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1.
Behav Sci (Basel) ; 13(5)2023 Apr 24.
Article in English | MEDLINE | ID: mdl-37232592

ABSTRACT

A paradigm shift is under way in the human services because of breakthrough knowledge and research in understanding the underlying etiology of physical, emotional, and social problems at the micro-level of the individual, at the meso-level of the family and institutions, and at the macro-level of the entire society. The three levels of human existence-micro, mezzo, and macro-constitute interactive, interdependent, complex adaptive living systems. The complexity of these problems requires us to use our imaginations to envision health in individuals, organizations, and societies because it does not presently exist. After thousands of years of unrelenting exposure to trauma and adversity, we have all normalized what is a traumatogenic civilization. As a result, we live in a trauma-organized society in ways we are just beginning to understand in this century. This biopsychosocial knowledge base that is drawn upon here has come to be known as "trauma-informed" knowledge because it began with a deepening understanding of the impact of trauma on survivors of combat, disasters, and genocide, but now extends far beyond those specific boundaries. To lead any organization in a time of significant change means leading a revolution in understanding human nature and the fundamental causes of human pathology that are endangering all life on this planet and then helping organizational members develop skills to positively influence the changes necessary. In the 1930s, Dr. Walter B. Cannon, a Harvard physiologist who had named the "fight-flight" response and defined homeostasis, used the word "biocracy" to describe the relationship between the physical body and the social body, emphasizing the vital importance of democracy. This paper is a beginning attempt at integrating the concept of a biocratic organization with that of the trauma-informed knowledge necessary for leadership. Hope lies in properly diagnosing the problem, remembering ancient peace-making strategies, embracing universal life-preserving values, inspiring a new vision for the future, and radically and consciously changing our present self and other-destructive behavior. The paper concludes with a brief description of a new online educational program called Creating Presence™ that is being used in organizations as a method for creating and supporting the development of biocratic, trauma-informed organizations.

2.
Soc Sci Med ; 258: 113136, 2020 08.
Article in English | MEDLINE | ID: mdl-32585543

ABSTRACT

RATIONALE: Integrating trauma-informed peer support curriculum into the Temporary Assistance for Needy Families (TANF) program can help address caregiver trauma symptoms (e.g., depression, low self-efficacy, economic hardship) caused by exposures to violence and adversity that negatively impact one's ability to maintain employment and improve earnings; yet, it is unclear if trauma-informed peer support interventions designed for TANF impact co-occurring disorders, such as depression and substance use, that inhibit resiliency in the labor market. OBJECTIVE: The aim of this study is to examine whether integrating trauma-informed peer support curriculum into the TANF program is associated with reductions in co-occurring depression and substance use, and improvements in self-efficacy and economic security. METHOD: From October 2015 to May 2018, 369 caregivers were enrolled in the 16-week Building Wealth and Health Network Phase II single-group cohort study. Participants responded to questions regarding their socio-demographic characteristics, mental health, economic security, and use of drugs and alcohol at baseline and four three-month follow-up surveys. Associations between the trauma-informed peer support curriculum and health outcomes were assessed using maximum likelihood estimation. RESULTS: Using class attendance records, participants were separated into a low-exposure group (

Subject(s)
Alcoholism , Substance-Related Disorders , Cohort Studies , Curriculum , Depression/therapy , Humans , Self Efficacy , Substance-Related Disorders/complications , Substance-Related Disorders/therapy
3.
J Child Fam Stud ; 27(5): 1594-1604, 2018.
Article in English | MEDLINE | ID: mdl-29657515

ABSTRACT

Temporary Assistance for Needy Families (TANF) has limited success in building self-sufficiency, and rarely addresses exposure to trauma as a barrier to employment. The objective of the Building Wealth and Health Network randomized controlled trial was to test effectiveness of financial empowerment combined with trauma-informed peer support against standard TANF programming. Through the method of single-blind randomization we assigned 103 caregivers of children under age six into three groups: control (standard TANF programming), partial (28-weeks financial education), and full (same as partial with simultaneous 28-weeks of trauma-informed peer support). Participants completed baseline and follow-up surveys every 3 months over 15 months. Group response rates were equivalent throughout. With mixed effects analysis we compared post-program outcomes at months 9, 12, and 15 to baseline. We modeled the impact of amount of participation in group classes on participant outcomes. Despite high exposure to trauma and adversity results demonstrate that, compared to the other groups, caregivers in the full intervention reported improved self-efficacy and depressive symptoms, and reduced economic hardship. Unlike the intervention groups, the control group reported increased developmental risk among their children. Although the control group showed higher levels of employment, the full intervention group reported greater earnings. The partial intervention group showed little to no differences compared with the control group. We conclude that financial empowerment education with trauma-informed peer support is more effective than standard TANF programming at improving behavioral health, reducing hardship, and increasing income. Policymakers may consider adapting TANF to include trauma-informed programming.

