1. Understanding and responding to the trauma of children and young people in Northern Ireland

2. The issue
There have been improvements in assessing and documenting childhood trauma
However the responses are so varied that we don’t fully understand the impact of trauma or how to best support young people who have experienced trauma (Duncan et al., 1996; Devaney et al. 2012; 2013).

3. The issue
There have been a lot of efforts recently to understand the impact of some forms of abuse such as CSA but, there are significant gaps around our understanding of other types of adversity that young people experience (McMullan et al., 2013).

4. The issue
Literature Reviews
Meta-analysis
Cross-cultural
Epidemiological
It is estimated that 75–80% of young people with a diagnosable disorder are not able to access services that could reduce their symptomatology (Kataoka et al., 2002).
Trauma+ load =PTSD
Kendall-Tackett, Williams, & Finkelhor, 1993; Duncan et al., 1996; Paolucci, Genuis, & Violato, 2001; Brown, 2003; Kilpatrick et al., 2003; Chen et al., 2010; Kessler et al., 2010.

5. The impact on young people
Post-traumatic stress disorder (PTSD) is a complex and chronic disorder (DSM-V)
PTSD can cause substantial distress to a YP and interferes with social and educational functioning on both the immediate and longer term (Trickey et al., 2010).
The key symptoms of PTSD are re-experiencing symptoms (e.g. flashbacks, nightmares); avoidance of reminders of the trauma; hyper-arousal; and emotional numbing (Morris et al., 2015).

6. The impact on young people
“Up until now, little research has been carried out to examine the prevalence and impact of childhood adversities in the Northern Ireland (NI) population, a society which has experienced a prolonged period of civil conflict…” McLafferty and O’Neill 2019
One of the few epidemiological studies in NI (n=1,986) ) illustrated that trauma load, maltreatment and conflict related trauma were associated with higher levels of PTSD in children and young people.

7. Why is this important to know?

8. The impact on young people
Elevated without therapeutic supports
Social Skills
Attainment
Attachment
Relational
Reduction over time
Porshe et al, 2011
Wamser-Nanney & Steinzor, 2017

9. The impact on young people
Many children who experience trauma and develop PTSD also present with co-occurring psychiatric symptoms (Howe, 2005; Cohen et al, 2010).
PTSD
DEPRESSION
ANXIETY
(Foa & Rothbaum, 1998; Kolko et al., 2010; MacDonald et al., 2010).

10. The impact on young people
Some studies have found associations between maltreatment experienced and behavioural responses (van der Put et al., 2015).
Conduct Disorder (Atlas et al., 1991).
PTSD
Behavioural Interventions(Stevens et al., 2003).
E.g. Mentoring, Diversionary activities
Substance Abuse (Leenarts et al, 2013).
Aggression (Silvern & Griese, 2012)

11. The potential response
Evidence based assessment tools have been developed
Evidence based treatments (EBT’s) are available
But only a minority of young people who need EBT’s, access them (Devaney et al., 2012; O’Brien et al., 2016)

12. The potential response
Screens identify young people who require a more in depth assessment.
Screening tools can enable practitioners to more accurately assess the nature of problems or challenges facing children and their carers (Morris et al., 2015).

13. QUB Screening Study
Whilst evidence based assessment is so critical to practice (Beidas et al., 2015), there have been few studies that have sought to explore how mental health assessment screens could be implemented into routine practice (Cross, 2012).
Aim:
To explore the feasibility and acceptability of incorporating a screening tool for PTSD, anxiety and depression into routine assessment processes
Objectives:
To train non-mental health specialist practitioners in administering a validated measure
To assess the accuracy of the screens administered
To undertake a process evaluation to explore the feasibility and acceptability of using the tool within non-clinical service settings

14. Context
Work with vulnerable children e.g. on edge of youth justice system, in care/edge of care, subject to a child protection plan.
Staff working in two large third sector organisations
Children mostly referred by statutory services.
Employ staff with a wide range of professional qualifications.

15. Recruitment (May 17/April 19)
Training (June 17/April 19)
Pilot (July 17)
Study commenced (Oct 17/May 19)
Initial results (Sept2019)
Initial engagement phase
Review and refinement phase
Coaching and support phase

16. Training and Coaching Initial half day workshop:
What is trauma?
Why is screening potentially beneficial for young people?
How to use the screening tool
The nature of being involved in a research study
Follow up half day workshop
Attendance at individual team meetings

17. Process Screen Review Assess
During a routine assessment a staff member uses the CRIES-8 (Perrin et al, 2005) to ask a young person a series of questions about their experience of any traumatic incidents in their life, and the impact of this.
Review
Staff members score the information which is then uploaded to an anonymised database, along with some information about the child.
Assess
A sample of young people screening positively for PTSD have a full clinical assessment carried out by an independent therapist

18. N %
Total screens to date (excl pilot data) 77
Trust
SEHSCT 45 58 26 39
WHSCT 6 8
BHSCT
Male 43 56
Female 34 44
Source of referral (social worker) 53 69
Reason for referral (behaviours) 59 79
CPR 41
CAMHS
*May 2019-
1 organisation

19. Outcome N %
+ PTSD 59 77
+ Anxiety 46 60
+ Depression 30 39

20. Initial findings No sig difference between gender and PTSD
No sig difference between CAMHS involvement and PTSD, indicating that those with or without known mental health difficulties equally as likely to score as probable PTSD
Small positive correlation between higher levels of adversity and high CRIES-8 scores
Significant association between PTSD and comorbidity (p<.005)
Fair agreement (k=.26) between CRIES-8 outcomes and worker reports of PTSD (p=<.005)
Sensitivity calculations indicated that 84.7% of those with probable PTSD were correctly identified by practitioners and specificity calculations indicated that 72% of those without probable PTSD were correctly identified
75% of screens quality assured confirmed as accurate by full clinical assessment (circa 58)

21. Learning to date Trauma related Practice related
Significant proportion of YP referred into community projects such as this have undiagnosed MH issues
On average, YP have experienced 3.2 types of adversity
Not all front line practitioners have actively engaged in the process (34 trained/12 active)
Higher than anticipated proportion of staff not engaging
- 36% of screens undertaken by only 4 staff
Some evidence that project/direct line manager mediates level of staff engagement
Concerns around: making a diagnosis; needing to see that young people are benefitting from the screening; worry about getting the screening wrong; implications of labelling young people; young people not engaging with the assessment.
Trauma related
Practice related

22. Project will be completed by March 2020
Project will be completed by March For further information Contact: Dr Colm Walsh School of Social Sciences, Education and Social Work, Queen’s University