Do community mental health staff ask about and respond to adverse childhood experiences and attachment histories?

Abstract

The links between adverse events, attachment, and mental health problems are well documented. However, there has been limited focus on clinicians' enquiry and response behaviour in the literature to date. This project had two main objectives: 1) To add to this limited field of research and 2) to function as a replication of 1997 file audit (Agar & Read, 2002). The current study examined 250 computerised medical files, to see if clinicians working in four community mental health centres (CMHC) in Auckland, New Zealand, routinely asked about adverse events and if they incorporated disclosed information into psychological case formulations and treatment recommendations. All files were read in their entirety, and information regarding adverse events in childhood, adulthood and attachment related experiences was recorded. Results indicate that there have been significant improvements in both enquiry and response behaviours since the last audit. For instance, 20% of the files included recorded disclosures of child sexual abuse in the 1997 audit, compared to 32.4% in 2010. Furthermore, the inclusion of adverse events in clients' case formulations had increased by more than 300% since 1997. Despite these encouraging results, there were also some concerning findings. There had been no improvements in the proportion of individuals referred for psychological therapy or in the number of alleged crimes that had been reported to the authorities. Furthermore, men and individuals with a psychotic disorder diagnosis appear to continue to receive a less than satisfactory service regardless of efforts made by a training programme. Findings from this study suggest that focus needs to be placed on assuring that more individuals are referred to and able to access trauma-focused therapy. Future CMHC training providers would benefit from considering ways to disseminate this information to minimise misunderstandings, misdiagnosis, and ineffective treatment recommendations, especially for males and clients experiencing psychosis. Furthermore, reporting of historical abuse to legal authorities also needs some future attention at policy level.