Healing Horizons: Weekly News & Research - August 29, 2024
Welcome to our weekly news show, Healing Horizons, hosted by experts Bri Twombly and Alison Cebulla. Dive into the most recent updates on trauma-informed care practices, positive and adverse childhood experiences, and the critical concept of psychological safety. Each episode is designed to keep you informed on the latest research, trends, and best practices in these essential areas. Whether you're a healthcare professional, educator, or simply passionate about mental health, our show provides valuable insights and practical advice. Stay tuned for in-depth discussions and expert interviews that will enhance your understanding and application of trauma-informed care and psychological safety.
Here are the news stories and research we featured:
The Australian Government is investing $10.6 million to ensure that Victim-survivors of family, domestic and sexual violence living in the Central Coast and Moree regions of New South Wales will have access to free, specialised mental health support close to home.
The pilot recognises that victim-survivors of violence need support well beyond the initial crisis response, to continue their physical and mental health recovery. The Supporting Recovery pilot will provide case management, care coordination and trauma-informed mental health care to victim-survivors of FDSV, up to two years.
Macon Mental Health Matters receives funding to provide free support services in community
Mayor Lester Miller said “Mental health wellness is something we need to normalize, and I think we have been getting closer to that, thanks to the work MMHM does. We are proud to continue funding this initiative so everyone can get the resources they need without any barriers.”
Plans for the upcoming year include another Adverse Childhood Experiences (ACEs) study, starting a Mental Health Symposium, and more.
From MMHM’s website “Understanding and addressing ACEs is crucial for fostering a healthier, more resilient community. At Macon Mental Health Matters, we are dedicated to comprehensively studying ACEs within our community. Our inaugural ACES report goes beyond traditional surveys, offering a trauma-informed approach to understanding the impact of these experiences. We not only collected data but also provided participants with empowering tools, practical mental health techniques, and personalized support through our unique “Teranga” counseling sessions.”
New Hanover County officials celebrate Community Justice Center, set to open in a few weeks
District Attorney Ben David unveiled the Community Justice Center, which will assist survivors of trauma and adverse childhood experiences through wraparound services from law enforcement, prosecutors, and counselors.
David says the goal is for those working in the criminal justice system to collaborate together, not only to respond to crime, but to prevent it through community involvement.
There are over 100 family justice centers around the country, but David said what distinguishes this center from its counterparts is the focus on healing adverse community experiences along with adverse childhood experiences (ACEs).
“It really takes all the areas of outreach… around this idea that the social determinants of health are the same thing as the root causes of crime, and when we make people healthier, we make them safer,” David said.
Trauma-informed tattoo artists combine ink with empathy
A more mindful approach to tattooing is an emerging trend in the industry and across Greater Boston. In a more general sense, several parlors incorporate customer-facing language that relays inclusivity, safety, and client agency on their websites and social media.
The individual concept of trauma-informed artistry spans education and practices centered on consent, empathy, PTSD, and trauma-adjacent challenges that can arise during body modification. Some tattoos also come with emotional weight, and an artist must then generate a permanent, physical reminder of a design’s deeper meaning.
Here’s What the CDC’s New IUD Pain Management Recommendations Mean for Patients
Intrauterine devices, or IUDs, are an increasingly popular form of birth control, but getting one placed is often a painful experience. According to one recent study, 78 percent of patients who had an IUD inserted described the pain during the procedure as either moderate or severe. On social media, 97 percent of the TikTok videos tagged with #IUD include complaints about pain.
Those complaints led the Centers for Disease Control and Prevention to update their guidelines on pain management during IUD placement procedures earlier this month.
“There has been increasing awareness about the pain patients experience during the procedure, and there is a history of women’s pain not being taken seriously,” says Dr. Robyn Schickler, the chief medical officer of Planned Parenthood of Southwest and Central Florida. “We’re seeing a cultural shift thanks to social media, where more people are sharing their experiences. The research is confirming what many women with IUDs already knew—the discomfort during placement can be much more than just ‘a little cramping.’”
The introduction of sedation services is seen as a crucial step in making IUD placement more accessible and comfortable. “Sedation services break down barriers, allowing patients to receive care in a way that’s more comfortable and empowering for them,
The release of the new guidelines is part of a movement toward implementing trauma-informed care in many different areas.
International Journal of Mental Health Nursing, August 2024
The research aim was to explore the literature related to trauma-informed supervision in nursing to answer the question 'what skills and strategies can a supervisor use to support nurses who provide TIC in adult populations?'. An integrative review method was used and identified fifteen published articles for inclusion.
