Trauma-Informed Ethics and Marginalization Stress Springer Nature Link

Public health initiatives throughout this global pandemic have largely centered on flattening the COVID‐19 infection and mortality curves. This system is triggered by chronic low‐grade activation of the sympathetic nervous system and is characterized by increased expression of proinflammatory genes and decreased expression of genes involved in innate antiviral responses, antibody synthesis, and gene expression (Cole, 2013, 2014). First, racial differences in the regulation of the renin–angiotensin system and, in particular, the angiotensin‐converting enzyme 2 (ACE 2), the entry receptor utilized by COVID‐19, which is also implicated in racial differences in hypertension, may account for the disproportionate risk of severe COVID‐19 outcomes in African Americans.

1. Implications for Practice, Policy, and Research

Positioning communities to take the lead to cultivate and mobilize community strengths and skills through a trauma-informed lens demands more innovative funding models that allocate resources directly into the hands of residents rather than organizations to enable capacity and scaling of collective change efforts driven by the community, for the community (Chapin Hall, 2022). This often also requires communities, potential funders, and other change partners to shift from a scarcity mindset to an abundance mindset and can require significant action given how counter-cultural a collective approach to allocating resources can be to what those in power in communities are used to. Given the complexity of transformative change in trauma-impacted communities, aligning, leveraging, braiding, and blending resources from various sectors and sources is often necessary to sustain support for change. Various mechanisms and settings for learning, such as community events, meetings, online platforms, and competency-based education, can raise consciousness and promote leadership within communities (Matlin et al., 2019). Workforce development is integral to building and sustaining trauma-informed communities, necessitating an understanding of trauma’s impacts and self-care for professionals (SAMHSA, 2017). For instance, some changemakers have found that creating open education opportunities through community-based events and/or integrating discussions about trauma and community transformation at existing town hall meetings can powerfully foster competency- and content-based learning, equipping community members with the knowledge, tools, skills, and pathways to make an impact (Matlin et al., 2019).

The implementation of TIC involves a vital cultural shift, where changes must occur across settings, disciplines, and service users, at all levels of an organization 16,17,18,19. Thus, there is a significant need for programs or frameworks that aim to change how the helping professions work with trauma and prevent victimization. These reactions may be exacerbated if they themselves have experienced trauma in the past, such as interpersonal violence. In psychiatric populations, the prevalence is much higher, and many (between 75 and 98%) report multiple traumas mentioned before . Trauma may occur because of a harmful incident or series of events that are emotionally disturbing or life-threatening, such as violence, neglect, abuse, disaster, serious illness, or historical injustice. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.

• With commitment to these next steps, TIC shows promise for meaningfully addressing marginalised communities’ trauma and promoting their long-term health, wellbeing and empowerment.
• The authors highlighted TIC approaches across sectors of policy, education, and research that are critical to the success of using the SAMSHA’s 10 TIC domains as an implementation framework.
• We do not intend for trauma-informed caregiving to replace existing interventions for children in need of services, but simply to infuse trauma-informed thinking and practice into everyday interactions that shape a developing child’s life.

Acknowledge and address systematic oppression and discrimination as trauma to inform the necessary steps toward healing the trauma that millions of people of color face and the circumstances of poverty that exacerbate and reproduce this trauma. Trauma, especially when systematically reproduced by racism and discrimination, has generational impacts on the health and well-being of people of color. According to reports from the Alaska Resilience Initiative, “when an individual, agency or setting is “trauma-informed,” they realize how widespread trauma is, recognize the signs and symptoms, respond by including a trauma perspective in policies and practices, and resist unintentionally re-traumatizing clients or staff.” Trauma generates poverty by negatively impacting physical and mental health which, in turn, increases barriers to employment. Trauma has generational effects that reproduce poverty, especially trauma inflicted by systematic oppression as discrimination works to perpetuate conditions of poverty.

General Health

Additionally, many groups are subject to additional identity-specific forms of historical trauma such as the history of genocide and forced assimilation faced by Indigenous people in the US (Heart, 2003; Mohatt et al., 2014). Between 82% and 90% of people in the United States (US) are exposed to trauma in their lifetimes, including experiencing or witnessing violence and surviving war or a disaster (Kilpatrick et al., 2013; Koenen et al., 2017). Articles from The Permanente Journal are provided here courtesy of Kaiser Permanente Martina Jelley, MD, MSPH, conducted data extraction and participated in the critical review of drafts and the final manuscript. Successful integration of TIC will require the support and commitment of senior leadership and the infusion of TIC principles throughout organizational policies and procedures.

Sixteen studies used previous reviews of trauma-informed care in their https://www.umassmed.edu/TransitionsACR/resources/culturally-competent-mhc-to-LGBTQIA/additional-resource-links/ definitions, seven studies referred to a review by Muskett from 2014 , and nine studies used Hopper and colleagues’ overview of definitions from 2010 . For example, twelve studies referred to Elliott, Bjelajac, Fallot, Markoff, and Reed’s ten principles of trauma-informed care, four studies mentioned Chadwick’s trauma-informed system project , and four studies referred to the work of Hodas on trauma-informed care in child and youth welfare. There were also studies that referred to other models of trauma-informed care in their definitions. Although most of the studies referred to SAMHSA’s definition, including the six core principles (safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; cultural, historical, and gender issues), the studies varied greatly in how they applied this definition. Finally, four studies were carried out in substance abuse services, and four were conducted in intellectual and developmental disability services. Nine studies (6%) were conducted in residential treatment services, and the same number within social services.