Trauma-Informed Practices


Susan’s story background “When Susan Brown was 24 years old, she was brought to the emergency department in 2010 for beating up her 28-year-old sister, Karen, and threatening to kill her twoyear-old nephew at a family brunch. Susan accused Karen of ‘doing the devil’s work’ and had left Karen badly bruised before the police responded to the 911 call put out by their mother, Pam.” “Susan had reportedly ‘not been herself’ since she was 18. Susan dropped out of her first year of college and spent most of her time ‘holed up in her bedroom’. Pam thought she seemed different – suspicious even- but attributed this to her ‘being depressed, hanging out with the wrong crowd and smoking a lot of marijuana’. Pam also thought that Susan was depressed as a result of breaking up with her first serious boyfriend. Pam blamed herself for not realizing earlier that Susan was ill.” [page 217]

 • After the violent incident, Susan experienced psychosis and voices telling her to separate from her family

 • Susan was angry with her family

 • Susan believed she had not problems and was not ill

• Pam became her substitute decision-maker

• Susan started medication

• Susan improved

• Pam told Susan she could not return home unless Susan agreed to Depot Medication of the antipsychotic medication and agreed to psychiatric follow up. Pam was worried that without this plan that Susan would get violent again.

 • Susan did not want this plan and wanted to stay away from her family when discharged

• Susan did not want her family to have any access to her health or treatment information

• Referral made for Pam to see family worker for “support, education and counseling”

Family’s story

• On care team – family worker to support Pam and Karen

• On care team – case manager and psychiatrist for Susan

• Family worker for Pam and Karen chose to not look at Susan’s hospital record so as to not be aware of confidential information

• Family worker met with family away from hospital

• Note – Pam has history of interpersonal violence with ex-husband [Susan’s father] and Susan’s behavior was triggering

• Pam and Karen reported major stressors in trying to access mental health care for Susan for a few years and feeling judged negatively

 • Pam felt judged by hospital treatment team for refusing to take Susan home, reporting hospital team thinks she is ‘a bad mother’

• Family worker was validating and supportive, helped her grieve feelings related to Susan, helped her maintain hope for the future reconciliation with Susan

 • Pam working on understanding Susan’s illness and developing a sense the illness trajectory

• Pam commits to her own self-care

 • Karen decided to seek psychological support elsewhere and withdraws from her mother

• Pam continued to seek support with family worker

 • Part of Pam’s stressors included feeling isolated and feeling stigma related to her daughter’s mental health issues

• Pam held attitude that important to have “tough love” approach with her daughter and hold boundaries about plan for conditions regarding Susan returning home [eg importance to be on Depot Medications and seek psychiatric follow up]. Pam thought the “tough love” approach would “save Susan”

• Pam had ongoing guilt in not recognizing or getting help for Susan sooner and in thinking violence in home was a factor in Susan’s development of psychosis

6 months later

• Susan hospitalized again. Pam found out about it and reached out to hospital in wish to contact Susan. Susan was receptive

• An in-hospital meeting was arranged

• Pam felt afraid of her daughter and staff arranged seating so that Pam could be near doorway for a quick exit if needed

 • Susan restarted medication and wanted to re-start relationship with her mother

• Susan wanted to continue medication and wanted Depot Medication and psychiatric follow-up once discharged

• Susan was discharged to live with her mother

• Family worker continued to support Pam individually

• Susan had own case manager

• Also regular family meetings were held with Pam and Susan

• Susan engaged in various steps to “regain her life” • Pam notices Susan relies on her, as if Susan were younger

• Pam aims for Susan to become as independent as possible

• After 6 months, Pam joins family psychoeducation group for families with members’ experiencing mental health/substance use issues

• Pam joins in becoming an advocate for Susan

• Pam decides to seek education to become a family worker Currently

• Susan enrolled in college classes. Starting to ‘regain her life’ in developing interests and friendships.

• “Susan says that ‘losing my mom and Karen was devastating and helps me remember to take my medication every day and to do everything that I can not to land back in hospital’.” [page 221]

• After 6 months, Pam joins a family psychoeducation group for families with members’ experiencing mental health/substance use issues

• Pam joins in becoming an advocate for Susan

• Pam decides to seek education to become a family worker Trauma-informed Family Work

• “Family-centred trauma-informed care focuses on meeting the needs of both the person with mental health or substance use issues and his or her family. It builds on the strengths and interconnectedness that exists in families.” [page 222]

• Builds on “listening, responding to and supporting the family’s concerns, opinions, values, beliefs and cultural background” [page 222]

• Person in recovery maintains control

• Family is given support even if the client does not wish to be involved with their family

• Collaborative

• Parallel recover process theme [eg client and family are in recovery in parallel process]

• Efforts made to avoid blaming

• Acknowledgment of history in family treatments of blaming approaches

• Focus on safety, strengths, and resilience

• Referral to peer supports including other families with lived-experiences

Which trauma-informed principles were used by the professionals in the case?

How did the professionals integrate these principles in their care of Susan and her family?

 Discuss your impression of the trauma-informed practice principles’ general importance and overall usefulness.

Did the trauma-informed care practices help in the case or not help? Provide examples from the case in your discussion.


Trauma-Informed Practices

Professionals used various trauma-informed principles in the case of Susan and her family. The professionals, in this case, used safety, experience, voice and choice, trustworthiness and transparency, peer support, and collaboration and mutuality. They also integrated these principles into their care in this case.

At first, regarding voice and choice, the professionals did not force Susan to go live with her family after been discharged, and they respected the fact that Karen did not want to seek psychological help with them. Therefore, they enabled Susan and Karen to actively take part in determining their own care, thus preventing re-traumatization by respecting their choices and hearing their voices in care decisions. Additionally, to promote trustworthiness and transparency, the family worker dealing with Susan’s mother and sister did not look at her hospital records because she had prohibited her treatment information from reaching her family. The transparency ensured that Susan did not lose trust with professionals working in the case. Regarding safety, the professionals ensured that that fan and Karen did not meet the family worker in the hospital where Susan was and ensured that Pam felt safe when she meets to reconcile with her daughter for the first time. By considering Susan’s and Pam’s fears that were based on previous events, the professionals made sure that the two felt physically, emotionally and psychologically safe while in care.

The professionals also ensured collaboration and mutuality by factoring in pam’s view of that “tough love” approach of saving her daughter. Also, while Susan had her own case manager and Pam worked with the family worker, the two groups eventually came together and embraced Pam’s idea of making her daughter as independent as possible…………for help with this assignment contact us via email Address:

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