Article

The Three Pillars of Trauma-Informed Care

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Abstract

The past decade has brought with it a greatly increased awareness about the impact of trauma on children, which has, in turn, led to a focus on the treatment of trauma-related conditions. Much of the recent literature describes different approaches to therapy. However, there are a few consistent propositions arising from the research and clinical literature which suggest that much of the healing from trauma can take place in non-clinical settings. There is some evidence to suggest that trauma-informed living environments in which healing and growth can take place are a necessary precursor to any formal therapy that might be offered to a traumatised child. It stands to reason that the treatment of children exposed to complex trauma will itself be complex and long-lasting. However, there appears to be a remarkable consensus about the key prerequisites for healing--those critical factors or therapeutic pillars that need to be in place if healing is to take place. Although there is debate about the number of critical factors, there are three that are common to most approaches. This article outlines the three pillars of trauma-informed care: (1) safety; (2) connections; and (3) managing emotional impulses. (Contains 1 footnote.)

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... The three aspects of TIC include safety, connections, and managing emotions (Bath, 2008). Citing van der Kolk and Courtois (2005), Bath (2008) writes: ...
... Quarantining, social distancing, and wearing masks now replace normal day-to-day actions. As Bath (2008) notes, though, to fully address trauma, especially with young people, "it stands to reason, then, that the first imperative in working with traumatized [people] is creating a safe place for them" (p. 19). ...
... When students come to college with specific traumas, those memories leave deep emotional scars that can interfere with pursuing a eudaimonic way of living. Bath (2008) explains that young people need "adults in their lives who can understand the pervasive impact of their experiences and who recognize that the pain from ruptured connections" and those adults must "develop trauma-informed approaches that promote healing and connection" (p. 20-21). ...
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The arts and entertainment sectors remain fragile because of the global pandemic. Unemployment, physical and emotional stress, social isolation, a loss of purpose, and a problematic future are just a sample of the ongoing traumas that music educators and practitioners experience under duress. As an inherently social activity, music-making becomes especially difficult when the threat of infection persists, further exacerbating somatic trauma and decreased health and wellness. The sudden loss of daily contact with others, coupled with multiple kinds of crises, complicates matters for educators. How does one flourish when their livelihood, personal connections, and sense of meaning-making disappear? Likewise, how ought the music educator navigate such uncertainty when teaching others? To address these issues, psychologists have often turned to Trauma-Informed Care (TIC), a collaborative model between the practitioner and client that recognizes and validates the impact of painful memories and experiences. This article advocates for a compassionate eudaimonic pedagogy model that prioritizes healing and self-care for teachers and students and cultivating an ethos of critical digital pedagogy—itself a form of eudaimonia. Drawing on Noddings’ (1992, 1995, 2002) Philosophy of Care, the article concludes with suggestions on future connections between eudaimonia and music education.
... TIC creates a basis for understanding the negative impact of psychological trauma and can help prevent re-traumatization [25,26]. TIC's three pillars, which create a context for healing, are (a) safety, (b) connections, and (c) managing emotions [26]. ...
... TIC creates a basis for understanding the negative impact of psychological trauma and can help prevent re-traumatization [25,26]. TIC's three pillars, which create a context for healing, are (a) safety, (b) connections, and (c) managing emotions [26]. Safety relies on consistency, reliability, predictability, and transparency to promote safe environments. ...
... These positive interactions, in turn, help with the third pillar (managing emotions), which improves the ability to control one's impulses and regulate oneself. These three pillars work together to create a context for healing, but they both impact and are impacted by surrounding human ecological systems [26]. ...
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This transcendental phenomenological study explored psychologically traumatic incidents and risk factors among international faculty members (IFMs) who experienced long-term lockdowns during the Delta and Omicron outbreak periods in East China. Based on empirical voices from 18 IFMs in Shanghai, Hangzhou, and Nanjing, this study used trauma-informed care as its primary theoretical lens to examine potential traumatic incidents and risk factors. Findings showed that participants had neuroses about the omen of lockdowns and felt exhausted and frustrated about persistent polymerase chain reaction (PCR) tests. They also experienced or witnessed burnout and dropout due to leisure constraints. Most notably, participants had concerns about families and friends during the series of lockdowns, entailing extreme stress due to separation, illness, loss, and grief. Overall, this study provides practical implications for counseling practices about social and cultural considerations and systemic barriers that impact clients’ well-being.
... However, complex relational trauma occurs over time and can be repeated often by someone known to the child. When children experience complex trauma, the effects are profound, multiple and not always well understood (Van der Kolk, 2005;Bath, 2008). Throughout the pandemic incidences of complex trauma have increased with ongoing financial insecurity, lack of social connectedness and a rise in family violence (Wilkins et al., 2021). ...
... In order to support children to meet their needs for safety at school, teachers should be supportive, caring, and avoid acting in ways that might trigger the child and produce power-laden behavioral responses like bullying (Bath, 2008;Shonkoff et al., 2012;Carello and Butler, 2015). To successfully support children, teachers require training about trauma and exposure to risk and how it is expressed by children (Day et al., 2015;Berger, 2019;Stokes and Brunzell, 2019). ...
... This was based on the TIPE professional learning to first understand what had been in place at the school where the punitive discipline approach ignored the complex histories of the children with whom they were working (Costa, 2017). Instead, both leaders and teachers learnt the importance of support and avoiding actions that might trigger escalated power-laden responses in children (Bath, 2008;Shonkoff et al., 2012;Carello and Butler, 2015). ...
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Advances in trauma-informed practices have helped both researchers and educators understand how childhood trauma impacts the developmental capacities required for successful learning within school. However, more investigation is required to understand how leaders can implement trauma-informed practices in targeted areas of their schools. This paper is a case study of one school who intentionally implemented a trauma-informed instructional practice approach after undertaking trauma informed positive education professional learning over a period of two and a half years. The research was guided by three questions: how are students supported in their learning and wellbeing; how can teachers be supported to develop consistent trauma-informed practice in their classrooms; and what is the role of leadership in this process? To research the approach, quantitative measures of staff and student perceptions and qualitative strategies centering the voices and experiences of students, teachers, and school leaders, were employed. Implications for school leaders suggest that when implemented as a whole-school approach through multiple and simultaneous mechanisms, trauma-informed positive education instructional practices have the possibilities of yielding enhanced outcomes for wellbeing and enable students to be ready to learn.
... Without a clear and integrated approach to training medical students to provide care to TGD patients, the disproportionate discrimination and barriers to care TGD that individuals experience within the healthcare system will likely continue [20,21]. Given this inequity and the worrying levels of trauma experienced by TGD individuals in their interactions with the healthcare system [22], training cannot solely be a matter of skills and knowledge, it needs to be trauma-informed to address these longstanding and systemic issues [23]. ...
... Initial topics and issues were based on the 2018 pilot UME curriculum developed at the University of Calgary and from a narrative review of the literature (outlined in the introduction section). Given the extent of the negative experiences TGD patients have had in interacting with the healthcare system [1][2][3][4]11], we also took a trauma-informed approach that meant we specifically attended to dimensions of safety, connection, and emotion [23] within the curriculum framework, and to stakeholder communication and involvement around it [28]. ...
