‘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.     

Dare to Care: Exploring the Relationships between Socio-Moral Climate,Perceived Stress,and Work Engagement in a Social Service Agency

Abstract

Human service professionals working in an interpersonal violence social service agency are at increased risk of experiencing emotional burnout, compassion fatigue, and high levels of stress, which may reduce work engagement, increase turnover, and ultimately negatively affect client outcomes. However, a positive organizational climate has the potential to buffer the negative effects of perceived stress on work engagement. Socio-moral climate is a behavioral-based organizational construct that assumes that workplace practices and procedures can impact employees’ attitudes and behaviors. This exploratory study (N?=?41) investigates the relationships between perceived stress, work engagement, and socio-moral climate in a social service agency serving survivors of interpersonal violence, comparing employees with direct interactions with clients in a shelter to those with indirect contact at a different location. Results of moderation analyses show that socio-moral climate significantly predicts higher work engagement, while perceived stress is negatively associated with work engagement; however, the interaction effect was not significant and there were no differences in perceived stress between both employees. Further research should continue to investigate the role of socio-moral climate on employee work engagement in social service agencies, which could improve the quality of services for their clients.     

Assessment of a State TANF Funded IDA Initiative: A Case Study

Individual development accounts (IDAs), wealth-building programs for the working poor, have existed since the late 1980s. Current research suggests that IDA programs benefit families while contributing to local and state economies. This program evaluation assessed the impact of one state Temporary Assistance for Needy Families (TANF)-funded IDA initiative. Quantitative and qualitative data were collected from four agencies chosen using cluster sampling across the state. Agency programmatic and participant data from the last year of operation (N?=?160) were examined. Agencies also provided contact information for three participants who had graduated and three who exited the program prematurely in the past year of operation. In person, interviews were held with agency directors (n?=?6) and IDA participants (n?=?11) were interviewed by telephone. Results indicate that 69% (n?=?111) of IDA enrollees successfully completed the program. IDA participants who exited the program prior to completion also expressed benefits associated with the time in which they were involved. Programmatic and individual benefits and challenges reported guide recommendations for improving IDA marketability, participant outcomes, and organizational performance rates. A critical implication of the findings is the need to expand the use and design of IDA programs legislatively to better serve historically oppressed and working poor families more effectively.     

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.     

Caregiving for Parents and In-Laws: Commonalities and Differences

This study examined support, stress, and well-being between adults who provide care for an aging and disabled parent and those who care for an aging and disabled parent-in-law. The study utilized a sample of individuals caring for a parent (n?=?77), individuals caring for an in-law (n?=?26) and a comparison group of noncaregivers (n?=?1,939) from the Midlife Development in the United States study. In-law caregivers provided more financial assistance but adult child caregivers provided more emotional support and unpaid work. Adult child caregivers reported poorer mental health and family strain; in-law caregivers reported more spouse support and less family strain.     

A Client Satisfaction Measure of Homecare Services for Older Adults

Client satisfaction can be used as an indicator for service quality. Without concrete feedback from clients, however, the usefulness of client satisfaction data for service improvement can be limited. This study described the development of a client satisfaction measure that can be used to provide concrete feedback for service providers. Based on a conceptual framework proposed in the literature, the Client Satisfaction: Home Care (CSAT-HC) uses a client-centered perspective to measure client satisfaction for homecare services for older adults. A survey of 200 older adults receiving homecare services provided by a social service agency in a large U.S. Midwest city was conducted to assess the psychometric properties of CSAT-HC. Results based on the 156 completed surveys show that CSAT-HC has good validity (correlation r = .62 with a popular client satisfaction measure) and test-retest reliability (r = .75). These results indicate that CSAT-HC is a valid and reliable client satisfaction measure; and therefore, providers of homecare services for older adults can use CSAT-HC to obtain client feedback for quality assurance or program evaluation purpose. Future research may use CSAT-HC to explore the potential influences of quality of homecare services on the well-being of older adult clients.     

Gerontological Social Workers' Perceived Efficacy for Influencing Client Outcomes

Using a sample of practitioners (n = 269) from the 2004 National Study of Licensed Social Workers, this article employs a quality assurance structure–process–outcome model to examine factors at the practitioner, workplace, and service delivery levels that influence the perceived efficacy of licensed gerontological social workers to affect client outcomes in the context of a highly challenging health care environment. A regression model accounted for 33.9% of the variance (adjusted R ² = .291) in perceived efficacy with 3 aspects of service delivery satisfaction having significant effects: ability to address complex/chronic care, to influence the design of services, and to help clients navigate the system.     

