Client Experiences of Trauma-Informed Care in Social Service Agencies

This paper describes a qualitative study of individual client interviews (n?=?26) from four social service agencies to understand how clients experience trauma-informed care services and implementation challenges. We used the Fallot and Harris framework to explore client experiences of the five core concepts of trauma-informed care (safety, trustworthiness, choice, collaboration, and empowerment) using semi-structured interview questions with each client. The four agencies consisted of: refugees (n?=?4), substance abuse (n?=?8), older adults (n?=?12), and maternal/child health (n?=?2), and the agencies varied in size, service goals, and clientele. The results of the study suggest that clients’ experience of these concepts was shaped by the actions of other clients, and these experiences were either mitigated or hindered by actions of the agency employees. Agency policies either supported or enhanced their experiences as well. The results also suggest that it was challenging for agencies to provide for all of the trauma-informed care (TIC) concepts at the same time. We discuss the implications of these findings for social service delivery in a range of agency types. Future research should examine the effects of trauma-informed policies on client experiences of each TIC domain.     

‘We’re Civil Servants’: The Status of Trauma-Informed Care in the Community

ABSTRACT

Trauma-informed care (TIC) in social service organizations means that the organizations operate with the understanding that everyone involved has possibly experienced trauma in their lifetime. This qualitative study examined local service organizations’ usage of the 5 main principles of TIC: safety, trustworthiness, collaboration, empowerment, and choice (as developed by Fallot & Harris, 2006). Ten focus groups (n = 69) and 6 individual interviews (n = 6) with employees from administration through management were interviewed such that almost all facets of each agency were represented. The participants were asked about their agencies’ policies and practices for utilizing the 5 principles of TIC. The results suggest that the vast majority of organizations in this study implemented many of the principles of TIC with clients, though they had not labeled their practices as “trauma-informed.” However, although clients were receiving TIC, some of the principles were neglected as they pertain to staff, such as choice and empowerment. The findings of this study suggest that agencies are unaware of the relevance of TIC as it relates to staff. It is recommended that future research examine whether the use of TIC in agencies prevents “burnout,” high turnover rates, and vicarious traumatization of staff.     

Measuring Support Provisions for People Living With Disabilities in South Asia: An Accessibility Index

ABSTRACT

The terms “empowerment,” “rights,” and “inclusiveness” are now commonly used in public policy, but little emphasis is placed on “accessibility” issues in the integration of disabled people. This article proposes a composite index to measure economic support provisions, such as employment, vocational training, microfinance, and safety nets. The index was tested in a case study (N= 245) of two districts in Pakistan. Results support a “cost/benefit”-based philosophy, rather than the “means–ends” goal, where the disabled poor are viewed as unproductive and risky payers, instead of giving them an opportunity to exercise their potential. Change for the disadvantaged poor can be brought about with the mandatory use of this index in local annual audits. Future research might examine the impact of the index and standardize it for global use.     

On the Value and Meaning of Trauma-Informed Practice: Honoring Safety,Complexity, and Relationship

ABSTRACT

In social work, as in other mental health fields, there has been a surge of literature regarding trauma-informed practice. Even so, the value and meaning of being a trauma-informed practitioner still call for further explication and analysis, especially in the realm of clinical social work practice. Approaching and engaging traumatized clients with a trauma-informed lens carry profound implications in the assessment, diagnostic, and intervention stages of treatment, and these implications warrant further unpacking. Additionally, it is critical to explore, through real-world case examples, the significance of working with a trauma-informed lens. This article develops a stage-based, relational definition of trauma-informed practice and argues that trauma-informed practice prioritizes client complexity, social context, and the therapeutic relationship throughout the assessment, diagnostic, and treatment process. In addition, it prioritizes the nuanced experiences and needs of the client, in particular the need for safety, above specific treatment modalities. In this way, it has vital importance to the field of social work. The significance of being trauma informed is considered at all stages of treatment and will be illuminated through practice examples and a longer clinical vignette.     

