Download as PDF, PPTX
More Related Content
Similar to ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care
More from Christine Wekerle
ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care
- 1. The Impact ofDomestic Violence on Children’s Functioning: Care Planning Approaches to Foster Trauma-Informed Care www.interrai.org Shannon L. Stewart, Yasmin Garad, Natalia Lapshina
- 2. Children’s Mental Healthin Ontario • Clinicians, educators and school personnel want to play a crucial role in the identification of students struggling One in five students experiences mental health issues Yet only about 25% receive the treatment needed 50-75% of adult mental health issues persist from school-age years • Highly predictive of Impaired social and emotional functioning Poor academic achievement School absenteeism Substance abuse Academic failure and drop out in both elementary and secondary schools
- 3. Impacts of Trauma •Children who experience domestic violence and abuse are at a higher risk of experiencing: physical health issues mental health problems social skills deficits academic underachievement and school dropout underemployment poverty pre/postnatal exposure to drugs, alcohol, and toxins parental substance abuse • Placement instability exacerbates this risk for mental and physical health, and socio-emotional problems
- 4. The interRAI Trauma-InformedCare Project Gain a comprehensive understanding of the mental health dynamics of individuals exposed to DVA Improve outcomes and enhance early intervention for mental health, behavioural and socio-emotional problems Improve understanding Early intervention Strengthen capacity at community level to address the health of victims of DVA using trauma- informed care Enhance multi-agency collaboration and improve continuity of care to better meet the needs of clients who have experienced DVA Strengthen Capacity Multi-agency Collaboration Project Objectives www.interrai.org
- 5. interRAI interRAI is aninternational collaborative to improve the quality of life of vulnerable persons through a seamless comprehensive assessment system. Our consortium strives to promote evidence-informed clinical practice and policy decision making through the collection and interpretation of high-quality data about the characteristics and outcomes of persons served across a variety of health, school and social services settings
- 8. How do interRAIinstruments help children, youth, and their families? • Improving early identification of mental health and substance use across service sectors • Enhancing access to mental health care services • Improve transitions • Contributing to increased evidence-informed care planning to improve the functionality of mental health services across multiple service sectors
- 9. Lifespan Approach Through theuse of an integrated suite of setting- and sector-specific assessments, the child/youth suite delivers comprehensive information about children and youth that can support them from birth through to adulthood and beyond.
- 10. interRAI Child andYouth Suite School Community HospitalJusticeHome
- 11. Examples of Manualsin Children and Youth Instruments
- 12. What sets interRAIInstruments Apart? One assessment…multiple applications
- 13. CAPs • Collaborative ActionPlans are documents containing current evidence-informed approaches to guide interventions in target areas. • Case finding methodology • CAPs target to those who may benefit from an intervention • Enable service providers to use time efficiently • Decision-support tools to inform interactions between service providers and individuals with identified needs • A triggered CAP will highlight child or youth needs and appropriate interventions in that area. Judgement is required to determine clinician ability and availability. • 29 ChYMH CAPs available; 30 ChYMH-DD CAPs; 17 0-3 CAPs; 29 Youth Justice CAPS Example:
