Health Care: Trauma Counselling Assignment - Impact Analysis

This report, focusing on health care, analyzes the immediate and long-term impacts of childhood sexual assault (CSA) on victims and their families. Part A details the physical and psychological consequences, including emotional distress, developmental issues, substance abuse, and social adjustment problems, extending into adulthood. It also explores the impact on family members, including emotional distress and relational changes. Part B applies the eight principles of trauma-informed care (Bateman, Henderson, and Kezelman) to a case study involving Steve, a veteran, addressing his behaviors stemming from trauma. The report outlines how each principle – understanding trauma, providing a safe environment, considering cultural context, supporting consumer choice, promoting equality, integrating care, fostering relationships, and promoting recovery – can be integrated into Steve's care plan to promote healing and recovery. The report emphasizes the importance of a holistic approach, building on strengths, and instilling hope for recovery.

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s note

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Part A:
Immediate and long-term impact of CSA on the child and their family members:
Childhood sexual assault or abuse (CSA) is defined as an incidence of sexual activity
or development is done with children without their consent. It involves sexual contact
regardless of age by the use of force. This event is an extremely traumatic incidence for the
affected child and their family as it leads to many immediate and longer-term impact on the
individual and the person who are in contact with them (Reid, 2019). Some of the likely
immediate impact of such sexual assault includes physical harm as well as adverse
psychological outcomes. The immediate physical effect of the incidence includes abdominal
or pelvic pain and eating disorders. In addition, psychological consequence of such trauma
includes feelings of shock, grief, denial, confusion, withdrawal and guilt. Such children
display extreme emotional reactions and they suffer from distorted self-perception (Tonmyr
and Shields, 2017). Hence, intense emotional behaviour is the first sign that a child has been
sexually abused. This can be followed by several adverse effects on development process
leading to poor coping, adverse effects on cognitive style and emotional regulation which
may continue till adulthood.
Childhood abuse leads to development issues too as indulgence in wrongs act become
common in such children. Such victims engage in substance abuse which begins in childhood
and continues till adulthood. Social adjustment issues become common for such victims and
such problems carry over for some individual during adulthood too (Musliner & Singer,
2014). The long-term social effects of CSA include engaging in crime, suffering from
academic problems and sexual behaviour related problems. According to Reid (2019), the
consequence of abuse differs widely in adolescents and childhood. For example, consequence
of sexual abuse in childhood is manifested by depressive symptom, anxiety, maladjustment,

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somatic problems and social isolation behaviour. These symptoms transform to behaviours
that are more harming in adolescence. Some examples are delinquency, homelessness, drug
abuse, risky sexual behaviour, multiple sexual partner and lack of emotional commitment in
relationships (Reid, 2019). Tonmyr and Shields (2017) explains that childhood maltreatment
is associated with heavy drinking, illicit drug use and use of marijuana. These findings
indicate the need for timely and effective intervention for adolescents affected by sexual
abuse to prevent recurrence and associated high risk behaviours.
CSA is regarded as a public health issue because of its long lasting effects on
psychiatric, developmental and neurobiological outcomes. Victims of sexual abuse
experience certain long-term psychological impact too as the traumatic affects their
development and socialization process. They become exposed to risk of severe mental health
issues like depression, pain disorder, personality disorder, poor self-esteem and suicidality
(Shrivastava et al., 2017). McLean et al. (2017) gives evidence for the risk of post-traumatic
stress disorder in such children too and the abuse characteristics that leads to subsequent
PTSD includes the severity of abuse, frequency of such assault and duration of abuse. The
study revealed higher risk of PTSD for those victims who were abused by a family member.
In very severe cases, history of CSA is associated with greater risk of suicidal behaviour too
(Musliner & Singer, 2014). CSA in the long term increase risk of poor social relational and
challenges in maintaining intimate partner relationship in the future (Kong & Moorman,
2015). Thus, giving emotional support to such individuals at the right time is the key to
decrease the risk of future depressive episode in victims.
Apart from the trauma and developmental impact of CSA on affected children, such
incidence is associated with great mental trauma for victim’s immediate family members or
relatives too. Research literature shows that discovery of sexual abuse in children is
associated with serious emotional and psychological distress for family members too. Strong

