©2017 National Association of Social Workers. All Rights...

Trauma-Informed Practice with Older Adults

Sandra A. López, LCSW, ACSW

Diplomate in Clinical Social Work

5311 Kirby Drive, Suite 112

Houston, Texas 77005

[email protected]

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.

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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.

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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


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 self-

perpetuating.

• Trauma differentially affects the more vulnerable.

• Trauma affects how people approach services.

• The social service system has often been re-

traumatizing.

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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)

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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.

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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 well-

being;

• Results in vulnerability or loss of control, leaves

people feeling helpless and fearful; and

• Interferes with relationships and our beliefs.

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Trauma Types

• Natural Disasters

• Manmade Disasters

• Interpersonal Violence

• Cultural or

Intergenerational Trauma

• Traumatic Loss

• Medical Trauma

• Provider Trauma


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%;


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.


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.


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


Trauma-Informed Interventions (SAMHSA 2014)


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

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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.


Trauma-Informed Social Workers (Levenson, 2017)

• Convey respect and compassion;

• Honor self-determination; and

• Enable the rebuilding of healthy interpersonal skills

and coping strategies.


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.


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.


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...

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