Knowledge regarding trauma informed care

Knowledge regarding trauma informed care

Assessment Task 1 – Knowledge Questions

Required Document and equipment

• The purpose of this assessment is to determine your knowledge regarding trauma informed care. You will be able to answer the questions based on the information you have obtained in your classroom activities and/or researching information contained within the documents below or on the internet.
• You will be required to log on to EQOnline to answer the relevant knowledge questions for this unit.
• You will be required to complete this assessment at home in your own time (and/or during class if time permits)

• This assessment is due by x session.
• Your assessor will mark your questions on EQOnline and you will be notified of your outcome via email.
• Candidates are required to achieve a satisfactory result for this assessment task. Failure to do so will result in not commencing Professional Placement.
• The final outcome of your assessment will be recorded on the Summary of Assessment Tool for this unit

• The following documents can be accessed from EQOnline when reviewing answers to the questions:

1. Recovery Guide – Practitioners and Providers
2. National Practice Standards for the Mental Health workforce 2013
3. National Practice Standards for Mental Health 2010
4. Blue Knot Foundation Practice Guidelines

Question 1 – What are the codes of practice that are applicable to caring for people who have experienced trauma?

Question 2 – Provide an example of how you will demonstrate your duty of care whilst still upholding a person’s dignity of risk:

Question 3 – Provide an example of the actions you will follow to respect the human rights of a person who has experienced trauma.

Question 4 – What do you need to do when obtaining informed consent from a person who has experienced trauma?

Question 5 – What are your mandatory reporting obligations for people who have experienced trauma?

Question 6 – According to the Mental Health Coordinating Council’s position paper, many consumers who self-harm and present to emergency departments are labelled, condemned and discriminated against because they are considered attention seeking and not deserving of care. Review the information contained within this position paper and in no more than one paragraph, outline how these people are treated:

Question 7 – Review the practice guidelines that are available on the Blue knot foundation website and identify what the “purpose of the guidelines” is:

Question 8 – Organisations will have privacy and confidentiality procedures in place based on the Australian Privacy Principles. Confidentiality provisions restrict an individual or organisation from using, storing, disclosing information about a person that is outside of the scope for which the information was collected. However, there are certain circumstances in which this information will be required to be disclosed, outline a minimum of 4 circumstances in which you would be required to disclose a person’s confidential information:

Question 9 – Policy frameworks are generally made up of federal and state legislation relevant to the industry sector, service standards, practice standards, codes of ethics, codes of conduct, organisational policies and procedures as well as workers’ job role descriptions and/or duty statements, and sometimes government policies. Identify the legislation and codes of ethics/practice standards that would be included in the Mental Health policy framework:

Question 10 – Which standard from the National Standards for Mental Health Services addresses records management?

Question 11 – What information can provide you with guidance on the rights and responsibilities of the workers, employers and consumers?

Question 12 – In no more than one paragraph explain why is it essential to work within the responsibilities and limitations of your work role:

Question 13 – WHS laws are based on Duty of care principles applied specifically to place of work. This means that everyone in the workplace has a duty to follow the relevant policies and procedures and to identify and report safety issues. What is the current WHS legislation?

Question 14 – The experience of trauma and its impacts on individuals, communities and society as a whole are substantial. A large percentage of those seeking help across a diversity of health and human service settings have trauma histories severely affecting their mental and physical health and wellbeing. The impacts of trauma characteristically persist long after the trauma has ended. Although exact prevalence estimates vary, there is a broad consensus that many consumers who engage with public, private and community managed mental health and human services are trauma survivors.

To ensure you are able to provide the best possible recovery plan to meet consumers needs, what type of care should be provided?

Question 15 – Referring to the Blue Knot Foundation’s practice guidelines, identify what trauma and complex trauma is and the impacts this can have on a person

Question 16 – How can trauma and complex trauma impact development of those affected?

Question 17 – According to the World Health Organisation, what are the dynamics of interpersonal violence and the relationship to trauma?

