Ms. Johnson Case Study (SWK-625 Topic 2): Trauma-Informed Care, PTSD Assessment, Interventions and Resources

Understanding Ms. Johnson’s presentation

Ms. Johnson’s symptoms closely follow the four symptom clusters of posttraumatic stress disorder (PTSD) described in the DSM-5-TR (American Psychiatric Association [APA], 2022). The table below organizes the case information. It is a starting point for assessment, not a diagnosis; a diagnosis requires a full clinical assessment by a qualified clinician within the social worker’s scope of practice and licensure.

Her history includes several adverse childhood experiences (ACEs): childhood abuse and witnessing domestic violence. The landmark ACE Study showed that these experiences are linked to higher risks of mental and physical health problems in adulthood (Felitti et al., 1998). Because her trauma began in childhood and was repeated, the social worker should also screen for complex trauma features, such as difficulties with emotion regulation, self-concept and relationships.

A trauma-informed approach to working with Ms. Johnson

The Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) describes a trauma-informed approach in terms of “four Rs”: the service realizes the widespread impact of trauma, recognizes its signs and symptoms, responds by integrating that knowledge into policies and practice, and seeks to resist re-traumatization. SAMHSA’s six principles guide how the social worker would engage with Ms. Johnson:

Because Ms. Johnson avoids thinking about her trauma, the social worker should not push her to disclose details in early sessions. Herman’s (2015) three-stage model of recovery, (1) establishing safety and stabilization, (2) remembrance and mourning, and (3) reconnection, offers a useful sequence: build safety, coping skills and trust before moving into trauma processing.

Step 1: Comprehensive, strengths-based assessment

• Biopsychosocial-spiritual assessment covering trauma history (at a pace she controls), current symptoms, sleep, physical health, substance use, work, finances, parenting, relationships, culture and spirituality.
• Standardized screening tools, such as the PTSD Checklist for DSM-5 (PCL-5) to measure PTSD symptoms and track progress, plus screens for depression (PHQ-9) and anxiety (GAD-7).
• Safety assessment, including suicide risk, any current intimate partner violence or conflict with her husband, and the children’s safety and well-being.
• Sleep assessment, because nightmares and insomnia are central complaints and may need targeted treatment.
• Strengths and resources inventory, documenting her coworkers, supervisor, neighbor and personal qualities such as resilience and commitment to her children.
• Ecological perspective, considering how her micro (family), meso (work, childcare) and macro (racism, health care workforce pressures) systems interact.

Step 2: Stabilization and coping skills

Before trauma processing, the social worker would help Ms. Johnson manage symptoms in daily life:

• Psychoeducation about trauma and PTSD, so she understands that nightmares, startle responses and avoidance are normal reactions to abnormal experiences, not personal weaknesses.
• Grounding techniques for flashbacks, such as the 5-4-3-2-1 senses exercise, holding a cold object or naming the date and location.
• Emotion regulation and relaxation skills, including diaphragmatic breathing, progressive muscle relaxation and mindfulness.
• Sleep support, including sleep hygiene and, where available, cognitive behavioral therapy for insomnia (CBT-I), which the VA/DoD guideline recommends for insomnia in PTSD (Schnurr et al., 2024). For trauma nightmares, imagery rehearsal therapy, in which the client rewrites a nightmare and rehearses the new version while awake, is recommended by the American Academy of Sleep Medicine (Morgenthaler et al., 2018).
• A personal coping and safety plan for stressful shifts, such as identifying triggers at work and a brief break strategy.

Step 3: Evidence-based trauma treatment

Current guidelines recommend individual, trauma-focused psychotherapies as the first choice for PTSD, ahead of medication (Schnurr et al., 2024). Options the social worker could offer, deliver if trained, or refer to include:

• Cognitive Processing Therapy (CPT): helps clients identify and change “stuck points,” such as self-blame or beliefs that the world is completely unsafe.
• Prolonged Exposure (PE): gradually and safely approaches avoided memories and situations to reduce fear.
• Eye Movement Desensitization and Reprocessing (EMDR): processes traumatic memories using bilateral stimulation.

Ms. Johnson should be given information about each option and choose the approach that fits her. Because of her schedule, secure telehealth sessions may improve access; the VA/DoD guideline supports video delivery of validated psychotherapies (Schnurr et al., 2024). If symptoms remain severe, the social worker can refer her to a psychiatrist or psychiatric nurse practitioner for a medication evaluation. The guideline recommends medications such as sertraline, paroxetine or venlafaxine and advises against benzodiazepines (Schnurr et al., 2024).