4.
Acad Pediatr ; 17(7S): S130-S135, 2017.
Article in English | MEDLINE | ID: mdl-28865645

ABSTRACT

The Philadelphia ACE Task Force is a community based collaborative of health care providers, researchers, community-based organizations, funders, and public sector representatives. The mission of the task force is to provide a venue to address childhood adversity and its consequences in the Philadelphia metropolitan region. In this article we describe the origins and metamorphosis of the Philadelphia ACE Task Force, which initially was narrowly focused on screening for adverse childhood experiences (ACEs) in health care settings but expanded its focus to better represent a true community-based approach to sharing experiences with addressing childhood adversity in multiple sectors of the city and region. The task force has been successful in developing a research agenda and conducting research on ACEs in the urban context, and has identified foci of local activity in the areas of professional training and workforce development, community education, and local practical interventions around adversity, trauma, and resiliency. In this article we also address the lessons learned over the first 5 years of the task force's existence and offers recommendations for future efforts to build a local community-based ACEs collaborative.


Subject(s)
Advisory Committees , Life Change Events , Residence Characteristics , Resilience, Psychological , Stress, Psychological , Child , Cooperative Behavior , Humans , Organizational Case Studies , Philadelphia , Research
5.
J Hunger Environ Nutr ; 12(2): 269-297, 2017 Apr 03.
Article in English | MEDLINE | ID: mdl-28503244

ABSTRACT

Household food insecurity is linked with exposure to violence and adversity throughout the life course, suggesting its transfer across generations. Using grounded theory, we analyzed semistructured interviews with 31 mothers reporting household food insecurity where participants described major life events and social relationships. Through the lens of multigenerational interactions, 4 themes emerged: (1) hunger and violence across the generations, (2) disclosure to family and friends, (3) depression and problems with emotional management, and (4) breaking out of intergenerational patterns. After describing these themes and how they relate to reports of food insecurity, we identify opportunities for social services and policy intervention.

6.
Inform Health Soc Care ; 42(1): 77-96, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27259373

ABSTRACT

BACKGROUND/PURPOSE: Adolescents from urban, socioeconomically disadvantaged communities of color encounter high rates of adverse childhood experiences. To address the resulting multidimensional problems, we developed an innovative approach, Experiential Participatory and Interactive Knowledge Elicitation (EPIKE), using remote experiential needs elicitation methods to generate design and content requirements for a mobile health (mHealth) psychoeducational intervention. METHODS: At a community-based organization in a northeastern city, the research team developed EPIKE by incorporating elicitation of input on the graphics and conducting remotely recorded experiential meetings and iterative reviews of the design to produce an mHealth smartphone story application (app) prototype for the participants to critique. The 22 participants were 13- to 17-year-olds, predominantly African American and female, from underresourced communities. RESULTS: The four goals of the design process were attained: 1) story development from participant input; 2) needs-elicitation that reflected the patient-centered care approach; 3) interactive story game creation that accommodates the participants' emotional and cognitive developmental needs; 4) development of a game that adolescents can relate to and that which matches their comfort levels of emotional intensity. CONCLUSIONS: The EPIKE approach can be used successfully to identify the needs of adolescents across the digital divide to inform the design and development of mHealth apps.


