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Heffernan S, O'Malley M, Curtin M, Hawkins A, Murphy R, Goodwin J, Barry K, Taylor A, Happell B, O' Donovan Á. An evaluation of a trauma-informed educational intervention to enhance therapeutic engagement and reduce coercive practices in a child and adolescent inpatient mental health unit. Int J Ment Health Nurs 2024; 33:978-991. [PMID: 38291645 DOI: 10.1111/inm.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
High-risk behaviours are sometimes encountered in Child and Adolescent inpatient mental health units and can prompt the use of coercive practices to maintain safety. Coercive practices may lead to re-traumatisation of young people and deteriorating therapeutic relationships. Trauma-informed practice (TIP) has successfully reduced coercive practices. While education is identified as foundational to implementation, evaluations of programmes remain minimal. The aim of this study was to explore mental health professionals' views and experiences of a trauma-informed education programme and its likely impact on their approach to practice. Five mental health professionals agreed to participate, four contributed in a focus group and one in an individual interview. Data were analysed thematically using the Braun and Clarke Framework. Three main themes were identified. Firstly, shifting attitudes and perceptions of trauma-informed practice. Participants believed they had developed more compassion towards clients and these attitudes were reflected in their clinical practice. Secondly, challenges associated with trauma-informed practice educational intervention. Staffing issues and shift work made it difficult for participants to attend education sessions regularly. Participants identified barriers to practicing in a trauma-informed manner in the current clinical environment. Finally, the need for interdisciplinary communication and support was identified. Participants saw the need for all professionals, not only nurses, to take responsibility for changing practice, and for stronger support at the organisational level. Trauma-informed practice is crucial to recovery-focused mental health nursing practice. These findings highlight the importance of TIP education and suggest areas for further improvement to enhance positive mental health outcomes for young people.
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Affiliation(s)
- Sinéad Heffernan
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Maria O'Malley
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Margaret Curtin
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Andrew Hawkins
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Rachel Murphy
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
| | - Karen Barry
- Eist Linn, Child and Adolescent Mental Health Services, Cork and Kerry Healthcare, Health Service Executive, Cork, Ireland
| | - Alice Taylor
- Eist Linn, Child and Adolescent Mental Health Services, Cork and Kerry Healthcare, Health Service Executive, Cork, Ireland
| | - Brenda Happell
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
- Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia
| | - Áine O' Donovan
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, County Cork, Ireland
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Harding KB, Di Ruggiero E, Gonzalez E, Hicks A, Harrington DW, Carsley S. Supporting Ontario public health units to address adverse childhood experiences in pandemic recovery planning: A priority-setting exercise. Health Res Policy Syst 2024; 22:68. [PMID: 38872217 PMCID: PMC11170865 DOI: 10.1186/s12961-024-01156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and restored following the state of emergency, it is important to plan using an ACEs-informed lens. The aim of this study was to identify and prioritize initiatives or activities that Public Health Ontario (PHO) could undertake to support Ontario public health units' work towards ACEs-informed pandemic recovery plans. METHODS The Child Health and Nutrition Research Initiative method was adapted to conduct a priority-setting exercise (May-October 2022). Two online surveys were administered with members of the Healthy Growth and Development (HGD) Evidence Network, comprised of public health unit staff working in child and family health/HGD from Ontario's 34 public health units. In the first survey, participants were asked to propose activities or initiatives that PHO could undertake to support Ontario public health units' work towards ACEs-informed planning. In the second survey, participants were asked to score the final list of options against pre-determined prioritization criteria (for example, relevance). Responses were numerically coded and used to calculate prioritization scores, which were used to rank the options. RESULTS In all, 76% of public health units (n = 26) responded to the first survey to identify options. The 168 proposed ideas were consolidated into a final list of 13 options, which fall under PHO's scientific and technical support mandate areas (data and surveillance, evidence synthesis, collaboration and networking, knowledge exchange and research). A total of 79% of public health units (n = 27) responded to the follow-up survey to prioritize options. Prioritization scores ranged from 76.4% to 88.6%. The top-ranked option was the establishment of a new provincial ACEs community of practice. CONCLUSIONS Over three quarters of public health units contributed to identifying and ranking 13 options for PHO to support public health units in considering and addressing ACEs through pandemic recovery planning. In consultation with the ACEs and Resilience Community of Practice, recently formed on the basis of this exercise, PHO will continue to use the ranked list of options to inform work-planning activities/priorities.
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Affiliation(s)
- Kimberly B Harding
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Erick Gonzalez
- Family Health Division, Niagara Region Public Health and Emergency Services, 1815 Sir Isaac Brock Way, Thorold, ON, L2V 4Y6, Canada
| | - Amanda Hicks
- Family Health Division, Niagara Region Public Health and Emergency Services, 1815 Sir Isaac Brock Way, Thorold, ON, L2V 4Y6, Canada
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Daniel W Harrington
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada
| | - Sarah Carsley
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada.
