As we work on solutions to community violence, it is important to remember that current events are only the most recent causes of stress. The stress of abuse and violence that we experience or witness replays in our brains and still lives in our bodies. Over the past several years, more and more people are becoming aware of the effects of trauma and violence on individuals. In the mid-1990s, Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) began a large study. Researchers looked at the effects of bad events from childhood (called “adverse childhood experiences” or ACEs) on people’s health and well-being. These adversities include childhood emotional, physical or sexual abuse, neglect, violence between parents and parental separation or divorce. They also include living with household members who were using substances, suffering from mental illness or in prison. This research showed two important points. The first is that ACEs are common. About two-thirds of adults report experiencing at least one ACE. The second is that the more ACEs a person has experienced, the higher his or her risk for developing serious health problems as an adult. Some of these health problems include sexually transmitted infections, obesity and depression. The ACE study did not include the effects of poverty, racism, homophobia, historical oppression and other inequalities. These are also forms of trauma and contribute to poor health. Strengthening our communities and confronting these social inequalities are an important part of healing and becoming a trauma-informed community.
Not everyone who is exposed to ACEs has poor health outcomes. The effect of ACEs can be lessened by helping people to be more resilient, to “bounce back” more easily from trauma. One key factor that supports healing and resiliency is connection. People who feel loved and who have the opportunity to talk about their experiences and feelings and get support do better. Feeling like part of a community—whether it is family, church, neighborhood or even a book club—provides important social connections. Feeling connected provides comfort during difficult times. Many people need help to learn healthy ways to manage painful feelings rather than relying on numbing the pain. Perhaps most important to resiliency is finding a sense of purpose and hope. (See studies on resiliency and examples of how to build individual resiliency at https://ggia.berkeley.edu/.)
Health care providers, front line responders, teachers, counselors and policy makers all can benefit from learning about research on trauma and resiliency. For health professionals, including counselors, understanding that ACEs may contribute to poor health outcomes can help to guide treatment. This understanding can make sure that patients feel supported (and, importantly, not judged) in the health care setting. It can also connect patients to trauma-focused care. For parents and adult caregivers, understanding how their own past experiences may affect how they parent their own children may also be helpful.
In Pittsburgh, many individuals, organizations and institutions have joined forces to focus on strategies to build a trauma-informed community. This means a community that acknowledges the effect of trauma and violence on our lives and uses proven strategies to build resiliency. A trauma-informed community means that everyone—from early child care to schools, faith communities, home visitation programs, health care settings, social services, child protective services, the juvenile justice system and those working with children, youth, families, adults and elders—focuses on building connections and support. Research continues in our region to develop best practices in trauma-informed care to help reduce violence and to increase resiliency.
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