Recognizing Trauma in Mental Health: Trauma-Informed Responses with Youth and People with Psychosis
ANTI-OPPRESSION PSYCHOTHERAPY™: “The Intersectional (Diverse) Client”
Trauma-Informed Case Conceptualization
Healing Milestones: Insights from a Trauma-Survivor Chiropractor
Massage Therapy: A Resource for Establishing Safe Touch in Clients with Trauma Histories
Trauma-informed Care for Paramedics Through Prevention
Challenging Bill C-31: Advocating for Refugee Claimants at the Supreme Court of Canada
Trauma-Informed Youth Justice in Canada
Hidden in Plain Sight: The Need for Trauma-Informed, Disability-Affirmative Care for Women with Physical Disabilities
Your Experiences Matter: Creating an Organizational Culture of Trauma Informed Care
A Trauma-Informed Approach to Supportive Housing for Women
Child & Youth Advocacy Centres: A Multidisciplinary Team Response to Child Abuse
Integrating Trauma- and Violence-Informed Care in Health Care Responses to Health Inequities and Family Violence
Recognizing Trauma in Mental Health: Trauma-Informed Responses with Youth and People with Psychosis
Presenters: Debbie Ernest, MSW,RSW Advanced Practice Clinician – Complex Mental Illness Program, CAMH, Robert Bancroft, MSW, RSW Advanced Practice Clinician –Child Youth and Family Service, CAMH and Sandra Cushing, MSW, RSW Advanced Practice Clinician – Complex Mental Illness Program, CAMH
Presentation Format: Workshop
Skill Level: All
Abstract: This workshop will assist clinicians develop knowledge and skills in applying a trauma-informed lens to assessment and treatment of complex clinical presentations with a focus on two vulnerable populations: children/youth and people with psychosis. A better understanding of trauma, its associated behaviours and effective treatment planning will be highlighted through the use of didactive and interactive modalities, emphasizing the opporutnitiy for applied learning. Three clinician-facilitators will present information on PTSD symptoms, trauma impacts and stage-oriented trauma-informed care that can be applied across clinical populations . Videotaped vignettes will demonstrate the application of trauma-informed care theory to clinical practice with a youth and with an adult with psychosis. Participants will participate in reflective debriefing and discussion of the vignettes and will be encouraged to share experiences from their own practice and work contexts.
Learning Objectives:
ANTI-OPPRESSION PSYCHOTHERAPY™: “The Intersectional (Diverse) Client”
Presenters: Roberta K. Timothy, PhD. and Mercedes Umana, PhD. Candidate, Continuing Healing Consultants
Presentation Format: Workshop
Skill Level: All
Abstract: This introductory training workshop will examine how Anti-Oppression Psychotherapy™ (AOP), a trauma-informed modeli, can be used as a tool of advocacy with diverse clients. Firstly, the historical and contemporary context in relation to the impact of racismii and other determinants of health will be briefly explored. Secondly, the importance of theoretical and methodological concepts and practices of AOP iii will be discussed and essential definitions of AOP will be described. Thirdly, some of the principles of AOP will be explained in the context of issues relating to anti-oppression, trauma, and psychotherapy looking at how its implementation impacts diverse communities in Canada, America, Caribbean, Latin America and transnationally. Fourthly, the “diverse client” will be explored indicating the importance of addressing intersectional factors of identity such as race, indigeneity, class/SES, gender/gender identity, sexual orientation, age, (dis)ability, and spirituality in psychotherapy praxis. Fifthly, the experiences of intersectional trauma in clients’ lives will be looked at. Finally, the importance of the use of resistance and resiliency as empowering therapeutic tools for clients, practitioners, and communities will be examined. This presentation will utilize several case studies to indicate how AOP can be used with diverse clients as a model of trauma-informed social justice praxis.
Learning objectives:
i See Timothy, R., (2012). “Anti-Oppression Psychotherapy as trauma-informed practice,” in “Moving the Addiction and Mental
Health System Towards Being more Trauma-Informed” edited by Nancy Poole and Lorraine Greaves of the British Columbia Centre
of Excellence for Women’s Health.
ii See Timothy, R., (2007). ”Third World Women, of Color and Other Racialized Terms: Black Women Speak” in Centering Black
Feminist Thought in the Canadian Feminist Landscape, Inanna, Publications, Canadian Women’s Studies’. Toronto. Wane, N.,
Massaquoi, N (Eds.).
iii See Timothy, R. (2007). “Resistance Education: African/Black Women Shelter Workers’ perspectives.” Doctoral Dissertation.
