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.     

Characteristics of Women Seeking Services at a Transitional Housing Facility for Women Leaving Street-Based Sex Work: Implications for Social Service Providers

ABSTRACT

Women who decide to leave street-based sex work often struggle with addiction, trauma-related mental health consequences, and exclusion from employment and housing. To offer recommendations for social service providers, this article draws upon primary data from interviews and surveys with 87 residents at a transitional housing facility for women leave sex work to elucidate: 1) a demographic profile of the women, 2) life history patterns and circumstances that encourage women to leave street-based sex work and 3) recommendations for service providers. Results indicate the need for service providers to assist women with basic needs, strengthen referral networks, and extend trauma-informed services.     

Common Ground: The Development of a Support Group for Survivors of Homicide Loss in a Rural Community

ABSTRACT

Losing a loved one from human-perpetrated violence can lead to a debilitating process of stigma-generated isolation and trauma. Layers of social services are needed to support surviving family members, all secondary victims of homicide. Although urban populations have enriched access to victims-of-crime services, rural-bound populations often do not. This article describes homicide-specific trauma and the development of a community support group for rural-bound persons suffering homicide loss. The support group process offers potential for real help in areas where few trauma-informed options exist. The authors chronicle their journey of group-work practice with underserved persons coping with homicide loss.     

“I don't know what to do—Could it be cultural?” The operationalization of cultural sensitivity among street‐level workers in the Norwegian Labour and Welfare Administration

Faced with increased global migration and a more ethnically diverse clientele, several studies stress the need for more culturally sensitive welfare services. Others warn that the focus on culture might lead to the culturalization and othering of clients from ethnic minority or migrant backgrounds. In the Norwegian context, cultural sensitivity is implemented in policy documents of the Norwegian Labour and Welfare Administration (NAV) to improve services for immigrant clients. However, the operationalization of cultural sensitivity into service delivery remains unscrutinized. Based on ethnographic fieldwork at a frontline NAV‐office, this article unpacks the practical work embedded in being culturally aware, by exploring the circumstances in which street‐level workers factor culture into their comprehension and consideration of a case. The article employs a process‐oriented approach to its analysis of caseworkers' discussion of cases. Findings show that caseworkers explicitly consider culture mainly when cases appear diffuse and intangible. The caseworkers discuss plausible explanations to make sense of these cases, only one of which is culture. Thus, the caseworkers distinguish culture from the client's ethnicity or migrant background. These findings refine the perception of street‐level workers' inability to respond to questions of ethnicity and culture, by describing the dynamic processes of implicit categorization and sensemaking embedded in being aware of culture. The study also highlights the importance of empirical, ethnographic accounts to unpack the operationalization of such theoretical and ambiguous concepts into practice.     

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.     

Improving Intimate Partner Violence Services in Home Visiting: A Multisite Learning Collaborative Approach

Abstract

To improve intimate partner violence (IPV) service delivery, the Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Initiative’s continuous quality improvement (CQI) team implemented a Breakthrough Series model Learning Collaborative with eight program sites. Using mixed-methods, we: examined post-Collaborative changes in Florida MIECHV home visitors’ knowledge, system awareness, and confidence; identified strategies to address challenges in supporting families with IPV; and assessed post-Collaborative program improvements. The Collaborative included three interactive 2-day sessions, six webinars, and testing strategies using the Model for Improvement (Plan-Do-Study-Act). Three online surveys assessed changes influencing IPV screening, referrals, and safety planning. Thematic content analysis of qualitative data revealed existing barriers and strategies to address challenges. Home visitors reported accurate knowledge (change: 2.3%-34.8%), confidence (change: 31.8%-37.9%), and system awareness (change: 22.7%-53.5%) for all items from baseline to final survey. There was also an increase in rates of IPV screening (change: 88.0%-91.0%) and referrals (change: 43.0%-100.0%). Strategies for addressing challenges in supporting families experiencing IPV were identified at the individual (self-care, continuous education); interpersonal (reflective supervision, trauma-informed approach); organizational (defining success, supportive agency/program, policies); and community (collaboration with IPV service providers) levels. Lessons learned from the MIECHV IPV Learning Collaborative informed future CQI projects.     

An Examination of the Effects of Race/Ethnicity and Social Class on Adolescents' Exposure to Violence

ABSTRACT

The study examined the influence of race/ethnicity and socioeconomic status on adolescents' exposure to violence in their families, schools and communities. The sample included a large racially/ethnically and socioecomically diverse group of high school students residing in urban and suburban areas. Findings revealed that this sample of students experienced/witnessed high rates as well as severe forms of violence in all three social settings. Overall, race/ethnicity and SES had negligible effects on exposure to family violence. However, race/ethnicity emerged as an important risk factor for exposure to school and community violence, even when the effects of SES were statistically controlled. The implications of the findings are discussed.     

