TRAUMA INFORMED CARE DURING COVID-19

TRAUMA INFORMED CARE DURING COVID-19

Taiwo Odesola (MSW)

Introduction

Trauma-informed care is a significant approach in human services specialization as it is assumed that an individual has possibility of experiencing one history of trauma in their life-time. The primary intention of trauma-informed care is not to treat symptoms related with sexual, emotional and physical abuse or other traumatic experience which affect human but rather focus on support services that is primarily accessible and appropriate to individuals experiencing the trauma. During COVID-19 pandemic, every individual is exposed since the virus is already entry the stage of community transmission.  For people who have experienced trauma previously in their lives, the fear they are experiencing amid COVID-19 may be strong. Health threats from the coronavirus, social distancing measures, economic fears, and isolation all have the potential to retrigger people who have already experienced traumatic events.

Trauma isn’t rare. Statistics show that trauma is pervasive. According to the National Center for Post-Traumatic Stress Disorder, (2019) about 60% of men and 50% of women experience at least one trauma in their lives and about 25% of the Nigerian population suffers from Post-Traumatic Stress Disorder (PTSD). These prevalence statistics are likely to increase with the trauma COVID-19 has already caused and will continue to cause long after the virus is gone. Given the ubiquity of trauma, TIC is an acknowledgment that a past event, multiple events, or a set of circumstances can cause intense physical and psychological stress, which creates vulnerability and influences one’s actions, reactions, and perceptions thereafter. Thus, TIC is important in helping clinicians and members of the community reframe their judgment of those who may seem difficult, rude, non-compliant, or “crazy” and help them understand that their actions or demeanor may be related to past or current trauma. TIC further ensures that a sense of safety can be created so that someone with trauma can receive proper care and attention.

Importance of Trauma informed care during COVID-19 pandemic

Although the COVID-19 pandemic require clinicians and community workers to focus on rehabilitation and treatment that it care services during the pandemic must be informed care, regardless of disclosure of prior trauma. In fact, TIC can be implemented in the same manner other universal precautions – to maintain hygiene or to address low literacy – are undertaken across an organization in providing medical care. Many individuals will not disclose their trauma, some may not even realize underlying trauma they carry with them. How patients react may suggest the presence of trauma. These reactions may be emotional, physical, cognitive, behavioral, or existential. Those experiencing trauma may not be able to verbalize what they are experiencing and many reactions will come in the form of non-verbal cues such as becoming stiff, pulling away, shaking uncontrollably, startling, crying, becoming disoriented or confused, sweating, becoming irritable, seeming uncooperative or defensive, acting aggressively, shutting down, or changing tone or pace of communications. Being aware of these reactions can help clinicians and the community recognize trauma and properly attend to reactions as they arise. Protocols of care that isolate patients with COVID-19 may inadvertently limit the expression and recognition of these reactions, hindering TIC when it is not an existing competency of universal application

Implementing TIC helps everyone, as this form of care establishes environments where individuals feel protected and empowered. Yet, COVID-19 uniquely highlights the importance of TIC. Existing trauma, whether from previous medical encounters, abuse, or other sources may prevent individuals from seeking care if they were to develop symptoms of COVID-19 or may hinder clinicians’ efforts to treat them (e.g., by rejecting auscultation to avoid being touched, or a procedure that requires lying still because this instruction replicates an abuser’s request). This understandable reluctance to seek care may unintentionally put others at risk of contracting the virus. Patients with medical trauma may find it difficult to trust clinicians. These individuals may fear re-traumatization and forgo much needed care. And if they do seek medical care, clinicians may not understand trauma reactions patients may have, like being reticent to follow orders, being more confrontational, showing signs of panic attacks, or other behaviors and reactions.