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Introduction The lack of attention to transgender and gender diverse (TGD) people in undergraduate medical education (UME) is a point of concern, particularly among medical students. A project was undertaken to develop a UME curriculum framework for teaching the healthcare needs of TGD people. Methods Using a modified Delphi methodology, four rounds of surveys were presented to an expert stakeholder group that included content experts, generalist physicians, UME teaching faculty, and medical students. Questions covered what content should be taught, who should teach the content, and how much time should be dedicated for this teaching. Once the Delphi process was complete, feedback on the provisional framework was sought from members of the TGD community to ensure it represented their needs and perspectives. Results 71 panel members and 56 community members participated in the study. Core values included the scope of the framework, and topics such as inclusivity, and safety in practice and in teaching. The framework included terminology, epidemiology, medical and surgical treatment, mental health, sexual and reproductive health, and routine primary care. There was also guidance on who should teach, time to be allocated, and the learning environment. Discussion There is a clear need to train tomorrow’s doctors to provide competent and respectful healthcare services to and for TGD patients. Although local factors will likely shape the way in which this framework will be implemented in different contexts, this paper outlines a core UME-level curriculum framework for Canada and, potentially, for use in other parts of the world.
... Specifically, it has involved acknowledging the importance of attachment difficulties (Laybourne et al., 2008) which have been understood to be at the root of many of the difficulties experienced by children in the care system. Based on a literature review, Bath (2008) proposed three pillars of trauma-informed care that are necessary for helping these children: Felt-Safety, Self-Regulation and Connection. ...
... The interventions that were based on DDP (4, 12 and 14) and on Bath's (2008) ...
Thesis
Childhood maltreatment has previously been associated with neurodevelopmental (ND) problems, including Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder symptoms. Attachment plays an important role in neurodevelopment; however, its role in adoptees who suffered maltreatment and their adoptive parents, has not yet been fully explored. A review of a range of attachment-based interventions has tentatively suggested that attachment-based interventions may reduce neurodevelopmental problems in looked after children. This exploratory study aimed to provide greater understanding on how child maltreatment affects neurodevelopmental problems and how the parent-child relationship with the adoptive parents, may play a role in this, as a moderator or protective factor. Data from 94 children 6 to 11 years old, adoptees with a history of maltreatment (n=26) and biological children without experiences of maltreatment (n=68), was analysed to explore the relationship between maltreatment and ND outcomes. A moderation analysis was run to see whether parent-child relationship had an influence on that association. Results indicated that adoptees had significantly higher scores on inattention and hyperactivity. Adoptees were three times more likely to meet screening criteria for further autism assessment. The moderation analysis was not significant. Findings were consistent with previous research, where child maltreatment has been associated with ND outcomes. However, despite previous evidence indicating that the attachment relationship may influence the ND problems in children in care, our hypothesis of this relationship being a potential protective factor was not confirmed. There were significant power issues due to the small sample of adoptees.<br/
... In responding to the needs of individuals who have been exposed to ACEs and the subsequent psychological distress they may experience, one increasingly adopted approach across the child welfare sector is that of trauma-informed care. Traumainformed care has been defined as a practice framework that is grounded in the recognition of possible trauma and the complex physical, psychological, and emotional impacts that it has on the lives of individuals (Bath, 2008;Steele & Michiodi, 2011). In conceptualising trauma-informed care, reference has been made to SAMHSA's (2014) four underlying assumptions (i.e., the four 'R's'). ...
... These three stages are: (1) Safety and stabilisation; (2) Remembrance and mourning; and (3) Reconnection and integration. These three stages are not unlike the underlying principles of trauma-informed care (Bath, 2008;Steele & Michiodi, 2011;Substance Abuse and Mental Health Services Administration, 2014). Furthermore, the ideologies advocated by the social and human rights models of disability, in recognising that the experience of adversity is an issue with the environment rather than the individual and that the concept of humans rights applies equally for people with disability, should also be adopted. ...
Article
A high prevalence of maltreatment, abuse, neglect and the onset of subsequent trauma has been well-documented among both young people with disability and young people residing in foster and kinship care. However, no uniform policies or guidelines currently exist for the delivery of trauma-informed models of care to build the capacity of foster and kinship carers in responding to and supporting the complex needs of children and young people in their care with disability who may have been exposed to trauma. While no evidence of the application of trauma-informed models of care for this cohort exists, some evidence of trauma-informed models of care to support people with disability beyond the scope of out-of-home care has recently emerged. The authors discuss this emerging work and recognise an opportunity to leverage this evidence to guide the practices of foster and kinship carers. Clearly, there is an opportunity to work towards improving the development and wellbeing of children and young people with disability in foster and kinship care through the development, implementation, and evaluation of a tailored trauma-informed model of care that is co-designed and grounded in the underlying theoretical principles of disability and trauma.
... Exposure to trauma in childhood may damage children's belief and trust in the caregiver's ability to protect them (Lieberman et al., 2011). To mitigate exposure to trauma and help children build the resilience needed to thrive, Bath (2008) proposed three pillars of trauma-informed care: safety, connection and self-regulation. Children who have experienced trauma feel inherently unsafe. ...
... Building positive connections with adults helps children restructure negative emotions associated with trauma and learn to develop positive emotional responses to caring adults in their lives. Finally, learning self-regulation skills allows children to manage their emotions and impulses in a way that promotes positive experiences in educational, social, and other settings (Bath, 2008). For example, a recent study suggests that of children who have experienced trauma, those who demonstrate the ability to self-regulate have better educational outcomes (e.g. ...
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Ongoing trauma-focused assessment is critical to developing trauma-informed treatment plans. The current study examines the clinical benefits of utilizing the Child and Adolescent Needs and Strengths (CANS) assessment to guide intervention based on the Attachment, Self-Regulation, and Competency (ARC) model to address children’s trauma related symptoms in a rural state. WV CANS was developed by adapting the language of original CANS to be culturally specific to the state’s unique situation and culture in consultation with the original CANS developer. This study included the data from children who received mental health services under WV CANS-ARC mapping from 2017 to 2019. Children’s trauma-related symptoms are assessed using the WV CANS at intake and every 90 days to identify any changes in their symptoms. In order to examine the changes of traumatic symptoms over time, the study was limited to children who have at least three time points, with a total of 362 children used for the current analyses using Multilevel modeling with SAS PROC MIXED. The study found that children’s trauma related symptoms significantly decreased in all ARC outcome domains over time after adjusting for basic demographic variables. The current study contributes to the evidence on treatment for children’s trauma-related symptoms, especially with the application of the CANS-ARC mapping in a real-world clinical setting. The findings have significant implications for clinicians in integrating the assessment and treatment process using CANS-ARC mapping and for cross-system collaboration with continuity of care serving children who have experienced trauma.
