PRACTICUM REPORT: INCORPORATING INTERSECTIONALITY INTO
TRAUMA-INFORMED PRACTICE IN HOSPITAL SOCIAL WORK
by
Tasha Laurio

PRACTICUM REPORT SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SOCIAL WORK DEGREE

UNIVERSITY OF NORTHERN BRITISH COLUMBIA
March 2025
© Tasha Laurio

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Table of Contents
Chapter 1: Introduction, Agency Overview, and Positionality ................................................. 3
Introduction ................................................................................................................................. 3
Overview of Practicum ................................................................................................................ 3
Trauma-Informed Practice and Intersectionality ......................................................................... 5
Key Definitions and Concepts ..................................................................................................... 7
Positionality and Reflexivity ....................................................................................................... 9
Chapter 2: Theoretical Inspirations ...........................................................................................13
Intersectionality ......................................................................................................................... 13
Useful Concepts from Systems Theory ..................................................................................... 15
Chapter 3: Literature Review ........................................................................................................ 17
The Rise of Trauma and Trauma-Informed Practice ................................................................. 17
Popular Principles of Trauma-Informed Practice ...................................................................... 19
Safety...................................................................................................................................... 19
Trust ....................................................................................................................................... 20
Collaboration ......................................................................................................................... 20
Choice .................................................................................................................................... 21
Empowerment ........................................................................................................................ 21
Towards an Intersectional Understanding of Trauma and Trauma-Informed Practice . 21
Chapter 4: Learning Experiences from Practicum .................................................................. 26
First Rotation: Holy Family Hospital ........................................................................................ 26
Introduction............................................................................................................................ 26
Social Work at Holy Family Hospital .................................................................................... 27
Unique Aspects to Consider for Trauma-Informed Practice and Intersectionality ............... 30
Case Examples ....................................................................................................................... 32
Second Rotation: Eating Disorders Inpatient Treatment Unit ................................................... 36
Introduction............................................................................................................................ 36
Social Work on St Paul's Hospital Eating Disorders Inpatient Unit (4Northwest) ............... 37
Unique Considerations for Trauma-Informed Practice and Intersectionality ....................... 38
Case Examples ....................................................................................................................... 41
Third Rotation: Emergency Department + High Acuity Unit ................................................... 45

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Introduction............................................................................................................................ 45
Social Work on Mount Saint Joseph Hospital Emergency Department & High Acuity Unit
............................................................................................................................................... 45
Unique Considerations for Trauma-Informed Practice and Intersectionality ....................... 47
Case Examples ....................................................................................................................... 49
Education and Training During Practicum ........................................................................... 53
Chapter 5: Reflections, Implications for Social Work Practice, and Conclusion.................. 56
Expectations versus Reality ....................................................................................................... 56
Review of Practicum Goals .................................................................................................... 56
Surprises ................................................................................................................................ 59
How Can Intersectionality be Incorporated into Trauma-Informed Practice in Hospital Social
Work? ........................................................................................................................................ 61
The Micro-Level ..................................................................................................................... 61
The Macro-Level .................................................................................................................... 65
Conclusion ................................................................................................................................. 70
References .................................................................................................................................... 72
Appendix ...................................................................................................................................... 77
Learning Contract ....................................................................................................................... 77

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Chapter 1: Introduction, Agency Overview, and Positionality

Introduction
This practicum report will explore incorporating intersectionality into trauma-informed
practice (TIP) in health care social work through the lens of my Master of Social Work
practicum experience with Providence Health Care. First, I will provide an overview of my
practicum setting and the structure of the experience. Second, I will discuss the Learning Goals
developed in my Learning Contract. Then, I will provide an overview of TIP and
intersectionality alongside my rationale for their intertwinement and application of this
intertwinement in my practicum setting. In order to ground my discussion, I will then explore my
own positionality and how it relates to my topic of inquiry. Next, I will explore how ideas from
systems theory further support the use of intersectionality as a theoretical lens to undergird my
work. I will follow this with a review of the literature on trauma and TIP as well as criticisms of
the dominant ideas of these concepts, and ideas for incorporating intersectionality into TIP.
Afterwards, I will provide a detailed discussion of my practicum experience, broken down into
sub-sections for each of its four major components (three site rotations and the education and
training element). This discussion will give an overview of each component, the skills and
knowledge I developed in each, and draw from specific incidents to discuss how TIP and
intersectionality showed up in each setting. Finally, I will weave together my experiences to look
forward to how to take my learnings with me into my future practice.

Overview of Practicum
To begin, I must introduce my practicum agency: Providence Health Care (PHC) is a
non-profit Catholic-based organization providing healthcare services in Vancouver, British

4
Columbia. It is probably best known for operating St. Paul’s Hospital in downtown Vancouver,
which serves many patients from the Downtown Eastside (DTES), a neighbourhood infamous
for its nexus of high poverty levels, homelessness, and addiction, and where I had initially
expected to complete the entirety of my practicum. However, PHC operates multiple healthcare
sites including several clinics and long-term care facilities. This includes the inpatient
rehabilitation centre, Holy Family Hospital, and the small community hospital, Mount Saint
Joseph Hospital, where I completed two of my three rotations during my practicum. Although
PHC provides services within the geographic region covered by the Vancouver Coastal Health
(VCH) Authority, they are separate entities. PHC is governed by its own board of directors
(Providence Health Care, 2024). PHC has also been the source of some controversy due to the
logistical manifestations of its Catholic values. For example, PHC has received public criticism
for not providing medical assistance in dying (MaiD), although they will facilitate a patient
transfer to a VCH site for this to take place.
Moreover, PHC has designed a highly structured experience for MSW practicum
students, which they refer to as the MSW Internship Program. Before our orientation day,
students completed several courses in LearningHub, an online training platform for healthcare
workers. Orientation day included introductions from social workers with PHC who had
previously completed the MSW Internship Program and who provided us with advice and
reassurance about our beginnings. Besides our days “in the field”, we were also provided a
schedule for weekly group supervision, weekly seminars to buff up our knowledge, and biweekly, individual one-hour supervision. We also received handouts about the learning
objectives for each of our rotations, which was very helpful in guiding the formation of my
Learning Contract.

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Thus, I developed my Learning Contract collaboratively with my agency supervisor who
guided me to think about broadly applicable skills and knowledge areas for hospital social work.
The Learning Outcomes included completion of psychosocial assessments with minimal editing
required by my preceptor or supervisor and drawing on relevant legislation when discussing
cases with my supervisor. They also included developing knowledge of: risk assessment, ethical
considerations, resources and referrals, discharge planning, TIP, and developing skills in
strengths-based work, collaboration with other service providers, documentation, and working
with families. The full Learning Contract is attached to this report as an appendix.

Trauma-Informed Practice and Intersectionality
To begin the discussion of the academic lenses framing my practicum, I feel compelled to
note that trauma has become an increasingly popular subject of public discourse and professional
inquiry (Becker-Blease, 2017; Kleber, 2019; Mersky et al., 2019; Sweeney et al., 2018). It is my
observation that the idea that social work practice should be trauma-informed has become
increasingly popular to the point of nearing ubiquitousness. It is easy to understand this
increasing popularity in consideration of the lives of those that social workers tend to touch.
Social workers frequently work in settings where clients have suffered traumatic experiences
such as with survivors of domestic or sexual violence, in child protection roles, in hospice and
palliative care, and with refugees. I observe that a TIP approach has become increasingly popular
in parallel with the overall increasing awareness of trauma in broader society.
By improving the ability to respond to client needs and situations, TIP holds clear and
pragmatic strengths in client service provision. This approach also manifests the compassion that
is at the heart of social work. However, TIP has its opportunities for improvement. Despite its
steadily increasing ubiquitousness, no unitary definition or framework of trauma-informed social

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work practice exists. A lack of standard understanding means that interpretation and
implementation are up to individual agencies and practitioners. Further, traditional thought about
trauma and TIP policies face criticism for typically demonstrating a "neutral" stance that fails to
adequately account for the sociopolitical contexts of trauma (Bryant-Davis, 2019; Quiros &
Berger, 2015). I propose that trauma-informed social work practice is strengthened by
incorporating intersectionality into its lens.
Frequently, social workers serve a particular client population as specified by their
employment agency (for example, the Ministry of Children and Family Development). Hospital
social work is unique as it entails working with a diverse client population. Thus, this
environment is ripe for considering intersectionality. Hospitals are also noteworthy environments
for practising social work as they are large institutions operating from a biomedical model rather
than an agency positioned as a social service provider. A confluence of professions (and
accompanying variety of ideologies) converges within the hospital ecosystem to provide care, in
contrast to a designated social service or mental health agency where everyone shares similar or
overlapping educational backgrounds and professional ideologies. The hospital itself can also be
a site of traumatic experiences for the patient.
Alongside social work, the notion of TIP has also become increasingly popular in
healthcare settings. Despite this, there remains a consistent recapitulation of systemic biases in
health care and hospital settings (Centola et al., 2021). The ongoing issues of structural
discrimination and various "isms" in these settings indicate the utility of incorporating an
intersectional approach in providing care. This is a particular imperative considering the
increasing evidence that systemic racism, sexism, and other forms of discrimination propel
health inequities in marginalized populations (Centola et al., 2021; Raphael, 2016; Taylor &

7
Glowacki, 2020). Incorporating intersectionality into TIP enables social workers to better
support members of marginalized groups and redress inequities in alignment with the social
justice aims of the profession (Canadian Association of Social Workers, 2024).
Thus, adding an intersectional approach would enrich TIP and allow social workers to
better respond to the nuances of each client's situation. Therefore, the question brought forth to
my Masters of Social Work practicum was: How can intersectionality be incorporated into
trauma-informed practice in hospital social work?

Key Definitions and Concepts
First, I wish to explore some pertinent definitions and concepts related to my topic of
inquiry in order to ground my work.
•

Intersectionality: "the interconnected nature of social categorizations such as race,
class, and gender as they apply to a given individual or group, regarded as
creating overlapping and interdependent systems of discrimination or
disadvantage" (Oxford Languages, 2023).

•

Post-Traumatic Stress Disorder (PTSD): "a disorder that may result when an
individual lives through or witnesses an event in which he or she believes that
there is a threat to life or physical integrity and safety and experiences fear, terror,
or helplessness" (American Psychological Association, 2023).

•

Moral distress: “a term describing the various harms that result from feeling
morally compromised: when people are unable to make decisions or act according
to their core values, including avoiding wrongdoing or harm” (The Provincial
Health Services Authority (2023, p. 7).

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•

Trauma: "a deeply distressing or disturbing experience" (Oxford Languages,
2023).

Language provides us the ability to think about, explore, and discuss phenomena.
Therefore, it is essential to unpack these definitions as they conceptually inform the work,
especially as TIP becomes increasingly popular. For instance, the American Psychiatric
Association, via the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR, 2022),
determines the conditions under which PTSD can be diagnosed. The “official” authorities on the
subject matter set the mould within which legitimated discourse about mental and emotional
distress and potential interventions can occur. This is important as it creates a shared perceptual
frame with which to capture our queries and findings within. For instance, the definition of moral
distress shapes discourse about a particular type of suffering among service providers.
Despite the lack of a standardized definition of TIP many of the same or overlapping
concepts appear in the literature. The principles of safety, trust, collaboration, choice, and
empowerment are commonly identified as the core concepts of this approach (Bent-Goodley,
2019; Knight, 2015; Knight, 2019; Levenson, 2017; Levenson, 2020; Mersky et al., 2019;
Sweeney et al., 2018). Scholarship on TIP also frequently includes an emphasis on client
strengths (Bent-Goodley, 2019; Levenson, 2020; Quiros & Berger, 2015; Sweeney et al., 2018).
Application of TIP does not require any diagnosis or disclosure of trauma; instead, it is a
framework that assumes the possibility of trauma among service users' backgrounds and strives
to avoid retraumatization (Knight, 2015; Knight, 2019; Levenson, 2020; Sweeney et al., 2018). I
will explore TIP in greater detail in my literature review.
Alongside TIP, the concept of intersectionality has seen a similar explosion in popularity
in social work and other fields. The theory of intersectionality is attributed to Crenshaw’s (1989)

9
discussion of how the law failed to recognize discrimination specific to black women as it only
recognized discrimination based on being black or being a woman, neglecting to recognize the
unique issues that arose from the interaction of these two social categories. Since then,
intersectionality has gained steady traction in multiple fields of scholarship.

Positionality and Reflexivity
To begin, I must situate myself within the work. I started my journey as a "helping
professional" by pursuing my Bachelor of Psychology degree with the initial plan to complete a
Master’s in Counselling Psychology degree and pursue therapy as my occupation. Towards the
tail end of my bachelor’s degree, I acquired a supervisory job at the local crisis line, where I had
spent a year volunteering. As I began spending more time at the crisis line, I also began
interacting with other young people in pursuit of various "helping professional" careers. Through
this exposure I learned more about social work, which I had previously believed consisted
mainly of child protection work. I decided to switch to social work for the greater variety of job
opportunities and the ability to pursue a career better aligned with my strong sense of social
justice.
Next, I completed my Bachelor of Social Work degree with the University of Victoria. I
completed my practicum at Lookout Housing and Health Society, performing front-line work
with highly street-entrenched people. I enjoyed it so much that I continued my employment there
as I progressed through my Master of Social Work journey. I believe working with the
population that I do has given me uniquely intimate knowledge of the significance of trauma in
influencing life trajectories and the experience of accessing social and health services. From
hearing clients' stories, I have learned of many barriers that trauma places in their ability to
interact with providers and programs.

