June 27, 2020
By Helen Nicoll
Recently, there has been increased recognition of the impacts of trauma on young people accessing healthcare services. By the age of 16 it is estimated that approximately two thirds of young people will have been exposed to a traumatic event. Trauma-focused therapy is a specific treatment, whereas trauma-informed care is a systems intervention which relies on the whole system being trauma-informed. In the best possible care, a trauma-informed approach would be implemented across a youth healthcare system, and trauma-focused psychological therapies would be offered to young people with PTSD.
The availability of specific evidence based trauma therapy such as exposure therapy varies depending on the service systems in place. There are many barriers to these psychological interventions being offered, some are system level barriers such as lack of public funding for the appropriate level of exposure therapy sessions as well as clinicians feeling as though they don’t have the skills and knowledge to deliver these interventions.
There is growing consensus that outpatient health services for young people need to deliver trauma-informed care to ameliorate the effects of trauma, offer safe treatments, and avoid retraumatization. A recent systematic review into trauma-informed care, clarifying definitions and how it should be operationalised was recently carried out by Bendall and colleagues at Orygen. Ten components of trauma-informed care were identified as factors operationalized in practice: seven of which occurred at the system level including interagency collaboration; service provider training; safety; leadership, governance and agency processes; youth and family/carer choice in care; cultural and gender sensitivity; youth and family/carer participation. Three involved trauma-specific clinical practices such as, screening and assessment; psychoeducation and therapeutic interventions.
Universal screening is a widely-accepted key component of trauma-informed care in youth healthcare settings, it is important that every service works to accommodate screening in ways most suited to their specific service setting. There is no consensus in the literature which defines when universal screening should take place or who should do it but clearly there needs to be consideration as to the support that a young person disclosing trauma may need following disclosure as well as the skills, knowledge and support for the person asking the young person about their trauma experience.
The key messages and call to action to improve the trauma response for young people globally and improve early evidence based interventions include; universal screening, early identification, a trauma-informed service system and access to access high quality evidence based interventions such as exposure therapy. This should be delivered by skilled and competent therapists regardless of profession. Thus, there needs to be stronger training programs in trauma-specific interventions, clinical supervision and access to more funded psychological sessions to ensure fidelity to the model.
You can follow Helen on Twitter @HelenNicoll6