Promoting Evidence-Based,Trauma-Informed Social Work Practice

ABSTRACT

Given the human costs of psychological trauma, social workers should be well versed in trauma-informed care (TIC). This framework helps guide the efforts of systems, organizations, and practitioners toward reducing trauma or mitigating its effects. The field has created TIC principles, although they have yet to be fully realized as practical applications. This article makes the case that theoretically and empirically grounded content on trauma should be foundational to social work education. We also argue that social work practice will be advanced by clearly defining trauma and by distinguishing TIC from trauma-focused and trauma-sensitive approaches. Finally, a TIC certificate program illustrates how graduate student training and social work practice are enhanced by integrating trauma content into classroom and field settings.     

Navigating the ‘shadow of loss’ in mental health social work

ABSTRACT

The human experience of loss has been at the centre of psychoanalytic understandings of the human condition since Freud’s first writings on ‘melancholia’. This essay draws on psychodynamic theory to show how workers who are attuned to the experience of loss in service users can shape their interventions accordingly. By reflecting on how a diagnosis of ‘depression’ might better be understood as the rippling wave of past grief, professionals can utilise the dynamics of projection, transference and containment to help understand the emotional pain of individuals they support. But this essay also suggests that the use of psychodynamic practice works best when it is bolstered by other frameworks – in this case an understanding of systems theory. When the two traditions are utilised together, they provide an understanding of psychic phenomena which can enable social workers to build a basis for effective interventions with service users experiencing mental distress.     

Trauma-informed services for children with incarcerated parents

Children of incarcerated parents have often experienced not only the trauma of family separation, but also other forms of adverse events. Social workers can improve service delivery to this population by incorporating SAMHSA’s components of trauma-informed care (TIC). Translating TIC concepts into practice is an important but challenging goal for social work practitioners. The first half of this article reviews the literature about the effects of parental incarceration on attachment, stigma, physical and mental health, and intergenerational transmission of trauma. The latter half of the article applies principles of TIC by offering specific recommendations for conceptualizing cases through the lens of trauma and utilizing trauma-informed responses with these children.     

Advocating the Clinical Social Work Professional Identity: A Biographical Study

Aiming to portray the clinical social work (CSW) professional identity, the present biographical study examines the CSW knowledge and practice domain boundaries as they appear from the perspectives of three Greek mental health social workers who have advocated for the professionalization of CSW. The practitioners' perspectives are studied in relation to their demographic characteristics, education and training, and multidisciplinary relationships. A thematic analysis of the in-depth interviews revealed that these practitioners retained their nuclear social work identity and felt their skills and interests to be different from those endorsed by the present generic social work education and practice system. The study also revealed differences in the educational qualifications and routes that each of the three practitioners followed in order to be able to identify themselves as ‘clinical social workers’. Although the common denominator in the practitioners' perspectives was their training in psychotherapy, the type of psychotherapy training pursued and the experience of personal psychotherapy differentiated each practitioner's ability to theorize on the CSW practice identity. The research data were filtered through a psychodynamic lens to reveal the dynamics of the unconscious processes within the relationships formed between individuals and organizations.     

Mixing Apples and Oranges and Other Methodological Problems with a Meta-Analysis of Long Term Psychodynamic Psychotherapy

Current trends in mental health practice indicate that mental health practitioners, including clinical social workers, are tending to move away from psychodynamic approaches and are favoring short-term empirically supported approaches such as cognitive-behavioral therapy (CBT). Recently, the presumption that long-term psychodynamic psychotherapy (LTPP) approaches lack empirical support has been challenged, however, with the publication in major peer reviewed journals of meta-analyses that are claimed to demonstrate its equality to or superiority over empirically supported short-term therapies for some conditions. The present article examines the methodology employed in one particular meta-analysis which compared LTPP to short term therapies and the studies upon which the analysis was based. We found that major methodological and statistical flaws with the meta-analysis and with the individual studies preclude drawing any conclusions regarding the efficacy of LTPP.     

