The Toolkit
TRAUMA
What do we mean by trauma?
Trauma can be caused by many different events or experiences (direct and witnessed) that are physically or emotionally harmful or threatening. These can include war, interpersonal violence, accidents, natural and man-made disasters, and loss of a loved one. Trauma can be acute (relatively short term), complex (from multiple sources) or chronic (long-term). Regardless of its causes, trauma can have physical, psychological, and social consequences that are adverse, cumulative, and enduring. Children and adults in poverty or violent situations, and those who face stigma and discrimination due to their identity, abilities or health are most vulnerable to trauma.
Because trauma is so complex and triggered by different circumstances, it can show up in a variety of ways. Clients may seem fearful, angry or depressed, emotional or withdrawn, appreciative or resistant. They may be motivated sometimes and then unwilling or unable to perform important tasks or pursue needed assistance.
Surprising Fact!
Approximately half of all people in the US will experience a traumatic event in their lives and 8% will experience post-traumatic stress disorder (PTSD). Women are approximately 32% more likely to experience PTSD than men.
How can trauma affect health equity?
Trauma can disrupt brain and cognitive development and functioning, leading to learning, attention, memory, and sleep difficulties. It can increase stress-related illnesses and chronic diseases like cancer, diabetes, asthma and stroke, and reduce immune system function. It can increase the likelihood of risky behaviors like self-injury and substance use, as well as poor dietary and exercise habits.
The mental health effects of trauma can decrease cognitive and emotional functioning, and produce excessive anger, aggressiveness, and emotional confusion. Trauma can cause depression, anxiety, PTSD, and acute stress disorder. It can lead to psychological disorders (e.g., personality, attachment, mood), and poor impulse control. Social-emotional wellbeing is often affected as well; signs include social isolation, peer conflict and loneliness, emotional shutdown, withdrawal, low self-esteem, trust issues, and interpersonal violence. Adverse Childhood Experiences (ACEs) can have especially negative, short- and long-term consequences since children’s brains are developing and they lack the cognitive capacity and agency to navigate or resolve difficult situations. Any of these can contribute to poor academic and professional functioning and heighten the likelihood of dropping out or failing to achieve personal goals. Therapeutic interventions can often help people experiencing the effects of trauma. Non-clinical staff can also help by making people feel welcome, understood, and in control of their lives and choices.
Actionable Examples
WHAT OTHERS HAVE DONE
Create a safe and welcoming environment
In designing a home-like shelter for families fleeing domestic violence, an Ohio organization decided to leave cabinets with food, toys and linens unlocked. No rules are posted. The private rooms are furnished and painted differently in warm colors. Residents are treated with dignity and respect the moment they arrive. This approach shows that the shelter staff trust families to take what they need. Trustworthiness and transparency are important aspects of trauma-informed care.
Train staff in trauma-informed care
An Arab-American support center was committed to training staff and volunteers in trauma-informed care. They began by interviewing staff to identify issues, such as barriers to completing intake forms. This led to establishing uniform procedures and training so that intake staff could clearly describe the purpose of the required information and its specific relevance to the programs and service needed. They also moved sensitive personal information to the end, offering a “decline to answer” option, and engaged in role playing both to understand the client experience and to practice strategies.
Bibliography
Clearinghouse of research on the causes, impacts, and interventions related to ACE and trauma. From the Centers for Disease Control and Prevention.
Enhancing the Client Intake Experience
Training brief for intake staff at an Arab-American support center. From the Arab-American Family Support Center.
Hidden trauma victims: Understanding and preventing traumatic stress in mental health professionals.
Research on the impact of secondary trauma on professionals working with people experiencing trauma. From the peer-reviewed academic journal, Social Work in Mental Health.
Key Ingredients for Success in Trauma Informed Care Implementation
Evidence-based recommendations for trauma informed care and training. From the Center for Health Care Strategies.
The principles and application of Psychological First Aid for children and families. From the National Child Traumatic Stress Network and National Center for PTSD.
SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Care Approach
Accessible primer on trauma and how to implement trauma-informed care in community settings. From The Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services.
Toolkit to understand and address the unique circumstances facing historically marginalized populations. From the American Psychiatric Association.
Expansive trauma-informed toolkit and resources for community organizations and providers. From Klinic Community Health Center, Manitoba.
Understanding the Impact of Trauma
Book excerpt describing trauma’s biological, behavioral and psychological and social impacts and models. From SAMHSA.
Excellent set of infographics describing the causes, manifestations, and impacts of trauma and tips for community service providers. From LA County Department of Public Health.
Acknowledgements
Dr. Renee Linklater
Director of Shkaabe Makwa, Centre for Addiction and Mental Health, Ontario, Canada
Dr. Isha Metzger
Professor of Psychology and Director of the Empower Lab, University of Georgia
Dr. Rose Lopez
Director, Wellness and Recovery Training and Anti-stigma Group liaison, Pacific Clinical Services, Los Angeles
Virgina Beckman
Executive Director, and Simon Wahdat, Legal Advocate, Genesis House, Lorain County Safe Harbor, Ohio
Melissa Eggleston
Founder, Birdcall UX, North Carolina, and Designer, U.S. Digital Service
Amelia Rubenstein
Director of Research and Programs, SAFE Center, University of Maryland
Jattna Gomez
Director of Equity and Community Engagement, SAFE Center, University of Maryland
Tessa Whitecloud
Former Executive Director, One Just City, Winnipeg, Canada
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Support for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.