eusarf, copenhagen 2014 dr ian barron, reader (uod) mr david mitchell, professional services manager...

EUSARF, Copenhagen 2014

Dr Ian Barron, Reader (UoD)

Mr David Mitchell, Professional Services Manager

Emeritus Prof Bill Yule, Children and War Foundation

Pilot study: Evaluation of Teaching Recovery Techniques in Scotland’s Secure Estate (Barron and Mitchell, 2013)

Aims

1. Shift focus - symptom management to addressing underlying trauma which

(i) drives the behaviour

(ii) results in YP being unresponsive to behavioural programmes

2. Introduce trauma-specific programme, screening and evaluation

3. Training for trauma-sensitive milieu

Teaching Recovery TechniquesEvaluative research design

• Randomised control trial (n=17)• Case file analysis (Dev T. framework)• YP Trauma history interviews• Pre/post-tests – SUDs; normative screening

measures (CRIES-13; MFQ; ADES; TGIC; SDQ); behaviour monitoring

• Programme fidelity - video• YP interviews & Staff focus groups

Sample - Young People

• N=17; 14-18yrs; 11 female/6 male; Scottish Caucasian; absolute poverty; homeless (n=2); parental prostitution (n=5); drug dealing (n=3); substance misusing (n=11); sex offender access to home (n=3), mother sectioned-mental health act (n=1)

• In free fall , e.g. 40 absconding, 20 break ins, 7 assaults, 3 suicide attempts ….. short period of time.

Case file analysis

Trauma invisible in medical files - physical symptoms rather than MH

‘Scatter Gun’ of professional s - wide range of ‘types’ & changes of professionals per YP (n=31)

Lack of social justice - 1 YP experienced justice for abuse vs. multiple police stations, over-night custody, court & charges (n=17)

Extensive abuse histories - multiple ‘types’ of harm/trauma (n=10) - Assault; traumatic losses; frequent placement change; physical; sexual; emotional abuse; neglect; witness/experience DV; T Hospitalisations – only 4 coherent chronologies

PTSD unrecognised (n=17) / Triggers not connected to historical abuse (n=8) – extensive behavioual difficulties; omission YP internal intrusive sensory experience

DTD unrecognised – Chaotic families; negative emotions/behaviour (n=17); lack of future hope (n=12); re-victimisation (n=5); depression (n=3); dissociation (n=2); disturbed cognitions ?

What the young people report – Trauma history interviews(Ricky Greenwald’s script) events and SUDs 0-10

• 9-11 T events on average; multiple 10s cumulative Ts not processing

• Multiple T losses: deaths, into care, parent in prison, sibling into care

• Violence endemic: gang, assaults (experienced and done)

• Agency traumas: returned to abusive home; hearings; in custody; into care (esp. 1st time); secure accommodation

Compared with standardised measures

Clinical levels (mostly clusters) of:•PTSD 65% (30-60% Palestine)•Depression 65% (25-40% Palestine)•Dissociation 18% (25% in Palestine)•Underestimated trauma? - measures developed around ‘single’ events

Where is Rossie?

Montrose

Manualised Programme intervention

• Group - CBT ‘Teaching Recovery Techniques’ (TRT)

• Children and War Foundation - Patrick Smith, Bill Yule & Atle Dyregrov

Teaching Recovery Techniques –Content

• TRT – Cognitive - Behavoural Programme• Normalises trauma and addresses symptoms of

PTSD (intrusive memories, hyper-arousal and avoidance)

• 2 presenters: 7 sessions delivered during school day (40 mins)

• Methods – information giving, modeling, experiential learning, reflection and feedback- encourage self help and mutual support

Teaching Recovery Techniques Content

• Sessions 1-3 dealt with INTRUSIVE THOUGHTS AND FEELINGS: problems, e.g. bad memories, nightmares, and flashbacks.

• 4-5th sessions dealt with AROUSAL: e.g. difficulties in relaxing, concentrating, and sleeping

• 6-7th sessions dealt with AVOIDANCE: Children’s fears, and difficulties in facing up to reminders of the disaster

TRT Findings

• SUDs - Large effect size (d=1.10)

[52.60 (sd = 17.34) to 26.40 (sd = 19.55 ) v 56.28 (sd = 28.83) to

46.14 (sd = 17.52; p<.05)

• Behaviour change – small effect size

• Standardised measures – no statistical difference

• YP mostly positive about TRT & specific aspects helpful (safe place; imagery for intrusions)

• Presenters (i) YP selection and grouping important (ii) liaison with care/education staff enable transfer of YP strategies (iii) further gains after evaluation (less reactive)

• Programme fidelity high

• Substantial financial post-placement gains achieved for some young people (average £28, 642)

• Whole staff group - substantial knowledge gains in trauma-sensitive environments

Evaluation - Group Process

• Responsivity issues important

• Groups didn’t entail difficult or ‘heavy’ emotional expression

• 3 activities completed each session

• Lots of acculturation- “this is what we are going to do”- “this is what you are going to do..... and why” .

• Programme fidelity – high adherence to programme protocols

• At times high numbers of de-escalating responses by staff (n=72 in one session)

TRT Outcome evidence sheet

Evaluation – presenters role

• Crucial in setting pace and tone.  • Model respect and understanding of others, listening

attentively, demonstrating empathy, initiating a sense of optimism, active coping and self efficacy without undermining young people’s problems, making affirmative statements

• Tasks divided between leading and recording, monitoring reactions, checking engagement and understanding, monitoring emotionality, using humour where appropriate..............

• Evaluating and debriefing - YP’s engagement,

understanding of materials  

Thank You! Tac!, Tack!, Kiitos!, aw’ right nee’bour !

Ian Barron, University of Dundee

i.g.z.barron@dundee.ac.uk

David Mitchell, Rossie Young People’s Trust

david.mitchell@rossie.org.uk