 Principles of Trauma-Informed Care

Chart by the Institute on Trauma and Trauma-Informed Care (2015)

The Five Guiding Principles are; safety, choice, collaboration, trustworthiness and empowerment. Ensuring that the physical and emotional safety of an individual is addressed is the first important step to providing Trauma-Informed Care. Next, the individual needs to know that the provider is trustworthy. Trustworthiness can be evident in the establishment and consistency of boundaries and the clarity of what is expected in regards to tasks. Additionally, the more choice an individual has and the more control they have over their service experience through a collaborative effort with service providers, the more likely the individual will participate in services and the more effective the services may be. Finally, focusing on an individual’s strengths and empowering them to build on those strengths while developing stronger coping skills provides a healthy foundation for individuals to fall back on if and when they stop receiving services.

It has been projected that, anxiety, stigma, depression and post-traumatic stress disorder (PTSD) would increase. It is crucial to consider people’s experiences of COVID-19 related trauma in the context of their psychosocial circumstances, including existing mental disorder and socioeconomic position (The Lancet, 2020). The effect of the pandemic on survivors, family and relatives is of optimum concern here. One Critical care Physician has said that, “After surviving severe COVID’19, the issue to be faced with the most in the coming months is how we’re going to help people recover”.

So, protecting survivors’ mental health, Supporting Healing and recovery must be our main focus. I will like to raise the following suggestions for survivors’ care both during Covid’19 and after:

• Open and honest communication
• Training on trauma management for all Health practitioners including Medical social workers.
• Creative approaches to supporting people who are vulnerable to traumatic effects of the crisis.
• Be calm and listen to survivors
• Show more concerns for survivors or their relatives, to show more concern, there might be a need to put on personal protections such as gloves and nose masks, hold their hands and stroke their arm for like 2 minutes.
• Create an environment where survivors feel physically & emotionally safe.
• Clients with dementia may need written reminder posted on the walls instructing them to wash their hands, use sanitizer or use facemask.
• Offer psychological support to people who need it.
• Assessment should be made simple and enable clients to have a voice in the decision.
• Instead of isolating survivors, we are all in this together, Covid’19 is a Global challenge and we must take a Global approach to its treatment. Virtual support groups can be created and run effectively within Nigeria as a country or globally. Social platforms such as telegram, Facebook or Zoom, can be used which will involve health practitioners like as Doctors, Medical social workers and other Mental health practitioners. I have personally tested these platforms on some burn survivors and I recommend it as an effective treatment plan for Covid’19 survivors.
• Webinar and virtual counseling sessions focusing on survivors’ recovery should be of paramount interest.
• Health practitioners should include Trauma therapy as part of the treatment plan such mindfulness practice and coping skills on mobile phones.

Conclusively, Trauma-Informed Care understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize.  More importantly, COVID-19 presents many new challenges to community life and health care. Among those challenges is implementing Trauma Informed Care during a pandemic when resources are in short supply, systems are overwhelmed, and we all face the unknown every day. However, it is because of these dire issues that TIC must be implemented. Without trauma informed care, we risk individuals not seeking care and exponential growth of trauma among communities living in fear and in those who survive.

Ms Taiwo Odesola, a Nigerian Social worker. She’s been involved in the promotion of mental health among teenage and young persons for some years. She holds a Master of Social Work from the University of Ibadan. She is a Trauma Recovery Coach and Manager at Scars2stars Initiative, this is a UK Based Organization that focuses on helping people living with scars especially burn survivors, to recover and turn their scars to stars using several psychosocial therapies. She is a pro bono Program Officer of Divine Well Global Foundation.

Reference

1. COVID trauma response: trauma-informed mental health support. Retrieved from  https://www.nationalelfservice.net/mental-health/ptsd/covid-trauma-response/ on 6/26/2020.
2. How will the world be different after covid’19; retrieved from https://www.imf.org/external/pubs/ft/fandd/2020/06/how-will-the-world-be-different-after-COVID-19.htm
3. Kelly Servick, April 2020. For survivors of severe COVID-19, beating the virus is just the beginning. Article retrieved 26/06/2020 from;  www.sciencemag.org
4. Photo by Raphael Lovaski on Unsplash
5. Terrey L. Hatcher, (May 2020). Integrating Trauma-Informed Care in Home Health: COVID-19 Considerations. Retrieved on 6/27/2020, from; https://www.relias.com/blog/integrating-trauma-informed-care-home-health *

