Ms. Johnson Case Study (SWK-625 Topic 2): Trauma-Informed Care, PTSD Assessment, Interventions and Resources
13 min read SWK-625 Topic 2: Ms. Johnson Case Study
Case Study: Trauma-Informed Care for Ms. Johnson
Background of the Client: Ms. Johnson is a 35-year-old African American woman who has recently sought counseling due to recurring nightmares and heightened anxiety. She works as a nurse in a busy urban hospital and is a single mother to two young children. She holds an associate degree in nursing and is considering returning to school to earn a bachelor’s of science in nursing. She is separated from her husband, who is the father of her two children. Ms. Johnson reports experiencing childhood abuse and witnessing domestic violence between her parents. These experiences have left a lasting impact on her mental health and daily functioning.
She frequently experiences vivid nightmares related to her childhood trauma and occasionally has flashbacks during stressful situations. Ms. Johnson is often on edge, easily startled, and has difficulty relaxing or sleeping. She avoids discussing or thinking about her traumatic experiences and tends to isolate herself from others emotionally. Ms. Johnson reports she has supportive co-workers, an engaged boss, who encourages her to seek additional education and training, and a retired neighbor who often watches her children.
She was referred to your agency for treatment options and resources. How might you as her social worker assist her with her symptoms and support needs?
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.
| PTSD symptom cluster | What Ms. Johnson reports |
|---|---|
| Intrusion | Vivid, recurring nightmares about childhood trauma; flashbacks during stressful situations |
| Avoidance | Avoids discussing or thinking about her traumatic experiences |
| Negative changes in thoughts and mood | Emotional isolation and detachment from others |
| Arousal and reactivity | Always “on edge,” easily startled, difficulty relaxing and sleeping |
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.
Childhood abuse and witnessing domestic violence; PTSD symptoms; sleep loss; marital separation; single parenting; high-stress nursing job; emotional isolation
Help-seeking; stable career as a nurse; educational goals; supportive coworkers; encouraging boss; retired neighbor who helps with childcare; love for her children
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:
| SAMHSA principle | How it applies to Ms. Johnson |
|---|---|
| Safety | Create a calm, predictable space; explain what will happen in each session; assess current safety, including any risk from her separated husband, and screen for suicide risk. |
| Trustworthiness and transparency | Explain confidentiality and its limits, the purpose of each assessment and the options for treatment so there are no surprises. |
| Peer support | Offer connections to trauma survivor support groups or groups for working mothers, if she wants them. |
| Collaboration and mutuality | Set goals together; treat her as the expert on her own life; share power in decisions. |
| Empowerment, voice and choice | Let her choose the pace of trauma work, the type of therapy and when to talk about difficult memories; build on her strengths as a nurse and mother. |
| Cultural, historical and gender issues | Acknowledge how race, gender, culture and historical trauma shape her experiences and her trust in helping systems. |
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
| Goal | Measurable objective | Interventions |
|---|---|---|
| Reduce trauma symptoms | Lower PCL-5 score by at least 10 points within 12–16 weeks | Psychoeducation; CPT, PE or EMDR based on her choice |
| Improve sleep | Reduce nightmares from most nights to 1–2 per week; sleep 6+ hours on most nights | Sleep hygiene; CBT-I; imagery rehearsal therapy; medical referral if needed |
| Manage flashbacks and stress at work | Use a grounding skill within minutes of a trigger in 80% of reported episodes | Grounding, breathing and relaxation training; work trigger plan |
| Reduce isolation | Engage in one social activity per week with a trusted person | Behavioral activation; peer or support group referral |
| Advance education and career | Apply to an RN-to-BSN program within 6 months | Resource linkage; tuition assistance; time management planning |
| Support children and parenting | Maintain a consistent routine and backup childcare plan | Parenting support; child referrals if needed; childcare planning |
Sample discussion post
Original example for study purposes. Use it as a model, not as your submission.
Ms. Johnson’s nightmares, flashbacks, avoidance, emotional isolation and hyperarousal align with the PTSD symptom clusters in the DSM-5-TR (APA, 2022) and with the long-term effects of adverse childhood experiences (Felitti et al., 1998). As her social worker, I would use SAMHSA’s (2014) trauma-informed principles, especially safety, transparency, collaboration and choice. I would begin with a strengths-based biopsychosocial assessment, the PCL-5, and screening for suicide risk and current safety, letting her control how much she shares about her trauma.
Next, I would focus on stabilization: psychoeducation, grounding skills for flashbacks, relaxation and sleep strategies, including imagery rehearsal therapy for nightmares (Morgenthaler et al., 2018). Once she feels ready, I would offer or refer her to a first-line trauma-focused therapy such as CPT, PE or EMDR (Schnurr et al., 2024), with a psychiatric referral if needed. I would build on her strengths: her supportive coworkers, encouraging boss and neighbor, her nursing career and her goal of earning a BSN. I would connect her with her hospital’s EAP, telehealth options, childcare backup and education funding. Throughout, I would practice cultural humility, recognizing how racism and the “strong Black woman” expectation may affect her help-seeking (Comas-Díaz et al., 2019), and honor her self-determination as the NASW (2021) Code of Ethics requires.
Frequently asked questions
Can a social worker diagnose PTSD?
Licensed clinical social workers can diagnose mental health conditions in most U.S. states. Social workers without clinical licensure should assess, document symptoms and refer for diagnosis.
What are the first-line treatments for PTSD?
Trauma-focused psychotherapies such as Cognitive Processing Therapy, Prolonged Exposure and EMDR are recommended over medication. Sertraline, paroxetine and venlafaxine are recommended medication options (Schnurr et al., 2024).
Why not ask Ms. Johnson to describe her trauma right away?
Pushing disclosure before safety and coping skills are established can re-traumatize clients and increase dropout. Trauma-informed care lets the client control the pace.
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).
