Trauma-informed training at Riverview
Reprinted from "Women's" issue of Visions Journal, 2004, 2 (4), p. 44-45
Twenty years ago it was taboo to talk about violence and trauma while people were in contact with the mental health and addictions services where I worked. At that time, I was a graduate student in psychiatric social work and counsellor in an addictions recovery home for women. I also volunteered at two women’s centres that encouraged empowerment, creativity and peer support in recovery from trauma. They helped survivors make sense of their pain. These centres saw addictions as efforts to selfmedicate and encouraged a harm-reduction strategy.
My graduate research led me to discover a few clinicians—such as Dr. John Briere, with UCLA and Klinic Community Health Centre in Winnipeg—who were documenting the numbers of abuse survivors they were seeing. Dr. Judith Herman at Harvard Medical School was organizing sexual abuse support groups in her outpatient department. Drs. Elaine Carmen, Patricia Rieker and Trudy Mills identified a “victim to patient process.”1A groundswell of knowledge has been slowly building since that time.
We are now living in an exciting era, where research on trauma and the brain complements the wisdom originally shared in women’s programs throughout North America—including the centres I worked in 20 years ago. More effective therapies are being developed and backed by research. Vancouver General Hospital now sponsors an annual trauma conference, has a post-traumatic stress disorder (PTSD) clinic, and an Integrative Personality Program. Trauma specialists are documenting the impacts of violence, neglect and discrimination on our mental health that go beyond the diagnosis of PTSD. One of the last frontiers to understand is the role of trauma and recovery for survivors who are diagnosed with serious, persistent mental illness (SMI). Riverview Hospital found high rates of disclosures of physical and sexual abuse in a sampling of 72 women and men in hospital.
A review of studies of women diagnosed with SMI compared a lifetime history of physical or sexual abuse among this group (51 to 97%) with histories in general population studies of 14 to 34%.3 Dr. Marina Morrow of the BC Centre of Excellence for Women’s Health recently documented that while “an awareness of violence and abuse is critical for understanding mental illness” and supporting recovery, it has been “routinely overlooked” in our province.
Many staff have not been trained in this area. Only a few mental health teams have an abuse resource worker, who cannot meet all the demand for services.
At Riverview Hospital in 2000, the Vulnerable Patients Task Group was organized to address some of this need. I was invited to design and pilot training for staff under the guidance of this group, which included a cross-section of professional staff plus family representatives and consumer advocates from the Mental Patients’ Association.
Our goals were to increase patient safety and to minimize retraumatization while in hospital. In my earlier research, survivors reported that mental health staff too often inadvertently repeat the dynamics of trauma in their efforts to help patients. Since the ‘safety stage’ of recovery from trauma is the foundation for later work, the group planned to equip staff with knowledge of ‘coping and containment skills’ for survivors.
In order to promote hospital-wide ownership of the project, an organizational development approach was essential. The trauma training was connected to other treatment practices, and related presentations were hosted at hospital grand rounds. We gave a workshop, Safety, Voice and Choice, at Riverview’s annual patient conference. Two wards were chosen for training because committee members recognized that the staff were already doing good work with some patients with trauma histories, even though most staff didn’t have previous trauma training. These staff members were also asked to give feedback on the training’s effectiveness.
Since severe early trauma survivors have understandable difficulties with trust and boundaries, staff often find themselves ‘splitting’ in their reactions; some tend toward empathy, for example, while others believe limits are most important. This dynamic can only be avoided when all staff working together are trained together. All 70 staff of these two wards, including the physicians, took the training in interdisciplinary groups. In-house cofacilitators were prepared to take the workshops to other parts of the hospital.
An evaluation of this training by the BC Centre of Excellence for Women’s Health found 85% of staff rated the sessions as “very helpful” in raising issues that are relevant in their work. A “definite increase in confidence” was reported “in their ability to work with patients with severe trauma histories.
The training package, now called Seeking Solace and Safety, can be customized to any mental health setting.
About the Author
For more information, visit www.kathleenwhipp.com
Rieker, P. & Carmen, E. (1986). The victim to patient process: The disconfirmation and transformation of abuse. American Journal of Orthopsychiatry, 56(3), 360-370.
Fisher, P. (1997). In-house Study at Riverview Hospital. Unpublished study prepared for the Trauma Services Group, Coquitlam, BC.
Goodman, L.A., Rosenberg, S.D., Mueser, K.T. et al. (1997). Physical and sexual assault history in women with serious mental illness: Prevalence, correlates, treatment, and future directions. Schizophrenia Bulletin, 23(4), 685-696.
Morrow, M. (2004). Violence and trauma in the lives of women with serious mental illness often overlooked. Canadian Women’s Health Network Magazine, 7(2-3). Retrieved November 15, 2004 from cwhn.ca/ network-reseau/7-23/7-23pg7.html
Poole, N. (2002). Evaluation report on the Vulnerable Patients Project. Coquitlam, BC: Riverview Hospital.