Study Of The Ethical Challenges Faced By Social Workers During The Covid-19 Pandemic

Study Of The Ethical Challenges Faced By Social Workers During The Covid-19 Pandemic Published

Pandemic, Politics & Practice of Social Work

Boye Leye ALABI

Politics seem to be a staple of major global events, the climate of fear and uncertainty created by pandemic has provided a breeding ground for conspiracy theories and various governments’ responses to it. At the start, Public perceptions regarding the danger posed by influenza altered markedly following the 1918 Spanish Influenza pandemic. When the decision was taken to establish a new universal health organization in 1946, one of the first tasks assigned to the Interim Commission of the WHO was to develop a new program to monitor and study influenza. Another theory which was able to spread as rapidly as a virus itself in the African region was that novel coronavirus is somehow linked to 5G technologies. Some claimed that 5G is the cause of COVID-19, another claimed that the Corona Virus is a biochemical/biosecurity weapon to put the entire globe under the control of some high-profile individuals like Bill Gates and that the development of a COVID-19 vaccine is an attempt to microchip the global population

Despite these conspiracies being debunked by medical scientists, technology experts and fact-checkers, they have spread across social media platforms which have been slow to react in clamping down on misinformation. According to research in the UK, over one-fifth of people think that COVID-19 is a hoax, while nearly two-thirds believe that it is to some extent man-made. The President of the U.S, Mr. Donald Trump once labeled the coronavirus “China Virus” while China had also promoted the theory that the Virus may have been intentionally transplanted to Wuhan by the U.S military

The trace to the actual source of the virus remains uneasy and groundless speculations about the origins of the pandemic continued to gain ground by how some eye-catching tweets reveals how China’s changing propaganda tactics have interacted with mangled news reporting, social media conspiracy theorising, and underlying US-China tensions — all resulting in high-profile misinformation about a global public health crisis, It’s clear some conspiracy theorists see COVID-19 as an opportunity to gather more mainstream appeal.

Pandemic and politics is not only limited to China or the US, conspiracy theories are everywhere since the outbreak of the virus. Even in many Muslims countries, people blame western countries for the spread of the virus. China has recently turned to Norway in the blame game over claims of Corona Virus detected from imported frozen Salmon fishes. Everyone seems confused.

In Nigeria, the NCDC and the federal government have been accused by many Nigerians of playing politics with the pandemic. People have expressed concerns over the release of only the figures like ‘ daily livescores’ and have continued to criticize the decision to keep the identity of the infected cases strictly confidential. Many believed that knowing the identity of the infected cases could have helped far better in the collective fight against the pandemic. We saw footage of videos of political rallies from Oyo State in March and recently from Edo state publicly defiling the lockdown and social distancing rules. Nigeria government at various levels have continued to ease the lockdown at a time when the Covid-19 cases continue to rise significantly despite the fact that there are questions begging for answers.

What is Nigeria’s readiness after its first case was confirmed on 28 February? As of 17 June, the country had more than 17,000 cases and 455 deaths. Is Nigeria among the global race to find a vaccine? If not, Why not if a production laboratory in Lagos was still functional? Records show that Nigeria’s Federal Vaccine Production Laboratory in Yaba, Lagos was created from the Rockefeller yellow fever laboratory, established in 1925. “The Yaba laboratory started producing smallpox vaccine in 1930s, followed by anti-rabies vaccine in 1948 and yellow fever vaccine in 1952,”

A 1987 technical consultancy report on the laboratory showed that it was making yellow fever vaccines in the 1970s and 1980s. It produced 316,000 doses of yellow fever vaccine in 1978, reaching a peak of more than 500,000 doses in 1987.  As at now, no human vaccines are currently being produced in the country. Only vaccines for animals are being made. In May 2020, Nigeria’s parliament passed a motion urging the government to reopen the Yaba facility to help fight diseases such as Covid-19.