Step 4: Strengthening support systems and resources

• Natural supports: encourage her to gradually reconnect with coworkers and her neighbor, reducing isolation, and explore whether she wants to involve trusted friends, family or a faith community.
• Childcare: develop a backup childcare plan so she can attend sessions and classes, and acknowledge her neighbor’s support.
• Workplace resources: explore her hospital’s Employee Assistance Program, peer support programs for health care workers, schedule flexibility and, if needed, job protections such as leave under the Family and Medical Leave Act.
• Education goals: support her plan to pursue a BSN through tuition assistance, online or part-time RN-to-BSN programs and scholarships, linking her goals to empowerment and hope.
• Legal and family supports: if separation involves custody, support or conflict, connect her with legal aid and co-parenting resources, and assess whether any domestic violence is present.
• Crisis resources: make sure she knows about the 988 Suicide and Crisis Lifeline and local crisis services.

Step 5: Supporting her children and breaking intergenerational cycles

Ms. Johnson’s own experiences of witnessing violence may make her especially concerned about her children’s well-being during the separation. The social worker can offer parenting support, information about how children respond to family stress and, if the children show signs of distress, referrals to child-focused services such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Parent-Child Interaction Therapy. Framing her treatment as part of protecting her children can increase motivation while avoiding blame.

Cultural humility and anti-oppressive practice

As an African American woman, Ms. Johnson may face additional stressors, including racism and racial trauma, stereotypes such as the expectation to be a “strong Black woman” who does not need help, and mistrust of health care and mental health systems rooted in historical and ongoing discrimination (Comas-Díaz et al., 2019). The social worker should ask about her cultural identity, values, spirituality and experiences of discrimination, rather than making assumptions, and should reflect on their own biases. Offering choices, such as a clinician of a similar background if she prefers, and integrating culturally meaningful sources of strength, such as faith or community, can make treatment more effective. These practices reflect the NASW Code of Ethics values of dignity and worth of the person and cultural competence (National Association of Social Workers [NASW], 2021).

Professional considerations for the social worker

• Scope of practice: deliver only interventions the social worker is trained and licensed to provide, and refer for specialized trauma therapy or medication.
• Ethics: respect self-determination, obtain informed consent, protect confidentiality and explain mandated reporting obligations, including child safety concerns.
• Her role as a nurse: recognize that health care work involves repeated exposure to others’ suffering, which can add secondary traumatic stress to her own history.
• Self-care and supervision: the social worker should use supervision and self-care to prevent vicarious trauma.

Sample treatment plan

Sample discussion post

Frequently asked questions

Related reading: intimate partner violence and the cycle of violence, PTSD treatment plan case study, psychological resilience and coping, cultural humility, workplace violence and nurse well-being and family assessment and genograms.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Comas-Díaz, L., Hall, G. N., & Neville, H. A. (2019). Racial trauma: Theory, research, and healing: Introduction to the special issue. American Psychologist, 74(1), 1–5. https://doi.org/10.1037/amp0000442

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8

Herman, J. L. (2015). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror (Rev. ed.). Basic Books.

Morgenthaler, T. I., Auerbach, S., Casey, K. R., Kristo, D., Maganti, R., Ramar, K., Zak, R., & Kartje, R. (2018). Position paper for the treatment of nightmare disorder in adults: An American Academy of Sleep Medicine position paper. Journal of Clinical Sleep Medicine, 14(6), 1041–1055. https://doi.org/10.5664/jcsm.7178

National Association of Social Workers. (2021). Code of ethics of the National Association of Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics

Schnurr, P. P., Shiner, B., Kelly, U. A., Lang, A. J., Petrakis, I. L., Norman, S. B., Wiechers, I. R., Hamblen, J. L., Morganstein, J. C., Sall, J. L., Riggs, D. S., Holtzheimer, P. E., Wolf, J., Coller, R., Collie, C., Fuller, M. A., McGraw, K., Papke, K., & Kelber, M. S. (2024). The management of posttraumatic stress disorder and acute stress disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Annals of Internal Medicine. https://doi.org/10.7326/M23-2757

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884).