Andrea Hall - Australian Catholic University

Andrea Hall

The Victorian Reducing Restrictive Interventions Project (RRI) 2013-2014 Aimed to support the reduction, and where possible

elimination, of restrictive interventions in Victorian mental health services (MHS) and emergency departments (EDs)

Assist services to comply with the new legislative requirements of the Victorian Mental Health Act 2014 (the Act)

Assist MHS & EDs to work together to develop and implement Local Action Plans (LAP) for competitive funding

Emergency Department (ED) ObjectivesIdentifying: What restrictive interventions are being used in ED’s How & where these interventions are being recorded How data is subsequently used for QI purposes

In addition we were scoping what: Policies, Procedures and Pathways were in place Nurses working on the floor with MH patients felt was needed

to bridge the gap of skill and training deficits Training opportunities exist in EDs relating to this subject Current level of effectiveness of relationships between EDs &

MHS

Survey data collection process/demographics

230 responses (nurses)

16/22 Victorian gazetted EDs represented

5 rural EDs

11 Metropolitan EDs

Majority of respondents were Registered Nurses who work on the floor with patients

Emergency Department Survey findings

Emergency Nurses:

Reported not feeling adequately trained in terms of mental health presentations to the ED

Want more education regarding mental health presentations

Very few identified receiving informal or formal support from their affiliated MHS

Reported using high levels of physical and mechanical restraint

Reported confusion around data recording, reporting and use for quality improvement

Evidence to support the need for further education

Rising number of presentations to EDs Australia wide(Department of Health 2013)

The Victorian Mental Health Act 2014 emphasises the need to provide care in the least restrictive environment possible

(Victorian Mental Health Act 2014)

Australians reporting a history of a mental and behavioural health condition has increased to over 3 million

(Australian Bureau of Statistics 2012)

What is trauma Informed Care (TIC)?

Trauma-informed care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological and emotional safety for both providers and survivors and that creates opportunities for survivors to rebuild a sense of control and empowerment

(Hopper et al., 2010)

Why is TIC important?

Hospitals can evoke memories of traumatic experiences for some patients and thereby exacerbate symptoms

We might unintentionally cause harm by following practices, policies and activities that are insensitive to the needs of our patients

Understanding trauma also means recognizing that our personal traumatic experiences or the stress associated with working in healthcare may impact our emotional and physical well being as well as our work success and satisfaction

TIC pilot

Aimed to understand whether TIC education can lead to practice change

Decision to pilot TIC training with one rural and two metropolitan EDs

Due to competing training priorities we offered multiple delivery options

Need for interdisciplinary training/collaborative approach inclusive of Lived experience

TIC pilot development

Co-design

Co-delivery

Content established initially for MHS then contextualised for the ED workforce

3 services invited to participate as a pilot site

Rural & 1 metropolitan pilot site planned as an 8 hour workshop (8 modules over 1 event)

1 metropolitan pilot planned over 4 days (45 minute modules delivered during in-service times)

Evaluation questionnaires developed to measure effectiveness of pilot

Focus groups scheduled 3 months post training

Modules

1. Introduction to Trauma Informed Care

2. Neurobiology

3. Social consequences of trauma

4. Cognitive model of trauma

5. Self fulfilling prophecy

6. Responding to stories

7. Trauma and the workforce

8. Where to from here

Participants

Trials completed:

52 Metropolitan attendees

17 Rural attendees

Total: 69

Participants demographics:

All Emergency Department nurses

Average age group: 25-30

Average years of experience in an ED: 5-10

Initial pilot outcomes

Allowing nurses to talk about trauma in an informed way

Nurses identified this education as one way to understand and prevent occupational violence

Beneficial to the mental well being of staff

Consumer project officer identified as one of the most valuable components of the day

Data reflected 100% of attendees would recommend this training to their colleagues & offered to other acute care staff

Module 7- ‘trauma and the workforce’ identified as one of the favourite modules

Outcomes 3 months post training

Participants reported:

Increased confidence engaging with persons with a trauma history

Desire for more education involving consumer consultants

Increased capacity to build more therapeutic relationships with patients

Circumstances where restrictive interventions have been avoided using skills learned during this training

Desire for permanent and accessible TIC education within their workplace

Key learnings

TIC education can lead to practice change

Restrictive interventions can be avoiding without adverse consequences

Nurses want more education on mental health presentations to the ED

Where to from here?

Further modules are being developed

Vicarious trauma

Child and infant trauma

Long term consequences of unaddressed trauma

Systems

Western Victorian Mental Health Learning & Development Cluster taking requests from services to have access to this education

Thank you