Sandra L Bloom

Trauma is a global issue and public health concern. Political decisions may directly impact rates of trauma exposure, be it individual trauma or mass disaster, and guide how we deal with the consequences of trauma. In this editorial, we warn that the current U.S. administration's decisions are impacting exposure to and consequences of trauma worldwide as well as disrupting the field of traumatic stress in research and practice.

The next decades are likely to increase exposure to adversity, as climate worsening and increased global migration cause natural disasters to grow more frequent and intense social conflicts to become more widespread. However, effective response is likely to require significant changes to large, relatively intractable economic and political systems that are difficult to modify. By contrast, groups, organizations, and communities represent "zones of possible influence" on larger groups of people that can be meaningfully affected by social scientists and mental health professionals, who are well positioned to help prepare them for exposure to and healing from adversity and trauma. Ideas presented in this article can help mental health professionals and social science researchers move from primarily intervening with individuals to working with larger communities of persons, in the service of a broader trauma-informed, public health approach. The article identifies some promising avenues of development for new larger group interventions to increase resilience, including public education for trauma and adversity, resilience-related organizational goal setting, large group coping skills training, and technology-facilitated interventions for large groups. It explores potential roles for mental health professionals in working with groups and identifies ways that the content of their training can be supplemented to enable them to more effectively engage with communities and organizations. It raises key issues that will require consideration as mental health professionals and social scientists pivot toward working with larger groups.

Financial well-being and overall health are significantly linked, especially among those in poverty who have been exposed to violence and suffer from unaddressed trauma. Yet existing public assistance programs fail to address the presence or impact of trauma and adversity. Built specifically for families living in poverty who experience adversity, the Building Wealth and Health Network (the Network) provides a space for families to heal from the effects of trauma while also building social networks and economic security. The sample for this study was primarily Black (91%) women (92%) in Philadelphia with at least one child. A repeated measures linear regression model was performed via a Difference-in-Differences approach to test differences in financial well-being scores between two groups (full participation vs. low/no participation) at two time points (baseline vs 3 months, and baseline vs 6 months). We use this program as a field study to better understand the financial well-being of program participants who took part in fewer or more program sessions. Those who participated in more sessions reported greater increases in two measures of financial well-being at three months and six months post baseline, when compared to those with low or no participation.

A paradigm shift is under way in the human services because of breakthrough knowledge and research in understanding the underlying etiology of physical, emotional, and social problems at the micro-level of the individual, at the meso-level of the family and institutions, and at the macro-level of the entire society. The three levels of human existence—micro, mezzo, and macro—constitute interactive, interdependent, complex adaptive living systems. The complexity of these problems requires us to use our imaginations to envision health in individuals, organizations, and societies because it does not presently exist. After thousands of years of unrelenting exposure to trauma and adversity, we have all normalized what is a traumatogenic civilization. As a result, we live in a trauma-organized society in ways we are just beginning to understand in this century. This biopsychosocial knowledge base that is drawn upon here has come to be known as “trauma-informed” knowledge because it began with a deepening understanding of the impact of trauma on survivors of combat, disasters, and genocide, but now extends far beyond those specific boundaries. To lead any organization in a time of significant change means leading a revolution in understanding human nature and the fundamental causes of human pathology that are endangering all life on this planet and then helping organizational members develop skills to positively influence the changes necessary. In the 1930s, Dr. Walter B. Cannon, a Harvard physiologist who had named the “fight-flight” response and defined homeostasis, used the word “biocracy” to describe the relationship between the physical body and the social body, emphasizing the vital importance of democracy. This paper is a beginning attempt at integrating the concept of a biocratic organization with that of the trauma-informed knowledge necessary for leadership. Hope lies in properly diagnosing the problem, remembering ancient peace-making strategies, embracing universal life-preserving values, inspiring a new vision for the future, and radically and consciously changing our present self and other-destructive behavior. The paper concludes with a brief description of a new online educational program called Creating Presence™ that is being used in organizations as a method for creating and supporting the development of biocratic, trauma-informed organizations.

Integrating trauma-informed peer support curriculum into the Temporary Assistance for Needy Families (TANF) program can help address caregiver trauma symptoms (e.g., depression, low self-efficacy, economic hardship) caused by exposures to violence and adversity that negatively impact one's ability to maintain employment and improve earnings; yet, it is unclear if trauma-informed peer support interventions designed for TANF impact co-occurring disorders, such as depression and substance use, that inhibit resiliency in the labor market. The aim of this study is to examine whether integrating trauma-informed peer support curriculum into the TANF program is associated with reductions in co-occurring depression and substance use, and improvements in self-efficacy and economic security. From October 2015 to May 2018, 369 caregivers were enrolled in the 16-week Building Wealth and Health Network Phase II single-group cohort study. Participants responded to questions regarding their socio-demographic characteristics, mental health, economic security, and use of drugs and alcohol at baseline and four three-month follow-up surveys. Associations between the trauma-informed peer support curriculum and health outcomes were assessed using maximum likelihood estimation. Using class attendance records, participants were separated into a low-exposure group (