Analysis revealed three themes that were developed into an emotion-cognition-action sequence;
create a safe supervisory relationship;
facilitate TIC learning; and
build resilience.
Discussion noted the intersection of review findings with the Supervision Alliance Model and TIC framework, and where other skills may be integrated to inform a trauma-informed supervisor.
Actions towards strengthening emotional intelligence and resilience were described and parallels drawn to how these same resilience-building practices also strengthen one's relational skills, helping the populations served.
Polyvictimization:experiencing multiple types of trauma
BMC Public Health, August 2024
10,674 nurses, midwives and carers participated and 5,982 participants had experienced at least one type of lifetime violence; half had experienced two or three types.
Survivors of child abuse were three times more likely to experience both intimate partner violence and non-partner adult sexual assault.
Any violence was associated with poorer health and well-being, and violence in the last 12-months was associated with the poorest health and well-being
The findings demonstrate the need for more accessible and effective workplace interventions to prevent and mitigate psychosocial ill health, especially in the recent aftermath of violence.
How Better Health Strategies Could Reduce Juvenile Crime
JAMA Health Forum, August 2024
Despite data showing a fairly steady decline in violent and major property crime in the US since the 1990s, the public perceives that crime is now on an upward trajectory.
As a result, many states and cities have passed or are considering laws aimed at deterring delinquency, such as curfews and stiffer penalties. But punitive approaches often ignore the relationship between psychological trauma and adolescent brain development, and how such trauma can increase the probability of criminal behavior as well as depression and other mental health conditions.
Appreciating that ACEs can affect judgment and behavior, courts are increasingly turning (especially for first-time offenders) to pretrial diversion programs that address education, health, or other risk factors in the least restrictive setting. The goal is to reduce recidivism by improving the young person’s health and education trajectory, and perhaps living circumstances.
There are still many barriers to preventing behavioral health conditions that can lead to crime and incarceration.
funding and staffing shortages often impede progress.
Poor integration of behavioral health and child support services, such as the foster care system, may result in some youth not receiving needed services and increases the likelihood of later rearrest and incarceration.
Researchers noted a possible solution to this as shown by Arkansas who recently produced a roadmap based on collaboration between Medicaid, child welfare, and the juvenile legal system to coordinate services.
Although a juvenile might normally be eligible for Medicaid or the Children’s Health Insurance Program (CHIP), the inmate exclusion rule prohibits them from receiving health services under those programs. Thus, any previous treatment is interrupted and released youth are less likely to obtain treatment—and thus are more likely to become repeat offenders.
Fortunately, at the beginning of 2025, new changes will authorize Medicaid and CHIP to cover certain services just before and after their release, including behavioral health screenings and case management.
In health care, it is important to look upstream and address factors that lead to ill health rather than focus only on treating its consequences. This approach includes recognizing and dealing with factors such as child abuse, neighborhood gun violence, and other traumas that can lead to crime, especially crimes committed by children.
The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis
BMC Medicine, August 2024
In this systematic review and meta-analysis, we aimed to identify, synthesise, and quantify the current evidence linking ACEs and multimorbidity.
From 15,586 records, 25 studies were eligible for inclusion (total participants = 372,162)
This is the first systematic review and meta-analysis to synthesise the literature on ACEs and multimorbidity, showing a dose-dependent relationship across a large number of participants. It consolidates and enhances an extensive body of literature that shows an association between ACEs and individual long-term health conditions, risky health behaviours, and other poor health outcomes.
Although 25 years have passed since the landmark Adverse Childhood Experiences Study by Felitti et al. [3], there is still no consistent approach to determining what constitutes an ACE. This is reflected in this review, where fewer than half of the 58 different ACEs (n = 25, 43.1%) were reported by more than one study and no study reported more than 15 ACEs. Even ACE types that are commonly included are not always assessed in the same way [67], and furthermore, the same question can be interpreted differently in different contexts
ACE research is often based on ACE counts, where the types of ACEs experienced are summed into a single score that is taken as a proxy measure of the burden of childhood stress. The original Adverse Childhood Experiences Study by Felitti et al. took this approach [3], as did 17 of the studies included in this review and our own quantitative synthesis. At the population level, there are benefits to this: ACE counts provide quantifiable and comparable metrics, they are easy to collect and analyse, and in many datasets, they are the only means by which an assessment of childhood stress can be derived. However, there are clear limitations to this method when considering experiences at the individual level, not least the inherent assumptions that different ACEs in the same person are of equal weight or that the same ACE in different people carries the same burden of childhood stress.
