Immigrants

Posted: January 4th, 2023

Nadia Case Study

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Nadia Case Study

Immigrants often escape difficult conditions by immigrating to western countries, including the United States. For children caught in the middle of such experiences, vicarious trauma is a likely eventuality. The reaction of parents towards traumatizing events can aggravate any underlying adverse childhood experiences (ACEs) of their children (Substance Abuse and Mental Health Services Administration, 2014 b). Therapists should be particularly careful to avoid retraumatization during therapy by attending to the history and symptoms of the patient. Ten-year-old Nadia and her mother, Jamila, are Iranian immigrants that experienced a recent fire incident in their apartment, after which Nadia started displaying physical, emotional, social, and spiritual ramifications characteristic of trauma.       

Summary of the Problem

A trauma-informed assessment of Nadia is conducted using the parent report of post-traumatic symptoms (PROPS). During the assessment process, it is critical that this tool unearths the varied impact of trauma, helps recognize the traumatic signs and symptoms, responds comprehensively, and avoids retraumatization (Substance Abuse and Mental Health Services Administration (2014 a). Since Nadia declined responding to questions and conversation, her mother Jamila, described Nadia’s condition through her sister, Yasmin, as the translator. Nadia is a 10-year-old Iranian immigrant whose adverse child experiences have been aggravated by a fire experience in her residential block. Nadia experiences panic attacks at night and when in unfamiliar surroundings because of the recollection of the traumatic experience of their burning apartment. In turn, the lack of sleep is causing the loss of attention and poor performance at school. Moreover, Nadia’s social development is becoming impaired by increased isolation, detachment, and irritation by her sibling and peers. The condition fits vicarious trauma or secondary traumatic stress because although Nadia did not experience the burning apartment directly as it happened in another one below theirs, she witnessed the panic it caused her mother and family, which left indelible memories. In this respect, Nadia’s exposure to people suffering from trauma has caused her post traumatic stress disorder-like (PTSD-like) psychological condition (Middleton & Potter, 2015).

Trauma-Informed Assessment

History

Nadia lives with her mother (Jamila) and siblings (Daquan and Sabina) in an apartment complex populated by Iranian families. Despite struggling financially, Nadia’s mother provides for the family by working as a cleaner for three days a week. Moreover, Nadia can function in a fifth-grade class at her school following special education assistance, thus having attained sufficient English proficiency for her developmental level. She also enjoyed the company of her siblings and cousins, and the responsibilities bestowed on her by her mother. However, all this changed with the fire that broke in their apartment block. The fire occurred while Nadia and her family were asleep. They were woken up by violent banging on their door and shouting by the firefighters. Besides, Nadia’s mother was so scared by this incident that she only managed to hold Nadia close without attempting to escape the smoke-filled apartment. In this regard, Nadia’s harrowing experience was worsened by the terror she saw in her mother and her inability to secure Nadia. Unfortunately, Nadia and her family still lived in the same apartment in the block that had caught fire by the time they came in for therapy.  

Symptoms

Nadia exhibits several symptoms that are a testament to her secondary or vicarious trauma, as revealed by the initial assessment using a parent report of post-traumatic symptoms (PROPS). Nadia’s symptoms fitted those associated with specific traumatic experiences. For instance, her mother indicated that Nadia clutched to her whenever they frequented a new, unfamiliar, and threatening environment, and avoided sleeping at night. This indicates that Nadia experienced fear brought about by the memories of the fire in their apartment block. Nadia also experienced negative moods and thoughts as exhibited by her swings between irritability, detachment, and isolation at home and school.  

Physically, Nadia is unable to sleep, which means that she is sleep-deprived and, therefore, perpetually fatigued. This could also be her need to stay alert and on-guard to avoid being caught by surprise and the memories of the fire recur. Besides, Nadia does not eat well, which may manifest as physical weakness. In addition, Nadia’s behavior has been impacted adversely because she often isolates herself from others, especially in school, and has difficulty completing tasks at home. Emotionally, Nadia is irritable, uncooperative, easily distracted, experiences mood swings, and has intense feelings of being unsafe. Spiritually, Nadia appears to have lost hope in life because she is no longer interested in school work and is disconnected from others, including her family members, considering that her mother does not provide much assurance and protection.  

