eusarf, copenhagen 2014 dr ian barron, reader (uod) mr david mitchell, professional services manager...
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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
David Mitchell, Rossie Young People’s Trust