1. Addressing Trauma in Our Communities
Matters of the Mind:
Addressing Trauma in Our Communities
Nancy C. Lee, M.D. Deputy Assistant Secretary for Health-Women’s Health Office on Women’s Health U.S. Department of Health and Human Services
April 22, 2013

2. Functional Definition of Trauma
Trauma occurs whenever an external threat overwhelms a person’s coping resources.

3. What is Trauma? A Practical Definition
Non-consensual
Victim feels discomfort, fear, intimidated
Bodily integrity, or that of someone else, is threatened

4. Prevalence of Trauma in the U.S. Rape and Sexual Assault
One out of 6 U.S. women has been the victim of an attempted or completed rape in her lifetime
17.7 million U.S. women have been victims of attempted or completed rape.
Source: RAINN

5. Intimate Partner Violence
1 out of 3 women experience at least one physical assault by a partner.
Men who have witnessed their parents' domestic violence are twice as likely to abuse their wives.
Girls who have witnessed domestic violence are more likely to stay in an abusive relationship as an adult.
More than 50% of batterers also abuse their children or their victim’s children.

6. Prevalence of Trauma in the U.S. Childhood Sexual Abuse
At least 2 of every 10 girls, and 1 of every 10 boys are sexually abused by the end of their 13th year.

7. Prevalence of Trauma in the U.S.
Very common that an individual will have exposure to multiple traumatic events during their lives

8. Long Term Consequences
Emotional Stress and Mental Illness
Physical Illness, Disease and Disability
High-Risk Behaviors
The Impact of Trauma is Dramatically Underestimated

9. The Adverse Childhood Experience (ACE) Study
Study analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behaviors later in life among 17,000 adult patients.
Collaboration between the CDC and Kaiser Permanente Health System.
The Co-principal Investigators -
Vincent J. Felitti, MD, Kaiser Permanente
Robert F. Anda, MD, CDC
Over 17,000 Kaiser patients participated in routine health screening volunteered to participate in the study. 
Data continues to be collected and analyzed.
Study reveals staggering proof of the health, social, and economic risks that result from childhood trauma.

10. What is an ACE? Growing up experiencing any of the following
conditions prior to age 18
Physical abuse
Emotional abuse
Sexual abuse
Physical neglect
An alcohol or drug abuser in home
Someone who is mentally ill or suicidal in home
Mother is treated violently
One or no parents in home
An incarcerated family member

11. ACE Score Prevalence 0 33% 1 25% 2 15% 3 10% 4 6% 5+ 11%*% % % % % %*
*Women are 50% more likely to have a score >5.

12. ACE Study Findings
As the number of ACEs increase, the risk for health problems increase in a strong and graded fashion.

13. ACE Study Findings
Suicide At least 2/3 of all attempted suicides can be attributed to adverse childhood experiences. Sexually Transmitted Diseases There is a 250% increased risk of having an STD between individuals with an ACE Score of 4 vs. an ACE Score of 0.

14. ACE Study Findings An Individual with an ACE Score of 4 is:
Chronic lung disease
260% more likely than someone with an ACE Score of 0.
Depression
460% more likely to than someone with an ACE Score of 0.

15. ACE Study Findings IV Drug Use
The relationship of ACE to IV drug use is particularly striking.
A man with an ACE score of 6+ has a 4600% increased risk of becoming an IV drug user.

16. In Summary, the ACE Study indicates… ACEs are basic and long lasting determinants of:
health risk behaviors
mental illness
social malfunction
disease
disability
death
healthcare costs

17. Secondary Victimization
Also referred to as “Retraumatization” Victimization which occurs, not as a direct result of the traumatic event, but through the response of institutions and individuals to the victim

18. Examples Dental settings Ob-Gyn
The supine position
Can’t speak
Ob-Gyn
Pelvic exam
Breast exams
So what can be done to prevent Retraumatization?

19. Trauma-informed Care Take the trauma into account
Avoid triggering trauma reactions
Adjust the behavior of providers to support the individual’s coping capacity
This will allow survivors to access and benefit from services
Services that are provided for issues other than trauma but require knowledge about the impact of trauma to improve effectiveness
Every part of an agency or institution from front desk staff, administrators, to care providers:
Understand the effects of exposure to traumatic events
Sensitively interact with trauma survivors
Prevent re-traumatizing
Engage in trauma screening as appropriate

20. Trauma-Informed Care Paradigm shift from… What’s wrong with you? to
What happened to you?

21. Keep in Mind
You are likely to encounter survivors of trauma who do not disclose
Not all survivors are psychologically ready to discuss their experiences

22. Summary Traumatic events are prevalent in our society
Trauma has negative physical, psychological and behavioral consequences
Survivors may experience “secondary victimization” when they seek help
You can help reduce some of these problems through trauma-informed practices

23. Substance Abuse Mental Health Services Administration (SAMHSA)
SAMHSA's National Center for Trauma- Informed Care provides technical assistance to build awareness and promote implementation of trauma-informed practices.

24. Webinar Series provided by
the Office on Women’s Health, in partnership with SAMHSA
To Register for our upcoming webinars:

25. Thank you!