Question 18 – Trauma, particularly that which arises from interpersonal abuse and/or neglect in childhood, as well as victimisation in adulthood, can lead to serious long-term consequences and many survivors adopt extreme coping strategies which can persist into adult life (as an attempt to manage overwhelming traumatic stress). Identify a minimum of 4 strategies that people may implement to cope with their trauma:

Question 19 – For many people, being admitted to a mental health service places them at risk of witnessing or experiencing a traumatic event, and hence being re-traumatised. Identify a minimum of 8 events that have the potential to cause re-traumatisation;

Question 20 – According to the Blue Knott foundation fact sheet for health practitioners, what is the current best practice model for complex trauma?

Question 21 – According to the Blue Knot Foundation’s practice guidelines, how can loss and grief impact a person who has experienced trauma?

Question 22 – Why do you think it would be necessary for men and women to provide trauma informed care to their respective sexes?

Question 23 – Based on a 2013 National Survey (NCAS) conducted by VicHealth, it was evident that some of the beliefs and attitudes towards interpersonal violence, particularly in relation to violence against women included:

• A male is justified in using physical force if his partner has sex with another person
• Anger and violence is excusable if there is a good reason
• Women bear some responsibility when violence occurs
• People who experience domestic abuse should feel weak and ashamed
• People can’t understand why a woman would stay in a domestic violence situation

Considering these beliefs and attitudes, provide your opinion in no more than one paragraph on how you think they impact on a person accessing services:

Question 24 – What are the 8 foundation principles that represent the core values of trauma-informed care and practice, include a brief explanation of each:

Question 25 – Read the following case study then answer the question:

Thomas’s Story

Thomas presented at his local hospital Emergency Department (ED), concerned about his level of anger towards one of his children and his thoughts about harming himself and his family.

Thomas underwent a psychiatric assessment at the ED, where his level of distress was given a context: a history of torture and trauma as a political prisoner in another country.

Thomas and his family had migrated to Australia many years ago, however his medical notes indicated that he recently experienced depression following victimisation and bullying in his workplace.

Following his voluntary admission to the hospital’s psychiatric inpatient unit, Thomas underwent further assessment. According to his medical notes, “last evening [Thomas] became very upset and lost his temper … and felt out of control. So he packed his bags with the intention of getting away so that he would not harm anyone. He had no intention of harming anyone. He went into the Emergency Department because he felt he needed help.”

The medical notes at every stage of Thomas’s admission indicated the risk of harm to himself and to others as “significant” and made a further alert that he was “homicidal/suicidal”. Thomas was seen by a psychiatrist who recommended he see a social worker and be linked to counselling services. At no stage did Thomas receive information about his rights as a voluntary patient. He was not provided with services for his preexisting diabetes, nor was he checked for ‘sharps’ or any other dangerous goods despite being noted as “homicidal/suicidal”.

Nursing staff noted that Thomas had a poor appetite, however there were no notes indicating referral to a dietician. Of greater concern was the food he was provided with, which was inappropriate for his religious background.

After some time, Thomas became concerned that his ‘treatment’ involved nothing more than medication and did not include any referral to a social worker, psychologist, or community counselling service, despite this being recommended by a psychiatrist.

These concerns were expressed to both a hospital doctor and nurse. When no action was forthcoming,

Thomas informed the hospital of his intention to discharge himself, which was his right as a voluntary patient.

Thomas was not told at this time that if he attempted to leave, or refused his prescribed medication, then his patient status would change to ‘involuntary’.

Not confident about his standard of treatment, Thomas refused medication and attempted to leave the ward.

According to his medical notes, he was “aggressive and argumentative”.

Thomas was consequently reclassified as an involuntary patient and put into seclusion.

The Approval of/Authority for Seclusion form indicated the view that Thomas was secluded in part because he was an absconding risk.

Thomas spent 6 ½ hours in seclusion. Thomas was stripped of his clothing and woke up in seclusion clothed only in his underpants.

No consideration was given to Thomas’s past history of political imprisonment and torture, or his religious beliefs regarding the removal of clothing. Thomas was not provided with an explanation of his change of patient status (voluntary to involuntary) nor why he was being placed in seclusion.

He did not receive a debriefing session after his seclusion experience.

Having supposedly met the criteria for involuntary admission throughout the time he was secluded, Thomas was then found to be well enough to be discharged as a voluntary patient the next day without any follow up planned.

Thomas’s seclusion suggests it was used as a punishment rather than a ‘therapeutic intervention’.