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Priego-Parra BA, Triana-Romero A, Lajud-Barquín FA, de Fátima Higuera-DelaTijera M, Martínez-Vázquez SE, Salgado-Álvarez GA, García-Mora U, Cruz-Márquez MÁ, Cano-Contreras AD, Cid HV, Remes-Troche JM. Association of adverse childhood experiences with irritable bowel syndrome in Mexican adults: A cross-sectional study. Neurogastroenterol Motil 2024; 36:e14743. [PMID: 38243398 DOI: 10.1111/nmo.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/21/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are linked to the development of gastrointestinal disorders during adulthood, but there is limited research on the prevalence of ACEs in Latin American populations. This study aimed to assess the prevalence and impact of ACEs on Mexican adults with irritable bowel syndrome (IBS). METHODS In this cross-sectional study, we recruited 290 Mexican adults (aged 18-65), including 90 individuals with IBS and 200 healthy controls. All participants completed four self-reported questionnaires: The Adverse Childhood Experiences Questionnaire (ACEs), Visceral Sensitivity Index, Irritable Bowel Syndrome Symptom Severity Scale, and Hospital Anxiety and Depression Scale. Statistical analyses included mean differences using either the Student's t-test or the Wilcoxon test, correlations assessed with Spearman's correlation coefficient, and logistic regression models. Statistical significance was defined as a p-value less than 0.05. KEY RESULTS Among IBS subjects, the prevalence of ACEs was 80%, significantly higher than the 59% prevalence observed in controls (p < 0.0001). Individuals with ACEs exhibited elevated levels of anxiety and depression. Seventy-five percent of IBS subjects with severe symptoms reported four or more ACEs. The presence of four or more ACEs was found to be associated with an increased risk of IBS. CONCLUSIONS AND INFERENCES ACEs are notably prevalent among Mexican individuals with IBS and are positively correlated with the severity of gastrointestinal pain. These findings underscore the critical significance of evaluating and addressing ACEs in the comprehensive management of IBS within Latin American populations.
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Affiliation(s)
- Bryan Adrian Priego-Parra
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
- Centro de Investigaciones Biomédicas, Universidad Veracruzana, Veracruz, Mexico
| | - Arturo Triana-Romero
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | | | | | | | - Giovanni Alejandro Salgado-Álvarez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - Uriel García-Mora
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - Miguel Ángel Cruz-Márquez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - Ana Delfina Cano-Contreras
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - Héctor-Vivanco Cid
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - José María Remes-Troche
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
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LeBeau K, King L, Vacca R. Interorganizational collaboration in a trauma-informed community: A network analysis of cohesion and change. JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 52:89-104. [PMID: 37708082 DOI: 10.1002/jcop.23087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/14/2022] [Accepted: 11/26/2022] [Indexed: 09/16/2023]
Abstract
Strengthening interorganizational collaboration is critical to mitigate the impact of adverse childhood experiences (ACEs) and improve community health. We examined change in interorganizational collaboration around ACEs within Peace4Tarpon's network and investigated factors influencing collaboration. We conducted a community-wide social network analysis among 32 trauma-informed organizations in 2016 and 2018, using network analysis methods to examine interorganizational cohesion (density, transitivity, triad census) over time, and multiple regression quadratic assignment procedure to investigate factors influencing collaboration. Network cohesion measures indicated small increases in collaboration level and greater network cohesion over time. Conducting ACEs screenings was a significant factor (b = 0.237; p < 0.01) predicting likelihood of interorganizational collaboration in 2016. No assessed ACEs practices predicted collaboration in 2018, suggesting variables assessed predicted a small proportion of variance in collaboration change. Results provide a foundation for understanding how ACEs/trauma-informed practices influence collaboration and highlight implications of interorganizational collaboration. Peace4Tarpon's 2-year progress provides insights for other trauma-informed communities.
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Affiliation(s)
- Kelsea LeBeau
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Veterans Rural Health Resource Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Lindsey King
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Raffaele Vacca
- Department of Social and Political Sciences, University of Milan, Milan, Italy
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Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
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Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
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Siantz E, Lansing AE, Center K, Gilmer TP. The development of trauma-informed community partnerships: A mixed method social network study. HUMAN SERVICE ORGANIZATIONS, MANAGEMENT, LEADERSHIP & GOVERNANCE 2023; 48:1-18. [PMID: 39055065 PMCID: PMC11271692 DOI: 10.1080/23303131.2023.2260432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Trauma-informed communities establish cross-sector coalitions that advocate for the use of trauma-informed practices. Whether and how communication occurs within newly established trauma-informed communities is unclear. We collected qualitative data and social network data from six trauma-informed community partnerships that received funding to build community capacity to address trauma across a range of special populations in Los Angeles county. We identified three communication network sub-types and highlight contributions of network leadership in setting the tone for cross-partnership communication. While partnership leaders shared the goal of strengthening cross-organizational communication, social network results illustrated a need to develop strategies that target these goals.
