Assessment of complex trauma symptoms in adults: a systematic review; and, Exploring consensus in best practice when working with trauma in male populations detained in secure forensic mental health settings: a Delphi study
This thesis is completed in accordance with the academic component, in part fulfilment, of the Doctorate in Clinical Psychology at the University of Edinburgh. Following the research portfolio structure, a thesis abstract is presented. This is followed by a lay summary of the background, methods, results and conclusion sections of the presented projects. Chapter One illustrates a systematic review which examines instruments that assess complex trauma related symptoms in adult populations. Chapter Two describes an empirical study exploring what a best practice framework may entail when working with male populations detained in secure forensic mental health hospital settings. The reporting of the empirical study and the systematic review have been prepared for submission to the International Journal of Forensic Mental Health and the Journal of Trauma & Dissociation, respectively. The reporting format of both projects has followed the journal author guidelines, a summary of which has been included in Appendix F. Background: Exposure to adverse experiences, particularly those considered more repetitive and enduring (such as sexual abuse and neglect) has been associated to negative mental health outcomes including complex trauma. Though assessment tools to capture complex trauma-related symptomology have been developed, a systematic review of these measures does not appear to have been completed. Furthermore, researchers have argued for the better detection and intervention of trauma-related presentations in male populations detained in secure forensic mental health settings. Improved awareness in this area is likely to help inform treatment and rehabilitation delivery for this population. Method: A systematic review critically appraised the methodological and psychometric features of instruments assessing a range of complex trauma-related symptoms. The empirical study attempted to explore how such features may be understood, detected and responded to in clinical settings. Using a Delphi process, the empirical study investigated consensus among practitioner psychologists in the United Kingdom with expertise in working with male populations detained in secure forensic mental health settings. Through an online survey format, the study involved three rounds of data collection to assess consensus on what a best practice framework may entail when detecting and working with trauma in this population. Data from the open-ended questions in Round I was assessed using qualitative analysis. This generated a number of statements upon which consensus was explored; the respondents were required to rate their agreement with the statements in Round II and III of the survey. Results: The instruments identified from the systematic review, measuring complex trauma-related symptomology, had been subjected to some degree of evaluation regarding their validity and reliability. Views of the psychologists in the empirical study indicated consensus regarding several elements that may be considered best practice in relation to working with trauma in male populations detained in secure forensic mental health settings. These related to: a range of presentations that may indicate the need for a trauma assessment; trauma-related intervention goals in light of both mental health and criminogenic needs; training and guideline recommendations. The results also indicated however, more varied views about the theoretical models that underpinned their clinical practice and the interventions employed. Conclusion: From the systematic review, no measure was assessed to be better than the others at capturing complex trauma-related presentations, though the purpose of its use is likely to impact why one would be preferable to another (e.g. screening versus outcome monitoring). Interestingly, the more recently published measures appear to have been developed for diagnostic requirements. The empirical study identified several considerations for a best practice framework in relation to working with trauma in male populations detained in secure forensic mental health settings. Further exploration and guidance for implementing trauma-specific interventions in these settings, with individuals presenting with multiple complex needs (e.g. including mental health and criminogenic), may be warranted.