Healing Complex Trauma through Therapeutic Residential Care: The Lighthouse Foundation Therapeutic Family Model of Care

2014 ◽  
Vol 39 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Pauline J. McLoughlin ◽  
Rudy Gonzalez
Keyword(s):  
Residential Care ◽  
Therapeutic Community ◽  
Traumatic Experiences ◽  
Positive Development ◽  
Model Of Care ◽  
Discussion Paper ◽  
Complex Needs ◽  
Community Approach ◽  
Family Model ◽  
The Impact

Therapeutic Residential Care (TRC) has attracted increasing interest in Australia, as a specialised out-of-home care option for children with complex needs. Extending beyond the limitations of traditional residential programmes, TRC aims to address the impact of trauma and promote positive development and wellbeing. The Lighthouse Foundation is a not-for-profit organisation based in Melbourne, providing a long-term programme of TRC to young people aged 15 to 22 at intake. The organisation has developed an attachment and trauma-informed therapeutic community approach, embodied in the Therapeutic Family Model of Care. This discussion paper explores how the therapeutic community approach taken by Lighthouse provides a different experience of the cultural ‘sites’ in which early traumatic experiences occur – including the home environment, experiences of family, and the wider community. In doing so, we propose that an important dimension of TRC is the capacity to challenge traumatic relational blueprints of abuse and neglect. This, in turn, supports children to form and sustain positive and reciprocal relationships, and to live inter-dependently in the community.

Gangs and groups: the impact on therapeutic processes

2018 ◽  
Vol 39 (1) ◽  
pp. 50-58
Author(s):  
Geraldine Ann Akerman
Keyword(s):  
Design Methodology ◽  
Therapeutic Community ◽  
Research Paper ◽  
Gang Members ◽  
Discussion Paper ◽  
Content Type ◽  
Conceptual Paper ◽  
Therapeutic Processes ◽  
Conducting Research ◽  
The Impact

Purpose The purpose of this paper is to consider the impact having been in a gang has on being in a group in a democratic therapeutic community (DTC). In particular what characteristics attract (in this case) males to join a gang and or group, and what is the impact on a DTC of having former gang members in it. Design/methodology/approach The paper is a discussion paper considering the implications of the points raised above. It also includes results of research relating to the “Changing the Game” programme. Findings The findings result from experience of having worked in the environment, reviewing available literature, conducting research and having managed some of the issues raised. It is not a research paper but does present findings. Research limitations/implications This is a conceptual paper which incorporates findings from this author and others on the impact of gangs in a DTC. There is limited research in this area and so much is drawn from findings in other settings. Originality/value Little is written on the impact of having been in a gang and the dynamics that introduces in a forensic DTC. Therefore, it is hoped that it will encourage further research in this area.

scholarly journals The impact of poly-traumatization on treatment outcomes in young people with substance use disorders

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sidsel Karsberg ◽  
Morten Hesse ◽  
Michael Mulbjerg Pedersen ◽  
Ruby Charak ◽  
Mads Uffe Pedersen
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Psychological Trauma ◽  
Well Being ◽  
Traumatic Experiences ◽  
Treatment Entry ◽  
Trauma Types ◽  
Using Data ◽  
The Impact ◽  
Drug Use Disorder

Abstract Background It is believed that clients with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders. However, knowledge on the effect of the number of trauma experiences is scarce. Methods Using data from drug use disorder (DUD) treatment in Denmark, we assessed the impact of having experienced multiple potentially traumatic experiences on DUD treatment efficacy. Baseline and follow-up data from 775 young participants (mean age = 20.2 years, standard deviation = 2.6) recruited at nine treatment centers were included in analyses. Results Analyses showed that participants who were exposed multiple trauma experiences also reported a significantly higher intake of cannabis at treatment entry, and a lower well-being score than participants who reported less types or no types of victimization experiences. During treatment, patients with multiple types of trauma experiences showed a slower rate of reduction of cannabis than patients with few or no trauma experiences. The number of trauma types was not associated with number of sessions attended or the development of well-being in treatment. Conclusion Overall, the results show that although traumatized youth in DUD treatment show up for treatment, helping them to reduce substance use during treatment is uniquely challenging. Trial registration ISRCTN88025085, date of registration: 29.08.2016, retrospectively registered.