University of Toronto.
Trauma-Informed Case Conceptualization
Presenters: Dr. Rosemary Barnes Independent Practice and Dr. Nina Josefowitz Independent Practice
Presentation Format: Workshop
Skill Level: All
Abstract: This workshop will describe how to develop a trauma-informed case conceptualization using a lifespan framework based on attachment, developmental psychopathology, trauma, and risk and resilience research. The workshop will focus on mental health assessment of adults and will discuss (1) locating an individual’s past traumatic experiences in relation to developmental stages and (2) identifying negative cascades of events, attachment style, and complex posttraumatic reactions. Evidence concerning the cumulative effects of trauma on physical and mental health will be reviewed. Childhood or adolescent exposure to extensive adversity or trauma is well-known to increase risk for later difficulties with mental disorders, behaviour, relationships, physical health, intellectual function, school achievement, and occupational function. A lifespan developmental framework can provide a trauma-informed understanding of how risk and resilience factors have affected an individual over an extended period and can guide clinical intervention decisions.
Learning Objectives:
Healing Milestones: Insights from a Trauma-Survivor Chiropractor
Presenter: Dr. Patrick Milroy, BA, MA, DC - Chiropractor
Presentation Format: Single Paper
Skill Level: All
Abstract: A presentation by Chiropractor, Dr. Patrick Milroy, that couples his personal trauma-survival
with clinical insights for the touch professional. The touch professional is in a unique position to
either facilitate healing the healing journey of the survivor, or disrupt healing, or worse yet, retraumatize, because of the nature of the practitioner-client relationship. Dr. Milroy’s
presentation reviews the importance of history taking, and relationship building, when
consulting with the trauma survivor. The importance of story-telling by the trauma survivor is
shared with and emphasis on what Dr. Milroy refers to as “Healing Milestones” and subtopics
such as trauma’s “ripple effect,” reframing, spirituality and trauma, gratitude and forgiveness.
Dr. Milroy’s personal trauma was that of sexual violence which he hopes will now serve as a
lightening rod to educate and sensitize practitioners on trauma-informed care.
Learning Objectives
Massage Therapy: A Resource for Establishing Safe Touch in Clients with Trauma Histories
Presenter: Erin Whyte, R.M.T.
Presentation Format: Single Paper
Skill Level: All
Abstract: Massage therapists are in a unique position to provide treatment to survivors of childhood sexual abuse, victims of partner violence, people with PTSD, or anyone with negative touch histories. A trauma-informed care perspective coupled with a strong therapeutic relationship by a massage therapist can facilitate client outcomes in a safe, boundaried, and empowering way. Massage therapy can be a resource for trauma clients that are stable enough in their emotional process to safely receive touch without being triggered into implicit memories. It can be a helpful adjunct to traditional therapy when clients are ready to reintroduce safe touch into their lives and reinforce a mindful connection to their body. Trauma clients that exhibit high degrees of muscular tension, depression or anxiety can also benefit from a trauma-informed care approach . Evidence is emerging that bodywork is a relevant, valid, and evena necessary piece to the trauma healing process.
Learning Objectives:
Trauma-informed Care for Paramedics Through Prevention
Presenters: Polly Ford-Jones PCP, MA Faculty, Humber College Paramedic Program, PhD Student Health Policy and Equity York University, Craig MacCalman ACP, MSc, BScN, Faculty Humber College Paramedic Program and Richard Alvarez ACP, MSc Faculty, Humber College Paramedic Program
Presentation Format: Single Paper
Skill Level: All
Abstract: Paramedics respond daily to emergency situations and individuals in crisis. This repeated exposure to trauma has led to a heightened risk of occupational stress injury and PTSD diagnosis amongst paramedics (Sterud et al., 2006; Fjeldheim et al., 2014). Current intervention strategies for managing paramedic occupational stress include time out periods, peer support teams, voluntary and mandatory debriefings and access to mental health services (Paramedic Chiefs of Canada, 2014). These strategies are deployed after exposure to a traumatic event and encompass an approach known as critical incident stress management (CISM) (Paramedic Chiefs of Canada, 2014). While the CISM approach has benefit, it does not prepare the paramedic for predictable exposures to traumatic events. Exposure to trauma evokes individual behavioural and psychological changes that can either be transformational or maladaptive (Fernando, 2010). An individual’s response to trauma depends on their level of resilience prior to the critical incident (Agaibi and Wilson, 2005) and evidence suggests improvements to stress management in paramedics can be made through preventative strategies. In order for care for paramedics to be ‘trauma-informed,’ it is necessary to acknowledge the significant exposure to trauma in this work and employ preventative strategies, as well as comprehensive care following traumatic events. The need for trauma-informed care for paramedics is explored through discussion of implementation of individualized prevention and intervention strategies.
