Trauma-informed Treatment Framework Essay Example

adults and kids cases. For a kid, effort should be made to ensure that there are responsible adults who will ensure that things are safe for the kid at all times (Reece, Hanson, & Sargent, n.d.).

This model also provides for the safety of the clinician/ therapist thus the clinician must have a mastering of the S.E.L.F framework and should follow these principles in work with kids and parents/ caregivers. It makes use of didactic, cognitive-behavioral, biological, psycho-educational and experiential interventions to ensure the victim achieve the social, psychological, biological and moral safety.
Emotion management, this is a kind of therapy and treatment that works towards helping the person to make connections between their affect and cognition. This should be introduced when there are symptoms that are trauma-based that may vary from; body memories, disturbing flashbacks, nightmares, trauma-based behaviors, depression. Immediately when a client exhibits struggle with these symptoms and behaviors, a clinician should take a step further by making an informed decision about making use of trauma treatment intervention. (Reece, Hanson, & Sargent, n.d.)

At this stage it is vital to use psycho-education to make sure that the client and the caregivers have acquired as much information as possible to enable them understand the impact of trauma and how it manifests itself in a person’s life. This psycho-education can be delivered also through group therapy, as it is true that much of the problem associated with trauma results from disconnected non-verbal materials it is essential to involve nonverbal or experiential intervention. It is recommendable that no matter how the client tells the clinician, if there are any trauma based symptoms the clinician need to recognize the nonverbal

material which can be reconnected to the verbal or cognitive mind so as to reduce dysfunction. There are a number of cognitive techniques and interventions which help handle both cognitive and non-verbal aspects of a particular problem these include; Trauma Focused CBT and Trauma Art Narrative therapy. Trauma focused CBT interventions make use of nonverbal techniques such as art, music, body oriented psychotherapy, somatic experiencing, tapping method, yoga, movement among others.

When the client has undergone a specific trauma technique or intervention, the clinician should pay attention on observing whether the client has got some symptom relief and the path to things getting better.

Loss, relate to a particular effect of grief or rather loss work in therapy that is mostly emotionally painful. This loss work sometimes makes the person to truly have a transformation from their traumatic experience and be able to move on with their life. The clinician should put into consideration the grief work principles and follow the stages of grief and at the same time giving necessary help to the client to help go through; also the specific trauma treatment interventions will be very effective (Feliciano, Mattox, & Moore, 2008).
This grief work emotion management is associated with anger, thus clients need to learn and adapt some self-soothing techniques that may incorporate containment. A number of measures or activities will be very important for clients at this particular area of emotional processing which includes; guided imagery, relaxation techniques and grounding.

Future, this entails the great work of transformation, ensuring the client is able to see they can proceed well with their life. They are able to do away with their past, learning from it and

not living by it. The whole process is aimed at one goal of helping the person get back to developmental track. It entail turning the traumatic experience into something that the client has been able to survive and learn from it, thus it requires meaning making skills (Feliciano, Mattox, & Moore, 2008).

Illustrative Case

A neighbor 30 year-old man who has pain, discomfort and persistence worry was otherwise healthy but tells that he had sustained his left hand as well as both legs fracture in a traffic accident that occurred four years earlier. After the accident he was evaluated by medical personnel, administered with anxiolytic medication and finally referred to counseling where he attended for few weeks and opted not to attend.

The client says he had been late for work that day and he got preoccupied with the daily schedule he had to go through that day, he was distracted by a street roaming dog that was crossing the road that made him make a tilt of the steering. The next place he ended to the kiosk that was along the road trapped against the steering wheel and the dashboard, experiencing intense pain. Emergency team arrived about thirty minutes earlier the period that was like hell on earth to him due to failed effort of the humanitarian residents and passers-by to help get him out. During this time the patient was exposed to lot of gasoline smell that he started vomiting. At the time he was taken out of the scene he had gone out of his senses.

He underwent rehabilitation and after one and half year period he resumed back work but slowly developed difficulties, he nauseated

whenever he smell gasoline, he refused to drive and would only walk, became so anxious whenever in public and the only way he has been doing to drive all these away was drinking to calm himself. The patient ended up leaving his job and his wife persuaded him and took him to seek a psychiatric care. For half a year he went through treatment with medication and psychotherapy which he disengaged shortly after his wife divorced her due to her unstopped domestic violence and drunkard behavior which he had resumed. The nauseatic problem had now increased that he fears to go to the city claiming its smells gasoline everywhere and makes him feel uncomfortable, thus he prefers in house or around his compound.

