Sarah Wilson: And welcome you as you all continue to join this webinar. I'm Professor Sarah Wilson. I'm the co-CEO at the Victorian Collaborative center for Mental Health and Wellbeing, and it gives me absolute delight
Sarah Wilson: to welcome you all to this webinar. The center is very proud to be supporting this webinar. It's work that we've done in partnership with our colleagues.
Sarah Wilson: at Transforming Trauma Victoria and Phoenix, Australia, and we're very proud to be sharing the results of that partnership and the work that will be shared with you today, looking at
Sarah Wilson: practical, trauma-informed practice strategies for mental health and wellbeing services across Victoria.
Sarah Wilson: I want to begin by acknowledging the traditional owners of the land on which we're meeting. I'm sure you're from many different parts of country. I'm on Wurundjeri country, but we pay our respects broadly to elders, past, present, and emerging, and welcome all those from Aboriginal and Torres Strait Islander background joining us here today.
Sarah Wilson: More broadly, I want to welcome everyone to this webinar, and especially people who bring lived and living experience to their practice and their work, and to recognise the ongoing and, you know, crucial contribution that they play in mental health reform.
Sarah Wilson: It's a good way of just pausing and reminding ourselves of the importance of centering lived and living experience in all of the reform and the work that we do.
Sarah Wilson: So, as you can see from the number of people joining us here today, we've had an amazing response to this webinar, which is really exciting for us to see. And it shows, I think, what an important topic this is for the sector and how crucial this work is. So we've had over 800 people register interest.
Sarah Wilson: And so we will be supporting more webinars and events of this nature. This is the first in a series, and we want you to… and encourage you to sign up to our newsletter to make sure you get regular updates and invitations about upcoming events, and there'll be a link that's put in the chat for all of you to access, so please do that.
Sarah Wilson: Now, if we just pause for a moment, the Royal Commission really identified a need for driving exemplary trauma-informed practice across the mental health and wellbeing system, and that's what we're all here to do today, to really think about trauma-informed practice. And so, trauma… Transforming Trauma Victoria, TTV, and Phoenix
Sarah Wilson: Australia, along with the Victorian Department of Health.
Sarah Wilson: and the Collaborative center have developed and evaluated a best practice process and toolkit.
Sarah Wilson: For implementing a trauma-informed practice model, and it's…
Sarah Wilson: You know, been done with a huge amount of
Sarah Wilson: Co-design and expertise brought to that process.
Sarah Wilson: To provide a consistent way of responding to the needs of people who have experienced trauma, and to be shared across the workforce, so that we really begin to address that
Sarah Wilson: aim of, no matter where you are in Victoria, it's a core competency that is working with someone in mental health, that you have this set of capabilities to provide trauma-informed care.
Sarah Wilson: So, the toolkit has been tested.
Sarah Wilson: Through an innovative Hospital in the Home program.
Sarah Wilson: Really led by the TTV team, and delivered in partnership with that program to inform people
Sarah Wilson: Who identify as women, and who have experienced complex mental health issues, about, you know, ways of working differently, and doing that, putting that into practice.
Sarah Wilson: And, you know, there's an intersectionality here. These people have also had experiences of domestic violence, and so there's that crossover, and this toolkit helps you deal with the complexities that we often face in mental health practice.
Sarah Wilson: Now, before we start, there are some housekeeping issues. We'll be using both the chat and the Q&A functions for questions.
Sarah Wilson: And we'll try and arrange to have those questions that cannot be answered in the session itself certainly followed up and answered post-session.
Sarah Wilson: As you've probably all been informed as you've entered, the session is being recorded and will be accessible, and we'll share that also after the session.
Sarah Wilson: But now it's, all that's left for me to do is introduce our expert panellists, who are here with us, on the webinar today. We have Anne Law Cuono, our Director of Policy and Service Development at Phoenix, Australia. Welcome, Anne Law, really great to have you lead this work.
Sarah Wilson: Also supported by Dr. Rao Khanna.
Sarah Wilson: our Clinical Program Director at Phoenix, Australia. Great to have you here, and… and to be at this point to be
Sarah Wilson: You know, sharing this toolkit. We have Millie Reid, who is Lived Experience Lead at the Geelong Queenscliff Mental Health and Wellbeing Local. Welcome, Millie, great to have you here.
Sarah Wilson: We have Jenny Babb, the Director of Statewide and Specialist Services at the Alfred.
Sarah Wilson: Health. Welcome, Jenny. And we have Claire Conlon, Mental Health and Wellbeing Locals Lead at CoHealth. So, I'm going to share and hand over now to Anne Law, who will kick off the session for us. Thanks so much.
Sarah Wilson: And enjoy your session.
Anne-Laure Couineau: Hi, everyone. Thank you, Sarah, for that introduction. So, as Sarah mentioned, we're going to talk to you about really practical ways of,
Anne-Laure Couineau: adopting trauma-informed practice in mental health services, and this is a result of the work we have done with three organizations. So, as Sarah mentioned, we worked with the Women's Recovery Network, and the Hospital in the Home program, and Jennifer
Anne-Laure Couineau: Jenny Babb, who's gonna be one of our panelists, has been our collaborator around this to develop, tools and resources and a process to,
Anne-Laure Couineau: role at Trauma Informed Practice, but we also have worked with two mental health and well-being locals who have been instrumental in developing these resources, and I've brought a lot of wisdom to the process. And one of those services was
Anne-Laure Couineau: the Bringbank Local, and Claire is… has been really collaborating with us around this project, and the Geelong and Greater Queenscliff
Anne-Laure Couineau: Local has also contributed hugely to the wisdom and the advice that we're going to be providing throughout this session.
