©2017 national association of social workers. all rights...
TRANSCRIPT
-
1 ©2017 National Association of Social Workers. All Rights Reserved.
-
Trauma-Informed Practice with Older Adults
Sandra A. López, LCSW, ACSW
Diplomate in Clinical Social Work
5311 Kirby Drive, Suite 112
Houston, Texas 77005
-
Key Objectives
• Define trauma-informed practice and its significance;
• Briefly explore trauma and its relevance to older adults; and
• Explore guidelines and principles for trauma-informed practice with older adults across diverse practice settings.
©2017 National Association of Social Workers. All Rights Reserved. 3
-
Trauma-Informed Practice
©2017 National Association of Social Workers. All Rights Reserved.
• An approach to engaging people with histories of trauma;
• Recognizes the presence of trauma symptoms;
• Acknowledges the role that trauma has played in the lives of clients we serve;
• Facilitates the adoption of trauma-informed systems, organizations, environments in the delivery of a broad range of services.
4
-
Trauma-Informed Practice
©2017 National Association of Social Workers. All Rights Reserved.
• Represents a profound cultural shift in which clients
are viewed differently by all involved—staff respond
differently, and the day to day delivery of services is
conducted differently.
• “Trauma informed practices” are not specifically
designed to treat symptoms related to the trauma,
but they are informed about, and sensitive to,
trauma related issues present in clients.
5
-
Changes the Paradigm
What’s wrong with you?
• Blaming and judgmental
• Insensitive to the “person”
• Takes an accusing stance
• Negatively impacts our
relationship with clients
What’s happened to you?
• Non-judgmental/respectful
• Starts with the client
• Draws from client’s strengths and resilience
• Supports the building of a positive working relationship with clients
©2017 National Association of Social Workers. All Rights Reserved. 6
-
Why Trauma-Informed Practice is Important
©2017 National Association of Social Workers. All Rights Reserved.
• Trauma is pervasive.
• Trauma’s impact is broad and diverse.
• Trauma’s impact may be deep and life-shaping.
• Trauma especially interpersonal violence is often self-
perpetuating.
• Trauma differentially affects the more vulnerable.
• Trauma affects how people approach services.
• The social service system has often been re-
traumatizing.
7
-
Adverse Childhood Experiences (ACE)
©2017 National Association of Social Workers. All Rights Reserved.
• ACE study is one of the largest studies to examine the long
term effects of negative childhood experiences on behavior
and health. (Anda, et al, 2010)
8
-
What is Trauma? (SAMHSA 2014)
©2017 National Association of Social Workers. All Rights Reserved.
• Refers to experiences that cause intense physical
and psychological stress reaction;
• Can be a single event, multiple events, or a set of
circumstances that is experienced by an individual
as physically and emotionally harmful or
threatening;
• Has a lasting adverse effect on the individual’s
physical, social, emotional or spiritual well being.
9
-
Traumatic Stress (Guarino et al, 2009)
©2017 National Association of Social Workers. All Rights Reserved.
• Refers to a level of stress that is so intense that it
can be overwhelming for our bodies to manage;
• Creates overwhelming experiences;
• Involves threat to our physical and/or mental well-
being;
• Results in vulnerability or loss of control, leaves
people feeling helpless and fearful; and
• Interferes with relationships and our beliefs.
10
-
Trauma Types
• Natural Disasters
• Manmade Disasters
• Interpersonal Violence
• Cultural or
Intergenerational Trauma
• Traumatic Loss
• Medical Trauma
• Provider Trauma
©2017 National Association of Social Workers. All Rights Reserved. 11
-
Trauma & Older Adults (National Center for PTSD)
• Although literature on trauma and older adults is
growing, there is still a dearth of studies examining
trauma among older adults;
• Approximately 70% to 90% of adults aged 65 and
up have been exposed to at least one potentially
traumatic event during their lifetime;
• About 70% of older men reported lifetime exposure
to trauma while older women reported a lower rate,
around 41%;
©2017 National Association of Social Workers. All Rights Reserved. 12
-
Trauma & Older Adults
• Although many older adults do not meet full criteria for a PTSD diagnosis, they may still exhibit some symptoms;
• Among a community sample of older women, 72% had experienced at least one type of interpersonal trauma during their lives (childhood physical or sexual abuse, sexual assault)
• Older women are more likely to have experienced intimate partner violence for a longer time span and to have remained in a violent relationship.