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In locating my own intersecting identities, I identify as a heterosexual, invisibly disabled,
cisgendered, biracial female. I believe when I first learned of intersectionality it spoke to me due
to my experience of being biracial. I have long felt that the mixed-race experience is unique and
neglected in academia, the media, and broader society. My observation is that in explorations of
issues surrounding race and ethnicity and these identities there is a "siloing" of categories. We
explore the experiences of Indigenous peoples, Black people, Indian people, and so on. I also
feel, as with the premise of intersectionality, that the experiences of my multiple identities (being
half one thing and half another) cannot be "added up" to explain the experience of my racial and
ethnic identities. It is precisely the intersection of these two things that explains this experience
for me and why I feel the label "biracial" best describes my experience rather than saying I am
half this and half that.
Besides being forgotten about in discussions about race and ethnicity, I have found the
experience of mixed racial and cultural identity also brings with it the experience of
simultaneously belonging to and also being an "Other" in certain racial and ethnic groups,
presenting ethnically ambiguous, having curiosity about my ethnic and racial background thrust
upon me, and identifying more with the beliefs and values of one culture versus the other at
certain times on specific issues. Just like the experience of the Black women fighting legal
discrimination could not be explained by adding up the experiences of race and womanhood
(Crenshaw, 1989) so too the mixed-race experience cannot be explained by adding up the
experience of this race and that one. Therefore, I feel this is why intersectionality resonates with
me.
Finally, I am likely drawn to hospital and healthcare social work as I am a person with
chronic health issues and have had to interface frequently with healthcare systems and

11
professionals. Therefore, I can readily appreciate the vulnerability inherent in accessing health
care services. This is even more so in a hospital setting, where healthcare needs are typically the
most acute and critical compared to other settings such as a general practitioner's office or
imaging lab. This aspect of my identity is something I must attend to as part of my reflexivity.
For instance, I appreciated that Lamb's (2012) writing discussed how her experience of
disability intersected with her experience and identity as a social worker with her interactions
with clients and co-workers. I think this spoke to me because, like Lamb (2012), I have a
disability that is usually invisible (Multiple Sclerosis or MS) and anticipated the need to navigate
issues of self-disclosure, accommodation and countertransference. I also realized the need to
remain attentive to the possibility of making assumptions about clients with the same diagnosis
so that I do not overwrite their experiences with my own and thus render theirs less visible.
However, contrary to my expectations, during my practicum found that I did not have
countertransference issues among patients with Multiple Sclerosis or related diagnoses within
that family of neurological conditions. Regardless of diagnosis, the situations that I found most
distressing were those where previously “high-functioning” and independent people had rapidly
lost this level of function and independence accompanied by little or no likelihood of regaining
them. It became clear to me that it is not particular diagnoses that may trigger me, but rather
patient experiences reflecting my fears around loss of independence and ability. These fears were
already present prior to my diagnosis but of course have become more salient post-diagnosis.
This experience provides me more insight about myself but also about the situations in which I
must be aware that I may be more likely to have challenges in implementing a strengths-based
and empowering practice. Empathy is important in social work, but empathy unchecked can
evolve into pity. Pity is ultimately disempowering to the service user because it causes the social

12
worker to approach them from a pathologizing perspective. I will revisit this personal aspect of
my practice in Chapter 5 of this report.

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Chapter 2: Theoretical Inspirations
In this section, I will further unpack the history and theory of intersectionality and its
relevance to my work. I will also explore the notion of “Red Intersectionality” (Clark, 2016) to
centre Indigenous perspectives and help avoid the centrism on Western worldviews that I
criticize in this document. I will also briefly discuss how some ideas from systems theory can
assist in exploring the incorporation of intersectionality into TIP.

Intersectionality
The "invention" of intersectionality as a concept is generally attributed to Crenshaw's
(1989) seminal paper, which illuminated how the experience of being a Black woman was its
own unique experience that could not be explained by "adding up" the separate experiences of
being Black and being a woman. The interaction of these two identities created a specific
experience and set of challenges. Crenshaw (1989) described a series of events that specifically
discriminated against black women and only black women (not black men or non-black women).
However, the law and thinking at the time were unequipped to conceptualize discrimination and
oppression in this way. As these specific experiences of black women neither applied to women
as a group nor black people as a group, the legal case brought forward against this discrimination
failed. Through the lens of intersectionality, experiences are understood and explained as
emergent properties of multiple interacting identities. In essence, the whole is greater than the
sum of its parts. For instance, a growing body of research indicates that pain and health concerns
presented by women and racial minorities are taken less seriously and treated less effectively
than they are for men and white patients (Centola et al., 2021). Further, this problem is even
more pronounced for racial minority women (Taylor & Glowacki, 2020). An intersectional lens

14
indicates that this experience cannot be explained by summating the experiences of being a
racialized minority and of being a woman. The interaction of these two social categories results
in the outcome: significantly increased risk of receiving poor quality pain management and
minimally investigative health care.
Further, an intersectionality lens also spotlights dimensions of experience that could
otherwise go unseen even within attempts to advance social justice. For example, Crenshaw
(1989) criticized the dominant discourse of feminism for representing solely white women's
perspectives and trying to apply these to black women's lives. By subjugating black women's
experiences, this brand of feminism was oppressive to black women instead of advancing the
goal of women's liberation. Heberle, & Obus et. al. (2020), in their discussion of the
overrepresentation of black children in the child welfare system in the United States, note that
the discourse of explanations revolves around racial or socioeconomic bias. They propose a shift
to an intersectional lens of explanation, to " ... instead ask what it is about the interlocking and
amplifying experiences of systemic oppression related to anti-Blackness and class inequality that
leads to this disproportionality" (p. 826).
Finally, I am compelled to include some Indigenous perspectives in the discussion as I
have learned throughout my social work education that social workers have an ethical duty to
decolonize their work. Clark (2016) presents the concept of "Red Intersectionality," which is
inherently activist, centred around Indigenous sovereignty, foregrounds the colonial context of
struggles experienced by Indigenous peoples, emphasizes traditional teachings, and analyses how
policies intersect to create harm. Clark (2016) contends that Crenshaw did not "invent"
intersectionality as Indigenous ontology has always included an intersectional focus. Clark
(2016) also criticizes dominant notions of trauma and trauma interventions as re-entrenching the

15
construction of Indigenous peoples as pathological and therefore in need of colonial control, such
as through medication or talk therapy. Clark's (2016) writing compels the reader to consider the
popular ideas of trauma and intersectionality as perpetuating colonial discourse and power
operations regarding Indigenous peoples.

Useful Concepts from Systems Theory
Systems theory concerns the phenomena emergent from multiple interacting dimensions
of experience (systems) (Friedman & Allen, 2021) and holds some valuable ideas to borrow for
my work. For instance, Brofenbreenner's ecological environment perspective discusses how
situations where a person is not even present can significantly influence that person's
development. (Crawford, 2020). An example is how a child's school environment heavily
influences their development (Crawford, 2020). However, the child is not involved in decisions
that create the school environment, such as school board meetings and government funding
decisions. Such a perspective also orients towards the historical and cultural pieces of the system,
not just the immediate contexts. For example, we can unpack intergenerational trauma by
conceptualizing this as a system with unique effects on individuals based on historical
experiences rather than simply the here and now. With intergenerational trauma, the impacts of
psychological trauma on a parent influence their relationship with their child, extending the
impacts of trauma into the subsequent generation (and the one after that, and after that, and so
on) (Heberle et al., 2020). One specific example is how the effects of the residential school
system constitute a collective intergenerational trauma for Indigenous peoples in Canada.
A systems perspective also foregrounds the idea of adaptations (Crawford, 2020;
Friedman & Allen, 2021), as in how people alter their behaviour to navigate the systems in

16
which they reside. Viewing behaviour as an adaptation rather than a spontaneous development
helps practitioners situate behaviour and choices within the context of trauma. For example,
substance abuse may lead to disruptions across several domains of a person's life and, therefore,
can easily be construed as a maladaptive way of living. However, substance abuse can also be
viewed as an adaptation to the environment, such as a method of self-medicating for those with
unresolved trauma or untreated mental illnesses.
Finally, systems theory is helpful for social work practice in the hospital environment as
this environment is an extensive system with many sub-systems containing many opportunities
for growth to serve clients better. Systems theory emphasizes the function and goals of a system
and its ability to fulfil these functions and meet these goals (Friedman & Allen, 2021). This
theory thus orients me to questions such as: What are the goals of the hospital system and its
various sub-systems, and how are these achieved? Who decides on these goals? How does goal
development evolve? How do these goals interact with those of the patients and with the
question I wish to explore in this setting?

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Chapter 3: Literature Review
In this section, I will briefly trace the history of trauma’s emergence as a topic of inquiry,
its relevance for social work practice, and some of the impacts of trauma on the individual. I will
then discuss the arguments for TIP and expand on some of the core principles of this approach. I
will follow this by exploring some criticisms of the prevailing notions of trauma and TIP.
Finally, I will conclude by discussing the relevance of including an intersectional focus in the
trauma discourse and the operationalization of TIP.

The Rise of Trauma and Trauma-Informed Practice
In contrast with its present popularity, minimal attention was paid to the concept of
trauma until the 1970s, when the mass of soldiers returning from the Vietnam War forced focus
on widespread psychological disturbance across this population (Kleber, 2019; Wilson et al.,
2013). PTSD was subsequently added to the DSM-III in 1980 (Kleber, 2019), and 1985 saw the
creation of the International Society for Traumatic Stress in the United States (Wilson et al.,
2013). Public and scholarly interest in trauma has grown steadily over time including a rise in the
number of professional organizations centred on trauma and the inclusion of trauma in social
work education (Kleber, 2019; Mersky et al., 2019), The recent "Me Too" movement brought
the trauma of sexual assault to the forefront of society, to the point of near-inescapability of
exposure (Bent-Goodley, 2019).
This increase in focus on trauma in the public and academic sphere can be more easily
understood in light of research about the nature of traumatic events. Research indicates that
exposure to traumatic events is quite common (Kleber, 2019; Mersky et al., 2019; Sweeney et
al., 2018). This frequency of trauma is perhaps easier to understand when considering the range

18
of traumatic experiences that can occur with assault, sexual assault, combat, car accidents,
natural disasters, and family violence, among some of the more common ones. Service users in
settings that social workers tend to frequent such as the child welfare system, penal system, and
mental health and substance use services present with exceptionally high rates of trauma
(Becker-Blease, 2017; Knight, 2015; Knight, 2019; Wilson et al., 2013). Traumatic experiences
also drive contact with specific service settings, such as domestic violence support services. The
service system itself can also impose additional traumas on service users, for example, the
removal of children from the family home as the result of a child welfare investigation (Wilson
et al., 2013) or the placing of psychiatric patients in restraints (Sweeney et al., 2018). Social
workers must hold a rich understanding of trauma and how to effectively consider the role of
trauma in their response to their clients.
In addition to the increased research interest in trauma in general, the distinct
neurobiological, physiological, and behavioural changes that occur due to trauma have also been
an increasing focus of study. Although the majority of people who experience a potentially
traumatic event will not develop PTSD, it is common to experience after-effects such as
hypervigilance and disturbed worldview (Kleber, 2019). Exposure to traumatic events can
dysregulate the nervous system, leading individuals to engage in maladaptive coping mechanics
to self-soothe (Sweeney et al., 2018). Childhood trauma has been shown to interfere with normal
brain development (Knight, 2015) and can result in long-lasting impacts on thinking and
behaviour (Knight, 2019; Levenson, 2017; Sweeney et al., 2018). These impacts include a
tendency towards negative beliefs about self and others and diminished abilities to self-soothe,
handle criticism and feedback, and manage one's emotions (Knight, 2015). Childhood trauma
also increases the risk of a diagnosis of various mental and physical illnesses in adulthood

19
(Mersky et al., 2019; Wilson et al., 2013). Clearly, trauma bleeds into the survivors' experience
throughout their lifespan, especially when trauma occurs in childhood.
The rationale for TIP becomes clear in light of the growing body of research about the
widespread nature of trauma and its deleterious effects. Although a traumatic event may not be
the reason an individual accesses services, Mersky et al. (2019) point out that "...social workers
routinely work with and on behalf of children and adults whose presenting physical and
psychosocial difficulties are linked to a history of trauma" (p. 646). Knight (2019) argues that
without education on TIP, practitioners will fail to recognize the role of trauma in their clients'
presenting troubles. For example, Sweeney et al. (2018) point out that the biomedical system
tends to frame "extreme" behaviours as symptoms of mental illness. In contrast, a trauma lens
interprets such behaviours as a response to or attempt to cope with trauma. Behaviour is
understood as an attempt to adapt to the environment rather than a reflection of the individual's
pathology. Instead of asking, "What is wrong with you?" TIP asks, "What happened to you?"
(Sweeney et al., 2018).

Popular Principles of Trauma-Informed Practice
Next, I will unpack the most commonly identified principles of TIP: safety, trust,
collaboration, choice, and empowerment (Bent-Goodley, 2019; Knight, 2015; Knight, 2019;
Levenson, 2017; Levenson, 2020; Mersky et al., 2019; Sweeney et al., 2018).

Safety
Since traumatic events cause one to experience the world as unsafe, safety is a crucial
component of TIP. Safety includes attending to physical and psychological safety (Bent-

20
Goodley, 2018; Knight, 2019), for example, by attenuation to the working relationship (Knight,
2019), creating as much predictability and consistency in the environment as possible (Quiros &
Berger, 2015), and identifying and minimizing possible triggers in the environment such as a
sterile looking physical space or chaotic noise (Bent-Goodley, 2018). Plants, warm lighting,
muted colours, comfortable seating, and proper disability accommodations can all enhance the
comfort and security of the physical space (Levenson, 2020).

Trust
As trust in others and the world is damaged when experiencing a traumatic event, it is
easy to understand how trust emerges as a central principle of TIP. Practitioners can enhance
trust by explaining the limits of confidentiality (Knight, 2019) and allowing the client to lead the
pace of disclosures and the development of the helping relationship (Levenson, 2017).
Practitioners must also remember that traumatic experiences can predispose clients to mistrust
authority figures (Levenson, 2017; Levenson, 2020). The onus is on the practitioner to prove
themselves trustworthy.

Collaboration
Collaboration enables the client to co-create their journey with the practitioner rather than
passively "receiving" help. The practitioner should seek the client's perspective in decisionmaking and avoid giving advice (Levenson, 2020). The client is situated as the expert, not the
practitioner (Levenson, 2017), and client feedback and direction are privileged (Bent-Goodley,
2019). Collaboration is essential for reducing the sense of "power-over" in the helping

21
relationship (power of the practitioner over the client) (Sweeney et al., 2018). Collaboration also
ties in with the principles of choice and empowerment.

Choice
Choice is a significant consideration in TIP as traumatic experiences involve one’s choice
being taken away or entrapment into an undesirable set of choices (or sometimes both). The
principle of choice is upheld through such methods as ensuring informed consent (Knight, 2019),
presenting all available options to clients and exploring their preferences (Levenson, 2017), and
asking clients to state their goals rather than proscribing goals to clients (Levenson, 2020).
Creating as much opportunity as possible for clients to choose helps re-entrench a sense of
control over one’s life.