Anne-Laure Couineau: I'm going to be sharing a presentation, so bear with me while I do that.
Anne-Laure Couineau: So what we,
Anne-Laure Couineau: What we will be doing today is to really share, all the things that we found out through
Anne-Laure Couineau: a year worth of discussions with the locals and the Women's Recovery Network, and how we've really thought about applying trauma mental health,
Anne-Laure Couineau: trauma-informed practice in mental health services. So it's very much embedded in the work we've done with them in the last year.
Anne-Laure Couineau: And today's session, what we're going to do is talk about how trauma-informed principle applies to really critical aspects of care.
Anne-Laure Couineau: in mental health, things like intake, risk management, how a multidisciplinary team can support care. We'll also talk about,
Anne-Laure Couineau: organizational and team-based strategies that promote trauma-informed practice. Our focus today is going to be very much on how do teams… how do organizations change? So, not so much on individual practice.
Anne-Laure Couineau: We'll particularly think about how leaders can support trauma-informed practice, and how they support their staff,
Anne-Laure Couineau: In applying principles of trauma-informed care and support their well-being. And we'll also think about service design and the challenges that are often encountered by services when they try to roll out trauma-informed practice.
Anne-Laure Couineau: So, one of the things that's really important to think about,
Anne-Laure Couineau: In… when thinking about trauma-informed care is…
Anne-Laure Couineau: how do services think about the aims of trauma-informed care? When you look at mental health services across Victoria and Australia, often there's a variation across different services. Some services focus on
Anne-Laure Couineau: Building safety, reducing harms, other services, think more about empowering
Anne-Laure Couineau: clients through collaboration. And so, one of the things that's really important to do as a service to begin with is to be really clear about the aims of trauma-informed care, and to consistently apply,
Anne-Laure Couineau: trauma-informed care to meet a number of critical aims, and these include minimizing barriers to accessing and engaging with services. We know that in mental health services, there are
Anne-Laure Couineau: communities that just don't access our services, and that feel, uncomfortable accessing those services. We also know that there are groups that experience additional barriers, and because of the trauma they experience.
Anne-Laure Couineau: in their life. So, an example that Sarah mentioned in her introduction is women who experience family violence often find it difficult to engage with mental health services.
Anne-Laure Couineau: It's also about minimizing harm from service delivery. We know that inherently, mental health services
Anne-Laure Couineau: can cause harm to people who have experienced trauma. They can act to remind people of their experiences. For example, they might not feel as in control of their circumstances, or feel like they have as choices, and that might remind them of their trauma.
Anne-Laure Couineau: There are restrictive practices that still exist in our system that can reignite trauma in a person, and…
Anne-Laure Couineau: Importantly as well, trauma-informed practice is about supporting recovery from the impacts of trauma, and that's often something in mental health services that's hard to do, because often mental health services are dealing with crisis.
Anne-Laure Couineau: And often the root cause of the problem, which is often trauma, is not addressed.
Anne-Laure Couineau: And finally, you can't do trauma-informed practice without supporting staff's safety and well-being. And trauma-informed practice
Anne-Laure Couineau: care is very much about also empowering staff and making their work meaningful and safe. And that often leads to better retention of staff.
Anne-Laure Couineau: So when we, when we think about trauma-informed practice, again, when you talk… look at services across Australia.
Anne-Laure Couineau: People adopt slightly different models and principles of practice, and what we've done through these projects is to really think about what would those principles of practice look like.
Anne-Laure Couineau: In a mental health services, and what is important to focus on when, being trauma-informed.
Anne-Laure Couineau: So we, I've worked through 6.
Anne-Laure Couineau: principles of trauma-informed practice. Some of them will look very familiar to you. So, for example, we've talked about, you know, the importance of being trauma aware, which means having a service that is,
Anne-Laure Couineau: able to identify trauma-related needs in the service users and the families that support them. It's also by being aware of how,
Anne-Laure Couineau: Behaviors and distress that you see in clients.
Anne-Laure Couineau: Maybe explained by the experience of trauma and how that impacts on the experience of the service delivery and the system they are in.
Anne-Laure Couineau: There's also principles around building safety and trust, which often is talked about in trauma-informed practice.
Anne-Laure Couineau: There's also about giving choice and control, which is very much about collaborative care and ensuring that people not only have choices about their care, but are actually supported to make decisions about their care, even when they're in crisis, or they're facing risk, that they feel like they have.
Anne-Laure Couineau: The tools, the support, To make decisions for themselves wherever it's possible.
Anne-Laure Couineau: And one of the… Sorry, I'm having trouble hearing you. And one… and one of the things that are particularly important that we looked about at while we worked is the principle of sharing power.
Anne-Laure Couineau: Power is incredibly important in service delivery,
Anne-Laure Couineau: And that's really making sure that services are
Anne-Laure Couineau: Aware of the power imbalances, not only between service users and…
Anne-Laure Couineau: the workers that help them, but also amongst workers. For example, thinking about, you know, is there disparity between the access to training or the access to care progression between a peer worker and a clinician?
