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Self-Care as a Trauma-Informed Practice
By Karen Flint Stipp, MSW, PhD, and Kyle Miller, MEd, PhD

Before social workers begin problem solving or providing services, we attune ourselves to the client. We establish a relationship by being present and empathic and supporting client efforts to survive and thrive. This relationship helps workers understand client needs and dreams, and also supports what has been called the "ordinary magic" (Masten, 2014) of resilience, which seems to vaccinate a person against the debilitating effects of traumatic stress.

This magic is especially important for clients who carry the trauma of violent events that occur in war and domestic conflict or the chronic trauma of growing up without secure attachment to a primary caregiver. Whether resulting from violence, abandonment, or a combination, "the essence of trauma is feeling godforsaken, cut off from the human race" (van der Kolk, 2014, p. 335). Connection to another human—relationship—supports this ordinary magic of resilience.

Relationships with a succession of people living in trauma's wake, however, create worker vulnerability to a trauma contagion, to the deep unsettledness of secondary trauma. These repeated exposures affect even the most experienced professional, and the price of ignoring our unsettledness is high. The price may be physical, collected deep in our shoulders or down in our gut. The price may be emotional, expressed in responses that are dysregulated as too restrained or too unruly. The price may be relational, giving too much away to clients and leaving too little in reserve for our friends and family. Social workers need some of that ordinary magic for ourselves.

It can be counterintuitive for compassionate professionals to attune to our own need for care. As social work students we all created self-care plans, but many of those are left behind in old notebooks or forgotten computer files. Social workers need ongoing training to notice the effects of client situations amid what Pyles and Adam in Holistic Engagement: Transformative Social Work Education in the 21st Century deem "skill-building opportunities that will help them to understand these complexities and develop skillfulness in this type of paying attention." Beyond the classroom, the profession has begun urging workers to be as compassionate toward ourselves as we are toward clients. A position statement on professional self-care urges social workers to attend to their own needs (National Association of Social Workers, in press). The profession urges social workers to apply skills they honed for attuning to and caring for clients, to attuning to and caring for themselves.

Self-care is not a luxury ancillary to our professional assignments but a professional activity that makes being present and empathic a possibility. Ongoing self-care boosts our capacity to build healing relationships time and again with clients who live in trauma's wake.

Attunement to the humanness we share with clients supports our seeking out the physical and emotional care all humans require. Attunement to the unsettled effects of trauma's contagion supports our own resilience. Self-attunement, variously called self-awareness, self-engagement, or mindfulness, is foundational to the ordinary magic of our own resilience (Masten). Resilience allows social workers and clients to manage ordinary stressors, as well as traumas from violent events or insecure attachment. Further, resilience allows social workers to manage the trauma contagion of our work, as we continue in relationships that support clients' healing, growth, and learning.

Relationship has been a tenet of social work throughout its history and has received new emphasis in social work and beyond. Enhanced brain imaging that became available in the 1990s helped neuroscientists observe the damage to neural pathways caused by the trauma of abusive and chaotic relationships (Masten; Matto, Strolin-Goltzman, & Ballan, 2014). Trauma creates injury to children's social, emotional, and academic development. Remarkably, however, neuroscientists also observed that even for the child whose development was impaired by the trauma of abusive and chaotic relationships, subsequent dependable relationships supported healing, growth, and learning in social, emotional, and academic domains (Masten; Matto, Strolin-Goltzman, & Ballan).

Conventional wisdom once held that neuroplasticity, the ability of the brain to develop social and emotional competence, was nearly expired by early elementary years. As anticipated, brain imaging revealed sensitive periods for optimal neural development. Brain imaging also revealed, however, that new neural pathways continue to develop in the context of dependable, safe relationships. It is hopeful news that at any age, dependable, safe relationships are a force for improved adaptive thinking, self-regulation, academic learning, social skills, and problem solving (Masten; Matto, Strolin-Goltzman, & Ballan). Relationship is not just an avenue for understanding and responding to client need but also the very vehicle of healing, growth, and learning.

Neuroscience research initiated new evidence-based trauma-informed interventions that help professionals bring knowledge from brain imaging into clinics and classrooms. Social workers open a manual to new evidence-based trauma-informed protocols and find a pleasant surprise in the familiar call to the self-care that is essential for relationship. Once considered a soft skill of the helping professions, self-care that supports relationship is evident throughout the new protocols.

For social workers, it is a good reminder to update and implement self-care plans and commitments, as well as a good time to consider the NASW position statement on self-care. For our sister professions, the trauma-informed call to self-care may be unfamiliar. If social workers succumb to a view of self-care as ancillary despite its emphasis in the profession, it is reasonable that our compassionate sister professionals will have difficulty viewing self-care as essential.

Schools are an area of particular interest to social work because trauma does its most devastating work against the healthy development of children and adolescents. Classrooms and schools are essential venues for social, emotional, and academic growth.

Bessel van der Kolk wrote, "The greatest hope for traumatized, abused, and neglected children is to receive a good education in schools where they are seen and known, where they learn to regulate themselves, and where they can develop a sense of agency. At their best, schools can function as islands of safety in a chaotic world. They can teach children how their bodies and brains work and how they can understand and deal with their emotions. Schools can play a significant role in instilling the resilience necessary to deal with the traumas of neighborhoods or families … to be the places where children are taught self-leadership and an internal locus of control" (2014).