Commitment of Private and Public Agency Workers to Child Welfare: How Long Do They Plan to Stay?

ABSTRACT

Method: Child welfare professionals completing training to work in foster care were asked about reasons for taking their child welfare position, commitment to their agencies, and commitment to child welfare. Analyses compared responses from new public agency foster care workers (N = 100), public agency workers making lateral transfers to foster care (N = 64), and new private foster care workers (N = 105).

Results: Private agency foster care workers were less committed to their agencies and to child welfare and more likely to have taken the position because it was the only one available.

Conclusions: The practice by public child welfare of outsourcing foster care services to private agencies needs to be evaluated. This practice may not benefit children in care and may create organizational problems for agencies.     

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.     

Practices of activation in frontline interactions: Coercion,persuasion, and the role of trust in activation policies in Germany

Following Michael Lipsky's well‐known argument that policy is made in the daily encounters between street‐level bureaucracy and citizens, a growing body of research emphasizes that actors and organizations delivering social and labor‐market policy play a crucial role in welfare‐state politics. Using qualitative data collected at three local employment agencies in Germany, this article explores worker‐client relations as a crucial mechanism through which activation policies are translated into practice. The analysis investigates how caseworkers define their role and their relationships with clients. The findings show that it is essential for caseworkers to achieve client compliance. In such a context, building relationships of trust is a strategic instrument in overcoming possible barriers to co‐operation in the caseworker‐client interaction. Caseworkers develop strategies to create the impression of trustworthiness and to motivate both unemployed clients and employers to become trust‐givers in the caseworker‐client relation. While research has often stressed the dichotomy between disciplining and enabling elements of activation policies, our explorative study shows that persuasion and trust‐building are a further important dimension of the frontline delivery of activation policies. These strategies reflect the importance of emotional aspects of frontline work.     

Bridge Builders: A Qualitative Study Exploring the Experiences of Former Refugees Working as Caseworkers in the United States

ABSTRACT.

Individuals who come to the United States as refugees and work as resettlement caseworkers offer peer support, modeling, and assistance with integration to newly arriving refugees, despite often having limited training or experience in social service provision. A phenomenological approach was utilized to gain understanding about the experiences of refugee caseworkers. Nine caseworkers who came to the United States as refugees completed in-depth interviews. Thematic analysis was used to identify primary themes, including: a) the caseworker's bridge-building role with clients; b) their role in building bridges with others in the community, including the resettlement agency; and c) the caseworkers’ experience as bridge builders, including motivations, perspectives toward their role, and needed supports. Refugee service providers face unique challenges in negotiating boundaries with clients and meeting the expectations of their ethnolinguistic community members. Their strengths in understanding household experiences and in building agency and community understanding highlight their ability to contribute to positive resettlement outcomes. The findings from this study have implications for agencies serving refugees and for other social services that utilize peer-support strategies, particularly in regards to staff training and support. Findings highlight the need for research examining effective resettlement strategies and the perspectives of refugees toward resettlement approaches.     

Boomer Matters: Responding to Emotional Health Needs in an Aging Society

This study explores baby boomer-aged adults’ experiences accessing an emotional health program (EHP) in a community-based seniors’ center, examining differences between it and an older cohort of users. Data generation includes client-based surveys (n=118), in-depth qualitative interviews (n=20) with client users and professionally-trained counselors (n=2), and a focus group with peer support service worker (n=14). Key findings suggest EHPs as a preventative strategy to address familial abuse, the need for education and support on sexual health and dating, and the need to combat ageism to improve access. Community-based seniors’ centers as a cost-effective approach to health promotion is also highlighted.     

Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

Youth Experiences Survey (YES): Exploring the Scope and Complexity of Sex Trafficking in a Sample of Youth Experiencing Homelessness

ABSTRACT

In the United States, sex trafficking victims have been identified at ages across the lifespan but young persons (under age 25) have been found to have unique vulnerabilities. At-risk youth, such as those who run away from home or those experiencing homelessness, are also at an increased risk of sexual exploitation. To better understand the scope and complexity of sex trafficking among these at-risk youth, a convenience sample of 131 homeless youth aged 12 to 25 years old experiencing homelessness recruited from Kentuckiana youth service providers completed an enhanced version of the Youth Experiences Survey (YES). Univariate and bivariate analyses were conducted. Results indicated that 41.2% of the homeless youth were victims of sex trafficking. The sex trafficked youth were more likely to report previous self-harm behaviors, suicide attempts, and substance use. This study not only provides support for improved service delivery, but also provides essential statistics that should inform internal policy and procedures for youth serving agencies in Kentucky and Indiana. Findings highlight a need for trauma-informed interventions designed to treat not only females but also males and LGBTQ youth. Additionally, service providers should consider partnering with victim providers and clinicians to offer therapeutic groups, individual therapy, and supportive services that increase prevention, education, and wraparound care for clients. In regards to future research, findings point towards a need to better understand the role that trauma and adverse childhood experiences may play in making young people vulnerable to sex trafficking, and encourage the need for testing prevention and early intervention practices among vulnerable youth.     

ANALYSIS OF CLIENT CAREERS FOR PROGRAM EVALUATION

The present study analyzes the careers of clients, both within and between agencies. Several phases of the careers of 316 adolescent clients are examined as part of a process evaluation of Professional Youth Services (PYS). Clients' movement within PYS is described to provide on understanding of when and why clients leave a helping agency and to describe some of the characteristics of clients who are most likely to have their treatment interrupted. In addition, clients' "between agency" movement is analyzed by exploring the other human service agency involvements) of clients; in this way the role of PYS in the larger service delivery network is clarified.     

Lessons learned implementing community‐based comprehensive case management for families surviving homicide

Family members of homicide victims often experience a wide range of adverse reactions to the homicide. This study reports on the Traumatic Loss Response Team, a project conducted by a community‐based, mental‐health agency to provide comprehensive case‐management services to meet homicide survivors' complex needs. To conduct the study, we abstracted service/process data from open client cases in 2013 (most recent year with available data) and conducted interviews with the project's implementing agencies. Interviews revealed both initial challenges and factors facilitating successful implementation. Main challenges to overcome included gaining credibility and trust from police and issues around overlap of services provided to families by numerous agencies that may become involved in a homicide. Partners view the project providing a range of important services to families, including intermediary/buffer between families and police. Concerning service data, of the 131 cases open in 2013, most were referred directly by police and involved community violence, an adult victim and a firearm. Most of the 164 clients receiving services were female, adult, African‐American and parents of the deceased. Grief support was the most common of numerous services provided. We hope that this study will catalyse sharing of similar data and experiences among organizations providing services to homicide survivors.     

Importance Counts: The Role of Relative Importance of Service Elements in Client Satisfaction Measures

ABSTRACT

It is not uncommon for social work service providers, researchers, and evaluators to develop measures to obtain client satisfaction data relevant to their particular service settings. These measures are often constructed through a set of (usually Likert-type) satisfaction rating response items for each of the service elements relevant to their settings. Scores from these multiple items are then either summed or averaged to produce global satisfaction scores. By summing or averaging satisfaction scores across all items, one implicitly assumes that all survey items that represent various service elements carry equal weight. This assumption of equal weight is somewhat counterintuitive because individual clients may perceive certain survey items or service elements to be more important, or carry more weight, than others. Analyzing data from interviews with 112 clients of an elderly case management service agency in a large city in the Midwest region of the United States, this study examined this equal weight assumption in an elderly case management service setting. Results indicated that not all service elements were considered equally important, which called into question the common practice of summing or averaging satisfaction scores of various service elements to represent global client satisfaction.     

Toward Client-Centered Service: Asking Clients for Their Views of TANF,Food Stamps,Child Care,and Medicaid Services

ABSTRACT

This article presents the results of a randomized study that asked Division of Family and Children Services' (DFCS) clients throughout the state of Georgia to rate their satisfaction with Temporary Assistance to Needy Families (TANF), food stamps, child care services, and Medicaid services, as well as their perspectives of the customer service they received through their county DFCS offices. Telephone interviews were conducted with 2,408 clients. Overall client satisfaction percentages are: TANF, 80%; food stamps, 88%; child care, 92%; and Medicaid, 94%. Satisfaction indices were also created from the data collected. Client suggestions for improvement are presented as well as practice and educational implications.