From clinicians to cleaners: leading trauma informed practice to trial whole-of-agency training in the Inner Gippsland

Cayte Hoppner, Director of Mental Health for Latrobe Regional Hospital (LRH)  in south-eastern Victoria and a member of the Inner Gippsland Child and Youth Area Partnership steering group, has led a trial on how  a whole agency can change practice to be trauma informed.

The training was rolled to nearly 300 staff members of the LRH's mental health services, across 13 sites and multiple disciplines and roles – from clinicians to cleaners – and is seen to have had a profound impact on the way that teams and individuals think and work.

See storyboards at the bottom of the post about the trial.

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Cayte Hoppner writes:

Area Partnerships are a Victorian Government initiative intended to facilitate shared responsibility between government departments, local government and the community sector and to build collective effort to ensure vulnerable children and young people are kept safe from harm and have every opportunity to succeed in life.

The Inner Gippsland Children and Youth Area partnership is steered by leaders from state and local government services, community sector organisations, the Aboriginal community and other partners working within the south-eastern Victorian region that encompasses Bass Coast Council, Baw Baw Council, Latrobe City and South Gippsland Council.

Our challenge

Inner Gippsland has a relatively high proportion of children and young people living in out-of-home care. As elsewhere, despite the best efforts of many services and workers, outcomes for children and young people in care as they grow into adult life are often poor.

How we set the agenda

The Inner Gippsland Innovation Bootcamp was a one day event held earlier in 2016 that focused on designing a better care system for children and young people in our area. It was attended by more than 100 people from diverse fields and backgrounds,  including young people, carers, service providers and service creators, coming together to set a shared agenda.

Out of the event emerged a commitment to develop a whole of area shared understanding of trauma informed practice, with a special taskforce formed to “put Trauma Informed Practice on the map”.

Research tells us that “the more severe and prolonged the trauma, the more severe the psychological and physical health consequences are for the person” (Mental Health Coordinating Council (MICC) 2013).

How we tested our approach

With one of the taskforce actions being to develop a whole-of-agency approach to trauma-informed training, Latrobe Regional Hospital took the lead to develop and trial an approach across its mental health services. As one of our staff put it:

"This is a game changer, it changes the way we do our business. It lit up light bulbs for me."  Mental Health Nurse                                                                                                 

How we made it happen

This pioneering program on trauma-informed practice has been rolled out to nearly 300 staff members of the LRH mental health services – from clinicians to cleaners – and has had a profound impact on the way that teams and individuals think about and work with consumers seeking mental health support.

Staff have reported the training they received in the program was both liberating and revelatory, allowing them to:

• understand how childhood trauma impacts mentally, physically and biologically throughout someone's life
• be part of building a trauma-informed community
• have a shared understanding to guide their practice, wherever in the system they work.

Taking a whole-of-department approach allowed all people in the service to understand their role in delivering a trauma-informed service. Those who work in reception, who are often the first person in their service to meet a consumer, reported back that it was the first time they were able to fully understand what lies behind behavior they have found challenging.

"There was a bit of resistance at the start, Admin didn't see how it could be relevant to them, they felt it was more a clinical subject and approach and that they wouldn't benefit. But we have had a complete turnaround and everyone said it was the best training they have done”.  Administration Assistant

It also opened the eyes of staff members to the impact of their own responses on consumers who might be deeply distressed and to the understanding that, even with the best of intentions, an interaction with the health care system can be re-traumatising.

 "It's changed the way I worked. I felt I was always aware that some of our clients had very stressful and traumatic backgrounds, but it made it much clearer, helped me empathise more. Even though we are not connected clinically, we are connected on a human, day-to-day basis and I felt it was really helpful."          Administration Assistant

Championed from the top, it took just a few months to design and deliver targeted training to nearly all staff members across multiple roles and disciplines at 13 sites across a 40,000 square kilometre area. It is the first time the hospital has undertaken such training across so many services and roles.

“In terms of rolling out training like this, the lesson is that if there is strong leadership and motivation, you can get something like this done very quickly."  Project Officer

LRH put together an interactive 1.5 hour session, with moving real life case studies, graphic video stories, and a powerful introduction to neurobiology that shows the physical impact of neglect and abuse on the brain of a three year old child. It explained how trauma is caused, that it is significantly more damaging if it occurs in childhood, is subject to varying triggers or flashpoints, and that staff should see 'behaviour' issues as ways a person has learnt to cope.

 "If we don't listen to the story of a person's early childhood experience and their trauma, and we judge their presentation without the guiding narrative of their trauma, then we are saying 'what is wrong with you?' rather than 'what happened to you?' That itself can be invalidating for the patient, and propagates the sense of helplessness and trauma." Child and adult psychologist

While not mandatory, all staff were expected to attend, and training sessions were run on multiple days on each site to work around rosters. Key elements of the program that staff nominated as helping to make it effective included rapid decision-making, passion and commitment from the content developers, senior managers, and training presenters, and the appointment of champions across each service.

"The plan was to saturate all the services in trauma-informed thinking and practice, to capture as many staff as possible across our inpatient and community services. We were adamant we should target not just medical and allied health staff, but everyone who is going to have any kind of patient contact." Clinical Nurse Educator

"The biggest part is getting the managers on board (and then) getting champions skilled up, so they can keep the conversation going."   Education Manager

The sessions were also designed to be interactive, with each staff member asked at the end to respond in writing on a leaf-shaped piece of paper to the question: 'what will YOU do differently tomorrow?' as a result of the training. Their 'leaves' have been placed on prominently displayed Trauma Trees in their services, as a reminder and inspiration.

 "We always finished the training with Trauma Trees: a way of saying that we don't want this to be just a training session that you tick off on your list and walk back to 'business as usual'. We wanted people to leave feeling inspired, based on what they had talked about, the videos they had watched, the cases we'd presented, to know 'I do have the power to do things differently'." Clinical Nurse Educator

 As well as providing "light bulb" moments in understanding, the training is changing the way staff work with clients and how they reflect on their practice.

 "I have seen a real shift in the language and the way people engage with consumers. At the nurses' station, the response to a patient coming over would often be 'what's wrong?' and so they would be told what was wrong. Now, nurses are learning to ask 'how are you?' or 'is there anything I can do for you?'. That has been a big shift. So has the understanding that it takes time for someone to reveal the trauma that they are dealing with." Consumer Consultant

From my role, I have directly observed a change in staff language and outcomes for clients through an understanding of a person’s background and a clear process of planning care differently to take their trauma history into account.

The program will inform the Area Partnership taskforce's work to help develop trauma-informed practice among the broader local community, including police, GPs, and schools to provide better support for vulnerable children and young people across services and the community.

 "It had a profound effect on me, especially the understanding of the neurobiology – that impact of trauma on the brain and how that translates into behaviour and feelings. That really resonated for me."  Project Officer

About Latrobe Regional Hospital

LRH is the specialist provider of mental health services in Gippsland, and offers inpatient, sub-acute, community and residential programs across the region. LRH provides adult and older persons inpatient care, a community residential care unit (Traralgon), a residential prevention and recovery care service (Bairnsdale), a residential therapeutic program for families experiencing postnatal difficulties, mental health support to general hospital wards, mental health services in the Emergency Department, and acute and recovery based mental health services in the community.