The nature and culture of social work with children and families in long‐term casework: Findings from a qualitative longitudinal study

Social work in the United Kingdom is preoccupied with what social workers cannot do due to having limited time to spend with service users. Yet remarkably little research has examined what social workers actually do, especially in long‐term relationships. This paper draws from an ethnographic study of two social work departments in England that spent 15 months observing practice and organizational life. Our findings show that social work some of the time has a significant amount of involvement with some service users and the dominant view that relationship‐based practice is rarely achieved is in need of some revision. However, families at one research site received a much more substantial, reliable overall service due to the additional input of family support workers and having a stable workforce who had their own desks and were co‐located with managers in small team offices. This generated a much more supportive, reflective culture for social workers and service users than at the second site, a large open plan “hot‐desking” office. Drawing on relational, systemic, and complexity theories, the paper shows how the nature of what social workers do and culture of practice are shaped by the interaction between available services, office designs, and practitioners', managers', and service users' experiences of relating together.     

From “what works” to “making it work”: A practice perspective on evidence-based standardization in frontline service organizations

Evidence-based standards are becoming increasingly influential in frontline services connected to labor market inclusion of vulnerable citizens. To increase our understanding of standardization in such public service delivery, this study draws on interviews and ethnographic fieldwork from two frontline offices in the Norwegian Labour and Welfare Administration (2017–2018) that use the evidence-based Individual Placement and Support (IPS) standard. Adopting a theoretical perspective of organizational practices, the study highlights two distinct approaches to practicing IPS in the frontline organizations: as a “practice shift” in one organization (i.e., creating and legitimizing radically new service practices involving closer collaboration with employers) and as a “practice revival” in the other (i.e., reinstating more traditional service practices involving a holistic client orientation). Each approach relates to a specific constellation of recruitment practices, dynamics between frontline supervisors and staff, and team integration. The study contributes to the literature in two ways. First, it shows the underlying flexibility embedded in standardization and how standards may be implemented and adapted in ways that may either promote more radical change or revive traditional practices. Second, it nuances positions in the literature on the impact of standards on professional service work. On this basis, the study suggests broadening the attention in research on evidence-based standards in public service delivery from discussions of “what works” to understanding the broader organizational dynamics involved in “making it work.”     

Is “humane managed care” an oxymoron? (Essay Review)

Abstract

Though the impact of managed care on clinical social work practice and education has been widely acknowledged and critiqued, Humane Managed Care? edited by Schamess and Lightburn, represents a compendium of papers addressing all aspects of the recent phenomena and its impact on practitioners, educators, and most especially our clients. In reviewing this impressive and comprehensive volume, this paper addresses many of the most controversial and painful aspects of the “Managed Care Revolution,” including its impact on the level of clinical practice and its economic and political ramifications. It is suggested that the editors and some of the authors are less hopeful about the possibility of providing “humane” treatment in the managed care environment than they were only a few years earlier, as indicated by a comparison of this volume with the 1996 special edition of Smith College Studies in Social Work. This article also critiques some of the anthology's chapters, which suggest that the changes in health care delivery will ultimately be beneficial to clinical social workers.

Essay Review: Humane Managed Care? Gerald Schamess, M.S.S. & Anita Lightburn, Ph.D. (Eds.). (Washington, DC: NASW Press, 1998.)     

Institutions and Social Structures1

This paper clarifies the terms “institutions” and “social structures” and related terms “rules”, “conventions”, “norms”, “values” and “customs”. Part one explores the similarities between institutions and social structures whilst the second and third parts explore differences. Part two considers institutions, rules, habits or habitus and habituation, whilst part three critically reflects on three common conceptions of social structures. The conclusion comments upon reflexive deliberation via the internal conversation.     

