Preventing Retraumatization: A Macro Social Work Approach to Trauma-Informed Practices & Policies

by Patricia Shelly, MSW, Shelley Hitzel, MSW, and Karen Zgoda, MSW, LCSW

     This article is based on conversation and materials shared during the February 18, 2016, #MacroSW Twitter Chat, “ACEs and Trauma-Informed Systems: Building Practices & Policies to Avoid Retraumatization.” #MacroSW Twitter chats are held every Thursday night at 9 p.m. ET– for more information, check out https://macrosw.com. Additional resources for this article are posted to: https://macrosw.com/2016/02/12/aces-trauma-informed-systems-building-practices-policies-to-avoid-re-traumatization-feb-18-2016/. The New Social Worker Magazine is a #MacroSW Media partner.

     A trauma-informed approach, based on the principles of trauma-informed care (TIC), produces sound policies that can help not only our clients but ourselves and our co-workers. It undergirds an ethical path in the work toward social justice. All social workers and other professionals who work with people who have experienced trauma are at risk of being personally affected by that trauma. Secondary traumatic stress (STS) -- sometimes called compassion fatigue -- and retraumatization are common among helping professionals. We typically think about how to avoid retraumatizing our clients. But what about considering a trauma-informed approach to the systems in which we work? How can we build system-wide policies and practices that minimize retraumatization? For social work practice and systems policy-setting, we propose a macro approach to preventing re-traumatization.

Defining Secondary Traumatic Stress (STS) and Retraumatization

     Secondary traumatic stress can follow exposure to another’s experience of trauma, resulting in emotional distress and symptoms of post-traumatic stress disorder (PTSD). It is as if we take in a portion of the trauma that the other has survived. Unlike burnout, which is a gradual process, STS can result from a single exposure to another’s trauma.

     Retraumatization is a conscious or unconscious reminder of past trauma that results in a re-experiencing of the initial trauma event. It can be triggered by a situation, an attitude or expression, or by certain environments that replicate the dynamics (loss of power/control/safety) of the original trauma.

     Trauma is something that has an impact on communities, not just individuals. A community – be it a geographic one, an organizational one, or an identity-based one – can respond in various ways, from ignoring the trauma to offering support, respect, and collaborative action. A community can be retraumatized too – consider the numerous deaths and acts of violence reflected by the community of activists and others under the #BlackLivesMatter hashtag.

How Systems Can Be Traumatizing

     Systems that operate in isolation, with fragmentation of authority and lack of accountability, systems that lack resources adequate to provide necessary services – these can retraumatize members of the public as well as the system’s employees.  

     Here are some examples of how systems can be traumatizing:

  • Public Schools: unaddressed school bullying, funding based on property tax with resulting unequal resource allocation
  • Public Utilities: Flint, Michigan lead-contaminated water supply
  • Federal Agencies: Bureau of Indian Affairs and residential schools policy; nuclear waste regulations that allow radioactive pollution
  • Legislative Bodies: lack of legislative response and gun control measures following the mass shooting at Sandy Hook Elementary School
  • Mental Health: indifferent psychiatric inpatient programs; lack of enough rehab beds for those dealing with addiction
  • Law Enforcement: incidents of police brutality; shooting deaths of Michael Brown in Ferguson Missouri, and Freddie Gray in Baltimore, Maryland
  • Mass Media: perpetuation of rape culture through accounts in which the victim of a rape is portrayed as being responsible for the rape
  • New Media: lack of protection or redress against trolling
  • Emergency Response:  the aftermath of Hurricane Katrina, in which systems failed to provide adequate relief

Elements in Building Systems To Prevent Retraumatization

     A trauma-informed approach is one way to institutionalize social work values and guide the allocation of resources. Improving the well-being of one affects the well-being of the whole. We have an ethical obligation to provide education and training on trauma, retraumatization, and resilience for bureaus, agencies, executives and staff, and policy-makers. We must acknowledge the fact that often social work (as well as other helping and caregiving professions) is work that involves trauma and thus the risk of STS and retraumatization is high. Coordinated systems that are client-centered, trauma-informed, and culturally sensitive are best positioned to minimize this risk.