Given the prevalence of trauma and traumatic stress reactions among child welfare system-involved children, families, caregivers, professionals, and other stakeholders, it is critical that child welfare professionals integrate an understanding of trauma into their own practice and link families with trauma-informed treatment and services, which are essential elements of a trauma-informed child welfare systems. This introductory article provides an overview of the trauma-informed paradigm shift occurring in public child welfare and discusses the importance of moving from a trauma-informed framework to a trauma-responsive organizational culture in order to create and sustain trauma-resilient organizations and communities. In this special issue, readers will discover articles that include research findings relevant for multiple stakeholders engaging in trauma-informed care. Contributions provide insight that is relevant for understanding and engaging in trauma-informed practice across three levels within the socio-ecological model: individual (children and families), organizational (agency leaders and workforce), and community (university-state partnerships).

Background and Aims: The inflammatory bowel diseases (IBD) are particularly common among the Ashkenazi Jewish (AJ) population. Population-specific estimates of familial risk are important for counseling; however, relatively small cohorts of AJ IBD patients have been analyzed for familial risk to date. This study aimed to recruit a new cohort of AJ IBD patients, mainly from the UK, to determine the familial occurrence of disease. / Methods: A total of 864 AJ IBD patients were recruited through advertisements, hospital clinics, and primary care. Participants were interviewed about their Jewish ancestry, disease phenotype, age of diagnosis, and family history of disease. Case notes were reviewed. / Results: The 864 probands comprised 506 sporadic and 358 familial cases, the latter with a total of 625 affected relatives. Of the UK cases, 40% had a positive family history with 25% having at least one affected first-degree relative. These percentages were lower among those recruited through hospital clinics and primary care (33% for all relatives and 22% among first-degree relatives). Examining all probands, the relative risk of IBD for offspring, siblings, and parents was 10.5, 7.4, and 4, respectively. Age of diagnosis was significantly lower in familial versus sporadic patients with Crohn’s disease. / Conclusions: This study reports familial risk estimates for a significant proportion of the AJ IBD population in the UK. The high rate of a positive family history in this cohort may reflect the greater genetic burden for IBD among AJs. These data are of value in predicting the likelihood of future recurrence of IBD in AJ families.

Temporary Assistance for Needy Families (TANF) has limited success in building self-sufficiency, and rarely addresses exposure to trauma as a barrier to employment. The objective of the Building Wealth and Health Network randomized controlled trial was to test effectiveness of financial empowerment combined with trauma-informed peer support against standard TANF programming. Through the method of single-blind randomization we assigned 103 caregivers of children under age six into three groups: control (standard TANF programming), partial (28-weeks financial education), and full (same as partial with simultaneous 28-weeks of trauma-informed peer support). Participants completed baseline and follow-up surveys every 3 months over 15 months. Group response rates were equivalent throughout. With mixed effects analysis we compared post-program outcomes at months 9, 12, and 15 to baseline. We modeled the impact of amount of participation in group classes on participant outcomes. Despite high exposure to trauma and adversity results demonstrate that, compared to the other groups, caregivers in the full intervention reported improved self-efficacy and depressive symptoms, and reduced economic hardship. Unlike the intervention groups, the control group reported increased developmental risk among their children. Although the control group showed higher levels of employment, the full intervention group reported greater earnings. The partial intervention group showed little to no differences compared with the control group. We conclude that financial empowerment education with trauma-informed peer support is more effective than standard TANF programming at improving behavioral health, reducing hardship, and increasing income. Policymakers may consider adapting TANF to include trauma-informed programming.

The Philadelphia ACE Task Force is a community based collaborative of health care providers, researchers, community-based organizations, funders, and public sector representatives. The mission of the task force is to provide a venue to address childhood adversity and its consequences in the Philadelphia metropolitan region. In this article we describe the origins and metamorphosis of the Philadelphia ACE Task Force, which initially was narrowly focused on screening for adverse-childhood experiences (ACEs) in health care settings but expanded its focus to better represent a true community-based approach to sharing experiences with addressing childhood adversity in multiple sectors of the city and region. The task force has been successful in developing a research agenda and conducting research on ACEs in the urban context, and has identified foci of local activity in the areas of professional training and workforce development, community education, and local practical interventions around adversity, trauma, and resiliency. In this article we also address the lessons learned over the first 5 years of the task force's existence and offers recommendations for future efforts to build a local community-based ACEs collaborative.

The political scene in the USA has changed dramatically with the election of Donald Trump, and antidemocratic forces appear to be gaining momentum in other countries as well. Using a post-traumatic lens to view these political forces, the author summarizes social psychology research on authoritarianism, terror management theory, and obedience studies to illustrate some of the challenges that lie ahead for citizens who want to restore Enlightenment values to their rightful position and, in doing so, defeat the antidemocratic, authoritarian and antiscientific forces that are on the rise. Then, drawing upon the growing knowledge base about the power of organizational culture and the change process, the author emphasizes the importance for any group aiming at progressive ideals to embrace a shared knowledge base, a set of shared values, a shared language and an array of shared tools for practical application in a group.