Empowerment
Finally, empowerment is central to TIP as traumatic experiences involve a profound loss
of power. The client should be able to exert as much control as possible over their goals (Knight,
2019). Emphasizing strengths and resilience also supports client empowerment (Levenson,
2017). Using person-first language and supporting clients in making their own decisions also
present paths to client empowerment (Levenson, 2020)

Towards an Intersectional Understanding of Trauma and Trauma-Informed Practice
With the increasing popularity of trauma and TIP in the literature and discourse, there is a
parallel school of thought emerging that criticizes dominant notions of trauma and TIP for
operating from a white, Western worldview which neglects the role of socio-political contexts in

22
these phenomena (Becker-Blease, 2017; Bryant-Davis, 2019; Litam, 2020; Quiros & Berger,
2015). This perspective neglects the whole lived experience of service users which contradicts
core social work values and goals such as spotlighting marginalized perspectives, situating a
person within their contexts, and privileging the voices of lived experience. This is particularly
troubling considering the evidence of the prevalence of traumas related to systemic oppression
among marginalized populations (Levenson, 2017) and the increased likelihood of developing
PTSD among those who experience multiple forms (i.e., intersections) of oppression (BryantDavis, 2019). Despite this, critics argue that most writing and discourse ignore oppression as a
site and driver of trauma (Becker-Blease, 2017; Bryant-Davis, 2019; Quiros & Berger, 2015).
For instance, Bryant-Davis (2019) criticizes the American Psychological Association's
treatment guidelines for PTSD for only containing a brief mention of intersectionality, which
neglects any direct mention of discrimination, oppression, modifying treatments based on client
culture, treatments emergent of the culture, or development of PTSD as a result of victimization
due to membership in a specific culture. Bryant-Davis (2019) argues that this amounts to cultural
erasure which fails to enable practitioners to assess and respond to trauma in marginalized
groups appropriately. If trauma is understood solely from a Western point of view, then the
interventions that flow from it erase the ideas of trauma held by other cultures. Quiros & Berger
(2015) further argue that "...experiences of systemic oppression are not included in what is
defined as trauma because the victims are typically oppressed groups and their voices are
silenced by the universality of the White, middle-class, and heterosexual experience that
dominates the treatment and research literature" (p. 152). Becker-Blease (2017) also argues that
"trauma is inextricably linked to systems of power and oppression" (p. 131-132) and implores
the reader to consider who defines trauma and how these actors define it. Quiros and Berger

23
(2015) also point out that the prevailing thought and approach to trauma demonstrates a microlevel, individualized concept of trauma. For example, this is reflected in PTSD's definition as an
individual experience. If dominant notions of trauma, and therefore interventions, revolve around
the white, western, middle-class, individualized perspective of the world, this renders
marginalized perspectives invisible.
However, conditions of marginalization exert unique influences on the experience of
trauma. For example, social conditions in and of themselves can be traumatizing (Quiros &
Berger, 2015). Homelessness is a salient example: it involves a profound loss of safety, security,
and stability in one's life in tandem with suffering incredible stigmatization. Quiros and Berger
(2015) also implore the reader to consider that many social work clients have experienced trauma
related to conditions of marginalization. For instance, victimization in the form of a hate crime
due to one's sexual orientation or race is a traumatic experience unique to particular oppressed
groups. Violent victimization is always traumatizing, but in the context of a hate crime, there is
an additional layer of its intersection with belonging to a particular marginalized identity. The
survivors' experience cannot be explained only by the experience of suffering violence or by
belonging to a particular group. The interaction of these two experiences produces a unique
experience and type of trauma. For example, in discussing the rise in acts of racial discrimination
against Asians, American Asians, and Pacific Islanders (AAPI) during the Covid-19 pandemic,
Litam (2020) explains that "healing race-based trauma requires counselors to consider the
intersectional identities that uniquely influence experiences of oppression and discrimination for
marginalized groups" (p. 147). In addition, the interplay of experiences of multiple diagnoses
shines a light on unique experiences and needs for those occupying such labels. For example,
during my practicum, a patient’s family member brought to our awareness the link between

24
eating disorders (ED), particularly anorexia nervosa (AN), and autism spectrum disorder (ASD).
Recent literature highlights notable comorbidity between ASD and ED diagnoses, and points to
the utility of tailoring ED treatment interventions for those with both diagnoses (Brede et. al
2020; Kelly & Kelly, 2021; Nimbley et. al., 2023). Traumatic events can also be experienced
differently by different social identities. For instance, with intimate partner violence (IPV),
disabled men (Savage, 2021) and disabled women (Disabled Women's Network of Canada,
2014; Savage, 2021) face different challenges in their victimization and in accessing professional
support than their abled peers.
Finally, TIP without attendance to the interplay of social locations, power, and
oppression may cause additional harm to social work clients. A response to trauma which fails to
account for socio-political contexts dismisses and invalidates the role of these contexts in the
survivors' experience. For instance, Quiros & Berger (2015) argue that trauma interventions tend
to use a "one-size-fits-all" approach, which ignores sociopolitical contexts to the detriment of
service users. Although well-intentioned, such approaches may impair the helping relationship or
even re-traumatize service users. For instance, although the principle of choice is frequently
deemed an essential component of TIP (Bent-Goodley, 2019; Knight, 2015; Knight, 2019;
Levenson, 2017; Levenson, 2020; Mersky et al., 2019; Sweeney et al., 2018) being given the
responsibility of making choices may be anxiety-inducing for a woman belonging to a heavily
male-dominated culture where men hold decision-making authority (Quiros & Berger, 2015).
Litam (2020) also explains that the dominance of white Western ideas of trauma means that
"...many existing theories and trauma-based interventions may, therefore, lack cultural relevance
for AAPI [Asians, American Asians, and Pacific Islanders] groups" (p. 148). Failure to
incorporate culture in the therapeutic response does a functional disservice to clients and

25
recapitulates the oppressive dynamic of rendering minority perspectives invisible.
In review of the research highlighting the role of oppression and socio-political contexts
in trauma the utility of intersectionality becomes apparent in implementing TIP. A blanket
approach to trauma interventions neglects nuances of experience wrought by particular social
identities which can potentially cause further harm. It also perpetuates the dominance of white,
Western, middle-class thought as a universal worldview. While conducting my literature review,
I also noticed that much of the popular research and discourse focuses on helping people cope
with and move forward after trauma without mention of the social conditions that contribute to
trauma or how to change them. Intersectionality, on the other hand, draws attention to the
omnipresent operations of power and oppression inherent in social category identities. I believe
incorporating this lens into TIP enables a richer response to the full scope of client experiences
better rooted in the social justice ideals at the core of social work.

26
Chapter 4: Learning Experiences from Practicum
In this section, I will discuss my practicum experience in detail, breaking them down
into subsections for each of my rotations and an additional subsection to cover the
educational/training component. I will include an introduction to each site, an exploration of
skills and knowledge I acquired, noteworthy challenges and successes, and my observations and
thoughts on how intersectionality and TIP showed up and wove together throughout the process.

First Rotation: Holy Family Hospital

Introduction
Holy Family Hospital (HFH) is a rehabilitation centre offering inpatient and outpatient
services as well as a separate long-term care facility on the top floor called Holy Family
Residence. Patients at HFH are generally those recovering from significant medical events such
as stroke, hip replacement, falls, and amputations. Those admitted as inpatients will stay for
weeks or even months. Patients are assigned a “team” of service providers which includes
nursing, physicians, social work, physical and occupational therapists, and may also include
speech language pathologists, spiritual health workers, and dieticians. The rehabilitation is
intensive and patients will be meeting with a service provider for most of their day from Monday
through Friday. The majority of patients will not exactly “get better” in the typical sense as they
will experience a different level of functioning upon discharge than what they had prior to their
medical event. Therefore, part of the patient rehabilitation and recovery process is the pragmatic
and logistical, as well as mental and emotional, adaptation to a new baseline.

27
Social Work at Holy Family Hospital
To support patients in their transition to their new baseline, each patient at HFH is
automatically assigned a social worker. Social work is heavily involved in the discharge planning
process, which tends to be complex due to the changes in patients’ baseline functioning. Upon
assigning me this rotation, my agency supervisor informed me that working at this site would
provide me a solid foundation to develop core hospital social work skills. I found that the
intensive and long-term nature of social work service provision at this site definitely supported
this learning. These features of the site enabled social workers to get to know their patients on a
fulsome level and provide them with a large depth and breadth of service.
To begin, the first task I needed to embark on was the social worker psychosocial
assessment, as the rest of the work flows from this evaluation. Thankfully, my preceptor
provided me with a template to follow, and the first three of the internship program weekly
seminars were on this topic. I had my first opportunity to complete a psychosocial assessment
interview within my first few days at HFH. I found that asking the questions was quite
straightforward. The real work was in determining when to probe further beyond what my
template indicated, and in how to construct the documentation. For example, once when I was
conducting a psychosocial assessment interview with a patient and following along with the
questions in the template my preceptor had provided me, my preceptor took over to ask a patient
further questions about their (the patient’s) seemingly off-hand comment about long-term care.
This later led to a conversation with my preceptor about listening for “clues” in the patient’s
verbalizations and body language which may indicate to us a prompt to probe for further
information. In this case, my preceptor wanted to gather the patient’s perspective about long-

28
term care, as it was possible it could end up being an outcome of the patient due to the nature of
a diagnosis they had received.
Documentation also proved its own challenge. Developing a clinical impression felt
confusing, especially when I felt like a clueless student. Adapting to medical jargon became
another piece of the puzzle. For instance, my preceptor corrected my documentation of
“concerns that patient is not eating enough” to “concerns about poor oral intake”. Developing my
clinical documentation skills continued to be a theme throughout my entire practicum.
In addition, some other core skills I developed on this rotation were gathering collateral
from family members, collaborating with other providers on the care team, and participating in
rounds. One of the key takeaways from connecting with other disciplines, especially rounds, was
not just communicating the facts of what had occurred but advancing the social work perspective
into the conversation and care plan. This was significant for influencing the shape of the
discourse because every other professional communicated from a biomedical model perspective.
Fortunately, I had the opportunity to observe ways to infuse other pieces of information
into the holistic picture of the patient beyond what the biomedical model engenders. For
instance, staff were brainstorming how to enhance family compliance to instructions from one of
the allied health staff to refrain from smoking near the patient. One of my preceptors, who is
Chinese, suggested that the patient's physician sign a printed copy of these instructions as the
patient/family were Chinese and Chinese cultural values include a respect for authority figures.
Therefore, the family would be more likely to follow the instructions if the physician endorsed
them.
Additionally, I was also able to successfully participate in rounds twice. The first time,
my preceptor for that team’s rounds was not present so I took on sharing the necessary pieces of

29
information about the patients. My other preceptor was supervising me, but she was unfamiliar
with the patient case load on this team. I explained to the team the social barriers to discharge of
one of the patients on this caseload. I was startled by, but able to answer well enough, the followup questions from other team members, which I had not anticipated. My second participation in
patient rounds I had planned ahead of time. The patient in question was a retired health care
worker who had demonstrated in my interactions with them that they wanted to be involved
collaboratively in their process rather than a passive recipient of care, such as showing up to
meet with social work with notes about their discharge planning and communicating to us they
had decided to seek counselling services at a specific future point in time. I felt it important to
advocate for this patient’s perspective in rounds and communicated that I had determined it
would be conducive to their well-being if providers involved them in their care planning and
decision making and that we should keep that in mind. I also noted such in my clinical
impression when I documented the psychosocial interview with this patient.
Finally, my experience reinforced something I discovered during my time working with
the homeless and street entrenched: sometimes it is the non-clinical work that makes the biggest
impact for service users. For example, after completing a psychosocial assessment interview with
an elderly patient who did not speak much English, I escorted the patient back to their room and
used Google translate to explain it was my last day there but my preceptor would follow them
throughout the rest of their stay and they would be in good hands. This patient then wanted to
learn how to use Google translate. After I showed them, the patient seemed incredibly happy;
smiling widely, repeatedly expressing thanks, taking my hand in between theirs and wishing me
a happy life. I have had parallel experiences in community settings. After several years doing
front-line work with a street-entrenched population I am unable to count how many overdoses I

30
have reversed, and in plenty of these occasions the person was indifferent to the fact that I exist
upon their revival. Yet, others fall over themselves with gratitude because I gave them a cup of
coffee or photocopied something for them and will remember this interaction several months or
even years later. Part of the social work stance is to identify what the person using our services
needs or could benefit from, but we can never know for certain which of the supports we provide
is most impactful.

Unique Aspects to Consider for Trauma-Informed Practice and Intersectionality
When working with patients in a physical rehabilitation facility, some key aspects of the
patient experience present readily salient considerations for the provision of TIP. First, the events
that brought the patient into the facility can be traumatic experiences in and of themselves due to
their sudden, unexpected, and dramatic nature. The change in functioning as a consequence of
these events also confronts the patient with an experience of traumatic loss and complex grief.
Loss of independence can be a profound struggle for many. Second, the change in function
instigates a cascade of effects within the person’s support system. Role change, caregiver stress,
and home modifications are significantly impactful on the well-being of the entire family system
and require dramatically re-shaping a stable dynamic.
Further, some people are not able to return home and must be transferred into a long-term
care facility. This can be very difficult for some people as it requires grappling with the grief of
loss of autonomy, independence, and home. On the other hand, this cannot be an assumed
experience for the patient. For instance, one patient at HFH specifically requested placement in
long-term care. The team thought this patient was a perfect candidate for long-term care.
However, the health authority denied this request and the patient was discharged home with

31
support services instead. This person therefore grappled with the loss of an expected or hoped for
support system.
Additionally, the feelings of vulnerability inherent from requiring physical care and
limited ability to maneuver oneself can be very triggering for persons who have experienced
trauma. I shared with my supervisor my observation that it would be triggering for people who
have a history of physical or sexual abuse to receive personal care, possibly especially so from
strangers or someone of the opposite gender, and unfortunately abuse is a common occurrence in
people’s life histories. Among professionals, I occasionally sensed an undercurrent of frustration,
confusion, or helplessness when observing patients who declined to engage with home support
and long-term care, especially as this often meant they were becoming physically or medically
compromised as a result (for example, due to hygiene concerns).
Finally, many of the patients at HFH utilized mobility aids such as walking poles or
wheelchairs as they were recovering their functioning. I noticed that sometimes clinicians would
ask patients for permission to touch a patient’s wheelchair or push them in their wheelchair and
other times they would not. This is noteworthy because mobility aids can essentially become an
extension of one's body. However, this may not be readily apparent to those who do not use
mobility aids. I recognize this is more readily apparent to me due to my social location as
someone with an invisible disability. First, this occurs because I occupy disability spaces (such
as online support groups) and therefore I hear from disability voices such problems as others
entitling themselves to touch or maneuver their mobility aids (similar to people who feel entitled
to put their hand on a pregnant person’s protruding belly without asking). Secondly, this occurs
because I recognize the experience of disability is often invisible to the able-bodied, even in
situations such as these where the disability itself is visible.

