Resisting (Re)traumitization & Preventing Trauma

A program, organization, or system that is trauma-informed and actively seeks prevention and to RESIST (RE)TRAUMATIZATION.

Preventing ACEs and the trauma that results from them can be achieved by creating and sustaining safe, stable, nurturing relationships and environments for all children and families.

The first step is to identify risk and protective factors relevant to specific individuals, families, and communities (CDC, https://www.cdc.gov/violenceprevention/aces/riskprotectivefactors.html). Organizations and communities can then implement strategies that are evidence-based and evidence-informed to reduce risk factors and strengthen protective factors.

The Centers for Disease Control and Prevention (CDC) identified six of these strategies (Centers for Disease Control and Prevention: Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence)

    • Strengthen economic supports to families
    • Promote social norms that protect against violence and adversity
    • Ensure a strong start for children
    • Teach skills
    • Connect youth to caring adults and activities
    • Intervene to lessen immediate and long-term harms

Each of these strategies has several approaches that can be adopted. For example, strengthening economic supports to families can be addressed by strengthening household financial security and adopting family-friendly workplace policies. “By addressing the conditions that give rise to ACEs and simultaneously addressing the needs of children and parents, these strategies take a multi-generation approach to prevent ACEs and ensure safe, stable, nurturing relationships and environments. Together, these strategies are intended to work in combination and reinforce each other to prevent ACEs and achieve synergistic impact.” (CDC, Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence, pg. 9,  https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf)

Types of Prevention

pyramid of trauma prevention graphicThere are four types of prevention: primordial, primary, secondary, and tertiary. Primordial prevention seeks to eradicate conditions that fundamentally contribute to disparities and inequities deeply rooted in systems and structures across society that often lead to traumatic experiences. Primary prevention works to reduce the impact of risk factors that give rise to trauma to prevent their negative effects on individuals, families and communities. If trauma has already occurred, secondary prevention aims to provide nurturing conditions and supportive programs to promote healing and resilience. And tertiary prevention is essentially treatment for individuals who have been impacted by trauma to prevent escalation and embedding of problems that result.

Primordial prevention reduces the very exposure to detrimental influences at the outset by tackling adverse social determinants of health across whole communities, states, and society through social, economic, and structural policies. The focus is on conditions that fundamentally contribute to disparities and inequities deeply rooted in systems and structures that give rise to trauma/ACEs. Also, there is an embedding of components of proven programs into our mindsets, daily practices, and systems responses that are known to ensure the health and wellbeing of children and youth. Investments should be geared toward more upstream strategies to yield the greatest benefits.

Primary prevention targets populations or environments characterized by high levels of trauma before children are adversely affected. The focus is on reducing risk factors and promoting healthy conditions under which young people can thrive and avoid trajectories to negative outcomes. This can be accomplished by systematically delivering evidence-based programs via practice and systems-level change.

Secondary prevention is targeted at those who have been exposed to trauma and are developing problems to prevent their escalation. This is an inoculation stage where modifying individual behavior or prevailing conditions that give rise to negative outcomes from trauma exposure is necessary. It works by identifying and providing early supports and programs to children and adolescents who are at risk of a variety of poor outcomes that tend to be interrelated; e.g., substance misuse, delinquency, school drop-out, depression, and other mental and behavioral problems.

Tertiary prevention involves interventions for individuals who are already afflicted or affected by trauma and have developed a problem in need of treatment. It is at this level at the focus tends to be on managing chronic problems and providing services and supports where indicated. Although investments are needed here, an emphasis on funding treatments for these populations is indicative of opportunities missed to act earlier in development.

Some examples of each level include:

Primary: ensure a strong start for children; build a safety net to address all the determinants of health; teach skills

Secondary: teach coping skills; build resilience; build connections with caring adults; promote opportunities for community connections

Tertiary: treat consequences of trauma and prevent re-traumatization; increase access to mental health and substance use services; provide economic and other supports to help individuals and families thrive and be healthy.

Primordial:  the apparent effect of the child tax credit on improving infant and child brain development in low income families, as well as significantly reducing the incidence of child maltreatment. 

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A Note About Trainings

Creating a trauma-informed organization or becoming a trauma-informed practitioner/teacher/provider is not about completing a training and checking a box. Trainings are an invaluable tool on the road to becoming trauma-informed, but trainings are NOT in themselves enough to say one is trauma-informed. Rather, becoming trauma-informed is about a lifelong process of learning to put on a “trauma lens” in everything one does, to question and assess all of our actions to make sure we are keeping the idea of how trauma (our own or others’) might be influencing our decisions and actions.