Formulation meeting in time of crisis

Please describe a relationship, service intervention, program implementation, policy, or other that you initiated or know about that would be considered trauma-informed:

A service user in a supported accommodation had reached a point of crisis and could have potentially died at any time. Different services had started to become very defensive and hostile to each other. There was evidently blame being placed on different teams. Some teams had tried to see the bigger picture in terms of considering what had happened to this service user however most people involved were fixated on the current problems which revolved around physical health. The view was that this person had to be always observed by staff and whilst there was some risk to his physical health that this mitigated to a degree, it was evident that this was having much greater impact on the service user in terms of his engagement with others, motivation to live and general mood.

People involved in the care were gathered to start again with a new formulation for this service user. This went right back to the beginning of his life and focussed on what had happened to reach this point. It attempted change the narrative around the current behaviours and place them into a context of previous trauma and recent potential repletion of this trauma. It was important that all people in the room had a chance to discuss this new hypothesis and to gain a common agreement that it was a useful way of thinking about these things. People were encouraged to express concerns and doubt. From this point we were able to develop a different approach, the question about are we doing anything to make this situation worse lead to a conversation and agreement about positive risk taking.

 

What was the outcome?  

Some aspects of care plans were changed, and different interventions were attempted that explored finding ways of getting the client’s needs for social attention (particularly from family) met in a safer and more positive manner. Restrictions and deprivations of liberty were reduced, and a degree of risk was accepted. A common set of goals was agreed, and people roles were made clearer.

 

What supported the positive outcome? (Systemic supports? Organizational supports? Interpersonal supports?):

The immediacy of the situation, having people in the room with prior training and understanding of trauma informed care.  

 

In what way has your example changed you, your practice, or your goals:

It has made me more motivated to improve understanding of trauma informed care.

 

Tell us more about what motivated you to bring this example to discuss:

I was quite proud of the outcome and being able to see the influence that the trauma programme had made.

 

Whose needs are met in the example that you outline:

In all honesty the intervention has met the services needs in the first instance but also the needs of the service user and their family.

 

Was there any one person or factor that was central to the success of your example and why:

One nurse who is somebody with lots of knowledge in trauma informed care became very influential during the meeting and I think this helped to influence others.

 

What can you or others do to spread this good practice to colleagues and services:

Keep doing what we are doing with the TIC Programme but with more resource into training and embedding/ building leaders within the services.