Nadia is primarily suffering from early exposure to traumatic events directly and indirectly, which highlights the salient developmental and cultural factors associated with her condition. Notably, Nadia has not experienced any delays in developmental milestones yet. For instance, her continued missing school and lack of attention in class may lower her academic achievements. Similarly, Nadia is expected to enjoy the company of her peers in school and siblings at home. Continued irritability and isolation will slow her social development, leaving her social maladjusted as she grows older. In the same vein, Nadia’s attachment relationships have a cultural bearing. She has overheard the narratives of the traumatic experiences of her older family members when interacting with authorities. This relation was confirmed by her mother’s behavior during the fire in their apartment block when she refused to open the door to firefighters, and after banging and shouting, and instead curled up in a corner. In effect, Nadia’s mother managed to transfer her fears to her daughter, worsening the vicarious trauma.  

Treatment Summary

The treatment issues to be prioritized are influenced by the inherent complexity of traumatic experienced in children and the diversity of children’s reaction towards trauma (National Child Traumatic Stress Network, 2013). In this respect, Nadia has experienced traumatic events that have several layers of complexity, which causes them to consider different thoughts and actions that vary and occasionally conflict each other. In addition, Nadia exhibits various reactions towards stressful situations that disrupt Nadia’s developmental trajectory associated with emotional regulation, peer and sibling relations, and attachment relationships with her mother and relatives (National Child Traumatic Stress Network, 2013).  

 Trauma-Focused cognitive behavioral therapy (TF-CBT) is the most appropriate therapeutic intervention for addressing Nadia’s vicarious trauma. This method can be tailored to suit the needs of the patient and thus improve outcomes (Goldbeck et al. 2016). In developing the best therapeutic approach to address Nadia’s condition, it is pertinent to let her family know that Nadia may exhibit several reactions to her trauma, which may differ in diverse aspects, such as duration, frequency, intensity, onset, and type. Moreover, these reactions can disrupt Nadia’s developmental trajectory associated with emotional regulation, peer and sibling relations, and attachment relationships with her mother and relatives.

Nadia has resisted any attempts to engage her and her mother is frustrated that Nadia is unresponsive to her as well. Therefore, a skillful social work approach that recognizes the rights of Nadia and her mother, the need to secure their privacy while guaranteeing them their freedom to disclose personal information is pertinent, if any therapeutic headway is to be made (Madhusudanan & Nalini, 2015). Moreover, accommodation of diversity is critical to be able to address the parent and child who have a significant age difference and their cultural uniqueness in the United States as components of good social work practice grounded in solid core values (Beckett, Maynard, & Jordan, 2017). Nonetheless, once a safe environment has been achieved, the next step would be to engender Nadia’s trust so that she can feel accepted and discuss her thoughts, feelings and emotions in an unfettered manner (Madhusudanan & Nalini, 2015). Thereafter, individual and conjoint sessions can be conducted to help Nadia cope, and her mother help Nadia to address her condition.

References

Beckett, C., Maynard, A., & Jordan, P. (2017). Values and ethics in social work. Sage.

Goldbeck, L., Muche, R., Sachser, C., Tutus, D., & Rosner, R. (2016). Effectiveness of trauma-focused cognitive behavioral therapy for children and adolescents: A randomized controlled trial in eight German mental health clinics. Psychotherapy and Psychosomatics, 85(3), 159-170.

Madhusudanan, S., & Nalini, R. (2015). Indigenizing social casework principles in the light of Thirukural. International Journal of Advances in Social Sciences, 3(3), 107-110.

Middleton, J. S., & Potter, C. C. (2015). Relationship between vicarious traumatization and turnover among child welfare professionals. Journal of Public Child Welfare, 9(2), 195-216.

National Child Traumatic Stress Network (2013). Child welfare trauma training toolkit: Comprehensive guide (3rd ed.). Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress.

National Child Traumatic Stress Network (NCTSN) (2012). The 12 core concepts: Core curriculum on childhood trauma. Los Angeles, CA, and Durham, NC: UCLA-Duke University National Center for Child Traumatic Stress.

Substance Abuse and Mental Health Services Administration (2014 a). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Substance Abuse and Mental Health Services Administration (SAMHSA) (2014 b). Trauma-Informed Care in Behavioral Health Services: Treatment Improvement Protocol (TIP). HHS Publication No. (SMA) 13-4801, Rockville.