... What might this look like? Most often, trauma-informed care is described as consisting of three parts: safety, connections, and managing emotions (Bath, 2008). What women seek is safety, what they desire is connections, and what they need is a way to manage their emotions. ...
Thesis
With gender inequality holding a powerful presence in todays’ discourse following the third wave of feminism, #MeToo movement, and potential changes to Title IX guidelines, it is becoming increasingly clear that we do not know enough about the life experiences of women. The jail resident population in particular has increased almost eight-fold in the past 30 years (The Sentencing Project, 2019). Research should focus specifically on women because they not only experience more trauma, substance use (SU) problems, and mental health (MH) issues than men, but they leave the criminal justice system no better than when they entered it, and therefore are more likely to return (Belknap, 2007; Belknap et al., 2016; Belknap & Holsinger, 2006; Covington & Bloom, 2003; Drapalski et al., 2009; Fazel et al., 2006; Greenfeld & Snell, 1999; Hills et al., 2004; James & Glaze, 2006; Langan & Levin, 2002; Pollock, 2002; Salina et al., 2004; Snell & Morton, 1991). Thus, in order to curtail their rising population, we need to understand and serve their needs more effectively in attempts to propel their desistance from crime. The purpose of this research is to identify women jail residents’ perceptions of their own needs throughout their criminal justice experience (i.e., pre-incarceration, during incarceration, and after incarceration) to inform jail programming which could successfully target those needs. This study relies on administrative data and data collected via interviews with women jail residents at all three security levels (i.e., low, medium, high) and women correctional staff at one mid-Atlantic jail. By comparing perceptions of needs across security-level, this research advances the current understanding of women jail residents’ needs from multiple perspectives. In addition, it also furthers our knowledge on how connection and access to programming addresses some/all of the needs of these women. Gauging in what ways the perceptions of women staff and jail residents may overlap or differ is an important distinction that informs whether hierarchical (i.e., power-based) roles change perceptions of women’s needs. Interviews with women jail staff inform how the social connection (i.e., relationships) between women jail residents and staff facilitates or inhibits women’s connection to appropriate resource essentials during their jail stay and in planning for their reentry process. In this specific setting, only women jail staff are permitted to work with the women jail residents and thus are the only connection for women jail residents to access the resources they need. Overall, this research highlights the life experiences of women in jail and may inform jail administrators on the needs of women who are incarcerated and whether those needs are adequately met or if there are gaps that need filled regarding programming.
... Just what this entails is as loose as trauma itself. Bath (2008) identifies three pillars of trauma-informed care (TIC): safety, connections, and managing emotional Mark Smith, Sebastian Monteux and Claire Cameron impulses. The US Substance Abuse and Mental Health Services Administration (SAMHSA, 2014), rather circularly, defines a trauma-informed approach as 'a program, organization, or system that realizes the impact of trauma, recognizes the symptoms of trauma, responds by integrating knowledge about trauma policies and practices, and seeks to reduce re-traumatization'. ...
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A recent special issue of this journal focussed on the emergence of the Adverse Childhood Experiences (ACEs) movement as a key driver of Scottish social policy. In this article, we extend the critiques advanced therein by locating ACEs within a wider cultural turn towards psychological trauma which, over the past decade, has become reified as a master theory across social welfare. Yet, the concept is insubstantial and ill-defined, and the claims made for policy based upon it are at best disputable. Its prominence is less evidence-based than it is testimony to how a particular (cultural and professional) ideology, regardless of its intellectual merit, can be insinuated into policy discourse. ACEs, we suggest, is utilised to provide the trauma paradigm with some ostensibly quantifiable substance. We illustrate our argument through reference to the Scottish Government’s National Trauma Training Programme (2020). We go on to consider some of the implications of such ideological capture for the direction of Scottish social welfare policy and practice. The prominence given to trauma perspectives has potentially iatrogenic consequences for those identified or self-identifying as traumatised. At a wider level, it reflects a professional and epistemic privileging of a narrow, ostensibly therapeutic, worldview which, in turn, acts to marginalise ‘the social’ that characterised erstwhile Scottish approaches to welfare.
... CRT has also been used in a broader Western capitalist and multicultural context (e.g. Europe and Oceania) (Barker, 2012). Notably, from sociopsychological standpoints, scholars are recently called upon to pay more attention to the CRT to understand ethnic Asian immigrants and international students as a racialised group in the U.S. who are potentially at risk of experiencing racially-traumatic incidents (Chou et al., 2012;Litam, 2020). ...
Article
This phenomenological study explores the experiences of Chinese international undergraduate students in the United States as they work through the complications of COVID-19 that are potentially intertwined with Sinophobia. By drawing on insights from critical race theory, especially the lens of racial trauma and trauma-informed care, the current study interprets four primary themes: (a) Paradox: Confusions about Racism in Academic Life; (b) Racially-Traumatic Incidences and Risk Factors in Social and Cultural Life; (c) Exodus: Burnout, Homesick, and the Dilemma; and (d) Determined Traumatic Symptoms: Insomnia, Nightmare, and Negative Memories. Noticeably, social justice issues such as isolation, exclusion, threats, and discrimination were present during the 2020 academic year. Therefore, the implications are explored through sociopsychological perspectives.
... Children rely on their parents immediately after a disaster, and the parental reactions will influence the recovery of children. Teaching parents to identify the warning signals in children post-disaster, creating a safe environment, modelling healthy behaviours etc. could increase the resilience of children for future disasters [43,[46][47]. This training programme can also be extended to teachers such that schools become a mediator between parents and mental health professionals. ...
Article
Background: Frequent disasters and weak mental health system pose a risk to psychological
... The mechanisms that underlie the associations between trauma exposure, psychiatric disorder, and suicide risk are well documented. Individuals enduring trauma, especially when there is grave threat to physical integrity and bodily harm, are at increased risk for feelings of hopelessness, intrusive reexperiences of trauma, and feelings of disassociation and inability to feel closeness to loved ones (Bath 2008;Ásgeirsdóttir et al. 2018;Beautrais 2002;Nolen-Hoeksema 2012). Social isolation and fear of reporting or continued harm can also render difficult emotional pain leading to suicidal crises Möller-Leimkühler 2002). ...
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Background The role of traumatic event exposure and psychiatric disorders as central risk factors for suicidal behavior has been established, but there are limited data in high conflict regions with significant trauma exposures such as Afghanistan. Methods A nationally representative, cross-sectional survey was conducted through systematic stratified random sampling in 8 regions of Afghanistan in 2017 ( N = 4474). Well-validated instruments were used to establish trauma exposure, psychiatric disorders. Death preference, suicidal ideation, plan, and attempts were assessed. Results In the total sample, 2.2% reported suicidal ideation in the past 12 months, and 7.1% of respondents reported that they had suicidal ideation at some point in their lives; 3.4% reported a suicide attempt. Women were at higher risk than men. All traumatic event exposures were strongly associated with suicidal behavior. Respondents who reported experiencing sexual violence were 4.4 times more likely to report lifetime suicide attempts (95% CI 2.3–8.4) and 5.8 times more likely to report past 12-month suicidal ideation (95% CI 2.7–12.4). Associations were strong and significant for all psychiatric disorders related to suicidal behavior. Respondents who met criteria for major depressive episodes (OR = 7.48; 95% CI 4.40–12.72), generalized anxiety disorder (OR = 6.61; 95% CI 3.54–12.33), and PTSD (OR = 7.26; 95% CI 4.21–12.51) had the highest risk of past 12-month suicidal ideation. Conclusion Traumatic event exposures and psychiatric disorders increase risk of suicidal behavior in the Afghan general population; women are at high risk. Interventions to reduce trauma exposure, including expansion of a mental health workforce in the region, are critically important.