32
Case Examples
Case Example #1. Prior to completing a psychosocial assessment interview with a
patient, I reviewed their chart and noticed psychiatric documentation indicating “Cluster B
Personality Disorder Traits” (Histrionic, Narcissistic, Antisocial, and Borderline Personality
Disorders). I further discovered within charting from other service providers descriptions of
patient interactions that could be construed as congruent with the psychiatric assessment. I
started thinking that the psychosocial assessment process would be difficult with the patient and
began thinking already of strategies to navigate our conversation.
However, when I met with the patient, I did not find our meeting particularly unwieldy or
difficult. I found that the patient was highly talkative and at times meandering, and I occasionally
needed to interject in order to keep us on-topic. Although it is possible that these communication
features manifested in ways congruent with Cluster B Personality Disorder traits, they did not
create major barriers to my ability to connect with the patient. Here, I must admit I fell into the
trap of anticipating a negative or challenging interaction with the patient based on the narrative
that emerged from the chart. This can cause a social worker to be of disservice to the patient
because it can lend itself to being less open and interpreting the patient’s words and actions in a
pathologizing light, which is contrary to social work values but can also make us blind to
potentially important aspects of the patient experience that could be better explained by
something else besides their (stigmatized) label. Presence of Cluster B Personality Disorder
Traits may or may not be relevant for every professional, task, or intervention.
Further, if a Cluster B Personality Disorder is a part of a patient’s experience, an
intersectional lens invites us to consider how this would impact and intersect with their other
identities and health care experience. If we acknowledge that there are those whose patterns of

33
thinking and belief are officially “dysfunctional” or “pathological”, then we must acknowledge
this can show up in the experience of receiving care as well. This leads to some interesting
questions when we start looking at these patients through an intersectional lens such as how does
someone with Antisocial or Borderline Personality Disorder experience an amputation, or
becoming a senior, or a permanent change in ability differently than a person who does not hold
such a diagnosis? How do providers attend to possible considerations without re-entrenching
pathologization of the individual?
Case Example #2. One of the more complex cases that I encountered during my time at
HFH constituted that of an elderly patient who needed a high level of care and of their spouse.
The spouse was highly involved in the patient’s care, spending many hours at HFH with them
and often taking on tasks of their personal care. It appeared that some staff perceived this as the
spouse being devoted to their partner and others as intrusion on the work of health care
providers, or a mix of both.
It was not the medical aspects of the case that caused its complexity. It was the conflicts
between the patient’s spouse and health care providers. On several occasions the spouse
performed actions that were not approved of by the care team or not technically “allowed”, such
as taking the patient home for a few hours (which was not far), providing personal care to the
patient (such as showering), and bringing certain foods to the patient (specific to their culture,
which was non-western). At times, I felt the frustration from some of the people on the care team
was palpable. The idea that the couple had a low level of health literacy was tossed around a few
times.
On the other hand, the social work perspective re-oriented focus to the couple’s
viewpoint and needs beyond physical health concerns. For example, my preceptor pointed out

34
that the patient and spouse’s unauthorized home visit served to fulfill a need for intimacy and
closeness. There was also an incident where the spouse was hesitant for the patient to be
transferred off-site and back for imaging. The spouse shared with me and my preceptor that they
did not want to cause needless stress or suffering for their partner, who had already undergone a
multitude of health care interventions and meetings. This resulted in an argument between the
spouse and the staff, who explained that the imaging was medically necessary. However, when
discussing this case in supervision, my supervisor pointed out that due to this patient’s advanced
age and poor medical condition they would likely not live much longer anyways.
Additionally, in this case the patient was already in poor health and there was a wellestablished dynamic of their spouse as caregiver prior to hospital admission. Consequently, the
disruption to this dynamic, especially when accompanied by conflicts with service providers, is
an important aspect to consider in the traumatic potential of this hospitalization. This case also
forced consideration of where the “line” is between what the patient wants and what service
providers think is best.
Case Example #3. One of the most dramatic examples of intersectional considerations
of trauma came from a patient and his wife who came from a culture with strong values and
beliefs about the man acting as a provider for the family and the woman remaining out of the
paid workforce, instead focusing on taking care of the home and the family. Unfortunately for
this couple, the man had undergone a dramatic and unexpected medical event from which his
baseline had changed from working a highly demanding and lucrative job to being unable to
continue working in a physical capacity. This family also had a child who was too young to
work. Their housing was also not accessible, so the patient was going to be housebound upon
discharge. Along with coping with the grief of loss of functioning, this family had to cope with a

35
dramatic change in their socioeconomic status, and disruption of the ability to live in accordance
with their cultural norms. Here, the experience of a traumatic medical experience is influenced
by and intersects with socioeconomic and cultural identities. In this instance the patient’s wife
ended up working with social work to apply for various programs such as BC Housing and
Income Assistance. To my eyes this appeared quite stressful for her, given her questions and
comments on the monetary amounts of assistance programs and her occasional sighs and
restlessness during conference calls between her, social work, and government agencies.
Further, this patient was at HFH for a lengthy period and their case seemed to be framed
as one of the patients being “resistant”, in my opinion a close cousin to the unfortunate stamp of
“non-compliant”. To my discomfort I found other health care providers making comments to the
effect of them refusing to accept reality, them thinking he will go back to work, they should sell
one of their vehicles, the wife needs to get a job, and so forth. I felt like these comments reflected
a feeling of frustration with the patient and family for not “behaving” the way they “should”, and
a lack of appreciation for the psychology of the situation. I found this case distressing as well
because the family had gone quite rapidly from being very financially comfortable (designer
clothes, multiple fancy vehicles) to looking at potential poverty. I spoke of this case in group
supervision and shared how I found it depressing. My supervisor encouraged me to re-frame to
find hope in the situation. In reflecting, I found I was looking at the situation narrowly, and hope
could be found in recognizing that the patient’s time at HFH was only the beginning of their
journey. Upon discharge, the patient and family would continue to find new ways of living and
being. However, I still felt moral distress as a result of the nature of commentary and opinion by
some of the other health care providers. It felt achingly obvious to me that part of the trauma for
this family was the new limits on their ability to live according to their cultural norms and loss of

36
their socioeconomic identity. I felt it was unfair and unrealistic to expect zero resistance to these
sudden changes in circumstances. I discussed this case in group supervision, sharing that I think
that understanding an unwelcome change to one's life on an intellectual level does not
automatically extinguish any urge to fight against it.

Second Rotation: Eating Disorders Inpatient Treatment Unit

Introduction
The SPH Eating Disorders Inpatient Unit, also referred to within-hospital as 4 Northwest
(4NW) is a locked unit containing a maximum of 7 patients experiencing symptoms of anorexia
and bulimia. This unit constitutes a provincial treatment program titled Provincial Adult Tertiary
and Specialized Eating Disorders Program (PATSEDP). Generally, patients are referred from
regional outpatient programs they are already involved in. 4NW essentially comprises “Step 1”
in eating disorder treatment with a maximum stay of 7 weeks. Upon discharge, patients may
return to the services of their regional outpatient programs and may later return to do further
work in 4NW. In addition, 4NW offers outpatient support following discharge for up to 3 months
(6 if the patient is pregnant). Patients also have the option to pursue a more intensive and
lengthier (12-15 weeks) residential treatment program, Discovery Vista, which entails much
“deeper” work such as lots of therapy and group cooking. For consideration of Discovery Vista,
patients must first enroll in a 4-week “Readiness” program in order to explore and prepare for
their program, where they are assessed if they are ready for the level of inner work that is
expected in Discovery Vista. These treatment paths are not linear and it is not uncommon for
patients to have multiple admissions to 4NW or Discovery Vista.

37
Social Work on St Paul's Hospital Eating Disorders Inpatient Unit (4Northwest)
As repeat admissions are common, and the caseloads are small, the social work role on
4NW is unique in its ability to work with patients very closely and intensely. Social work on
4NW is also unique for the amount of therapeutic work involved. There are two social workers
on this unit: an outpatient family therapist, and an inpatient social worker. Although the inpatient
social worker does not carry the therapist title, there is still frequent therapeutic conversation
with patients. For example, my inpatient preceptor and I had the luxury of meetings with patients
evolving into one or two-hour therapeutic conversations. I found these meetings rewarding and
intellectually stimulating as I was able to utilize some of my counselling skills, which I will
describe later on in this section.
Treatment on 4NW also involves regular therapeutic groups, some of which are run by
the social worker. I had the opportunity to lead a therapeutic group a few times, which was well
out of my comfort zone, but a good learning opportunity about navigating the dynamics of a
group intervention. This was especially challenging with the patients in 4NW, as although
patients are generally voluntary, many were not keen on participating in groups. As per my
preceptor’s instruction, I had to accept the discomfort in challenging people to participate. In
comparison, I found that outpatient group patients were more eager to participate, and that my
contributions seem to “land” much more with them. I theorize this can be partially attributed to
the level of physical, emotional, and mental unwellness patients are experiencing when they are
inpatient on 4NW, as well as the exhausting nature of the programming. Patients spend a lot of
time being challenged in groups, individual meetings with different practitioners, during eating
times, and so on - it is constant programming.

38
This constant intensity translates into the social work role as well. Patient rounds
occurred almost every single morning, and the social worker is required to act as the “meal
monitor” for two meals of the week. I also noticed a common belief among team members, but
especially from the social workers, that people with eating disorders were “super feelers”. “Super
feelers” were described as highly empathic, emotionally attuned and sensitive individuals, whose
eating disorder could be attributed in part due as an attempt to regulate emotional intensity. I
found that this background undercurrent of emotional intensity permeated the work in this
rotation.

Unique Considerations for Trauma-Informed Practice and Intersectionality
The SPH Eating Disorders Inpatient Unit, or 4NW, is a very intriguing ward to consider
from a TIP lens as it is a locked ward characterized by a rigid rule system accompanied by
markedly diminished autonomy and privacy. For instance, patients have to essentially “earn”
passes in order to spend time off-unit, they must follow certain rules about completing their
meals, and they must attend groups. The washroom has no door (although the stalls have doors)
and it is closed during and for one hour after meals. If patients need to use the washroom during
this time a nurse will accompany them and wait by the door, and the patient is not allowed to
flush the toilet but must signal the nurse to first view the contents. If patients break rules, they
are required to complete a “reflection plan” worksheet. It is important to note here that although
this is a locked unit, the vast majority of patients are voluntary admits. In fact, patients must be
interviewed for suitability before being admitted into the unit. Patients are also provided a
handbook (Providence Health Care, 2023a) and a list of unit agreements (Providence Health
Care, 2023b) upon admittance.

39
In fact, I took some time to peruse these documents so that I could see exactly what the
patients are provided. These documents clearly outline the expectations and rules, which are
referred to as “non-negotiables”, for patients during their time in the unit. I think providing this
to patients supports the safety and trust components of TIP, as it clarifies what the environment
will be like. However, some of the punitive aspects of these instructions did not fully sit right
with me. For instance, patients who express suicidality or engage in self-harm behaviours “...will
not attend groups, meals or snacks and will remain in their room during these times until reevaluation by the care team is completed” (Providence Health Care, 2023b, p. 13). I feel my
discomfort with what appears to me as a punishment would be mitigated if this were followed by
a rationale for this procedure. Additionally, the unit agreements also state that suicidality or selfharm may lead to discharge from the program if the patient is medically and psychiatrically
stable enough to avoid hospitalization (Providence Health Care, 2023b). I felt conflicted about
these guidelines. On the one hand, I can understand concerns about the patient not being
emotionally or mentally stable enough to participate in the program. On the other hand, I wonder
if this positions those who are perhaps especially in need of help to be denied it. Interestingly,
when discussing these materials with my supervisor she noticed that the handbook indicated it
was developed in partnership with patients and families and was stamped as: “Patient Approved This material has been reviewed and approved by patients, families and staff”. Looking back, I
see a missed opportunity in my practicum to explore what constitutes the Patient Approval
process and receiving of this stamp.
In addition, during my rotation on 4NW I attended a group education session held by one
of the unit psychologists in which she shared that the program had been criticized by past
patients for not being trauma-informed. We explored some ways to increase the ability to

40
perform TIP in light of the realities of the program. For instance, sometimes it can appear there
are no choices available to the patient. She encouraged us to re-frame that the patient always has
choice, but to validate that sometimes all the available choices may be an awful experience. I
believe that radically validating the patient’s experience supports TIP by facilitating safety and
trust in the practitioner. She also shared some interesting research with us regarding patients that
had come to 4NW on the basis of involuntary admission: they reported they were okay with the
non-negotiables as long as they were treated with respect, they received explanations which had
a good rationale, there were no surprises, and they were still able to make some decisions. These
results are congruent with previous scholarship on principles of TIP. When justifications are
given for decisions, and these decisions are congruent with expectations, this supports
predictability and consistency. These features uphold the safety principle of TIP (Quiros &
Berger, 2015). Sustaining opportunities for patients to make their own decisions even in highly
controlled environments aligns with the TIP principles of choice and empowerment (Knight,
2019, Levenson, 2020). This psychologist also introduced the idea that it may be helpful to come
up with a different word for “non-negotiables”. I was pleased to hear this openness to changing
the language used in the service delivery as a movement towards providing further traumainformed care. This seminar also felt quite enriching in providing ideas on how to find ways to
employ TIP principles in environments which impose limits on the scope of service users’
choices and empowerment.
Finally, the features of the service design itself means there are swaths of people who are
blocked from participating in this support. For example, my supervisor shared with me that a
previous student had highlighted how socioeconomic status intersected with the eating disorder
experience. Specifically, only those of a certain level of privilege (of economic and/or financial

41
stability and/or personal support network) would be able to enter into a lengthy inpatient
program requiring them to put their life on hold. As noted previously, the program is specifically
for those with anorexia and bulimia symptoms, therefore those suffering from Binge Eating
Disorder (BED) are also excluded from PATSEDP. This is particularly troublesome because
PATSEDP is the only inpatient eating disorder program in the entire Province for adults. This
raises questions of what help is available to those who are lesser-resourced and/or have BED
concerns, how adequate this help is, how being lesser-resourced affects the experience of eating
disorders and eating disorder treatment, what is needed to better serve these individuals or if
anyone is even doing this research. I will return to these queries in the final chapter of this report.