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Affiliation(s)
- Elizabeth Siantz
- University of Utah College of Social Work, 395 S. 1500 E. Salt Lake City, UT 84106
- Hebert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093
| | - Amy E. Lansing
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093
| | - Kim Center
- Hebert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093
| | - Todd P. Gilmer
- Hebert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093
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Scheer JR, Wall MM, Veldhuis CB, Ford JV, Cascalheira CJ, Helminen EC, Shaw TJ, Jaipuriyar V, Zaso MJ, Hughes TL. Associations Between Latent Classes of Trauma Exposure and Minority Stressors and Substance Use Among Cisgender Sexual Minority Women. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:8286-8315. [PMID: 36843440 DOI: 10.1177/08862605231153886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Psychosocial stressors (e.g., minority stressors, trauma exposure) profoundly impact sexual minority women's (SMW's) risk of alcohol and other drug (AOD) use. However, research has not examined whether there are distinct typologies (i.e., patterns) of psychosocial stressors and whether these vary based on sociodemographic characteristics or are differentially associated with AOD outcomes (e.g., alcohol dependence) among SMW. This study aimed to identify latent classes of SMW reporting distinct typologies of psychosocial stressors and examine predictors and outcomes of latent classes of psychosocial stressors among SMW. Participants included a community sample of 602 SMW (Mage = 39.9, SD = 14.0; 74.0% lesbian; 37.4% White, 36.6% Black, 22.3% Latinx; 26.6% annual income ≤$14,999). Latent class analysis was used to identify typologies of psychosocial stressors. Regression analyses were employed to examine sociodemographic predictors and AOD outcomes of class membership. Three classes of psychosocial stressors emerged. Participants in Class 1 were likely to report relatively low adversity. SMW in Class 2, who reported childhood physical abuse (CPA), severe childhood sexual abuse, and adult physical assault, were vulnerable to discrimination and stigma consciousness. A distinct subgroup of SMW (Class 3) was at heightened risk of CPA, adult sexual assault (ASA), and stigma consciousness. Older SMW, Black SMW, and SMW with lower social support were more likely to be in classes characterized by higher adversity. Older SMW were at disproportionate risk of CPA and ASA. Different combinations of psychosocial stressors were uniquely associated with AOD outcomes. Findings underscore the importance of considering within-group heterogeneity in SMW's differential risk of psychosocial stressors and AOD outcomes. Routine screening of psychosocial stressors across several dimensions, brief interventions targeting AOD outcomes, and policies mitigating structural drivers of SMW's increased risk of trauma and minority stressors may be especially important for older SMW, Black SMW, and SMW who lack social support.
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Affiliation(s)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University School of Nursing, Center for Sexual and Gender Minority Health Research, New York, NY, USA
| | - Cindy B Veldhuis
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Cory J Cascalheira
- Syracuse University, Syracuse, NY, USA
- New Mexico State University, Las Cruces, NM, USA
| | - Emily C Helminen
- Syracuse University, Syracuse, NY, USA
- Rochester Institute of Technology, Rochester, NY, USA
| | - Thomas J Shaw
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | | | | | - Tonda L Hughes
- Columbia University, New York, NY, USA
- Columbia University School of Nursing, Center for Sexual and Gender Minority Health Research, New York, NY, USA
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8
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Lansing AE, Romero NJ, Siantz E, Silva V, Center K, Casteel D, Gilmer T. Building trust: Leadership reflections on community empowerment and engagement in a large urban initiative. BMC Public Health 2023; 23:1252. [PMID: 37380973 DOI: 10.1186/s12889-023-15860-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/10/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Trust is essential for healthy, reciprocal relationships; creating safe environments; engaging in transparent interactions; successfully negotiating power differentials; supporting equity and putting trauma informed approaches into practice. Less is known, however, about the ways that trust-building may be at the forefront of consideration during community capacity building efforts, what trust-building elements are perceived as essential for optimally engaging communities, and what practices might support these efforts. METHODS The present study examines an evolving understanding of trust-building over the course of 3 years, from qualitative data derived during interviews with nine agency leads from a large and diverse urban community, who are spearheading community-based partnerships to create more trauma-informed communities and foster resiliency. RESULTS Data reflected fourteen trust-building elements, captured by three themes: 1) Building relationships and engagement (e.g., behavioral practices such as meeting people "where they are at" and creating safe spaces), 2) Embodying core values of trustworthiness (e.g., traits such as being transparent and embodying benevolence), and 3) Sharing decision-making, championing autonomy, and addressing barriers to trust (e.g., collaborative practices such as creating a shared vision and goals and addressing systemic inequities). These trust-building elements are presented in the Community Circle of Trust-Building, which provides an accessible, visual format that can facilitate capacity building efforts within organizations and with the broader community; guide the selection of training opportunities that support healthy interpersonal relationships; and aid in the identification of relevant, supporting frameworks (e.g., health equity, trauma-informed practices, inclusive leadership models). CONCLUSIONS Community engagement and trust are essential for overall health and well-being, increasing equitable access to resources, and supporting an effective and connected citizenry. These data shed light on opportunities for trust-building and thoughtful engagement among agencies working directly with community members in large urban areas.
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Affiliation(s)
- Amy E Lansing
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Department of Sociology, San Diego State University, San Diego, CA, USA.
| | - Natalie J Romero
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | | | - Vivianne Silva
- Department of Education and Information Studies, University of California, Los Angeles, Los Angeles, USA
| | - Kimberly Center
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Danielle Casteel
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Todd Gilmer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
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Holmes MR, King JA, Miller EK, King-White DL, Korsch-Williams AE, Johnson EM, Oliver TS, Conard IT. Innovations in Trauma-Informed Care: Building the Nation's First System of Trauma-Informed Recreation Centers. Behav Sci (Basel) 2023; 13:bs13050394. [PMID: 37232631 DOI: 10.3390/bs13050394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
Exposure to adversity and traumatic events affects well-being across important domains of functioning, including mental, physical, social, emotional, spiritual, and neurobiological. Situated as a focal point throughout neighborhoods, recreation centers are a prime opportunity to cultivate spaces of safety and healing. However, current models of trauma-informed care largely do not map neatly onto the recreation organizational structure and functioning. This paper describes the efforts over the past five years to transform the City of Cleveland, Ohio's 22 recreation centers into trauma-informed Neighborhood Resource and Recreation Centers (NRRCs)--places where children, youth, and adults can readily acquire the support and services they need in an environment in which trauma-informed care principles are fully embedded in the fabric of the organization's culture. Phase 1 included transitioning the recreation centers to NRRCs, hiring of trained social workers and counselors to work within the recreation centers, and training all recreation staff about trauma. Phase 2 included development of NRRC trauma-informed standards, development of the Trauma-Informed Progress Tool to track change over time, development of Trauma-Informed Leadership Competencies for Center Managers, and ongoing training for the social workers and counselors. We discuss ideas for future work and lessons learned from each phase.
