An R&P program manager emphasized the awareness around trauma and mental health as a prerequisite for TIC and stated, So, in those regards, it’s good for trauma-informed care.” Interagency dependency is seemingly inevitable to most agencies, but particularly to those with little internal support or capacity, and such collaboration is highly valued and seen as an opportunity for TIC. Facing a relatively deep divide in capacity and support for TIC between providers in small local agencies and those in large national entities, participants considered it collective responsibility to make refugee services trauma-informed and seamless. Participants in resettlement agencies deplored current resettlement policy for not being informed by refugee experiences, especially refugee trauma, and for creating additional hassles and distress for both their clients and staff. CBOs and health or mental health services reportedly experienced growing opportunities for training on general topics in TIC, and yet few are available for refugee-specific training.
Expanding the ACEs Lens to Focus on Racialized Trauma
Implicit in the principle of autonomy is a universal notion that individuals have a right to make decisions for themselves, free from coercion, though some groups have historically had less control over their lives than others. While in theory this offers the potential to increase the inclusion of vulnerable individuals by gathering data from multiple non-traditional source, vulnerable individuals may be structurally excluded from data collection in the first place. Our purpose is to highlight how individuals belonging to these groups are more likely to be vulnerable and structurally excluded from research endeavors than others.
Patients and Families
Even after external funding ends, the community infrastructure and relationships built through these models continue to support recovery. For example, in Philadelphia, 40.5% of adults reported experiencing collective traumas, including violence, bullying, racism, and discrimination. Women, Native American and Black individuals, and those identifying as “other racial/ethnic group” are more likely to report four or more Adverse Childhood Experiences (ACEs) than males and white individuals. Intersectional care integrates an understanding of interpersonal, structural, and historical trauma.
Conversely, COVID‐19 has been deepening preexisting social inequities and further worsening health, with job and income losses and access to health care inordinately affecting Black communities and other people of color. In these minorities, COVID‐19 has magnified prepandemic inequities, such as finances, access to employment, health care, stigma, and transphobic violence, adding to the preexisting mental health burden in this population (e.g., PTSD, anxiety, depression, suicidality) and to overall lower levels of well‐being (Buspavanich et al., 2021; Diaz et al., 2021; Gibb et al., 2020; Krause, 2021; Salerno et al., 2020). The impact of discrimination on mental health during the pandemic, as well as the increase in mental health problems such as anxiety, depression, and psychosis, extends to other marginalized ethnic and indigenous groups, such as the Kashmiri Indians (Mukherjee, 2020) and Aboriginal and Torres Strait Islander populations in Australia (Newby et al., 2020). Currently, the deleterious effects of identity‐linked exposures (i.e., discrete and nondiscrete, within and across generations) on health, functioning, and social relationships have rapidly been shaped by the cumulative impact of a severe, unpredictable, and prolonged global trauma that is continuing to inflict much physical, mental, and economic suffering. The 13 studies Culturally competent care for LGBTQIA+ youth add to the extant global discourse on discrimination stressors and provide unique insights on a spectrum of health disparities.
However, to further the evidence base for TIC, more experimental methods should be considered that focus on service user and employee outcomes linking these to the principles and practices of trauma informed care. While meta-analyses provide evidence of peer support across mental health and substance use 78,79,80 there is a paucity of research in the extant literature as it relates to peer support from a trauma perspective specifically. Overall, the literature exposes a lot of heterogeneity with regard to where and how trauma informed care is being implemented, and the range of outcomes that are being reported on in the literature and practice-based settings. On this point, trauma informed care as a universal organizational approach assumes that many people accessing services and employees may have potentially experienced trauma. TIC is a universal method of service delivery that acknowledges that many people accessing services, and employees working in services, may have experienced traumas, it also realizes that how service settings are constructed and delivered can help support individuals in their healing, or hinder people through re-traumatization 3,4,21. There are several definitions of trauma informed care put forward 4,22,23,24, with some of these literatures going beyond definitions and providing value-based principles to help inform practice.
- If that hurdle is overcome, the waitlist for specialty mental health providers is incredibly long, a year in length at times, to the point where some primary care providers have stopped making referrals.”
- A holistic approach integrating mental health care, addiction support, and social services is essential, alongside coordinated care to meet multifaceted needs.
- By combining policy and practice changes, a more equitable and just society that promotes healing and well-being for all individuals can be created.
- These positive experiences achieved through task accomplishment along the change process are connected to profound shifts in worldview among those who have experienced trauma (Keyes & Galea, 2016; Tebes et al., 2019).
- Costs will need to include support for research on macrosocial determinants of health related to trauma exposure and expansion of graduate and professional training to include a population health perspective on trauma-informed practice.
