Beyond medicalized approaches to violence and trauma: Empowering social work practice

Abstract

Summary: Social workers are positioned to respond to clients with a history of trauma by practicing bio-psycho-social, trauma, and violence-informed care but frequently encounter systemic barriers to providing holistic care. The research presented in this article was initiated by a College of Social Work in Canada in response to concerns raised by social work providers that their practice was constrained by ideological, structural, and system limitations within publicly funded mental health and addiction services. Ideologically trauma-based social work care is defined by five principles of safety, trust, collaboration, choice, and empowerment and recognizes that what has happened to individuals, including early adversity, can influence their bio-psycho-social functioning across the lifespan. Structurally, trauma-based care recognizes the corrosive impact of poverty, systemic discrimination, and exclusion. Findings: Our research included a literature review, an online survey (n = 115 completed surveys), individual interviews (n = 50), and three focus groups (n = 15). The findings consistently highlighted a dissonance between dominant bio-medical approaches and reliance on the Diagnostic Statistical Manual of Disorders and social justice–based practice. Primary themes included a recognition by social workers of the pervasive presence of trauma and its effects, including mental health and addiction challenges; intergenerational impacts of trauma; the limitations of the medical model; and the need to reposition social work practice. Applications: Repositioning the role of social work within mental health and addiction settings to center social justice responses to trauma presents transformative opportunities to better meet the needs of service users and increase workplace satisfaction.