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Affiliation(s)
- Megan R Holmes
- Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Jennifer A King
- Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Emily K Miller
- Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Dakota L King-White
- Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
- Levin College of Public Affairs and Education, Cleveland State University, Cleveland, OH 44155, USA
| | - Amy E Korsch-Williams
- Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Erica M Johnson
- Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
- Weatherhead School of Management, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Tomeika S Oliver
- Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ivan T Conard
- Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
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Duncan S, Horton H, Smith R, Purnell B, Good L, Larkin H. The Restorative Integral Support (RIS) Model: Community-Based Integration of Trauma-Informed Approaches to Advance Equity and Resilience for Boys and Men of Color. Behav Sci (Basel) 2023; 13:bs13040299. [PMID: 37102813 PMCID: PMC10136213 DOI: 10.3390/bs13040299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Mental health and health promotion research and practice have consistently revealed the social and structural inequities that boys and men of color (BMoC) face. Moreover, scholarship highlights the importance of gender, especially the concepts of masculinity and manhood, in understanding inequities that are experienced. Providers and community leaders are finding culturally relevant ways to foster healing and restoration while addressing racial trauma and the adverse community environments tied to adverse childhood experiences (ACEs). This article introduces the restorative integral support (RIS) model to promote connectivity through networks and to acknowledge the contextual differences BMoC experience when suffering from trauma and adversities. RIS is a framework used to address adversities and trauma while increasing societal awareness and advancing equity. This community-based, multidimensional approach is offered to enhance individual, agency, community, and policymaking leadership, raising awareness of mental health concerns and trauma while offering a flexible guide to developing safe spaces and support for recovery from ACEs and trauma. This article offers an in-depth appreciation of the real-life contexts within which BMoC overcome histories of adversity and trauma, demonstrating how the RIS model is applied to advance structural transformation while fostering community resilience.
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Affiliation(s)
- Stephanie Duncan
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Correspondence: (S.D.); (H.H.); (H.L.)
| | - Heather Horton
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Correspondence: (S.D.); (H.H.); (H.L.)
| | - Richard Smith
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Richard Smith Speaks, Brooklyn, NY 11201, USA
| | | | - Lisa Good
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Urban Grief, Albany, NY 12204, USA
| | - Heather Larkin
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Correspondence: (S.D.); (H.H.); (H.L.)
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Watters ER, Aloe AM, Wojciak AS. Examining the Associations Between Childhood Trauma, Resilience, and Depression: A Multivariate Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:231-244. [PMID: 34313169 DOI: 10.1177/15248380211029397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
TOPIC OF REVIEW Childhood trauma has been associated with increased depression; however, resilience has been found to reduce this association. METHOD OF REVIEW Present analyses were based on multivariate meta-analytical techniques, an extension of univariate meta-analysis. All computations were performed using the metafor package and the metaRmat package from R. Bivariate associations (r) between trauma, resilience, and depression were utilized as the pooled effect sizes. CRITERIA FOR INCLUSION Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were coded based on the following inclusion criteria: (a) sample participants had a history of childhood trauma; (b) studies included one of the four instruments of trait resilience; (c) studies included measures of individual outcomes of depression; (d) studies were published in peer-reviewed journals, dissertations, book chapters since 2009, or provided by leading scholars who had yet to publish their data; (e) all manuscripts were written in English; and (f) studies included the Pearson Product Moment Correlation Coefficient (r) for the effect size. CRITERIA FOR REVIEW We systematically coded for the following items for each study: year of publication, type of report, peer-reviewed, funding, sampling strategy, sample size, gender, mean age, country of study, measure of resilience, measure depression, and measure of childhood trauma. MAJOR FINDINGS The pooled correlations indicate that trauma, resilience, and depression are significantly associated. There were no significant differences in symptoms of depression for high versus low reports of resilience for individuals with a history of trauma. Year of publication was a significant moderator for the associations between trauma, resilience, and depression. Resilience significantly mediated the association between trauma and depression.
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Affiliation(s)
- Elizabeth R Watters
- Department of Psychological and Quantitative Foundations, University of Iowa, IA, USA
| | - Ariel M Aloe
- Department of Psychological and Quantitative Foundations, University of Iowa, IA, USA
| | - Armeda S Wojciak
- Department of Family Social Sciences, University of Minnesota, MN, USA
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12
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Implementing Trauma Informed Care in Human Services: An Ecological Scoping Review. Behav Sci (Basel) 2022; 12:bs12110431. [DOI: 10.3390/bs12110431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/16/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Trauma and toxic stress are growing public health concerns with increasing risks to morbidity and mortality. Trauma informed care is an organizational response that challenges providers to adapt principled based approaches that seek to reduce adverse effects of care and support healing. However, there is a scarcity of empirical evidence on how trauma informed care is implemented in systems. A preferred reporting items for systematic reviews and meta-analysis-compliant scoping review based on Arksey, and O’Malley’s five steps model was conducted. Four databases, PubMed, Scopus, Embase and PsychINFO were searched for English articles published since 2000. Studies were included if they reported on trauma informed care delivered by services that support adults and there was some reference to implementation or organizational implications. Of 1099 articles retrieved, 22 met the inclusion criteria. Findings suggest that trauma informed care is being implemented in a range of human services, including at the city/state level. While implementation research is still at an early stage in this field, the findings elucidate several challenges when implementing this approach across systems of care. An ecological lens is used to present findings at the macro, mezzo, and micro level, and these are further discussed with reference to practice, policy, and research.