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emotions like anger, guilt and depressed mood is common for parents or relatives after
learning that their child has been sexual abused. They also experience changes in sleep,
concentration and appetite which affected their health and work. These are examples of
immediate impact of learning about the experience. Such intense emotional and
psychological distress is seen because of concerns about their child, self-blame, fear about the
anticipated actions of behaviour of other members of the society and being disturbed by past
maltreatment experiences (Fong et al., 2017). Thus, whole family dynamics and relationship
is affected by an incidence of CSA. The family relationship seems to vary in case of such
discovery. Some family caregivers have reported about worsening family relationship after
discovery of such maltreatment, whereas there are other groups who have reported increase in
family cohesion after being aware about sexual abuse experience (Kong & Moorman, 2015).
Part B:
Integration of the eight principles while working with Steve:
Considering the condition of Steve, what I have understood is that his current
behaviours of disrupted sleep, recurrent nightmares, excessive alcohol consumption and
outburst of anger towards her husband are all the affects and consequences of several types of
trauma and disrupted family environment that he has experienced throughout his life. Thus,
in such circumstances, engaging in trauma-informed care will be the most crucial to
understand the role of trauma in shaping his current behaviour. This will ensure providing
culturally safe and inclusive care. I will use the eight foundation principles of Bateman,
Henderson and Kezelman (2013, pp 101-11) that represent core values of trauma-informed
care. I would ensure integration of each of the eight principles during interaction with Steve
in the following ways:

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1. The first core value is about understanding traumatic stress and how it impacts people.
While starting work with Steve, I will have to review his past history of traumatic
experience and link them with his current challenging behaviours. Based on the
review of the case study, it has been found that Steve was exposed to war related
trauma due to his nature of job. He works in the army and he was expose to physical
trauma in his most recent deployment as he sustained serious leg and body injuries.
He has been on numerous tours in the past too when witnessed the death of his
colleagues. Thus, it will be necessary to review whether his current behaviour is a
response to his past traumatic experience or not (Korinek, Loebach &
Teerawichitchainan, 2017). This can be done by inquiring more about the trauma
from Steve’s wife, Susie. Such knowledge can help to minimize triggers that interfere
with executive functioning.
Stressful encounters and exposure to hazards are common in military service
and such extreme level of stress expose survivors to high risk of mental health
disorders. These incidences induce both psychogical and physiological adaptation.
Steve also faced the brunt of combat operations and the experience of witnessing
death of his colleagues might the reason for his current behaviours (). Such veterans
are also at high risk of Post Traumatic Stress Disorder (PTSD). PTSD leads to
intrusive, avoidance and arousal symptoms. Although arousal symptom of anger,
sleep disturbance and irritability was present for Steve, however effective questioning
can help to see if he displayed avoidance and intrusive symptoms because of war
related stress or not (Reeves, Parker & Konkle-Parker, 2016). Some question that can
help include ‘have you witnessed Steve to have nightmares recently?’ or ‘Is Steve
interested in joining his work soon?’

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2. The second principle of trauma-informed care includes providing safe physical and
emotional environment to client (Bateman, Henderson and Kezelman, 2013, pp 101-
11). I would do this while working with Steve by ensuring that the physical
environment around him is less-disruptive and more empowering for him. While
going to interact with Steve, I will ensure that the room is silent and there is not too
much people around to disturb him. These considerations will ensure that Steve is
relaxed and any noise or commotion that does not triggers his challenging behaviours
again. To ensure safe emotional environment, I would seek Steve’s permission before
proceeding with the counselling. He will be informed about the purpose beforehand
and all efforts will be done to prevent any changes in his schedule. Sufficient notice
will be given to him and communication will be done in an open, respectful and
compassionate manner (Menschner & Maul, 2016).
3. The third principles states understanding the cultural context and its influence on
traumatic events. To achieve this, I would inquire from Susie about the cultural
practices of Steve to understand his perception of safety and perceived trauma. This
will help to understand the boundaries to be maintained during the communication
process and avoid any changes that disrupt his engagement in his cultural rituals.
Knowledge about Steve’s cultural values and practices will also help to ensure that all
vulnerabilities are mitigated and recovery from trauma is achieved (Bryant-Davis,
2019). This knowledge would also help to plan appropriate prevention and
intervention plan for Steve.
4. The four principle of trauma informed care related to supporting consumer choice,
control and autonomy. Considering ways to enhance client’s self of control and
empowerment is vital to their recovery. I intend to enhance Steve’s sense of control
by creating opportunities for empowerment. I would reinforce his sense of

