To what extent are Child and Adolescent Mental Health Services engaged in Trauma Informed Practice: an Irish study

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Heffernan, Sinead
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University College Cork
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Background: Children and adolescents attending the mental health services are likely to have experienced childhood or intergenerational trauma. International and national mental health policy recommends that services integrate TIP into mental healthcare provision. A lack of research studies exploring the integration of TIP, with this cohort were identified. Method: A descriptive correlational study design utilised a convenience approach to gain a sample from the target population: all CAMHS staff nationally. Data were collected using a psychometrically validated organisational assessment tool. Mostly descriptive, inferential, and some thematic analyses were deployed. Results: Respondents reported low levels of TIP, overall. The majority of respondents were female, community based, clinical staff. Levels of trauma informed therapeutic engagement with service users, and organisational supports for TIP were ascertained from a staff perspective. Results indicated a varied results with therapeutic engagement revealing higher scores than the organisational related areas in CAMHS. Areas that pertained to person centred approaches to consistent care delivery, safety and care planning, and de-escalation were to some extent developed. Gaps in care provision related to language, culturally sensitive care provision, and coproduction including eliciting feedback routinely, communication, flexibility, and staff supports to mitigate vicarious trauma were identified. Further gaps pertained to educating both service users and staff about trauma and its impact on mental health, as well as TIP delivery and evaluation. Overall organisational rather than individual staff factors represented require significant development to achieve TIP. The results of inferential analysis identified relationships between staffs’ levels of satisfaction in current role; which was found to be the strongest predictor of TIP (R2=14.7%, p<0.001), followed by location of role (R2=8.2%, p<0.001) and length of service (R2=3.3%, p<0.040). No relationships were found re: role in CAMH service (p=0.495) and attending TIP training (p=0.840). Thematic analysis found that training was not systematically provided or attended. Gaps in relation to TIP training content, frequency and duration were identified. Discussion: TIP has been described as a humanistic approach to care delivery that recommends approaches that can optimise therapeutic relationships and person-centred care characterised by flexibility, peer supports and collaboration and require further development. Organisational supports for training provision for all CAMHS staff, that is sustainable, evaluated, and accessible, is required. Staff supports that mitigate vicarious trauma for staff also requires further development. An organisational commitment underpinned by resources, strategies to deliver change, guided trauma-informed policy to support TIP, is recommended. Conclusion: CAMHS acute and even more so, community-based services are not currently engaged in TIP, as recommended by mental health policy. The multifaceted nature of TIP requires an organisational approach to guide implementation. The results from this study have identified gaps in relation to organisational support for TIP which can add to the growing knowledge base to support the integration TIP into CAMH Services.
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Trauma Informed Practice , Child and Adolescent Mental Health Services (CAMHS) , Organisational whole-systems approach
Heffernan, S. 2023. To what extent are Child and Adolescent Mental Health Services engaged in Trauma Informed Practice: an Irish study. PhD Thesis, University College Cork.
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