March/April 2013 Issue

Trauma-Informed Social Work Education
By Lindsey Getz
Social Work Today
Vol. 13 No. 2 P. 18

In recent years, trauma education has vastly evolved, and frequent mass violence, natural disasters, and other tragic events amplify its importance in social work curriculum.

On December 14, 2012, six-year-old Noah Pozner became the youngest victim of the Sandy Hook Elementary School massacre. His horrific slaying alone is enough to be deemed a tragedy in small Newtown, CT, but the fact that 19 other children and six educators also were slain that day is beyond comprehension.

Yet for Noah’s twin sister, Arielle, there is no escaping the reality that her brother is gone forever. Just a few doors down the hall when the shooting broke out, Arielle survived.

Experts say survivors like Arielle may be experiencing “survivor’s guilt” among other feelings of anxiety and PTSD following the shooting. In the coming weeks and months, it will be vital for these trauma survivors to receive the proper support so they can process their grief as well as the symptoms that may be emerging as they live with the aftereffects of trauma.

The emergency responders, including the first police officers to arrive at the school and discover the gruesome scene, also need support. The Associated Press recently reported that symptoms of PTSD were so great for some of the first responders that lawmakers are considered expanding workers’ compensation benefits to help them cope.

Beyond the family and friends of those who were lost and the first responders, the Newtown community at large and people across the nation are experiencing feelings of fear and anxiety as a result of the massacre.

Individuals negatively affected by this and other traumatic events in our culture prioritize seeking best practices for trauma treatment. Many of today’s social work programs are incorporating trauma treatment techniques into their curricula. And while the face of trauma education in modern social work is evolving, it took a while to get to this point, and there’s still more to do.

Trauma Interventions
“Social work by its very definition has always meant working with vulnerable patients and those who have experienced trauma,” says Nancy Smyth, PhD, LCSW, dean of and a professor in the University at Buffalo School of Social Work in New York. “But what we’re learning from the trauma literature that is emerging is that there are specific interventions that a trauma patient needs. In the past, social work has not kept up with staying trained on that, but it’s changing. Future social workers are becoming trained in evidence-based trauma treatment [EBTT].”

Over the years, social work programs have infused some elements of trauma education, but the need for greater emphasis on trauma training has become evident. No matter what area of social work today’s students enter, at some point in their career, they likely will encounter clients who have experienced trauma.

Trauma education in the past was highly specific and failed to take into account the broader context of the trauma or the fact that there are many overarching themes that exist no matter what type of trauma occurred. “Historically, the social work curriculum has been very categorical,” says Virginia C. Strand, DSW, a professor in and the codirector of the National Center for Social Work Trauma Education and Workforce Development (the National Center), which aims to build a mental health workforce that is better trained to serve traumatized children, adolescents, and their families. “There have been courses on topics such as sexual abuse or domestic violence, but what’s happened in the last decade as a field is that people both in service and in social work education have begun to think more broadly about trauma.”

Smyth agrees: “We have always addressed trauma in terms of specific issues like abuse, combat trauma, or domestic violence. We’re beginning to understand trauma as a phenomenon that has common characteristics across events. The entire field of traumatology has really grown up since the DSM first recognized PTSD. Most of the knowledge base about trauma has developed in the last 30 years.”

 As the social work profession begins to better understand trauma, the push toward incorporating training into curricula grows as well. The National Center works with schools of social work to provide trauma-informed, evidence-based child trauma treatment education and training, according to Strand. The educational focus in the past always has been more on interpersonal violence, areas such as child abuse or neglect, she explains, but there’s been a growing awareness in the field about postdisaster work, such as after events like the Sandy Hook shooting.

“Increasingly, social workers need to know not only how to respond to the serious and chronic exposure of a child to ongoing trauma, such as abuse or neglect, but also the differential response needed for disasters such as Hurricane Sandy or, even more severe, a school shooting like that in Newtown,” Strand says. “How they respond can make a big difference.”

The National Center would like to see community-based agencies providing EBTT and the production of more culturally sensitive practitioners. Robert Abramovitz, MD, a distinguished lecturer and codirector with Strand at the National Center, adds that some Newtown responders may have lacked critical training.

“We were seeing a lot about social workers in the news in the days following the shooting,” he says. “They were being called counselors to the children, and we know that many social workers made themselves available to help. But we also know that from the very nature of past education and training, some of those social workers may not have been as well versed as they needed to be—that is, unless they got some on-the-job training on trauma and grief. It’s an area where, until more recently, social workers simply haven’t been trained, so that has been another impetus for why we feel trauma is so important to get into the current curriculum. You see the responders to a tragedy like this, and you just hope that they are prepared to deal with it.”

Teaching Self-Care
Lack of training or limited training can be detrimental not only for clients but also for social workers who find themselves unprepared for their cases. Secondary trauma is very real. “Social workers need to think about how they will deal with the impact of the work on themselves as they help people heal from traumatic experiences,” says Ellen DeVoe, PhD, MSW, an associate professor and the founding director of the trauma certificate program at the Boston University School of Social Work (BUSSW).

