2017 National Association of Social Workers. All Rights Reserved.

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1 2017 National Association of Social Workers. All Rights Reserved. 1

2 Trauma-Informed Practice with Older Adults Sandra A. López, LCSW, ACSW Diplomate in Clinical Social Work 5311 Kirby Drive, Suite 112 Houston, Texas

3 Key Objectives Define trauma-informed practice and its significance; Briefly explore trauma and its relevance to older adults; and Explore guidelines and principles for traumainformed practice with older adults across diverse practice settings National Association of Social Workers. All Rights Reserved. 3

4 Trauma-Informed Practice 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 National Association of Social Workers. All Rights Reserved. 4

5 Trauma-Informed Practice 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 National Association of Social Workers. All Rights Reserved. 5

6 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

7 Why Trauma-Informed Practice is Important 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 selfperpetuating. Trauma differentially affects the more vulnerable. Trauma affects how people approach services. The social service system has often been retraumatizing National Association of Social Workers. All Rights Reserved. 7

8 Adverse Childhood Experiences (ACE) 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) 2017 National Association of Social Workers. All Rights Reserved. 8

9 What is Trauma? (SAMHSA 2014) 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 National Association of Social Workers. All Rights Reserved. 9

10 Traumatic Stress (Guarino et al, 2009) 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 wellbeing; Results in vulnerability or loss of control, leaves people feeling helpless and fearful; and Interferes with relationships and our beliefs National Association of Social Workers. All Rights Reserved. 10

11 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

12 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

13 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 National Association of Social Workers. All Rights Reserved. 13

14 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 National Association of Social Workers. All Rights Reserved. 14

15 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

16 Trauma-Informed Interventions (SAMHSA 2014) 2017 National Association of Social Workers. All Rights Reserved. 16

17 Six Guiding Principles of Trauma-Informed Care 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 2017 National Association of Social Workers. All Rights Reserved. 17

18 Trauma-Informed Practice Guidelines Develop a trauma-informed practice; Incorporate knowledge of trauma in all aspects of service delivery; Advocate for trauma-informed practice environments; Encourage trauma screening or exploration during the intake process with clients; Avoid or at least minimize re-traumatization; Provide psychoeducation Facilitate recovery and empowerment National Association of Social Workers. All Rights Reserved. 18

19 Trauma-Informed Social Workers (Levenson, 2017) Convey respect and compassion; Honor self-determination; and Enable the rebuilding of healthy interpersonal skills and coping strategies National Association of Social Workers. All Rights Reserved. 19

20 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: 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 National Association of Social Workers. All Rights Reserved. 20

21 Selected References Kaiser, A. P., Wachen, J. S., Potter, C., Moye, J., & Davison, E. (Updated March 2, 2017). Posttraumatic stress symptoms among older adults: A review. National Center for PTSD website. Levenson, J. (2017). Trauma-informed social work practice. Social Work, 62 (2): National Association of Social Workers. All Rights Reserved. 21

22 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) 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 National Association of Social Workers. All Rights Reserved. 22