Implication on Social Work Practice

Social workers and national social work organizations should be a part of the national advocacy movement to enact these precautionary and responsive changes in large numbers. Some of this advocacy can even be done from home by writing letters or making phone calls. There is no limit to the number of issues that need social work advocacy. We must rise to the challenge. It is critical to discuss triage. Our hospitals will be overwhelmed. There is very little suggesting at this time that we can completely stop this. There is still hope of flattening the curve to help minimize this surge in hospitals, but avoiding it all together seems like a statistical improbability. Social workers absolutely must engage in this process – first, the hotspots. Underlying structural racism and socioeconomic barriers will exacerbate difficulties in this public health emergency as with health care writ large.

Lastly, Social workers working in hospitals have a responsibility to be involved in the policies addressing access in this emergency. We have expertise in social determinants of health and can be essential in identifying policies that might impact them before poor policies are enacted. Triage decisions will need to be made in the moment. Hospitals are already discussing the guidelines. How will we ensure that people with disabilities are not denied care simply by virtue of their disability? How can we ensure that implicit (or even explicit) bias does not drive triage decisions? Social workers can serve on ethics committees. We can volunteer to work on the committee designing the policies.

Boye Leye ALABI, is a Medical Social Worker at the Medical Social Services Dept, Neuropsychiatry Hospital, Akure

08038293244; leyealabi@gmail.com

Spotlight of Newly Qualified Medical Social Workers in Nigeria

Meet @AkinjisolaS A Medical Social Worker at the University of Medical Science Teaching Hospital, Ondo State. His passion evolves around psychosocial care for patients experiencing trauma in the hospital.

http://www.ifsw.org

http://amswon.org

http://Global Social Service Worforce Alliance

CONTACT TRACING FOR COVID-19: THE INDISPENSABILITY OF THE MEDICAL SOCIAL WORKER

Introduction

The emergence of the novel corona-virus was a wake-up call for a public health emergency around the world. The virus emanated from the Chinese central city of Wuhan in the Hubei Province and has since spread to most countries of the world. The infective agent is known as Covid-19 and has been considered a public health pandemic by the World Health Organization.

Read More

Secretary-General report on the Social Work Response to COVID-19

Ethical Decision-making in the face of COVID-19

Ethical Decision-making in the face of COVID-19

MESSAGE OF HOPE IN THE ERA OF COVID-19

Dear Medical Social Workers,

I am writing with a special message of support and encouragement to you all in these challenging times. It is not more news that COVID-19 is confronting the global community with extraordinary challenges and opportunities, transforming our lives as we knew them and overwhelming our healthcare systems. The virus poses serious risks to our patients and their families, other vulnerable populations, and healthcare providers everywhere, exposing the global unmet need for psychosocial support services.

Distinguished colleagues, the task before us as Medical Social Workers in Nigerian hospitals is serving as frontline workers conducting contact tracing, conducting home visiting which is to ensure that people who have been identified as being in contact with the index patient are self-isolating as directed by Nigerian Center for Disease Control (NCDC). Medical Social Workers has being providing psychological first-aid to patients and their family members who are experiencing high levels of anxiety, fear, paranoia and despair arising from multiple reasons i.e. fear of infection, financial insecurity, job security and loneliness may occur due to the extended periods of self-isolation and lockdown of the country. As Medical Social Workers, we must ensure that rights of patients and their expectations are paramount, protected and addressed as the health system adapts to deal with the COVID-19 crisis. Organizing communities to ensure that essentials such as food and clean water are available and facilitating physical distancing and social solidarity.

As we help people in our communities, we need to heed the best scientific information. As critical thinkers, we need to search out the best available information as we work to support the people we serve and our communities. There are many reliable resources beginning with our local public health agencies, the Nigerian Center for Disease Control (NCDC), Federal Ministry of Health, WHO and other relevant agencies.

The Association of Medical Social Workers of Nigeria (AMSWON) is here to help you. I would like to hear what you are doing in your community to support the efforts to reduce the impact and spread of the virus. Take care and be safe.