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competence by introducing him to positive ways of coping which would help him
recover from prolonged stress reaction. This would be done by utilization of his
strengths and giving him choice regarding intervention options. The strategy of choice
and empowerment will be applied not only in treatment planning, but also while doing
common tasks (Center for Substance Abuse Treatment, 2014). Other strategies of
empowerment may include development of peer support services and establishing
their sense of self-efficacy by inculcating the belief that they can carry out particular
coping strategies (Bateman, Henderson & Kezelman, 2013).
5. The next important principle is promoting democracy and equality in power
distribution. This can be done in the context of working with Steve by preventing use
of coercive intervention and considering holistic care value while planning
interventions for him. Instead of misusing one’s power, I will partner with Steve’s
family in a way that they are very clear about all the issues, the kind of support they
required and the pros and cons of each treatment option (Stokes et al., 2017).
6. Another crucial principle is integrating care by consideration of holistic view of
consumers and interpreting all aspects of their recovery process. This can be
practically achieved with Steve by using strength based approach to engage with his
families. I would achieve this by identifying the role of his strengths in the provision
of care (Stokes et al., 2017).
7. The seventh principle gives the notion that safe and authentic relationship is crucial to
recovery of client. Using this concept, I would promote healing of Steve by
developing a transparent relationship and giving Steve the perception that his well-
being and recovery is the top most priority. I can achieve this by taking time to
understand to understand how Steve perceives trauma. It will be possible to apply the
trauma informed lens once I am able to understand that his current behaviour are

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adaptive response to abnormal situations. This thinking can help me to focus on
positive aspects of recovery (Leitch, 2017). I can build on his strengths by asking
questions like ‘What has worked for you during traumatic situations?’
8. The most important principle is having the thinking that recovery is possible for
everyone regardless of their vulnerabilities. I plan to do this by narrating several
stories or introducing Steve to other people who have gone through similar traumas
yet they have recovered. Such act will instil hope for recovery for Steve and his
perception regarding his current competence level will change. I will also introduce
him and his wife to community resource which would support him to come out from
the trauma. In addition to this, I would also focus on utilizing Steve’s strength to
increase his chances of recovery. This can be done by encouraging him to recall times
when he successfully handles past crisis in his family such as separation of their
parents and the assaultive nature of his brother, Tony. Such activities will build
resilience and enable Steve to have positive outlook towards life (Bateman,
Henderson & Kezelman, 2013).
Assessing risk of suicide:
Past incidence of childhood abuse and exposure to traumatic life events increase risk
of suicide in an individual. Proper assessment of behaviours of such individuals is
necessary to predict their risk of suicide. Some of the warning signs of suicide risk
includes long lasting mood swings, deep sense of hopelessness, sleep disturbance, social
withdrawal and change in personality (Zitelli & Palmer, 2018, February).. After review of
Steve’s current sign and symptoms, it can be said that he also possess similar warning
signs. He is experiencing disrupted sleeps, nightmares, extreme feelings of anger and
deep sense of hopelessness. His hopelessness is evidenced from his comments like ‘the
world is being better off without him’. Such comments are strong indications of suicide

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ideation and the possibility that Steve may try to commit suicide. Another rationale for
his high risk of suicide is that he has two other risk factors of suicide. Firstly, he is
exposed to a past traumatic event and secondly, he is dealing with substance abuse issues
too. Ásgeirsdóttir et al. (2018) gives the evidence regarding strong association between
traumatic life events and suicidality. Thus, Steve’s past history of traumatic events
increase his risk of suicide. Research literature also shows how alcohol abuse increases
risk of suicide ideation and frequency of suicide attempts (Darvishi et al., 2015).
Benefits of engaging in supervision in relation to the case:
As I am the Steve’s counsellor, I can get many benefits by engaging in supervision
with him. This is said because I find his case to be an excellent opportunity for me to learn
about the aftermath of not just traumatic events, but also the impact of a poor family
relationship and poor upbringing on personality of the person in adulthood. Steve has gone
through many things in life. His family is unlike other families as he witnessed domestic
abuse experiences of his mother, he witnessed separation of his parents and conflicting
relationship of his mothers. All these experience can significantly influence his way of
interaction with others and having outlook towards life. Thus, interpreting the past incidence
of trauma on his current behaviour would be a good learning experience for me personally. In
addition, as this client provides me the opportunity to implement trauma informed care, I will
be able to judge my skills in empowering and re-instilling new hopes in such clients with
challenging behaviour. As I have already learned all about the core values and principles of
trauma informed care, it would be beneficial for me to witness the benefits of such form of
care by practically integrating those values during my counselling session. Thus, the
experience of supervising with Steve will challenge my current competence, support me to
develop skills in working with difficult client and become aware of useful resources that
could help people like Steve to recover from trauma related stressors. A challenging situation

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in professional counselling is an opportunity for continued learning and professional
development.

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