The Lancashire Traumatic Stress Service (LTSS) was established in 2008 and aims to provide a specialist assessment and treatment service for adults who are experiencing a range of severe difficulties as a result of exposure to a traumatic event
What We Did
The Lancashire Traumatic Stress Service (LTSS) was established in 2008 and aims to provide a specialist assessment and treatment service for adults who are experiencing a range of severe difficulties as a result of exposure to a traumatic event
The service has been designed to work in partnership with local secondary care teams across the county . It operates two days a week and is staffed by a small core team of experienced clinicians who deliver a range of NICE compliant interventions
The range of treatments or interventions we provide are designed within a clear modular framework which is always explained to service users at the beginning of their journey with us.
Crucially this discussion of the modules makes it clear that there will be no “ jumping in the deep end” – asking them to retell their most troubling memories – until a sufficient amount of groundwork has been completed to ensure that the service user is in a “good enough” place to open the door on these difficult memories.
We will often talk about three main blocks of work – reclaiming a life, building a future and dealing with the memories.
As with all good services, our work is based on a careful and collaborative understanding of the difficulties and their origins. As one of our service users told us – don’t ask me what is wrong – ask me about my story. We try to listen carefully to the individual story and use this as the basis for an agreed plan of joint work
Psycho-education has an important role in our service. Helping individuals to understand how the brain stores memories and how this process can be thrown off line when it comes to storing memories of traumatic events is almost always an important early part of our work
We have also learned that dealing with sleep difficulties and distressing nightmares is another important early intervention module. It is always good to see how improvements in sleep patterns and a reduction in nightmares not only starts to give individuals back a sense of control – but also facilitates improved concentration, energy and motivation.
Pharmacological interventions are always an important part of the work undertaken by the service. Working within the context of secondary care mental health, the vast majority of the service users we see will be taking medication. Reviewing, revising and optimising the medication regime to work in partnership with psychological therapies is a crucial and important part of the overall work of the service
In relation to the treatment of sleep and nightmare difficulties, the service provides an innovative and very successful combination of Prazosin and appropriate psychological interventions (such as Imagery Rehearsal Therapy) to achieve sustained reductions in these often difficult to treat problems
These improvements set the occasion for work on reclaiming their lives – or for some starting to find a new life – and, where appropriate, work on managing emotions and tolerating distress. This is particularly important where responses to traumatic events may involve powerful emotions such as anger, guilt and shame
The above work, undertaken in the context of a strong and secure therapeutic relationship, sets the occasion for more direct work on the trauma memories. The service offers NICE compliant treatments of eye movement desensitization and reprocessing (EMDR), trauma- focussed cognitive behaviour therapy (TF-CBT)
It is not unusual for the service to find that careful “groundwork” – in terms of work on earlier modules – can mean that working with the trauma memories is perceived as less daunting than might have been initially expected
Like many other professional colleagues, we continue to be humbled by the courage and determination service users show in facing their traumas and building for themselves a life that gives a sense of meaning, purpose, hope and direction.
The latter stages of our work involve looking forward in terms of what this new life might mean and how to sustain the progress that has been made.
As a specialist clinical team , our partners are colleagues in local secondary care teams with whom we work in partnership. All referrals to the LTSS are actively discussed with locally based care co-ordinators.
The LTSS is one of three specialist teams provided by the Mental Health Network of the Trust which aim to enhance service user outcomes
As a specialist clinical team we aim to ensure that active collaboration with service users is central to our work. At the time of referral, prospective service users are invited to have a face to face discussion with a member of the core team . This helps to clarify the way the service works, answer any questions about the treatments we provide and gives the person concerned the chance to make an active and informed decision regarding getting involved with the service.
At the end of this discussion – service user feedback might suggest that they are not ready to embark on treatment for their trauma related difficulties at this point in time – but may ask that they can return in a period of time when they are better prepared – we are always pleased to agree with this proposal
Also crucial to our collaborative approach is the established real time feedback system that is in place . At the end of every appointment, service users are asked to complete a short questionnaire that provides the therapist with important feedback on aspects of the session that has just been completed . We believe this is a respectful and helpful way of assuring a collaborative approach to our work
Our service has evolved continually over the years . We consider that the active process of referral that we now adopt – no written letters of referral – active conversation with the care co-ordinator and face to face meeting with the prospective service user is time well spent –
It makes for a shorter waiting list of individuals who are known to us and who have actively indicated that this is a good time to work on their trauma related difficulties .
This is something we would have done from the outset.
It is reasonable to indicate that the small ( 1.0 wte) service has enjoyed support from the organisation – at Network and at Trust level
This question is hard to answer singulair inhaler. Our carefully structured , modular based service and our provision of regular twelve month secondments for colleagues keen to improve their knowledge , skills and confidence in working with complex trauma does mean that there are others who would be keen to contribute to the continuation of the service
Evaluation is built into the service in a number of important ways and from the outset the LTSS made a strong commitment to transparency regarding outcomes
We are one of the few services that routinely publishes outcome data in relation to our work with service users . This information is easily available through the service website at lancashiretraumaticstressservice.nhs.uk
As indicated above our service users evaluate each and every appointment they have with the service and this feedback goes directly to the clinician they saw .
Following the end of our involvement , service users are sent a feedback questionnaire and the scores and comments made are discussed with the team as a whole – and – changes to the way the service is organised and provided are considered
The comments made by service users are also published on the service website . Below are a number of illustrative comments
“Having a mental illness is very challenging; I had nowhere left to turn, felt I had no future and was nervous about attending the service. The staff are excellent and put you at ease straight away. I would not hesitate recommending Lancashire Traumatic Stress Service.”
“For me it’s been a life saver and has changed my life for the better, because all the staff have caring natures, the time they invest in you to address your mental needs and the support is endless. Thank you.”
“This is the first time in 17 years of looking for treatment for PTSD that I believe the
professionals involved truly understand the condition and its effects on the individual and their families. They offer a practical approach to finding solutions.”
“Life changing, life saving, life now worth living.”
We are particularly keen to contribute to the development of knowledge , skill and confidence in working with complex trauma and undertake this in the following ways
The provision of 12 month one day a week secondments for colleagues to come and work with us. These secondees receive specialist supervision for their work and contribute to the training and education programme of the service
The provision of annual two or three day training workshops designed for colleagues in primary care and secondary care services
The provision of specialist supervision and consultation , in both individual and group formats
Presentation of papers at conferences in relation to innovative areas of work within the service ( see below )
The publication of information about trauma and the management of trauma related difficulties on our website (lancashiretraumaticstressservice.nhs.uk )
Is there any other information you would like to add?
The structured, modular based approach to treatment provided by the LTSS does, we believe, provide service users with a sense of structure to their engagement with us
The importance of structure also applies to the way the clinical day is organised . This aims to ensure that as well as clinical work there are clear structured opportunities for supervision , for case discussion and for learning .
The LTSS is also always interested in improving the provision of clinical services . We collaborate with our colleagues in the Early Intervention Service – working with them on the provision of effective treatments for trauma.
We are also working on combining psychological and pharmacological treatments for nightmares and colleagues in the service have presented a paper on this work at the BABCP annual conference in 2016