At BUSSW, the trauma curriculum includes a study of different frameworks for self-care, such as the model from the Traumatic Stress Institute that emphasizes looking at all components of the social worker. “We talk about that framework in the realities of everyday practice,” DeVoe says. “For example, when you come home, are you still thinking about your trauma cases? Is trauma sneaking into your interpersonal relationships? We help students do a self-assessment to stay on top of how they’re managing the material. That’s important to talk about because we know that when social workers aren’t engaging in self-care, they are more bound to make clinical and ethical errors.”

At the University of Denver’s Graduate School of Social Work, self-care is an assignment in the first course, says Marian C. Bussey, PhD, LCSW-CO, an associate professor and the director of program assessment and evaluation. Students are asked to create a self-care plan, and literature on secondary trauma is tied into the lesson, says Bussey, who also is program coordinator of the interpersonal trauma studies certificate program.

“In the second part of the course, we ask them to take a look at that plan and whether they were able to stick to it,” Bussey explains. “If their plan was to relax by doing yoga three times a week, we ask if they were able to actually do it. As busy students, many are not able to stick to their self-care plans, and we point out that it will be the same case once they are employed. That often hits home for the students, and we start talking about ways to find, at the very least, a mini break. We talk about how secondary trauma is different from burnout. Burnout can happen in any area—even too much paperwork can cause burnout. But when working with traumatized clients, the secondary trauma that caregivers can experience may be severe.”

Evolving Education
Until recently, many school programs didn’t have a strong focus on trauma education despite the fact that many social workers regularly work with trauma patients. Over the years, the programs that began to adopt trauma education often did so in the form of a trauma certificate program or elective courses. But even that is changing.

Bussey says this is the last school year in which the University of Denver’s Graduate School of Social Work will offer trauma education in the form of a certificate. “So many students want to know about working with trauma and have over the years told us that every social worker should learn about trauma, so rather than a certificate, we are keeping all the existing trauma classes and field placements and adding more specialized trauma courses,” she explains. “The trauma courses will also be open to students in a community or macro concentration, whereas the certificate was limited to students in a clinical concentration.”

The University at Buffalo School of Social Work is in its fourth year of infusing content about trauma throughout the curriculum. “Trauma is typically taught as an elective or by some professors in a human behavior course, so not all students are getting that education,” Smyth says. “It doesn’t matter what kind of social work you’re getting into—direct practice or policy—you need to understand how trauma affects people and systems. That’s why we changed the curriculum here at the University at Buffalo. If you make it an elective, what happens to the students who choose not to take those courses? They are still working with trauma patients, no matter what population they’re working with. We need trauma education to be part of our core knowledge base as social workers.”

“There is a very deliberate, expressed interest in how we can get our providers better prepared for practice and for work in agencies, and the fact is that better trauma training is needed,” adds Susan A. Green, LCSW, codirector of the University at Buffalo’s Institute on Trauma and Trauma-Informed Care. “As providers, we are spending more time thinking about being trauma sensitive, trauma specific, and trauma informed and forgetting the fact that trauma impacts all of us, making self-care truly critical.”

Realistic trauma training also is important. Abramovitz says students need more exposure to real-life cases. “The case studies our program looks at are very realistic, and we go through them step by step as though they were a real case,” he explains. “The students have very strong reactions to the written material, and we see their reflection papers discussing the fact that their eyes were opened to the possibilities of secondary trauma. That helps them realize the importance of developing self-care techniques before they even get into the field.”

Back in the Field
Reflecting on Newtown and other recent mass shootings and the tasks professionals face when helping trauma survivors, it’s impossible not to consider the importance of trauma education and training and where it’s headed.

Bussey says that following the Columbine High School shooting in 1999, she took some training offered by the state of Colorado on disaster response and learned the importance of not forcing traumatized clients to talk about what happened right away. She hopes that the responders in Newtown have gotten the same message. It may take a long time for the shock to wear off, and the people of Newtown need to be treated gently.

“The first step is to focus on immediate safety and psychological first aid, [asking] do they feel safe and what steps can we take to make them feel safer?” Bussey explains. “We know we are good-hearted people, but with trauma clients it takes time to build trust, and we have to understand we can do more harm than good by being too eager to talk about what happened. It could be weeks or even months before these clients are ready to really talk about it, and that’s the time when they need really good trauma-trained therapists to help them start coping.”

Smyth agrees, adding that the caregivers responding to traumatic events need support of their own. “The bad news is that anytime there is a large disaster like this, there is a lot of chaos,” Smyth says. “I’d be interested in what kind of support is available for the caregivers in the coming months because, as a profession, we’re good at caring for others but often not for ourselves. That’s why it’s so important that self-care is taught at the curriculum level. As a profession, it would be wonderful if we could find ways to more actively support our caregivers when they’re facing some of the most difficult parts of their work, such as responding to a crisis like Newtown. I think that has to start at the education level to better prepare social workers for the field.”

— Lindsey Getz is a freelance writer based in Royersford, PA, and a frequent contributor to Social Work Today.