Anne-Laure Couineau: Or are they… or are they equally valued and supported?
Anne-Laure Couineau: That's a really important part of trauma-informed practice.
Anne-Laure Couineau: And then there's that really important aspect of making sure that the voice of service users and their families and carers are really central to service planning and improvement, that their feedback matters, and that it's really effectively used to keep reviewing the service and improving the service.
Anne-Laure Couineau: So that… and that lived experience expertise is central to everything that's being done.
Anne-Laure Couineau: And the final, principles are very,
Anne-Laure Couineau: will be very familiar to you. Again, it's really making sure that there is a focus on strengths and recovery from trauma. And that's not just about making sure that strengths are recorded in your assessment and treatment plan. It's every step of the way, how do you harness the resources and,
Anne-Laure Couineau: Harness the strengths of the people you work with throughout their journey in the service system.
Anne-Laure Couineau: And how do you support them making connections?
Anne-Laure Couineau: So… Thinking about,
Anne-Laure Couineau: a trauma-mindful practice. The thing from a leadership perspective and a service perspective that's really important
Anne-Laure Couineau: Is making sure that all those principles
Anne-Laure Couineau: operationalized at every step of the service user journey. What does it look like when they first enter the service? What does it look like when they go through intake or assessment? What does it look like as they're waiting to see a clinician or a peer support worker?
Anne-Laure Couineau: what does it mean when they leave the service? And there were four issues that were particularly important to look like in a mental health service. One was really making sure that people had access.
Anne-Laure Couineau: to the service throughout that journey. What… what are the barriers to access that are trauma-related? For example, between intake and seeing your clinician, is there a long waiting time?
Anne-Laure Couineau: Where you don't know what's going to happen to you, and you have no sense of, where you're going next in a system.
Anne-Laure Couineau: Do you have to see them at hours when usually you're at work? Things like that.
Anne-Laure Couineau: There's a… also making sure that trauma is identified, that people at every…
Anne-Laure Couineau: Part of the… in every part of the system, know what their role is, and how they can help a person share their story if it's appropriate.
Anne-Laure Couineau: And that… and also how they share that information across the system. So, someone may be sharing their story at intake, but does the intake person ask permission to share that story with the psychiatrist they're going to see? Will the psychiatrist tell them, oh.
Anne-Laure Couineau: you know, I know you've told this to someone, but can I hear your story yet again?
Anne-Laure Couineau: Things like that.
Anne-Laure Couineau: And do people, at every step of the way, have a shared understanding of what it means to recover from trauma and what their role is in it?
Anne-Laure Couineau: And how do they…
Anne-Laure Couineau: respond to risk in a trauma-informed manner. So these were the areas of practice in trauma-informed care that were particularly important to… to look at.
Anne-Laure Couineau: And… what I'm going to do is show… share with you,
Anne-Laure Couineau: a couple of ways that you could practically look at those things. I'm not going to go through each principles, because we'll talk about that in the panel, but just to give you some examples of this practice. So, one of the things, for example, to think about is
Anne-Laure Couineau: Trauma-inform ways of breaking down barriers for communities that usually wouldn't access
Anne-Laure Couineau: a mental health service, or would drop out, because they feel like it's not a place that's safe for them. So.
Anne-Laure Couineau: What does that mean in terms of recruitment and staffing? Do the staff in your organization
Anne-Laure Couineau: Is there anyone that understands that community, looks like that community, understands their language or their preferences?
Anne-Laure Couineau: And it's not just a one staff member that's, that's doing that. There might be a team that supports them.
Anne-Laure Couineau: During, you know, recruitment, do you have enough peer support workers that represent communities, or is it the one peer advisor in your team that's the only one that represents the needs of service users or carers?
Anne-Laure Couineau: So, thinking about that from that perspective, in terms of service design, have you…
Anne-Laure Couineau: thought about elements of the service design that might get in the way of a particular community accessing your service? So, for example, is there a community that will not go into a hospital or clinical setting, and you need an outreach program, for example?
Anne-Laure Couineau: It's also thinking about the environment itself, and…
Anne-Laure Couineau: is an environment that reflects that community, and looks like them has, you know, posters in their language, that has a place where their children can be seen to because they don't have access to babysitters, for example, things like that.
Anne-Laure Couineau: Have you thought about capability support for the workforce, and what does that…
Anne-Laure Couineau: Does the training and supervision people do talk about the communities that don't tend to access the service, or are they not talked about?
Anne-Laure Couineau: Do they receive training to engage with those communities and understand what they… how they view trauma and healing from trauma?
Anne-Laure Couineau: Have you addressed the team culture? So, are there spaces where the team can talk about their own assumptions, their own blind spots, about groups that usually don't access?
Anne-Laure Couineau: The… the service.
Anne-Laure Couineau: And are there policies and procedures that really not just think about everyone, but have,
Anne-Laure Couineau: processes and procedures that will support particular communities. And that may mean, for example, having partnerships with particular organizations that work with those communities that are meaningful partnerships, where the time is put in to think about cross-referrals, advice, support, and how that works.
Anne-Laure Couineau: And when you do evaluation, service reviews, and obtain feedback, is it easy for those groups to provide feedback and feel safe in providing feedback? Do they have to fill in a 20-question survey in English, and that's the only thing that's available for them to provide feedback?