Protective legislation: The “third pillar” of the welfare state

Welfare states are built upon three central social policy pillars: (1) income programs, including an assortment of income maintenance and security benefits; (2) social services, comprising a diverse constellation of provisions, which furnish care such as health care and education, and “in kind” benefits; and (3) protective legislation, encompassing a dense web of proactive and preventative laws, rights, and entitlements, such as health and safety legislation, minimum wage laws, child protection acts, rent controls, and laws governing evictions and foreclosures. Despite its centrality to the welfare state and to our well‐being, this third pillar has received considerably less attention in comparative social policy research. The dominant welfare state typologies have focused almost exclusively upon income measures and, more recently, on social services, to construct their welfare state categories or “worlds” of welfare while largely neglecting this crucial third pillar. A greater focus on protective welfare legislation can help sharpen the distinctions among welfare states within and across the welfare worlds, which is particularly valuable in light of the ongoing erosion of the other two pillars over the past few decades.     

The nature and quality of engineering research

Engineering is the application oí science to design and development of products intended for useful social purposes. Engineering research consists of a wide variety of activities ranging from study of material properties for possible future application to the testing necessary to establish design parameters or to verify the adequacy of new design concepts. Professors of engineering are generally expected to conduct research, preferably in the “engineering sciences”; (e.g. thermodynamics, metallurgy), to publish their results, and find their own sources of funding. Many private corporations maintain departments of research and development, the findings of which are often proprietary and not subject to peer review. Managers of engineering research projects attempt to assure the quality of their results by “instrumental”; or “organizational”; methods. Instrumental methods assure accuracy in data collection and processing, while organization methods maintain a work environment conducive to creativity and integrity among researchers. Organizational conditions can affect research quality adversely, by giving rise to ethical problems associated with conflicts between corporate interests and those of individuals.     

Social workers' perceptions of their power and service outcomes

While social workers are becoming increasingly interested in methods of client empowerment, little attention has yet focused on the links between workers' own power and the services they provide to clients. The authors examine the link between workers' perceptions of their power on the job and perceived service outcomes. Bivariate and multivariate analyses were conducted on survey responses from 591 direct practice social workers in Israel. Results indicate that power perceptions are significantly associated with an array of perceived service outcomes. These findings highlight the relevance of self-efficacy and control theory in understanding social workers' efforts toward effective service delivery. Further, they underscore a need to consider more carefully direct practitioners' own power concerns as they increasingly consider empowerment of their clients.     

Gerontology as a Graduate Social Work Concentration

Abstract

Gerontology education in one graduate school of social work is advancing across a life course. From its origins of three students, now over 100 graduates serve elders and significant others. Grounding, growing, and sustaining gerontology as a “concentration” comes with challenge and reward. This article denotes the origins of a gerontology concentration, describing “community as impetus” and “outreach to students.” It proceeds to concentration outcomes, presenting “alumni as partners” and “community as beneficiary.” Sustainment of gerontology as a concentration is attributed to internal and external investment in a gerontologically- and geriatrically-sophisticated social work force.     

A Joined-up Approach to User Participation in Public Services: Strengthening the "Participation Chain"

Participation has emerged as a key theme for social policy and administration in the UK. Public service providers are often keen to consult users, and users themselves want to make their voices heard. Despite this, however, there is a perennial problem in getting people to participate, and participation is often better supported in principle than in practice. The motivations of key actors are crucial, but are often poorly understood. This article attempts to build a more detailed understanding of the motivations to participate of one key group: service users. Using Mutual Incentives Theory, it shows the extent to which users are motivated by individualistic or collectivistic concerns. These “demand side” factors are then combined with others on the “supply side” in a model we call the “participation chain”. This model provides a systematic framework for understanding what makes public service users participate, and seeks to demonstrate that, while the question of participation requires a combination of answers, it is a combination that can be predicted, planned for and acted upon.     