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13
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King LM, Zori G, Collins SL, Lewis C, Hack G, Dixon BN, Hart M. What does community resilience mean in the context of trauma-informed communities? A scoping review. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3325-3353. [PMID: 35322432 DOI: 10.1002/jcop.22839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
UNLABELLED Several communities are implementing trauma-informed, community-level approaches focused on addressing/preventing adverse childhood experiences (ACEs), yet most community resilience definitions from published articles are based on acute traumas. This scoping review aims to determine how community resilience is defined and operationalized within the context of chronic/complex traumas. METHODS We performed a rigorous, comprehensive literature search using multiple databases. RESULTS The 38 included articles addressed multiple types of chronic traumas, including historical trauma, poverty, minority stress, mass incarceration, and ACEs. A variety of definitions of community resilience were cited, several of which stressed the ability to thrive despite risk factors and the safety and wellbeing of residents. Few articles operationalized community resilience within the context of ACEs, suggesting significant gaps in the literature. CONCLUSION This review can serve as an important building block to develop expanded definitions of community resilience for chronic traumas and assist communities in promoting community-wide responses to ACEs.
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Affiliation(s)
- Lindsey M King
- Department of Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
- Social and Behavioral Sciences, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Gaia Zori
- Social and Behavioral Sciences, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Sarah L Collins
- Social and Behavioral Sciences, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Carol Lewis
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA
- Cofounder, Peace4Gainesville, Gainesville, Florida, USA
| | - George Hack
- Department of Occupational Therapy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Brittney N Dixon
- Department of Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
- Social and Behavioral Sciences, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Mark Hart
- Central Administration Office, Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
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14
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Cruz D, Lichten M, Berg K, George P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry 2022; 13:800687. [PMID: 35935425 PMCID: PMC9352895 DOI: 10.3389/fpsyt.2022.800687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.
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Affiliation(s)
- Daniel Cruz
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | | | - Kevin Berg
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | - Preethi George
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
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15
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Schroeder K, Dumenci L, Sarwer DB, Noll JG, Henry KA, Suglia SF, Forke CM, Wheeler DC. The Intersection of Neighborhood Environment and Adverse Childhood Experiences: Methods for Creation of a Neighborhood ACEs Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137819. [PMID: 35805478 PMCID: PMC9265402 DOI: 10.3390/ijerph19137819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022]
Abstract
This study evaluated methods for creating a neighborhood adverse childhood experiences (ACEs) index, a composite measure that captures the association between neighborhood environment characteristics (e.g., crime, healthcare access) and individual-level ACEs exposure, for a particular population. A neighborhood ACEs index can help understand and address neighborhood-level influences on health among individuals affected by ACEs. Methods entailed cross-sectional secondary analysis connecting individual-level ACEs data from the Philadelphia ACE Survey (n = 1677) with 25 spatial datasets capturing neighborhood characteristics. Four methods were tested for index creation (three methods of principal components analysis, Bayesian index regression). Resulting indexes were compared using Akaike Information Criteria for accuracy in explaining ACEs exposure. Exploratory linear regression analyses were conducted to examine associations between ACEs, the neighborhood ACEs index, and a health outcome—in this case body mass index (BMI). Results demonstrated that Bayesian index regression was the best method for index creation. The neighborhood ACEs index was associated with higher BMI, both independently and after controlling for ACEs exposure. The neighborhood ACEs index attenuated the association between BMI and ACEs. Future research can employ a neighborhood ACEs index to inform upstream, place-based interventions and policies to promote health among individuals affected by ACEs.