It is our sincere prayer that this epidemic will be over very soon.

Yours in service to Humanity,

ALHAJI ABUBAKAR ALHASSAN BICHI

National President, Association of Medical Social Workers of Nigeria (AMSWON)

27^th March, 2020

Letter to Medical Social Workers in the Era of Coronavirus Pandemic

Dear Colleagues,

The world has been plunged into an unprecedented crisis by the spread of the Coronavirus, we are experiencing new challenges that require new behavioural and cognitive processes to address it.

As observed by the many negative reactions to countries “shutting down”, the human race does not readily adapt to change. Especially change that is sudden and forced as many believe it strips them of their fundamental right to freedom. Unfortunately, in this situation, the greater good of the community surpasses the right of the individual. Global health systems are under a huge strain combating this novel virus so atypical approaches have to be used to battle it.

As Medical Social Workers, we are trained to value and respect the rights of the individual, but our ethical standards provide guidelines and regulations for flexibility and decision making that benefits the larger community as a whole and aids us during these public emergencies.

What are Medical Social Workers doing to help globally?

The pandemic started in China and the Chinese Association of Social Workers played an active role in fighting the virus in China. What lessons can we learn from them and incorporate in a culturally sensitive manner into our interventions here in Nigeria? The International Federation of Social Workers released guidelines for our role during this global emergency that can be adapted for our setting on their website.

The situation in Nigeria has presently not developed to the levels we are seeing in China, South Korea, Italy, Iran or the U.S.A and hopefully, we will not reach those stages, but the reality is that we need to be proactive and prepared for such a situation.

What can Medical Social Workers in Nigeria do?

We, as a nation find ourselves at a critical point where we have to actively contain and prevent further infection. The Federal Government has closed the borders to reduce the risk of new infections being brought unknowingly into the country (as evidenced by several of the first few positive cases we have in Nigeria). The Federal Government and several states have banned public gatherings including gatherings of religious organisations to reduce the spread and have asked all civil servants except essential services to stay at home. As Medical Social Workers, working in health facilities, we fall into this category and are expected to be at work doing our part to fight the pandemic in Nigeria. We must be seen following all government directives concerning the containment and prevention of the Coronavirus as recommended by experts. It is the professional and responsible thing to do.

Within our different facilities, our roles will be varied and evolving as the needs arise but primarily, we need to: –

1. Advocate and Mediate: Be involved and play a prominent part in developing strategies and protocols of engagement amongst staff and with patients and their relatives. This is essential because as patient advocates and mediators, we understand the peculiar needs and expectations of patients within the system but are also aware of the resources and capacity of our medical facility. We need to ensure that patient’s rights and expectations are paramount, protected and addressed as the health system adapts to deal with the Covid-19 crisis.

2. Disseminate information: One of our primary roles is that of educating patients, this cannot be overemphasized during this global crisis as we are all aware of the amount of fake information being peddled especially over social media. We need to educate ourselves about Covid-19, social distancing and prevention from reliable sources such as the World Health Organisation (WHO) and Nigeria Centre for Disease Control (NCDC).

The internet is awash with advice on how to prevent or cure Covid-19 and some people are being mercenary by selling unproven, untested and probably life-threatening cures. We need to be pushing out accurate, real-time information as published and verified by reliable sources. As professionals, we should not be seen repeating, posting or forwarding false information. Please beyond providing accurate information with references in public, we must refrain from providing unverified information that can be repeated by people who will claim “a healthcare provider/expert told me”

The onus of responsibility is on YOU as a professional to verify information from official websites before sharing.

3. Contact Tracing & Home Visits: As the numbers of people diagnosed with Covid-19 increase across the country so also will there be a need for increased levels of contact tracing to help contain the infection. Home visits will be required to ensure that people who have been identified as being in contact with someone with Covid-19 are self-isolating as mandated. As a core skill of social work, contact tracing and home visitation in this era will require changes in the way in which we carry it out, things like social distancing, observing standard infection & prevention control methods and in necessary situations wearing Personal Protective Equipment (PPE).

