Question

Article in a healthcare initiative in any state or community that reflects the concepts ACEs and toxic stress as a problem for just one community or another and is designed to address healthcare disparities among multicultural, multi-ethnic, and marginalized patient populations in a community?

Thoughts about the viability of this initiative "ACEs" for decreasing health disparities as a means of trauma prevention and future prevention of health problems. What Social Justice theoretical frameworks support the implementation of these changes?

How would this initiative affect the Primary care practices of providers (NP, MD,) in community?

Answer 1

Ans) Strategies to help reduce ACEs in families include promoting safe, stable, nurturing relationships and environments for children and families; emphasis on early prevention; and strengthening economic supports for families, such as earned income tax credits and family-friendly work policies.

- Multiple socioeconomic factors contribute to health disparities, including income, education, residential segregation, stress, social and physical environment, employment, and many others. Disparities according to income and education have increased for smoking, with low-income persons smoking at higher rates.

- The trauma-informed care paradigm has diffused across a range of practice settings, reflecting the reality that trauma contributes to a multitude of health and social problems. We have provided a framework extending these principles to social policy. Policy is fraught with compromise, and just as trauma-informed social service programs may not fully actualize all principles of trauma-informed care at all times, it is unlikely that any single policy or article of legislation would fully reflect all the principles outlined in this framework. The framework instead provides a conceptual ideal whose aspects policies on the ground may reflect to varying degrees.

- A commonality across all the principles of trauma-informed care is that their enactment implies a greater focus of attention and resources upstream in terms of the social determinants of health. Although there is a price tag attached to many of the upstream policy actions recommended by such analysis, it is possible that considerable financial savings—in addition to the prevention of human suffering—could be gained through policies that prevent trauma or mitigate its primary health consequences. Cost–utility analyses could be conducted of trauma-informed policy reforms in particular areas. Further analyses could use this framework to examine specific social policies in greater detail for their congruence with the principles we have outlined and to articulate directions for trauma-informed policy change. We believe that such subsequent analyses could yield valuable insight and directions for reform and implementation, whether applied to broad and expansive policies, such as the National Prevention Strategy, or more local and focused policies, such as university policies addressing sexual assault.

- Perhaps the most important implication of the framework we have proposed is that it can serve as a basis for guiding policy advocacy. Public health professionals, especially those who work with trauma-affected populations and communities, should encourage social policy to integrate a trauma-informed focus. To shape policy so that it better reflects the realities of practice and lived experience, it is critical that policymakers hear directly from those on the ground, including service providers and service users. Therefore, trauma survivors, those who might be considered at high risk for trauma, and people who provide services to these populations can aim to educate policymakers about the importance of the principles of trauma-informed care and how social policies can manifest them. The current reality is that even service providers delivering the highest quality of trauma-informed care must draw their clients from and release them to a society and a social order that are largely not trauma informed. Trauma-informed policy advocacy offers an avenue for gradually shifting this reality.

- Trauma and its repercussions are not equally distributed in society. Because marginalized populations are more likely to experience some types of current and historical trauma and generally have fewer resources with which to cope with trauma’s negative effects, shaping policy to be more trauma informed may have an especially meaningful impact on disadvantaged communities. Public health practitioners may find community-based participatory research tools such as photovoice and community capacity-building strategies useful when engaging communities in evaluating policy shortcomings, generating trauma-informed policy alternatives, and advocating policy action.

- Research interest in trauma and its consequences does not appear to be waning. With considerable recent media coverage, the link between trauma and many health and social problems appears to occupy a place of interest in the eye of the general public, researchers, and public health practitioners. Now, therefore, is an opportune time for public health and allied fields to expand on the shift toward trauma-informed care already underway in the service system and promote a parallel transformation in social policy. When social policy becomes more trauma informed, it will be more participatory, transparent, and collaborative, and it will be better able to promote the safety and empowerment of its target constituents and, ultimately, disrupt trauma-driven disparities in health and well-being.