A man experiences sleepless nights after losing his home in a fire. A teen runs away after experiencing abuse. Many social workers confront the consequences of past trauma every day on the job, but not all helping professionals take trauma into account as a cause for the behaviors they treat. In fact, misdiagnosis and mistreatment of trauma and trauma-related symptoms are all too common. So what does trauma-informed practice look like?
Trauma-informed social work requires us to recognize the signs of trauma, acknowledges the impact of trauma, identifies paths to address the effects of trauma experience, and actively prevents people from experiencing further trauma. Rather than solely focusing on problematic behaviors, trauma-informed social workers aim to understand what happened to people that caused those behaviors in the first place. They take their clients’ personal histories, vulnerabilities and triggers into consideration and tailor treatment to each individual’s complex, nuanced needs.
As a social worker, being sensitive to people’s unique lived experiences fosters trust and creates an environment conducive to effective treatment and healing. By addressing past trauma, social workers can better serve people who have experienced it.
Why Trauma-Informed Practice Is Important
Trauma can take many forms, from interpersonal violence, sexual assault and medical trauma to natural disasters, institutionalized oppression, war-related trauma and the sudden loss of a family member. According to the National Council for Behavioral Health, 70% of U.S. adults have experienced a traumatic event in their lifetimes. That means more than 223 million people are living with the effects of trauma in the U.S. alone.
Despite those numbers, the general public has very little understanding of the impact of trauma. Many people who have experienced trauma face doubt, judgment and even the possibility of experiencing further related trauma. And the ramifications of those experiences can be profound. Due to prolonged and sometimes extreme stress, people who have experienced trauma are more likely to develop severe mental health issues, social and emotional problems, harmful coping mechanisms, and serious diseases.
Ways to Practice Trauma-Informed Social Work
Due to the nature of their work, clinical social workers are practically guaranteed to encounter the impact of trauma. Understanding how to identify the symptoms of trauma and provide competent care is a key to success as a social worker. But trauma-informed care can’t be accomplished through a single technique or practice. It requires constant evaluation, attention and sensitivity.
“Trauma-informed social work practice is not about who wants to work with people who have experienced trauma — you will work with people who have experienced trauma,” says Virginia Commonwealth University (VCU) School of Social Work associate professor Nicole O-Pries. “If you don’t understand how trauma impacts people, then it will be very difficult to provide whatever service they need. And it will be difficult to understand the ways that they respond to your services, the way that they respond to you.”
Understand the Impact of Trauma
The effects of trauma are personal and complicated. Many factors contribute to how an individual experiences post-traumatic stress, from personal history and family circumstances to cultural norms — like the way men in different cultures show grief — and availability of support services. But studies show that across the board, those who have experienced trauma have a higher risk of developing mental health problems.
Studies have linked traumatic events to depression, anxiety and post-traumatic stress disorder. In addition, people who have experienced trauma are more likely to develop harmful coping mechanisms, such as alcoholism and other substance abuse.
And the impact of trauma is not limited to mental health. In fact, the Centers for Disease Control and Prevention’s Adverse Childhood Experiences (ACE) study found correlations between childhood trauma and lifelong physical health problems. According to the study, those who experienced a traumatic event at some point in their childhood are more likely to develop chronic lung and heart disease, diabetes, liver cancer, autoimmune disease and sexually transmitted infections.
Screen for Trauma
Often, people aren’t aware of the link between their behavior and past trauma. For example, someone with anxiety might not realize it was triggered by a traumatic medical encounter. Or someone with a history of abuse might not see how that history contributes to feelings of low self-esteem and depression. If left untreated, the long-term effects of trauma can be devastating. Unrecognized trauma symptoms can lead to:
- Misdiagnosis: incorrectly identifying an illness or other problem, or failing to identify it at all
- Improper treatment: providing inadequate or misaligned treatment
- Relapse: suffering deterioration after a period of improvement
- Additional mental health problems: experiencing compounding mental health issues — anxiety leading to isolation and depression, for example
According to O-Pries, an expert in trauma-informed social work, early identification and intervention is key to limiting the impacts of trauma. “The way we typically look at mental health is that we wait to see whether something is going to hurt them before we even explain what the potential impact can be,” says O-Pries. It is important to share information about traumatic stress with people as soon as possible after traumatic events. There are consequences for waiting.