Case Examples
Case Example #1. One of the most challenging situations I came across during this
rotation was a patient who was denied their request to switch psychiatrists due to their originally
assigned psychiatrist having a feature which triggered them due to their personal trauma history.
This became an ongoing battle between the patient and the rest of the team, and a source of
moral distress for myself and I suspect this included my preceptor. This patient also had a label
of “Cluster B Personality Disorder features”, and I was suspicious of how much this identity
marker was influencing the way that providers interpreted their behaviour. In speaking with the
patient, I felt it important to validate their feelings and bravery in continuing to advocate for
themselves as a way to support their empowerment. At the same time, I felt conflicted as I
anticipated the patient would continue to meet defeat. I also felt discomfort encouraging the
patient to continue their conflict with the rest of the team.
Secondly, this case represented a conflict between being trauma-informed for the
individual versus being trauma-informed for all participants in the program. Although

42
acknowledging the value of patient-centred care, there appeared to be a sentiment among the
team that making one exception could instigate a slippery slope problem. There was concern that
this patient, or others, would continue to make further requests to bend the rules if this one
exception was made. The patient expressed they felt that the care they were receiving was not
trauma-informed, whereas providers felt that sticking to the principle of predictability they were
in fact remaining trauma-informed. I wondered if the patient’s “Cluster B” label was intersecting
with the team’s concerns about the patient’s request and if that were absent perhaps there would
be less concern that the patient would continue to push for further accommodations if one was
conceded. However, I do also have to concede that this patient was well-known to the team, so
there was likely additional context at play beyond my purview of knowledge. This case raised
challenging considerations about the intersection of group versus individual TIP and how to
navigate these. I wondered why, in this case, were the TIP needs of the group prioritized over the
TIP needs of the individual? I also wondered that if the presence of “Cluster B” was strongly
influencing the patients perception and behaviour, were there additional considerations in
responding to them that could or should be implemented? Further, is it possible such
considerations were being implemented and I was simply unable to see them?
Case Example #2. A second case that made a strong impression on me was that of a
patient who was in an abusive relationship. They had been in this relationship, and a repeat
patient in 4NW, for the past several years. As a result, the patient’s chart contained a plethora of
documentation about the details of this relationship. I noticed that much of this documentation
carried a tone of pity and disempowerment. The records had constructed an image of a helpless,
sad, traumatized victim with zero ability to stand up for themselves.

43
However, throughout engaging in lengthy therapeutic conversations with this person I
discovered they demonstrated many strengths such as boundary setting skills and high levels of
insightfulness. I was able to implement some of my counselling skills to reinforce these qualities
in the patient’s perception of themselves. For instance, the patient was quick to criticize and
devalue themselves, but also responded affirmatively to my re-framing of their negative
interpretations of themselves. The patient was also very receptive to my use of strengths-based,
open-ended questions and my reflections highlighting the capacities embedded in their answers.
When charting on this patient I made a concerted effort to write in a style reflective of a
strengths-based lens. I also included, in my clinical impressions, a recommendation for other
providers to continue re-framing and noting the patient’s strengths and capacities when in
conversation.
In part, my intentions were to buttress the TIP principle of empowerment to be more
salient in this person’s care. The medical record ends up constructing a particular image of the
person therein, which influences how providers think about and approach their work with the
patient. In this case the image was ultimately disempowering and pathologizing, denying the
patient any agency or strength. This can create a self-perpetuating cycle herein subsequent
documentation and interactions with the patient flow from this vision of them and therefore
reinforce the helpless victim narrative. A pathologizing perspective of the patient is repeatedly
re-entrenched. I sought to challenge this perception within the person themselves through my
dialogue with them, and also within the minds of providers via my documentation and
recommendation. I felt this was especially important in light of the patterns evident in previous
chart entries. Social work notes might be the person’s only chance to have strengths-based
documentation in their file.

44
Case Example #3. A patient’s family member actually catalyzed a previously unknown
to me consideration of intersectionality in eating disorders: the link between these mental
illnesses and autism spectrum disorder (ASD). This person was wondering if their family
member who was receiving treatment was possibly experiencing ASD. This family member
shared that their curiosity came from attending a presentation on eating disorders from a clinician
(unrelated to PATSEDP) about the relationship between eating disorders and ASD.
This conversation led me down a research rabbit hole wherein I found several
speculations and studies. I will discuss some of this literature (Brede et. al., 2020, Kelly & Kelly,
2021, Nimbley et. al., 2023) later in this document. I think this incident was also an important
reminder to remain humble as a practitioner and be open to learning from patients and their
support network about the academic or scientific background of their presenting issues. Besides
raising the question for me about how the ASD and eating disorders interact and influence one
another and the treatment considerations, it also added to the appreciation of the complexity of
eating disorders. One of the unique features about eating disorders is that their etiology and
presentation is muddled by the appearance of “choice”, which can be a source of frustration to
many. The attempts to understand the “choice” aspect, as perhaps an attempt at self-regulation,
control, or a trauma response, further murky the intellectual waters and treatment provisions. The
ASD dimension adds an additional layer of confusion, but perhaps also an additional layer of
insight into the development and function of eating disorders, and barriers to successful
treatment.

45
Third Rotation: Emergency Department + High Acuity Unit

Introduction
My third rotation took place in the Emergency Department (ED) and High Acuity Unit
(HAU) at Mount Saint Joseph Hospital (MSJ), a small community hospital (240 beds) in East
Vancouver. This hospital also contains a long-term care centre on its second floor. The MSJ ED
is only open from 8am-8pm, and the hospital does not have the resources to address certain types
of emergencies such as gunshot wounds or psychiatric emergencies among children, youth, and
adults (although it does have a geriatric psychiatry ward). Thus, the ED is lower-volume, and not
as chaotic or critical as the SPH ED, where I also completed two shifts. At MSJ, the ED social
worker also covers the HAU, which only has a handful of beds. The HAU sees patients that need
a higher level of care than a regular hospital bed, but lower level of care than the ICU. Many
patients here are not admitted from or discharged to home but rather a medical service bed they
previously occupied before being transferred to the HAU, such as the internal medicine ward or a
long-term care facility.

Social Work on Mount Saint Joseph Hospital Emergency Department & High Acuity Unit
Due to the unique features of this hospital and the social work role in these units, this
work includes a lively blend of acute crisis work, connecting patients with outpatient resources
to address their social needs, brief solution-focused counselling, and discharge planning for
inpatients. There is a lot of variety in the day-to-day tasks although there are several recurrent
themes, such as discussing the Rapid Access Addiction Clinic (RAAC) with those seeking help
with substance abuse concerns. There are also commonly present legislative responsibilities for
the social worker in this role. For example, the social worker is tasked with completing Mental

46
Health Act (MHA) Forms 13, 15 and 16 (Notification to Involuntary Patients of Rights Under
the Mental Health Act, Nomination of Near Relative, and Notification to Near Relative) with
patients who are involuntarily admitted to hospital for a mental health crisis. A fulsome
psychosocial assessment is not always possible or particularly necessary in the ED, so this role
requires problem solving and judgement skills to hone in on the most immediate concerns for
social work. Some of the skills I observed included reviewing pending consult requests at the
start of the shift, checking the “Tracking Shell” (essentially a live Excel spreadsheet of all
patients in the ED) throughout the shift, and prioritizing based on factors like imminence of
discharge, potential death, or loss of decision-making ability or need to launch a child or
vulnerable adult neglect/abuse investigation. I was informed that typically ED patients were first
priority to be seen than HAU patients, and ED patients who were to be admitted were usually
later priority to be seen. However, these guidelines were overruled if an urgent situation arose,
such as one of the afore-mentioned conditions of imminence.
Additionally, social workers are challenged with requests to assist with problems
unsolvable in an ED visit. The social workers’ assistance then centres around directing the
patient towards the correct resource for addressing their concern and addressing imminent needs.
For instance, if a patient experiencing homelessness requests social work to help them find
housing, it is beyond the ED social worker’s scope to complete BC Housing applications with
the patient, but social work would educate them on how to connect with an outreach worker and
attempt to secure them a shelter bed for that night.
Finally, I observed that the rest of the ED team had a well-developed sense of the social
work role and when to flag the social worker for involvement. Besides the “obvious” social
worker referrals such as a patient experiencing homelessness, ED providers would also request

47
social work for patients appearing emotionally distressed or presenting with “clues” of potential
social concerns. For example, social work was referred to a patient who had come in for a
medical issue but while speaking with ED providers shared that their child had died recently.
Social work attended to provide emotional support and grief counselling resources to this patient.
Social work also received a referral request for housing concerns, as a patient had expressed
concern to the attending physician regarding their housing. However, in conversation with social
work, it became clear the patient’s concern was really about a conflict with their neighbour, not
an inability to find a place to live. I believe the awareness of, and compassion for, patients’ social
and emotional concerns and recognition of the social worker’s role in attending to these is a huge
contributing factor in providing trauma-informed care in the ED.

Unique Considerations for Trauma-Informed Practice and Intersectionality
Social work and medical care provision in the ED faces distinct considerations and
challenges in the context of trauma informed care and attendance to intersectionality. First, the
patient may be presenting to the ED for a traumatic experience, or they may experience
secondary trauma from something they witnessed in the ED, or they may receive a devastating
diagnosis. Second, many aspects of the ED environment can be triggers for people with a trauma
history: feeling trapped in a chaotic setting, sounds of people yelling, being in close quarters with
strangers, sudden feelings of vulnerability or fear, sudden loss of control over one’s body, being
touched by strangers, repeating their story multiple times, directives from authority figures, and
so on.
Further, people belonging to certain social identities may be reluctant to access ED care
due to an expectation of a negative experience or certain triggers related to this identity. For
example, Indigenous patients may enter the ED fearing anti-Indigenous racism, invalidation of

48
cultural healing practices, and battling the institutional nature of a hospital as a trigger.
Throughout my experience working in shelters and harm reduction I have heard many clients
express they don’t want to go to the hospital due to poor treatment toward those who are
homeless and/or use street drugs. I also know from my membership in the chronically ill
community that many with chronic health conditions avoid the ED due to, 1. Acute issues
automatically being brushed off as part of the chronic condition and 2. ED staff lacking
knowledge about their condition combined with dismissing and invalidating the patient’s
(frequently more extensive) knowledge of it. I could only imagine how overwhelmingly unsafe
the ED could feel for a person occupying all three of the aforementioned identities
simultaneously.
Additionally, there are many barriers to the ability of ED staff to deploy TIP. As the ED
is the “drive-thru” of health care, staff are limited in the time they can spend with their patient
and the scope of issues they can address in that moment. ED staff frequently cannot determine an
explanation of patients presenting symptoms. Due to the dynamic nature of the ED the planned
sequence of tasks or patient interactions can change at any moment. Social work and other ED
staff are also required to have very personal conversations in a very not-private manner. As we
typically do not have access to or the means to dive into in-depth information about the patient,
we will likely be unaware of any unique triggers they may have. Even if we are aware of triggers
they have or potential triggers in the environment, we are often still forced to engage within this
context. For instance, although I tried to make myself level with patients by sitting on a chair or
squatting on the ground near them, sometimes this was simply not a viable option. However,
being a 5’ 3” woman gave me an advantage in this respect, whereas if I were a 6’ 3” man I would
be much more self-conscious of intimidating patients.

49
Despite these challenges, the most blatant examples of TIP I observed during my entire
practicum were in the MSJ ED. For example, I heard a male-presenting nurse ask a female
patient if she was okay with him taking out her “wires” or if she preferred he found a female
nurse to do this instead. I also observed physicians kneeling on the ground, sitting on a chair, or
perching on their patient’s bed so that they could speak to them face-to-face rather than standing
over them while conversing. The body language of the latter can feel intimidating and reinforce
an aura of authoritativeness from the service provider. This is detrimental to supporting feelings
of safety. Being more physically level with the service user is a much more non-threatening body
language from the service provider. This is a technique I have used many times when speaking to
clients accessing shelters or harm reduction services.
Further, I also observed my preceptor’s strategies to mitigate some of the challenges to
TIP posed in the ED environment. For instance, I noticed if a sensitive conversation was
warranted my preceptor would pull the curtain around the patient’s bed. Although the rest of the
world could still hear everything, it created a barrier between us and the rest of the hospital and
demonstrated intention to facilitate privacy. At other times, we spoke with patients in the parking
lot right outside of the ED.

Case Examples
Case Example #1. As mentioned above, social workers at PHC must complete certain
legislative requirements with patients who are involuntarily admitted to hospital (also referred to
as “certified”) via the Mental Health Act (MHA) as part of their duties. This task was a semiregular occurrence during my rotation in the MSJ ED. Prior to my practicum, I would imagine
cases of imminent suicide risk and homicidal psychosis when I thought of certification under the
MHA. However, the MSJ ED regularly sees cases of patients with dementia who are certified in

50
their long-term care home (for example, for escalating delirium or behavioural and psychological
symptoms of dementia such as aggressiveness) and sent to the hospital for further assessment.
This further raises the question of how the experience of dementia intersects with the trauma of
having choice taken away and how to enact TIP with a person who does not understand what is
happening but also may be unlikely to ever understand. Although adding complication, I do not
believe that these factors make TIP impossible. In the example below, I will illuminate how I
was able to attend to the safety and trust aspects of TIP with a patient who was unable to
understand what was happening to them.
During the tail end of my practicum, I took on the task of completing MHA Forms 13,
15, and 16 with an involuntarily admitted patient. Specifically, these are Patient Notification of
Rights (13), Nomination of Near Relative (15), and Notification to Near Relative (16). My
intervention was also complicated by the fact that the person was an immigrant who did not
speak English, therefore this conversation was done via video translator service. The patient also
had a family member present with them who helped clarify the translations and provided
reassurance to the patient. I began by briefly explaining who I was and my role and asking the
patient about their understanding of why they were in the hospital. The patient believed they
were in the hospital to undergo medical testing. I explained to the patient they were there
because the people in their life had noticed they did not seem their usual self and felt they needed
help with their mental and emotional health. I was attempting to build rapport and attend to trust
and safety by engaging in the patient’s perspective and introducing their hospitalization in a
gentle way. The patient kept asking me when they were going to be discharged from the hospital.
I replied that it was not certain yet when that would be but the goal of the team would be to get
them well and discharged as soon as possible.