Subject(s)
Black or African American/psychology , Decision Making , Mental Health/ethnology , Mobile Applications , Video Games , Adolescent , Female , Humans , Male , Narration , Needs Assessment , Safe Sex/psychology , Smartphone , Socioeconomic Factors , Software Design , Spouse Abuse/psychology , Substance-Related Disorders/psychology , Urban Population , User-Computer Interface
8.
Am J Prev Med ; 48(2): 162-169, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25442223

ABSTRACT

BACKGROUND: Violent injury is a major cause of disability, premature mortality, and health disparities worldwide. Hospital-based violence intervention programs (HVIPs) show promise in preventing violent injury. Little is known, however, about how the impact of HVIPs may translate into monetary figures. PURPOSE: To conduct a cost-benefit analysis simulation to estimate the savings an HVIP might produce in healthcare, criminal justice, and lost productivity costs over 5 years in a hypothetical population of 180 violently injured patients, 90 of whom received HVIP intervention and 90 of whom did not. METHODS: Primary data from 2012, analyzed in 2013, on annual HVIP costs/number of clients served and secondary data sources were used to estimate the cost, number, and type of violent reinjury incidents (fatal/nonfatal, resulting in hospitalization/not resulting in hospitalization) and violent perpetration incidents (aggravated assault/homicide) that this population might experience over 5 years. Four different models were constructed and three different estimates of HVIP effect size (20%, 25%, and 30%) were used to calculate a range of estimates for HVIP net savings and cost-benefit ratios from different payer perspectives. All benefits were discounted at 5% to adjust for their net present value. RESULTS: Estimates of HVIP cost savings at the base effect estimate of 25% ranged from $82,765 (narrowest model) to $4,055,873 (broadest model). CONCLUSIONS: HVIPs are likely to produce cost savings. This study provides a systematic framework for the economic evaluation of HVIPs and estimates of HVIP cost savings and cost-benefit ratios that may be useful in informing public policy decisions.


Subject(s)
Hospitals , Violence/economics , Violence/prevention & control , Cost Savings , Cost-Benefit Analysis , Criminal Law , Efficiency, Organizational , Health Care Costs , Humans , Secondary Prevention , United States
9.
J Health Care Poor Underserved ; 24(3): 1021-30, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23974377

ABSTRACT

Hospitals represent a promising locus for preventing recurrent interpersonal violence and its psychological sequella. We conducted a cross-sectional analysis to assess the prevalence of post-traumatic stress disorder (PTSD) and adverse childhood experiences (ACEs) among victims of interpersonal violence participating in a hospital-based violence intervention program. Participants completed PTSD and ACE screenings four to six weeks after violent injury, and data were exported from a case management database for analysis. Of the 35 program participants who completed the ACE and/or PTSD screenings, 75.0% met full diagnostic criteria for PTSD, with a larger proportion meeting diagnostic criteria for symptom-specific clusters. For the ACE screening, 56.3% reported three or more ACEs, 34.5% reported five or more ACEs, and 18.8% reported seven or more ACEs. The median ACE score was 3.5. These findings underscore the importance of trauma-informed approaches to violence prevention in urban hospitals and have implications for emergency medicine research and policy.


Subject(s)
Crime Victims/psychology , Hospitals, Urban , Stress Disorders, Post-Traumatic/epidemiology , Violence/prevention & control , Violence/psychology , Adolescent , Adult , Cross-Sectional Studies , Databases, Factual , Emergency Service, Hospital , Female , Humans , Male , Prevalence , Professional Role , Young Adult
10.
J Trauma Dissociation ; 12(5): 510-25, 2011.
Article in English | MEDLINE | ID: mdl-21967178

ABSTRACT

The Surgeon General's report on youth violence, the Centers for Disease Control and Prevention, and other national organizations are calling for public health approaches to the issue of youth violence. Hospital-based violence intervention programs have shown promise in reducing recurrent violence and decreasing future involvement in the criminal justice system. These programs seldom address trauma-related symptoms. We describe a conceptual framework for emergency department-based and hospital-based violence intervention programs that intentionally addresses trauma. The intervention described--Healing Hurt People--is a trauma-informed program designed to intervene in the lives of injured patients at the life-changing moment of violent injury. This community-focused program seeks to reduce recurrent violence among 8- to 30-year-olds through opportunities for healing and connection. Healing Hurt People considers the adversity that patients have experienced during their lives and seeks to break the cycle of violence by addressing this trauma.