... This review focuses on non-clinical TIC interventions that can be carried out by practitioners and carers working outside formal clinical settings, and so are relevant to groups like social workers, foster carers and adoptive parents. The interventions have three main components, referred to as the pillars of TIC, first identified by van der Kolk (2005) and later by Bath (2008). These are employed in phases and comprise: (1) developing the child's sense of safety; (2) promoting trusting carerchild relationships; and (3) teaching child self-regulatory strategies and coping skills. ...
Article
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Trauma-informed care (TIC) psychoeducational group-based interventions for foster carers and adoptive parents are growing, but evidence about their effects have not been integrated. A narrative review was undertaken of studies that evaluated the effects of these interventions. It found that they appear to increase carers' capacity to provide children with TIC and reduce child trauma-related difficulties. Three core components-psychoeducation, reflective engagement and skills building-were identified as helping to explain how the interventions work. However, the evidence is weak due to the mixed findings, diverse research designs, varied measures and methodological deficiencies, so results should be interpreted with caution. This highlights the urgent need for more rigorous research. Implications for practice, policy and research are discussed.
... Since being trauma informed in practice is grounded in educators' beliefs (Bath, 2008), and since beliefs drive practice (Brookfield, 1995), the need to challenge currently held beliefs about student learning and behavior is essential. Thus, a developmental approach was chosen to underpin the embedded nature of this work. ...
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In this essay, as a group of teacher educators, we discuss our experience of “walking the walk” of teacher education transformation at a time of urgent change. We reflect upon our process of integrating three key priorities in our preservice teacher education courses: education for sustainability; trauma-informed practice; and Indigenizing curriculum. Specifically, we reflect on how these processes were adapted according to the needs of individual courses and units, while at the same time making space for our strengths and our “unlearnings” as academics, and for the ethical considerations that troubled us. In this essay, we explore walking the walk of change and integrating social, environmental, and cultural justice principles in our work together toward equipping and enabling new teachers to be themselves agents of change.
... Further, our coding was guided by a Human Rights in Patient Care (HRPC) framework (Patel, 2017). We analyzed our selected documents within these broader frameworks, using guiding concepts including, but not limited to, cultural safety (Smye & Browne, 2002), trauma-informed care (Bath, 2008), systemic discrimination (Kendall et al., 2020), and Indigenous intersectionality (Levac et al., 2018). ...
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Between 2015 and 2019, over 100 Indigenous women from six provinces and two territories have come forward to say that they were forced or coerced to undergo a sterilization procedure in Canada. Despite this, government action is lacking. Through this paper, the research team aims to collect and synthesize the recommendations that have been made in response to the recent cases of forced or coerced sterilization of Indigenous women in Canada. Through a secondary analysis of data, we outline the findings of a thematic analysis of 162 recommendations from four selected sources: (a) Tubal Ligation in the Saskatoon Health Region: The Lived Experience of Aboriginal Women, an external review by Senator Yvonne Boyer and Dr. Judith Bartlett, July 22, 2017; (b) a meeting of the Senate Committee on Human Rights, April 3, 2019; (c) meetings of the House of Commons Standing Committee on Health, June 13 and 18, 2019; and (d) a letter from Bill Casey, Member of Parliament and Chair of the House of Commons Standing Committee on Health, to three federal ministers, August 2, 2019. Seven themes emerged following the thematic analysis of the 162 recommendations: (a) Services and Supports (b)Accountability, (c) Training and Education, (d) Legislation and Policy, (e) Criminalization, (f) Data Collection, and g) Investigation. These themes represent seven areas where immediate government action is required to meaningfully and appropriately respond to the recent cases of forced or coerced sterilization of First Nations, Inuit, and Metis women in Canada.
... As part of trauma-sensitive care, trauma-focused therapies can play an important role. Integrated health care strategies directed at the psychological and physical health, as well as rigorous control of risk factors, are likely to improve the quality of life of traumatised refugees (Bath, 2008;Reeves, 2015). ...
Article
Thank you for this opportunity to share perspectives from our work within the Physiotherapy and Refugees Education Project, PREP, an Erasmus+ funded project within the KA2 strategic partnership program. Researchers, educators, students, and clinicians within institutions of higher education, health services and humanitarian organisations, have worked together in this project to define competencies that physiotherapists need in working with refugees. Based on this, we have made a course openly available for physiotherapists worldwide. A central aim of the work in PREP has been the creation of a network in which educators, students and clinicians can meet, discuss, and learn from each other. We welcome everyone who shares our interest to join us in this network. In this perspective paper, we want to share our thoughts and opinions on how such a collaboration can be used for building competence. We will discuss topics that are central for physiotherapists working with victims of torture, and finally, we will discuss what we believe are the important next steps within physiotherapy to be able to support this group.
... Dyregrov 2004, Van der Kolk 2003 suggests that young people benefit from an acknowledgement of traumatic events, as well as teaching that makes adjustments to the usual behavioural and learning expectations sensitively, but it is also found that frequent reference to the trauma can be counter-productive. This approach echoes the work of Bath (2008) who suggested that there are three ways that can support children who have experienced disruption to schooling: 'the development of safety, the promotion of healing relationships, and the teaching of self-management and coping skills' (p.18). ...