51
Then, after providing reassurance I felt it was appropriate to move onto reading the
patient their rights as indicated on Form 13. I explained to the patient that I would be reading
them their rights before launching into the required monologue. I felt that this was important
because keeping the patient as informed as possible about what was going to happen would
enhance trust and safety. However, the language in Form 13 is not the kindest, which is
unfortunate given the legal requirement to read it word-for-word. Upon reflection, in the future I
will explain to patients beforehand that the language on the form is not the nicest, but I am
legally required to repeat it word for word to them. I hope that this would further enhance trust
and safety.
Case Example #2. A second noteworthy case was that of an Indigenous woman who
shared with the attending physician she wanted help with substance use concerns. Therefore,
social work was flagged to meet with her and provide resources. Upon social work approaching
her, she had an immediate reaction expressing fear about social workers removing her child from
her care. My preceptor and I provided reassurance that we were not there for anything regarding
her child, and mentioned that as her child was an adult we would not be involved anyways. We
listened attentively as she spoke about the experiences and subsequent ingrained fears of
Indigenous peoples when interacting with social workers. We also reassured her continuously
that she was not obligated to pursue any particular resource and simply wanted to inform her of
what the available options are. Upon reflection, I wonder if it might have been helpful to
comment that I understood where her fear was coming from given the role of social work/ers in
the systemic struggles Indigenous peoples face. However, another part of me wonders if this
could have felt patronizing or further triggering. It may also have been helpful, and perhaps a
“safer” option, to offer water or juice as a way to build further rapport.

52
Case Example #3. Social workers at Providence Health are required to attend Code Blue
calls (respiratory or cardiac arrest requiring resuscitation) on their unit. The social worker’s main
role is to provide support to the patient’s loved ones, such as by contacting them if they are not
present or providing information and emotional support if they are. I see this as facilitating
empowerment for the loved ones by maintaining awareness and involvement, whereas lack of
knowledge and involvement could reinforce feelings of helplessness. This also ensures that the
next-of-kin or temporary substitute decision maker has the opportunity to participate should the
Code Blue progress to the point of needing to make choices about stopping or changing
interventions, such as stopping CPR.
During my MSJ ED rotation I participated in a Code Blue event (outside of the ED)
where the patient’s spouse was present. My preceptor immediately grabbed and placed a chair
and directed the spouse to sit there. This spouse was positioned to be out of the way of the Code
Blue team, but still close enough to be part of the scene and clearly see what was happening. I
grabbed the spouse’s belongings, brought them to them, and sat next to them and informed them
I would stay with them. The spouse was crying so I provided them tissues. My preceptor
switched between approaching the scene to gather information and returning back to myself and
the spouse to report the information back to them. The patient was successfully revived and
brought to the ED. The spouse then became worried about their car being towed so I told them I
would take their plate and validate their parking.
Although I have previously discussed the significance of supporting choice as a piece of
TIP, I also argue that at certain times it is more TIP to make some decisions for the person we
are serving. For example, in times of acute crisis, making decisions for the person provides
direction in a moment where they likely feel lost, such as my preceptor directing the spouse

53
where to sit. Making decisions for the person also alleviates some of their mental load, for
example by taking care of practical considerations. For instance, I think in this incident it was
more appropriate to tell the spouse I would take their plate and register their parking, rather than
ask (therefore creating choice). I also provided tissues without asking if they were desired. When
the patient was revived, we told the spouse the patient was going to the ED and to meet them
there. It is also important to consider that people do not have the same decision-making capacity
when they are highly emotionally escalated, and being asked questions or to make decisions can
cause further stress.

Education and Training During Practicum
Finally, I found the structured education component of PHC’s MSW Internship program
a unique and useful aspect of the experience. This included required courses, bi-weekly
individual supervision, and a weekly seminar followed by group supervision with the other
students. Courses and seminars covered topics such as the BC Mental Health Act, adult
guardianship, working with involuntary patients, integrated case conferences, and ethics and
ethical dilemmas. I will not detail every supervision and education session here, but highlight
some of my key take-aways.
In one-on-one supervision, I sought support with a case I found upsetting as perceiving
unfairness is a huge trigger for me and I felt that was occurring with the treatment of a patient. I
needed guidance, not only because of my own feelings, but because clashes between social
workers and the medical perspective are an anticipated challenge in health care social work.
Sometimes the social worker may be the only member of the team approaching care with a lens
located outside of individualizing and biomedical frameworks. My supervisor instructed me to
remain curious about the perspective of other team members and points of view I disagreed with.

54
I feel this helps me emotionally by channeling my passion into action. I also recognized a
parallel here between this strategy of communicating with other team members and the TIP
perspective on human behaviour, in respecting that people have reasons for their beliefs and
behaviours and seeking to understand these.
In addition to the seminars required as part of the practicum program, I signed up for a
seminar on the needs of 2SLGBTQIA+ seniors, which illuminated unique considerations for
service providers. This seminar confronted attendees with the fact that non-cis-heteronormative
gender and sexuality identities are often treated as the “main” facets of one’s identity. However,
other facets such as cultural or religious background may truly be the “primary” or more
important aspect of identity for the person in question. The presenter also invited us to think
about the implications of the fact that everyone outside of the cis-hetero sphere is lumped into
one acronym. This incited me to observe that the cis-hetero majority feels a need to “label” or
“contain” those that “don’t belong”. We also explored how many people may not feel safe
disclosing their non-cis-hetero identity to service providers, especially for those who have
suffered their identity being illegal, such as older persons or immigrants from certain countries.
This seminar also compelled attendees to consider that 2-Spirit people have faced a double
genocide of both their cultural and gender identity. In sum, this seminar was one of the most
illuminating for intersectionality by highlighting how the experience of 2SLGBTQIA+ people is
influenced by other components of their identity, and what differing needs may arise as a result
for service providers to be aware of.
Second, this seminar raised an interesting “counter-consideration” of those on the “other”
side. What about the needs of those who firmly believe being non-cis-hetero is a sin or are
otherwise deeply uncomfortable and rejecting of such persons? When a senior is placed in a care

55
facility, how do we consider the needs of both 2SLGBTQIA+ and those who feel morally
distressed at their existence? This raised interesting ethical musings about the former and latter
person’s ability to feel safe and express themselves. This part of the seminar made such an
impression on me, as social work is such a politically left and “progressive” field focused on the
needs of the marginalized. Yet we have just as much of a duty to utilize TIP with a homeless
residential school survivor as we do with a white, wealthy, right-wing extremist.
Further, I was pleasantly surprised to find that the in-person violence prevention training
was taught from a TIP lens. The course explored trauma triggers as a precipitator of aggressive
behaviour. For instance, we discussed the situation of a military veteran experiencing care
delays. The instructor highlighted to us that besides the possible PTSD, such a person would be
accustomed to a rigid, highly planned structure of their time. Therefore, the uncertainty and
waiting around may be distressing not only in and of itself but due to the unfamiliarity of such
problems. This course also was helpful in highlighting how changes in one’s health can create
new considerations for potential triggers. For example, the instructor informed us that persons
with dementia often experience a limited field of vision. The instructor had attendees pair up to
take turns as patient and provider so we could experience how this affects the patient’s
perception and interaction with others, for instance the patient in this case is not able to see the
provider until they are quite physically close to them. This exercise was useful for this specific
topic but also in instigating me to think about how the aspects of the medical condition itself,
which may be new, need to be considered in a TIP approach.

56
Chapter 5: Reflections, Implications for Social Work Practice, and Conclusion
In this section, I will broadly review my practicum journey. First, I will discuss my plans and
expectations before starting my practicum and how these played out in the field. I will also
identify key take-aways for my personal professional practice. Second, I will discuss my
conclusions on how to incorporate intersectionality into TIP in hospital social work. I will
explore potential micro-level and macro-level applications of this approach. Finally, I will
conclude my experience and this report.

Expectations versus Reality

Review of Practicum Goals
To begin, I will review the four overarching goals I framed my practicum experience
with. My first and most immediate goal was to develop my learning contract with my agency
supervisor. I initially went into this process feeling unsure as the protocol was to develop it after
some initial time in the practicum setting. However, I found this beneficial because familiarity
with the day-to-day scope of the work was useful in guiding the development of this document. I
also found the learning contract useful in providing me more structure and clarity in how to
approach my learning experience. Additionally, I found it useful because it helped guide me to
think about intersectionality and TIP on a more micro-level and in specific contexts by focusing
on how these could be attended to within the context of utilizing certain skills and knowledge.
This helped me create points of focus so my inquiry did not feel so vague and shapeless. For
example, the emphasis on developing documentation and psychosocial assessment skills
provided an opportunity for me to think about deploying considerations for intersectionality and
TIP in these contexts. For instance, in the case of the patient in the abusive relationship, a

57
trauma-informed lens lent me to value empowering the patient in my written construction of
them and their situation, which felt especially potent in the context of their chronic mental illness
(the eating disorder).
Moreover, the learning contract also assisted with my second goal: learning the roles and
responsibilities of hospital social workers. I found this process went quite smoothly, although at
times could be mildly overwhelming with the amount of information I was inundated with. I will
not detail every single task and responsibility but I felt I underwent a rich introduction to the
day-to-day work of hospital social workers across different settings. Although each unit has its
own specific duties, core tasks (such as psychosocial assessments, using counselling skills,
connecting patients to resources) remained the same and I was able to see how these manifested
across different environments.
Third, I sought to determine the language, policies, and operationalization of TIP within
the organization. To this end, my supervisor set me up to work a shift with the social worker who
was to present on the topic of TIP at one of our weekly seminars. The seminar ended up being
cancelled, but I was still able to pick the brain of the social worker who ran it. This social worker
works in the Urban Health unit at SPH. This unit is essentially a medicine unit for people
experiencing complex social problems - largely street entrenched, using hard street drugs, and so
on. Essentially, the population I have grown to know and love over the past several years in my
provision of front-line services to them. When I asked this social worker if there were any
specific agency-wide policies or frameworks about TIP, to my disappointment (but not surprise)
she informed me that was not the case. Although I had found references to providing traumainformed care on several St. Paul’s web pages, I could not uncover any details about what this
care entails. This social worker seminar about TIP is available to the other social workers at

58
PHC, however, it is uncertain what training is required or available to other professionals within
the hospital. She also directed me to the guide that she used to inform her presentation. In
perusing this guide, I found that although it did not use the word intersectionality it did touch on
intersectional considerations of trauma. For example: noting the high rates of trauma among
psychiatrically institutionalized patients and how use of restraints could be triggering for them,
the high rates of victimization via abuse among those with mental illness and substance use
concerns, and the role that culture can play in the experience and expression of trauma (Centre of
Excellence for Women’s Health, 2013).
Finally, my fourth major overarching goal was to attend to manifestations and
opportunities for utilizing TIP and intersectionality. I found that attending to this goal oscillated
rapidly between easy and difficult. For populations I knew much about, such as those living a
street-entrenched lifestyle, this was much easier as considerations for such populations were
salient in the forefront of my mind. However, for populations I was less familiar with, such as
refugees from countries I knew little about, it was much more difficult to identify how
intersectionality ought to come into play in terms of applying TIP. Further, the volume of
demands on my time and attention were a significant barrier to fulfilling this goal. I simply did
not have the time or capacity in my working memory I would if I were, for example, solely
focused on performing a research study on this topic rather than exploring my ideas within the
background of learning so many other things. I did take many notes, but was often not able to do
so as closely to the event in question as I would have liked. As I become a more experienced
social worker and performing my duties requires less cognitive load, I believe I will be able to
attend to theoretical contexts with greater consistency.

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Surprises
For my practicum experience, I explicitly asked for as much variety as possible so that I
could gain exposure to new areas and extend myself past my comfort zone. I did not want to
pigeon-hole myself into only doing crisis work and working with very marginalized populations,
as my professional history entails. However, my passion for working in chaotic and “gritty”
settings prevailed over my attempt to diversify my interests. Although I am glad I had a
professional rumspringa, I found that the rotation I enjoyed the most was my final one in the ED
and HAU at MSJ. I enjoyed the variety and pace, the general buzz of energy in the ED, and
being adjacent to medical emergencies. Because MSJ is a small hospital with two large hospitals
nearby (SPH and VGH), it sees a lesser volume of patients and lesser level of acuity than bigger
hospitals. This makes the workload and flow feel a lot more manageable as a fresh social worker.
I also felt fortunate and fulfilled that I was generally able to spend as much time with the patient
as I wanted to. This contrasts with the two shifts I completed with SPH ED. Although I enjoyed
these shifts as well, I was unable to indulge the privilege of taking as much time with the patient
as I would have liked.
Initially, I expected the specific skills and tasks involving patient interaction to be a large
chunk of learning for me. However, I found I picked these up quite quickly and was able to build
on my pre-existing skills from my work in the community. For me, the true learning curve was
building clinical discernment skills and developing comfort with the level of authority I was
granted. As a student, I had expected to be treated more as a passive recipient of information.
However, I found myself frequently asked for my opinion by fellow social workers and staff
from other disciplines. I also received consistent feedback about incorporating my interpretations
and recommendations into my charting, rather than simply transcribing information. I also often

60
found it difficult to explicitly name or describe what I accomplished in terms of theory used or
labelling the technique utilized, whereas I would note my preceptors easily identifying things
such as: “used solution-focused counselling” in their documentation. I see this ability to pinpoint
as simply another skill to be developed. However, this is one that is more difficult for me as I am
accustomed to speaking and writing very literally about my work with clients in the community,
and as a personality trait tend to operate intuitively. Thus, overall, my biggest area for learning
was and remains in the “invisible” background activity undergirding the provision of direct
service.
Further, another “invisible” background factor that was rendered into visibility during my
practicum was the realization that the meaning of social work/ers varies widely around the
world. This is significant for my practice as I work and reside in the Lower Mainland of BC, a
highly multicultural environment with immigrants from countries all over the world. Although I
felt I had done a good job considering the varying experiences and perceptions of social workers
among different populations, it took me some time to realize I was only thinking about these
populations as within a western lens. However, the role and meaning of the social work
profession can be vastly different in different countries. Further, some places may not even have
such a profession, or others may have professionals Canada would identify as social workers but
are called a different title in another country. Therefore, perhaps extra consideration needs to be
given to the process of informed consent when working with immigrants from non-western
countries in terms of clearly explaining the social worker’s role, purpose, and intention.
Finally, I must revisit my aforementioned concerns about personal feelings that could
arise with patients who have MS or similar diagnoses. My experience uncovered that it was
specific patient experiences of decreased independence and ability that stirred up personal

61
feelings for me, regardless of diagnosis. For instance, when in group supervision discussing the
case of the man at HFH whose medical event caused loss of ability to perform his job, I
described this situation as “depressing”. Upon further reflection, I have realized that when I work
with patients whose circumstances reflect my own fears I am at risk of projecting my own
perspective on the patient's life, muddying my ability to see theirs. This functionally privileges
my interpretation of events as the “correct” or “logical” version which can reinforce a “powerover” dynamic in the patient-provider relationship. In addition, we can miss out on useful
information to guide our interventions if we do actively elicit service users' perspectives of their
presenting problem. This case from HFH demonstrates that I must pay extra attention to seeking
out the patient's view of their situation when I have a strong sense of what my view would be. I
also must consider there is a higher likelihood I will need to seek supervision in cases which
bring out complicated personal feelings for me based on my own health issues.