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Affiliation(s)
- Krista Schroeder
- Department of Nursing, Temple University College of Public Health, Philadelphia, PA 19122, USA
- Correspondence:
| | - Levent Dumenci
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA 19122, USA;
| | - David B. Sarwer
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, Temple University College of Public Health, Philadelphia, PA 19122, USA;
| | - Jennie G. Noll
- Department of Human Development and Family Studies, Penn State College of Health and Human Development, University Park, PA 16802, USA;
| | - Kevin A. Henry
- Department of Geography and Urban Studies, Temple University College of Liberal Arts, Philadelphia, PA 19122, USA;
| | - Shakira F. Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA;
| | - Christine M. Forke
- Master of Public Health Program, Perelman School of Medicine, University of Pennsylvania, Center for Violence Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - David C. Wheeler
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA;
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16
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Kothari BH, Fischer C, Mullican N, Lipscomb ST, Jaramillo J. Interagency collaboration among community organizations serving children and families in child welfare. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2022. [DOI: 10.1002/casp.2612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Brianne H. Kothari
- Human Development and Family Sciences Oregon State University‐Cascades Bend Oregon USA
| | - Cameron Fischer
- Human Development and Family Sciences Oregon State University‐Cascades Bend Oregon USA
| | - Nicole Mullican
- Human Development and Family Sciences Oregon State University Corvallis Oregon USA
| | - Shannon T. Lipscomb
- Human Development and Family Sciences Oregon State University‐Cascades Bend Oregon USA
| | - Jamie Jaramillo
- Human Development and Family Sciences Oregon State University Corvallis Oregon USA
- Oregon Social Learning Center Eugene Oregon USA
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17
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Champine RB, Hoffman EE, Matlin SL, Strambler MJ, Tebes JK. "What Does it Mean to be Trauma-Informed?": A Mixed-Methods Study of a Trauma-Informed Community Initiative. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:459-472. [PMID: 35018088 PMCID: PMC8736308 DOI: 10.1007/s10826-021-02195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 05/04/2023]
Abstract
Trauma during childhood has the potential to adversely affect one's physical, cognitive, emotional, and social development across the life span. However, the adverse effects of trauma can be prevented and mitigated through holistic services and supports that are trauma-informed. The Pottstown Trauma-Informed Community Connection (PTICC) is a community-based initiative that aims to build a trauma-informed community through training diverse stakeholders (e.g., school staff, providers, community leaders, parents) on the potential signs and symptoms of child trauma and how to create safe physical and emotional environments for children and families. This paper presents findings from a mixed-methods study of education and community partners' (N = 82) experiences in PTICC and their understandings of what it means to become trauma-informed. Paired sample t-tests found significant changes in participants' beliefs about trauma-informed practice, but there were no changes in participants' perceptions of the impacts of PTICC on their use of trauma-informed practices and supports. Focus groups with education (n = 6) and community (n = 5) partners found that participants regarded being "trauma-informed" as reframing one's perspective, being more self-reflective, acquiring skills to respond more effectively to others who have experienced trauma, and having a sense of hope for the future. Findings also revealed perceived benefits of trauma training and challenges associated with getting others to buy-in to trauma-informed work. Potential methodological considerations for future community-engaged research in building trauma-informed communities are discussed. These considerations include the need to address ceiling effects, disaggregate data, and mitigate challenges associated with participant engagement.
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Affiliation(s)
- Robey B. Champine
- Division of Public Health, Michigan State University College of Human Medicine, Flint, MI 48502 USA
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
| | - Erin E. Hoffman
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
- College of Science and Health, Department of Psychology, DePaul University, Chicago, IL 60604 USA
| | - Samantha L. Matlin
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
- The Scattergood Foundation, 1501 Cherry Street, Philadelphia, PA 19102 USA
| | - Michael J. Strambler
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
| | - Jacob Kraemer Tebes
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT 06511 USA
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18
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Wright SS, Johnson DB, Bernstein KT, Valentine JA. Program-Level Strategies for Addressing Sexually Transmitted Disease Disparities: Overcoming Critical Determinants That Impede Sexual Health. Sex Transm Dis 2021; 48:e174-e177. [PMID: 33783408 DOI: 10.1097/olq.0000000000001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Shauntā S Wright
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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19
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Gerlach B, LaBrenz CA, Barczyk AN, Larkin H, Van Diest H, Morris M, Faulkner M. ACE-Informed Responses in Central Texas: Findings from a Needs Assessment. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:820-831. [PMID: 34380381 DOI: 10.1080/19371918.2021.1958118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The objectives of this study were to examine: a) adverse childhood experience (ACE) knowledge among healthcare professionals in Central Texas; b) prevalence of screening and patient disclosure of ACEs; c) implementation of ACE-informed response strategies; and d) the relationship between ACE knowledge and familiarity, and implementation of ACE-informed response strategies. A needs assessment was conducted using an online survey that included closed- and open-ended questions. Purposive and snowball sampling were utilized to recruit healthcare providers, with a focus on pediatric and women's healthcare providers. Eighty-five healthcare providers completed the survey. Most respondents were unfamiliar with the ACE study, but 59.6% had attended trainings on the impact of trauma on child health. Respondents screened most frequently for mental illness and drug/alcohol abuse in their practice. The most frequently reported ACE-informed response strategies included identifying strengths and utilizing on-site resources, while broader strategies such as creating an ACE-informed culture within their practice were implemented by less than 10% of respondents. ACE knowledge was correlated with two of the ACE-informed response strategies. Although many healthcare providers still lack familiarity with ACEs, awareness of trauma and its impact on child health may be more common. Given the positive correlation between ACE familiarity and ACE-informed response strategies, it appears more education and resources are needed to engage healthcare providers in responding to ACEs. Specific strategies, such as community-wide trainings, opportunities for provider collaboration and communication, and critical analysis of policies, may cultivate a more ACE-informed and ACE-responsive culture.
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Affiliation(s)
- Beth Gerlach
- University of Texas at Austin, Texas Institute for Child and Family Wellbeing, Austin, Texas, USA
| | - Catherine A LaBrenz
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Amanda N Barczyk
- Department of Population Health, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Heather Larkin
- School of Social Welfare, University at Albany, Albany, New York, USA
| | - Heather Van Diest
- Department of Health Social Work, Dell Medical School, Steve Hicks School of Social Work, the University of Texas at Austin, USA
| | - Marian Morris
- Department of Population Health, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Monica Faulkner
- University of Texas at Austin, Texas Institute for Child and Family Wellbeing, Austin, Texas, USA
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20
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Alessi EJ, Hutchison C, Kahn S. Understanding COVID-19 through a Complex Trauma Lens: Implications for Effective Psychosocial Responses. SOCIAL WORK 2021; 67:swab045. [PMID: 34694385 DOI: 10.1093/sw/swab045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/19/2020] [Accepted: 11/18/2020] [Indexed: 06/13/2023]
Abstract
The psychosocial impact of COVID-19 on individuals, families, and communities will likely persist for years to come. While briefing notes informed by disaster psychology and crisis management have been released to guide social workers and other mental health professionals in their work during the pandemic, the far-reaching impacts of COVID-19 may require inclusion of additional theories of trauma and resilience. Thus, this article first examines the application of complex trauma theory as an effective framework for assessing the psychosocial impacts of the pandemic, especially among individuals with prior trauma exposure, those with preexisting mental illness, and communities affected by marginalization and historical trauma. Authors then discuss the importance of using trauma-informed practice to address the effects of the pandemic on both individual and community levels during this unprecedented moment in history.
