Trauma-Informed Care and Practice: Practice Improvement Strategies in an Inpatient Mental Health Ward

Beckett, Paul; Holmes, Douglas; Phipps, Monique; Patton, Declan; Molloy, Luke

doi:10.3928/02793695-20170818-03

Cited by 31 publications

(56 citation statements)

References 17 publications

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“…The intervention that has been applied in the widest clinical settings is Six Core Strategies. Six standalone interventions [127][128][129][130][131][132] had been implemented in multiple settings within the same intervention/study, as had four intervention families (i.e. interventions with multiple records): Six Core Strategies (in acute and secure wards); Brøset Violence Checklist [in acute wards and psychiatric intensive care units (PICUs)]; Tower Hamlets Violence Reduction Collaborative (in multiple acute settings); and Initiatives to Reduce Seclusion and Restraint (in multiple, unreported settings).…”

Section: Clinical Settingmentioning

confidence: 99%

“…77 143 another aimed to replace PRN medication with 'other clinical strategies' (no further explanation provided), 131 and another to reduce restraint associated with PRN medication and security involvement. 69 None of the interventions explicitly reported targeting the use of rapid tranquillisation, although Beckett et al 130 referred to reviewing its use (in their procedures) and Sarkar 78 examined the impact of their intervention on their use of rapid tranquillisation (reported in their outcome measures). Some interventions specified the type of restrictive practice they wanted to address, whereas others specified frequency 115,131,144 or duration.…”

Section: Assumed Change Process and Design Principlesmentioning

confidence: 99%

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Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

Baker

Berzins

Canvin

et al. 2021

Health Serv Deliv Res

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Objectives The study aimed to provide a mapping review of non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings; classify intervention components using the behaviour change technique taxonomy; explore evidence of behaviour change techniques and interventions; and identify the behaviour change techniques that show most effectiveness and those that require further testing. Background Incidents involving violence and aggression occur frequently in adult mental health inpatient settings. They often result in restrictive practices such as restraint and seclusion. These practices carry significant risks, including physical and psychological harm to service users and staff, and costs to the NHS. A number of interventions aim to reduce the use of restrictive practices by using behaviour change techniques to modify practice. Some interventions have been evaluated, but effectiveness research is hampered by limited attention to the specific components. The behaviour change technique taxonomy provides a common language with which to specify intervention content. Design Systematic mapping study and analysis. Data sources English-language health and social care research databases, and grey literature, including social media. The databases searched included British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Technology Assessment (HTA) Database, HTA Canadian and International, Ovid MEDLINE®, NHS Economic Evaluation Database (NHS EED), PsycInfo® and PubMed. Databases were searched from 1999 to 2019. Review methods Broad literature search; identification, description and classification of interventions using the behaviour change technique taxonomy; and quality appraisal of reports. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were retrieved and subject to scrutiny of content, to identify interventions; quality appraisal, using the Mixed Methods Appraisal Tool; and data extraction, regarding whether participants were staff or service users, number of participants, study setting, intervention type, procedures and fidelity. The resulting data set for extraction was guided by the Workgroup for Intervention Development and Evaluation Research, Cochrane and theory coding scheme recommendations. The behaviour change technique taxonomy was applied systematically to each identified intervention. Intervention data were examined for overarching patterns, range and frequency. Overall percentages of behaviour change techniques by behaviour change technique cluster were reported. Procedures used within interventions, for example staff training, were described using the behaviour change technique taxonomy. Results The final data set comprised 221 records reporting 150 interventions, 109 of which had been evaluated. The most common evaluation approach was a non-randomised design. There were six randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Behaviour change techniques found in the interventions were most likely to be those that demonstrated statistically significant effects. The most common intervention target was seclusion and restraint reduction. The most common strategy was staff training. Over two-thirds of the behaviour change techniques mapped onto four clusters, that is ‘goals and planning’, ‘antecedents’, ‘shaping knowledge’ and ‘feedback and monitoring’. The number of behaviour change techniques identified per intervention ranged from 1 to 33 (mean 8 techniques). Limitations Many interventions were poorly described and might have contained additional behaviour change techniques that were not detected. The finding that the evidence was weak restricted the study’s scope for examining behaviour change technique effectiveness. The literature search was restricted to English-language records. Conclusions Studies on interventions to reduce restrictive practices appear to be diverse and poor. Interventions tend to contain multiple procedures delivered in multiple ways. Future work Prior to future commissioning decisions, further research to enhance the evidence base could help address the urgent need for effective strategies. Testing individual procedures, for example, audit and feedback, could ascertain which are the most effective intervention components. Separate testing of individual components could improve understanding of content and delivery. Study registration The study is registered as PROSPERO CRD42018086985. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.