The Social Construction of Reality in the Realm of Children's Mental Health Services

ABSTRACT

Across the United States, systems of care have emerged to provide mental health care to children and their families; fragmentation inhibiting the success of collaboration by stakeholders is common and compromises these systems of care. Survey data were collected from 1,428 respondents in a Midwestern state to examine problems that exist within systems of care from the perspective of the different stakeholder groups. Stakeholder group membership was based upon the respondent's employment or involvement within various child-serving systems and included those in child welfare, juvenile justice, and education, mental health providers, and consumers (i.e., caregivers/parents). Group differences revealed patterns of “finger pointing” by the stakeholder groups on where specific problems exist within systems of care. The findings provide insight into how the social construction of service delivery and practice emerges as stakeholder groups describe, understand, and evaluate problems within the system of care as a function of their own practice location within the system of care. Future research should consider exploring methods that might minimize the competitive nature of disparate child-serving systems and its potentially negative impact upon system performance and treatment outcomes.     

The Perception of Organizational Issues of Social Work Practitioners in Saudi Hospitals

ABSTRACT

Health care has evolved rapidly in Saudi Arabia, based upon a Western model of service that incorporates multidisciplinary professional teams. Social work practice forms part of patient care. This study explores how Saudi social workers perceive their role and how they describe their practice within the hospital context. A quantitative methodology was employed using a self-administered questionnaire. Analysis revealed that 219 social workers perceived formidable limitations to their daily work practice. The study identified factors relating to the hospital's organizational circumstances where a) organizational structural aspects, b) organizational resources, and c) hospital management and interprofessional teamwork impacted best practice. Future research and recommendations for further study are outlined.     

Realism and Contingency

This paper constitutes an extended response to Athanasia Chalari's paper The Causal Impact of Resistance, which suggests that one may derive from internal conversations a causal explanation of resistance. In the context of our engagements with critical realism and digital research into social movements, we review Chalari's main argument, before applying it to a concrete case: the student protests in London, 2010. Whilst our account is sympathetic to Chalari's focus on interiority, we critique the individualism that is implicit in her argument, arguing that it emerges because of an underlying neglect of the relational aspects of resistance. Instead, we offer a relational realist analysis that treats resistance as process within an ontologically stratified account of reality that is mindful of the contingency of political acts. Taking this route, we establish resistance as an emergent relation, generative of distinctive “relational goods” in the context of collective action, which we locate at different levels of reality, as we move from an analysis of individual to collective reflexivity. In doing so we offer a sympathetic critique of Chalari, building on the thought provoking arguments contained within it, whilst also making a contribution to the theorisation of social movements and the “relational turn” within realist social theory (Archer, 2010, 2012).     

Area Teams in Social Work Practice: A Programme for Research

Summary This paper critically examines assumptions underlying the beliefthat the organization of service delivery through a system ofarea teams has major advantages in the field of social work.It is generally felt that area teams are accompanied: (1) byimproved client access to service provision, (2) by a closeridentification with the local area on the part of social workers,(3) by decentralized organizational decision-making, and (4)by an increased sense of colleague support amongst professionalstaff. A review of some relevant literature casts doubt on thevalidity of these assumptions and reveals that the operationalacceptance of the area team principle has not been complementedby thorough investigations of organizational and other influenceson service delivery. In outline a programme of further researchis proposed. The paper attempts to broaden discussion on thissubject and place the basic philosophy of area teams for comparisonagainst a body of empirical research material.     

Good Intercultural Practices in Social Services Projects

ABSTRACT

This article reflects part of the results obtained from a wider research project aimed at the elaboration of a “Map of Good Intercultural Practices” in several areas of social intervention in Andalusia, Spain. It also reports the results obtained from the analysis portion related to the participating projects within the social services. Intercultural assessment was conducted at the level of institutional intervention through a 32-item questionnaire that was sent to 139 intercultural project-leading institutions measuring intercultural sensitivity. A definition of the fundamental concepts of “interculturality” and “good practice” is given to support the foundations of “good intercultural practice” (GIP). Such definitions help in the design and validation of a GIP Scale that was used in the analysis of 60 social services projects with an intercultural component. The results obtained underline the relevance of aspects such as intercultural empathy and show significant differences between the social services and other intervention sectors. Future research is proposed that studies GIP scale in other intervention sectors such as the private and public sector. Also, the transferability of the instruments and methodology used makes it possible that the research presented in this article is conducted in other geographical areas.