Through screening, social workers can gain holistic insight into the problems their clients face and increase their ability to give effective, individualized care. Screening is an intake process focused on learning about what trauma people have experienced. Screening is typically paired with trauma assessment, which is designed to identify symptoms of trauma. Successful screening and assessment processes are well-defined and comprehensive. Social workers should explore everything from common trauma-related symptoms to substance abuse problems, coping mechanisms, past mental health disorders and physical health.
Develop Cultural Competence
Understanding the many factors that contribute to an individual’s experience is the basis of trauma-informed practice. Cultural backgrounds, norms and expectations can play a major role in the way someone experiences or copes with trauma. For example, many rites of passage around the world involve inflicting pain and violence for the purpose of spiritual advancement and transformation. While these ceremonies can lead to serious trauma, they are seen as culturally significant and meaningful. Because of this, resulting trauma symptoms may not be viewed as something to address and may be overlooked entirely.
Another example is how cultural norms and community expectations impact a person’s willingness to seek mental health care. Studies show that African Americans are less likely to seek mental health care than their Caucasian counterparts. Researchers have linked this trend to cultural stigma surrounding mental health issues and mistrust of medical professionals, which stems from the historical prevalence of biased and unethical treatment of racial and ethnic minorities.
Factors such as these make it critically important for social workers to incorporate cultural competence into their work. By addressing trauma through a culturally informed lens, social workers can forge stronger connections, build greater trust and provide more effective care. Furthermore, awareness of cultural differences can help social workers communicate effectively and avoid triggers.
“If we don’t understand how systems of oppression work, systems that are inherently discriminatory, we don’t understand how different groups of individuals are impacted by the systems. Then we’ll have a lot of difficulty providing clinical services that are effective,” says O-Pries. “True trauma-informed work takes into account how racism and other forms of discrimination lead to trauma and generations of trauma.”
Create a Safe Space
There is arguably nothing more important to the success of trauma-informed social work than creating an environment where trauma survivors feel safe. This is especially true when asking individuals to confront their trauma — work that requires a significant amount of vulnerability. Safe spaces can be literal: calm, soothing and secure environments with no adverse stimuli or environmental stressors. But safe spaces can also exist in terms of the relationship between social workers and the people they work with. Trust, transparency, empowerment and choice can all contribute to making a space feel safe. In order to incorporate these elements into their care effectively, social workers need to tailor their interactions to each individual’s needs.
Learn More About Trauma-Informed Care in Social Work
Virginia Commonwealth University’s Online Master of Social Work program helps aspiring social workers gain skills to practice with people who have experienced trauma. Through intensive coursework and hands-on field experiences, students gain a greater understanding of the impact of diversity and unique lived experiences — knowledge that empowers them to make an immediate, lasting difference in the lives and communities they touch.
American Psychological Association, “Toward Culturally Centered Integrative Care for Addressing Mental Health Disparities Among Ethnic Minorities”
Centers for Disease Control and Prevention, “Infographic: 6 Guiding Principles to a Trauma-Informed Approach”
Center for Health Care Strategies, Trauma-Informed Care Implementation Resource Center, “What Is Trauma-Informed Care?”
The National Council for Behavioral Health, “How to Manage Trauma”
The New Social Worker, “What Every New Social Worker Needs to Know…Trauma-Informed Care in Social Work”
Psychology Today, “Trauma-Informed Care and Why It Matters”
Substance Abuse and Mental Health Services Administration, “Trauma-Informed Care in Behavioral Health Services”
Virginia Commonwealth University School of Social Work, M.S.W.