Trauma Informed Curriculum

MODULE 3

Adaptive Ways of Addressing Trauma Across Cultural Differences

Summary

This experiential module focuses on four activities designed to guide participants in developing adaptive thinking when partnering with families in the process of child welfare interventions.  Trauma-informed practice requires respectful partnership with families and ensuring that client voices and perspectives are honored.  These activities highlight that partnering with clients to gain their local wisdom is essential to practice.  Trainers may elect to identify and critically analyze specific practices, including evidence-based practices, used in local contexts to highlight the importance of evaluating how specific practices may apply (or not) across cultures or with specific families.    

Learning Objectives

• Social workers will understand the difference between technical problems and adaptive challenges
• Social workers will be able to rate the degree of family involvement by comparing various trauma-related services
• Social workers will gain an appreciation that client-driven assessment and planning in trauma settings helps to reinforce self-determination on the part of trauma survivors.

Audience:Intermediate (activities may be easily adapted to beginner or advanced audiences)

Module Outline

I. Thinking about Challenges: Adaptive vs. Technical Frameworks

Activity Title: Adaptive vs. Technical

Modality: Individual Reflective Journal Activity, small group activity

Learner Level: All levels

Duration: 30-60min

Materials: 

1. Adaptive vs. Technical Supplemental Handout (provided in text below);
   
2. reflective journals or blank pieces of paper and pens; 
3. large chart pad paper, tape and markers.

Facilitator Instructions:

• Co-Facilitators can distribute the handouts and ask participants to think of times they have seen adaptive challenges (often relational, emotional or cultural) addressed with technical solutions (protocols, processes, tasks) and to speak in small groups about the results they witnessed.

• Co-Facilitators can ask small groups to think about what causes groups to move so quickly to technical solutions for nearly every challenge?

• Co-Facilitators can ask small groups to consider what can be done using relationships, emotion and cultural exchanges of values and ideas to bring more awareness to adaptive challenges and solutions into their agency.

• Co-Facilitators can ask participants to think reflectively about a time when they have struggled with a change resistant challenge, only to resolve it later by way of a shift in thinking or a change in perspective, rather than applying a technical solution.  What were some things that allowed them to make the thinking change?  What types of questions helped you consider the problem from a different vantage point?  Participants can write down their responses in their reflective journals or on blank pieces of paper.

• Co-Facilitators can ask the large group to share some of the questions that helped them make a thinking shift or change in perspective, charting the responses on large chart pad paper for all to see.

Technical Problems vs. Adaptive Challenges[2]

“The single biggest failure of leadership is to treat adaptive challenges like technical problems.”

Technical Problems are:

• Easy to identify
• Often lend themselves to quick and easy solutions
• Often can be solved be an authority or expert
• Require change in just one or a few places, often contained within the organizational boundaries
• People are generally receptive to technical solutions
• Solutions can often be implemented quickly – even by a directive

Examples of Technical Problems:

• Take medication to lower blood pressure
• Implement electronic ordering and dispensing of medications in hospitals to reduce errors and drug interactions
• Increase penalty for drunk driving

Adaptive Challenges are:

• Difficult to identify and easy to deny
• Require change in values, beliefs, roles, relationship and approaches to work
• People with the problem do the work of solving it
• Require change in numerous places, usually across organizational boundaries
•  People often resist even acknowledging adaptive challenges
• Solutions require experimentation and new discoveries,
• Solutions can take  along time to implement and cannot be done by edict

Examples of Adaptive Challenges:

• Change lifestyle to eat healthy, get more exercise and lower stress
• Encourage nurses and pharmacists to question and even challenge illegible or dangerous prescriptions by physicians
• Raise public awareness of the dangers and effects of drunk driving, targeting teenagers in particular

II. Reflection on Respectful Partnership with Families

Activity Title:  Golden Rule versus Platinum Rule

Modality: Individual Journaling, Small Group/Large Group Activity

Learner Level: All Levels

Duration: 10-30min depending on audience size and participation

Materials: 

1. Reflective Journals or blank pieces of paper and pens (for each person); 
2. large chart pad paper, tape and markers

Facilitator Instructions:

• Trainer asks participants if anyone knows the Golden Rule.  If no one knows the Trainer says, “Do unto others as they would have them do unto you” or “treat others the way you want to be treated.”

• Trainer then asks participants if anyone knows the Platinum Rule.  If no one knows the Trainer says, “Do unto others as they would have done unto themselves” or “treat others the way they want to be treated.”

• Trainer then asks participants how they would know how someone else would want to be treated.  Participants are asked to write their responses in their reflective journals (5min) and then share their answer among either small groups or as a large group (20min).

• Trainers reinforce the simple response: Just ask.

• Options for deepening the discussion include the following questions:

1. What keeps you from asking when doing case planning, safety planning or treatment planning with trauma survivors at times?
2. What are your worries about sharing power by asking for input from the primary trauma survivor directly?
3. How is your own self-care planning similar or different than how you engage safety plans, case plans or treatment plans with trauma survivors?  
4. What can be done to enhance the trauma survivor’s experience of self-determination in planning processes, especially when interventions chosen may be uniquely different than interventions you may chose for yourself.  
   

• Trainers can chart responses or themes on large chart pad paper.

III.  Continuum of Family Partnership

Activity Title:  Family Partnership Continuum

Modality: Individual Reflective Journal Activity, Small Group Activity, large group activity

Learner Level: All Levels

Duration: 15-30min

Materials: Large chart pad paper, tape, markers, reflective journals or blank pieces of paper and pens

Facilitator Instructions:

• Co-Trainers ask participants to brainstorm a list of all the various groups or teams that take place involving trauma survivors in assessment, planning or treatment that are offered at their agency or organization or that they know of (10min).