Subject(s)
Crime Victims/psychology , Crisis Intervention/organization & administration , Emergency Service, Hospital/organization & administration , Stress Disorders, Post-Traumatic/therapy , Urban Population , Violence/prevention & control , Violence/psychology , Adaptation, Psychological , Adolescent , Child , Combined Modality Therapy/methods , Domestic Violence/prevention & control , Domestic Violence/psychology , Female , Homicide/psychology , Humans , Male , Mental Healing , Models, Psychological , Patient Care Team/organization & administration , Psychotherapy, Group/methods , Secondary Prevention , Social Work, Psychiatric/organization & administration , Stress Disorders, Post-Traumatic/psychology , Wounds and Injuries/psychology , Wounds and Injuries/therapy , Young Adult
12.
Psychiatr Q ; 75(3): 249-61, 2004.
Article in English | MEDLINE | ID: mdl-15335228

ABSTRACT

This paper, cowritten by Kingsley Norton, since 1989 Director of Henderson Hospital (a therapeutic community founded by Maxwell Jones in 1947 in the United Kingdom), and Sandra Bloom, Founder of the Sanctuary Model in the United States, compares and contrasts the practice of the democratic therapeutic community (TC) as applied to the notion of long-term care (up to twelve months), to that of the democratic therapeutic milieu (TM) as applied to short-term care (up to one month).


Subject(s)
Mental Disorders/therapy , Mental Health Services/organization & administration , Organizational Culture , Therapeutic Community , Countertransference , Democracy , Humans , Professional Role , Professional-Patient Relations , Psychotherapy , Time Factors , United Kingdom
14.
Psychiatr Q ; 74(2): 119-35, 2003.
Article in English | MEDLINE | ID: mdl-12602829

ABSTRACT

This paper addresses the need for a coherent conceptual therapeutic approach to guide work with disturbed children and adolescents in residential treatment centers. The paper identifies changes in the population currently in care; examines the two dominant approaches that historically have shaped the standard treatment models used by most residential centers; and discusses four longstanding debates that have complicated the development of a consistent therapeutic approach for residential programs. It concludes with a description of The Sanctuary Model. Integrating a variety of treatment approaches, this trauma-based systems approach to care was first used with adult inpatients traumatized as children. It is now being introduced by a major social agency into three of its residential centers to provide a systematic treatment model for use in their schools, living units, and treatment sessions.


Subject(s)
Mental Disorders/therapy , Residential Treatment/organization & administration , Therapeutic Community , Adolescent , Adolescent Psychiatry/methods , Child , Child Psychiatry/methods , Humans , Mental Health Services/organization & administration , New York , Social Support
15.
Psychiatr Q ; 74(2): 137-54, 2003.
Article in English | MEDLINE | ID: mdl-12602830

ABSTRACT

This paper describes methods being used to implement and assess the effects of a trauma-focused intervention in residential treatment programs for youths with emotional and behavioral problems, and histories of maltreatment and exposure to family or community violence. Preliminary baseline profiles of the therapeutic environments and youths are also presented. The intervention, referred to as the Sanctuary Model (Bloom, 1997), is based in social psychiatry, trauma theories, therapeutic community philosophy, and cognitive-behavioral approaches. Within the context of safe, supportive, stable, and socially responsible therapeutic communities, a trauma recovery treatment framework is used to teach youths effective adaptation and coping skills to replace nonadaptive cognitive, social, and behavioral strategies that may have emerged earlier as means of coping with traumatic life experiences.


Subject(s)
Mental Health Services/organization & administration , Residential Treatment/organization & administration , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , Therapeutic Community , Violence/psychology , Adolescent , Adolescent Psychiatry/methods , Adult , Child , Child Psychiatry/methods , Female , Humans , Male , Mental Health Services/standards , Outcome Assessment, Health Care , Program Evaluation , Random Allocation , Residential Treatment/standards , Social Support , United States
16.
Psychiatr Q ; 74(2): 173-90, 2003.
Article in English | MEDLINE | ID: mdl-12602832

ABSTRACT

This article describes the experience of five change agents from a diverse group of settings: two residential treatment programs for children and adolescents, a group home for disturbed adolescents, a residential substance abuse program for urban women, and an acute care psychiatric inpatient unit. What all of these innovators share is a willingness to engage in the challenging and complex process of changing their systems to better address the needs of the traumatized children, adolescents, and adults who populate their various programs. Using the Sanctuary Model as originally applied to a specialty inpatient psychiatric program for adult survivors of childhood abuse as their guide, the leaders of each of these organizations discuss the process of change that they are directing.


Subject(s)
Residential Treatment , Substance-Related Disorders/rehabilitation , Adolescent , Child , Female , Group Homes , Health Services Needs and Demand , Humans , Male , Mental Disorders/rehabilitation , Mental Health Services/organization & administration , Urban Population
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