Evaluation of the patient

I asked the patient to assist with the police accident report and the medical report which indicated the injuries sustained both on the legs and the left hand, this confirmed his accident history. I started an initial screening of the patient by asking a number of questions that he gave affirmative answers. He reported to be experiencing flashbacks of the event during the accident when he is free and nightmares which cause the feeling of helplessness and horror. He reported to have difficulty with driving and when travelling to places in vehicle he feels general uneasiness since when he got the accident.

Intervention and Treatment

Recognizing the traumatic stress symptoms from the patient is the key to helping out, the aim of intervention is to assist the patient to re-establish his psychological symmetry and return to pre-accident state and functioning to the extent possible. This will be achieved by offering re-assurance to

the patient, educating the patient about post accident trauma, establishing and enacting coping strategies and prescribing medication (Huddleston, 2012).

Educating the patient on the traumatic effect will commence on discussing the associated trauma symptoms and their associated prevalence among other accident survivors. This will help stabilize the patient experience at the same time reducing the level of reluctance to disclose symptoms he is experiencing, at the same time informing him of the symptoms that are associated with loss-work to prevent the patient from overreacting when these signs portray later in the process. At the same time for an effective and less painful time to the patient it is necessary to teach relaxation techniques that the patient can practice then and later, this include moderate physical exercise and yoga.
Medication will help also in the treatment of post accident trauma, although has side effects it is very essential to help the patient lessen the stress symptom and break down the vicious cycle that occurs when during or travelling with a vehicle that evokes memories and reactions of the accident (Huddleston, 2012).

Personal reflection on working with individual with trauma history

After sharing and having heard the patient trauma history I finally went back home, being my first case to have a contact with the trauma patient I found myself thinking and having flashbacks on the story and conceptualizing the scenario. Following day I found myself crying at my sit due to the bad previous night with recurrent flashbacks wondering how can I do it.

Working on these cases causes lot of personal distress to the social worker which can range from; relationship problems resultant at home, the feeling of being un-effective

at work, sometimes depression and nightmares. Research indicates that there is a great connection between the helping professions in these trauma incidents and to what they refer as secondary traumatic stress. This actually confirms to be true based on the scenario at hand which I had to assist individual under a trauma history.

So far there is lot of cases out there that reports high incidence of associated suicide rates among the social workers, a high rate of employment turnover and also registered number of disruptive symptoms resulting from traumatic stress to personal social workers lives. This indicates the harsh and very critical state of working with trauma history individuals.
Themes in the case relating to trauma narrative and trauma informed treatment.

Trauma symptoms- these manifested in a number of ways which include; depression, nightmares, flashbacks, nausea, discomfort and hopelessness. Most trauma patients portray a number of symptoms that make their lives difficult and to some extents affect their productivity thus making them detach from their usual lives (McGrath, 2008). The cause of this emotional and psychological trauma is the onetime event, that is; an accident that turned things around, other causes may include; ongoing or relentless stress such as life-threatening illness and other cause is the commonly overlooked causes such as; breakup of a significant relationship or deeply disappointing experiences.
Risk factors-these factors make a person more susceptible to the emotional and psychological trauma hence becoming more traumatized by a stressful experience that came post the traumatic incident (McGrath, 2008). Based on this case the patient had an exposure to traumatic factors that included gasoline smell and travelling in vehicles which made it worse for him hence experiencing

nausea.

Separation or isolation- majority of trauma patients apart from the real problem of trauma they are faced with other recurrent problems that includes isolation by their family, marriage partners, friends and society at large. This to some extent becomes a risk factor making the severity of the trauma to be more experienced by the person. In our case the patient first isolated his job hence working colleagues, finally he was divorced by his wife and being the main cause of this separation was the very symptoms of traumatic experiences. Trauma individuals should not be isolated rather they should be given company to keep them active and hence keeping off from flashbacks and other symptoms (McGrath, 2008).

Vicarious Traumatization And Self Care

Vicarious trauma refers to the emotional residue that counselors are exposed to from working with people as they are hearing their traumatic cases and become witness to the associated pain and fear that the trauma victims have gone through (Huddleston, 2012). Counselors may be affected by this tension in a number of ways which includes; thinking about the traumatic story, avoiding talking and sometimes lacking concentration on their other schedules.

It is necessary for counselors to be aware of the symptoms of vicarious trauma and it associated emotional effects that accrue due to working with trauma survivors. The major and mostly occurring signs and symptoms are; having difficulty falling asleep, free floating anger at a slight confrontation, sometimes loss of appetite, the state of getting worried that one is not doing enough for his clients, having nightmares or dreaming about their clients trauma experiences, lack of joy in things one used to enjoy, having the feeling of

hopelessness resulting from working with their clients and having a blaming others trend (Huddleston, 2012).