The Impact of Military Service Exposures and Psychological Resilience on the Mental Health Trajectories of Older Male Veterans

2020 ◽  
pp. 089826432097523
Author(s):  
Stephanie Ureña ◽  
Miles G. Taylor ◽  
Dawn C. Carr
Keyword(s):  
Mental Health ◽  
Depressive Symptom ◽  
Military Service ◽  
Later Life ◽  
Traumatic Experiences ◽  
Psychological Resilience ◽  
Previous Exposure ◽  
Negative Consequences ◽  
Symptom Trajectories ◽  
The Impact

Objectives: We examine the impact of exposure to the dead, dying, and wounded (DDW) during military service on the later-life depressive symptom trajectories of male United States veterans, using psychological resilience as an internal resource that potentially moderates negative consequences. Methods: The Health and Retirement Study (2006–2014) and linked Veteran Mail Survey were used to estimate latent growth curve models of depressive symptom trajectories, beginning at respondents’ first report of resilience. Results: Veterans with higher levels of resilience do not have increased depressive symptoms in later life, despite previous exposure to DDW. Those with lower levels of resilience and previous exposure to DDW experience poorer mental health in later life. Discussion: Psychological resilience is important for later-life mental health, particularly for veterans who endured potentially traumatic experiences. We discuss the importance acknowledging the role individual resources play in shaping adaptation to adverse life events and implications for mental health service needs.

scholarly journals Implementing a digital health model of care in Australian youth mental health services: protocol for impact evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Piper ◽  
Tracey A. Davenport ◽  
Haley LaMonica ◽  
Antonia Ottavio ◽  
Frank Iorfino ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Impact Evaluation ◽  
Digital Health ◽  
Youth Mental Health ◽  
Model Of Care ◽  
Health Service Provision ◽  
Industrial Grade ◽  
The Impact

Abstract Background The World Economic Forum has recently highlighted substantial problems in mental health service provision and called for the rapid deployment of smarter, digitally-enhanced health services as a means to facilitate effective care coordination and address issues of demand. In mental health, the biggest enabler of digital solutions is the implementation of an effective model of care that is facilitated by integrated health information technologies (HITs); the latter ensuring the solution is easily accessible, scalable and sustainable. The University of Sydney’s Brain and Mind Centre (BMC) has developed an innovative digital health solution – delivered through the Youth Mental Health and Technology Program – which incorporates two components: 1) a highly personalised and measurement-based (data-driven) model of youth mental health care; and 2) an industrial grade HIT registered on the Australian Register of Therapeutic Goods. This paper describes a research protocol to evaluate the impact of implementing the BMC’s digital health solution into youth mental health services (i.e. headspace - a highly accessible, youth-friendly integrated service that responds to the mental health, physical health, alcohol or other substance use, and vocational concerns of young people aged 12 to 25 years) within urban and regional areas of Australia. Methods The digital health solution will be implemented into participating headspace centres using a naturalistic research design. Quantitative and qualitative data will be collected from headspace health professionals, service managers and administrators, as well as from lead agency and local Primary Health Network (PHN) staff, via service audits, Implementation Officer logs, online surveys, and semi-structured interviews, at baseline and then three-monthly intervals over the course of 12 months. Discussion At the time of publication, six headspace centres had been recruited to this study and had commenced implementation and impact evaluation. The first results are expected to be submitted for publication in 2021. This study will focus on the impact of implementing a digital health solution at both a service and staff level, and will evaluate digital readiness of service and staff adoption; quality, usability and acceptability of the solution by staff; staff self-reported clinical competency; overall impact on headspace centres as well as their lead agencies and local PHNs; and social return on investment.

scholarly journals Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Mann ◽  
Fintan Thompson ◽  
Robyn McDermott ◽  
A. Esterman ◽  
Edward Strivens
Keyword(s):  
Older People ◽  
Older Persons ◽  
Hospital Admissions ◽  
Community Dwelling ◽  
Trial Registration ◽  
Significant Finding ◽  
Complex Needs ◽  
Primary Practice ◽  
The Impact ◽  
Open Arch

Abstract Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

scholarly journals The potential for person-centred planning to support the community participation of adults with an intellectual disability

2021 ◽  
pp. 174462952110221
Author(s):  
Darren McCausland ◽  
Esther Murphy ◽  
Mary McCarron ◽  
Philip McCallion
Keyword(s):  
Intellectual Disability ◽  
Mixed Methods ◽  
Community Participation ◽  
Social Inclusion ◽  
Mixed Methods Approach ◽  
Complex Needs ◽  
Qualitative Case Studies ◽  
Quantitative Analyses ◽  
The Right ◽  
The Impact

Person-centred planning (PCP) puts individuals with an intellectual disability at the centre of service and support planning, identifying how individuals wish to live their lives and what is needed to make that possible. PCP has been identified as having the potential to facilitate improved social inclusion and community participation. A mixed-methods approach combined quantitative analyses with qualitative case studies of individuals with severe-profound intellectual disability to assess the impact of PCP on community participation for adults with an intellectual disability at a disability service in Dublin. We conclude that PCP may provide a good basis to plan community participation and, with the right supports in place, may provide opportunities for people with complex needs to improve their community participation. Supports including familiar staff and family are critical to the success of PCP for people with complex needs, and their absence may undermine the best intentions of PCP for this population.