A Clinician-Researcher’s Understanding of “The Effectiveness of Long-Term Psychodynamic Psychotherapy”

Leichsenring and Rabung’s meta-analysis of long-term psychodynamic psychotherapy offers a useful summary of available research data. Their adaptation of meta-analysis has many merits as well as some important limitations. Their work provides preliminary support for the effectiveness of this therapy, a widely used method of treatment that also has detractors. The article also sets the stage for reviewing how the research ideology of evidence-based practice (EBP), and the economic forces behinds EBP, may limit research on several therapeutic methods of interest to clinical social workers and our clients. A call is made for additional high quality research on many therapies with considerable research support that may not (yet) meet the standards of EBP.     

Teaching Trauma Theory and Practice in MSW Programs: A Clinically Focused,Case-Based Method

Social workers provide much of the mental health treatment in the United States, and, given the ubiquity of trauma, most clinical social workers will provide treatment to trauma survivors during their careers. Therefore, trauma theory and practice must be included in MSW curricula and taught as a clinical course. This paper suggests that experienced clinician instructors teach trauma theory and practice classes using a case-based method. Bringing case material into the classroom helps prepare students for the complexities and challenges of treating survivors of trauma. To demonstrate how cases can help students connect theory to practice, the paper presents the treatment of a Central African asylum seeker recovering from trauma. The case emphasizes the centrality of the therapeutic relationship and illustrates the use of several evidence-supported trauma interventions along with core principles of social work practice. Finally, the paper suggests that social work educators consider developing a structured method of integrating cases into the trauma curriculum.     

Transnational social workers’ transition into receiving countries: what lessons can be learned from nursing and teaching?

Appropriate interventions for assisting transnational social workers (TSWs), nurses and teachers in their transition into the receiving country are significant for enabling competent and safe professional practice. These professionals form a significant part of the professional workforce of many countries as globalisation and liberal migration policies encourage many to cross borders for professional practice. Engaging in employment overseas, however, is a challenging process for them as it entails relocating to a new country and working in unfamiliar sociocultural and practice contexts. While some form of profession-wide assistance is found in nursing and teaching, social workers rarely receive any such interventions. This article discusses existing support offered to transnational nurses and teachers in English-speaking countries such as the UK, US, New Zealand, Australia and Canada and suggests how a similar approach to social workers can assist their transitioning into the receiving country. It draws on the findings of a thematic review of the literature addressing support for transnational nurses, teachers and social workers. The imperative of interventions to assist transition of TSWs into host countries is explored and the article concludes with recommendations for some intervention strategies and mechanisms.     

Potential and Possibility: Psychodynamic Psychotherapy and Social Change with Incarcerated Patients

In the present paper, Pierre Bourdieu’s theory of symbolic power is used to illustrate how the practice of psychodynamic psychotherapy in a prison-based mental health treatment program constitutes both a psychological and sociological intervention, congruent with clinical needs of this particular population. The author draws from psychodynamic theory, Bourdieu’s framework and her experience as a clinical social worker with the California Department of Corrections and Rehabilitation.     

Toward Trauma-Informed Career Counseling

The Adverse Childhood Experiences study (Felitti et al., 1998) showed that early adversity can have a profound lifelong effect on personal development, social relationships, coping methods, and career trajectories. The authors review critical findings related to trauma-informed counseling practices, discuss literature linking trauma and career theories, and consider how career counseling could address the effects of adverse childhood experiences using trauma-informed practices. An integration of trauma-informed practices with career counseling using narrative and other approaches is proposed. The proposed integration holds implications for incorporating trauma-informed practice in career counselor preparation programs and in career counseling practice.     