Anne-Laure Couineau: by example.
Anne-Laure Couineau: So, thinking about those things is really important.
Anne-Laure Couineau: And another example of this that I'll go through very quickly, because we started a bit late, is thinking about trauma disclosure and
Anne-Laure Couineau: and what that may look like from an organizational perspective. So, when you ask people to share their history of trauma.
Anne-Laure Couineau: You need to make sure that, with, a very clear understanding of
Anne-Laure Couineau: what the goal is when they share their trauma, and where that information is going to go. And role… staff have a very clear role and boundaries around what they do with that story. You know, are they in in-tech, and they only need
Anne-Laure Couineau: to know a little bit about it, but not too much, because they can't support a person safely to share their full story. Do they have the…
Anne-Laure Couineau: do they have a process where they can ask for permission and share the information so that person doesn't have to repeat their story? And our staff then have…
Anne-Laure Couineau: places to go to, get support if they're affected by the story. So it's… it's really thinking about.
Anne-Laure Couineau: You know, all the different aspects of the organization and how that can support trauma disclosure.
Anne-Laure Couineau: And safe trauma disclosures, rather than focusing often as we do on training and staff training only.
Anne-Laure Couineau: Maybe, and making sure that telling people to put it in their notes.
Anne-Laure Couineau: Oh my god.
Anne-Laure Couineau: I'll, quickly mention that one of the key things to do this work, to make sure that
Anne-Laure Couineau: You are supporting, staff to individually changes practice, where you re…
Anne-Laure Couineau: you're thinking about your systems and your policies, where you review service design. One of the key things to doing that is having reflective practice in your organization and supporting this as a leader. So that means creating time and space where people can reflect
Anne-Laure Couineau: on the experience of service users, their families, and carers. Not case discussions, where we think about diagnosis and care planning and the next steps, but actually their experience and the impact that has on individual workers and the team.
Anne-Laure Couineau: And to examine assumptions, to examine what the service model does and how it works. And having that space to do that on a regular basis is incredibly important. And
Anne-Laure Couineau: The tools that we've developed through this pilot, for example, a huge amount of it is around reflective practice and trauma-informed practice, and how we can apply that in formal and informal spaces.
Anne-Laure Couineau: But you can't just do reflective practice once a month with an external supervisor. It's about embedding it in your culture day to day.
Anne-Laure Couineau: I think,
Anne-Laure Couineau: I might just do a quick overview of the kind of things that are really important to consider, and then we'll go to our panel to really go through a very practical example of how we're going to do trauma-informed practice.
Anne-Laure Couineau: So… Leadership is… Absolutely crucial in
Anne-Laure Couineau: embedding trauma-informed practice. It… it is about culture change. It is not about just capability and training. It really is about making sure that the service models, the policies, the values of the organization really reflect trauma-informed practice.
Anne-Laure Couineau: And it means having people that champion trauma-informed practice.
Anne-Laure Couineau: Embedded in the service, and that might be the leadership, or it might be senior clinicians, senior peer workers, service excellent leads, people that really will keep the momentum around trauma-informed practice, and use reflective practice to do that.
Anne-Laure Couineau: So that's really important. It's also important to have built environment that really feels safe and are welcoming.
Anne-Laure Couineau: And that includes having a service model that is flexible, and might consider things like outreach, or after hours, or things that make access much more user-friendly for service users.
Anne-Laure Couineau: It's also about supporting the workforce, and again, not just through training and trauma-informed practice. We have lots of training out there, and yet we see not so much trauma-informed practice in a lot of services. It's increasing, but we're far from being there yet.
Anne-Laure Couineau: And it's more about, again, reflective supervision, having really clear roles around things, like identifying trauma, around, dealing with, risk and distress in a trauma-informed manners.
Anne-Laure Couineau: And feeling like there's an equitable culture in the team that… where everyone, no matter what their role is, as a voice in service design, is really important too.
Anne-Laure Couineau: It's also about making sure that service users, again, have not just choices in care, but are supported to make decisions and to provide real feedback, and that that feedback is really integrated in service reviews.
Anne-Laure Couineau: And, in planning in an ongoing manner. And it's also about having really strong partnerships with other agencies, that may have, you know, expertise, knowledge.
Anne-Laure Couineau: for groups that experience massive amounts of trauma, but may find it very difficult to engage with mental health services. So that's it from me.
Anne-Laure Couineau: I'm going to open up to the panel now, and Rahul Khanna is gonna…
Anne-Laure Couineau: Get us to really think about some practical aspects of trauma-informed practice.
Rahul Khanna: Thank you, Anne Law, and the Calabra Center for supporting this event, and all of you for coming along.
Rahul Khanna: I… I know we're running a bit behind, so I will watch, pretty, pretty quickly straight into the discussion, but I just, just wanted to give a, give a heads up that, unfortunately, Millie wasn't able to make it at, at, the last minute, so, and more, we will…
Rahul Khanna: dragged back to… to help us a little bit with the discussion, and poor Claire has picked up an extra question. But, without further ado, if it's okay, I might start with you, Claire. Now, as… as the lead of the, locals for,
Rahul Khanna: or co-health. I think you guys have really been in the vanguard of, I guess, the modern workforce in the system, so if you could start by talking about… a bit about the challenges of bringing together multiple professions and cultures, particularly in, kind of, consortia arrangements that have become much more common as well.
