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How trauma-informed toolkit supports practice and care in forensic mental health

In this article Acting Senior Forensic Psychologist with the Problem Behaviour Program, Forensicare Dr Bonnie Albrecht looks at the application of Mental Health Coordinating Council’s Trauma-Informed Care and Practice Organisational Toolkit in a state-wide forensic mental health service.

The Community Forensic Mental Health Service (CFMHS) is a Victorian state-wide service, which provides programs for people who have a serious mental illness and have offended, or are at high risk of offending, and who are based in the community.

The CFMHS Trauma-Informed Care Working Group was established in 2018, with recognition of the need to attend to the complexities of trauma-informed care in forensic mental health settings.

Members of the CFMHS Trauma-Informed Care Working Party undertook the Trauma-Informed Care and Practice Organisational Toolkit (TICPOT), with support from the Mental Health Coordinating Council.

Comprehensive review the starting point

TICPOT encouraged a comprehensive review of the CFMHS’ various programs and systems, including policies, and involved active discussion with staff across programs and consultation with the CFMHS Consumer Advisory Group, Forensicare’s Lived Experience team, and consumers and families and carers involved with that team.

Positively, the audit identified a number of ways in which the CFMHS already promotes or enacts trauma-informed care principles. This includes attunement and attendance to emotional safety and trauma response at the individual client level, collaborative treatment and intervention planning, support for staff wellbeing initiatives, and the presence of appropriate policies and procedures regarding incidents, complaints, and feedback. However, the review also identified a number of opportunities for improvement.

An important consideration for CFMHS is the variability of services provided, ranging from consultation to direct care. The suite of programs operating across Community Services are inherently different, with different aims, procedures, staffing profile, and expertise. However, across the programs, core themes were identified. Broadly, these centred on inconsistent knowledge and understanding of trauma and trauma-informed care, the need for further guidance of how to embed trauma-informed care into practice, and limited uptake and consideration of Lived Experience teams or individuals.

In consideration of these identified gaps, the CFMHS Working Party recommended:

• The creation of a CFMHS Trauma-Informed Care and Practice Guideline. This Guideline will support CFMHS staff in identifying practical steps they can make in their everyday work to enhance the way in which CFMHS embed trauma-informed care approaches, and will provide avenues for accountability and review in the future.
• Regular training to attend to issues of trauma, trauma-informed care, and applying trauma-informed care in forensic settings which also encompasses the experience of families and carers.
  • This recommendation included supplementary recommendations for management and supervisor training specifically around performing these roles in a trauma-informed manner, and an increased emphasis on trauma-informed care at staff recruitment and orientation
• The CFMHS better embed consumer and family/carer engagement in system evaluation and modification.

An Action Plan has been developed to attend to these recommendations, and progress has started on policy and procedural update.

TICPOT provided an informed and structured method for reviewing CFMHS policies and procedures. Stage 1 of the tool prompted the Working Party to critically examine whether there was sufficient evidence of trauma-informed care principles in our daily processes, and ways in which we could improve our processes.

While it was a lengthy endeavour, it prompted important debate about the ongoing suitability of systems operating at the CFMHS. The definitions and literature review included within the TICPOT helped the Working Party members remain anchored and ensured we were considering the domains with a shared understanding of trauma, and trauma-informed care.

We also found it helpful to engage the broader workforce for feedback on the domain Healthy & Effective Workforce, and consulted with consumers and Forensicare’s consumer and family representative teams regarding the domains Consumer & Carer/Family Participation, and Direct Services to Consumers.

Regular correspondence with Corinne Henderson, Principal Policy Advisor at MHCC, further assisted our process.

Action Plan in action

While our implementation of the resulting Action Plan has only just begun, the resources provided in Stage 2 & 3 of the TICPOT have given us guidance on how to plan and structure this implementation. The included policy templates, resource links and examples, and further definitions will support us to remain anchored to the research and trauma-informed care principles as we move through this next stage, and offers helpful examples of how to effectively convey and instill these sentiments within our workforce.

THE TOOLKIT

The TICPOT toolkit is a systematic approach to guiding organisational change, suitable for any human services organisation. The two-part toolkit is a roadmap to preparing for an audit, planning, implementation and evaluating outcomes as part of a quality improvement cycle. It is free to download and includes resources and tools to build on existing trauma-informed practices, and incorporates the most contemporary research evidence.

Download the TICPOT Toolkit for free

Dr Bonnie Albrecht is an Acting Senior Forensic Psychologist with the Problem Behaviour Program, Forensicare. She has long-held a passion for instilling trauma-informed care within forensic mental health service practices, and over the past six years has been involved in such efforts in Forensicare’s inpatient and community services.