     The principles of Trauma-informed Care (TIC) can be a useful guide. The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) has adopted this model. The six principles are:

  1. Safety
  2. Trustworthiness
  3. Peer Support
  4. Collaboration and Mutuality
  5. Empowerment and Voice and Choice
  6. Cultural and Historical and Gender Issues

     Establishing safety and trust; providing opportunities to make choices and decisions; using strengths-based and empowerment models; and addressing the intersections of racism, sexism, ableism, and other oppressions reflect the six principles of TIC. It is an ethical way to write policy that supports a non-traumatizing mode of operation and service provision. It is essential that there is a long-term commitment to this approach that is supported with adequate and ongoing funding. Multifaceted assessments, research partnerships, cross-sector collaboration, and other tools can contribute to improved practices and policies. We also note that this approach is an economically sound investment that helps reduce staff turnover, increase job satisfaction, improve quality of service and delivery, and provides evidence-based benefits of trauma-informed care to clients.

     Some general examples of how TIC can be instituted at the macro level: 

  • Establish a central locus for national TIC policy.
  • Involve consumers of TIC and TIC providers from the beginning.
  • Provide support for research on evidence-based practices, efficacy of TIC policy.
  • Launch national public education campaigns on trauma, and elements of TIC and support training/graduate programs with this specialty.
  • Feature TIC in all social work education, including macro-mezzo-micro levels.
  • Roll out a training program for all sectors of the workforce.  

Specific Examples of Trauma-Informed Policy by Area:

  • Child Welfare: Chadwick Trauma-Informed Systems Dissemination and Implementation Project (CTISP) (http://www.chadwickcenter.org/CTISP/ctisp.htm). Chadwick Center for Children and Families and the Child and Adolescent Services Research Center (CASRC) at Rady Children’s Hospital-San Diego is directing a pilot project to transform child welfare programs into trauma-informed systems, with sites in five states. The CTISP definition of a trauma-informed child welfare system:

…one in which all parties involved recognize and respond to the varying impact of traumatic stress on children, caregivers, families, and those who have contact with the system. Programs and organizations within the system infuse this knowledge, awareness, and skills into their organizational cultures, policies, and practices. They act in collaboration, using the best available science, to facilitate and support resiliency and recovery.

     This SAMHSA guide assists behavioral health professionals in understanding the impact and consequences for those who experience trauma. It discusses patient assessment, treatment planning strategies that support recovery, and building a trauma-informed care workforce.  

  • Policy Analysis: Trauma-Informed Social Policy: A Conceptual Framework for Policy Analysis and Advocacy. Trauma-informed care is a service provision model used across a range of practice settings. Drawing on an extensive body of research on trauma (broadly defined as experiences that produce enduring emotional pain and distress) and health outcomes, the authors argue that the principles of trauma-informed care can be extended to social policy. See: Bowen, E., & Murshid, N. (2016). Trauma-informed social policy: A conceptual framework for policy analysis and advocacy. American Journal of Public Health, 106(2), 223-229. http://dx.doi.org10.2105/AJPH.2015.302970    
  • Education: Universal trauma-informed education (with Intimate Partner Violence as the example) http://www.socialworktoday.com/archive/011716p34.shtml

     Providers of health care services, including clinical social workers in a variety of practice settings, are often well aware of the relationship between IPV and poor health outcomes, but are challenged to find a "point of entry," or a reason to talk with clients that connects the client's trauma history to her presenting concern in a way that supports and empowers the client toward a positive change. A universal, trauma-informed education intervention, an innovative approach supported by research-driven clinical practice guidelines, offers a solution.

Additional Resources

More resources are available at:

https://macrosw.com/2016/02/12/aces-trauma-informed-systems-building-practices-policies-to-avoid-re-traumatization-feb-18-2016/

Patricia Shelly, MSW, is the Director of Community Engagement and Expansion at the University at Buffalo (UB) School of Social Work. She represents UB as a founding partner in the weekly #MacroSW twitter chats as @UBSSW.

Shelly Hitzel, MSW, is a member of a multidisciplinary team providing direct services to both child and adult survivors of trauma at the Child Advocacy Center of Niagara in Niagara Falls, NY. She interned at the University at Buffalo School of Social Work Institute on Trauma and Trauma-Informed Care, graduating with her MSW in May 2016.

Karen Zgoda, MSW, LCSW, is an instructor of social work at Bridgewater State University and founding member of #MacroSW. Her web site is http://karenzgoda.org.