Rahul Khanna: How you work with that in, supporting teams to embrace trauma-informed practice?
Claire Conlon she/her Wurundjeri Lamd: Thank you, Rahul. And, yeah, it's terrific to be here, so thank you for that. So at, the Bringbank Local, we do have a range of disciplines from.
Claire Conlon she/her Wurundjeri Lamd: creative therapies, clinical services, and wellbeing services, and we do work in a consortium, as you said, Rael. And this also includes a large lived experience team of both consumer and carer workers.
Claire Conlon she/her Wurundjeri Lamd: So, bringing together multiple professions is about ensuring all perspectives and voices at the table were authentically heard.
Claire Conlon she/her Wurundjeri Lamd: And this was really pivotal in embracing trauma-informed practice. This was both enriching, but also complex. So, we all came from a place that assuming trauma as the expectation, not the exception, and that actually every person that came into our local
Claire Conlon she/her Wurundjeri Lamd: coming into our treatment setting may have been exposed to, some sort of trauma or traumatic experience. So, we had lots of conversations around the table, and Anne Law was a part of those conversations, where we had clinicians, peer workers, and leaders
Claire Conlon she/her Wurundjeri Lamd: Really rethinking around how we do the work, and this is where, sort of, that culture comes in, and not just what we do.
Claire Conlon she/her Wurundjeri Lamd: And so, each profession absolutely brought its own language, power structures, and models of care, where approaches to trauma and healing may have been seen through different lenses.
Claire Conlon she/her Wurundjeri Lamd: So, what we found was that, clinicians, sort of lean towards prioritising diagnosis, symptom reduction, and risk management.
Claire Conlon she/her Wurundjeri Lamd: Our psychosocial workers had a bit of a focus on the environment and the relationships and empowerment.
Claire Conlon she/her Wurundjeri Lamd: And our lived experience workforce, prioritized mutuality, trust, connection, and really reducing re-traumatisation, because for many, they had had their own lived experience. And really thinking about how risk feels from a consumer perspective, and what does safety and trust look like.
Claire Conlon she/her Wurundjeri Lamd: So there was really this sort of shifting of the paradigm from doing, with and not for.
Claire Conlon she/her Wurundjeri Lamd: And so one of our mantras when we were looking at our service model was to use that mantra around nothing about us without us when working with our consumers. So one of the challenges was around, aligning these perspectives, without one dominating the other, but absolutely recognizing everyone's expertise.
Claire Conlon she/her Wurundjeri Lamd: We found that we're working in an environment, you know, more broadly around, you know, that clinical risk frameworks can sometimes feel a bit at odds with relational safety or autonomy principles.
Claire Conlon she/her Wurundjeri Lamd: So there were lots of really great conversations, and there was really healthy tension, that arose, as a result of this, especially around risk.
Claire Conlon she/her Wurundjeri Lamd: power and decision making. But that was also the point, right? Because these intersections also created the richest opportunities for learning and reform.
Claire Conlon she/her Wurundjeri Lamd: So what was really important was that we had leaderships, we had, champions around the table, and that we needed to value multiple truths.
Claire Conlon she/her Wurundjeri Lamd: So, we all, did some work around what… how we were going to work together, what… what we would get out of this space, and that there was no single worldview, would be… would dominate. We wanted to ensure that everyone,
Claire Conlon she/her Wurundjeri Lamd: would be heard. And so, often there was a… a lot of our conversations moved to risk and power, and, often.
Claire Conlon she/her Wurundjeri Lamd: Lots of people were really vulnerable in the space, and actually talked to, particularly a lot of the clinicians, that often when fear sort of takes over, that they would resort to risk assessments, or thinking about, we're doing this for your own good.
Claire Conlon she/her Wurundjeri Lamd: And I'm uncomfortable, so I need to control the situation. So there was really… we kind of arrived at a lot of that, which… which really was… was very enriching.
Claire Conlon she/her Wurundjeri Lamd: So the… I guess the…
Claire Conlon she/her Wurundjeri Lamd: The peer work, you know, they often would come from a place of how to use disclosure safely, and whereas the clinical leaders might sort of guide reflective practice and secondary consultations.
Claire Conlon she/her Wurundjeri Lamd: But we really need to have those shared reflective spaces, so the co-reflection was really important. We have weekly client care reviews.
Claire Conlon she/her Wurundjeri Lamd: And also working in supervision, both discipline-specific supervision, but also multidisciplinary supervision, where we… which allowed the professionals to examine their own assumptions.
Claire Conlon she/her Wurundjeri Lamd: And how that might influence how they understand trauma, risk, and recovery. So, it was really, really enriching and valuable, but these tensions were really important to actually work through as a group.
Rahul Khanna: Thanks so much, Claire. I think, you know, that really resonates and shows how much the… sometimes the co-design itself is, you know, an intervention in its own right, right? Bringing people together, and of course, our consumers are experiencing those, different worldviews live, and we get such
Rahul Khanna: Few opportunities to kind of bring those worldviews together as a team.
Rahul Khanna: So if I could pick up that theme, did you notice any, impacts that introducing trauma-informed care had on influencing the service model itself and practice?
