The Impact of Trauma, Adversity and Violence on Societal Health

Dear Colleagues,

Beginning in the 1980s, with the impact of traumatic stress on returning veterans, survivors of natural disasters, victims of rape and childhood sexual abuse and victims of gun violence, the field of traumatic stress studies was launched in 1985. Since then, the field has expanded significantly, especially after the landmark Adverse Childhood Experiences Study was published in 1998 that clearly established the relationship between childhood exposure to overwhelming events and adult disease and dysfunction. In the last three decades, there has been a growing awareness of how widespread exposure to trauma, adversity and violence in the general population and in every system that comprises our societies. This has led to a growing recognition that population mental health cannot be significantly improved without taking into account the physical, psychological, social, moral and cultural effects of this exposure and the multiple ways that individuals with serious trauma-related problems show up in all of our social systems.

The last two decades have seen an emergence of increased awareness and intervention in the field of trauma responsive practice. The current literature has effectively expanded our understanding of trauma-informed care from having a sole focus on addressing the behavioral health needs of symptomatic patients seeking help from mental health practitioners to recognizing the needs of staff in every institution who are routinely confronted with the effects of trauma on their service delivery as well as impacts on the organizational climate and culture in which services take place. The United States Surgeon General's Report of 2022 has made this point clear by centering on the importance of the overall organizational climate of the workplace—all workplaces.

This Special Issue aims to further advance the literature on trauma-informed and trauma-responsive services beyond its current concentration on the impact of trauma and violence on mental health of individuals to a more expansive centering on the overall social health. We conceptualize social health as the relational and developmental functioning of individuals, families and communities within their social environments, including mental health, healthcare, education, justice, social and traditional media and employment, as well as a wide range of social service and healthcare sectors directed at children, families and adults. Despite the reality that many trauma survivors end up presenting to many different components of the overall system, the systems that determine much of the social health of our nations do not connect in any significant way with each other, nor is there necessarily a shared knowledge base that would support and encourage more meaningful connections.

The accumulated knowledge that we now have about the widespread impact of trauma, adversity and violence provides the knowledge base, and yet much of the understanding of what it really means to our various systems and how they must change to truly become "trauma-informed" and "trauma-responsive" remains oversimplified. Training in the existing knowledge about trauma, adversity and violence and the effects on mind, body and social development is essential, but so are changes in leadership style and skills so that leaders at every level of our systems that determine social health can also respond appropriately to the people who work for them and those they serve. The intention of this volume is to explore what constitutes this basic PARADIGM SHIFT by defining the current basic assumptions that inform each component of our social system—the mental models that have historically informed each part of the system, how those basic assumptions change when the knowledge we now have about the impact of trauma, adversity and violence is assimilated into each system and what that implies for the future. This Special Issue reflects the experiential, theoretical and conceptual contributions of authors who are exploring the practical applications of trauma-responsive knowledge, skills and interventions and the impacts of these applications on humanity's collective social health.

Dr. Sandra Bloom
Prof. Dr. Charles R. Figley
Prof. Dr. Mariana Chilton
Guest Editors

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• trauma
• adversity
• violence
• mental health

Title: Trauma-Informed Implications for Outpatient and Inpatient
Authors: BENNINGTON-DAVIS; HAYS; MAYS
Affiliation: Temple University, PA 19122, Philadelphia, USA
Abstract: Nearly three decades after the seminal paper on Adverse Childhood Experiences laid the groundwork for understanding the links among childhood trauma, stress, and illness, "trauma-informed care" has become a widely accepted best practice for adult mental health services. There are many trauma-oriented treatments and mental health staff and providers are generally well-versed in understanding the role of trauma and its symptomatic manifestation in their patients' lives. However, to create treatment environments that are crucibles for healing, service providers need to transcend their focus on the dyadic provider-patient treatment relationship. It is paramount that service providers also begin to infuse trauma-informed care into three separate but interconnected cultures: 1) amongst each other, 2) amongst service users (particularly in inpatient settings), and 2) amongst the broader organization’s administration. In this paper, the authors describe practices in adult mental health services that create a culture where safety and healing are experienced by everyone

Title: Trauma-Informed Substance Abuse Treatment
Authors: STEPHANIE S. COVINGTON
Affiliation: Center for Gender & Justice, La Jolla, United States
Abstract: Substance use disorder treatment settings are overly represented with service users who have experienced adversity and trauma. The original Adverse Childhood Experiences Survey and subsequent studies consistently reflect this interconnection. For many individuals, substance use and dependency are developed as a way to cope with the challenges of adversity and trauma. Therefore, it is critical for treatment providers to incorporate the three levels of trauma work into their services: trauma informed, trauma responsive, and trauma specific. This paper will discuss the development of addiction treatment through the lens of trauma, including the role that women’s services have played in advancing the field.

Title: Trauma-Informed Criminal Justice & Incarceration
Authors: Stephanie Covington; Robert Reed; Meagan Corrado
Affiliation: Center for Gender & Justice, La Jolla, United States
Abstract: This article explores how trauma-informed principles such as safety, respect, mutuality, and shared power can transform the systemic structure, policies, procedures, and environmental conditions within the justice system. Authors first explore the traumatogenic nature of incarceration and the historical and social conditions that contribute to incarceration. They highlight the experiences of specific populations that are disproportionately impacted by the justice system including women, men of color, and youth. Next, authors share two very different visions for trauma-informed care across the criminal justice system. One vision focuses on how trauma-informed criminal justice reform can be applied to the current system by improving existing policies, procedures, and conditions. The second vision imagines what it would look like for the current carceral system to be abolished so that a new, reimagined approach to rehabilitation that reconciles the fundamental contradiction between human captivity and holistic care can be created.

Title: Trauma-Informed Leadersihp
Authors: Gerry Vassar; Maggie Bennington-Davis
Affiliation: Community Works, Philadelphia, United States
Abstract: Trauma-informed leadership begins with deep understanding of the effects of trauma and stress on staff and organizational behavior. These leaders acknowledge the need for physical, emotional, psychological and social safety both for staff and those in services. They provide environments and relationships that encourage creativity and inspire accountability. In this paper, the authors offer characteristics, skills, and examples of leadership that foster trauma informed and engaging business environments.

Title: Trauma-Informed Media and the Arts
Authors: Joan Cook; Meagan Corrado; Scott Giacomucci
Affiliation: Yale School of Medicine, New Haven, United States
Abstract: This paper will discuss the ways in which trauma-informed approaches can be applied to public communication in the media, creative storytelling through the written and visual arts, and experiential psychodrama methods. In one section of this paper, Dr. Joan Cook will describe how vital it is that the media and the public understand the true meaning of trauma-informed practice. She considers the role that trauma researchers, practitioners, and educators can play in educating the media and public about the principles of trauma-informed care. In the second section, Dr. Meagan Corrado explores the importance of creative approaches including trauma-informed storytelling and the visual arts in supporting individuals and communities as they process, integrate, and understand their experiences. She envisions what trauma-informed practice might look like for systems and programs using narrative and arts-based approaches. A third section, by Dr. Scott Giacomucci, will explore the value of trauma-informed psychodrama as an experiential method used for healing trauma, empowering trauma survivors, cultivating trauma-informed and engaging organizational dynamics, and promoting social and relational change. The use of psychodramatic methods to explore and educate others about trauma-related issues in action will be emphasized while mitigating potentials for retraumatization.