- 14. Safety CAPs Services and Supports CAPs Functional Status CAPs Family Life and Social Integration CAPs Health Promotion CAPs interRAI ChYMH Collaborative ActionPlans (CAPs) Functional Status CAPs Communication, Life Skills Family Life and Social Integration CAPs Attachment, Caregiver Distress, Interpersonal Conflict, Parenting, Social and Peer Relationships Safety CAPs Control Interventions, Criminality Prevention, Harm to Others Hazardous Fire Involvement, Sexual Behaviour, Suicidality and Purposeful Self-Harm, Traumatic LifeEvents Services and Supports CAPs Education, Informal Support, Readmission, Support Systems for Discharge,Transitions Health Promotion CAPs Caffeine Use, Gambling, Medication Adherence, Medication Review, Physical Activity, Sleep Disturbance, Strengths, Substance Use, Tobaccoand Nicotine Use, Video Gaming, Weight Management www.interrai.org
- 15. Using the results Resultsof interRAI Assessment Youth Profile = 47 Support referrals Track change Support planning Assist triage decisions
- 16. Implementation of traumainformed care using the interRAI Child and Youth Mental Health instrument (ChYMH) Collaborative Action Plans (CAPs) www.interrai.org The interRAI Trauma-Informed Care Project Training staff at participating agencies on the use of the interRAI ChYMH CAPs using a trauma-informed lens Assessing the impact of implementing interRAI ChYMH Collaborative Action Plans from a trauma-informed perspective
- 17. Goals of theCurrent Project • Determine the needs of children who have been exposed to domestic violence (DV) • Identify specific developmental, behavioural, and emotional problems of this sub- population • Engage diverse team of knowledge-users, research, and decision-makers • Strengthen the delivery of mental health care for children and youth
- 18. Participants • Recruited fromover 70 schools, secure custody sites and mental health facilities in Ontario, Canada • English-speaking children and youth • N = 8924 • No DV trauma n= 4764 • DV trauma n= 4160 No DV trauma DV trauma Age (M, SD) 11.56 (3.59) 12.54 (3.50) Gender Males (%) 61.4 54.6 Females (%) 38.6 45.4
- 19. Child and YouthMental Health Instrument • Comprehensive assessment system • Approximately 60-90 minutes for completion • Semi-structure interview of individual needs • Well established reliability and validity of psychometric properties • A wide range of domains are possible needs are evaluated including: Substance Abuse Social Relationships Environmental Issues Medical Issues • Applications are included to support decisions related to care planning and outcome measurement
- 20. Measures Domestic Violence Trauma- 6 questions: Victim of: sexual abuse, physical abuse, emotional abuse; witness of domestic violence; physical neglect, emotional neglect Dichotomized 0 = Never, 1= Present in last 3 days- 1 year ago Combined into a cumulative trauma variable (range: 0-6) Dichotomized into 0= no DV trauma, 1 = yes Medical diagnosis: asthma, diabetes, epilepsy, FASD, traumatic brain injury, migraines Family factors: family dysfunction, caregiver distress, communication with the child, frequent disruptions in care Peer relationships: victim of bullying Externalizing / internalizing symptoms scales Disruptive and Aggressive Behaviour scale
- 21. Poly-Victimization and Typesof trauma 0.0 10.0 20.0 30.0 40.0 50.0 60.0 None 1 trauma type 2 trauma types 3 trauma types 4 trauma types 5 trauma types 6 trauma types 52.9 16.3 10.6 7.6 3.8 2.8 1.0 Percent 0 10 20 30 40 50 60 70 WDV Emotional abuse Physical abuse Emotional neglect Sexual abuse Physical neglect 62.4 59.8 40 27.7 22.1 19.4 Percent
- 22. Externalizing and InternalizingProblems 0.0 5.0 10.0 15.0 DABS Internalizing symptoms Externalizing symptoms 4.1 9.2 3.8 5.6 11.1 5.6 MeanScore No DV trauma DV trauma
- 23. Family Factors 0.0 20.0 40.0 60.0 80.0 100.0 Caregiver distressEffective communication Disruptions in care 28.1 97.3 3.4 57.8 91.1 28.3 Percent No DV trauma DV trauma 0.0 0.5 1.0 1.5 2.0 2.5 No DV trauma DV trauma MeanFamilyDysfunction Family functioning
- 24. Medical Conditions 0.0 2.0 4.0 6.0 8.0 10.0 12.0 Diabetes EpilepsyFASD Migraine Traumatic brain injury Asthma No DV trauma 0.7 1.2 0.8 1.4 0.6 7.5 DV trauma 0.6 1.6 3.1 2.4 0.7 10.5 Percent No DV trauma DV trauma
- 25. 0.0 10.0 20.0 30.0 40.0 50.0 60.0 No DV traumaDV Trauma 35.6 57.6 Percent Victim of Bullying
- 26. History of NeedsMet (yes) 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Physical needs met Safety needs met Percent No DV trauma DV Trauma