A Multi-Dimensional Conceptual Framework for Trauma-Informed Practice in Addictions Programming

Previous research has conceptualized trauma-informed practice in relation to five key values: safety, trust, choice, collaboration, and empowerment. This research identifies key organizational, programmatic, and interpersonal characteristics in community-based residential addictions treatment programming that exemplify each of these principles. Utilizing qualitative research methods, involving open-ended, one to one interviews with clients in residential substance misuse treatment (n = 41), respondents identified the importance of experiencing “safety” in relation to physical safety, confidentiality, reassurance, rule enforcement, and peer relationships. “Trust” was manifested in sharing, staff availability, nonjudgmental interactions, positive relationship dynamics, and caring. “Choice” was articulated in relation to individual needs, participation, opportunities, and focus of efforts. “Collaboration” was characterized in relation to opportunities for feedback, planning, goal setting, specificity, and support. Finally, “empowerment” was characterized by comfort in sharing, trigger management, trauma awareness, and understanding. The findings provide a conceptual framework for a trauma-informed social services organizational practice environment. Findings can inform adaptations to social service delivery processes and programs to become aligned with the values of trauma-informed practice. Future research can build on this framework by testing the study findings with quantitative methods along with replicating current methods in other social service delivery sectors.     

Dilemmas in Creating an Intern/Field Instructor Supervision Group in a School Setting: Thoughts on Role and Authority

ABSTRACT

Being guests in a host system, a school-based health program (SBHP), presents social workers with complex challenges that underscores the need for regular, supportive supervision. Group supervision is especially useful in bridging this gap, reducing isolation, and uniting a social work team dispersed across four different schools. This article reports on efforts to strengthen a social work component in a four-unit SBHP through the creation of a bi-weekly supervision group. Due to the hierarchical mixed membership of field instructors, interns and program administrator, this group addressed challenges and opportunities around role, authority, and power dynamics.     

An exploration of social work supervision in Mainland China

ABSTRACT

Social work supervision is receiving increased attention in Mainland China. This paper uses qualitative interview data from a study in Mainland China, which involved telephone interviews with 24 social work supervisors which enabled the readers to know the current situation of supervision and its provision in the country. Common difficulties facing social work supervision and the possible solutions are identified. The Findings suggest greater attention should be given to the establishment of supervision system, the provision of the supervisor training and the adoption of new supervision methods.     

Mindfulness,meditation, and breathing exercises: reduced anxiety for clients and self-care for social work interns

ABSTRACT

The purpose of this article is to identify and describe a teaching tool that supports social work student success in the classroom and in field placement. The project introduced mindfulness, meditation, and breathing techniques to 2nd-year master of social work (MSW) students in a group classroom setting and engaged students as they applied those techniques in their internship settings with clients. Students were introduced to mindfulness, meditation, and breathing techniques through lecture, experimental exercises, video clips, and case studies and used the group setting to learn to use those tools to add trauma-informed mindfulness interventions to the clinical techniques they concurrently practiced in field placement. Students learned methods to incorporate those interventions into their psychotherapy/counseling sessions with clients and discovered that mindfulness-specific interventions also helped regulate their own autonomic nervous systems, contributing to decreased anxiety. Thus, mindfulness skills taught in social work programs have significant multidimensional benefits; engaging a group classroom setting to learn to utilize mindfulness, meditation and breathing techniques can reduce stress and anxiety for clients and promote adaptive self-care skills for MSW students.     

The implications of different ethnicity categorisation methods for understanding outcomes and developing policy in New Zealand

ABSTRACT

Identifying with more than one ethnicity is becoming increasingly common in New Zealand. It is therefore important that the methods of categorising ethnicity used by government agencies and researchers effectively account for diverse ethnic identities. The aim of this research was to assess the impact of using different methods of categorising ethnicity on understanding outcomes in New Zealand, using Census 2013 information about tobacco smoking among the population aged 15+ years as an illustration. Prioritised, total response and single/combination categorisation methods were compared. Prioritised and total response categorisation generally produced similar prevalence estimates and patterns for smoking status, although estimates diverged somewhat for Māori ethnic groups and to a lesser extent for Pacific Peoples and Asian ethnic groups. Single/combination categorisation indicated that combination ethnic groups tend to have smoking outcomes between those of the constituent groups. Categorisation method had a considerable impact on the size of some ethnic groups. Prioritised ethnicity categorisation may be inappropriate for use by government agencies and for policy-relevant research principally concerned with children, young people, Māori or Pacific Peoples. Single/combination categorisation is useful for understanding the associations between ethnicity and outcomes, however previous work suggests this method should be used with caution.     