Learning Objectives:
Challenging Bill C-31: Advocating for Refugee Claimants at the Supreme Court of Canada
Presenter: Pat Durish, MSW, RSW, Ph.D.
Presentation Format: Case Study
Skill Level: All
Abstract: This presentation is a case study in advocacy at the level of the Supreme Court of Canada. In 2013, three refugee claimants, (a gay man from Serbia, a gay couple from Romania and a gay, Roma man from Romania), after receiving negative decisions from the Refugee Board, applied to have these decisions judicially reviewed. The application proposed to challenge the constitutionality of the Conservative Government’s Designated Country of Origin, (DCO), designation established in 2012. The Canadian Association of Refugee Lawyers, (CARL), was given intervenor status for the proceedings. In an unprecedented move, CARL sought expert testimony not only from legal scholars and social scientists, but also representatives of advocacy groups and clinicians. As a social worker who regularly provides trauma assessments for refugee claimants, I was approached to submit an affidavit to support CARL’s challenge. This presentation describes the process, outcome and implications of my involvement. The discussion is specific to this particular case but also holds implications for advocacy in a broader sense. Refugees are by definition trauma survivors. It is imperative that we continue to do the work of educating policy and decision makers about the effects of trauma so that the refugee process can become more effective at granting protection to this vulnerable population.
Learning objectives:
Trauma-Informed Youth Justice in Canada
Presenter: Judah Oudshoorn, Professor of Community & Criminal Justice, Conestoga College
Presentation Format: Single Paper
Skill Level: All
Abstract: Childhood, psychological trauma is an influential factor why young people end up in trouble with the law. Research indicates that between 70 -90% of young offenders have histories of childhood trauma: many are survivors of individual traumas, such as family violence, sexual abuse, and/or neglect, and many are survivors of collective traumas, such as white supremacy (i.e., colonization of Indigenous peoples), patriarchy (i.e., male violence), and/or greed (i.e., overrepresentation of people living in poverty who are incarcerated). Yet, criminal justice professionals are often ill equipped to deal with the effects of trauma, instead reinforcing a system that further traumatizes. By taking a trauma-informed perspective, the criminal justice system can foster the creation of safe communities through
principles of resilience, restorative justice, decolonization, and healing, rather than risk assessment, prison, and punishment.
Learning Objectives:
Hidden in Plain Sight: The Need for Trauma-Informed, Disability-Affirmative Care for Women with Physical Disabilities
Presenter: Kaley Roosen, M.A. Affiliation: Clinical Psychology Doctoral Student, York University
Presentation Format: Single Paper
Skill Level: All
Abstract: The disturbingly high rates of abuse and trauma within the population of Canadian women with physical disabilities (60% or up to 2.1 times that of women without disabilities) have been largely unaddressed in the psychological and medical support communities. Disability scholars have used the phrase Hidden in Plain Sight to capture the seemingly limited attention in trauma literature towards caregiver abuse and medical trauma, which are rampant in the disability community. Despite being a particularly high-risk group, research has further demonstrated that women with physical disabilities face unique challenges in receiving treatment and support for trauma and abuse, including the unfortunate re-traumatization by medical health professionals who have little-to-no training in disability. This talk will explore the various physiological, psychological and sociocultural factors that place women with disabilities at such high risk for trauma and abuse. Next, I will explore the potential viability for introducing a trauma-informed, disability-affirmative model of care to specifically address the service needs and research gaps for this at-risk group of women. Participants will be provided with specific recommendations for adopting this practice within their established therapies and support services.
Learning Objectives:
Your Experiences Matter: Creating an Organizational Culture of Trauma Informed Care
Presenter: Holly Murphy MN, RN BScN, CPMHN(c)
Presentation Format: Single Paper
Skill Level: All
Abstract: The IWK Health Centre is a pediatric and obstetric hospital that provides care to women, children, youth and their families from Nova Scotia, New Brunswick and Prince Edward Island. We are currently in the process of becoming a trauma-informed organization and examining our trauma-specific services to better serve those who have experienced trauma. Since 2014, we have created a Trauma Informed Care Team (Advisory Group, Project Team and Working Groups) composed of over 150 individuals from internal teams and community system partners. We have just formally launched this initiative by providing trauma awareness and education sessions to staff and community partners. At this launch we presented our organization-wide education, evaluation, and research plans, as well as our new province-wide trauma informed care logo ‘Your Experiences Matter’ and website.