Claire Conlon she/her Wurundjeri Lamd: So it was actually really timely, because we were reviewing our service model, at the time, and looking at a refresh. And so all of those things that Anne Law had talked about before, around looking from intake right through to how we exit and transition, and thinking about how we do goal-directed care planning, so that we're actually bringing in all of those, things around safety, trust, and collaboration, decision making.
Claire Conlon she/her Wurundjeri Lamd: One of the things that did really come into the spotlight was our… how we manage risk. And I think when a service begins embedding trauma-informed practice, this really came under review, for us.
Claire Conlon she/her Wurundjeri Lamd: And what… again, being really honest in this space around that, you know, often traditionally, services have defined risk primarily in clinical or procedural terms.
Claire Conlon she/her Wurundjeri Lamd: Which sort of became a focus on prevention of harm and organisational protection.
Claire Conlon she/her Wurundjeri Lamd: However, with having every multidisciplinary team around the table, it became questions around, well, actually, whose safety are we prioritising?
Claire Conlon she/her Wurundjeri Lamd: When duty of care was always about doing no harm, but instead along the way, became about organisational protection.
Claire Conlon she/her Wurundjeri Lamd: So, we asked questions of each other, and this actually informed our service model.
Claire Conlon she/her Wurundjeri Lamd: you know, do our responses and the way we work with people, actually, around risk, inadvertently remove choice, or reinforce powerlessness. And so we… we wanted to talk about duty of care and dignity of risk, and that sort of theme, how we manage risk, was… was embedded into all parts of our service model. So moving from risk aversion.
Claire Conlon she/her Wurundjeri Lamd: to collaborative safety planning. So again, that nothing about us without us. Thinking. So,
Claire Conlon she/her Wurundjeri Lamd: I guess the duty of care, we've kind of redefined our duty of care around to use a shared responsibility to work in partnership, to support autonomy while minimizing, harm. So, and introducing our policies and looking at our service model around really promoting, decision… supported decision making.
Claire Conlon she/her Wurundjeri Lamd: And really, the belief that every person has the right to make choices, even those involving some level of risk, provided some supports are in place. It brought up lots of questions and lots of conversations around that supported decision-making actually is grounded in the UN Convention Rights, and it's also part of our Mental Health and Wellbeing Act. And that was really important that we align ourselves where
Claire Conlon she/her Wurundjeri Lamd: You decide what matters most, and we'll support you to make it happen.
Claire Conlon she/her Wurundjeri Lamd: But again, when Anne Laura talked a bit before about the importance of culture, so we needed to get, actually, our culture and conversations and values aligned before we could then actually look at our… how we're going to change our service model. And so, I think for our staff at the local, the…
Claire Conlon she/her Wurundjeri Lamd: trauma-informed project really raised questions, that there's parts of our Mental Health Act that still allow some traumatising practice, around coercion and control, but that trauma-informed practice really speaks to building connections, letting go of trying to predict behaviour, and really towards understanding people's stories. So the compassionate part of the Mental Health Act
Claire Conlon she/her Wurundjeri Lamd: is that really is that practice of supported decision making. And we wanted to ensure that that was actually flows from intake right through to exit and transitioning.
Claire Conlon she/her Wurundjeri Lamd: And yeah, just that it was a really powerful experience where those conversations, were had about building safety, trust, and choice, and really working with clients about what is strong, and not always what is wrong.
Rahul Khanna: Thanks, Claire. And I think there's a great point in there around organizational risk in the…
Rahul Khanna: the importance of bringing, organizations beyond, kind of, the mental health parts of it along for that, that journey as well. You know, how do you, kind of, educate, boards and others about the importance of what you're trying to do, for, for the consumers and for the end benefit and larger goal?
Rahul Khanna: And speaking of organisational risk training, perfect time to bring you into the conversation, Jenny, about what you've observed trying to apply trauma-informed care in kind of a more acute hospital-style setting.
Jennifer Babb: Yeah, there was so much of what Claire said that I could relate to, really, and I think it was really around
Jennifer Babb: I think we were so lucky to have a…
Jennifer Babb: a service that we were starting from scratch, and so I think it allowed us to really think about the culture and how we wanted to approach things, and doing a really authentic co-design and co-production process, I think, has influenced the practice just so…
Jennifer Babb: much, and so really listening, you know, really everything that Claire said, I think, had similar influences to get us to where we're at now.
Jennifer Babb: And so the important thing from our service was giving people
Jennifer Babb: Choice and control. And so that might be around things like you worked with our hospital in the home team, just giving people a choice other than an inpatient unit in an acute setting.
Jennifer Babb: say, to a home environment, you know, really listening to what people want and… and being able to meet them where they're at was… is just so empowering.
Jennifer Babb: Really going through the co-design process, we then,
Jennifer Babb: picked up… our service works on open dialogue principles, and they align really nicely with the trauma-informed practice, and once again, a lot of what Claire has spoken to. And I think it's things like, you need to flatten the hierarchy, that so many people have had.
Jennifer Babb: instances where their engagement, because hospitals tend to work in these sort of care pathways, and you have to fit into a particular pathway rather than, you know, ask someone what they're wanting, and who they want involved, and how they want this to look like. And…
Jennifer Babb: without any meaning, I mean, certainly no one's trying to do anything wrong, it can become just so disempowering and have…
Jennifer Babb: Things really… Traumatizing effects and re-traumatising effects.