Vicarious trauma has a severe impact on the counselor’s work performance and may adversely affect his/her judgment and results in error and mistakes. The professional may have: Behavioral effects that may include; becoming irresponsible, increased rate of absenteeism, job overwork, irritability and exhaustion, developing a talking to oneself behavior, disengaging from community or joint affairs, and going to the extent of rejecting physical and emotional closeness. Interpersonal effects that include; increased staff conflicts, laying blame on others, having poor relationships, developing poor communication with others, becoming generally impatient, starting avoidance working with clients with trauma histories and poor or no collaboration in work.

Effects on his/her personal values and beliefs these ranges from; having general dissatisfaction, negative perception of things, losing interest on things and matters, lack of appreciation for others or anything good, hopelessness feeling, low self esteem, being worried about having not done enough and disruption of personal beliefs, trust, control and intimacy. Effects on his job performance that results in; low individual motivation, increased number of mistakes and errors, decreased quality such as poor services rendered, the tendency to be over-involved in specific details or the perfectionism and rigidity allowing no flexibility (Kadambi, 1998).

Issues of socioeconomic, diversity and cross cultural considerations

Trauma informed treatment requires to be approached from the perspective that includes putting into consideration the context of the trauma- disturbed patients. These normally include his/ her relationships status with the family, the extended family, and the support systems, cultural factors, his/her social and economic environment.

When a member of a family is affected by trauma, there is the general

look where each member reacts differently to the fact that their loved one has gone through trauma, which may lead to misunderstandings, breakdown of communications and other problems if they don’t understand each other own way of experience. A trauma affected family member may be hard to get along with and may cause him/her withdraw from the rest of family team; this makes it harder for everyone. Thus coming up with a way to heal a family and make it cohesive is vital. This will make the counselor work easier as he will be able to get family support in the treatment plan through making sure the patient is following and adhering to the treatment schedule and practices. It also important to remember that despite of the traumatic reactions, at last most families look back and see that the crises has helped to bring them together enhancing their cohesion (Kadambi, 1998).

Support system represents a group of people like mentors, people who can give guidance, give some teachings and challenge a person in a respectful and a very compassionate way. These will be of great importance in the trauma informed treatment. They may include; teachers, spiritual advisors, cultural leaders, elders, spiritual leaders, family physicians, nurses and other competent health care providers, health workers and psychiatrists. A counselor should get awareness of existing support systems and be able to link with them to know their advancement in trauma treatment and help measures they have put in place.

Culture plays a role in determining what type of event is perceived as traumatic and the meaning attached in the interpretation of that event. Different cultures also influence the way individuals

and communities express any traumatic reactions that they may be having and at the same time manifestations of responses may differ significantly among individuals. Mostly traumatized individuals or communities use culture as a benchmark to judge their own responses, this also leads to secondary trauma which may result when individuals believe that the society will not confer upon them in that status and thus withdrawing into silence. Trauma counselor should assess a patient cultural identity and have a clear understanding of how his/her culture affects the explanation of the individual’s traumatic condition and the clinician-patient relationship that should be maintained and the treatment plan or framework to be used. Thus it is very important for the counselors to develop cultural competent attitudes, knowledge and adequate skills so as to effectively help trauma victims in diverse cultures.
Social and economic environment have an impact on the trauma counseling and treatment plan, counselors when examining the impact the economy is having on the clients should take an ecological approach. This refer to looking at the various systems within a person life and analysis how that situation affect the person belief system. Economic pressures such as job loss also may have an effect to the patient and the counselor need to be informed of matters of economic effect to the patient so as to be able to know how to approach the healing process.

Ethical Issues From Nasw Code Of Ethics When Using Trauma-informed Treatment

Social work has a profession aims at enhancing human well-being helping them meet their human needs, at the same time empowering people who are vulnerable, oppressed and those living in poverty conditions. Social workers are sensitive

to factors of cultural and ethnic diversity and promote social justice and social change through striving to end all kind of oppression, social injustices, discrimination and poverty among people. Trauma-informed treatment has a form of social work seek to enhance the capacity of and enable patients heal and be able to address their own needs. These practices are grounded on a set of core ethical values and principles, thus a counselor or psychiatrist is supposed to embrace these standards of ethics in their performance of trauma treatment and intervention (Code of ethics of the National Association of Social Workers, 1999).

The NASW code of ethics was developed to serve as a principal guide to daily to daily professional conduct of social workers. The NASW code of ethics offers a set of values, standards and principles that lay a guide on the conduct and decision making when ethical issues arise. These ethical responsibilities range from human relationships to personal social and professional conduct. In addition to the code social workers should bear in mind the impact on the ethical decision of their patients and also their own personal values, the in religious beliefs and cultural practices (Difranks, 2005).