Trauma-informed protocols enhance the social, emotional, and academic functioning already promoted in public school classrooms, including students' ability to get along on the playground, self-regulate, and focus attention in the classroom, and read, write, and do long division.

Despite the evidence, however, organizational change can be slow. Implementing trauma-informed schools requires more than reexamining the role of behavior charts. Organizational structures adapt to evidence slowly, even when there is extensive groundwork in place (Nadeem & Ringle, 2016). Individual teachers can implement trauma-informed practices, but districts serve the process, the teachers, and the students by recognizing and supporting teachers as humans in the classroom.

When it includes self-care in the curriculum, teacher education supports student resilience (Mansfield, Beltman, Broadley, & Weatherby-Fell, 2016). Even in those instances, however, many education majors graduate to organizational cultures with an ethos of teachers caring for students to their own neglect. There is a clear organizational message communicated by schedules that allow teacher visits to the toilet only on days when classes have art or music. New teachers may be reluctant to ask for what they need, and when student need outstrips available resources, these compassionate professionals may try to take up the slack from their own reserve. Teachers may take on a sense of responsibility for the whole system, viewing mental and physical exhaustion as evidence of dedication to their job and overwork as a response to public blaming of teachers for "failing" schools (Mansfield et al.).

Given a new evidence-based trauma-informed protocol, teachers may flip right past the manual's front matter that recognizes them as humans in the classroom. Teachers may flip past calls to the self-care that supports relationship in their quest for evidence that supports better classroom management. On page after page, they find calls to the self-care that builds the ordinary magic of their own resilience, and lay the manual aside. Before the manuals arrive and the cellophane wrap is broken, social workers may have a role in helping teachers attune to themselves, and once noticing themselves, to create and implement plans for their own care. Social workers may have a role in moving self-care that supports relationship out of the realm of a soft skill, or ancillary practice, into the realm of an essential skill, an essential practice.

A trauma-informed protocol widely used across settings, including in schools, is Blaustein and Kinniburgh's attachment, self-regulation, and competency (ARC) (2010). The protocol represents 10 intervention blocks in a pyramid, with four "attachment" blocks as the base. The base supports caregivers and professionals before setting about to support the child.

The base's first two blocks, caregiver affect management and attunement, support the adult's capacity to attune and respond to themselves, and then attune and respond to children in the classroom. The base's third block of consistent response supports adults in testing out their response strategies. The final block of routines and rituals supports adults in creating coherent and predictable learning environments that free students to "shift their energy from survival to healthy development" (Blaustein & Kinniburgh, p. 38). The entire base attunes the adult to what is happening within and around.

This may not satisfy the traditional quest for a classroom management protocol; ARC's pyramid does not address behavior per se until the third row. The second row supports the professional in creating attunement, self-management, and relational safety, and the third row finally addresses presenting the child with making more adaptive choices.

We often begin conversations with misbehaving children about making better choices, but a protocol such as ARC builds the child's capacity for choices. The child develops more capacity to make adaptive choices. The pyramid's message is that well-regulated adults support environments where children feel safe enough to learn (Blaustein & Kinniburgh, p. 35).

Relationship with the safe adult is as vital as pedagogy and curriculum for supporting a child's social, emotional, and academic learning. This is true for all children, including those who enter the classroom in trauma's wake.

Literature and mainstream dialogue make teachers out to be "neutral, unemotional, and static adults with no interior life" (Lawrence-Lightfoot, 2004, p.6). Trauma-informed protocols reject that notion, recognizing trauma's effects on all the humans in the classroom, including the teacher. For any child, including the child whose experiences of violence and disrupted attachment impede their learning, dependable relationships with adults support their social, emotional, and academic learning. For the compassionate humans who choose professions that place us in trauma's wake, self-care makes it possible to be that dependable adult.

— Karen Flint Stipp, MSW, PhD, is an associate professor who teaches social work practice with children and adolescents with an emphasis on trauma-informed practices at Illinois State University School of Social Work.

— Kyle Miller, MEd, PhD, teaches courses related to child development, elementary education, and working with diverse populations at Illinois State University School of Teaching and Learning.

References
Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self- regulation, and competency. New York, NY: The Guilford Press.

Lawrence-Lightfoot, S. (2004). The essential conversation: What parents and teachers can learn from each other. New York: Random House.

Mansfield, C. F., Beltman, S., Broadley, T., & Weatherby-Fell, N. (2016). Building resilience in teacher education: An evidenced informed framework. Teaching and Teacher Education, 54, 77-87.

Masten, A. S. (2014). Ordinary magic: resilience in development. New York: Guilford Press.

Matto, H. C., Strolin-Goltzman, J., & Ballan, M. S. (2014). Neuroscience for social work: current research and practice. New York: Springer.

Nadeem, E. & Ringle, V. A. (2016). De-adoption of an evidence-based trauma intervention in schools: A retrospective report from an urban school district. School Mental Health, 8(1), 132-143.

National Association of Social Workers (in press). Social work speaks: NASW Policy Statements. 11th ed. Washington, DC: NASW Press.

van Der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.