Acute Trauma Service Setup In Sheppard Pratt

Sheppard Pratt Health
System
Towson, MD
USA
Trauma Disorders Service Line
Overview

Mission
• To provide tertiary care for the most disabled
and treatment-refractory refractory patients with trauma-
related psychiatric illnesses in the U.S. (and
Canada).
• To provide training to psychology post-doctoral
fellows, as well as students in nursing,
occupational therapy, art therapy and social
work programs.

Program Structure
• Continuum of Care Including:
• Inpatient 20 bed unit
• Partial Hospital Program (IOP)
• Outpatient Program
• Acute trauma Services
• Training
• Supervision / Consultation (internal and external)
• Research

Program Structure
• Service Line Director: Psychiatrist
• Unit Chief: Psychiatrist
• Unit manager: Psychiatric RN
• Training Director: Psychologist
• Consultation Service Director: Psychologist

Inpatient Trauma Disorders Unit
• 20 bed Secure, co-ed Unit
• Individual rooms
• Voluntary Admission
• Referral by treating clinician with agreement to
accept the patient upon discharge
• Variable length of stay (21 day avg.)

Multidisciplinary Team Approach
• Psychiatrist
• Psychologist
• Social Worker
• Occupational therapist
• Psychiatric Nurses with trauma training
• Nursing staff with trauma training
• Art therapist
• Director of Pharmacy

Vision
• To be a specialized inpatient program providing
state-of
of-the-art treatment in all treatment
modalities to patients with complex post-
traumatic stress disorders and dissociative
disorders.
• To be recognized as a national center of
excellence in providing treatment to these
patients.

Reasons for Admission
• Safety / Crisis Stabilization
• Dissociative Disorder impairing functioning
• PTSD
• Acute
• Complex

Other Primary Diagnoses
• Anxiety/Mood Disorders
• Personality Disorders
• Eating Disorders
• Substance Abuse Disorders
• Somatoform Disorders
• Psychotic Disorders

Treatment Philosophy
• Patients are held responsible for their behavior and
their treatment despite their current suffering and their
histories of trauma and victimization.
• An emphasis on restoration of independent functioning
through the development of the patient’s s own
capabilities to manage symptoms and life stressors in a
progressive, adaptive and self-generated fashion.

Treatment Philosophy (con(
con’t)
• Safety is a Primary Goal
• Includes:
• Refraining from acting on impulses to harm self
and/or others
• Control of addictive, self-defeating, and risk taking
behaviors
• Avoid re-victimization
• Development of supportive relationships
• Ability to tolerate intense affective states

Treatment Philosophy (con(
con’t)
• Dedicated to the spirit of intellectual inquiry and
openness, as well as to rigorous differential
diagnosis of our patients.

Pre Admission Screening
• Referring clinician provides:
• Goals for admission
• History
• Diagnostic Issues
• Medication History
• Review of legal issues
• Agreement to accept Pt. upon discharge
• Medical History

Course of Treatment
• Assessment-
Diagnostic
Psychosocial
Somatic
Pharmacological
Coping Skills
Discharge Planning

Course of Treatment (con(
con’t)
• Treatment-
Therapy: A shift from external to internalized
management of symptoms, with a focus
on increasing awareness of precipitants
of self-harm, by resolving internal
conflicts or regulating intense affective
states driving dangerousness.

Treatment Structure
• Daily Attending Rounds
• Individual Psychotherapy- 3x/wk for 45 min
• Group Treatment Modalities
• Milieu Therapy

TIME SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
9 am Cognitive Task
Skills A
Cognitive Task
Skills B
Cognitive Task
Skills A
Ask Anything
A&B
Cognitive Task
Skills B
10 am Goals
A&B
Goals
A&B
Goals
A&B
Goals
A&B
Goals
A&B
Goals
A&B
Goals
A&B
11 am
Journal
Group
A & B
Art Therapy B
11:00 - 12:15
Containment II A
Containment A&B
Creative Expression
A&B
Transitions B
(11:00-11:45)
Art Therapy A
(11:00-12:15)
Containment II B
Journal
Group
A&B
1 pm Health &
Stress
Management
A & B
Cognitive
Therapy A
Containment II B
Art Therapy A
(12:45-2:00)
CognitiveTherapy B
Transitions A
(1:00-1:45)
Applied Containment
(1:00-1:45)(R)
Containment A&B
Art Therapy B
((12:45 -- 2:00)
Containment II A
Health &
Stress
Management
A&B
2 pm
DBT Skills
Family Issues ( R)
2:00-2:45
Tension
Reduction(R)
DBT Skills
3 pm
Medication
Education
(A&B)
4 pm
Newcomers Newcomers Collage (A&B)
Journal Group A&B
Journal Making (R)
Health & Stress
Management
Symptom
Management
A & B
7 pm
Small groups
(7:15)
Small groups
(7:15)
Small groups
( 7:15)
Small groups
( 7:15)
Small groups
( 7:15)
Small groups
( 7:15)
Small
groups
( 7:15)
8 pm Community
Meeting
A&B
Community
Meeting
A&B
Community
Meeting
A&B
Community Meeting
A&B
Community Meeting
A&B
Community
Meeting
A&B
Community
Meeting
A&B

Intensive Outpatient Program
• 9am -3pm , 5 days / week
• Capacity of 15-24
Pt.s
• Milieu Based therapeutic model
• Assessment Phase includes a multidisciplinary
evaluation
• Diagnostic clarification
• Individual Psychotherapy NOT provided

Outpatient Services
• Outpatient Program
• Individual Psychotherapy
• Psychiatric Services
• Family / Couples therapy
• Children and Adolescent Services
• Group Psychotherapy
• Psychological Testing Services
• Forensic Services
• Education / Training/ Supervision

Acute Trauma Services
• Began July 2002
• Outpatient Program( with ability to admit and
treat on inpatient unit when indicated)
• Designed to address needs of acutely
traumatized and to provide Preventative
Services for at risk populations
• Individual and Group Psychotherapy
• CISM services (internal and external)

Acute Trauma Services
• Resilience Focused
• Crisis / Early Intervention Services
• Advocacy Work (crime victims, military,
occupational injury patients)

Acute trauma Services
• Supervision
• Consultation
• Workers Compensation Services
• Disaster Drill Management and Evaluation

Acute Trauma Services
• Training was a major component
• HRSA Bioterrorism Funding Secured for 2 years
(2004-2005)
2005)
• Conducted 36 workshops (full day) for area medical
facilities, and schools to prepare personnel to
manage the psychological impact of disasters and
terrorism
• Multiple other acute trauma workshops

Lessons Learned
• You must balance the services that clinicians
provide to prevent loss of staff due to burnout /
secondary traumatization
• The impact of this type of service delivery on
staff is much different that other types of
Psychiatric care
• Staff care and peer support are essential
components

Lessons Learned
• Research, Consultation, and Training are
balancing factors
• Limiting Trauma Caseload
• A specialty center was greatly needed for the
complex trauma patients
• General psychiatric units were very willing to refer
and transfer for specialty care
• Pt.s often commented on the differences in care they
received