1. 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

3. 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

4. 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

5. 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

6. 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 between

7. 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)

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

9. 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 High risk social behaviours Poorer health outcomes

10. 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

11. 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

12. RESULTS: PATIENT AGE GROUPS

13. RESULTS: REFERRAL REASON

14. RESULTS: IDENTIFIED ACE

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

16. 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

17. 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

18. 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)

19. QUESTIONS?
THANK YOU

20. 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), 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, Mares, S., Newman, L. & Warren, B. (2012). Clinical skills in Infant Mental Health: The First Three Years, 2nd Ed. Acer Press. Camberwell, Victoria.