The long-lasting effects of trauma on individuals are often largely invisible to the outside world. But health care providers increasingly recognize that trauma’s hidden scars have all-too-real implications for people’s mental and physical well-being. Advancing Trauma-Informed Care, a national demonstration made possible by the Robert Wood Johnson Foundation and directed by the Center for Health Care Strategies, is supporting six innovative organizations in identifying practical ways to implement trauma-informed approaches across the health care sector. Two pioneers in the field who are participants in this initiative were recently recognized for their work.

San Francisco’s Center for Youth Wellness: Addressing Root Causes of Ill Health

In September, Nadine Burke Harris, MD, the founder and CEO of the Center for Youth Wellness in San Francisco, received the prestigious Heinz Award for the Human Condition for her work in addressing toxic stress in children, a significant yet often unrecognized risk factor for chronic disease later in life. Burke Harris was lauded for her efforts in developing a new modified screening tool for adverse childhood experiences (ACEs) that revolutionizes the way pediatricians can diagnose and treat children suffering from toxic stress. A recent profile in the Washington Post described the series of events that changed her thinking:

Soon after Nadine Burke Harris opened a pediatrics clinic in a low-income neighborhood in San Francisco, she began grappling with the high rates of asthma and other illnesses that she was diagnosing in her patients. She wanted to understand why so many of the kids she saw were so sick…

She found an answer in a decade-old [Adverse Childhood Experiences] study that showed a strong link between chronic disease and traumatic experiences during childhood — things such as physical abuse or neglect, or living with a family member addicted to drugs or alcohol. She knew the children she saw lived with high “doses” of adversity, she said, and it made sense: Trauma was affecting their developing brains and also their developing bodies.

So she began to regard her practice in a whole new way. She started evaluating children not just for their medical histories, but also their social histories. And instead of treating only symptoms, she sought to help with the root causes of the stress that were making them sick.

Through Advancing Trauma-Informed Care, the Center for Youth Wellness is expanding its implementation of ACEs screening and incorporating care coordination and data management strategies to further its integrated care approach for addressing the physical and behavioral health needs of families with exposure to ACEs.

Newark: Planting the Seeds to Become One of the Nation’s First Trauma-Informed Cities

Back on the East Coast, Keri Logosso-Misurell, executive director of the Greater Newark Healthcare Coalition, and others are partnering to make Newark one of the first trauma-informed cities in the country.  Logosso-Misurell recently discussed the issue of trauma and the importance of trauma-informed care on New Jersey Public Television’s Newark at a Crossroads series. She described how the Greater Newark Healthcare Coalition is engaging university faculty, researchers, and community-based advocates to reduce adverse traumatic experiences in urban areas. “Trauma-informed care shifts the conversation from focusing on what’s wrong with a person to what happened to the person — taking into account their life circumstances,” she said. “We have an opportunity to educate people about trauma and its lifelong implications on health.”

Under an innovative partnership made possible through Advancing Trauma-Informed Care, the Greater Newark Healthcare Coalition is working with educators at the BRICK (Building Responsible Intelligent Creative Kids) Academy — two innovative K-8 charter schools in Newark, New Jersey — to apply trauma-informed teachings to the classroom. Alongside Rutgers University Behavioral Health Care, Logosso-Misurell is bringing together mental health and school professionals to collaborate in creating trauma-informed strategies for the BRICK Academy. Together, they are determining how to effectively assess students for trauma and determine when to intervene early. The partnership is also equipping teachers with resources to understand and respond to trauma and work more effectively with the community on trauma-related issues. Beyond the school pilot effort, Greater Newark Healthcare Coalition is also working with the Children’s Hospital of New Jersey at Newark Beth Israel Medical Center to train pediatric health care providers in trauma-informed care, with the goal of spreading such training to all hospitals and health systems in the Newark region.

Building Momentum for Addressing Trauma in Children and Adults

Both the Center for Youth Wellness in San Francisco and the Greater Newark Healthcare Coalition are taking a two-generation approach to their work — as they address the needs of children, they also serve parents and other caregivers, who often suffer from toxic stress themselves. Other participants in the Advancing Trauma-Informed Care initiative are enhancing and expanding innovative trauma-informed approaches in communities in the Bronx and Philadelphia, and in additional San Francisco locations. It is heartening to see the accelerated awareness around the long-lasting effects of trauma. “I think we have reached a tipping point,” noted Burke-Harris in the Washington Post interview.

Look to in the future for information on practical opportunities to advance trauma-informed care drawn from the efforts of innovators like Nadine Burke Harris and Keri Logosso-Missurell.

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