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Section: Clinical Settingmentioning

confidence: 99%

Section: Assumed Change Process and Design Principlesmentioning

confidence: 99%

Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

Baker

Berzins

Canvin

et al. 2021

Health Serv Deliv Res

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“…Indeed, the documentation of a trauma‐related intervention or assessment is low and presents the possibility of an underestimation of need in this area. Trauma‐informed care is identified as a key component of mental health nursing (Beckett et al, 2017), and the absence of good assessment and intervention can lead to services retraumatizing individuals at worst and compromise the therapeutic relationship and effective engagement with consumers. Trauma‐focused assessment tools and interventions need to be clearly completed and documented.…”

Section: Discussionmentioning

confidence: 99%

“…Trauma‐focused assessment tools and interventions need to be clearly completed and documented. A pathway to better implementation of trauma‐informed care (TIC) requires concentrated work, with (Roviralta‐Vilella et al 2019) stressing the importance of supportive unit environments, strong leadership (Beckett et al, 2017), and a clear philosophy informing a practical model of care (Isobel & Edwards, 2017). Isobel and Delgado (2018) also suggest training in communication skills to support TIC can lead to improvements in care with ongoing supervision a necessity.…”

Section: Discussionmentioning

confidence: 99%

Care planning and nonpharmacological interventions in a metropolitan inpatient dual diagnosis service: A retrospective exploratory study

MacLeay

Fry

Roche

et al. 2020

Int J Mental Health Nurs

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In Australia, the terms dual diagnosis and comorbidity are commonly used, often interchangeably, to describe the experience of consumers with both mental health difficulties and difficulties with alcohol and other drug use. Consumers with comorbidity often have complex needs that require comprehensive assessment, multidisciplinary team support, and trauma-focused management. More information about the demographics of consumers admitted with comorbidity, and the documented assessed needs, care, and interventions provided, would provide the foundations for working towards improved quality and continuity of care. Therefore, the aim of this study was to explore the documentation of inpatient assessment, care, and interventions provided to people with comorbidity. The research design was a retrospective exploratory study, and data collection involved a 12-month healthcare record audit. Forty-one records were screened, and 36 consumer healthcare records were identified as eligible for inclusion in the study. Most consumers (n = 34, 94%) were admitted on an involuntary basis, and 8 (22.2%) were female. Consumers had a median length of stay of almost six months. In most healthcare records, there was no documented evidence of care planning involvement by consumers or the multidisciplinary team. There was great variance in the delivery of nonpharmacological interventions. Most consumers did not receive trauma-focused assessment or intervention, and assessment tools were often incomplete with outcome measures poorly documented. This study has demonstrated significant gaps in consumer and multidisciplinary engagement with care planning and goal setting. There was poor documentation of comprehensive assessment and nonpharmacological interventions.

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“…A recent article by Isobel in 2016 explored the current state in Australia medical practice and emphasized a need for psychiatry to view trauma-informed care as a significant and urgent paradigm shift [31]. Work in the USA in 2017 by Beckett did highlight that embedding trauma-informed care principles in acute psychiatric inpatient ward practice is important given the impact of trauma, but that this change has been slow to occur [32].…”

Section: Existing Literature On Trauma Education In Psychiatrymentioning

confidence: 99%

Positioning Psychiatry as a Leader in Trauma-Informed Care (TIC): the Need for Psychiatry Resident Education

Kosman

Levy‐Carrick

2019

Acad Psychiatry

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Trauma is highly prevalent in patient populations, particularly those encountered by psychiatrists and psychiatry residents. Exposure to traumatic events increases an individual's toxic stress burden and increases the risk of mental health problems and chronic physical disease [1]. Adverse childhood experiences (ACEs), including abuse and neglect, have been linked to an array of medical sequelae, including heart, lung, and liver diseases, obesity, diabetes, depression, substance use, and sexually transmitted infections [1-3]. Adverse experiences also lead to epigenetic cellular and molecular mechanisms that produce changes in gene expression, producing lasting effects in the body as well as alterations in neuronal structure and function [4]. The impact of adverse experiences across the lifespan impact interpersonal dynamics as well as individual health, and there is an emerging appreciation of the convergence of discussions about the impact of trauma on workplace morale and safety, with related concerns about resilience and burnout [5]. Trauma is ubiquitous worldwide, whether from adverse childhood experiences (ACEs), abuse, life events, or disasters. The scope of potentially traumatic events has, moreover, expanded in recent years to include experiences of social determinants of health, from food security to race, gender, and religious bias. Trauma-informed care (TIC) provides a framework for considering trauma at all levels, including patients, providers, and the overall organizational culture. Psychiatry as a field is uniquely positioned to advance trauma-informed care (TIC) and its implications for patient and clinician engagement. The field combines an understanding of neurobiological underpinnings of the effect of trauma, its consequences, and its sequela, with the psychodynamic and psychotherapeutic engagement with patients in their trauma narrative. Psychiatry resident education in TIC is essential to train the next generation of psychiatrists who are already interacting with patients and who will continue to shape this role in the future.

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Trauma-Informed Care and Practice: Practice Improvement Strategies in an Inpatient Mental Health Ward

Cited by 31 publications

References 17 publications

Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

Care planning and nonpharmacological interventions in a metropolitan inpatient dual diagnosis service: A retrospective exploratory study

Positioning Psychiatry as a Leader in Trauma-Informed Care (TIC): the Need for Psychiatry Resident Education

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