From trauma aware to trauma-informed:

Why it’s important for oncology social workers

OSWANZ

Conference 2019

Katie Carlson and

Toni Ashmore

November 2019

Overview

• Perspective is curious and reflective not expert

• Looking at a case study through a trauma informed lens

• What is trauma and types of trauma

• Essential knowledge social workers need to be trauma informed

• Frameworks

• Why it is important for oncology social workers

• Education package

• Discussing trauma: consider your own triggers and self care

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Case Study – “Mary”

• Woman, Mid 50s, European background

• High flyer in the public service for many years before retiring early

• Diagnosed with a terminal illness but can have good outcomes with Radiation Therapy

• Does not want to wear a gown, sit in a waiting room, or in another area with men in gowns, get a tattoo, have a photo taken, or have her name called out

• Well aware of resources to access health rights

• But wants treatment

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FRUSTRATION

ANGER

DON’T FEEL LIKE HELPING

TOO HARD - GIVE UPLANGUAGE

What is trauma?

• “…trauma has been described as the difference between the feeling of losing one’s mind (single-incident trauma) and losing oneself (complex trauma)” (Herman, 1992, 1997)

• “State of high arousal in which normal coping mechanisms are overwhelmed in response to the perception of threat” (Cozolino, 2003: 270).

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Trauma types

Intergenerational Trauma

Collective/

Systematic

Complex Trauma

Single Event

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The elephant in the room….

• 1 in 4 Australian adults living with the impact of childhood trauma (Blue Knot)

• 1 in 3 girls and 1 in 5 boys experience sexual abuse by age 18

• 1 in 4 women experience at least one incident of intimate partner violence (ANROWS). Research showing increased risk of cancer diagnosis

• 1 in 4 women and 1 in 6 men experience emotional abuse (AIHW)

• ACE study: 4 for more double the chance of developing a cancer diagnosis

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Daily Functioning Ongoing Vulnerability to Stress

Sense of Self Attachment/

Relationships

Fight – flight Chronic Hyperarousal and fear conditioning

Freeze and dissociation

Tend and Befriend

Physical ResponsePresent Impacts

Cognitive Responses Other Responses

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Information processing

Hemispheric Specialisation and

memory

Attention and

Focus

Decision making and judgment

Emotional Responses Behaviour Responses

Personality distortions

Intergenerational transmission

Trauma and social work in an oncology setting

• Why important

• Core work

• “difficult patient”

• Awareness of triggers (things not being in their control)

• SW values

• A biopsychosocial approach

“In the absence of supportive and trauma-informed responses, a person’s prior

trauma can be compounded. A lack of understanding, empathy and support for their distress can also foster devastating

secondary trauma”

(Blue Knot Foundation 2018).

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Applying trauma-informed care principles

Safety

Trustworthiness

CollaborationChoice

Empowerment

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Trauma informed care shifts the philosophical approach from:

“What’s wrong with you?”to

“What’s happened to you?”

Essential knowledge to become trauma informed

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1. Understand the impacts and stress on the brain

2. Signs of trauma can take different forms

3. Simple ways to lower arousal can restore safety

4. Challenging responses and behavior can be defenses against stress

5. The way in which we interact with a traumatised person not just what we say and do – is important

- Blue Knot Foundation, 2018

Education Package

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• Developed in response to unmet knowledge and skill needs of social work staff in Acute care, Cancer and Rehabilitation streams at Canberra Health Services

• Education based on essential knowledge and trauma informed principles

• Using Power Threat Meaning Framework and case examples, allowing staff to practice trauma specific questioning

• Including trauma in psychosocial assessment template with prompts

• Goal to develop educational package for other health professionals, in particular radiation therapists

Key questions to consider

• How might an experience of trauma: - Affect patient attitudes to and interactions with your cancer

service?- Affect patient's attitudes to and interactions with you as a

social worker?- Affect the ways in which you interact with and respond to

patients?• What does your organisation need to do to improve its

interactions with, and service delivery to patients?• What do you need to do to improve your interactions and

service delivery to patients?- Blue Knot Foundation, 2018

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Take away

• Important for oncology social workers to be:

- Trauma aware trauma informed

- Respond to trauma

- Be a trauma informed advocate

• Frameworks and training is available to develop trauma informed care and practice (go to: www.blueknot.org.au)

• Take some time to reflect on what you’re already doing

• What can be extended to your colleagues or work environment?

• Be mindful of the risk of vicarious trauma

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Thank you