Social workers' assessments of needs and interventions for adolescents with substance misuse problems,criminal behaviour and mental health difficulties: a vignette study

The aim of the current vignette study was to examine how social workers assess adolescents with substance misuse problems, criminal behaviour and mental health difficulties, and how they make decisions about treatment interventions to reduce these problems. Earlier research has shown lack of knowledge concerning factors and processes that govern assessments and decisions in social work practice. In this anonymously administered survey, social workers in Stockholm, Sweden, were invited to assess fictitious youth issues. We found that social workers recognise the problems and needs of young people, but that they find it harder to link needs to evidence-based interventions. Also, there is a tendency to overrate alleged non-serious problems in the vignettes. We conclude that there is a need for increased knowledge about evidence-based methods and more structured procedures to broaden the basis for decisions.     

Social Work with Homeless Mothers: A Strength-Based Solution-Focused Model

ABSTRACT

Social workers are increasingly called upon to provide services to homeless families, the vast majority of which are mother-headed. Drawing on empirical findings from the literature on homeless families and the practice literature on solution-focused and strength-based practice, this article describes and illustrates how principles and techniques of these two approaches to practice can be used to empower homeless mothers to resolve their housing crisis and restabilize their families after an episode of homelessness. Examples are given for how social workers can use these principles and techniques in various stages of the helping process.     

Evidence-Based Practice in Social Work: Challenges and Opportunities for Clinicians and Organizations

Evidence-based practice (EBP) is increasingly emphasized in social work, yet effective approaches for translating research evidence into social work practice remain elusive. Despite a growing body of evidence describing effective interventions with a variety of populations, social workers continue to encounter substantial challenges with incorporating knowledge gained from these intervention studies into their routine practice with clients. This paper presents the current research outlining the known barriers and promoters to using EBP in social work clinical practice. Because social workers practice within the context of organizations, we consider the barriers that exist at both the individual and organizational levels that affect clinical social work practice. In addition to addressing the various challenges to incorporating research evidence into practice, we will also discuss a variety of emergent opportunities accompanying the move toward EBP that can be leveraged by clinicians in their social work practice with clients.     

Recent Social Work Practitioners’ Understanding and Use of Evidence-Based Practice and Empirically Supported Treatments

The aim of this study was to evaluate how CSWE’s 2008 shift placing more emphasis on research have affected newly trained social workers’ use of evidence-based practice (EBP). This qualitative study examined the educational and practice experiences of newly trained social workers and how those experiences influence the use of EBP and empirically supported interventions/treatments in the field. Thirteen newly graduated social workers were interviewed using a semi-structured interview. Twenty-three codes emerged from the interviews, with the most prominent theme being a sense of overall confusion about EBP. Other themes included lack of educational preparation, lack of agency resources, and prohibitive agency culture. Implications for social work education and practice are discussed.     

Making it ‘APP’en: service user feedback: developing and implementing a service user APP: reflections from Northern Ireland,England and Scotland

Despite the advent of social media and increasing use of smart phone technology amongst global and UK populations, APP’s for social work remain in their infancy. Several have been developed which focus on the education of social workers and practitioners providing information on specific social work issues, and one we are aware of that explores ethics and values using a games-based approach. In this paper, we discuss the importance of service user perspective in social work practice and how this informed the development of the feedback App. We reflect on developing this instrument using digital technologies which social workers can use to gather anonymous feedback from service users about their experiences of social work interventions. This project, developed in response to demands placed on social work agencies to evidence the effectiveness of service interventions, provide robust data from service users for inspection regimes and sustain service user involvement in improving services. The evaluation model is designed to document the implementation process, exploring what works and what barriers, challenges and lessons were learned by the project team together with how some of the tensions in the process were addressed and resolved.     

Acknowledging the Impact of Social Forces on Sexual Minority Clients: Introduction to the Special Issue on Clinical Practice with LGBTQ Populations

Over the last two to three decades, advances in clinical practice with lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals have been extensive. Many clinical social workers now incorporate LGBTQ-affirmative approaches into their practice, and a number of social workers have contributed to the literature on clinical practice with sexual minority clients. Despite these advances, we still require specialized knowledge to understand a number of LGBTQ-related mental health issues. The Clinical Social Work Journal’s first special issue on clinical practice with LGBTQ populations emphasizes psychotherapy techniques that acknowledge and also address social forces (e.g., transphobia, homophobia, and heterosexism) that affect the psychosocial functioning of LGBTQ clients. The special issue focuses on LGBTQ populations, such as transgender and bisexual individuals, sexual minority youth, and older adults, and psychotherapy modalities informed by a number of clinical and theoretical approaches. These in-depth articles offer guidance to clinical social workers who need to expand their knowledge of LGBTQ-related mental health issues and also provide those with existing knowledge an opportunity to refine their clinical skills and sharpen their thinking.     

Resilience as Reflexivity: A New Understanding for Work with Looked-After Children

This article argues that the current model of resilience in the social work literature, through its predominant focus on outcomes and behaviours rather than the underlying processes of development involved, risks superficiality and appears to lack an underpinning psychological theory of the way in which resilience develops. In response, I propose a psychodynamic understanding of this process, which sees resilience as rooted in the capacity for reflexivity (defined here as an awareness of one's own mental state and the mental states of others), and which describes how this capacity develops. This holds that a strong-enough ego, with the capacity for resilience-as-reflexivity, is the necessary precursor of the child's ability to make use of positive experiences. This psychodynamic understanding of resilience development aims to give social workers a greater appreciation of how the mental health of children in the care system may have been affected by their experiences, and how they can be helped to develop the psychological foundations of resilience and therefore better mental health. I suggest that workers can use this understanding to assess the stage of resilience-development a child has reached, and to inform therapeutic work aimed at strengthening their resilience.     

Training research-minded social workers: experience from Estonia*

ABSTRACT

Social work education in its modern sense started to develop after Estonia regained independence from the collapsing Soviet Union. The aim of this article is to introduce good practices of teaching research-mindedness, this being one of the main principles in teaching social workers-to-be in the University of Tartu in Estonia. We have been inspired by the academic tradition of university teaching in general, the new international definition of social work and, not least, the realisation of social workers in practice of not being able to apply academic knowledge to everyday social work practices. This article revisits the term research-mindedness and examines how it has been integrated into the university level teaching process. Our purpose is to discuss the methods students of bachelor’s and master’s programmes can learn to ‘translate’ social issues into research questions, critically appraise the findings and ‘translate’ them back as new research evidence for social work practice.     

The social worker as psychoanalyst

This paper examines the development of social workers as psychoanalysts to determine whether psychoanalysis is a legitimate function of social work. Historically, social work has found psychoanalytic theory helpful. However, it is generally understood that for the caseworker to competently practice psychoanalytic psychotherapy, advanced training is necessary. Although many social workers have availed themselves of this opportunity, the profession continues to believe that the practice of psychoanalysis is incompatible with social work. This is based upon an inaccurate conception of psychoanalysis. Since the social work psychoanalyst is concerned with the client's adaptation to the environment, his or her practice can easily be defined as clinical social work.     

Editorial

This paper is primarily concerned with examining how the current re‐emergence of psychosocial theory, mainly emanating from sociology, is useful for informing social work theory. Firstly it considers two extended examples of the limitations and/or contradictions in current theory for social work (that of linguistic determinism and postmodern versions of identity), and suggests how psychosocial theory offers ways forward for understanding and practice. The paper then considers two particular strengths in psychosocial theory: the ability to offer a ‘rich’ conceptualisation of the subject, and the equalising of worker and service user implicit in the theory. A further section looks briefly at the recent application of psychodynamic principles in social work practice, as ‘relationship‐based practice’. It then briefly considers some further implications for research and ‘evidence’ for social work. The paper's final section offers a discussion of two potential limitations in applying psychosocial theory in practice, before concluding that overall psychosocial theory is both productive, useful and appropriate for social work.