Building Trauma-Informed Communities

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Many people will experience a traumatic event at some point in their lives. Often unexpected and shocking, it may overwhelm their ability to cope and create a lasting sense of fear, vulnerability, and helplessness.

Traumatic events are scary or dangerous experiences that can affect people emotionally and physically. They include acts of violence (e.g., assault, physical or emotional abuse, war), natural disasters, car crashes, and other accidents.(1)

Trauma is a physical, cognitive, and emotional response caused by a traumatic event, series of events, or set of circumstances that is experienced as harmful or life-threatening.(2) Trauma can have lasting effects, particularly if untreated.callout

A trauma-informed approach to emergency response is about acknowledging past trauma and showing sensitivity to the effects it can have on the survivors of present events. Knowing how to approach a person or group of people after a traumatic event can reduce the likelihood of re-traumatization.

Trauma and Emergencies

Emergencies can be traumatic. If trauma isn’t addressed appropriately, it can have longer and deeper negative effects on individuals, families, and communities. Recovery from a traumatic event can also be an opportunity to develop resiliency and [trauma-informed] tools in preparation for future emergencies or disasters.

Not everyone responds to trauma the same way, and not all people who are exposed to a potentially traumatic event experience trauma. Responses to trauma can last for weeks, months, or even years before people start to feel normal again.

A person’s response to disaster-related trauma may be influenced by the following:

  • Direct exposure to the disaster, such as being evacuated or witnessing others, including family members, in life-threatening situations
  • Prior experience with and exposure to trauma
  • Pre-existing physical or mental health conditions
  • The availability of a strong emotional support network(3)

Taking a Trauma-Informed Approach

Learning how to respond during or after a traumatic event can help your community. Emergency responders should be aware that individuals and communities may have experienced a variety of traumas—including mass trauma or historical trauma. They must also consider a survivor’s physical, psychological, and emotional safety and well-being after a disaster.(3)

The six guiding principles of trauma informed care are:

  1. Safety
  2. Trustworthiness and transparency
  3. Peer support
  4. Collaboration and mutuality
  5. Empowerment and choice
  6. Cultural, historical and gender issues(3)

This approach requires constant attention, sensitivity, and awareness to make sure the community and those affected receive the care they need after an emergency.

The keys to creating a trauma informed approach to care are:

  • Creating a safe environment
  • Hiring and training for a trauma-informed workforce (clinical and non-clinical staff)
  • Preventing secondary traumatic stress in staff
  • Engaging patients in organizational planning
  • Leading and communicating about the transformation process(4)

Adopting trauma-informed practices may require a cultural change at an organizational level. Emergency responders can use a trauma-informed approach to help during or after an emergency.

The Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Technical Assistance Center helps states, territories, tribes, and local providers plan for and respond to behavioral health needs after a disaster. Learn about trauma-informed care to help others in your community.

Building a Trauma-Informed Community

Building resilient and trauma-informed communities is essential to improving emergency recovery outcomes. No community is safe from the potential impact of unexpected traumatic events. But by being trauma-informed, they can become a safe place for those recovering from distressing events.(5)

Communities can be resilient if they have the right resources available. Unfortunately, resources may not always be available. There may be barriers that can prevent those in a community from accessing resources when they need them. These may include cost, lack of transportation, and availability of resources.

Nonprofit organizations such as United Way offer free services where individuals can reach out to find resources available in their area.

Federally Qualified Health Centers and Rural Health Clinics are community health providers in underserved areas that receive funds from the Health Resources and Services Administration that make their services affordable to patients that need assistance.

In today’s world, resources are not limited to in-person visits. Many mental health providers now offer telehealth services. These services make it possible for patients to access care from the safety, privacy, and convenience of their homes. More work is needed to provide universal broadband access so that persons at highest risk of poor mental and physical health outcomes from emergencies and trauma have access to this form of care. Mental health trainings are also available to help communities strengthen their resilience.

Communities and emergency responders should strive to provide their services with a trauma-informed approach in an effort to make sure people experiencing trauma receive care that promotes healing and avoids re-traumatization. Many resources and training for people who work in fields that support individuals experiencing trauma—for example, emergency medical services, law enforcement, and religious organizations—are available online.