As a result of his involuntary seclusion, Thomas now experiences insomnia, nightmares, stress, tension, pain and a lack of trust in the public mental health care service. He continues to have flashbacks of torture, flashbacks of hospitalisation and now has chronic depression. Thomas says his life has “stood still” since his hospitalisation.

Ref: National Mental Health Consumer & Carer Forum (NMHCCF) Working Group on Seclusion & Restraint.

How has the traumatic events in Thomas’ experience with seclusion and restraint impacted his life?

Question 26 – A trigger is a stimulus that sets off a memory of a trauma or a specific portion of a traumatic experience. A trigger can be any sensory reminder of the traumatic event: a noise, smell, temperature, other physical sensation, or visual scene. Triggers can generalize to any characteristic, no matter how remote, that resembles or represents a previous trauma, such as revisiting the location where the trauma occurred, being alone, having your children reach the same age that you were when you experienced the trauma, seeing the same breed of dog that bit you, or hearing loud voices. Triggers are often associated with the time of day, season, holiday, or anniversary of the event.

A flashback is re-experiencing a previous traumatic experience as if it were actually happening in that moment. It includes reactions that often resemble the client’s reactions during the trauma. Flashback experiences are very brief and typically last only a few seconds, but the emotional after effects linger for hours or longer. A trigger commonly initiates flashbacks.

Your role will be important to help consumers identify potential triggers, draw a connection between strong emotional reactions and triggers, and develop coping strategies to manage those moments when a flashback occurs resulting from a trigger. Identify a minimum of 5 ways in which you can help the consumer with managing their triggers and flashbacks:

Question 27 – Self-advocacy is when a person acts on their own behalf, in their own interests rather than being represented by someone else. Self-advocacy is pivotal to self-empowerment as it enables the individual to feel they are in control and autonomous. Encouraging and promoting self-advocacy is important to their recovery, one of the ways in which you can support self-advocacy is by linking the person to appropriate resources that will be conducive to their needs. Identify a minimum of 4 resources and/or referral options that may be beneficial for the consumer:

Question 28 – In no more than one paragraph explain why you think behaviours such as suicidality and selfharm are prevalent in people who have experienced interpersonal trauma in their lifetime?

Question 29 – Upon review of this article http://www.healthline.com/health/traumatic-events#overview1 explain the definition of a traumatic event and provide a minimum of 6 examples of events that may cause people to experience trauma

Question 30 – What is intergenerational trauma?

Question 31 – Review the paper – The effects of Trauma on Attachment by Dr Graham A

Barker, available here

http://www.ccaa.net.au/documents/TheEffectsOfTraumaOnAttachment.pdf  and  answer  the

following questions in your own words (no more than one paragraph for each):

• What are the effects of trauma our sense of self?
• What are the effects of trauma on our relationships?

• How does trauma effect our physical illness?
• What psychological disorders can result from experiencing trauma?

Question 32 – Vicarious traumatisation is commonly understood to refer to the cumulative transformative effect on the helper of working with people who have experienced traumatic life events, both positive and negative; or the “transformation in the inner experience of the therapist that comes about as a result of empathic engagement with clients’ traumatic material”. The impacts on the workers thoughts, feelings, behaviours and general sense of self can be similar to the difficulties faced by the people we are working with.

Information presented on the living well website https://www.livingwell.org.au/professionals/confrontingvicarious-trauma/ refers to strategies workers can use to minimise or respond to vicarious trauma. Read the information contained on this website and outline a minimum of 5 strategies that can be implemented:

Question 33 – Identify a minimum of 3 strategies workplaces can use to promote trauma informed practices:

Question 34 – Trauma-informed care must involve both organisational and clinical practices that recognise the complex impact trauma has on both patients and providers. Well-intentioned health care providers often train their clinical staff in trauma specific treatment approaches, but neglect to implement broad changes across their organisations to address trauma. Widespread changes to organisational policy and culture need to be implemented for a health care setting to become truly trauma-informed. Organisational practices that recognise the impact of trauma reorient the culture of a health care setting to address the potential for trauma in patients and staff, while trauma-informed clinical practices address the impact of trauma on individual patients. Changing both organisational and clinical practices to reflect the core principles of a trauma-informed approach to care is necessary to transform a health care setting: The core principles are:

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