Improved Prevention, Stronger Communities

Opportunity:

Strengthen families and communities through broad preventive efforts and adoption of trauma-informed practices so fewer families need social services.

Challenge:

Getting “upstream” in our solutions will require us to engage whole communities differently as we seek to build resiliency, promote preventative services, and adopt new behaviors as a nonprofit sector. Too often, families seek help only after they have experienced trauma. Wellness, particularly considering COVID-19 experiences, will require a preventative focus on addressing mental health and the negative stigmas associated with seeking help.

Portfolio Composition:

Investment of $1,485,000 in 14 partners

Trauma, or any event or series of events that causes significant stress, can come in many different forms. Through strong social support, coping abilities, and other protective factors, many people experience only short-term reactions to traumatic events.^[i] For others, traumatic experiences have lifelong impacts on their development, health, and overall well-being.^[ii] This is especially true for populations that disproportionally experience trauma, such as families living with low incomes.^[iii] By focusing on prevention, we can work to minimize the negative impacts of trauma and build well-being.

While it is important to build individual resilience, it is equally important to understand the role that families, organizations, and communities play in supporting well-being. Staff at many nonprofit organizations also experience trauma, or the effects of interactions with another person sharing their personal stories of abuse, trauma, or disempowerment.^[iv] This trauma is associated with detachment, burnout, or compassion fatigue.^[v] Individual staff experiences can build up within an organization and result in unhealthy characteristics across an organization, such as rigid or unfriendly boundaries, constant stress, or distrust. ^[vi]

At a community level, trauma aggregates and manifests into much larger symptoms that are interconnected with other community challenges, such as concentrated poverty, high violence or substance use rates, dilapidated infrastructure, damaged social networks, or low-performing schools. Those larger symptoms add additional stressors for families and communities. While the economic, social-cultural, and physical environments in communities can contribute to trauma, positive environments help prevent trauma and promote well-being.^[vii]

Focusing our efforts on “upstream” solutions that promote healing and resiliency for individuals, families, nonprofit organizations, and communities will build well-being and positive long-term outcomes for our region.

Key Driver: Supportive Communities (Influence Driver: Strong and Healthy Families) 

Area Pillars: Health and Wellness, Basic Needs

Trauma is a risk factor for nearly all behavioral health and substance use disorders according to Substance Abuse and Mental Health Services Administration (SAMSHA).^[viii]Instead of seeking help, many people choose to conceal their trauma because of internalized stigma, resulting in feelings of shame and efforts to manage it on their own.^[ix] As stated by Arthur Evans, CEO of the American Psychological Association (APA), when individuals have symptoms of trauma, like viewing the world as unsafe, it’s usually interpreted as “there’s something inside of me that’s wrong.” Approaches, such as trauma-informed care in social, provide a framework and the tools to flip this mindset. Instead of thinking something is wrong with them, “the idea of trauma helps people to understand that, no, this is something that is happening to me and how I’m responding is a natural response”, said Evans.^[x]

COVID-19 and the economic challenges resulting from it have negatively affected many people’s mental health. Prior research on economic downturns has shown associations with increased depression, anxiety, distress, and low self-esteem.^[xi] New anxieties and low, but constant stresses of COVID-19 have been felt across socioeconomic and geographic boundaries. The full, longer-term impact of these events on the mental health of Americans is yet to be understood.^[xii]

There are promising practices and research that trauma-informed care supports positive outcomes and well-being despite exposure to trauma, especially in children. Building resiliency, defined as “a dynamic process encompassing positive adaptation within the context of significant adversity”, can help heal the negative impacts of trauma, prevent recurrence of reactions despite further exposure, and help avoid traumatic experiences regardless of risk.^[xiii][xiv] Building resilient and trauma-informed communities is crucial for healing, treating adverse experiences, and building positive well-being.^[xv]

• NATIONALLY 

  • The average share of adults reporting symptoms of anxiety disorder and/or depressive disorder in January 2021 jumped to 41.1% compared to 11% averaged between January – June 2019.^[xvi]
  • Prior to the pandemic, 1 in 3 young adults (aged 18-25) experienced a mental illness and 1 in 10 experienced a serious mental illness. 1 in 5 young people reported that the pandemic had a significant negative impact on their mental health.^[xvii]

• LOCALLY 

  • Ohio was found to be of 5 states with the highest prevalence of children who experienced three or more adverse childhood experiences (ACEs), as many as one in seven children, placing them in a category of especially high risk.^[xviii]
  • A Cincinnati taskforce that is focused on addressing the increase in youth violence suggests supporting and expanding programs in schools that are trauma informed as well as exploring programs that train community volunteers on mental health wellness.^[xix]

Not only does stigma hold families back from seeking help, but reactive and punitive practices in systems of support can deter families from accessing help or create a “fear of the system.” For example, historically, the child welfare system has been reactionary. If a child is suspected of being abused or harmed, adults are mandated to report it. This can open a door to a formal investigation and result in removing a child from the family. Frequently, the reported concern does not warrant an investigation, but there is rarely a formal process to proactively support those families and resolve the challenge. There is an opportunity to explore new practices and mindsets focused on prevention and building resiliency opposed to maintaining reactionary systems that respond only after trauma has been experienced.

