1. The Highs and Lows of Trauma informed care
Forensic Services
Sarah Robinson – Trauma Lead
Dr Emma Groves – Principal Psychologist

2. WHERE THIS JOURNEY BEGAN
2001
WHERE THIS JOURNEY BEGAN

3. Hold on Tight

4. SECURE MENTAL HEALTH CULTURE

5. SECURE MENTAL HEALTH CULTURE

6. SEEK FIRST TO UNDERSTAND

7. Do not sit on the patients chair

8. ALTERNATIVE TO DEBRIEF

9. TRAUMA INFORMED CARE FOR ALL

10. WHERE DO WE START?

11. SANDPIPER

12. TRAUMA INFORMED CARE WROTE THE PROPOSAL (got the buy in from leads)
Measures taken
2 day away day training
Core stabilisation skills sessions 2 x per day
Incident reflection 24 hours post incident]
Staff supervision weekly CAT reflective and trauma CFT based
Service user meetings to explore incidents and experiences (came later)
Incentive based stages

13. TRAUMA TRAINING Day 1 Why do we need TIC?
What did the psychometrics tell us?
Vicarious trauma and staff wellbeing– why are we all burnt out?
Understanding why we & our ward can trigger someone's trauma

14. DAY 2 Compassion, building on what we have
Patients narratives (hard hitting)
3 stages of trauma work (focus is safety)
Skills Training
Incident reflection
Stages (passport system)
Implementation

15. CORE STABILISATION SESSIONS
RUN TWICE PER DAY- NO DEVIATION
MIXTURE OF DISCLIPLINES
CO PRODUCED
STAFF SIGN THE SKILLS SHEET RE ATTENDENCE AND PARTICIPATION
ATTENDENCE IS ENCOURAGED FOR 1 SESSION PER DAY
ENGAGEMENT IS EXPLORED IN MDTS
ENGAGEMENT IN SESSIONS = INCENTIVES

16. STABILISATION INTERNAL SAFETY Emotional awareness Emotional regulation
Emotional containment
Emotional normalising
Emotional expression in a positive way
Secure compassionate relations
Developing a set of skills for interpersonal effectiveness
Awareness and management of triggers
Mindfulness
Physical exercise
Art therapy
Spiritual discussion/expression
Investment between all parties
Healthy eating
Encouragement/positive reinforcement

17. STABILISATION EXTERNAL SAFETY Safe environment Stable routine
Consistency in rules
Limited deviations
Structure and routine
Similar staff structure
All MDT working together
Shared journey a space for patients to feel valued
Occupational Therapy
Routines for each patient (unchanged)
Reduce incidents/impact of them
Debrief for all

18. 7 DOMAINS OF SKILL DEVELOPMENT
MINDFULNESS
GROUNDING
EMOTIONAL REGULATION
DISTRESS TOLERANCE
INTERPERSONAL EFFECTIVENESS
MEANINGFUL ACTIVITY (art,music)
OT/GROUPS/GYM/EXERCISE/PEER CONNECTION/RECOVERY COLLEGE
HAD OTHER DISCIPLINES INPUTTING INTO SESSIONS

19. INCIDENT REFLECTION
TO INCREASE REFLECTION AND TRY TO HELP UNDERSTAND AND REDUCE CONSTANT CYCLE OF INCIDENTS
TO CREATE A SPACE FOR STAFF AND PATIENTS POST INCIDENT TO TRY TO UNDERSTAND WHAT HAPPENED AND WHAT THE FUNCTION OF THIS COULD BE
TO BUILD COHESION AND OPPORTUNITIES FOR COMPASSIONATE & CORRECTIVE EXPERIENCES

20. SUPERVISION STAFF – WEEKLY TRAUMA/COMPASSION FOCUSSED
STAFF 2 WEEKLY CAT RELATIONAL SUPERVISION
ALTERNATIVE TO DEBRIEF
SERVICE USERS – AD HOC WITHTHOSE WHO FELT THEY NEEDED IT POST INCIDENT
STAFF OFFERED 24 CONTACT TO ALL WHO MAY HAVE BEEN AFFECTED BY INCIDENTS – CONTACT NURSE
THESE WERE THE STRUCTURED ONES HOWEVER THERE WAS LOTS OF AD HOC SUPPORT ALSO PUT IN PLACE
STAFF ARE AND ALWAYS HAVE BEEN RESPONSIVE TO THOSE POST INCIDENT

21. SWEMWEBS

22. ESSEN

23. ESSEN SUBSCORES

24. PROQOL

25. PROQOL

26. PROQOL

27. DATA OUTCOMES

28. SDG MEETING

29. ROLL OUT

30. ASSESSMENT & SCREENING

31. FORMULATIONS

32. TRAUMA INFORMED CO PRODUCED PLANS

33. STAFF WELLBEING

34. TRAINING

35. PHYSICAL INTERVENTIONS
TO REVIEW THE CURRENT CURRICULUM FOR MOVA AND ENSURE IT IS TRAUMA INFORMED
TO ENSURE ALL PATIENTS HAVE ADVANCED DIRECTIVES IN PLACE AROUND CRISIS PLANS AND USE OF PHYSICAL INTERVENTIONS AND MEDICATION /RAPID TRANQ
TO ENSURE ALL TRAINING AROUND PHYSICAL INTERVENTIONS IS CO FACILITATED AND PRODUCED
TO ENSURE STAFF UNDERSTAND THE BALANCE BETWEEN MANAGING RISK AND TRAUMA INFORMED INTERVENTIONS

36. CO PRODUCTION

37. PHYSICAL HEALTH INTERFACE
TO HAVE SYSTEMS IN PLACE FOR IMPROVED COMMUNICATIONS BETWEEN PHYSICAL HEALTH AND WARDS
TO HAVE SCREENING IN SITU FOR FREQUENT ATTENDERS TO HEALTH CENTRE
FOR PHYSICAL HEALTH STAFF TO BE TRAUMA INFORMED
TO REVIEW CURRENT PHYSICAL HEALTH PLANS AND AGREE HOW THESE CAN BECOME TRAUMA INFORMED

38. INFORMATION AVAILABILITY AND ACCESSIBILITY
PARIS SYSTEM TO BE ADAPTED TO INCLUDE TRAUMA HISTORIES CLEARLY
SHARED DRIVE FOR SECURE SERVICES (CORE SKILLS, TRAUMA STANDARD PROCESSES, SCREENING TOOLS, ASSESSMENTS (INCLUDE COMPLEX TRAUMA ASSESSMENT)
ADVANCED DIRECTIVES
CO PRODUCED NARRATIVES WITH TRIGGERS AND MODIFIERS FOR NEW STAFF OR BANK STAFF

39. ENABLING ENVIRONMENTS
TO DEVELOP AND SUTAIN A PLACE WHERE THERE IS A FOCUS ON CREATING A POSITIVE AND EFFECTIVE SOCIAL ENVIRONMENT AND WHERE HEALTHY RELATIONSHIPS ARE SEEN AS KEY TO SUCCESS.
THIS REQUIRES COMPASSION AND UNDERSTANDING AND IDENTIFICATION OF ISSUES IN A CURIOUS NON PUNITIVE WAY
THAT WE SEE ALL EXPERIENCES AS POTENTIALLY CORRECTIVE

40. WORK IN PROGRESS

41. DISCUSSION
QUESTIONS