In so doing, both perceived explicit (Cronbach’s αs across the studies ranged from 0.93 to 0.94), and ambiguous (αs ranged from 0.93 to 0.95) discrimination were assessed. Participants for each of Studies 2–4 were recruited through advertisements posted on various websites, newspapers and community flyers, and signs posted on public bulletin boards of community centers, service organizations, and workplaces. Thus, this study (and the two that follow with Jews and a diverse sample of women) further assessed perceptions of discriminatory experiences that were explicit as well as those that were more ambiguous in intent. Not only did a substantial number experience such stressors, the intergenerational effects of historical trauma might also prevail.

While around 30% of the studies focused on services and education for children, they were Culturally competent care for LGBTQIA+ youth conducted in diverse populations and settings, using a myriad of methods. For example, the Institute for Trauma and Trauma-Informed Care has estimated that child abuse costs more than USD 5 trillion, and the Washington Family Policy Council states that it is possible to save USD 1.4 billion over a decade if TIC is used in social services and schools . This is very much needed according to the European Parliamentary Assembly , which demands that psychiatry ends coercion and calls for a human-rights-based approach, which TIC is. However, there is a paucity of studies implementing TIC in other countries, e.g., in Europe, although there is growing interest in this area due to its high success rates in reducing coercive practices . We provided an overview of 157 studies identified from more than 3000 papers, focusing on their settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used.

Racialized Migrant Transgender Women Engaged in Sex Work: Double Binds and Identifications with the Community

We also plan to develop international fieldwork placements in trauma psychology to help support efforts at the global level and provide much needed training opportunities for students/clinicians who wish to pursue this line of practice. We plan to liaise with and help support the efforts of the greater APA body and international organizations on their work pertaining to diversity and multicultural issues. To this end, we have created seven workgroups tasked to create factsheets with the most up-to-date research on trauma exposure, risk and protective factors, PTSD and other trauma-related disorders, and treatment among diverse/multicultural populations. In addition, we need more research and interventions centered on the perspectives of marginalized individuals and giving voice to these perspectives. Strategies to reduce barriers may include increasing access to trauma-informed programs; additional training in multicultural competence among service providers; increasing multicultural programs and staff; and matching of clients and therapists if preferred and feasible (Brown, 2008; Carter, Mitchell, & Sbrocco, 2012; Ford, 2008; Marsella, 2010; Roysircar, 2009). Allow utilization of Medicaid behavioral health funding to provide trauma-informed behavioral health support within public assistance and programs to improve health and economic security.

Impact of social unrest

Cultural lands is the third trauma-impacted resource, and refers to the material resources (e.g., physical property, housing, healthy foods, transportation, wealth) necessary to sustain health in a given society. For instance, the Western colonization of Hawai’i wrought sweeping changes to Hawaiian social and cultural order through oppressive policies that destroyed native cultural modes including the banning of the Hawaiian language, prohibiting traditional spiritual ceremonies and rituals, and mixing sacred male and female work and living roles (Bushnell, 1993; Cook et al., 2003). In addition, according to Evans-Campbell’s (2008) historical trauma framework, the devaluing/destruction of cultural modes by a dominant group may profoundly shift cultural roles and identities, leading some survivors to experience elevated suicide, depression, substance use, chronic grief, and PTSD susceptibility (Brave Heart et al., 2011; Cook et al., 2003; Duran et al., 1998). Kitayama et al. (2007) define ‘cultural modes of being’ as a group’s languages, norms, customs, values, and artifacts that construct both the internal and social worlds of group members.

• Furthermore, refugees often lack medical insurance and access to needed services.
• In addition, resources will be needed to develop valid systems-based measures of trauma-informed practice (Champine, Lang, Nelson, Hanson, & Tebes, 2019) and create data systems and local data infrastructures to support large-scale population health initiatives.9
• Unfortunately, targeting cultural trauma using these therapeutic and structural approaches alone places the onus on the oppressed to “fix the problems” created by dominant groups’ traumatizing behaviors.
• Various models of social work advocacy assist social workers in the intricate work of advocating for rights on behalf of service users.
• In the other case, Amanda decided to approach the Execution System manager directly, and together with a colleague and Sarah, as an expert by experience, was able to create immediate change.
• The most frequently assessed psychological outcome was PTSD, which was examined in 23 out of the 32 studies 17,20–27,31,33,35–39,41,42,44–48.

Policy, practice, and education efforts should include a focus on positive experiences, such as an individual’s strengths, resilience, and empowerment. In 2018, SAMHSA’s Interagency Task Force on Trauma-Informed Care was established to collate existing evidence, develop best practices, and make recommendations for ways federal agencies can better support and coordinate their response to families impacted by trauma.42 Future research should continue to evaluate the critical elements of TIC for effectiveness and the optimal sequencing of implementation. Our results underscore that investing in workforce development by providing ongoing staff education that enhances skills and improves knowledge related to the impact of trauma on health is fundamental to the successful integration of TIC throughout an organization. Using comprehensive models for larger-scale organizational cultural changes requiring more resources upfront can create longer-term and “deeper” changes to organizational culture that can result in cost savings (eg, increased cost-effectiveness, decreased staff turnover, and improved health care utilization).17 Delivering TIC is a strengths-based approach, which is a method that focuses on abilities, knowledge, and capacities rather than deficits.30 This approach can lead to the broad engagement of patients, especially those in marginalized populations, and can also promote a culturally competent workforce. Interprofessional health care teams equipped with physicians, nurse practitioners, physician assistants, pharmacists, social workers, psychologists, registered dietitians, patient navigators, and others work together to provide a more comprehensive understanding of a patient’s condition by sharing perspectives from their respective disciplines, which can help to improve practitioners’ overall understanding of patients’ psychosocial and health needs, enhance trust between the patient and practitioners, and maximize patient safety and quality of life.31

A population health perspective to trauma and its sequelae also redirects the focus away from clinical practices alone to prioritizing a multi-modal strategy of research and intervention that emphasizes risk prevention, health promotion, and policy development (Bachrach & Daley, 2017; Herrenkohl et al., 2015; Matlin et al., 2019). Finally, evidence from large-scale implementation of community-wide prevention trials, such as Communities that Care (CTC) (Hawkins, Oesterle, Brown, Abbott, & Catalano, 2014) and PROSPER (Spoth, Greenberg, Bierman, & Redmond, 2004), also have shown the benefits of a population health approach because of their respective impact on the population prevalence of various risk behaviors. These effects undoubtedly have positive cascading impacts on health to reduce eventual trauma exposure from any number of macrosocial determinants of health. That report appeared to echo George Albee’s seminal work in prevention, commissioned by the President’s Commission on Mental Health in 1961, that showed how investments in mental health treatment alone were insufficient to meet the mental health needs of the general population (Albee, 1959).