Jennifer Babb: Unfortunately, like Claire, most of the women that we
Jennifer Babb: Work with have had, you know, multiple
Jennifer Babb: Trauma histories, often from a very young age.
Jennifer Babb: And so, you know, it's… if you don't feel safe, I'm not sure that you can do much else, much other work, so you have to set up a…
Jennifer Babb: a framework where, you know, the people we're working with feel safe, but I think, as we've talked a lot about as well, that we also need to create a really safe environment for our staff, because
Jennifer Babb: You know, this… this… Trauma reactions can present with really extreme distress.
Jennifer Babb: And the system, and I think there was something in one of Annual slides around, you know, we then want to respond to that, and sometimes we respond to that in a really reactive way, and want to fix things and do things to people, and so we inadvertently buy into
Jennifer Babb: this whole disempowerment and re-traumatising. And so.
Jennifer Babb: it just really highlights everything everyone's talking about. You need to have these reflective spaces to be able to not be reactive. You know, you need to have oriented your staff in a way that
Jennifer Babb: you're sort of saying, you're going to be triggered. This is, you know.
Jennifer Babb: there is vicarious trauma that happens on a daily basis within this service. We need to think about how we work with you so that you don't fall into these traps in how you're working with people. And certainly a lot of the tools, that I would so encourage people to go and have a look at allowed us to do that
Jennifer Babb: And we were doing it prior to our engagement with Phoenix, but I think it allowed us, since then to do it in a much more systematized way, and have these tools that we can actually work with our staff, and so, you know.
Jennifer Babb: just… just trying to do things differently, and not just go down traditional pathways of, well, this is the way we've always done it, and so this is what we'll do. We're listening to people, you know.
Jennifer Babb: We're supporting our staff in a different way. You know, we're acknowledging this is really difficult work that we do, this is really complex, you know.
Jennifer Babb: And that… there isn't a particular way, you know, people present with trauma. It can come in
Jennifer Babb: So many different forms, and unless we have a really… Good understanding of the person.
Jennifer Babb: We shouldn't jump in with any sort of
Jennifer Babb: you know, treatment recommendations. There should be discussions with the people, and I think, you know, a lot of what Claire talked to, the voices at the table, like, we involve
Jennifer Babb: people and their networks within our dialogical approach, and it's… you might need people around you that help you feel safe to be able to come… like, coming into a meeting with multiple strangers is a really…
Jennifer Babb: disempowering, unsafe process, often. And so, it's some really, sort of, foundational things, just doing things differently, thinking about things differently, giving people's
Jennifer Babb: Voices, you know, making sure everyone's voice is equal, you know, understanding the power of our lived experience workforce,
Jennifer Babb: And…
Jennifer Babb: And the role they have to play, and that really often clinicians need to really take a bit of a backseat, and come in when people are ready, not come in
Jennifer Babb: you know, guns blazing first, and so I think there's just so many ways, keeping things very transparent, as you're saying, making sure there's shared decision-making in all the processes at all levels.
Jennifer Babb: And I think it's probably giving us
Jennifer Babb: Also, a bit of, like, we will get things wrong, like, we're not perfect, we need to be able to reflect on these things, we need to be able to apologize, you know, if we have.
Jennifer Babb: inadvertently re-traumatize someone. Really, you know, it is never… it's never our intention. But it's acknowledging that, you know, these interactions
Jennifer Babb: Can have impacts in all sorts of ways.
Jennifer Babb: Forgotten what the question was now.
Rahul Khanna: I think you've covered the bulk of them. I might do a quick pivot now, given that we've got just shy of 10 minutes, to bring in some of the questions that have come through the chat.
Rahul Khanna: Which really center around the sharing of power in practical terms.
Rahul Khanna: And perhaps, maybe if we go a bit around, Claire, maybe if you open up, because there was a final bit that we'd intended to get to around the role of peer work, and then Anne, maybe… and Law, if you want to kind of chip in with a bit of a closing comment on that theme, that'd be great.
Rahul Khanna: Yeah.
Claire Conlon she/her Wurundjeri Lamd: Thank you. So there's a saying that, power is never felt by those who have it, but always those who don't.
Claire Conlon she/her Wurundjeri Lamd: And we really needed to have some conversations up front around, organisational readiness for lived and living experience, and why they were there.
Claire Conlon she/her Wurundjeri Lamd: And that they're actually there as change agents, and to rattle cages, and to, you know, say that we don't need traditional ways of working. Actually, we don't need more of the same. And so I think, clinicians, in fairness, I was a clinician,
Claire Conlon she/her Wurundjeri Lamd: have actually, announced that there's some unlearning to do. And I think there needs to be a real humility there around some of that unlearning.
Claire Conlon she/her Wurundjeri Lamd: And so… but what we need to do is actually work together.
Claire Conlon she/her Wurundjeri Lamd: And… and then think about… but it's not up to lived experience to actually do all of the heavy lifting in this space around trauma-informed care. We need allies.
Claire Conlon she/her Wurundjeri Lamd: And we actually do need, clinicians and lived experience and everyone to be working together. So, lived experience do bring a authentic understanding and empathy of that sort of first-hand understanding of distress and trauma and recovery.