Learning Objectives:
A Trauma-Informed Approach to Supportive Housing for Women
Presenters: Chelsea Kirby, MPH, The Jean Tweed Centre and Kaela McCarney, MSW, RSW, The Jean Tweed Centre
Presentation Format: Case Study
Skill Level: All
Abstract: This case-study presentation will describe two trauma-informed supportive housing programs for women (and women with children) with substance use and/or mental health issues. The women involved in this housing experience complex substance use and/or mental health issues, are homeless or under-housed prior to entry into the program, are high users of the health care system (e.g. emergency department, withdrawal management services), and may have involvement with the criminal justice system and/or child welfare. These two supportive housing programs are unique in that they offer housing to women with children in their care, or transitioning back into their care, which is a gap in the system .The development of these housing programs will be presented, including; advocacy and collaborative strategies within the system and partnerships to promote trauma-informed, women-centered care, the design of unique housing models and programming to best meet the needs of women, and the use of feedback from women in the program to improve quality of services. This presentation will also offer a list of resources to participants who want to further their understanding of supportive housing and in particular, a trauma-informed approach.
Learning Objectives:
Child & Youth Advocacy Centres: A Multidisciplinary Team Response to Child Abuse
Presenter: Pearl Rimer, Director of Operations, Boost Child & Youth Advocacy Centre
Presentation Format: Single Paper
Skill Level: All
Abstract: In 2013, Boost Child & Youth Advocacy Centre (CYAC), together with community partners, opened Toronto’s first CYAC for child/youth victims of sexual and physical abuse, neglect, and human trafficking. The objective of the CYAC is to improve the current system of investigation, protection, treatment, advocacy and prosecution of child abuse with a collaborative approach resulting in a coordinated, multidisciplinary, trauma-informed response to victims in a child-focused environment. Research was conducted to evaluate the implementation of best practice standards and evidence-based/evidence-informed multidisciplinary practices, programs and services in a CYAC setting.
Method: The evaluation was a mixed-method, multi-site, multi-agency, multidisciplinary staff 18-month project that included both CYAC and comparison samples.
Results:
Conclusions: Based on the results, this research underscores that the CYAC model is an improved, efficient and effective approach to managing and servicing high-risk child maltreatment cases.
Learning Objectives:
Integrating Trauma- and Violence-Informed Care in Health Care Responses to Health Inequities and Family Violence
Presenters: Victoria Smye RN PhD, Associate Professor of Nursing, Faculty of Health Sciences, University of Ontario Institute of Technology, Marilyn Ford-Gilboe, PhD, RN, FAAN, Professor and Women’s Health Research Chair in Rural Health, Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, and C. Nadine Wathen, Associate Professor & Faculty Scholar, Faculty of Information & Media Studies, and Research Scholar, Centre for Research & Education on Violence Against Women & Children, Western University
Presentation Format: Symposium
Skill level: All
Abstract: In this symposium, we present an overview of the concept of Trauma- and Violence-Informed Care (TVIC)and illustrate its application using examples from research testing an organizational intervention to enhance equity-oriented primary health care (EQUIP) and a national initiative focussed on developing educational guidance and tools in family violence (VEGA)
Paper 1: “Integrating the “V” in Trauma- and Violence-Informed Care (TVIC): The Traumatic Effects of Violent People, Systems and Structures”
Presenting author: Victoria Smye RN PhD, Associate Professor of Nursing, Faculty of Health Sciences, University of Ontario Institute of Technology
Other authors (in this order):
Colleen Varcoe, RN, PhD, Professor, University of British Columbia School of Nursing
Annette J. Browne, PhD, RN, Professor, University of British Columbia School of Nursing
Marilyn Ford-Gilboe, PhD, RN, FAAN, Professor and Women’s Health Research Chair in Rural Health, Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University
C. Nadine Wathen, Associate Professor & Faculty Scholar, Faculty of Information & Media Studies, and Research Scholar, Centre for Research & Education on Violence Against Women & Children, Western University
When systems and providers who serve victims of violence lack an understanding of its complex and lasting traumatic impacts, they risk causing further harm. Trauma-informed Care (TIC) seeks to create a safe environment for clients based on an understanding of the effects of trauma, and its close links to health and behaviour. Unlike trauma-specific care, it is not about eliciting or treating people’s trauma histories. Trauma- and violence-informed care (TVIC) expands the concept of TIC to account for the intersecting impacts of systemic and interpersonal violence and structural inequities on a person’s life (Elliott et al., 2005). This shift is important as it brings into focus both historical and ongoing interpersonal violence and their traumatic impacts and helps to emphasize a person’s experiences of past and ongoing structural violence so that problems are not seen as residing only in their psychological state (Williams & Paul, 2008); rather, they also reside in social spaces. Importantly, because TVIC strives to make practices and policies safe, it fosters opportunities for service providers to prevent harm. In this presentation, we discuss the principles of TVIC and explore the added benefits of adopting this perspectives as a foundation for shifting practices and policies.
