Development, implementation and evaluation of a new trauma-informed model of youth treatment for substance use disorders.

Phase one: Development. The new trauma-informed model will be co-developed with Lives Lived Well staff and will build on the existing literature on TIC for adult outpatients model of care, in addition to incorporating existing evidence-based programs (Grit, Healthy Recovery) delivered alongside the new model. It will also incorporate one-to-one trauma-focused therapy for clients with PTSD delivered by a trained clinician (provisional psychologist supervised by a board-approved, endorsed clinical psychologist) on a weekly to fortnightly basis, over 6-8 weeks, with 90-minute sessions. The service environment (climate) and therapeutic milieu, as well as the existing therapeutic group programs will also be revised to be both more trauma-informed and strengths-focused, emphasising personal strengths in clients, rewarding positive behaviour, and creating a ‘shared language’ between clients and staff. The duration of the development phase is approximately 8-months to ensure all components of the new model are developed and ready to be implemented. Phase two: Implementation. Staff will undergo training the new trauma-informed model via a two day workshop, in addition to other facets of trauma-informed care. This training will be delivered face-to-face by a specialist clinical psychologist who developed and implemented adult outpatient models of TIC. The training will involve psychoeducation, experiential practice, short videos, and group discussion with staff. Following this training, staff will receive trauma-informed clinical supervision to assist with understanding events with clients from a trauma-informed perspective, and how to talk about trauma with clients. Staff will also have the opportunity to refer eligible clients who have a trauma history to receive trauma-focused therapy (submitted as a separate trial). A trauma-informed approach by staff will be used throughout client screening/assessment, one-to-one case management, and therapeutic group programs. The training will educate staff on the content of the new model, the proposed benefits for both staff and clients, how to implement the model, and how to refer clients to further treatment. It will also address barriers to delivering the model in the residential settings. The training will be organised and co-facilitated by the researchers. Implementation of other aspects of the model, such as revisions and changes to the service environment and therapeutic group programs, will be implemented following the staff training. Within the program, seven therapeutic group sessions are delivered to clients per week, equating to 42 sessions over the 6-week program. The implementation of trauma-informed adaptations to these therapeutic groups will be phased, and measures of adherence (among other service outcomes) will be collected when the client and service evaluation phase begins. The duration of the implementation phase is 18-months due to ongoing supervision and referrals to trauma-informed care. This phase will overlap with the development phase by 6-months since supervision will commence immediately following training in TIC. It will also overlap with the evaluation phase for 12-months, since supervision will continue until the end of the evaluation outcomes. Phase three: Evaluation. An evaluation of the staff training, client, and service outcomes will be conducted. The impact of the staff training on their knowledge, attitudes, skills and confidence in delivering trauma-informed feedback will be evaluated at baseline, 1, 3, 6 and 12 months follow up. For evaluation of client outcomes, all clients accessing participating residential treatment services will have the opportunity to take part in a survey, alongside their routine treatment. Client outcomes on alcohol and other drug (AOD) and mental health (trauma, depression, anxiety) symptoms will be evaluated at baseline, 6 weeks, 3 and 6 months follow up. To evaluate service outcomes, we will assess: the number of clients admitted/discharged; number of PTSD screens/trauma-informed feedback sessions/referrals to trauma-informed treatment completed; organisational TIC climate; number of groups/case management sessions delivered/attended, length of stay/treatment episodes completed; staff satisfaction and retention. These measures will be collected by the research team. All questionnaires will be administered and collected by the research team using an online survey platform, except for outcome measures that are routinely collected by the organisation. The duration of the evaluation phase will be 24-months in total which will incorporate the staff, client, and service outcomes. Staff outcomes will be collected in the first 12-months and will start in the weeks prior to the staff training in the new model (baseline), and follow ups will commence immediately after. This will overlap with the model development (Phase 1) for 6-months where other parts of the model (such as adaptations to the therapeutic groups) are implemented. Once these are fully implemented, client and service outcomes that will be collected and will continue for 18-months. Baseline client data will only be collected for the first 12-months, and the latter 6-months will only be collecting the client follow up data. Service outcomes will be collected for the 18-months. Phase four: Sustainability The sustainability of TIC service outcomes will be assessed once client recruitment to the trial has ceased. The duration of the sustainability phase is 6-months, which will overlap with the final 6-months of the evaluation phase where we will be collecting client follow ups (but not recruiting any new clients entering the program).