- 27. Summary of Results •25.8% of children and youth who had witnessed DV have experienced multiple forms of trauma • Children and youth who had experienced DV trauma were less likely to have their basic needs met in early childhood • Compared to clinically referred children who did not experience DV trauma, those who have experienced DV trauma: Experience more internalizing, externalizing, disruptive, and aggressive behaviours Have more problems with family functioning, are less effective communication with parents, experience higher caregiver distress, and more disruptions in care Experience more medical conditions such as asthma, epilepsy, Fetal Alcohol Syndrome Experience more bullying by peers
- 28. How do youthin secure custody compare to inpatient and outpatient youth with respect to trauma? N= 755 youth Age 16 to 19 (M = 16.76, SD = .81) Subsample Case Type: Secure Custody/Detention N = 90 (11.9%) Inpatient N = 75 (9.9%) Outpatient N = 590 (78.1%) All youth were recruited from facilities in Ontario, Canada
- 29. Measures Traumatic Life Events Abuse:Victim of: sexual violence, physical abuse, emotional abuse, bullying Family Factors: Parental addiction, change of legal custodian, abandoned by parent, witness of domestic violence, Neighbourhood Factors: Victim of crime, lived in a violent neighbourhood Dichotomized 0 = Never, 1= in last 3 days- 1 year ago Scales: Social Disengagement (0-16) Depressive Symptoms Scale (0-36) Anxiety (0-28) Aggressive Behaviour (0-16) Hyperactive/Distractible (0-16) Disruptive Behaviour (0-12) 29
- 30. Traumatic Experiences: Abuse 30 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Victimof Sexual Violence Physical Abuse Emotional Abuse Victim of Bullying Percent Trauma Type YJ Inpatient Outpatient
- 31. Traumatic Experiences: FamilyFactors 31 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 Percent Trauma Type YJ Inpatient Outpatient
- 32. Traumatic Events: NeighbourhoodFactors 32 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Violent Neighborhood Victim of Crime Percent Trauma Type YJ Inpatient Outpatient
- 33. Internalizing Problems: Anxiety, SocialDisengagement and Depressive Symptoms 33 0 2 4 6 8 10 12 Anxiety Social Disangagement Depression MeanScore Intermalizing Symptoms YJ Inpatient Outpatient
- 34.
- 35.
- 36.
- 37. Care Planning: Trauma 37 0 5 10 15 20 25 30 35 40 Reduce theimpact of prior traumatic life events Address immediate safety concerns Percent Trauma CAP YJ Inpatient Outpatient
- 38. Care Planning: Harm toOthers and Self-Harm 38 0 5 10 15 20 25 30 Moderate risk of harm to others High risk of harm to others Percent Risk of Harm to Others CAP 0 5 10 15 20 25 30 35 Moderate risk of harm to self High risk of harm to self Percent Suicidality and Purposeful Self-Harm CAP YJ Inpatient Outpatient
- 39. Care Planning: InterpersonalConflict 39 0 5 10 15 20 25 30 35 40 45 50 Reduce conflict within a specific domain Reduce widespread conflict Percent Interpersonal Conflict CAP YJ Inpatient Outpatient
- 40. Care Planning: Substanceand Tobacco Use 40 0 20 40 60 80 100 YJ Inpatient Outpatient Percent Substance Use CAP 0 5 10 15 20 25 30 35 40 45 50 Reduce or cease daily tobacco use Prevent long-term tobacco use Percent Tobacco Use CAP YJ Inpatient Outpatient
- 41. Care Planning –Other CAPs 41 0 10 20 30 40 50 60 70 Percent Triggered CAPs YJ Inpatient Outpatient
- 42. Conclusions: Comparison ofPatient Groups • Trauma rates were found to be higher for the YJ group. • Females experienced higher rates of sexual violence and emotional abuse compared to males. • Females reported higher depression and anxiety compared to males. • Males reported higher externalizing behaviours than females. • YJ group reported lower levels of depression and anxiety than the two patient groups. • Evidence for differentiated patterns of gender differences for aggression between youth who live in the community and youth either detained in the YJ system or within inpatient mental health care. • No gender differences were found for distractibility and hyperactivity in the YJ group. • Youth involved in the justice system have complex psychosocial issues that require unique interventions. • Current study highlights a need for further research into implementation of trauma-informed care within the justice system.
- 43. Dr. Shannon L.Stewart, Associate Professor Director of Clinical Training Faculty of Education, Western University International InterRAI Child and Youth Lead interRAI Fellow [email protected]