Download Traumaambulanzen in NRW

Trauma Ambulances in
NRW
Dr. Michaela Czeranski
LWL-Klinik Hemer
Hans-Prinzhorn-Klinik
Institusambulanz
Schwerte, 31th, .May 2011
LWL
Für die Menschen.
Für Westfalen-Lippe.
Statutory Basis
• The state has a statutory duty to protect citizens from the
effects of violence and crime against the person. If following an
act of violence or crime, a person has new needs, the state is
responsible to compensate the individual.
• The Victim Compensation Law or
Opferentschädigungsgesetz (OEG) aims to ensure that the
victim’s mental and physical health is restored as far as
possible, so that the victim is able to continue to work and live
within their community.
• Compensation and services granted will be in line with the
statutory guidance of the Bundesversorgungsgesetzes (BVG)
• In Nord Rhein Westphalen, the Regional Councils
Landschaftsverbände Westfalen-Lippe (LWL) und Rheinland
(LVR) are responsible for the approval of any claim by a victim
including the nature of the compensation to be provided.
In which cases is s.b. entitled for benefits
according to the OEG?
• It must be a clear act of violence and the vic suffers from it.
• The act must be committed after 15th May1976 in federal
territory.
• In cases of acts commited before this cut off date aid can
be received in form of “Hardship allowance provisions” if
there is an degree of injury consequences at least 50 %
and is experiencing financial hardship.
• Since the 1st July 2009 financial aid can also be received
in case of violence committed abroad (one off payment and
medical treatment)
• Eligible are also dependents (include 3rd degree since 1st
of July 2009) an also foreigners residing in Germany
(special rules and criteria)
Scope of Aid OEG
• Medical treatment including residential or ambulant
psychotherapy
• recovery aid
• aid with participation in a working life
• temporary family/maintenance aid/aid for the eldery
• assisted living
• residential rehabilitation measure (also with kids)
• nursing aid
• provisions for dependents for widows, orphans and
parents
• disability pensions
• death benefit and funeral allowance
• lump-sum payment/severance payment
Additional Aids For Children
• Private tutoring/school or home education
• after school care center /educational aid
• Psychotherapy also at therapists who are not
cowered in health insurance
• Ergotherapie, Logopedics und Physiotherapy/body
therapy
• residential rehabilitation measure with accompanying
person
• recreational holiday for the family
Why Project “Trauma Ambulances”?
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Low-threshold (there must not exist an disorder)
OEG with its aids was hardly known
the act don’t have to be proved
the cost absorption for the first 5 appointments is
guaranteed
near time (within 3 workday we arrange an appointment)
attainable within an hour car by the patient
treatment by special qualified therapists
networked with the Victim Protection Officer, the White Ring
and regional medical and social care providers of the health
care system
Network Trauma Ambulance - Adds of Patients
Practitioner/ Specialist Victim Protection Officer
Counselling centres
for women
Other:
• employee
Trauma Ambulance
• former patients
emergency
pastoral care
•relatives/friends
Employers/
job center
/special service for
integration/
employer`s liability
Insurance Association
Association
“White Ring”
Regional
authorities
LVR/LWL
Framework of the Trauma Ambulance
Application - post card sufficient
Framework Conditions of the Trauma Ambulances
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An Application must have been submitted
5 appointments at once possible
The ambulance sends a report to the LVR/LVA
6-15 appointments possible in all (acute treatment)
Payment of travel cost possible
duty to cooperate required including the attendance of
the victim at a formal meeting to clarify facts in relation
to the offence, examination, duty to participate in
professional development and learning or in residential
care treatment
• The act must be reported to the Police with the
exception if this would pose a danger to the health of
the victim, prosecution fails due to time lapsed since
offence
What Symptoms do patients suffer from?
• Symptoms of intrusion/avoiding/arousal/dissociation
Intrusion: flash-backs, nightmares, triggers, feelings.
Avoidance: of thoughts, people, places.
Arousal: Agitation, nervousness, lack of concentration
Dissociation: numbing, depersonalisation, derealization.
• Symptoms of depression
• Symptoms of panic attacks
• Symptoms of Agoraphobia
Intervention Methods of the Trauma Ambulances
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Psychoeducation (80%)
Diagnostics (89 %)
Stabilisation techniques (63%)
EMDR (16 %)
Exposition (16 %)
counselling of people close to the patient, such as carers
or family members (27 %)
• cognitive restructuring (23 %)
• counselling about suitable forms of Treatment (28 %)
• Support in changing to a different or further therapy
(20%)
Course Of Treatment
1. session:
Patient arrives – relationship building
What has happened to her and how has she experienced the
event/s?- empathy
From which symptoms does she suffer?