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21
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Gilmer TP, Center K, Casteel D, Choi K, Innes-Gomberg D, Lansing AE. Developing trauma resilient communities through community capacity-building. BMC Public Health 2021; 21:1681. [PMID: 34525982 PMCID: PMC8443397 DOI: 10.1186/s12889-021-11723-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/29/2021] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Trauma is a significant public health issue, negatively impacting a range of health outcomes. Providers and administrators in public mental health systems recognize the widespread experience of trauma, as well as their limited ability to address trauma within their communities. In response, the Los Angeles County Department of Mental Health funded nine regionally based community partnerships to build capacity to address trauma. We describe partnership and community capacity-building efforts and examine community impact, defined as successful linkages to resources and changes in stress tolerance capacities among community members. METHODS We conceptualized community capacity-building as dissemination of trauma-informed education and training, community outreach and engagement, and linkage of community members to resources. We measured trauma-informed trainings among partnership members (N = 332) using the Trauma-Informed Organizational Toolkit. Outreach, engagement and linkages were documented using Event and Linkage Trackers. We examined changes in the type of successful linkage after the issuance of statewide mandatory restrictions in response to COVID-19. We examined changes in stress tolerance capacities among community members (N = 699) who were engaged in ongoing partnership activities using the 10-item Conner-Davidson Resilience Scale; the 28-item Coping Orientation to Problems; and the pictorial Inclusion of Community in Self Scale. RESULTS Training and education opportunities were widespread: 66% of members reported opportunities for training in 13 or more trauma-informed practices. Partnerships conducted over 7800 community capacity-building events with over 250,000 attendees. Nearly 14,000 successful linkages were made for a wide range of resources, with consistent linkage success prior to (85%) and during (87%) the pandemic. In response to COVID-19, linkage type significantly shifted from basic services and health care to food distribution (p < .01). Small but significant improvements occurred in coping through emotional and instrumental support; and sense of community connectedness (p < .05 each). CONCLUSIONS Community-based partnerships demonstrated effective capacity-building strategies. Despite the pandemic, community members did not report reduced stress tolerance, instead demonstrating gains in external help-seeking (use of emotional and instrumental supports) and perception of community connectedness. Future work will use qualitative methods to examine the impact of community capacity-building and the sustainability of this approach for addressing the impact of trauma within communities.
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Affiliation(s)
- Todd P Gilmer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
| | - Kimberly Center
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Danielle Casteel
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Kyle Choi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | | | - Amy E Lansing
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Sociology, San Diego State University, San Diego, CA, USA
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22
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King LM, LeBeau K, Hart M, Vacca R. Organizational partnerships for a trauma-informed community: A community-wide social network study. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2658-2678. [PMID: 34174091 DOI: 10.1002/jcop.22645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/27/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
We investigated whether Peace4Tarpon's trauma-responsive community capacity activities led to greater collaboration among community partners. We conducted longitudinal social network analysis (SNA) among organizations within Peace4Tarpon's network in 2016 and 2018 to capture cooperation around adverse childhood experiences-related topics. We examined network structure, cohesion, organizational collaboration, and associations between centrality and organizational practices. Peace4Tarpon's network included diverse sectors, with a group of organizations forming the network core and collaborating over time. The network displayed a small increase in cohesion, more cross-sector collaboration, and less heterophily over time. We found a significant difference between the mean betweenness centralities of organizations who assessed resilience and those who did not in the 2018 average union network. This is one of the first studies using SNA to investigate a trauma-informed community network. Findings from this type of analysis may assist community organizations in strengthening outreach and strategically engaging organizations within a trauma-informed network.