How Can Intersectionality be Incorporated into Trauma-Informed Practice in Hospital
Social Work?

The Micro-Level
Returning to my pivotal question of how to incorporate intersectionality into TIP in
hospital social work, we can start by drawing upon core social work skills. A critical component
of the “work” of social work is the ability to identify resources and strategies that could
potentially support the well-being of our service users. We often need to do “detective” work to
sleuth out clues regarding potential unmet needs or enhancements to well-being. I propose we
think of intersectionality as adding another method of detective work to the TIP lens. This
approach requires the social worker to maintain an ongoing awareness of different identities and

62
the unique struggles faced by each. In my opinion, this should not be difficult to tune into as
empathic curiosity about the lives of others, with particular attention to the interplay of
individual struggles as situated within broader social contexts, is one of the most unique
strengths of social work as a profession.
Therefore, one strategy hospital social work/ers can use to incorporate intersectionality
into TIP is to keep abreast of the common populations presenting to their unit and common
experiences substantiating the patient’s visit there. Previously, I discussed how many patients at
HFH are grappling with grief, loss, and changes in family dynamics. Beyond these common
experiences, I was able to specifically identify the diminished capacity to live in accordance with
cultural values as part of the trauma in Case Example #2 because I have some knowledge of that
culture. On the other hand, my ability to include cultural factors in TIP shrunk while I was at
MSJ. This hospital serves many patients who are immigrants from China and often have minimal
English skills. I have minimal knowledge of Chinese history, society, and the experience of
Chinese immigrants in Canada. Consequently, I suspect that factors invisible to me although
right in front of my face contributed to these patients’ experiences which I was unable to attend
to. Although I am always passionate about TIP, could I really be trauma-informed without being
culturally-informed? Litam (2020) warns, for instance, that many Asians, American Asians and
Pacific Islanders are failed by dominating ideas of trauma and emergent interventions as these
reflect a white, Western worldview that is irrelevant for them. When we fail to account for the
unique experiences of minority identities, we risk defaulting to framing the experiences of all
service users within the dominant white, western lens. This results in an apolitical, asocial “onesize-fits-all” approach (Quiros & Berger, 2015). Such an approach is not truly “one-size-fits-all”,
rather, it is a “dominant-size-demanding-to-fit-all” which results in standardized interventions

63
that ignore the existence of all other “sizes”.
In contrast, incorporating the socio-political contexts that service users' lives are situated
within facilitates the development of tailored interventions. For instance, accounting for the
influence of different identities on the experience of IPV enables social workers to respond to
IPV cases in a more fulsome way. Men (Savage, 2021) and women (Disabled Women's Network
of Canada, 2014; Savage, 2021) with disabilities, for instance, experience higher rates of IPV
than their abled counterparts. People with disabilities can face disability-specific barriers to
exiting IPV relationships such as a lack of accessible housing alternatives. Persons who are
unable to work due to their disability are at risk of financial dependence on their partner. Barriers
to mitigate this dependency include government policies of poverty-level disability assistance
payments and rescinding these if the recipient lives with a partner whose income reaches a
certain threshold. Therefore, social workers cannot assume that the safety plan or relationship
exit plan they would create with an abled person would be of equal utility to a person with a
disability.
Further, men who suffer IPV perpetrated by women face specific barriers to receiving
help. For instance, men may fear being labelled the perpetrator when seeking support (Nybergh
et al., 2016). Men also grapple with limited societal belief in men’s IPV victimization by women
and from lesser available resources as compared to those for women (Scott-Storey et al., 2023).
Applying an intersectional lens to the above discussion invites us to search for and respond to the
distinct experiences of men with disabilities who are IPV survivors as compared to women with
disabilities or men without disabilities who are IPV survivors. Situating our work within the
contexts of intersectionality supports a greater openness to identifying unique sites of struggle
and opportunity than if we assumed everyone had the same experience.

64
Second, another key strategy is to remain mindful of the ways in which experiences of
health care treatment have been traumatic specific to vulnerable identities and how to address or
mitigate these. For example, patients with a past psychiatric admission may have undergone use
of restraints, isolation, and 24/7 monitoring (Sweeney et. al., 2018), and women and racial
minorities are at higher risk of receiving dismissive care and inadequate pain relief (Centola et
al., 2021, Taylor & Glowacki, 2020). Due to the historical and ongoing dominance of colonial
control over Indigenous peoples (Clark, 2016) these patients may fear undue interference in their
lives. I witnessed this directly during my practicum with the woman social work approached to
provide information on substance use resources who expressed fear of her children being taken
from her.
From my personal experience working with people engaged in a street-entrenched
lifestyle, I know this population frequently avoids or is hesitant to access health care due to past
experiences of judgement and stigmatization. For those who are dealing with an addiction,
concern about going into withdrawal if they are admitted to hospital and unable to access their
drug of choice is a further barrier to engaging with services. During the day I spent on the Urban
Health unit at SPH the social worker shared with me how staff on the unit recognized the need to
cater to the unique needs of many of the patients on the unit, for instance, by “allowing” patients
to go on and off the ward to participate in their day-to-day activities they needed to keep their
lifestyle churning. For many people who live on the street or are interconnected with those that
do, they do not follow the same sense of “schedule” that those of us in “mainstream” society do.
Recognizing and creating space for his difference alleviates the fear and anxiety of being blocked
from daily activities under threat of losing access to necessary health care.

65
Finally, social workers’ communications with other service providers and with patients
are also opportunities to incorporate intersectionality into trauma-informed practice. I have made
prior reference in this document to the social worker’s voice often being the only one among the
chorus of the team that speaks outside of a biomedical perspective. Some examples in my
practicum include using a strengths-based perspective when charting on the patient who was in
an abusive relationship and my preceptor’s identification of unmet needs for partner intimacy as
a possible driver of “non-compliant” behaviour. Looking back, I see potential opportunities for
social work to communicate in a manner reflective of an intersectional TIP lens. For instance, if I
had occupied a staff rather than student role at HFH, I may have felt confident enough to point
out to the team how the loss of full ability to live in congruence with cultural norms could be
contributing to the emotional and psychological experience of new physical limitations and to
the behaviours of the patient and his family that staff were frustrated with. Further, it could be
useful for social workers to verbalize to their patients the placement of their presenting problems
within intersectional socio-political contexts. For instance, it might be helpful for a social worker
to share with patients with both ED and ASD diagnoses that research shows that these influence
each other's experience of the conditions and of treatment (Kelly & Kelly, 2021, Nimbley et. al.,
2023) and so they may have different needs than neurotypical ED patients.

The Macro-Level
In addition to social workers individually intertwining intersectionality with TIP, we must
also encapsulate these efforts within a larger macro-scale holding pen. The social justice element
of social work as a field demands attenuation to broader-level change beyond our individual
actions. I also believe that micro-scale efforts are emboldened by congruent macro-scale efforts.
Therefore, I see an impetus to develop policy, frameworks, and professional guidelines

66
pertaining to TIP and how to intertwine intersectionality into its implementation.
Previously, I noted that PHC lacks a specific TIP framework or set of principles among
the social work department and broadly among the organization as a whole. I believe that
creating guiding material would increase staff and organizational capacity to prioritize and
implement TIP through an intersectional lens. Organizations support increased theoretical
knowledge and skills among their staff when they invest in developing referential materials like
policies or practice frameworks. Instating such materials also pushes organizations to commit to
upholding the ideals contained within as it makes them an explicitly stated priority. Official
materials backing the incorporation TIP and intersectionality also legitimizes these as a frame of
reference and their importance in health care provision. Theoretical or operational frameworks
provide a concrete tool to cross-reference situations or concerns which can be of great utility for
social workers navigating complex situations. For instance, the ability to link presenting TIP
concerns back to a specific policy, practice framework, or educational materials (like
presentations or toolkits) for employees can strengthen social workers advocacy for patients
during multi-disciplinary discussions of their needs.
First, those developing these tools must come to an agreement on the core basics in the
provision of TIP and then weave in an intersectional understanding of these roots. A
collaborative task force could constitute the starting point for development of such officiated
channels of practice. Perhaps the commonly identified principles of safety, trust, empowerment,
collaboration, and choice (Bent-Goodley, 2019; Knight, 2015; Knight, 2019; Levenson, 2017;
Levenson, 2020; Mersky et al., 2019; Sweeney et al., 2018) can provide such a starting point. To
extend past a one-size-fits-all TIP approach, such discussion must also include sociopolitical
contexts and the emergent properties of their interactions in the development of these documents.

67
Some basic starting points can include: acknowledging social identities as sites of unique types
of trauma, looking past individualized notions of trauma to recognize historical and collective
trauma, and understanding oppression as a form of trauma. Indigenous and other marginalized
voices must be part of the development process. Otherwise, such a task force risks perpetuating
oppressive and traumatic dynamics of minority silencing that it seeks to mitigate. Without
Indigenous perspectives, for instance, we are in danger of reinforcing conceptualizations of
trauma and intersectionality which function as buttresses of colonial control (Clark, 2016). This
danger demonstrates the significance of TIP and intersectionality not only in conducting front
line work but at all levels of organizational activity.
In addition, social work/ers should advocate for education for providers on TIP,
intersectionality, and how these can manifest in health care settings for those occupying various
social identities. To support the creation of useful and accessible educational tools we must
remember that providers from other fields are practicing within different background contexts to
social work. Although all contribute to the common goal of supporting patient well-being, each
healthcare profession is situated within its own ideological and logistical frames of reference.
Each profession also carries its own ultimate goals that must remain the provider’s top priority in
certain contexts. For instance, conducting a test successfully, triaging appropriately, or keeping
the patient alive. Social workers need to seek understanding of other professions’ perspectives to
effectively work across differences. For instance, the intersectionality of social identities could
be partially explained as a conceptual parallel to managing patients with comorbid medical
conditions whose interactions influence care decisions. This approach is a potential strategy to
facilitate knowledge translation from a social sciences to a biomedical sciences lens.
Further, there is room among research opportunities to integrate intersectionality into

68
TIP. For instance, healthcare organizations could create a survey with open-ended questions
asking patients about their thoughts, experiences and suggestions regarding TIP and
considerations of their social identities while receiving healthcare. The information gleaned
could be incorporated into subsequent professional guidelines or educational materials. This
strategy also facilitates service user collaboration, which is a key component of TIP (BentGoodley, 2019; Knight, 2015; Knight, 2019; Levenson, 2017; Levenson, 2020; Mersky et al.,
2019; Sweeney et al., 2018). Intersectionality also leads us to new research questions, like how
to reach and support individuals with eating disorders who cannot qualify or access inpatient
eating disorder treatment. If researchers can find online groups where these patients gather, they
may be able to collect data on what these patients identify as their unique needs in receiving
professional support and how this would look trauma-informed to them. If research results reveal
new-found patient-identified needs this enables practitioners to better respond to these patients
and can also serve to catalyze further research efforts.
However, social work/ers must be ready to lean into their advocacy skills in order to
support the development and provision for intersectionality-inclusive TIP initiatives. With a
chronically overstretched and underfunded health care system comes the need to justify the time,
resources, and expenses required for lofty projects to higher-up decision makers. Fortunately, an
intersectionality-inclusive TIP lens is not only a theoretical and practical ideology but a selfreinforcing method of illuminating arguments for its use. Below, I will unpack the case for use
on not only a human but also pragmatic basis.
Ethically, there is a moral impetus to provide care sensitive to a patient's needs in order to
best support their well-being. Care provision that fails to recognize that social identities can
impact the needs and experience of receiving care can cause unintended harm to patients. For

69
instance, ED treatment is often less successful for patients with ASD as compared to their
neurotypical peers (Kelly & Kelly, 2021). This finding suggests that this patient sub-group holds
unique considerations that require further attention in ED treatment provision. For instance, in
Nimbley et. al’s (2023) study on the experiences (ED) patients with co-occurring (ASD), patients
reported that they found themselves misunderstood as care providers interpreted their language
and behaviours through a neurotypical lens. These experiences reinforced these patients' preexisting feelings of alienation and difference from others, which were previously identified as
heightened in the periods of time directly before engaging in eating disordered behaviours. This
demonstrates how the ED and ASD diagnoses intersect with each other to co-create the patient’s
experience of them. It also illustrates how providers’ ignorance of patient identities and what
emerges from their interactions can negatively impact patients’ capacity to trust and engage with
health care providers. This is perhaps especially pertinent with particularly vulnerable
populations, as “...more marginalized and traumatized populations…struggle to make an initial
connection and subsequently may not return or follow-up” (Centre of Excellence for Women’s
Health, 2013, p. 25). Patient disengagement results in new health concerns going uninvestigated
and declining to re-engage results in chronic health concerns going unmanaged. These
behaviours lead to health concerns advancing into states of further decline and complexity by the
time the patient does receive care, thus escalating the length and severity of their suffering.
Further, implementing an intersectionality-inclusive TIP helps to mitigate the harms
following from fearful and anxious attitudes towards the health care system. If persons fear
accessing health care because it feels unsafe, then they are at risk of a decline in health due to
avoiding receiving treatment for preventable or mitigable problems. Unfortunately, some patients
do not access health care until they have seriously deteriorated to the point at which permanent

70
damage or death is imminent. A safer environment means patients are more likely to choose to
access health care before reaching this point. A safer environment would also likely reduce the
risk of patients leaving Against Medical Advice (AMA). Reducing the number of patients
leaving AMA and reducing the number of patients avoiding health care until it is no longer an
option is not only an ethical consideration in reducing patient distress but also in reducing the
moral distress and burnout experienced by care providers. There are also practical elements that
strengthen the argument for spending time determining how to make the hospital experience feel
safer for patients: lesser costs to the health care system as “minor” care costs less than “major”
care or a lengthy hospital stay, and a safer environment for providers (as patients being triggered
is a risk factor for aggression) thusly leading to less critical incidents and understaffing
challenges due to injuries or stress leaves. Therefore, implementing a robust and
intersectionality-inclusive TIP in hospital settings is not only a life and limb-saving measure, but
it also addresses some of the pragmatic pieces of our overburdened health care system.

