Providers should seek to understand what types of trauma are present—individual, interpersonal and/or communal. Known as toxic stress, this response has been linked to poor health outcomes, increased incidence of psychiatric and substance abuse disorders, and decreased immune responses.13 Toxic stress can come from trauma at all levels, and stress can come from all levels of trauma. Using trauma-informed care in a universal precaution method can address these concerns. Given that there is neither time nor precedent to understand ACE and trauma history before trauma evaluation, it is imperative that care providers recognize the impact of the unspoken traumas that are brought to the clinical https://www.umassmed.edu/TransitionsACR/resources/culturally-competent-mhc-to-LGBTQIA/additional-resource-links/ encounter.

• Trauma-informed community building
• For this study, the authors defined successful implementation outcomes as those that contributed to better patient care and satisfaction, staff understanding and support, and systems change.
• Further, because Malcolm shares a strong level of rapport and comradery with his previous colleagues, career practitioners would assess the current status of these relationships for a source of emotional support, as well as a resource for potential networking.
• Several reviews have concluded that discrimination has deleterious effects on a range of mental and physical health outcomes (Pascoe and Smart Richman, 2009; Williams and Mohammed, 2009; Pieterse et al., 2012; Schmitt et al., 2014; Paradies et al., 2015).

Center for Hunger Free Communities

These two broader categories were then further divided into smaller categories or themes based on the types of outcomes that were measured (coercion/aggression management, mental health, or physical health outcomes). These were studies about how certain measurements were validated, such as , which aimed to validate TICOMETER , a five-domain measure of the organizational implementation of trauma-informed care that can be used to evaluate cultural changes. TIC was implemented in healthcare or social work education settings, such as nursing and medical schools, in 11 studies (7%).

1. Direct mechanism: cultural resource loss and cultural wounding

The TIC program was brought to this school as part of the launch of a hospital-based violence intervention program (HVIP). At Rutgers New Jersey Medical School in New Jersey providers and residents were trained in depth in TIC, with follow-up provided for residents in the form of TIC-informed peer support. OHSU used a novel, interdisciplinary, peer-to-peer training model to address to the prevalence of these types of trauma in medicine. Oregon Health and Science University (OHSU), in Portland, Oregon recognizes the impact of trauma on patients and to surgical residents. By focusing training and education on physicians, nursing, and administrative staff, they have successfully identified champions who believe in the intrinsic value of recovery services.

2. Identification of Relevant Studies

Organizational and individual-level assessment of TIC knowledge can be a starting point,40 as well as the use of expert guidance in educational initiatives, such as the validated trauma-informed competencies for undergraduate medical education.41 Staff buy-in and motivation are essential for change.17,21,25 Sustained TIC changes can be realized through education targeted to all levels of the workforce, including administrative staff, clinical practitioners, and clinical staff (eg, receptionists, security personnel, community health workers).25 In addition, tailoring training to specific staff is important. Additionally, robust evaluation of policies, programs, and services can begin to fill the evidence gaps in the understanding of TIC, particularly for marginalized and historically vulnerable patient populations.30 Scaffolding of TIC through strong leadership and subsequent structural, practical, and policy changes can lead to balancing organizational pressures to follow safety and risk protocols and sharing power to bring about a cultural change.22 A clearly defined leadership endorsement to facilitate resources, allocation of time, and the provision of financial and other needed resources can enhance sustainable organizational change.17,32 Other strategies at the leadership level are to establish a trauma task force or steering committee, set clear targets, communicate the rationale for the initiative with staff, articulate “an unwavering belief” that TIC goals are achievable, and include TIC as a standing item at high level meetings. Informed and engaged care with family members/caregivers leads to increased parental satisfaction, medical understanding, confidence in care, fewer behavioral and withdrawal symptoms in patients, and reduced psychiatric morbidity (ie, anxiety) in their caregivers after discharge, and can foster reductions in costs and hospitalizations (ie, decrease length of stay and readmission) in pediatric care settings.18,33 Strategies for increasing engagement with families include information sharing, increased education and anticipatory guidance, check-in phone calls, and inclusion of family members in care planning.18

In the spirit of the African proverb, “If you want to go fast, go alone, if you want to go far, go together,” trauma-informed communities support the meaningful involvement of residents in efforts to build capacity and implement change. This emerging phenomenon demonstrates the powerful positive impacts that joining together to support one another in promoting well-being and engaging in collective experiences of witnessing resiliency and growth throughout the community and of the community-as-a-whole can bring about (Black et al., 2022). In the trauma-informed community context, trauma-informed peer support entails community members working together on issues of common concern. Traditional community-building models tend to mirror broader societal norms that ultimately prioritize mitigating threats to some groups’ safety over others based unjustly on ascriptive characteristics including but not limited to ethnic background; racial identity; gender identity or presentation; sexual orientation; socioeconomic status; age; (dis)ability; and religious/spiritual affiliation. Trauma-informed strategies offer an alternative to the oppressive “doing to” and the paternalistic “doing for” approaches embedded in traditional community development and instead make a shift toward “doing with,” ensuring that community voice is centered and meaningfully leading the direction of the work. With change, there is loss, and shifting the balance of how our world functions to support increasing access to resources to support justice, equality, and optimal well-being among a greater group of people can breed fear, uncertainty, and resistance among those who already enjoy these aspects of community life (Freire, 1972).

These frameworks prioritize treatment of acute trauma, partly in response to the urgency of caring for individuals experiencing severe disruptions in cognition, behavior, and emotion due to one or a series of traumatic events (SAMHSA, 2014a, 2014b). Actions to address trauma over the life course must thus be specific enough to be effective in the immediate aftermath of trauma, but also flexible enough to enable the individual to adapt to new traumatic stressors over time and, potentially, across generations. In recent decades, scholars and practitioners have implemented trauma-informed practices to address the effects of trauma (Becker-Blease, 2017); these include responses by individuals, professionals, and service systems to mitigate effects for those experiencing a potentially traumatic event (Branson, Baetz, Horwitz, & Hoagwood, 2017). Population studies indicate that virtually everyone experiences one or more traumatic events in their lifetime (Atwoli, Stein, Koenen, & McLaughlin, 2015; Fink & Galea, 2015; Kilpatrick et al., 2013), and almost half experience a trauma in childhood (Bethell, Newacheck, Hawes, & Halfon, 2014; SAMHSA, 2014b). Furthermore, implementing a culture-informed approach requires attention to the organizational context and the mental health care system as well as the clinical encounter between the provider and the refugee client . In particular, our findings highlight that trauma-informed care that is culturally responsive and relevant to refugee populations is a vital way to address the chasms between refugee-specific programs and mainstream services.