Complex PTSD in young people in care

Discussion about experiences of young people in care with complex PTSD and ways of improving support

Background

• March 2021: ACAMH joins CAMHS (an online journal club) in a discussion of PTSD in young people in care
• Discussion revolved around Rachem M Hiller’s recent paper, which provides valuable insights through her study of 120 10-18 year-olds living in care in England
• Findings
  • Our current models of PTSD are applicable to young people living in care
  • Specifically, maladaptive cognitions prove particularly important, as this suggests that targeting these mechanisms in intervention would be useful for young people with complex PTSD symptom

Are PTSD and complex PTSD different?

• PTSD: a trauma-specific mental health difficulty
• Complex PTSD: the young person must have PTSD as well as additional complex features of difficulties with: relationships, emotion dysregulation and negative self-concept (e.g., “I’m not worth anything”)
  • A new diagnosis in the ICD-11, not yet included in the DSM-5
• Hill’s findings reveal that the processes that drive PTSD also drive complex PTSD
• Treatment available for these processes include trauma-focused cognitive behavior therapies (tf-CBT) have shown to be effective for those with complex presentations

Getting young people in care the right treatment

• Young people with complex presentations may benefit from more sessions
• It is important that a young person receives psychoeducation about both the PTSD and their tf-CBT treatment, particularly in relation to avoidance
• Reflections by practitioners are important too, as this may reveal that they encourage avoidance by delaying starting parts of treatment that are harder, i.e. memory work
• Existence of barriers in services that make it difficult for practitioners to deliver tf-CBT
  • Limited amount of time available
  • A pervasive belief that tf-CBT is not appropriate for young people exposed to trauma
  • Discussion called for address of these service-level and individual-level barriers

Listening to young people in care, interview with Aishat Hamzat about her experiences

• Some young people in care reported of feeling let down by the mental health support system, which can lead to the decision to never engage with mental health services again
• Practitioners seem to often accept that mental health difficulties are inevitable or unchangeable, which is felt by young people in care who feel unsupported and unacknowledged
• Vital to work alongside young people and consider their individual needs within their treatment plan as they are the experts in their own experience
• Important to build rapport with young people in care, as they might struggle with rust and relationships