By centering a mindset toward prevention and building resiliency, we can build community well-being and work to reduce the negative impact of traumatic experiences.

How might we build systems and practices that focus on prevention and support families in proactive resiliency strategies to improve well-being?

As the need for mental health care is rising, nonprofit organizations best equipped to provide trauma-informed care are facing a shortage of mental health professionals. While families are experiencing more obstacles connecting with mental health supports, many families are still accessing the nonprofit system of care for other services such as basic needs programs like food pantries. Organizations that are less equipped or trained in trauma-informed practices, may unintentionally create barriers for their staff and the people they serve. Similarly, other systems that families engage with, whether it be work, school or public benefits, often lack the capacity or capability to establish trauma-informed environments. Building community well-being requires a coordinated approach across stakeholders and systems.

How might we work to broaden the adoption of trauma-informed practices through a coordinated effort to strengthen communities and build resiliency?

Survey participants shared the following insights:

• 58% of participants identified health and wellness challenges as one of the top challenges, including “People struggling with increased stress/anxiety can’t access services that assist with these types of needs”
• 52% identified the challenge of children not having the support to develop healthy social and soft skills as a top community challenge.
• 59% identified a top priority of solutions that build stronger connections between stakeholders in the community.

^[i] Center for Substance Abuse Treatment. (2014). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK207191/

^[ii] Levenson, J. (2017). Trauma-Informed Social Work Practice. Social Work, Volume 62, Issue 2, April 2017, Pages 105–113. https://doi.org/10.1093/sw/swx001

^[iii] Populations at Risk. (2018, January 25). The National Child Traumatic Stress Network. https://www.nctsn.org/what-is-child-trauma

^[iv] Silard, A. (2020). Interpersonal leader responses to secondary trauma in nonprofit human service organizations. Nonprofit Management and Leadership, 30(4), 635-653.

^[v] Arieh, A. B. (2018, August 14). When Nonprofit Work Can Lead To Secondary Traumatic Stress, Here’s How To Manage It. Forbes. https://www.forbes.com/sites/forbesnonprofitcouncil/2018/08/14/when-nonprofit-work-can-lead-to-secondary-traumatic-stress-heres-how-to-manage-it/?sh=29ad2d6a5d17

^[vi] Vivian, P., & Hormann, S. (2015). Persistent traumatization in nonprofit organizations. Retrieved on June 29, 2022, from https://ovc.ojp.gov/sites/g/files/xyckuh226/files/media/document/os_traumatization_nonprofit-508.pdf

^[vii] Pinderhughes, H., Davis, R., & Williams, M. (2015). Adverse community experiences and resilience: A framework for addressing and preventing community trauma. Retrieved June 22, 2022 from https://www.preventioninstitute.org/sites/default/files/publications/Adverse%20Community%20Experiences%20and%20Resilience.pdf

^[viii] Understanding Child Trauma. (2022, April 22). SAMHSA. https://www.samhsa.gov/child-trauma/understanding-child-trauma

^[ix] Nugent C., Rosato M., Hughes L., & Leavey G. (2021, June). Risk factors associated with experienced stigma among people diagnosed with mental ill-health: a cross-sectional study. Psychiatr Q. 2021 Jun;92(2):633-643. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110482/

^[x] Lonsdorf, K. (2022, April 7). People are developing trauma-like symptoms as the pandemic wears on. NPR. https://www.npr.org/2022/04/07/1087195915/covid-pandemic-trauma-mentalhealth

^[xi] Panchal, N., Kamal, R., Cox, C., & Garfield, R. (2021, February 10). The Implications of COVID-19 for Mental Health and Substance Use. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/

^[xii] Fitzpatrick, K. M., Harris, C., & Drawve, G. (2020). Fear of COVID-19 and the mental health consequences in America.Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S17–S21. https://doi.org/10.1037/tra0000924

^[xiii] Dym Bartlett, J., & Steber, K. (2019, May 9). How to Implement Trauma-informed Care to Build Resilience to Childhood Trauma. Child Trends. https://www.childtrends.org/publications/how-to-implement-trauma-informed-care-to-build-resilience-to-childhood-trauma

^[xiv] Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543-562.

^[xv] See SAMHSA “Spotlight: Building Resilient and Trauma-Informed Communities” publications available at: https://store.samhsa.gov/product/Spotlight-Building-Resilient-and-Trauma-Informed-Communities-Introduction/SMA17-5014

^[xvi] Panchal, N., Kamal, R., Cox, C., & Garfield, R. (2021, February 10).

^[xvii] Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf

^[xviii] Sacks, V., & Murphy, D. (2018, February 12). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity. Child Trends. https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity

^[xix] Costello, B. (2022, February 8). Cincinnati plans two new programs to reduce youth gun violence. WVXU. https://www.wvxu.org/politics/2022-02-08/cincinnati-new-programs-reduce-youth-gun-violence