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The COVID-19 global pandemic of 2020 onwards has revealed, and continues to reveal, a great deal about many of the social structures and processes that we take for granted. One of these is the everyday practice of sending children to school. It has been disrupted in a manner unprecedented outside wartime, with consequences that are not likely to become fully apparent for a long time. This study, funded by the UCL Office of the Vice-Provost (Advancement) and the Wellcome Trust, looks at the particular case of Year 6 children in England (aged 10-11 during the school year 2020-2021) who were undergoing transition from primary to secondary school during the initial phases of the pandemic. We chose this group of children as they were on the cusp of adolescence, and working through challenging educational experiences, the effects of which have been magnified by the pandemic. Our study is interested in how these exaggerated effects have shaped their future educational progress, social relationships, and mental health. Our review of the research literature suggests that a smooth transition to secondary school plays an important part in the general development of young people as they move towards adulthood. It also indicates that a successful transition is often the result of positive home and primary school experiences. Several additional factors are key to this. The first is carefully managing children’s expectations of secondary school. Ensuring suitable continuity of learning, as well as minimising any missed learning opportunities, are also important. All of these were heavily compromised by the pandemic. To investigate this, we used a combination of surveys and semi-structured interviews to engage with 196 children and 64 teachers in different regions and social circumstances across England via two fieldwork phases. The first took place in summer 2020 and the second in autumn 2020. We asked children and teachers about the different ways children’s educational experiences had diverged during the pandemic, whether there was likely to be any lack of learning opportunity or consequences for mental health and asked them to suggest changes that could be made to secondary school transition processes in general, in order to improve things in the future. A number of key themes emerged as a result of the research. Our participants reported that there had been increased fragmentation of learning, with some children making greater progress than usual, while other children missed out. This was sometimes, but not always, linked to deprivation. There were many problems with technology which had created barriers to learning, including deficits in national broadband infrastructure and tariffs, as well as hardware availability in some schools and homes. There was a general picture of uncertainty, compounded by the cancellation of Standard Assessment Tests (SATs) scheduled for the end of Year 6, which meant that teachers were unable to report formally on progress in the ways they were used to. Many children reported feeling more anxious than before about their education, as well as their peer relationships at school. In our findings, there were some positive outcomes of the pandemic for schooling, however. The teaching profession was forced into a programme of rapid modernisation and investment in terms of developing high level remote teaching skills. Additionally, those children attending school during the pandemic, because of Free School Meals (deprivation) status, or parental key worker status, sometimes made accelerated progress as a result of small group attention. Other children were able to explore their learning interests and hobbies in more depth than usual. We conclude that both positive and negative aspects of these children’s experiences during the pandemic provide opportunities for reflection around, and improvement of, secondary school transition processes generally. We make two specific recommendations, namely working further towards a distinct Year 7 phase in secondary school, and improving training in, and use of, educational technology by children and their teachers.
... Trauma-informed care (1) realises that trauma has a widespread impact on individuals and those around them and has an understanding of paths to recovery, (2) recognises the signs and symptoms of trauma, (3) integrates trauma knowledge into policies, programmes, and practices and (4) Seeks to avoid re-traumatisation (Bath, 2008). Within a trauma informed school, staff at all levels receive professional development in and have a basic understanding of trauma and how it impacts learning and behaviour (Cole et al., 2005). ...
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The Riroriro programme was a response to the needs of children with extremely dysregulated classroom behaviours, resulting from sustained exposure to traumatic high-stress and high-deprivation environments from pre-birth to school age. Evaluation of the accounts of key individuals involved in the pilot found that participants had improved emotional regulation abilities and interpersonal skills during and up to 1 year after the intervention. Academic performance was not improved significantly, but the interviewees’ accounts suggested that “academic readiness” had been achieved. In line with previous studies, the results indicate preliminary support for the effectiveness of the Riroriro programme in supporting children who have experienced trauma to become mainstream classroom ready. These results suggest that a whole-school, multi-tiered approach providing support at the student, school personnel and system levels can help mitigate the effects of trauma.
... Multilevel help efforts and interventions should be trauma-informed and, as such, "grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control, self-efficacy and empowerment" [48, p. 82]. Trauma informed care is built around three important pillars: safety, connections, and managing emotions [49]. It, thus, tries to translate trauma research into practice to inform and improve care efforts, practically address trauma, and promote resilience thus improving outcomes [50]. ...
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The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents , and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength-and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.
... The process of interacting with a legal system comes with high potential for revictimization. The principles of TIC underlie the other two theoretical perspectives, insofar as the latter convey ways to minimize trauma: conservation of resources theory (COR), which posits that victimization and its resultant trauma can lead to losses of valuable resources for the victim that need to be mitigated to prevent further loss and promote healing (Bath, 2008;Hobfoll et al., 2016;Littleton et al., 2009;Sullivan, 2016), and procedural justice, which posits that equitable application of justice and transparency of process promotes fairness and respect and avoids system re-victimization (Tyler, 2007). ...
... Trauma-informed care emphasizes three core approaches to addressing complex trauma (Bath, 2008;Ko et al., 2008) that include safety, connections, and emotional regulation. Safety addresses the impact of complex trauma on people's fundamental sense of when, where, and with whom they can be genuinely safe. ...
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This chapter is intended to provide practitioners with fundamental skills and concepts for understanding social work practice with lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. As a population subgroup, LGBTQ youth are at risk for numerous factors leading to negative health and social outcomes. These risk factors are often the subject of research, policy, and discourse on the experiences of LGBTQ youth and are at the center of a growing movement for increased awareness and funding of federal and foundation research on sexual and gender minority populations. While the heightened health and mental health risks for LGBTQ youth are important for social workers to understand, it is also important to note that they do not define LGBTQ youth. In this chapter, we promote a social work practice perspective that is strengths- affirming by advocating for practice approaches and models that emphasize the resilience, self- determination, and creativity of LGBTQ young people.
... Recovery and healing do not only take place in individual therapy, but mostly in the living environment of the child. A context with maximized psychological and physical safety, based on (co)regulation and connection, provides the base for recovery [43]. Insights from studies on neuroplasticity, epigenetics, and resilience may help to explain the wide variation in the effect of ACEs and traumatic experiences. ...
In this opinion article, we want to inspire readers by highlighting recent Dutch developments about two important health related issues regarding the quality of life of children and adolescents with intellectual disabilities. Firstly we focus on the prevention, treatment and reduction of (disability-related) somatic and psychological problems by specialized physicians for people with intellectual disabilities. Secondly, we emphasize the importance of the prevention of adverse childhood experiences and the promotion of protective and compensatory experiences. Subsequently, we stress the need for trauma informed care to support children and adolescents with intellectual disabilities who encounter adverse events. A specialized and multidisciplinary approach is advised as is the need for promoting healthy (family) relations with a focus on (co)regulation and connection as a basis for recovery.
... This paper argues that new teachers need to be trained in trauma informed practice through exposure to salient neuroscientific psychological research and its applications to the classroom and education (Anderson, Blitz and Saastamoinen, 2015;Venet, 2019;Chafoulceas et al, 2016;Delaney, 2020;Stokes and Brunzell, 2020;McIntyre et al, 2019;Dorado et al, 2016;Becker-Blease, 2017;Bell, Limberg and Robinson, 2013;Bath, 2008). ...