Post-traumatic Growth: Longitudinal Study on Battered Women in Close Relationships after Both They and Their Partners Undergo Therapy

2021 ◽  
pp. 088626052199793
Author(s):  
Dorota Dyjakon ◽  
Beata Rajba
Keyword(s):  
Battered Women ◽  
Three Dimensions ◽  
Traumatic Experiences ◽  
Important Indicator ◽  
Event Scale ◽  
Post Traumatic Growth ◽  
Polish Version ◽  
Close Relationship ◽  
Post Traumatic ◽  
The Impact

Violence in intimate relationships is a major problem worldwide. Many women, despite having experienced violence from a partner, decide to remain in a relationship with the perpetrator. A special premise for such a decision is that the abusive partner undertakes therapy that serves to build security in the family. An important indicator of dealing with violence is post-traumatic growth (PTG), a concept introduced by Calhoun and Tedeschi (1998) to describe positive changes as a result of traumatic experiences. The purpose of the research was to assess PTG changes in the course of relationships in which the woman had experienced violence from her partner, but both her partner and she had undertaken therapy and changed their behavior ( N = 48). The conducted research used a demographic survey and two questionnaires: The Polish version of the Impact Event Scale-Revised (IES-R, Weiss, Marmara prepared by Juczyński and Ogińska-Bulik [2009]) examining three dimensions of trauma (intrusion, hyperarousal, and avoidance) and the Post-traumatic Growth Inventory ( Tedeschi & Calhoun [2004] ; Polish version prepared by Ogińska-Bulik & Juczyński [2010] ). The studies showed that over a period of one and half years, significant changes in PTG had taken place. Reportedly, changes in self-perception and changes in relating to others have decreased, while appreciation of life increased but spiritual life remained the same. The research also allowed us to distinguish several groups of corelates in changes in individual PTG categories. The studies also indicate that building a close relationship with the person who caused the harm can limit the victim’s PTG.

scholarly journals The Impact of Macroeconomic Policies on Healthcare Delivery in Kenya: An Analysis of the National Sexual Violence Prevention and Care Response

2020 ◽  
pp. 0272684X2098259
Author(s):  
Leso Munala ◽  
Emily Welle ◽  
Nene Okunna ◽  
Emily Hohenshell
Keyword(s):  
Health Care ◽  
Sexual Violence ◽  
Healthcare Delivery ◽  
Health Economy ◽  
Economic Policies ◽  
Macroeconomic Policies ◽  
Complex Needs ◽  
Study Results ◽  
Structural Inequities ◽  
The Impact

Sexual violence is one of the most common forms of violence against women in Kenya. This study documents the care of sexual violence survivors from the perspective of health care practitioners based on an analytic framework developed in studies of the political-economy of health to examine the effects of International Financial Institutions’ conditionalities on the allocation of national fiscal resources. The study documented the working conditions of practitioners and myriad challenges that they experience in providing quality services to sexual violence survivors. The issues reflected in the results are grounded in social structural inequities driven by the global political economic policies that perpetuate poverty and dependency throughout Africa and the developing world. Macro-level variables associated with health care provision are assessed with a focus on global macroeconomic policies established by the International Monetary Fund and World Bank, their impact on Kenya’s health economy and their ultimate impact on the capacity of the health system to meet the complex needs of survivors of sexual violence. In this paper, study results are analysed within the context of these macroeconomic policies and their legacy.

Themes in a Therapeutic Community

1970 ◽  
Vol 117 (539) ◽  
pp. 389-395 ◽  
Author(s):  
David H. Clark ◽  
Kenneth Myers
Keyword(s):  
Therapeutic Community ◽  
Social Analysis ◽  
Small Unit ◽  
Face To Face ◽  
Community Approach ◽  
Increased Activity ◽  
Freedom And Responsibility

Introduction The therapeutic community method of treatment was developed by Maxwell Jones at Belmont Hospital (Jones et al., 1952; Jones, 1954; Rapoport, 1960) for the treatment of psychopathic personalities. The method has been applied to an admission unit by Wilmer (1958) and to psychopathic personalities by Craft (1965). Clark (1964) has differentiated between ‘the therapeutic community approach’, of increased activity, freedom and responsibility for all patients in the hospital, and the ‘therapeutic community proper’, the small unit with face-to-face gatherings of all members, social analysis of events, opening of communications, flattening of the authority pyramid and blurring of roles.

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