Claire Conlon she/her Wurundjeri Lamd: And those insights have been really important to help shift that organisational culture, to really honour humanity, dignity, and choice. And when we get these things right, everyone actually benefits. Everyone benefits, not just people who have experienced trauma.
Claire Conlon she/her Wurundjeri Lamd: So yeah, really important.
Anne-Laure Couineau: And to add to what Claire was saying, what came out as a really powerful thing when we implemented trauma-informed practice and developed those tools, and co-designed those tools with Claire and Jennifer's services and the Greater Queen…
Anne-Laure Couineau: Geelong and Queenscliff local, was it wasn't just about having lived and living experience representation, it was about leadership. We had lived and ex…
Anne-Laure Couineau: and living experience leaders. Whether they were workers, peer workers, or people that actually had a formal leadership position in the organization.
Anne-Laure Couineau: They took the lead in a project. They had a very strong voice and really influenced how we wrote things, how we thought about things.
Anne-Laure Couineau: That together with, talking to consumers and carers that were part of the co-design process as well.
Anne-Laure Couineau: Ease what made
Anne-Laure Couineau: the tools what they are now, but also, I think, created those conversations that both Claire and Jenny mentioned, that it really encouraged that multidisciplinary examination of things like power, or do we have to do things the same way we've always done? So, I think that leadership is really important.
Anne-Laure Couineau: And when you have… and what we saw is that, you know, when you had, you know, peer workers that had that strong voice, it was very powerful in supporting true mindful practice.
Rahul Khanna: Brilliant. Thank you so much, Anne Law. We are getting, unfortunately, to the, towards the end of our time, so if I throw back then to Jazz for any of your closing moments, it was a real pleasure to be part of this, and thanks again to our panelists.
Jas Routley (she/her) - Collaborative Centre: I've got one, probably, final question, if we could maybe see if we could get answered, which seemed to get a little bit of traction, and that is, how do you manage lack of resources, time, funding for services that impact capacity of agencies to implement?
Jas Routley (she/her) - Collaborative Centre: effective, change service models. So, how do we deal with the fact that there's obviously a lot of competing demand for things and services?
Claire Conlon she/her Wurundjeri Lamd: I'm just gonna say that, actually investing time in this is time well spent, and you will get better out… it's around what we prioritise, because yes, we all have, competing demands, and, but it is actually about what we prioritise.
Claire Conlon she/her Wurundjeri Lamd: And I'm taking some time out, working with all of staff, the benefits in the long run.
Claire Conlon she/her Wurundjeri Lamd: are massive, and outcomes for our clients are huge. So, I think that it's… it's an invest… this investment of running time, is an investment for the long term and for, really our…
Claire Conlon she/her Wurundjeri Lamd: Royal Commission is actually saying that, you know, we've heard all the consumers, carers, family supporters saying this is really needed, and so it's really… needs to be time well spent.
Anne-Laure Couineau: And I think it's about, you know,
Anne-Laure Couineau: dedicated time, sometimes to a small number of people that will champion change, but that are across that multidisciplinary lens that we've talked about, where there's
Anne-Laure Couineau: it's not just the lead clinician doing it, for example. It's not just one person, but a team that's multidisciplinary, that really owns that, can help with those challenges around,
Anne-Laure Couineau: you know, having not enough time, but I agree with Claire that there's a lot of, changes in trauma-informed practice actually gain you time down the track. For example, having less
Anne-Laure Couineau: clients that become less distressed, or that you have to follow up less because they feel more empowered and safer in the service, for example, might actually save you time down the track. So, it's also, of course, a message to funders that, you know, really providing the time and the
Anne-Laure Couineau: The funding to do this work will save
Anne-Laure Couineau: A lot of time and money down the track as well.
Rahul Khanna: I read… I was reading a leadership book some years ago, and the person said, saying that you're too busy to train is like saying you're too hungry to eat.
Rahul Khanna: And I think this, this does apply in this setting as well, where trauma-informed practice can be a really important, sort of.
Rahul Khanna: Investment, rather than a times time sink.
Anne-Laure Couineau: Can I mention before we go, as well, that we've mentioned the tools, but also Phoenix as a leadership training session online that's about a 3-hour training
Anne-Laure Couineau: course that's available that goes into all of the things we've talked about in greater detail. So, for those of you who are in leadership position, if you go to the Phoenix website and the education and training, you will see a course that's available that can add to what you've heard today in the webinar.
Jas Routley (she/her) - Collaborative Centre: Thank you, everyone. It's been a wonderful session this morning. I think everyone can agree that there's been a lot of, robust discussion also in the chat, and as we said earlier, we'll try and
Jas Routley (she/her) - Collaborative Centre: sort of glean those questions and insights out, and see if we can put them together and get some additional answers for some of you. We thank you all so much for attending this morning, and a huge thanks to our panellists, Anne Law, Jennifer, Claire.
Jas Routley (she/her) - Collaborative Centre: and Rael, we are very appreciative of your time. And for everyone who's still here, we do have a short evaluation, which we would love
Jas Routley (she/her) - Collaborative Centre: To have you complete, and I'll pop that link in the chat now. And that will also be sent to you via email, and we'd love to get your feedback, just to find out, what… what else you guys want to know, and how we can continue to deliver really, informative and valuable sessions for you. So thanks once again for your attendance.