trauma informed practice: what is it and how do you do it?
TRANSCRIPT
Trauma Informed Practice: What Is It & How Do You Do It?
• Heather Fulton, PhD, RPsyc • Ayesha Sackey, MSW • Justine Dodds, RN • Patricia Doyle, RPN • Kristina Conger, RPN
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Presenter Disclosures
• None- all employees of PHSA
• No sources of potential bias
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Our Expertise
• We did not write any of the TIP guides
• We do have experience reading all the guides and working to implement them
http://bccewh.bc.ca/publications-resources/documents/TIP-Guide-May2013.pdf
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Agenda/Goals
1. What is Trauma Informed Practice? Why do it?
2. How can you implement TIP at your site?
a) Evaluation Tools
b) Intake
c) Client Crises
d) Staff Education
Burnaby Centre Comfort Plan
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What is TIP?
Trauma Informed Toolkit, Klinic, 2013
Trauma Informed
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Trauma
• “Trauma as experiences that overwhelm an individual’s capacity to cope”
• Can include:
– Single Incident
– Complex or repetitive
– Developmental
– Intergenerational
– Historical TIP Guide, BC Ministry of Health, 2013
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Trauma
• Common elements:
– Unexpected
– Person was unprepared
– There was nothing the person could do to stop it from happening
• Traumatic events beyond a person’s control
• Can take serious emotional toll even if no physical damage
• Can deeply impact identity, have negative effects in mind, body, soul and spirit
• Nature of event does not determine if it’s traumatic
– Individual’s experience of the event, meaning they make of it
Trauma Informed Toolkit, Klinic, 2013
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What does TIP look like? Key principles: 1) Trauma Awareness
– Include understanding of trauma in all aspects of service delivery
2) Emphasis on Safety and Trustworthiness
– Safety and Empowerment are central
3) Choice, Collaboration and Connection
– Priority on individual’s safety, choice and control
4) Strengths and Skill Building
– Treatment culture of nonviolence, learning, collaboration
• Overall: “essence” or “way of being”; not specific method or strategy
• Disclosure of trauma experiences not necessary
• Trauma Informed Practice/Service ≠ Trauma Specific Service TIP Guide, BC Ministry of Health, 2013
Similar to Recovery
Model, Client-
Centered Care
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Why use TIP?
Trauma is pervasive – 76% of Canadian adults report some for of trauma exposure in their
lifetime • 9.2% meet the criteria for PTSD
– Approx. 50% of Canadian women & 33% of men survived at least on incidence of sexual or physical violence
TIP Guide, BC Ministry of Health, 2013
– Adverse Childhood Events study: • Trauma vastly more common than recognized, • Often coexisting and directly linked to later life substance use
and mental health problems, as well as a range of chronic diseases such as diabetes
Anda et al., 2002; Anda et al., 2007
– In some studies 80-90% of adults seeking help for mental health and substance use
Mueser et al., 1998, Christensen et al., 2005; TIP Guide, BC Ministry of Health, 2013
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Why use TIP?
TIP improves client care • Integrated, trauma-informed models of substance use and
mental health treatment for women found to be more effective did not result in increased service costs
Veysey et al., 2004
• Without understanding of trauma, misdiagnosis and inadequate treatment can result
TIP Guide, BC Ministry of Health, 2013
• Education and system change for healthcare to include TIP is consistent with recommendations from the Truth and Reconciliation Commission (2015)
www.trc.ca/websites/trcinstitution/index.php?p=3
reconciliationcanada.ca
www.sanyas.ca
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How implement TIP?
• Step 1: Get a team together
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How did we get a team together? • Challenge: Recruiting busy people
• Success: We had/have group of 15+ individuals
• Lessons Learned:
Plant many seeds:
– Shared TIP Guide from Ministry
– Call out for people to join a TIP working group
– Send a video link to drum up interest
• Maggie Bennington Davis video talk available through VCH education rounds
• Other options http://trauma-informed.ca/resources/videos/
– Appeal to authority: Link to something from ‘higher up’
This is a big deal & big opportunity
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Resources to share with your team
• BC TIP Guide:
• Bonus:
– Trauma Informed Toolkit from Manitoba: http://trauma-informed.ca/
– CCSA (4pgs): http://www.ccsa.ca/Resource%20Library/CCSA-Trauma-informed-Care-Toolkit-2014-en.pdf
– US: http://www.traumainformedcareproject.org/
– Bridging responses: Front line worker guide to working with women with traumatic stress http://www.coalescing-vc.org/virtualLearning/section1/trauma-informed-practices/documents/bridging_responses.pdf
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Step 2: Evaluate your program
• Challenge: Where do we even start? What needs to change to be more trauma informed?
• Lesson Learned:
Use a checklist
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Step 2: Evaluate your program
• Evaluation tools – We recommend TIP Guide (Appendix 2)
– Many out there
Other Tools:
– Organizational checklist: http://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf (note v. similar to BC version)
– TIP Culture: https://www.healthcare.uiowa.edu/icmh/documents/CCTICSelf-AssessmentandPlanningProtocol0709.pdf
– Agency Self Assessment: http://traumainformedcareproject.org/resources/Trauam%20Informed%20Organizational%20Survey_9_13.pdf
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Group Discussion:
• Who could you get on your team to help with TIP?
