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REGULATION
Regulating trauma-related specializations in private practice
BY ALEC STRATFORD, MSW, RSW
Recently the NSCSW Board of Examiners implemented new policy regarding the approval of trauma specializations for private practitioners of social work.
As articles in this issue of Connection address, the effect of trauma is becoming a more regular part of the public discourse regarding mental health, and there has been an increasing demand for trauma-related specializations within provision of mental health services. This is coupled with increasing and long-overdue public discourse on Canada’s legacy of enslavement and colonization and entrenchment of anti-black and anti-Indigenous racism. In addition, there is a continued entrenchment of patriarchy and neo-liberalism, which both aim to place the provision of care into the private sphere: where the labour of caring often falls to women and gender-diverse people, and men are diminished in their role of providing care and their need of care.
DESCRIBING TRAUMA
Trauma can be defined as anything that results from experiencesthat overwhelm an individual’s capacity to cope, such as abuseand neglect, sexualized violence, family conflict, poverty, havinga life-threatening illness, undergoing single/repeated and/or painful medical interventions, accidents, natural disasters,grief/loss, witnessing acts of violence, experiencing war,intergenerational and historical violence.
Trauma and traumatic experiences are inherently complex.Trauma occurs in a broad context that includes individuals’personal characteristics, life experiences, and current politicaland historical circumstances. Intrinsic and extrinsic factorsinfluence individuals’ experience and appraisal of traumaticevents; expectations regarding danger, protection, and safety;and the course of post trauma growth.
Trauma recovery is possible but presents specific challenges.In the context of exposure to significant adversity, resilienceis both the capacity of individuals to navigate their way to thepsychological, social, cultural, and physical resources thatsustain their well-being, and their capacity individually andcollectively to advocate for resources to be provided in culturallymeaningful ways.
IDENTIFYING A NEED
The Board of Examiners holds that social work practitioners need to be aware of the need to contend with issues involving colonialism and racism, justice, legal redress, and protection against further harm. In addition, working with trauma-exposed clients can evoke distress in providers that makes it more difficult for them to provide good care.
Given the complexity of trauma, practitioners need to take due care to ensure that they are immersed in professional development in various models of trauma therapy and advance their knowledge of vicarious trauma and their own selfawareness, while having a clear understanding of the current and historical political context and the ongoing harm created by neoliberalism. Given the risk to the public and the practitioners the Board of Examiners has created policy regarding the provision of trauma-related specializations in a private setting.
RIGHT-TOUCH REGULATION
The NSCSW utilizes right-touch regulation as a to guide its regulation of the profession. Regulators need to understand a problem before jumping to a solution, to make sure that the level of regulation is proportionate to the level of risk to the public. Right-touch regulation is also grounded in the understanding that there is no such thing as zero risk.
There are eight elements that sit at the heart of right-touch regulation:
• Identify the problem before the solution
• Quantify and qualify the risks
• Get as close to the problem as possible
• Focus on the outcome
• Use regulation only when necessary
• Keep it simple
• Check for unintended consequences
• Review and respond to change.
Trauma-related specialization policy was developed becausethe Board recognized that complexity of trauma therapy, theincreasing demand, and the current political context, all whichcreated an increasing risk to the public regarding the provision oftrauma specific therapy.
To mitigate this risk the Board developed criteria regardingcompetencies that social workers must demonstrate ifthey include trauma specializations in their application forprivate practice.
These criteria are specific to private practitioners, who are authorized to practice independently in their approved areas of specialization, and are solely liable for their practice. They do not pertain to social workers who practice with the supervision and support of an employer. However, members aspiring to eventual self-employment who may wish to use this information to guide their selection of professional development opportunities.
THE RESULT
The policy distinguishes between trauma informed andresponsive care, and trauma specific therapy.
Trauma informed and responsive 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.
Applicants for this specialization must meet minimum standards for professional development, at least two years of related practice experience, and supervised practice in this area of specialization. Core concepts include:
• Understanding of trauma
• Understanding of trauma informed responses and care
• The science of trauma
• Application of trauma-informed care
• Parallel process
These practitioners must demonstrate that they have been able to sufficiently integrate knowledge into their practice.
Trauma specific therapy involves therapeutic approaches that recognize and emphasize an understanding of how the traumatic experience impacts an individual’s mental, behavioural, emotional, physical, and spiritual well-being. This type of therapy is rooted in understanding the connection between the trauma experience and the individual’s emotional and behavioural responses.
The purpose of trauma specific therapy is to offer skills and strategies to assist in better understanding, coping with, processing emotions and memories tied to traumatic experiences, with the end goal of empowering clients to create a healthier and more adaptive meaning of the experience that took place in their life.
The policy was designed with two pathways to demonstrating competence in this area. The intent of the pathways is for applicants to reflect upon and demonstrate their competence to deliver trauma specific therapy in a private setting.
1. The first path involves certification in a trauma specific therapy modality, which members of the Board determined was a clear measurement of competence to deliver trauma specific therapy.
2. The second is to demonstrate multiple professional development activities on a trauma specific therapy; a minimum of two years of practice experience that demonstrates an integration of trauma specific therapy into social work practice; and clinical supervision on a trauma specific therapy.
To review the full policy regarding trauma-related specializations in private practice, please visit nscsw.org/manual. Questions can be directed to Alec Stratford, NSCSW Executive Director/Registrar.
