![]() ![]() In particular, trauma-informed care is increasingly getting closer attention and has been studied in a variety of contexts such as addiction treatment and inpatient psychiatric care. identified essential elements of promoting health equity in marginalized populations such as trauma-informed and culturally competent care. In the analysis, allostatic load burden was associated with higher cardiovascular and diabetes-related mortality among blacks, independent of socioeconomic status and health behaviors.īrowne et al. For example, a recent analysis using a sample including 4,515 National Health and Nutrition Examination Survey participants between 35 and 64 years of age revealed that black men and women had fewer years of education, were less likely to have health insurance, and had higher allostatic load (i.e., accumulation of physiological perturbations as a result of repeated or chronic stressors such as daily racial discrimination) compared to white men (2.5 vs 2.1, p<.01) and women (2.6 vs 1.9, p<.01). According to Farmer et al., because systemic exclusion and disadvantage are built into everyday social patterns and institutional processes, structural violence creates the conditions which sustain the proliferation of health and social inequities. noted structural violence-the disadvantage and suffering that stems from the creation and perpetuation of structures, policies and institutional practices that are innately unjust-as a major determinant of health inequities. Several factors have been discussed as root causes of health inequities. In 2014, 83% of all new diagnoses of HIV infection in the United States occurred among gay, bisexual, and other men who have sex with men, with African American men having the highest rates. The 2016 survey also revealed that 40.9% and 41.5% of Mexican Americans and African Americans with hypertension, respectively, had their blood pressure under control, compared to 51.7% in non-Hispanic whites. For example, according to the 2016 National Health and Nutrition Examination Survey (NHANES), 29.1% of Mexican Americans and 24.3% of African Americans with diabetes had hemoglobin A1C greater than 9% (the gold standard of glucose control with levels ≤ 7% deemed adequate), compared to 11% in non-Hispanic whites. Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5).ĭespite the United States’ commitment to health equity, health inequities remain a pressing concern among some of the nation’s marginalized populations, such as racial/ethnic or gender minority populations. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Intervention fidelity was addressed in 16 studies. Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). Thirteen studies were conducted in the United States. U.S.More than half of the 32 studies were randomized controlled trials (n = 19).The training provided by CPR and NCTIC was the first step for CDC to view emergency preparedness and response through a trauma-informed lens. 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. It requires constant attention, caring awareness, sensitivity, and possibly a cultural change at an organizational level. Participants learned SAMHSA’s six principles that guide a trauma-informed approach, including:Īdopting a trauma-informed approach is not accomplished through any single particular technique or checklist. The training aimed to increase responder awareness of the impact that trauma can have in the communities where they work. The CDC’s Office of Readiness and Response (ORR), in collaboration with SAMHSA’s National Center for Trauma-Informed Care (NCTIC), developed and led a new training for CPR employees about the role of trauma-informed care during public health emergencies. 6 Guiding Principles To A Trauma-Informed Approach
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