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This paper introduces the context of mental health in education and the importance of the teacher being acknowledged as an essential component and contributor to the function of society (Bower, 2020). The paper suggests that the mental health crisis impacting children has implications for new teachers in meeting the demand in the current global climate. (Education Endowment Foundation (EEF), 2017; 2018); (Lortie-Forgues, 2021). It explores why the definition of mental health might be a problematic construct for teachers and considers whether the teacher has a significant role to play in mental health provision in schools beyond the wider community. It considers the role pathologization of behaviour plays in our approach to education and proposes that the approach teacher training takes towards critically reflecting on retributive discipline and restorative approaches in schools, subsequently supports teacher understanding of child mental health. It also looks at the current teacher training landscape and reforms and argues that policy makers and practice should be interdisciplinary with effective mental health knowledge. The paper emphasises the importance of developing teacher understanding of the role of psychological awareness in supporting effective child mental health provision across the field of education and argues that new teachers have a part to play in this application through effective training to support the influx of demand. The paper proposes that critical considerations should be given to the potential application of interpersonal neurobiological research (Siegel, 2020), exploring concepts of the embodied brain through polyvagal theory (Porges, 2011). It touches upon developing new teacher understanding of trauma, (Van der Kolk, 2014) informed practice and transdisciplinary therapeutic approaches for practical use in schools. It considers the future of mental health knowledge in pre-service initial teacher training and proposes that such a focus will have a profound impact on making some headway in meeting child mental health needs. The paper finishes by proposing that future research should look to develop a psychological, neurobiological, developmental sensitive approach to exploring child mental health and well-being within education and support the role of initial teacher training education (ITT/ITE) in creating confident new teachers with efficacy to meet the needs of child mental health in schools.
... Carers are taught the exact words to say when trauma activators arise to allow consistent responses across various settings. This consistency and predictability are two other elements that help reduce the impact of trauma and build resilience in children [114]. These habits created in CDI are strengthened in TDI and are further reinforced in PDI. ...
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Parent-Child Interaction Therapy (PCIT) is one of the strongest evidence-based treatments available for young children and their families. Research has supported the use of PCIT for children with a history of trauma; however, the treatment does not directly address trauma in the child. PCIT is a dyadic treatment; yet, the impact of the carer’s trauma on the carer-child relationship is not assessed or incorporated into treatment. For these reasons, therapists, families, agencies, and funders tend to view PCIT as a trauma treatment with skepticism. PCIT therapists who currently address trauma within the intervention do so without a standardized approach. Trauma-Directed Interaction (TDI) is an adaptation developed to directly address these concerns. TDI maintains the key elements and theoretical underpinnings of PCIT while adding sessions to cover psychoeducation about trauma, carer response to a child’s trauma reactions (SAFE skills), and coping skills to aid both the child and the carer to manage trauma activators (COPE skills). The TDI module creates a consistent strategy for PCIT therapists to address trauma, thus allowing research and replication which will advance the dual fields of PCIT and family trauma. The theoretical conceptualization of TDI is presented along with next steps in its evaluation.
... Trauma is consistently linked to dysregulation in children (Kramer & Landolt, 2011;Ko et al., 2008); and when students present dysregulated behavior it often elicits a punitive response from adults in the classroom (Bath, 2008). However, the trauma-informed classroom views dysregulated behavior as an opportunity to teach about social-emotional competence and build a child's capacity to self-regulate without coercive measures (Anderson et al., 2015). ...
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This chapter reflects on some of the ways in which microMicroand macroMacro discourses interact with one another in society, both creating and perpetuating dominant ways of meaning-making that are culturally, historically, and politically mediated. We focus particularly here on the creation and sustainability of dominant discourses in relation to the concept of risk.
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Education has been historically branded as a tool to transcend conditions that have aided and abetted systems of generational and societal inequities. During a global pandemic, there has been no greater challenge to this view than considering the impact of life-altering events and their implications on higher education, success, and thriving. Specifically, the COVID-19 crisis has put this health-based issue on an international stage, but more specifically, spotlighting how it has exacerbated issues such as poverty, hunger, homelessness, and educational attainment. This chapter will examine the existing literature around the issue of global pandemics on college attainment for college students who are resource and access-gapped and best practices to consider to support holistic success during a global pandemic.
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This study is a phenomenological investigation of the emotional challenges of international students experiencing the 76-day lockdown in Wuhan during the early stages of the COVID-19 epidemic in China. This study employed the psychological concepts of stress, fear, and uncertainty to understand international students' risk factors and psychological symptoms during the Wuhan lockdown. Hence, this research assessed a) the emotional challenges associated with the lockdown and b) major sources to cope with emotional challenges. The overarching scholarly conversations are about diverse forms of emotional distress, such as stress and anxiety about their physical health and the social support from various sources at host universities and local communities, including students, teachers, administrators, and the students' respective embassies. Overall, the current study has theoretical and practical implications and offers a guideline for administrative practice in international higher education and international student migration.
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Trauma informed care (TIC) emphasizes the importance of professionals maintaining an emotionally regulated state. We interviewed eight staff members in a residential care unit for children and adolescents where TIC had been implemented, about situations wherein they experienced difficulty regulating their own emotions. We identified three major narratives in informants’ descriptions: (1) “Are we doing the right things?”, (2) “My childhood issues surfaced”, and (3) “Missing togetherness with trusted others.” The narratives illustrate the emotional strain that can be evoked when working in residential child welfare settings, and within TIC frameworks, and point to potential challenges to resolve when implementing TIC in similar organizations.
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Objective: In 2017, a Northern Territory PHN funded pilot program integrating psychology into remote Aboriginal Health Centres, was launched at Julanimawu Health Centre at Wurrumiyanga, Bathurst Island, Tiwi Islands (pop.1600). Psychology was identified as the allied health approach most attuned to the influential socio-cultural needs of Australian Aboriginal people when negotiating health care and effecting behavioural change; namely, providing a time rich, systemic, behaviourally focused, empathic perspective with a story telling method. Method: The program was designed to address the psychological needs of the community through two clearly stated pathways: supporting and educating the staff of the Health Centre on the effects of trauma, and providing a psychological service directly to the community. The psychologist recorded program participant demographic information and kept a diary that acknowledged the program intentions in relation to her experience. Results: Overall, the pilot program demanded non-traditional responses in a non-traditional psychology setting and the capacity to maintain equilibrium without expectation in the face of intergenerational trauma. Aboriginal culture impacted significantly on psychological practice, resulting in a process of decolonisation. The psychologist responded to different perceptions of time, resources, communication, connection and obligation and championed the Social Emotional Wellbeing approach to Aboriginal health. On a systemic level, while the program model recognised that behaviour largely determines health outcomes, the program outcomes suggested that culture largely determines behaviour. Conclusions: A Social Emotional Wellbeing approach is highly applicable, however, the approach requires champions to further support integration into the Health Centre system. Key Points What is already known: • The health and wellbeing of Australian Aboriginals is impacted by the consequences of colonisation. • The integration of psychology into health care is beneficial when addressing trauma related health issues. • Behaviour largely determines health outcomes. What this topic adds: • Behaviour largely reflects culture. • Decolonising psychology requires an active process contingent on cultural knowledge. • Privileging the multi-dimensional connections of social emotional wellbeing is a pathway forward.
