Trauma Informed Care – A Note to Our Colleagues
I got my first counseling job in 1987. By the end of my first week at that job – in a University counseling service – I had already come up with a system of shorthand to document abuse and trauma. Trauma was so ‘close to the surface’ that it emerged early in the intake session without prompting and was clearly having ongoing impacts in the lives of my clients even if the trauma was earlier in life. As I transitioned my work into serving people with multiple serious mental health conditions and substance use disorders the interrelationship between trauma, health, mental health and the role of substances became very obvious. And the role of substance use as ‘self medication’ became very obvious in a number of cases.
My clinical training through multiple degrees was broad but I kept coming back to the interplay of trauma in the lives of the people I served, whether I was working with children in Bedford Stuyvesant in Brooklyn or treating combat PTSD at the VA hospital. Ultimately, even the clinical research I conducted for my doctoral dissertation was about the long term effects of trauma across the lifespan, looking at differences between populations with mental health issues and without, and with co-occurring substance use disorders and without. Needless to say, trauma earlier in life had a major role in ongoing health and behavioral health later in life and this has become a major theme in my clinical practice since then.
Over the last decades we have documented how ones zip code is more predictive of your health than our genetic code, even mapping how if you take the Red Line on the Washington DC subway system out into the Maryland suburbs the average life expectancy in the communities around each subway stop goes up about 1.5 years per stop (it’s the same on most subway systems going from inner city to suburbs in cities around the world). We have discovered how a history of ownership (slavery) has a cascade of physiological effects in individuals and communities that lingers in the absence of intervention. We have even discovered the biological underpinnings of this transgenerational transmission of trauma in the form of changed levels of cortisol and other neurotransmitters. In short, a person’s context and experience is now considered to play a critical role in wellbeing, and it has all been tied up under the concept of the social determinants of health.
So wellness is impacted by context and experience and whether it’s treated or not. And while we have developed increasingly effective interventions and treatment for individuals, we have been challenged as to how to change the overall environments or ecosystems in our different communities. In fact we also know that whether the treating provider or organization has a perspective on trauma and social determinants of health impacts how effectively that provider or organization treats the social determinants of health. In the world of trauma and its treatment, we have come to see that being trauma informed in all we do can be critical to treatment outcomes, for example in the treatment of physical aches and pains with antidepressants in Latina patients due to the way that depression and anxiety often manifest physically as a culture-bound response in women with Latino-American heritage.
In the Sacramento region, a few organizational partners have been exploring the extent to which social determinants of health are understood from the perspective of being a trauma informed organization. These partners include WellSpace Health, Child Protective Services, multiple Sacramento County departments, La Familia, and the Sacramento County Office of Education (managing all school districts in the county). Following our initials meeting, we agreed to put out a survey to assess where our community is in terms of having truly trauma informed organizations and we are sharing a survey based on an instrument called Creating Cultures of Trauma-Informed Care; A Self Assessment and Planning Tool with our respective teams.
We hope that this survey will provide our community with an exhaustive assessment to see where we are relative to having a culture of trauma informed care.
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