Community members can talk about being trauma-informed with their families, coworkers, children’s teachers, and others within their social networks. Communities that work together to make these resources available to those in need can improve the resiliency of community members.

References

  1. https://www.nimh.nih.gov/health/topics/coping-with-traumatic-events
  2. https://www.samhsa.gov/trauma-violence
  3. https://blogs.cdc.gov/publichealthmatters/2018/07/trauma-care/
  4. https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf
  5. https://store.samhsa.gov/sites/default/files/d7/priv/sma17-5014.pdf

Resources

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Using Trauma-Informed Care to Guide Emergency Preparedness and Response

Exposure to a traumatic event or set of circumstances can negatively affect a person’s mental, physical, social, emotional or spiritual well-being for a long time after the initial incident. We know that not all individuals respond to trauma in the same way and we know that individuals with a history of trauma, especially childhood trauma, are more likely to experience psychological distress and are at increased risk for the development of Post-traumatic Stress Disorder (PTSD) with future exposure to trauma.

The chemicals in our bodies change during stressful or traumatic situationsEmergency responders are vulnerable to trauma during or after a disaster the same as survivors. Hazardous work conditions, being away from family, and exposure to human suffering can cause new and intensify existing feelings of stress, anxiety, grief, and worry in responders.

When the body is threatened, stress hormones are released to help you survive (fight or flight response). These hormones cause our bodies to minimize non-essential tasks, including growth, reproduction, and immune function and to maximize body functions that are necessary to prepare the body to fight or flee from a stressor.  Functions such as breathing, heart rate and alertness are useful for the body to survive the stress.   If someone is regularly exposed to trauma, stress hormones are repeatedly released and the brain can become exposed to these powerful stress hormones that would normally be present in the body for short periods of time. Over time repeated exposure to stress may cause your body’s natural stress response system to malfunction and can result in potentially unhealthy mental and physical responses to current or future stress.  These responses can include irritability, emotional reactivity, intrusive thoughts about the event, emotional numbing and avoidance, loss of one’s sense of safety, or diminished capacity to trust others.

Exposure to trauma can affect a person’s normal coping and stress management skills.  A person’s mental health during an emergency may be impacted by:

  • Direct exposure to the disaster, such as being evacuated or witnessing others (including family members) in life-threatening situations
  • Prior experience with and exposure to trauma
  • Pre-existing conditions, such as mental health conditions
  • Socioeconomic factors, such as family resources available
  • Family variables, for example, how parents react

Take trauma into account when responding to emergencies

When someone has experienced trauma, he or she can be re-traumatized if emergency medical service providers, healthcare professionals, and community service providers are not aware of and sensitive to the possibility of re-traumatization. Emergency responders should be aware that individuals and communities may have experienced a variety of traumas in their lives and need to consider a survivor’s physical, psychological, and emotional safety and well-being after a disaster.

Trauma-informed organizations and emergency responders need to be sensitive to the potential impact that widespread trauma can have on individuals. An essential underpinning of trauma informed care and approach is the awareness that procedures and interactions can be re-traumatizing.

Training emergency responders in trauma-informed care

The CDC’s Office of Public Health Preparedness and Response (OPHPR) collaborated with SAMHSA to develop a trauma-informed care training for CDC. Working with Mary Blake (SAMHSA) and the Technical Assistance Center, SAMHSA’s National Center for Trauma-Informed Care (NCTIC) developed and led a new training for OPHPR employees about the role of trauma-informed care during public health emergencies. The training aimed to increase responder awareness of the impact that trauma can have in the communities where they work. Participants learned the six principles that guide a trauma-informed approach, including:

  1. Safety
  2. Trustworthiness and transparency
  3. Peer support
  4. Collaboration and mutuality
  5. Empowerment, voice and choice
  6. Cultural, historical, and gender issues

Adopting a trauma-informed approach is not accomplished through any single particular technique or checklist. It requires constant attention, caring awareness, sensitivity and it may require a cultural change at an organizational level. On-going internal organizational assessment and quality improvement, as well as engagement with community stakeholders, will help to imbed this approach which can be augmented with organizational development and practice improvement. The training provided by OPHPR and NCTIC was the first step for CDC to view emergency preparedness and response through a trauma-informed lens.

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