A family-centred practice supervision project conducted for a child welfare agency

ABSTRACT

This paper reports on a supervision project that aimed to enhance a child welfare agency staff’s professional competence in family-centred practice through a strength-based approach. A qualitative study was designed to explore the effectiveness and the change agents of the supervision. Purposive sampling was used. Two agency supervisors and two social workers participated the study voluntarily. The findings indicated that after the period of supervision, the staff had changed in three respects: their conceptualisation of the meaning of family work in the care context; their understanding of the importance of relationship-based interventions with families; and their development of alternative ways of practice. The agents of change from the supervision were the consultants’ modelling effect and the co-worker experience of the consultants and the social workers. This supervision approach can discern the synergistic effect of supervision on an agency’s routine supervision and balance the cultural beliefs in qing, yuan and ‘face’ embedded in the supervisory process.     

Helping each other: a peer supervision group with facilitators of mutual aid groups

ABSTRACT

Mutual aid groups can help people cope with life’s problems. A peer supervision group can help facilitators to better understand their role and improve their facilitating skills in mutual aid groups. Peer supervision groups aim to support facilitators ability to reflect on their difficulties in working with groups, deepen their methodological questions, and improve their understanding regarding how to best proceed as facilitators. This paper studied a peer supervision group of experts-by-experience facilitators to demonstrate the dynamics of mutual aid that characterized the group’s functioning.     

Illuminating the Phenomenological Challenges of Cross-Cultural Supervision

ABSTRACT

The authors discuss transference enactments that occur during cross-cultural supervision. Previous research has shown that few mental health professionals willingly talk about race during supervision and that White supervisees experience significant difficulty when directly engaged in discussions about race. They introduce a new phenomenon, “stereotypical” transference enactments, as a means for understanding the countertransference Black female clinical supervisors experience during clinical supervision of White supervisees. The findings indicated that effective cross-cultural supervision should address the intersectionality of race and gender to enhance the development of multicultural clinical skills. The clinical and educational challenges are discussed by using two case vignettes.     

‘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.     

A Kaupapa Māori,culturally progressive,narrative review of literature on sport,ethnicity and inclusion

ABSTRACT

This Kaupapa Māori narrative review identifies themes in literature concerning sport, ethnicity and inclusion, from an indigenous ‘culturally progressive’ perspective. Scholars suggest that sport influences national identity and in Aotearoa/New Zealand, rugby is a rich site for examining such connections. Inclusiveness within sport is an expressed desire, although the academic scrutiny on this is limited. This study identifies and examines themes within literature (2008–2017), using a ‘Ngā Poutama Whetū’ culturally progressive review process, contributing nuanced understandings from the content. Results suggest that racist othering, representations and practices of ethnic minority exclusion are a reality in sport, although, locally, at least, the ‘cultural climate’ in sport strives for greater ethnic inclusivity. Conclusions suggest that current research in this domain is largely theoretical, insofar as challenges to organisations, power and privilege. However, future research should explore participants’ lived experiences at the intersections of ethnicity and inclusion in sport.     

Self‐reported proficiency in Māori language among those of Māori descent in New Zealand

Abstract

In a national survey in New Zealand (N = 12 992), participants of Māori descent (N = 2936) reported their proficiency in speaking, reading, and writing Māori and in understanding spoken Māori. Only 6–10% reported that they could cope “very well” in these areas while 36–52% reported their proficiency as “no more than a few words or phrases”. There was no evidence of subgroups of Māori with divergent proficiency across oral language or literacy. Six latent classes were fitted but these appeared to lie along a continuum, and analysis employing item response theory (IRT) and factor analysis confirmed this. A simple sum of scores across the four areas correlated very highly with the IRT factor score (r = 0.97). High proficiency was more common among older Māori and females, in the Midland region (lowest in the South), and for those with sole‐Māori ethnicity, followed by multi‐ethnic Māori (seldom seen in those of Māori descent but not ethnicity).     

Colorful Disclosures: Identifying Identity-Based Differences and Enhancing Critical Consciousness in Supervision

ABSTRACT

Managing microaggressions and marginalizing experiences while negotiating the ongoing oppression that occurs in micro, mezzo, and macro settings can be particularly challenging for clinicians of color. Thus, supervision with clinicians of color must include affirmation, empowerment, and exploration of the intracultural/intercultural dynamics inherent in the treatment-providing process and clinical supervision. Through case studies, autoethnographic studies of our supervision experiences, and interviews with supervisors and supervisees, we reflect on how axes of identity, including race, power, and privilege, inform practitioners’ clinical lenses and affect their vulnerability in treatment and the clinical supervision dyad. Special attention is placed on the clinical supervisor–clinician–client triad (the triple process) and the interpersonal dynamics of cultural sensitivity, cultural humility, and authentic responsiveness that supervisors aim to model and cultivate in the supervisory relationship. In addition to sustaining clinical growth for clinicians of color, adding this level of complexity to supervision supports equity in direct clinical practice, enhancing efficacy outcomes for clients and communities. Recommendations and pedagogical strategies are offered to support supervisors in initiating difficult dialogues and shifting the paradigm to promote this transformational perspective.     

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.