How is he/she being supported and is more help required?
Intervention: Psychoeducation, counselling of the relatives,
diagnostics including,
management of symptoms
Give written notes of intervention
Principle: Safety first - outer safety before inner safety!
Aim: “I feel unterstood.” “I’m reacting in a normal way”
“Now I know why I’m reacting this way” “I’m not to blame for
the act” “I’m able to protect myself in a better way”
Course Of Treatment
2. session:
Who is she doing?
What has worked?
How has life been?
What worked during a crises?
What are her competencies?
How is the social situation?
How does the social environment react
Intervention: Psychoeducation with management of
symptoms and resource activation (to offer things which
were helpful to others, remind patient of positive
experiences in her life), Diagnostics with safety check,
Stabilisation techniques (The Safe Place), consider
contacting partners/carers to offer more support
Couse Of Treatment
3. session:
evaluation - What has worked?
What is she avoiding and why?
Intervention: like session 2 plus
Diagnostics (Trauma land scape),
Psychoeducation and resilience building/ EMDR,
Consolidation of stabilisation techniques (CIPOS) ,
Course Of Treatment
4.sessions/and following ones
evaluation like session 2 and 3
Intervention: Consolidation/ perhaps Trauma confrontation
Counselling about further forms of treatment/aids
recommendation of contact addresses of
community therapists/offer of treatment in the
community
last session:
Reflection: What positives can I take from this crisis?
Ending
Aim: “I lived through something terrible, but now it’s over”
“It was good for something – I learned something about
myself...
“I can learn to live with it”
“I know what help I can get and where”
Evaluation Of The Trauma Ambulances 2007
Gender Aspects Ivonne Schürmann
Gender and Age
No significant gender difference concerning age, time of
claim, numbers of appointments,severity of the symptoms
exept severity of depression, outcome
Evaluation of the Trauma Ambulances 2007
Ivonne Schürmann
Participation of 17 Ambulances with 241 cases
Measurements befor the 1., after the 5. Session and after 6
months after end of treatment (BDI, IES-R, SCL-27 und GAF)
Age:
2-81  30,2 J.
Gender:
80 % female (<14 J. 1:1)
Offences :
39% against sexual self-determination (sexual
attacks)
32% a physical attacks
18 % robbery and extortion
Evaluation Of The Trauma Ambulances 2007
Ivonne Schürmann
Diagnosis:
Posttraumatic Stress Disorder :
49,2 %
acute stress disorder:
20,6 %
Adaptive Disorder:
2,7 %
Other Reaction of severe stress:
3,0 %
normal
2,6 %
Results- Evaluation OF The Trauma Ambulances 2007
Ivonne Schürmann
The averages of all instruments after the 1st and after the
5th session declined for all groups of symptoms as well as
for an calculated aggregate figure in a highly significant
way. And this is valid both for the self assessment and for
the external assessment intruments.
The decline of the averages was also consistent after 6
months.
For the group of patients whose mental health suffered
most (most damaged) the extent of positive change was
highest.
Approximately 41% of patients showed improved results
across all instruments, which are similar to a healthy
persons indicating that their mental health improved to that
of an average healthy person
Results - Evaluation Of The Trauma Ambulances 2007
Ivonne Schürmann
The treatment in the ambulances was succesful.
For most patients the development of a disorder or
chronification following the trauma could be prevented.
A very small minority of patients experienced a
worsening of their condition/mental health.
The evaluation shows that different groups of patients
with different symptoms of mental ill health benefited
after different lengths of treatment and different
methods of intervention.
Costs - Evaluation der Traumaambulanzen 2007
Ivonne Schürmann
500 Euro/per patient with on average 5,5 sessions. For
400-500 Patients – total costs are 200.-250.000 Euro
per year. (Total costs 40-50 Mill. Euro/Jahr equal to
<o,5%)
Savings and Benefits
50% reduction in appeals amongst people who applied
for the first time (16,8 vs 7,3%)
End diagnosis – 10% increase of patients treated
successfully with no further action required
50% reduction in patients with an End diagnosis with
GdS unter 25%
“The money is invested well” Möllering 2006 – An
invest to Save