©2017 National Association of Social Workers. All Rights Reserved. 13
-
Late-Onset Stress Symptomatology (LOSS)
• A late-life process that may be a consequence of
combat exposure earlier in life;
• Refers to development of increased thoughts and
reminiscence about, and emotional responses to,
one’s wartime experiences;
• Occurs in the context of aging, such as retirement,
loss of loved ones, increased health problems, and
can develop in Veterans who have otherwise
functioned well throughout their adult lives.
©2017 National Association of Social Workers. All Rights Reserved. 14
-
What Providers May See
• Struggle with sense of self
• Fear, hopelessness,
powerlessness
• Guarded or mistrusting
• Emotional dysregulation
• Maladaptive coping strategies
• Spiritual disconnection
• Problematic relational patterns
• Recurring feelings of shame, guilt, rage, isolation and disconnection
• Resilience
©2017 National Association of Social Workers. All Rights Reserved. 15
-
Trauma-Informed Interventions (SAMHSA 2014)
©2017 National Association of Social Workers. All Rights Reserved. 16
-
Six Guiding Principles of Trauma-Informed Care
©2017 National Association of Social Workers. All Rights Reserved.
• Safety – physically and psychologically
• Trustworthiness & Transparency – goal of building and maintaining trust
• Peer Support – key to building trust, safety and empowerment
• Collaboration & Mutuality – true partnering and leveling of power differences
• Empowerment, Voice, & Choice – a belief in resilience and recovery
• Cultural, Historical, & Gender Issues – draws on traditional cultural connections and addresses historical trauma
17
-
Trauma-Informed Practice Guidelines • Develop a trauma-informed
practice;
• Advocate for trauma-informed practice environments;
• Encourage trauma screening or exploration during the intake process with clients;
• Incorporate knowledge of trauma in all aspects of service delivery;
• Avoid or at least minimize
re-traumatization;
• Provide psychoeducation
• Facilitate recovery and empowerment.
©2017 National Association of Social Workers. All Rights Reserved. 18
-
Trauma-Informed Social Workers (Levenson, 2017)
• Convey respect and compassion;
• Honor self-determination; and
• Enable the rebuilding of healthy interpersonal skills
and coping strategies.
©2017 National Association of Social Workers. All Rights Reserved. 19
-
Selected References
• Anda, R. F., Butchart, A., Felitti, V. J., Brown, D. W. (2010). Building a framework for global surveillance of the public health implications of Adverse Childhood Experiences. American Journal of Preventive Medicine, 39: 93-98.
• Guarino, K., Soares, P., Konnath, K., Cherval, R., and Bassuk, E. (2009). Trauma organizational toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.
©2017 National Association of Social Workers. All Rights Reserved. 20
-
Selected References
• Kaiser, A. P., Wachen, J. S., Potter, C., Moye, J., &
Davison, E. (Updated March 2, 2017). Post-
traumatic stress symptoms among older adults: A
review. National Center for PTSD website.
• Levenson, J. (2017). Trauma-informed social work
practice. Social Work, 62 (2): 105-113.
©2017 National Association of Social Workers. All Rights Reserved. 21
-
Selected References
• Substance Abuse and Mental Health Services Administration. (2014). Trauma-informed care in behavioral health services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 14-4816. Rockville, MD: SAMHSA.
• Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s Concept of trauma and guidance for a trauma-informed approach. Rockville, MD: SAMHSA.
©2017 National Association of Social Workers. All Rights Reserved. 22