Nicole Lind Western Health Pre-EMPTS A trauma informed model of care in Sunshine Hospital Emergency Department A 2015 Reaching for the Stars Project Nicole Lind Western Health

WHAT IS THE Pre-EMPTS MODEL? “PROVISION OF RESPONSIVE EMERGENCY MATERNTIY AND PAEDIATRIC TRAUMA SERVICE” Psychosocial trauma care in health setting Babies, Children, Young People Pregnant Women ˂ 20 weeks State Government Funding Advanced Scope of Practice Social Work Pre-EMPTS aligned with the 2015 Reaching for the Stars project

A RESPONSIVE HEALTH CARE SYSTEM History of psychosocial trauma Increased use of the health care system (Clark, Cassen, Fourt & Shetty, 2014) ALERT to possible risk and psychosocial trauma in the lives of patients (Kezelman & Stravropoulas , 2012). STRENGTHS based - empowering and collaborative ENHANCE protective factors and resilience CULTURALLY SAFE

AIM & OBJECTIVES To develop and trial a psychosocial trauma informed model for Paediatric and Maternity patients in ED. Staff knowledge of psychosocial trauma informed care Identification of risk and Adverse Childhood Experiences (ACE) Supports to children and families

TRAUMA, ADVERSE CHILDHOOD EXPERIENCES & HEALTH An Obesity Clinic in USA noted a 50% patient drop out rate of patients Dr Felitti interviewed the patients who had dropped out and found that majority had experienced child sexual abuse Dr Felitti and Dr Anda then went on to survey 17,000 individuals in regards to their childhood experiences between1995-1997.

Adverse Childhood Experiences (ACE) ABUSE   NEGLECT HOUSEHOLD DYSFUNCTION PHYSICAL  EMOTIONAL  SEXUAL   EMOTIONAL FAMILY VIOLENCE  PARENTAL SEPARATION MENTAL HEALTH  EXPOSURE TO SUBSTANCE USE  INCARCERATED PARENT  (Larkin, Felitti and Anda 2014)

ACE MODEL (Adapted from: Felitti & Anda , 2009)

A STORY OF PSYCHOSOCIAL TRAUMA Sally, 16 years of age: Attends Emergency Department following drug overdose At 1 year old, her mother died from a heroin overdose No relationship with her father Lives with extended family members – Protective factor At 9 years of age she is sexually abused by her brother As an adolescent she has several suicide attempts She has limited social supports Her education is impacted ACE score of 3 High risk social behaviours Poorer health outcomes

Pre-EMPTS MODEL OF CARE Service Readiness Education to ED staff at Sunshine Hospital Emergency paediatric and maternity patients referred to Pre-EMPTS Assessment Psychosocial risk assessment Brief modified ACE Questionnaire: patient and caregiver Intervention Validation and supportive counselling Psycho-education to patient and caregiver Safety planning, referral and follow up plan

RESULTS: PRE-EMPTS REFERRALS 233 Total Referrals June – March 2016 23.3 Average monthly referrals to Pre-EMPTS Referrals when staff became more educated Referrals when new rotation of junior doctors Referral reason extended beyond support for medical diagnosis as staff knowledge increased Referrals became targeted for psychosocial trauma interventions

RESULTS: PATIENT AGE GROUPS

RESULTS: REFERRAL REASON

RESULTS: IDENTIFIED ACE

LIMITATIONS Patients lost to follow up Only 1 staff member credentialed for Pre-EMPTS Primary caregiver not always present Not longitudinal

RECOMMENDATIONS Pre-EMPTS After Hours Service Credentialing of additional staff Expand the model of Trauma Informed Care to other parts of the health service Additional data e.g. cultural background, war trauma Self report screening questionnaire Introduction of Resilience and Protective Factor Questions Evaluation including patient centred outcomes

OUTCOMES Multi disciplinary team educated and aware of psychosocial trauma, ACE and the impact on patient’s health and wellbeing outcomes Social Work Informed Trauma (SWIFT) Collaboration: Multi-Centre Pilot Study 12 months 3 Health Services ED, Paediatric Outpatients, Paediatric Ward

STAFF FEEDBACK “We have seen changes in our daily practice resulting in better performance in KPI’s and improved service provision from medical & nursing staff with the benefit of accessible expertise” (ED Paediatrician) “FANTASTIC & much needed for Paediatric patients in ED” (ED Paediatrician) “An excellent consultation service” (IRS Care Coordinator) “Yes, it provides a service, where ED had no service, the other benefit is we are now highlighting trauma for our patients and factoring that into their care.” (ED Paediatrician)

QUESTIONS? THANK YOU nicole.lind@wh.org.au anita.morris@wh.org.au

REFERENCES Kezelman, C., Stravropoulas, P. (2012). The last Frontier: Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery. Adults Surviving Child Abuse. Kirribilli, Sydney. Clark, C., Classen, C.,Fourt, A., Shetty, M., (2014). Treating the Trauma Survivor: An essential guide to Trauma Informed Care. Taylor and Francis. New York. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245-258. Larkin, Felitti and Anda (2014) Social Work and Adverse Childhood Experiences Research: Implications for practice and Health policy, Social Work in Public Health. 29:1, 1-16. Mares, S., Newman, L. & Warren, B. (2012). Clinical skills in Infant Mental Health: The First Three Years, 2nd Ed. Acer Press. Camberwell, Victoria.