Article
The purpose of this study was to examine the effect of occupational therapy group intervention using Trust Based Relational Intervention® (TBRI®) Nurture Groups© on preschool children’s social, emotional, and behavioral development in a Head Start program. This study used a retrospective mixed method, quasi-experimental design with non-equivalent groups and pretest-posttest measures. The intervention site teaching staff participated in 16 hours of TBRI® Caregiver training and the children participated in 12 weeks of Nurture Group© interventions. The Strengths and Difficulties Questionnaire (SDQ) and Teaching Strategies GOLD® (TSG) assessment measured child development in social, emotional, and behavioral domains. The intervention site teaching staff participated in a focus group to determine their perceptions of the intervention’s effectiveness. This data was evaluated using grounded theory methodology. SDQ: The children experienced statistically significant changes in the emotional symptoms and prosocial behavior domains. TSG: Results indicated a statistically significant main effect of site on objectives of Forms Relationships with Adults, Responds to Emotional Cues, and Balances Needs & Rights of Self and Others. Themes identified from qualitative analysis illustrated how the teachers highly valued the TBRI® training and adapted their teaching strategies to incorporate the TBRI® principles of empowering, connecting, and correcting. Teaching staff reported increased perceived social-emotional skills in the children and detailed how the children’s behavior changed to demonstrate these skills. Occupational therapy group intervention supports the social-emotional development of children attending Head Start. Occupational therapy practitioners need to engage in universal and targeted approaches to promote resiliency in this population of at-risk children.
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This chapter examines the effect of trauma on brain development and the subsequent impact in the academic setting. Childhood trauma is overwhelmingly common and has repeatedly been noted to have serious detrimental effects on children's developmental trajectories. Adolescents with trauma histories have a number of affected skills of which educators need to be especially aware. These skills include learning, memory, executive function, and emotion regulation. Fortunately, educators have a number of instructional practices at their disposal to help children with trauma histories, including classroom-level strategies like stimulus variation and structure and routine, coupled with high expectations. It is suggested that trauma-informed practices be implemented at the classroom and school-wide levels.
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This is an exciting time for Year 7 students as they see their friends again, and move up to secondary school. However they will arrive back at school with a very wide variety of experiences, losses and learning over the pandemic period. These will not necessarily align with socio-economic background or prior attainment as communicated by their primary school. Many, especially those with particular learning needs, or from badly-hit groups, will feel particularly insecure or concerned after missing usual year 6 transition routines, and having experienced little ‘normal’ schooling over the previous 6 months. Those with the greatest concerns or with experience of significant trauma may not be able to accommodate new expectations, or concentrate, as well as they normally would. Some might even worry about the size and noise of a secondary school more than usual. Reduced physical activity also threatens wellbeing further. Here teachers can help, by demonstrating positive expectations and providing opportunities for physical engagement with learning where possible. The emphasis here should be on student and teacher welfare rather than seeking learning gains in isolation, in the context of everyone adapting to a new way of approaching schooling.
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In the present paper, we discuss three challenges with the Norwegian Child Protective System (CPS) that might have contributed to the recent criticism from the European Court of Human Rights (ECtHR). First, how to balance the rights of the child with those of the parents. Second, the psychological field’s influence on the interpretation of what constitutes the best interest of the child, and third we describe several missing links in the CPS work. Throughout the paper, we find indications of a well-developed Act, but a less optional CPS practice. Likewise, we find evidence for a narrow interpretation of the best interest of the child related to CPS and expert psychologists’ application of attachment theory, and several organizational and educational shortcomings in the area of CPS. We conclude that the child is not fully seen as a legal subject in the eyes of the ECtHR, and that more research into CPS measures and organization are needed to better deliver adequate assistance to vulnerable families.
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This qualitative case study aimed to explore environmental circumstances and interactional processes that appeared to be relevant for the dynamics of resilience in adolescents exposed to child abuse. Fieldwork at a learning and coping centre for children and their families was combined with semi‐structured interviews with adolescent participants aged 12 to 18 years. A critical realist approach was used to unpack what has been called the ‘ordinary magic’ of resilience. We found that intensively validating qualities of both the environment and relationships seemed to be driving components for resilience. Borrowing ideas from the sociometer theory, we propose that particularly the consistent intensiveness may offer a recalibration of the adolescents' immediate life‐worlds, in terms of how they perceive the people they meet and the environments they step into. In keeping with the transactional‐ecological model of resilience, we suggest that such a recalibration leads to altered social agency that becomes visible through their immediate social participation.
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This chapter provides background on rural culture and the influence it has on the implementation of trauma-informed care. The cultural characteristics create additional obstacles to schools that are working to mitigate the adverse experiences that have debilitated many students. The poverty and drug use that families face has created a generation of children who struggle with chronic stress from the adverse childhood experiences that occur in their lives. This impedes all academic and many functional areas. Without appropriate education, teachers are often unable to reach students and misunderstand why students with multiple adverse experiences display behaviors. The authors share strategies to mitigate the impact of the adversities.
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The perpetration of murders by juveniles (individuals under age 18) has been a serious concern in the United States since the 1960s. As a result of four decisions by the United States Supreme Court during the 21st century, the likelihood that juvenile homicide offenders will be released back into society is substantially higher than it was in the year 2000. Given these changes in sentencing policies and practices, understanding why youths under 18 engage in homicidal behavior is more important than ever for two reasons: to prevent juveniles from killing in the first place and to determine whether their reasons for killing are related to post‐release outcome. This research is a part of a 35‐year follow‐up study of 59 boys, age 14 to 17, who were convicted of murder or attempted murder, and sentenced to adult prisons in a southeastern state. Twenty of these men discussed the reasons for their involvement in murder in person in a second interview conducted by the author 35 years after her first interview with them. These men's reasons for engaging in serious homicidal behavior reflected both psychological and sociological factors. Although the type of explanation for criminal involvement was not significantly related to post‐release outcome, some interesting patterns were discernible. The implications of these findings, limitations of the study, and suggestions for future research are discussed.
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Innovations in the trauma-informed care (TIC) field have promised to transform youth-serving institutions by asking practitioners to pay attention to the developmental needs of young people facing maltreatment. Despite notable TIC innovations, our knowledge about childhood trauma tends to be adult-centric, presenting youth as passive recipients of (rather than active agents responding to) harm. How 27 high school students made sense of childhood trauma emerged during an 11-year ethnographic study of students in a school-based counseling program in Oahu, Hawai‘i. To overcome hardships, the teens constructed what they believed to be strong, resilient, and respectable identities, although teens’ identity performances differed. Adolescents’ narratives highlight sociological understandings of trauma survival whereby youth creatively negotiated their sense of self and drew from ideologies embedded in larger institutional contexts.
Article
Although the past research has indicated that features of borderline personality disorder (BPD) increase the risk for violence, much less research has examined the mediators of this relationship. This study examined the mediating roles that impulsivity and emotion dysregulation may play in explaining the relationship between BPD and violence. The Pathways to Desistance data were used in analyses. Generalized structural equation modeling was used to estimate the direct effect of BPD features on violent offending risk and to examine the mediating roles of emotion dysregulation and impulsivity. Results indicated that the direct effect of BPD symptoms on violence was mediated to non‐significance by key constructs, and the magnitude of the effect was reduced by around 40%. The total indirect effect was significant, and the mediation was attributed mainly to impulsivity. This indicates the importance of structuring treatment programming for BPD patients around impulsivity for reducing violence. Programming focused on improving impulsivity among individuals suffering from BPD may aid in reducing violent offending among this population, particularly those prior histories of involvement with the criminal justice system.