• Co-Trainers ask each group to select a spokesperson to read the list while other groups add additional items they did not cover on their lists initially but may be offered at their agency or organization.  This large group sharing process allows for collective wisdom for a comprehensive list of groups and team processes offered locally to be listed.

• Co-Trainers ask participants to draw a continuum on their blank piece of paper or in their reflective journals with “Least Participation” as an anchor at the top and “Most Participation” as an anchor at the bottom of the page.  

1. The Top third of the continuum is labeled “Family Engagement.”
2. The middle third of the continuum is labeled “Family Involvement.” 
3. The bottom third of the continuum is labeled “Family Participation.”

• Participants then rank each identified team or group along their continuum and then compare and contrast their responses with each other in small groups.  

• Co-Trainers can extend this part of the activity by asking participants to re-order their rankings based on how trauma-survivors may rank them as compared to ranking them from a service provider lens.

• Co-Trainers can have the large group rank the groups collectively and encourage debate between the small groups as an extension to this activity.

IV. Partnering with clients to gain local wisdom

Activity Title:  Empty Cup Story

Modality: Individual Journaling, Small Group/Large Group Activity

Learner Level: All levels

Duration: 10-30min depending on audience size and participation

Materials: 

1. Reflective Journals or blank pieces of paper and pens (for each person); 
2. large chart pad paper, tape and markers;
3. Empty Cup Story (provided in text below)
   

Facilitator Instructions:

• This lesson can be done to support general concepts of Cultural Humility in comparison to Cultural Competence.  It also can be used in tandem with the lesson on Golden Rule versus Platinum Rule and the Module on Facilitation of Resilience through Teaming and Team Development.

• Co-Trainers read the story The Empty Cup.  Alternatives include having learner read the story on-line before the lesson or assist in reading of the story in the classroom or training room.

• Following the story, learners are asked to take time and imagine what it means for them to be an empty cup, open to local cultural wisdom and write down their thoughts in their reflective journals.

• Variations include having participants share their responses in dyads, small groups or even facilitating a large group discussion pending group size and time available.

• Co-Trainers are encouraged to chart responses and track emerging themes if facilitating discussion in a large group setting.

• Questions can be used for extending and deepening the reflection aspect of the exercise:

1. What may keep you from being an empty cup in various settings?
2. When contemplating “ask vs. tell” what causes you to move quickly past asking?
3. Co-Trainers are encouraged to share personally (eg. “to feel smart”, “to be right”, or “to have control”) as well as some underlying areas of vulnerability that may cause this “telling” response (eg. Insecurity about perceived wisdom or credibility, need for validation and self-righteousness or due to fear).
4. Learners can write down 2-3 reasons they may be pulled to “tell” instead of “ask” and some corresponding causes.
5. Learners are encouraged to consider ways to give themselves psychological reassurance as ‘self-talk’ in preparation for moments where they may anticipate feeling vulnerable and pulled away from being an ‘empty cup.’
   

The Empty Cup

Once there was a Social Worker visiting an Indigenous Tribal Community.  As was the local custom, the Social Worker sat down for a prayer and formal introductions with the Tribal Elder in front of the tribal community.  

Following the introductions the Social Worker declared that he had learned much about the Tribe before his visit.  He stated that he had in fact made a career studying the tribe and was very eager to learn more about how the people of the tribal community saw themselves

The Tribal Elder listened patiently then paused and said, “As is our custom, before we discuss these matters we will drink a cup of tea.”  A serving tray was brought out with a teapot full of hot tea, two cups on two saucers all placed on a serving tray.  As the Social Worker spoke about how appreciative he was to have a chance to be a part of a “tribal ritual” - like many he had learned about in graduate school, the Elder began pouring a cup full of tea.  

As the cup filled and neared the edge, the elder did not stop pouring.  Instead, he kept steadily pouring the tea as it overflowed the cup and began running down onto the saucer, then overflowing the saucer and falling onto the serving tray.  

The Social Worker, no longer able to hold back, blurted out, “Excuse me Sir, but you are pouring the tea onto the tray and it’s going to waste!”  The Elder, continued to steadily pour the tea as it began to overflow the serving tray and fall onto the ground.  

Jumping out of the way the Social Worker exclaimed, “Sir, Sir, please stop the tea is going to waste!  It will be of no use to us!”  With that, the Elder paused, stopped pouring the tea and looked up – making eye contact with the Social Worker.  

The Elder said to the Social Worker, “Ah, so it is as if you are a full cup, coming to our village but with no where for our local wisdom to go but onto the ground to be wasted.”  The Social Worker stepped back shocked and said humbly, “I’m so sorry, what can I do to make this right?”  

The Elder compassionately and calmly replied, “Be an empty cup.  When you come to our village be open to local wisdom filling you up and it will not be wasted.”

Key Resources and Reading

Engaging Families in Child Welfare - Resources from the Child Welfare Information Gateway

Bondi, L., Carr, D., Clark, C., & Clegg, C. (Eds.). (2016).  Towards professional wisdom: Practical deliberation in the people professions . Routledge.

Fadiman, A. (2012).  The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures . Macmillan.

Kemp, S. P., Marcenko, M. O., Lyons, S. J., & Kruzich, J. M. (2014). Strength-based practice and parental engagement in child welfare services: An empirical examination. Children and Youth Services Review , 47 , 27-35.