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Affiliation(s)
- Lindsey M King
- Department of Health Services Research, Management and Policy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Kelsea LeBeau
- Social and Behavioral Sciences, College of Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Mark Hart
- Department of Central Administration Office, Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Raffaele Vacca
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, Florida, USA
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23
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Mann MJ, Smith ML, Kristjansson AL, Daily S, McDowell S, Traywick P. Our Children Are Not "Behind" Due to the COVID-19 Pandemic, but Our Institutional Response Might Be. THE JOURNAL OF SCHOOL HEALTH 2021; 91:447-450. [PMID: 33754363 PMCID: PMC8250716 DOI: 10.1111/josh.13016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 05/11/2023]
Affiliation(s)
- Michael J Mann
- Associate Professor, , Boise State University, 1910 University Drive, Boise, ID, 83725-1835., USA
| | - Megan L Smith
- Associate Professor, , Boise State University, 1910 University Drive, Boise, ID, 83725-1835., USA
| | - Alfgeir L Kristjansson
- Associate Professor, , West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506-9190., USA
| | - Shay Daily
- Research Associate, , West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506-9190., USA
| | - Shannon McDowell
- MPH Student, , Boise State University, 1910 University Drive, Boise, ID, 83725-1835., USA
| | - Piper Traywick
- MPH Student, , Boise State University, 1910 University Drive, Boise, ID, 83725-1835., USA
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24
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Champine RB, Lang JM, Nelson AM, Hanson RF, Tebes JK. Systems Measures of a Trauma-Informed Approach: A Systematic Review. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:418-437. [PMID: 31469452 PMCID: PMC7003149 DOI: 10.1002/ajcp.12388] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Interest in trauma-informed approaches has grown substantially. These approaches are characterized by integrating understanding of trauma throughout a program, organization, or system to enhance the quality, effectiveness, and delivery of services provided to individuals and groups. However, variation in definitions of trauma-informed approaches, coupled with underdeveloped research on measurement, poses challenges for evaluating the effectiveness of models designed to support a trauma-informed approach. This systematic review of peer-reviewed and gray literature identified 49 systems-based measures that were created to assess the extent to which relational, organizational, and community/system practices were trauma-informed. Measures were included if they assessed at least one component of a trauma-informed approach, were not screening or diagnostic instruments, were standardized, were relevant to practices addressing the psychological impacts of trauma, were printed in English, and were published between 1988 and 2018. Most (77.6%) measures assessed organizational-level staff and climate characteristics. There remain several challenges to this emerging field, including inconsistently reported psychometric data, redundancy across measures, insufficient evidence of a link to stakeholder outcomes, and limited information about measurement development processes. We discuss these opportunities and challenges and their implications for future research and practice.
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Affiliation(s)
- Robey B. Champine
- Child Health and Development Institute of Connecticut,
Farmington, CT 06032
- Yale School of Medicine, Division of Prevention and
Community Research, New Haven, CT 06511
- Michigan State University, College of Human Medicine,
Division of Public Health, Flint, MI 48502
| | - Jason M. Lang
- Child Health and Development Institute of Connecticut,
Farmington, CT 06032
- UCONN Health, Department of Psychiatry, Farmington, CT
06032
- Child Study Center, Yale Schools of Medicine, New Haven, CT
06511
| | - Ashley M. Nelson
- Child Health and Development Institute of Connecticut,
Farmington, CT 06032
| | - Rochelle F. Hanson
- Medical University of South Carolina, Department of
Psychiatry and Behavioral Sciences, Charleston, SC 29425
| | - Jacob K. Tebes
- Yale School of Medicine, Division of Prevention and
Community Research, New Haven, CT 06511
- Yale School of Public Health, New Haven, CT 06511
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25
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Herrenkohl TI, Mersky JP, Topitzes J. Applied and Translational Research on Trauma-Responsive Programs and Policy: Introduction to a Special Issue of the American Journal of Community Psychology. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:281-285. [PMID: 31593311 DOI: 10.1002/ajcp.12402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The special issue highlights work across systems that include child welfare, education, juvenile justice and health, as well as agencies serving adults who are at-risk for high levels of childhood and adult trauma exposure. While articles appearing in the special issue are not divided equally across these systems, they cover important and overlapping concepts within each. Some articles span more than a single system or domain of research, whereas others fit primarily within single area or domain. Articles provide new insights from research on practices, programs, and policies that help to transform systems so they are increasingly more responsive to the needs of vulnerable populations.
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Affiliation(s)
- Todd I Herrenkohl
- School of Social Work, University of Michigan, Ann Arbor, Michigan, MI, USA
| | - Joshua P Mersky
- Helen Bader School of Social Welfare, University of Wisconsin- Milwaukee, Milwaukee, WI, USA
| | - James Topitzes
- Helen Bader School of Social Welfare, University of Wisconsin- Milwaukee, Milwaukee, WI, USA
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Tebes JK, Champine RB, Matlin SL, Strambler MJ. Population Health and Trauma-Informed Practice: Implications for Programs, Systems, and Policies. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:494-508. [PMID: 31444915 PMCID: PMC7006880 DOI: 10.1002/ajcp.12382] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Population studies indicate that trauma exposure is ubiquitous and has a significant impact on health. Trauma-informed practice seeks to address the health consequences of trauma through integrative responses that incorporate an understanding of the effects of trauma, the multiple pathways to recovery, and the potential for re-traumatization. Current trauma-informed practice considers trauma exposure an individual clinical problem rather than a societal problem with population health consequences. Population health refers to the aggregated health status of individuals who share some characteristic, such as trauma exposure, and includes the study of determinants that shape the distribution of health outcomes in specific populations. In this paper, we describe a population health perspective for trauma-informed practice that complements the current clinical perspective, and then discuss implications of that perspective for programs, systems, and policies. We summarize essential concepts about trauma over the life course and describe principles of population health science relevant to trauma-informed practice. We then discuss implications of these principles by identifying four priorities for trauma-informed practice from a population health perspective: (a) adopting trauma-informed policies to prevent trauma exposure and to foster resilience in the aftermath of trauma; (b) infusing trauma-informed practice into everyday activities so it is a routine part of interpersonal transactions; (c) incorporating trauma-informed practices into existing service systems; and (d) adapting existing treatments to incorporate trauma-informed principles for population health impact.
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Affiliation(s)
| | - Robey B Champine
- Yale School of Medicine, New Haven, CT, USA
- Child Health & Development Institute, Inc., Farmington, CT, USA
| | - Samantha L Matlin
- Yale School of Medicine, New Haven, CT, USA
- The Scattergood Foundation, Philadelphia, PA, USA
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