Article
Objective: Evidence of poor sleep health among children in foster care continues to mount, but information about whether and how sleep problems are addressed is unavailable. The goal of this study was to begin to fill these significant knowledge gaps. Methods: Four hundred eighty-five foster caregivers from across the United States completed a survey focused on the sleep health of one child, 4 to 11 years (M = 6.4; SD = 2.2) currently in their care. Caregivers provided quantitative and qualitative responses to questions regarding training, information, and services received in relation to their child's sleep. Caregivers also reported on the factors and strategies they perceived as most important for helping children in their care sleep well. Results: Only 13% of caregivers reported receiving any information/education about sleep from agencies or case workers, whereas 55% had sought help from a health provider related to their child's sleep. Nearly half of all caregivers (46%) reported giving their child melatonin. Caregivers reported that a bedtime routine/consistency, reassurance of safety/love, and a calming environment were most important for helping their child sleep well. A recurrent theme in qualitative responses was a need to mitigate child fear/anxiety at night. Conclusion: Children in foster care face a range of risk factors that increase the likelihood of poor/insufficient sleep, but these findings suggest this critical aspect of health requires greater clinical and research attention. As these data were collected during the initial months of the COVID-19 pandemic, replication studies are necessary.
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Foster carers require high-quality training to support them in caring for children with trauma-related difficulties. This paper describes a mixed methods approach that was applied to evaluate the complex intervention Fostering Connections: The Trauma-Informed Foster Care Programme, a recently developed trauma-informed psychoeducational intervention for foster carers in Ireland. A quantitative outcome evaluation and a qualitative process evaluation were integrated to capture a comprehensive understanding of the effects of this complex intervention. A convergent mixed methods model with data integration was used. Coding matrix methods were employed to integrate data. There was convergence among component studies for: programme acceptability, increased trauma-informed foster caring, improvement in child regulation and peer problems, and the need for ongoing support for foster carers. This research provides support for the intervention suggesting the importance of its implementation in Ireland. The integrative findings are discussed in relation to effects and future implementation.
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Policy Points In order to achieve successful operationalization of trauma‐informed care (TIC), TIC policies must include conceptual clarity regarding the definition of both trauma and TIC. Furthermore, TIC requires clear and cohesive policies that address operational factors such as clearly delineated roles of service providers, protocol for positive trauma screens, necessary financial infrastructure, and mechanisms of intersectoral collaboration. Additionally, policy procedures need to be considered for how TIC is provided at the program and service level as well as what TIC means at the organizational, system, and intersectoral level. In order to achieve successful operationalization of trauma‐informed care (TIC), TIC policies must include conceptual clarity regarding the definition of both trauma and TIC. Furthermore, TIC requires clear and cohesive policies that address operational factors such as clearly delineated roles of service providers, protocol for positive trauma screens, necessary financial infrastructure, and mechanisms of intersectoral collaboration. Additionally, policy procedures need to be considered for how TIC is provided at the program and service level as well as what TIC means at the organizational, system, and intersectoral level. Increased recognition of the epidemiology of trauma and its impact on individuals within and across human service delivery systems has contributed to the development of trauma‐informed care (TIC). How TIC can be conceptualized and implemented, however, remains unclear. This study seeks to review and analyze the TIC literature from within and across systems of care and to generate a conceptual framework regarding TIC. Our study followed a critical interpretive synthesis methodology. We searched multiple databases (Campbell Collaboration, Econlit, Health Systems Evidence, Embase, ERIC, HealthSTAR, IPSA, JSTOR, Medline, PsychINFO, Social Sciences Abstracts, Sociological Abstracts and Web of Science),as well as relevant gray literature and information‐rich websites. We used a coding tool, adapted to the TIC literature, for data extraction. Electronic database searches yielded 2,439 results and after inclusion/exclusion criteria were applied, a purposive sample of 98 information‐rich articles was generated. Conceptual clarity and definitional understanding of TIC is lacking in the literature, which has led to poor operationalization of TIC. Additionally, infrastructural and ideological barriers, such as insufficient funding and service provider “buy‐in,” have hindered TIC implementation. The resulting conceptual framework defines trauma and depicts critical elements of vertical TIC, including the bidirectional relationship between the trauma‐affected individual and the system, and horizontal TIC, which requires intersectoral collaboration, an established referral network, and standardized TIC language. Successful operationalization of TIC requires policies that address current gaps in systems arrangements, such as the lack of funding structures for TIC, and political factors, such as the role of policy legacies. The emergent conceptual framework acknowledges critical factors affecting operationalization.
Article
University libraries struggle to keep up with rapidly changing technology and the associated change in teaching strategy. Most administrators and librarians are often not trained to assess space needs and struggle to reassign library spaces for non-traditional library use. As such, they often embark on expensive and time-consuming feasibility studies, using (typically) hard-earned monies to complete the research or to pilot a new space. What academic research library administrators and staff lack is guidance for discovering and planning needed renovations and improvements in aging library facilities. The purpose of this research project was to develop a set of considerations that can be used by library staff to self-analyze existing academic library spaces and identify areas that can be effectively improved for student benefit. The end result is a series of hierarchical self-analysis space considerations with a structured framework based on Abraham Maslow's Hierarchy of Needs. The results of this research use evidence-based design to facilitate important conversations, and provide an organized quick reference checklist of various considerations for library administrators and facility managers as they navigate the world of twenty-first century pedagogy and student learning.
Conference Paper
One of the challenges for young people who have been forcibly displaced is the maintenance and production of identities across distance and in response to change. For them, settlement coincides with a life stage critical to personal and social identity development (Erikson, 1968; Kennedy & MacNeela 2014, Marcia, 1980). This paper explores how young men from Hazara backgrounds living in Australia, respond creatively to that challenge through their uses of social media. I will specifically be looking at their use of Facebook. I argue that social media platforms act as a mediator of mobile identities for young Hazara men. Looking at the ways these young men use social media as a daily practice, it becomes possible to see how young migrants are creating and maintaining identities over time and place. These platforms provide a space for multiple aspects of their lives to be kept in one place and are accessible wherever they find themselves. These young migrants who have experienced mobility and forced displacement (Wilding 2012), use virtual spaces to maintain various aspects of their lives when their own geographic positioning is in flux.
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Background Uganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda. Methods We conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis. Results Participants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse. Conclusions Our findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships.
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Defining trauma is an individualized process that includes looking at events, experiences, and effects. Best practices explicitly state the importance of an individual's experiences when defining trauma. Therefore, solely utilizing a professional lens for discussion is often inappropriate. The purpose of this chapter is to examine trauma and trauma-informed care through both a professional and personal lens. Research on outcomes for children internationally adopted or living in foster care will be intertwined with personal narrative. Erikson's theory of psychosocial development will be the lens to examine how trauma affects life and learning as children grow and mature. Finally, specific anecdotal strategies will be shared that either provided or negated support on how potentially to navigate public and higher education systems in the United States.
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