Conclusion
Upon reflection, I believe my practicum experience corroborated much of the information
in the literature I reviewed before embarking on this journey. Incorporating an intersectionality
lens into TIP allows us to provide trauma-informed care in a richer, more fulsome manner.
Several case examples I either directly experienced, or learned of, illustrated the utility and
compassion of such an approach. Witnessing care provision from others with attendance to the
possibility of trauma and consideration of various aspects of identity such as culture and gender
gave me hope and inspiration for my own future practice and the practice environment I wish to
cultivate. Beyond developing my individual practice, I hope to also one day contribute to helping
others utilize TIP and intersectionality as a cohesive approach. In this way health care providers

71
can facilitate the psychological safety of patients, which strengthens patient ability to engage
with health care, which ultimately saves lives.

72
References
American Psychiatric Association (Ed.). (2022). Trauma and stressor-related disorders.
Diagnostic and statistical manual of mental disorders: DSM-5-TR (Fifth edition, text
revision). American Psychiatric Association Publishing.
American Psychological Association (2023, November 15). APA Dictionary of Psychology.
https://dictionary.apa.org/posttraumatic-stress-disorder.
Becker-Blease, K. A. (2017). As the world becomes trauma–informed, work to do. Journal of
Trauma & Dissociation, 18(2), 131-138.
Bent-Goodley, T. B. (2019). The necessity of trauma-informed practice in contemporary social
work. Social Work, 64(1), 5-8.
Brede, J., Babb, C., Jones, C., Elliott, M., Zanker, C., Tchanturia, K., Serpell, L., Fox, J., &
Mandy, W. (2020). "For Me, the Anorexia is Just a Symptom, and the Cause is the
Autism": Investigating Restrictive Eating Disorders in Autistic Women. Journal of
autism and developmental disorders, 50(12), 4280–4296.
https://doi.org/10.1007/s10803-020-04479-3
Bryant-Davis, T. (2019). The cultural context of trauma recovery: Considering the posttraumatic
stress disorder practice guideline and intersectionality. Psychotherapy, 56(3), 400–408.
Canadian Association of Social Workers (2024). Code of ethics, values and guiding principles
2024. Retrieved from https://www.casw-acts.ca/en/casw-code-ethics-2024.
Centola, D., Guilbeault, D., Sarkar, U. et al (2021). The reduction of race and gender bias in
clinical treatment recommendations using clinician peer networks in an experimental
setting. Nature Communications 12, 6585. Doi:
https://doi.org/10.1038/s41467-021-26905-5

73
Centre of Excellence for Women’s Health (2013). Trauma-informed practice guide.
https://cewh.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf
Clark, N. (2016). Red intersectionality and violence-informed witnessing praxis with Indigenous
girls. Girlhood studies, 9(2), 46-64.
Crawford, M. (2020). Ecological Systems theory: Exploring the development of the theoretical
framework as con-ceived by Bronfenbrenner. J Pub Health Issue Pract, 4(2), 170.
Crenshaw, K. (1989). Demarginalizing the Intersection of Race and Sex: A Black Feminist
Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics.
University of Chicago Legal Forum, 1989(1), 139-167.
Disabled Women’s Network of Canada. (2014). Factsheet: women with disabilities and violence.
Retrieved from
https://www.dawncanada.net/main/wp-content/uploads/2014/03/English-Violence-Januar
y-2014.pdf
Friedman, B., & Allen, K. (2021). Chapter one: Systems theory. In J. Brandell (Ed.), Theory &
practice in clinical social work (pp. 5–19). Cognella. Wayne University.
Heberle, A. E., Obus, E. A., & Gray, S. A. (2020). An intersectional perspective on the
intergenerational transmission of trauma and state‐perpetrated violence. Journal of Social
Issues, 76(4), 814-834.
Kelly, C., & Kelly, C. (2021). What is different about eating disorders for those with autistic
spectrum condition. Int J Psychiatry Res, 4(2), 1-8.
Kleber, R. J. (2019). Trauma and public mental health: A focused review. Frontiers in
psychiatry, 10, 451.
Knight, C. (2015). Trauma-informed social work practice: Practice considerations and

74
challenges. Clinical Social Work Journal, 43, 25-37.
Knight, C. (2019). Trauma informed practice and care: Implications for field instruction. Clinical
Social Work Journal, 47, 79-89.
Lamb, H. (2012). Pity or pedestal?: perceptions and practices of chronic disease and disability in
hospital social work. doi:https://doi.org/10.24124/2012/bpgub1558
Levenson, J. (2017). Trauma-informed social work practice. Social Work, 62(2), 105.
doi:10.1093/sw/swx001
Levenson, J. (2020). Translating trauma-informed principles into social work practice. Social
Work, 65(3), 288-298.
Litam, S. D. A. (2020). " Take Your Kung-Flu Back to Wuhan": Counseling Asians, Asian
Americans, and Pacific Islanders with Race-Based Trauma Related to COVID-19.
Professional Counselor, 10(2), 144-156.
Mersky, J. P., Topitzes, J., & Britz, L. (2019). Promoting evidence-based, trauma-informed
social
work practice. Journal of Social Work Education, 55(4), 645-657.
Nimbley, E., Gillespie-Smith, K., Duffy, F., Maloney, E., Ballantyne, C., & Sharpe, H. (2023).
“It’s not about wanting to be thin or look small, it’s about the way it feels”: an IPA
analysis of social and sensory differences in autistic and non-autistic individuals with
anorexia and their parents. Journal of Eating Disorders, 11(1), 89.
Nybergh, L., Enander, V., & Krantz, G. (2016). Theoretical considerations on men’s experiences
of intimate partner violence: An interview-based study. Journal of family violence, 31,
191-202.
Oxford Languages (2023). Oxford University Press.

75
Providence Health Care (2023a). 4NW Patient Handbook. Provincial Adult Tertiary and
Specialized Eating Disorders Program (PATSEDP).
Providence Health Care (2023b). 4NW Eating Disorders Inpatient Unit Agreements.
Providence Health Care. (2024). Governance.
https://www.providencehealthcare.org/en/governance
Provincial Health Services Authority (2023). A resource and reflection guide for moral distress.
http://www.phsa.ca/our-services-site/Documents/Moral%20Distress%20Resource
%20Guide%20FINAL%20(June%202023)%20(2).pdf
Quiros, L. & Berger, R. (2015). Responding to the Sociopolitical Complexity of Trauma: An
Integration of Theory and Practice. Journal of Loss and Trauma, 20 (2), 149-159, doi:
10.1080/15325024.2013.836353
Raphael, D. (2016). Social determinants of health: Key issues and themes. Social determinants of
health: Canadian perspectives, 3, 3-31.
Savage, L. (2021). Intimate partner violence: Experiences of women with disabilities in Canada,
2018. https://www150.statcan.gc.ca/n1/pub/85-002-x/2021001/article/00006-eng.htm
Scott-Storey, K., O’Donnell, S., Ford-Gilboe, M., Varcoe, C., Wathen, N., Malcolm, J., &
Vincent, C. (2023). What About the Men? A Critical Review of Men’s Experiences of
Intimate Partner Violence. Trauma, Violence, & Abuse, 24(2), 858–872.
https://doi.org/10.1177/15248380211043827
Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift:
relationships in trauma-informed mental health services. BJPsych advances, 24(5),
319-333.
Taylor, M. A., & Glowacki, E. M. (2020). The language of women's pain: ideology and critical

76
cultural competencies in pain literacy. Frontiers in Communication, 5, 36.
Wilson, C., Pence, D. M., & Conradi, L. (2013). Trauma-informed care. Encyclopedia of social
work.

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Appendix
Learning Contract
Learning Goals

Tasks, Activities and

Performance Indicators

Strategies
Develop skills for conducting

-Review PSAs done by SW

By the end of my practicum, I

Psychosocial Assessments

-Collect patient collateral

will be able to:

(PSAs)

-Practice writing PSAs

1. Collect and document patient

-Attend relevant seminars

collateral

-Conduct interviews with

2. Complete a Psychosocial

patients under supervision of

Assessment interview with a

SW

patient
3. Write up a Psychosocial
Assessment sufficient for entry
into Cerner without need for
significant editing by my
preceptor
4. Demonstrate ability to
incorporate the social
determinants of health in
Psychosocial Assessments

78
I will know I’ve met these goals
when my field supervisors have
minimal edits to suggest and
when my clinical supervisor
indicates that I have

Develop working knowledge of -Complete relevant courses in

By the end of my practicum, I

relevant legislation for health

will be able to:

Learning Hub (such as MaID,

care social workers (ex. AGA) ReACT)

1. Identify and describe

-Consult with SW

legislation pertaining to patient

-Attend relevant seminars

situations
2. Discuss the application of
legislation pertaining to patient
situations

I will know I’ve met these goals
when I am able to draw on the

79
relevant pieces of legislation
when discussing cases with my
clinical supervisor

Develop working knowledge of -Complete relevant courses in

By the end of my practicum, I

risk assessment in clinical

Learning Hub (such as ReACT) will be able to:

practice

-Learn about red flags for when 1. Identify some of the red flags
to consider risk assessment

that indicate the need for risk

-Learn about risk assessment

assessment

tools ex. PQH9, VCH Risk

2. Identify and describe

Assessment Tool

commonly used risk assessment

Apply the VCH risk assessment tools
tool to a clinical scenario
Develop understanding ethical -Discuss ethical dilemmas with By the end of my practicum, I
considerations and clinical

SW

ethics principles in health care -Discuss day-to-day ethical
social work

will be able to:
1. Identify ethical dilemmas

principles and their applications that can arise in health care
with SW

social work

-Attend webinars/seminars on

2. Meaningfully contribute to

ethics

discussions on ethical dilemmas

80
-Learn about how PHC Ethics

3. Identify how core social

Services can support SW in

work ethical values show up in

patient care

a health care setting
4. Identify when to consult
ethics

Develop ability to work

-Writing documentation that is By the end of my practicum, I

collaboratively with other

to be shared with other service will be able to:

professions within an

providers

1. Make meaningful

interdisciplinary health care

-Participate in patient rounds

contributions to patient rounds

team

-Practice reading case notes

2. Write documentation that

from other professions and

will be useful to professionals

gleaning relevant information

in other disciplines on the

-Explore challenges with SW

patient care team

-observe how preceptors

3. Identify some situations

navigate differences of opinion where it would be fruitful to
request involvement from other
disciplines on the team

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Develop sufficient skills with

-Complete relevant courses in

By the end of my practicum, I

documentation software

Learning Hub (CST Cerner,

will be able to:

(Cerner, Paris)

Paris)

1. Navigate documentation

-Practice looking for different

software to find pertinent

pieces of documentation in the information
software

2. Create sufficient

-Read social workers

documentation in the applicable

documentation entries

software such as case notes,

-Enter documentation into

adding a violence risk alert, and

software

requesting a consult

Develop understanding and

-Discuss patient strengths with By the end of my practicum, I

skills for using a strengths-

SW

will be able to:

based perspective in health care -Elucidate/discuss strengths as 1. Identify patient strengths that
SW

identified by patient in

show up in documentation

conversation with them

2. Identify patient strengths

-Explore how to incorporate

based on interactions with the

patient strengths into

patient

documentation

3. Document patient

-Discuss how to identify patient interactions in such a way that
strengths in complex cases or

incorporates strengths into the

where patient experiences a lot narrative
of barriers, struggles

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4. Be familiar with strategies to
identify patient strengths in
complex and challenging cases

Develop skills for working with -Learn about family meetings By the end of my practicum, I
families in health care

and attend a family meeting if will be able to:
the opportunity arises

1. Identify situations where a

-Attend the seminar about

family meeting would be useful

family meetings

2. Identify situations where a

-Discuss planning/need for

family meeting is not needed

family meetings with social

3. Describe the basics of

workers and other team

facilitating a family meeting

members

4. Engage with family members

-Identify, discuss how to

as appropriate and offer support

support family members

5. Identify potential conflicts or

-Engage with family members, challenging family dynamics
discuss challenges, family

and identify opportunities for

perspective, possible supports

management of these

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Develop working knowledge of -Discuss operationalization of

By the end of my practicum, I

trauma-informed practice in

trauma-informed practice

will be able to:

health care social work

principles with social workers

1. Identify deployment of

-Attend relevant training and

trauma-informed practice

education

principles
2. Utilize and describe the
utilization of some of these
principles in my own practice

Develop working knowledge of -Learn about applicable

By the end of my practicum, I

community referrals and

community resources

will be able to:

referral process

-Assist in community referral

1. Identify commonly used

processes

community resources and their

-Assist in offering to make

applications

referrals to community

2. Identify when to offer a

resources for patient, where

referral to a community

appropriate

resource to a patient and
explain its relevance for them

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Develop working knowledge of -Discuss discharge planning

By the end of my practicum, I

the discharge planning process process with social workers

will be able to:

-Learn about what factors are

1. Identify and describe some of

involved in making the decision the factors that contribute to the
to discharge a patient

decision to discharge a patient

-Learn about barriers to

2. Identify some of the barriers

discharge than can arise and

to discharge and methods of

how to problem solve to

addressing these barriers

address them