BMC Psychology, August 2024
Researchers drew data from a sample of 888 mother-child dyads in rural Pakistan, to investigate these associations among 6-year-old children in a South Asian, low-resource setting.
90.5% of children experienced at least one trauma.
The most common traumas were death of a loved one (47%) and hearing about war/terrorism on the TV/radio (48%).
On average, boys experienced more traumas than girls.
Specifically, boys were more likely than girls to experience an injury or hospitalization and to hear about war/terrorism on the TV/radio.
Trauma was associated with increased mental health difficulties and increased anxiety scores.
There was little evidence that trauma exposure was associated with child cognitive skills.
Results suggest that trauma-informed interventions are important for supporting child mental health in South Asia.
Translational Psychiatry, August 2024
comfortable interpersonal distance (CID) – the physical distance humans prefer towards others during social interactions.
2986 adults with varying cultural backgrounds, residing in various countries.
Higher childhood maltreatment was linked to a larger comfortable interpersonal distance towards both friends and strangers. Moreover, insecure attachment and less social support were associated with larger comfortable interpersonal distance.
These findings demonstrate for the first time that childhood maltreatment affects comfortable interpersonal distance across countries and cultures.
Interrogating and Uprooting Systemic Racism in the Emergency Department
JAMA Health Forum, August 2024
Researchers discussed examples of systemic racism in the ED
Analyzing more than 300 000 ED visits, this study found marginalized populations were more likely to be bypassed and less likely to bypass others.2 Although some of these queue jumps may be clinically appropriate, such as patient deterioration, others provide an example of interpersonal racism in which subconscious biases may affect triage decisions resulting in queue jumps and differential wait times by race and ethnicity.
A study5 reported Black patients being flagged for violent or disruptive behavior at higher rates, leading to less time spent in the ED and a higher overall discharge rate.
Another systemic issue is the lack of training in trauma-informed care for managing patient behavior and understanding the underlying drivers for aggressive or inappropriate behavior. Without such training, staff may flag “behavioral or violent issues” without considering root causes and thus perpetuate inequities. In fact, at a structural level, patients who are marginalized, particularly those exposed to trauma throughout their lives, are more likely to have a psychiatric illness that manifests as behavioral issues in the ED
Partnering with historically marginalized populations to design solutions and strategies to address disparities can rebuild trust and challenge health systems to confront their biases, ensuring care is equitable and responsive.
Suggested goals:
Diversifying the ED workforce:
Enhancing transparency in ED care processes and goals
Building trust between marginalized communities and the EDs serving them
BMC Public Health, August 2024
A total of 36,485 participants (50.7% female, grades 7–12), were included
Findings showed that, when compared to students who endorsed low or no substance use, those who reported having adult social support demonstrated a 58% reduction in odds of reporting high substance use after Hurricane María, while students who reported having teacher/counselor social support demonstrated a 21% reduction in odds of reporting high substance use.
those who reported having peer social support demonstrated a 31% increase in odds of reporting higher substance use, compared to those who reported low or no substance use.
While social support was generally protective, prevention efforts to build positive family and community connections may be indicated.
The International Journal of Sport and Society, April 2024
researchers analyzed semi-structured interviews with twenty-nine coaches and sports leaders to ask: “what are the specific leadership and coaching practices that foster psychologically safe and high performance sports environments
This study posits that performance, health, and well-being are not mutually exclusive and discerns practices, structures, and behaviors that can foster both safety and performance in sport.
Findings also build on and adapt Tim Clark’s four stages of psychological safety framework to a sports context by highlighting the importance of ‘being and belonging’ as a basis for contributing, which is essential for individual, team, organization, and system learning, and lays the foundation for “challenging” norms and assumptions to optimize human performance and enable system transformation.
Skills Training Links Psychological Safety to Revenue Growth
MIT Sloan Management Review
Organizational performance can be improved by viewing psychological safety as a trainable skill that individuals develop with practice.
Training in psychological safety skills to increase perspective-taking — that is, intentionally putting aside one’s own perspective to envision another’s viewpoint, motivations, and emotions.
Skills-focused interventions involving senior leaders can be an effective way to get important work done by creating a climate of psychological safety that is enabled by perspective-taking in the context of a team’s actual work. This approach promises long-term benefits such as greater innovation, faster transformation, and improved inclusion, as well as short-term measurable performance gains — which are perhaps more important in terms of creating momentum for change.
