Collaboration with Public and Private Partners
Due to the multiple severe consequences of trauma, including physical, psychological and social problems, trauma treatment and services should be developed and implemented through integrated systems of care.
Facts and Discussion Points:
* Systems that duplicate efforts may waste time and money.1
* Medical impacts of childhood abuse include: head trauma, brain injury, sexually transmitted diseases, unwanted pregnancy, HIV infection, physical disabilities (back injury, orthopedic, neck, etc.), chronic pelvic pain, headaches, stomach pain, nausea, sleep disturbance, eating disorder, asthma, shortness of breath, chronic muscle tension, muscle spasms, elevated blood pressure.2-6
* Among the physical sequelae of trauma are autoimmune disorders.7
* Adults who experience multiple types of abuse and violence in childhood, compared to those who do not, have a 2- to 4-fold increase in smoking, poor self-rated health, a higher rate of physical inactivity, and severe obesity.8
* A study of adverse childhood exposures shows a relationship to the presence of adult diseases, including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.8
* Severe and prolonged childhood sexual abuse causes damage to the brain structure, resulting in dysregulated emotional systems, dissociation, and symptoms of PTSD.9-11
* Primary care physicians are often the sole or first professional seen by abused children and adults who present with medical or physical problems and/or behavioral problems.12
* Some primary care physicians prescribe as many anti-psychotic medications to asymptomatic children as they prescribe to symptomatic children.12
* Drugs are often prescribed for children misdiagnosed with Attention Deficit Hyperactivity Disorder (ADD), Oppositional Defiance Disorder (ODD), etc., whereas these children’s symptoms are indicative of trauma (chronic community/gun violence as well as sexual/physical abuse).12
* Theories and interventions on traumatic stress issues have been generated in the private sector for decades (Eye Movement Desensitization and Reprocessing [EMDR], Dialectical Behavior Therapy [DBT], Risking connection, Sanctuary, etc.).13
* Due to perceived high cost of individual treatment, existing approaches have not been widely implemented in public sector settings.13
* Many private practice trauma specialists are not aware of growing interest in the public sector to address trauma issues in public settings.13
* Unless affiliated with a research university, private sector trauma specialists generally cannot afford to conduct outcome studies that prove anecdotally successful approaches.13
* The lack of a shared language or a shared conceptual framework (e.g., mental health and criminal justice, or mental health and public health) significantly impairs the capacity of systems to collaborate effectively.14
* Launch an educational campaign targeting health care professionals (psychiatrists, primary care physicians, physician assistants, nurses, health clinicians, and other organizations and associations), which focuses on recognizing the signs and symptoms of trauma, and assisting children and adults via appropriate referrals and interventions.
* Collaborate with the Department of Health & Human Services Bureau of Primary Health Care (BPHC), which provides medical and mental health care in underserved urban areas through schools and community clinics.
* Collaborate with existing non-profit organizations that educate about trauma, abuse, domestic violence, etc., to provide widespread information and referral services.
* Collaborate with American Nurses Association, International Association of Psychiatric Nurses, and American Psychiatric Nurses Association, a professional population with people who are familiar with the incidence of violence and trauma, sympathetic to the cause, and who may hold influential positions.
* Foster and fund adaptation of existing models for public education settings.
* Create venues for teaching partnerships between private sector teachers and public sector learners.
* Foster models for group clinical supervision, in which experienced trauma therapists can supervise novice clinicians in both the public and private sector.
* Create and/or increase funding for outcome studies on the most successful trauma treatment approaches.
* Educate both public and private systems on the existing literature of trauma-informed system of care practices.
Collaboration with Public and Private Partners References
1. E. Giller (personal communication, April 2002).
2. Prescott, L. (1998). Women emerging in the wake of violence. Los Angeles, CA: Prototype Systems Change Center.
3. Cunningham, J., Pearce, T., & Pearce, P. (1988). Childhood sexual abuse and medical complaints in adult women. Journal of Interpersonal Violence, 3,131-144.
4. Morrison, J. (1989). Childhood sexual histories of women with somatization disorder. American Journal of Psychiatry, 146,239-241.
5. Springs, F., & Friedrich, W. (1993). Health risk behaviors and medical sequelae of childhood sexual abuse. Mayo Clinic Proceedings.
6. Walker, E., Katon, W., Harrop-Griffiths, J., Holm, L., Russo, J., & Hickok, L. R. (1988). Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse. American Journal of Psychiatry, 145, 75-80.
7. R. Mazelis (personal communication, April 2002).
8. Felitti, V. J. (May 1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med; Vol. 14 (4), pp. 245-58.
9. Lindsey, D., Stephen, Briere, J. (October 1997). The controversy regarding recovered memories of childhood. Journal of Interpersonal Violence, Vol. 12, Issue 5, p. 631, 17 p.
10. van der Kolk, B. A., (July 1996). Dissociation, somatization, and affect dysregulation: The complexity of adaptation of trauma. Am J Psychiatry, Vol. 153, (7 Suppl), pp. 83-93.
11. Perry. (1994). Biological and neurobehavioral studies of borderline personality disorder. In K. Silk (Ed.), Progress in Psychiatry, No. 45, American Psychiatric Press.
12. J. B. Harrod, Ph.D. (personal communication, based upon Maine epidemiological study conducted by Gwen Zahner Ph.D., Research Triangle Institute, 2002).
13. E. Giller (personal communication, April 2002).
14. S. Bloom (personal communication, April 2002).