Editor Introduction

I am excited to welcome you to this special Journal issue focusing on trauma-informed social work practice in end-of-life and palliative care!

Psychological trauma can be defined as events that threaten death, serious injury, or sexual violence to self or other. Further, the event must be experienced directly or personally witnessed (American Psychological Association, 2013). Taking this definition into consideration, hospice and palliative care patients may often be considered to have experienced trauma due to being diagnosed with a life-threatening illness and likely have undergone numerous intensive medical interventions. According to Ganzel (2018), it is important to note the hospice and palliative care population is composed of primarily older adults and that aging itself puts older adults at higher risk of experiencing trauma, and also include events other than medical such as the serious or life-threatening illness or death of a spouse, child, or others with a close relationship (Ganzel, 2018).

The Substance Abuse and Mental Health Services Administration (SAMHSA) established the first general Trauma-Informed Care model (TIC). In response to the issue of re-traumatization, many healthcare sectors have adopted these models to improve care delivery. The SAMHSA model emphasized recognition of trauma symptoms and interventions designed to lower risk of re-traumatization. SAMHSA outlined six key principles important for incorporating TIC into clinical practice, including creating safety, trustworthiness, peer support, collaboration and mutuality, empowerment, voice and choice, and attention to cultural, racial, historical and gender issues (SAMHSA, 2014). These are highly concordant with social work and palliative care values and practice.

Assessment of psychological trauma is thus essential first step to recognizing and safeguarding individuals’ and families’ safety and building trust during treatment in hospice and palliative care. Social workers can lead the way in this assessment and in designing and implementing trauma-informed palliative interventions. Another key role is in transforming agency policies and practices to prevent individuals from becoming re-traumatized while receiving further care in the agency. Personnel and practice policies should promote transparency, trustworthiness, safety and collaboration (Ganzel, 2018).

The articles in this issue all describe efforts to enhance the recognition of the effects of psychological trauma in the field of end-of-life and palliative care and potential interventions to minimize re-traumatization and increase quality of life. This issue begins with several reflections by social workers that provide a foundation for what follows.

In the first of three “practice concepts and innovations,” DiBiase provides a foundational perspective from which to understand Trauma-Informed Care; definition, growth in health care, including palliative care programs, and the essential role of palliative social workers. Goals include adapting the environment to meet the needs of patients and families rather than expecting them to adapt to the health care system. Early assessment of traumatic experiences and working with the interdisciplinary team to recognize and understand the meaning is important for building trust and lessening for further traumatization.

Next, Brown and colleagues address the frequent occurrence of the re-traumatization that occurs when individuals who are already affected by PTSD and then face a serious or life-threatening illness and interface with the health care system. Past trauma, could be reactivated when faced with invasive medical treatments and other aspects of care, particularly in acute inpatient settings. Further described are two specific avenues for TIC interventions and the utilization by palliative social workers: the Stepwise Psychosocial Palliative Care Model and Inpatient TIC Interventions. The authors provide a case example to illustrate a trauma-informed intervention.

Hansen, Davis, and Hubbard discuss the Neonatal Intensive Care environment as a source of considerable trauma for families. They present a tool that was developed, the Family Guidance Tool, that offers a way to build trust in this environment between the families and health care professionals; using a strengths-based approach. The goal is also to place the families in a position to help be a guide in the relationship with health care teams and regarding care. The authors provide a potent argument for the use of trauma-informed interventions to reduce the stressors inherent among families who are experiencing often long stays with numerous intensive medical interventions or death of their babies.

In a research study, Mirick and Berkowitz present a qualitative examination of adolescents’ experiences with grief and loss after a suicide. Suicide among adolescents is among the highest in the U.S., thus many adolescents will unfortunately have the experience of the suicide death of a classmate, peer or friend. In the study, these adolescents discussed how they processed the death and in particular regarding the struggle to make sense of the death and find meaning in it. Understanding these experiences, social workers can better support the adolescents and intervening to lessening potential negative coping.

We hope that you find this issue enlightening and thought-provoking, but also that it may encourage further practice efforts and research in trauma-informed care.