful experience from the past? 2. Feeling very upset when something reminded you of a stressful experience from the past? 3. Avoided activities or situations because they reminded you of a stressful experience from the past? 4. Feeling distant or cut off from other people? 5. Feeling irritable or having angry outbursts? 6. Difficulty concentrating? For each item, participants indicate how much they have been bothered by each problem in the past month. The response options are: not at all (1), a little bit (2), moderately (3), quite a bit (4), or extremely (5) Scores of 14 or higher are suggestive of difficulties with traumatic stress. Lang, A.J., Stein, M.B. (2005) An abbreviated PTSD checklist for use as a screening instrument in primary care. Behaviour Research and Therapy, 43,

15 Baseline Post Traumatic Stress Disorder Checklist Scores J2SI Phase 2 Program Participants: Baseline 69.2% of Js had scores indicative of difficulties with traumatic stress.

16 What is trauma informed care? Trauma-informed care is: a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasises physical, psychological and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment Hopper, Bassuk & Oliver (2010, p 82)

17 Post Traumatic Stress Disorder Checklist Scores over time J2SI Phase 2 Program Participants 69.2% Percentage of Js with PCL scores that indicate difficulties with traumatic stress 57.1% 52.7% 58.2% Baseline Wave 2 (6 Months) Wave 3 (12 Months) Wave 4 (18 Months)

18 PhD Student: Dr Kathryn Taylor Homelessness Trauma Health Justice

19 PhD Student: Dr Kathryn Taylor Collect lifetime trauma history and identify the index trauma WHO Composite International Diagnostic Interview (WHO CIDI) Collect variables related to the index trauma When did it occur? Where did it occur? Did it involve an abuse of trust? Assess outcomes for J2SI participants versus those in existing services every 6 months Episodes of homelessness Physical and mental health diagnoses Standardised mental health measures (PCL-C, DASS21, K10, ASSIST) Injuries from interpersonal events Contact with the justice system What is the impact of trauma at Baseline? What is the impact of trauma on the trial outcomes?