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Care and Support should be the primary Goals – Opinion piece by: Dr. Laura Lewis

To what degree are social work services caring and supportive, rather than controlling or solely focused on safeguarding?  This question is not purely academic in nature, as positive outcomes and effective interventions for service recipients may depend on the answer.

If, for example, recipients of service experience interventions as intrusive and unnecessary, the potential for positive outcomes is likely to be greatly diminished.

On the other hand, eliminating coercive practices and including service recipients as full participants in treatment, programming and policy development may result in more successful outcomes.

To what degree is this possible?  The answer may lie in the development of new paradigms for service delivery.   Some promising frameworks are identified below.

A trauma-informed approach to care promotes the transformation of mental health treatment and other services.  A reaction to the high prevalence of trauma, this approach directs providers to ask consumers, “What happened to you?” rather than “What’s wrong with you?”  (Visit Center for Disease Control:  The Adverse Childhood Experience (ACE) Study for more on the prevalence of trauma among individuals seeking services.)

Fallot and Harris (2001) differentiate between trauma-specific treatment services (treatment of PTSD, for example) and a trauma informed delivery system, which incorporates an understanding of trauma in to all aspects of service provision.  A program is trauma-informed to the extent that it meets criteria for safety, trustworthiness, choice, collaboration and empowerment.

Somewhat similar to a trauma-informed approach is the current focus on “person-centered” practices in the mental health and addictions fields, as well as the development of “patient-centered” practices in hospital settings.  Both offer strengths based alternatives to care, and attempt to integrate patients in to service delivery.

As social workers, we are better positioned than most professions to transform the way services are delivered.  We bring to the table a person-in-environment perspective that can position the goal of creating safe environments for service delivery at the center of the present debate.  We understand the importance of developing trusting and supportive relationships.

What would services look like if we began asking consumers about their experiences as Fallot and Harris suggest?  Social workers would strive to understand the strengths that individuals bring to the table; their values and their beliefs.   Peer and social supports would be incorporated in to service plans.

But might the inclusion of non-traditional approaches to healing also become possible?  Might the settings where services are provided be more inviting?  Might staff themselves enjoy the benefits of safety, trustworthiness, choice, collaboration and empowerment?  Bloom (2006) presents a model of transforming entire systems in which service settings are trauma-informed for both clients and agency staff.  (See The Sanctuary Model of Trauma-Informed Organizational Change for an example.)

Of course there are circumstances – where a child’s safety is concerned, for example – where a level of control and support are necessary.  Where there has been intergenerational involvement with the child welfare system, the need to create conditions of safety, trustworthiness, etc. are particularly important.  In these situations a social worker is far more likely to be successful if they convey empathy, support and respect.

To what degree can social work services be organized around principles of care versus control, and support versus safeguarding?

I believe that the provision of effective services depends on social workers tipping the scales in the direction of supportive and caring relationships.

Bloom, S.L. (2006). The Sanctuary Model of Organizational Change. Retrieved February 7, from

Fallot & Harris (2001).  Envisioning a trauma-informed service delivery system:  A vital paradigm shiftNew Directions for Mental Health Services, 89, 3-22.

Dr. Laura Lewis  (@swfield) is the Director of Field Education, School of Social Work at University at Buffalo.

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2 thoughts on “Care and Support should be the primary Goals – Opinion piece by: Dr. Laura Lewis

  1. Please learn more:
    WHO’s Dr. Gary Slutkin – Disrupting Violence
    Watch “The Interrupters” on Frontline, Feb 14th – Film based on Slutkin’s work.

    I am not affiliated with either of these resources. Just trying to educate and spread the word on trauma and “toxic stress.”

    Posted by Jackie | February 8, 2012, 1:17 am
  2. The misunderstandings about care and control maybe at the heart of the social work dilemma.

    I suspect it has effectively brought the probation service to its knees.

    Joe Public and most of the fearful parliamentarians think people should be controlled whereas our training and social work experience tell us that one only gets ‘improved’ behaviour when people feel it is generally in their best interests and that they are not being coerced primarily to suit the demands of the more powerfull and influential.

    ‘Social Work’ in all its guises nees to make this the Public relations priority of this century.

    Posted by essexandrew | February 8, 2012, 7:35 am

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