Cork Simon Community Moving Towards Trauma Informed Care

Cork Simon Community Moving Towards Trauma Informed Care

Founded in 1971 by Anton Wallich Clifford • Working with people with complex needs / multiple exclusion. • In 2018 worked with 1, 103 people in Cork. • Providing Shelter and Housing / Support to approx. 250 people every day in the city. Aim: As a consequence of our work, Cork Simon intends to end long term homelessness and rough sleeping in Cork, and to provide those we serve with the security, stability, and support to improve their overall well-being and to determine and pursue their own goals

Services Include • 48 bed Emergency Shelter • 15 Bed Night Light Shelter • Day Centre • Care and case management • Drugs and alcohol services • 5 High Support Houses • Housing First / Housing Led Services • Employment, Education and Training Services • Policy and Campaigning – Right to Houisng

Partnership Principal Investigators: Dr Sharon Lambert, Senior Lecturer, University College Cork Mr Graham Gill-Emerson, Addiction Counsellor, Cork Simon Community

Cork Simon & Trauma informed Practice Cork Simon’s comprehensive approach: – – – ACEs at Cork Simon Community Staff Trauma Impact Assessment Trauma Informed Services Assessment Staff training Comprehensive change plan

https: //vimeo. com/236549966

Cork Simon ACE Study Dr Sharon Lambert and Graham Gill Emmerson Total of 47 clients interviewed Average of 5. 15 aces person (Range 1 -10) The three most common aces referred to Emotional Neglect, Domestic Violence and Sexual abuse • Strong link between ACEs and early drug use (u 12) identified in the study. • Highlights need for homeless services to deliver Trauma Informed Services • •

Trauma Informed Assessment An agency self-assessment for Trauma Informed Care (Fallot & Harris, 2009) assesses an organisations readiness for implementing a trauma informed approach. The assessment is organised into five domains; • • • staff development, safe and supportive environment, assessment and care planning consumer involvement organisational policies. The agency self-assessment was completed by a walkthrough by researcher as service user across each point of care on the care & support continuum

Trauma Informed Assessment • Undertaken re Day Shelter / Pre-Stabilisation Service / High Support Housing / Housing First • 90% in line with Best Practice • Areas for improvement: • Physical environment • Assessments • Cork Simon policies • Staff Care • Government Policy – HRC /COI • Staff understanding of trauma (undertaken before Trauma Training)

Staff Survey The Professional Quality of Life survey, Pro. QOL (Stamm, 2010) a self-report measure to assess the compassion satisfaction, burn-out and compassion fatigue was administered with a sample of staff/volunteers • 53 people completed the survey • At least 11 / 53 had high scores re secondary traumatic stress • 9 /53 had low scores re compassion satisfaction…worries re effectiveness in role • At least 6 / 50 with worrying scores re Burnout

Secondary Traumatic Stress Scores High Scores indicate something in work may be frightening to the participant. They may have difficulty sleeping, have images of the upsetting event pop into their mind, or avoid things that remind them of the event. © Beth Hudnall Stamm, 2009. www. Pro. QOL. org

© Beth Hudnall Stamm, 2009. www. Pro. QOL. org

Consequences

Staff Training Dr Sharon Lambert provided training in trauma awareness for all staff at Cork Simon during the course of 2017 Overall more than 120 persons participated over 6 Training Days This included all frontline staff, ancillary staff (catering, cleaning, maintenance etc. management , administration and fundraising staff including senior management

Staff Training General approach and content: Training content was informed by the outcome of the three assessments (service users, staff and service). Stress and “Window of Tolerance” Principles of trauma informed practice Discussion of staff views on ‘what worked well’ and ‘what would work better’ in terms of their work. These view were themselves documented analysed

Staff Training Feedback received; ➢ The training provided me with insight to appropriately work with clients who have experienced trauma ➢ I will be more aware of language and space when working with people ➢ The trainer explained theory of trauma very well; it was easy to understand ➢ The training gave me an understanding of the significance of the impact of early childhood trauma ➢ This has been an excellent training and has allowed me to reevaluate my practice ➢ Showed me many areas we’re excelling and has also motivated me and given me ideas for improvement