4. Psychosocial Support: These are unprecedented times, high levels of anxiety, fear, paranoia and despair arising from multiple reasons i.e. fear of infection, financial insecurity, job security and loneliness may occur due to the extended periods of self-isolation and lockdown of the country. Psychosomatic symptoms such as unexplained fatigue, irritability, abdominal bloating, chest pain, increased blood pressure, palpitations, changes in libido &appetite etc. will be common during these periods and should be expected. Though these are normal human reactions during crisis periods, the individuals experiencing them should not be belittled or made to feel they are overreacting, rather they should be educated and supported. Patients who have preexisting health concerns are extremely vulnerable at this period and would require extra support.

Working in conjunction with other healthcare workers we should provide counselling and therapeutic services. These will help but may be constrained by the need for social distancing. The services may then need to become virtual via telephone or private one-on-one social media apps such as WhatsApp, Telegram, FaceTime, Skype etc. Please note that the rule of confidentiality still holds and is expected irrespective of means of providing social work interventions. (You are advised to consult and follow your facility’s guidelines in respect of such communications).

5. Referrals: Referrals will also be essential during these periods, referrals to community resources that will provide counselling services, food banks, visitation for the vulnerable etc. should be identified and proper linkages should be established to foster referrals. AMSWON can spearhead this by creating a national database of referral organizations that Medical Social Workers can tap into to aid adequate referrals to verified service providers.

Final Thoughts

The world and Nigeria are in an unparalleled health crisis, one we have not witnessed before in our lifetimes and it requires novel attitudes and thinking to deal with it. The Coronavirus doesn’t discriminate by religion, political party, socioeconomic standing or tribe. It can affect everyone directly or indirectly and we have to deploy concerted, unified efforts as a country to get ahead of this virus.

Personal responsibility should be the watchword of fighting this pandemic, personal responsibility to adhere to social distancing and personal hygiene, personal responsibility to self-isolate and above all personal responsibility to do all we can as Nigerians to end the pandemic in our country.

Thank you,

Warm regards and stay safe everyone.

Ms Titi Tade

Deputy Director, Medical Social Service, Lagos University Teaching Hospital, Idi Araba &

Guest Lecturer, Department of Social Work, University of Lagos, Akoka.

Coronavirus Resources

1. World Health Organisation: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
2. Nigeria Centre for Disease Control (NCDC): https://www.who.int/emergencies/diseases/novel-coronavirus-2019
3. Nigeria Centre for Disease Control (NCDC) dedicated Covid-19 micro website: http://covid19.ncdc.gov.ng/
4. Federal Ministry of Health: http://www.health.gov.ng/
5. National Association of Social Work (U.S.A): https://www.socialworkers.org/Practice/Infectious-Diseases/Coronavirus
6. Centre for Disease Control: https://www.cdc.gov/
7. National Health Service: https://www.nhs.uk/conditions/coronavirus-covid-19/
8. Live Science Guide for children: https://www.livescience.com/coronavirus-kids-guide.html
9. San Francisco Department of Public Health: https://www.sfcdcp.org/infectious-diseases-a-to-z/coronavirus-2019-novel-coronavirus/
10. Centre for Disease Control fact sheet: https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf
11. https://www.nctsn.org/sites/default/files/resources/fact-sheet/outbreak_factsheet_1.pdf
12. Self Isolation guide:
    1. https://www.health.gov.au/resources/publications/coronavirus-covid-19-isolation-guidance
    2. https://www.publichealthontario.ca/-/media/documents/ncov/factsheet-covid-19-guide-isolation-caregivers.pdf?la=en
13. Twitter Handles:
    1. NCDC: @NCDCgov
    2. Federal Ministry of Health: @Fmohnigeria
    3. WHO: @WHO
    4. CDC: @CDCgov

Tedros Adhanom Ghebreyesus (DG, WHO): @DrTe