Virgin Care trained clinical colleagues in trauma-focused cognitive behavioural therapy in our Journey after Child Abuse Trauma service in Devon to boost colleagues’ skills and By doing so, we were able to facilitate an improvement in the service and their clinical techniques that led to improved patient experience that has helped children and young people who experience trauma through sexual abuse cope with their challenges and avoid, or begin to recover from, Post-Traumatic Stress Disorder.

Introduction

Our Journey after Child Abuse Trauma (JACAT) service, part of Devon Integrated Children Services – supports children and young people who have been sexually abused, sexually assaulted or sexually exploited. The team use ways of working which have been tested by research and which we know can be helpful to children, young people, parents and carers.

To help improve our service, we trained our colleagues in trauma-focused cognitive behavioural therapy (TF-CBT), an evidence-based model of therapy recommended by NICE, that helps achieve the best possible outcomes for patients.

The three-course programme boosted our colleagues’ skills in the service and we continued to offer ongoing support to therapists as they learnt to use the new tools, which included additional supervision and team learning and development discussions to provide peer-learning opportunities.

The investment has meant the team are able to help more children and young people recover from symptoms of PTSD.


Training was also provided in other areas to continually develop our colleagues, which has led to the implementation of emotion groups to help people in the service with emotional health issues like low self-esteem, anxiety and stress.

The problem

National research shows that between 30-50% of people – including children and young people – who are sexually abused develop post-traumatic stress disorder and this can lead to life challenges, making going to school difficult or even lead to deliberate self-harm in some cases.

But a review of our Journey After Child Abuse Team’s (JACAT) service in Devon showed symptoms of post-traumatic stress were being acknowledged in more children (around 60-80%) than the national average.

Without tackling the problem, many children and young people were more likely to either be suffering, or suffer from, PTSD in the future.

We found that colleagues needed new skills that were more effective to help our patients, because a growing number were resistant to ‘treatment as usual’ techniques.

The solution

At Virgin Care we believe in our people and value working closely with them to transform the services we run to be more efficient, deliver improved experiences for patients and cope with increasing demand.

To help recruit and retain colleagues, we run a number of training and development programmes for all of our doctors, nurses and admin colleagues across England to create a new culture of change and improvement across services, where everyone – patients, colleagues, commissioners and the community feels the difference.

Our JACAT colleagues’ training was part of that approach, enabling the team access to training that was right for them, helping them improve the service for children and young people who had been sexually abused and who had started to reveal indicators of post-traumatic stress.

Our aim was to resolve the effects of the sexual abuse so the child or young person can develop to their fullest social and personal potential despite the challenges they’ve faced in the past.

Having recognised a need that more children would benefit from a new approach, colleagues were trained in trauma-focused cognitive behavioural therapy (TF-CBT), a therapy recommended by NICE, which helps improve their clinical techniques to screen for symptoms of PTSD and use the therapy to help children and young people who have experienced trauma through sexual abuse cope with their challenges and begin to recover.

Training for colleagues took place over a three-course programme that included:

• An online training course provided by the Medical University of South Carolina
• Studying and putting into practice work from Treating Trauma and Traumatic grief in Children and Adolescents
• Interactive skills training from Virgin Care’s training arm, The Learning Enterprise

Throughout training, we also gave our colleagues ongoing support as they learnt the new tools and techniques to deliver care to children and young people, which included additional clinical supervision from clinical leads and team learning and development discussions to provide colleagues with peer to peer learning opportunities that helps colleagues share best practice.

Virgin Care Limited 6th Dec 2016 Westbury - Joe Stallard Photography

We also supported our colleagues to undertake further training in Eye Movement Desensitisation and Re-Processing, Mindfulness and Improving Access to Psychological Therapies (IAPT) training in Systemic Family Practices (SFP) to continue their development that would benefit the service.

These additional training courses would continue our focus on an evidence based assessment and formulation approach, that enables our service to identify the most appropriate therapy for our children and young people who are referred to the service.

Our colleagues also meet weekly to discuss their development and share best practice to continue to develop their skills in the service.

The difference

Introducing the new type of therapy has allowed us to introduce new, creative ways to provide effective therapy for children and young people using the service.

Through supporting TF-CBT training we improved the service we provide, improved outcomes and have been able to better track changes in service users’ symptoms. Since introducting the new therapies, the service has found that all children on the programme have had an improved, and many have reported no substantial symptoms since.

The table below shows a marked reduction in a number of children and young people’s PTSD scores before and after receiving TF-CBT. The biggest drop was in a 15-year-old who saw their score drop from more than 30 to 0.

As a result of supporting colleagues the table shows how the training and measurements have improved patient’s lives.

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A colleague said: “I wish I’d known about the TF-CBT model earlier: it is so helpful for working with children and young people who have been traumatised by sexual abuse – transforming lives.”

Another told us: “Having just finished trauma narratives with [two adolescents], their PTSD scores have dropped below clinical levels. They seem to be as pleased about this as I am.”

Patient feedback also told us how they felt they benefited from our colleagues and the sessions.

Girl, aged 10, sexually abused aged 7: “I didn’t enjoy all of it but it did help me. At first it didn’t feel like it was helping me because it happened so gradually… It wasn’t as hard as I thought it would be to talk about what happened but it was hard.” Mother of girl, who at six month follow up all is still well: “She went from thinking about it all the time, having nightmares, finding school really tricky, crying a lot and worrying about everything to saying: ‘I just don’t think it’s important anymore’ – something I never thought I would hear!”

Girl, in care, aged 16, sexually abused aged 4-13: “[TF-CBT] is not nice…but it is worth it: now there are no flashbacks and no nightmares; life is easier, relationships are easier.”

We continued to provide colleagues with training to allow them to use the new skills gained to continually develop the service that helps improve outcomes for the patients we provide care for. This has included:

• Implementing emotion groups to allow service users to manage emotional health issues at home to help self-esteem, anxiety and stress as well as bringing groups of people together to support one another.
• Training in Eye Movement Desensitisation and Re-Processing, Mindfulness and IAPT training in Systemic Family Practice to develop colleagues further in trauma focused techniques.
• The development of two joint SFP clinics alongside colleagues in CAMHS.
• Recruit two part-time time clinical psychologists based on their trauma-focused skills.

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