Paper 2: “Fostering TVIC in Primary Health Care: Emerging Lessons and Findings from an Organizational Level Intervention”
Presenting author: Marilyn Ford-Gilboe, PhD, RN, FAAN, Professor and Women’s Health Research Chair in Rural Health, Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University
Other authors (in this order):
Annette J. Browne, PhD, RN, Professor, University of British Columbia School of Nursing
Colleen Varcoe, RN, PhD, Professor, University of British Columbia School of Nursing
C. Nadine Wathen, Associate Professor & Faculty Scholar, Faculty of Information & Media Studies, and Research Scholar, Centre for Research & Education on Violence Against Women & Children, Western University
Victoria Smye RN PhD, Associate Professor of Nursing, Faculty of Health Sciences, University of Ontario Institute of Technology
EQUIP is a complex intervention designed to enhance the capacity of primary health care (PHC) organizations to address the health consequences of discrimination and structural and interpersonal violence by shifting practices and organizational policies and processes. Facilitated by a practice consultant, EQUIP integrates education on equity-oriented care, trauma- and violence-informed care, and cultural safety, along with ‘Organizational Integration and Tailoring’, in which clinics select, implement and evaluate local changes to enhance care (Browne et al., 2015). In a multiple-case study, we are testing EQUIP in four PHC clinics serving patients living in marginalizing conditions. To evaluate process and impacts, we are drawing on different types of data collected before, during and after the intervention at various intervals including: surveys of staff knowledge, attitudes and practices; in-depth qualitative interviews with staff and key stakeholders, and detailed practice consultant reports to track the process of change and factors shaping it; and structured interviews with a cohort of 567 patients to assess their experiences of health care and selected health outcomes. We will describe the EQUIP intervention in relation to TVIC to address what was implemented, emerging findings about impacts and implications for fostering TVIC in “real world” clinical settings.
Paper 3: “The VEGA (Violence, Evidence, Guidance, Action) Project: A Public Health Response to Family Violence”
Presenting author: C. Nadine Wathen, Associate Professor & Faculty Scholar, Faculty of Information & Media Studies, and Research Scholar, Centre for Research & Education on Violence Against Women & Children, Western University
Other authors (in this order):
Harriet MacMillan, MD, MSc, FRCPC, Professor, Departments of Psychiatry and Behavioural Neurosciences, and of Pediatrics, Offord Centre for Child Studies, McMaster University
Marilyn Ford-Gilboe, PhD, RN, FAAN, Professor and Women’s Health Research Chair in Rural Health, Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University
Colleen Varcoe, RN, PhD, Professor, University of British Columbia School of Nursing
Family violence is a major public health problem with devastating effects on individuals, families, and society. The VEGA project is developing national, evidence-based public health guidance and education to enable health and social service professionals to provide safe, compassionate and integrated care for those exposed to family violence. Funded by the Public Health Agency of Canada, one of VEGA’s key deliverables is to develop educational tools based on principles of trauma- and violence-informed care (TVIC), integrating issues of equity with respect to race, ethnicity, culture, ability and gender and appropriate for adaptation and implementation by different provider groups and in various settings. Using an integrated knowledge translation model, a National Guidance and Implementation Committee (NGIC) representing22 Canadian health and social service professional organizations provides overall guidance and assists with testing of educational strategies and development of metrics and dissemination approaches. This presentation will introduce VEGA, provide an overview of activities to date, and set the stage for discussion of how TVIC principles are being used to develop family violence guidance that leads to care encounters that area positive and safe, including through specific engagement strategies to ensure participation from NGIC members from initial stages and through project completion.
Learning Objectives:
