Trauma-Informed Social Work Practice Jill Levenson
Social workers frequently encounter clients with a history of trauma. Trauma-informed care is a way of providing services by which social workers recognize the prevalence of early adversity in the lives of clients, view presenting problems as symptoms of maladaptive cop- ing, and understand how early trauma shapes a client’s fundamental beliefs about the world and affects his or her psychosocial functioning across the life span. Trauma-informed social work incorporates core principles of safety, trust, collaboration, choice, and empowerment and delivers services in a manner that avoids inadvertently repeating unhealthy interpersonal dynamics in the helping relationship. Trauma-informed social work can be integrated into all sorts of existing models of evidence-based services across populations and agency settings, can strengthen the therapeutic alliance, and facilitates posttraumatic growth.
KEYWORDS: adverse childhood experiences; adversity; trauma; trauma-informed care
Social workers frequently encounter clients with a history of trauma, which is defined as an exposure to an extraordinary experience
that presents a physical or psychological threat to oneself or others and generates a reaction of help- lessness and fear (American Psychiatric Association [APA], 2013). The exposure may have occurred in the distant or recent past, and pervasive symptoms such as intrusive thoughts of the event, hyperarousal to stimuli in the environment, negative moods, and avoidance of cues related to the trauma are charac- teristic of both acute and chronic posttraumatic stress disorders (APA, 2013). Traumatic experiences take many forms, but they typically involve an unexpected event outside of a person’s control such as criminal victimization, accident, natural disaster, war, or expo- sure to community or family violence.
An abundance of research has revealed that trau- mas involving early child mistreatment and family dysfunction are especially prevalent and impactful (Centers for Disease Control and Prevention [CDC], 2013). Children may experience other events that also result in trauma, such as bullying, death of a family member, illness, out-of-home placement, and poverty; historical traumas like systemic oppres- sion or discrimination are also prevalent for minority and other marginalized groups. Some traumas are quite overt, like physical and sexual abuse or wit- nessing domestic violence, whereas chronic experi- ences like emotional neglect, an absent parent, or a substance-abusing caretaker may be more subtle
but can leave insidious effects. Individuals are often exposed to multiple related traumas and polyvicti- mization, leading to toxic stress and complex trauma reactions (Cloitre et al., 2009; Finkelhor, Turner, Hamby, &Ormrod, 2011;Maschi, Baer, Morrissey, & Moreno, 2013).
Trauma-informed care (TIC) incorporates an understanding of the frequency and effects of early adversity on psychosocial functioning across the life span (Substance Abuse and Mental Health Ser- vices Administration [SAMHSA], 2014a). TIC is different from trauma-focused therapy, as its primary goal is not to directly address past trauma, but to view presenting problems in the context of a client’s trau- matic experiences (Brown, Baker, & Wilcox, 2012). Trauma-informed social workers rely on their knowl- edge about trauma to respond to clients in ways that convey respect and compassion, honor self- determination, and enable the rebuilding of healthy interpersonal skills and coping strategies. The person- in-environment perspective held by social workers helps us recognize the role that adversity might play in the formation of maladaptive coping pat- terns. Social workers are trained to avoid over- pathologizing behavior and to appreciate the complex nexus between poverty, oppression, and trauma. As well, the core values and mission of social work include promoting social justice for oppressed and vulnerable populations (National Association of Social Workers, 2015). Trauma-informed practice is consistent with these goals.