Ethical Principles/ issues that impact trauma-informed treatment

The guiding principles of NASW are based on broad ethical principles that are based on social work key values of service, social justice, the dignity and worth of the person, competence and integrity. Thus every social worker should aspire to follow them in their deal work.
Service- the primary goal of social work is to help people who are in diverse needs and help address problems. They should render their service at the expense of

their social interest. A counselor should make use of his values, knowledge and skills to help traumatized people get back to their normal way of life. They are expected to volunteer their services without expecting in return an equal or equivalent financial return (Difranks, 2005).

Social justice- traumatized people in the society face a lot of oppression and feels neglected. The fall on the vulnerable and oppressed individuals and groups in the society, thus a social worker should ensure access to the needed information and services to help the individuals regain equality of opportunity and appreciation.

Dignity and worth of the person- social workers should treat each person in a caring and with respect taking into consideration individual differences. Counselors should aim to enhance client’s capacity and opportunity for them to change and to address their own needs (Huddleston, 2012).

Importance of human relationships- counselors recognize the importance of relationships between people and engage others as partners in the helping process. They should seek to enhance relationships between people aiming to promote, restore, maintain, and improve the well-being of the involved individuals, their families, social groups and the community at large.

Integrity- every social worker should behave in a trustworthy manner. He/she should be aware and in consistent with the professions mission, values, ethical principles, ethical standards and practice of professional concern. Counselors should act in an honest, responsible manner and upheld ethical practices with which they are affiliated (Difranks, 2005).

Competence- as social workers practice within their competence areas, they should seek to for its professionals so as to ensure efficiency and effectiveness of the services that they render. The guiding principles act as a benchmark for social workers

as they lay down the professions core values and outlines specific ethical standards that act as guide to social work practice.

Informed consent- for professionalism social workers should provide service to their client only at a valid informed consent; they should make use of clear and understandable language to the client in the course of their trauma intervention. At the other end social workers should be willing to provide the social workers an opportunity to ask them questions.

Privacy and confidentiality- clients right to privacy should be upheld and protected by the social worker and should not give any information without the consent of the client unless it is of importance to the treatment or services rendered. Social workers should create awareness to the client the extent to which the information will be disclosed if it is necessary to do so (Barsky, 2014).

Sexual relationships- a social worker should not at any circumstance engage in sexual advances or sexual contacts with his/her current clients, no matter whether the contact is consensual or forced. Neither should the social worker engage in sexual activities with the client’s relative or maintain a close personal relationship if there is suspected risk of exploitation or potential harm to the client. Sexual contact may compromise the working relationship and make it difficult for the social worker to maintain a professional boundary with the client.
Access to records or files- the social worker should enable the client access the records of his concern. In other limited cases social workers should limit clients from accessing their records when there is substantial evidence that such access would have a disastrous effect or harm to the client.

Conflicts of interest-

social workers should at all cost avoid any conflict of interest that may interfere with their due exercise of professionalism and impartial judgment. They should tell the client when any conflict of interest arises and take any rational steps to resolve the matter (Barsky, 2014).

The Relevance Of Social Work Values And Ethics

The code of ethics and set of principles acts a benchmark or a ground one can fall back on if confronted with morally ambiguous issues in the practice. As ethical issues are key to professionalism in social work it becomes essential to have a guide that can be followed and used to solve any issues of violation of ethics by the social worker (Barsky, 2014).

The general public requires protection from the self interest of social workers and other unethical practices they may be made in the practice of social work. This code provides the ethical standards against which the general public will hold the social work profession accountable in case of any violation.

Social work has a profession just like any other profession requires a code of guidance for its professionals so as to ensure efficiency and effectiveness of the services that they render. The guiding principles act as a benchmark for social workers as it lays down the professions core values and outlines specific ethical standards that act as guide to social work practice (Conradi, 2015).
The code of ethics lay a framework against new practitioners to this field are familiarized to social work’s mission, its values, guiding ethical principles and the ethical standards, thus enabling social workers develop and enhance their professional knowledge and skills through applying them into practice. The code of ethics

stipulates the accepted standards against which the social work profession itself may be able to evaluate whether a social worker has engaged or violated in any unethical conduct.

References

1. Barsky, A. (2014). Being Conscientious: Ethics of Impairment and Self Care. The New Social Worker. Retrieved from http://www.socialworker.com/feature-articles/ethics-articles/being- conscientious-ethics-of-impairment-and-self-care/
2. Conradi, L. (2015). Supporting the Mental Health of Trauma-Exposed Children in the Child Welfare System. ABA Child Law Practice, 34 (1). 5-10
3. Herman, J. (1992). Chapter 1. In Trauma and Recovery: The aftermath of violence- fromdomestic abuse to political terror (pp. 7-32). New York: Basic Books.
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