Report Recommendations Formalise a trauma change team (should include former Service User) that will drive the implementation of TIC and allocate responsibility for the roll out of Trauma Informed Care requirements e. g. all policies, procedure and paperwork reviewed to ensure they incorporate TIC principles. TIC Team in place since 2017. Issues reviewed include Need for staff room Service user memorials Building signage What to call the people we serve “Sanctions” Strengths based documentation

Report Recommendations Identify and Introduce an appropriate universal trauma screening tool (that is fit for purpose inclusive of child and adult experiences) and include with the Initial Assessment. This should be evaluated as a pilot over 12 months. To be completed. Engage with external agencies to modify intake paperwork to include trauma screening and include strengths based approaches. This includes asking Service Users for their definitions of both physical and emotional safety. Ongoing work with Cork / Kerry Care and Case Management working group towards improving this

Reflective Practice

Report Recommendations Repeat Pro. QOL and Agency Self-assessment at 12 months -18 months. To be completed Provide programme details in more languages Agree languages / organise translation Email the report to all staff post trauma awareness training for feedback on their views of areas that need updating to improve organisations capacity for Trauma Informed Care Completed

Report Recommendations Address staff self-care by providing self-care training formal staff rooms reorganising structure of supervision regularly remind staff to use internal and external resources. Training sessions on self care and wellbeing arranged for all staff Staff room in place in Shelter from November 2019 Discussions re staff support and wellbeing given primacy in supervision structure. External Supervision for Outreach Workers, beingextended to others from 2020. Pilot Reflexive Practice Groups Wellbeing page and resources on Intranet

Report Recommendations Address trauma and trauma contagion at all team meetings by including trauma on each agenda and provide sufficient time for staff to address any trauma related issues they have observed in SU’s, any policy and/or procedure that appears to not be in line with TIC and discuss secondary trauma impacts (Including SMT /MDT) Room for this is provided for at Handover Meetings for each team and it is a standing agenda item on some (including BOD meeting) but not yet all team meetings

Report Recommendations Review current paperwork for Service Users such as rules, rights and agreements (Ref NQSF) Reduce paperwork and make it more universal between centres with an emphasis on positives and strengths. Much paperwork is required by funding bodies and not directly in our control Work ongoing over past two years developing automated systems that simplify documentation and reporting across the organisation Strengths based recommendations are to the fore in new materials being produced

Report Recommendations Source and provide informational material on stress and trauma for Service Users and increase access to interventions such as mindfulness training. Mindfulness training delivered for staff and weekly meditation and access to yoga available free to all staff. Seeking to put mindfulness training in place for service users for 2019/2020 Review waiting list systems within the service and identity ways of making these align with trauma informed principles Changes made and underway to prioritise the most vulnerable / traumatised for access to supports and to reduce stress points in the system. Difficult in demand led system

Report Recommendations Promote increased attendance at resident’s meetings. These are now happening biweekly at Shelter Review current capacity and operations within the Day Service as it has become increasingly busy and may not be able to facilitate all of the activities that operate from there. o IAFs – These are now undertaken by Intake Coordinator o Nx – Under Review o Reception duties –Additional staff in place o Review of sanctions – Under review o Managing bedlist – Changed allocations policy o Additional Staffing - Recruited

Report Recommendations Long term follow up: Advocate for additional resources to address building issues such as beds in offices and larger site for Day Service We continue to advocate for additional resources Assess and source resources required to provide single room occupancy and/or communal housing first sites for those who can utilise them. Strategic Plan 2020 -2024 Advocate for SU’s on a national basis to ensure that national policies that impact on homeless people (such as the ‘centre of interest’ policy) can be trauma informed Via SCI

Report Recommendations Review current bed rotation system for alternatives that can provide for more stability. Rotating beds largely eliminated

Report Recommendations In summary, a lot done Much more to do.

Cork Simon Community Home at Last! More than https: //www. corksimon. ie/wp-content/uploads/2017/10/Moving-Towards. Trauma-Informed-Care-Report. pdf