• How will you get their buy in?
• What first steps could you do in the next month to get people on board with TIP?
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Group Discussion Debrief
• Share with the larger group:
– Your service and population (1 sentence)
• Who could you get on your team to help with TIP?
• How will you get their buy in?
• What first steps could you do in the next month to get people on board with TIP?
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Step 3: Prioritize what to change
• Challenge: There is SO much that needs to change
• Lessons Learned:
– Make a list of desired changes
• What are the ‘quick wins’, the ‘must dos’, the ‘can wait’
–Example: We could easily change intake process to be more welcoming- but we need more changes here
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Step 4: Divide and Conquer • Ongoing Challenge: There are so many ‘must dos’
• Lessons Learned: Group areas of change
– Success: Divided changes into: Intake, Crises and Staff Education
• TIP WG divided into 3 WGs, more recruitment of staff
– Success: Create leadership opportunities for staff
• DELEGATE- get your change champions to help here
• People have complaints- get them on your side
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Our 3 areas of focus:
• Intake
• Client Crisis
• Staff Education
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Example: Intake
• Challenges:
– Our space could be more welcoming but we cannot vastly change the spaces
– Some procedures are necessary for safety
• Successes:
– Offering food and water
– Made some environmental changes (paint, signs, lighting)
– Reduced intake procedure time by 1hr+
– Orientation group happens later in week
– Other assessments take place later in week
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Example: Client Crisis
• Challenge: We have a very low seclusion room use, aren’t we doing okay here?
– Is our response just reactive?
– How could we be more proactive?
– Let’s look at literature- how are people reducing seclusion and restraint rates
– Are we using best practices?
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Example: Client Crisis
• Success: Creation of Client Comfort Plan
– Check out Quality Forum poster for more detail
• Lessons Learned:
– TIP is proactive not just reactive
– You need input from ALL levels of staff, different disciplines- not just management
– You need input from clients
– Pilot, revise, repeat
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Example: Staff Education • Challenge:
– How do we get staff buy in to TIP? – 1 day education won’t change everything, how do we sustain?
• Success: – Education after recruited TIP WG members
• They had been talking and doing things for awhile – Built ‘buzz’ around TIP for awhile – Education delivered by the TIP WG members (‘change leaders’) to
colleagues • They become point persons for staff for questions later
– Ongoing initiatives every year: videos, tip emails, talks, education rounds – Ongoing discussions and updates in meetings
• Lessons learned: – This isn’t a ‘quick win’- this will be ongoing – Culture change takes time
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Group Discussion
• What would need to happen in order for culture to change at your workplace?
– For all staff to incorporate TIP in interactions with clients AND each other
• Trauma Awareness
• Safety and Trustworthiness
• Building on Strengths and Skills
• Choice and Collaboration
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Group Discussion Debrief
• Any tips to share with larger group from your discussion:
– How could you foster culture change at your workplace?
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Examples of Past & Current TIP
Education Interventions • 1 day all staff training
• Weekly 30min “learning huddles” about challenge on the unit
– E.g. Challenging behavior by client- coaching how to view this and respond in trauma-informed ways
• Educational Rounds talks: 1hr, monthly
• Invitation of some staff to a provincial TIP retreat
• Invitation of special guest speakers
• San’yas Cultural Safety training for all staff
• Cultural Safety lunchtime webinars
• Email of new TIP resources/manuals, videos
• Targeted emails of select TIP practices (e.g. to psychiatrists, NPs, individual therapists)
• Weekly “TIP tips” emails – normalizing issues, suggestions of practical actions
• Encouraging staff to speak up and discuss TIP in meetings
– E.g. “Is that language TIP-consistent?”
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Summary
• TIP can improve client care quality, safety and outcomes
• FREE resources exist to help you evaluate your program, staff education
• It doesn’t take huge changes, or huge costs – you are likely already doing some TIP already!
• You likely already know about how to make a change in your program:
1. Get your team together
2. Evaluate your program for what changes to make
3. Prioritize what to change
4. Divide and conquer
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Questions? • Heather Fulton, PhD, RPsych [email protected] • Ayesha Sackey, MSW, Manager [email protected] • Justine Dodds, RN, Director [email protected] • Trish Doyle, RPN [email protected]
• Kristina Conger, RPN [email protected]
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Acknowledgements
Heather Baitz
Rick Johal
Daniella Sosdjan
Becky Hynes
Liina McNeil
Laura Dosanjh
Nicole Marcia
Amanda Nikkel
Crynos Mabiza
Jacklyne Rea
Kathryn Embacher
Monica McAlduff
Laura Blackadar
Brian O’Rourke
Isabella Mori
Craig Matsu-Pissot
Suki Brar
Anna Kitschke
Jane Sun
Vijay Seethapathy
Christian Schuetz
Bev Aird
Babita Heer
Michael Scott
Mandeep Grewal
Veronica Bodie
Allison Lee
Other key people at BCMHA involved in TIP: