Childhood adversity and trauma: experiences of professionals trained to routinely enquire about childhood adversity.

Research indicates that adverse childhood experiences play a causal role in the development of poor health and social outcomes in adulthood. Despite this, research suggests that such experiences go undetected since spontaneous disclosure is unlikely, and practitioners are unlikely to ask. A project was developed in which practitioners were trained to routinely enquire about adversity in their daily practice. Four pilot services took part that worked directly and indirectly with children and young people, many of whom were exposed to multiple adverse experiences. The aim of this study was to construct an understanding of the experiences of these practitioners. Seven interviews were conducted, and the data was analysed using thematic analysis. The emerging themes were: change in knowledge, perception and practice; the emotional impact of hearing and responding to disclosures; confidence in asking and responding appropriately; making sense of the impact for clients; how and when to ask. Findings indicate that participants' change toward more adverse-experience-informed formulations of clients' difficulties ensure commitment to routine enquiry and changes in referral patterns and therapeutic practice. Suggestions are made with regard to the practicalities of routine enquiry and how services can best support practitioners who are embedding this skill into their practice.

Feasibility of a supported self-management intervention for relatives of people with recent-onset psychosis: REACT study.

BACKGROUND: Relatives of people with psychosis experience high levels of distress and require support. Family interventions have been shown to be effective in improving outcomes but are difficult to access and not suitable for all relatives. AIMS: To assess the feasibility and effectiveness of a supported self-management package for relatives of people with recent-onset psychosis. METHOD: A randomised controlled trial (n = 103) comparing treatment as usual (TAU) in early intervention services with TAU plus the Relatives' Education And Coping Toolkit (REACT) intervention (trial identifier: ISRCTN69299093). RESULTS: Compared with TAU only, those receiving the additional REACT intervention showed reduced distress and increased perceived support and perceived ability to cope at 6-month follow-up. CONCLUSIONS: The toolkit is a feasible and potentially effective intervention to improve outcomes for relatives. A larger trial is needed to reliably assess the clinical and cost-effectiveness of REACT, and its impact on longer-term outcomes.

Relatives Education And Coping Toolkit--REACT. Study protocol of a randomised controlled trial to assess the feasibility and effectiveness of a supported self management package for relatives of people with recent onset psychosis.

BACKGROUND: Mental health problems commonly begin in adolescence when the majority of people are living with family. This can be a frightening time for relatives who often have little knowledge of what is happening or how to manage it. The UK National Health Service has a commitment to support relatives in order to reduce their distress, but research studies have shown that this can lead to a better outcome for service users as well. Unfortunately, many relatives do not get the kind of support they need. We aim to evaluate the feasibility, acceptability and effectiveness of providing and supporting a Relatives' Education and Coping Toolkit (REACT) for relatives of people with recent onset psychosis. METHODS: The study is a randomised control trial. Trial Registration for Current Controlled Trials ISRCTN69299093. Relatives of people receiving treatment from the Early Intervention Service for psychosis are randomly allocated to receive either Treatment As Usual (TAU) or TAU plus the REACT intervention. The main aims of the study are to: (i) determine the acceptability of a supported self-management intervention; (ii) determine preference for type of support; (iii) assess the feasibility of the design; (iv) identify the barriers and solutions to offering support for self-management approaches within the NHS; (v) estimate the likely effect size of the impact of the intervention on outcome for relatives; (vi) gain detailed feedback about the barriers and solutions to using a self-management approach; (vii) describe the way in which the intervention is used. Outcomes will be assessed from baseline and at 6 month follow-up. DISCUSSION: The intervention is compared to current treatment in a sample of participants highly representative of relatives in routine early intervention services across the UK. The intervention is protocolised, offered within routine practice by existing staff and extensive process data is being collected. Randomisation is independent; all assessments are made by blind raters. The limitations of the study are the lack of control over how the intervention is delivered, the short follow-up period, and the lack of assessment of service user outcomes. Despite these, the findings will inform future effectiveness trials and contribute to the growing evidence base for supported self-mangement interventions in mental health.

Relationships between trauma and psychosis: a review and integration.

OBJECTIVES: This paper examines the research and theoretical literature on potential links between trauma and psychosis. METHODS: Three main alternatives are considered; can psychosis cause PTSD, can trauma cause psychosis and could psychosis and PTSD both be part of a spectrum of responses to a traumatic event? The more influential studies considered are critically evaluated and methodological considerations specific to research regarding trauma and psychosis are also examined. RESULTS: Evidence is found in support of each of these relationships, and an integrative approach to conceptualizing the relationships is suggested. CONCLUSIONS: Recent conceptualizations of PTSD and psychosis are used to inform the consideration of these different pathways, and the implications for theories of psychosis and trauma and the clinical implications for services for psychotic patients are discussed.