CCMS Medicine Fall 2017 - 13

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Creating a Trauma
Informed Community
BY REBECCA A. TAVANGAR, M.A., C.C.T.P.
THE PHOENIXVILLE ACES COMMITTEE

C

hild maltreatment (CM) is a significant public
health problem, but it is also a preventable one. In
its 2015 report [1], the Children's Bureau of the U.S.
Department of Health and Human Services revealed that the
national estimate of children who received a child protective
services investigation response increased 9.0 percent from 2011
(3,081,000) to 2015 (3,358,000). The Journal of Adolescent
Health places the total lifetime economic burden of new cases of
child maltreatment in the United States (2008) at $124 billion
with it rising to as much as $585 billion in sensitivity analysis.[2]

In addition to the sheer magnitude and the enormous
financial cost of CM, an extensive body of research now exists
demonstrating the effects of chronic stress and traumatic stress
on trajectories across the lifespan and even across generations by
transmission of epigenetic changes to the genome.[3]
The Centers for Disease Control (CDC) confirms that the
maltreatment of children causes stress that can disrupt early
brain development, and serious, chronic stress can harm the
development of the nervous and immune systems.[4] As a result,
children who are abused or neglected are at higher risk for
health problems as adults. These problems include alcoholism,
depression, drug abuse, eating disorders, obesity, high-risk
sexual behaviors, smoking, suicide, and certain chronic diseases.
Unfortunately, CM never affects just the victim, it impacts the
entire family system. We see a positive correlation between CM
in one generation and the next.
Further, many experiences of maltreatment are recognized
as traumatic for the child. Trauma is defined by the individual's
reaction to an experience and not by the specific event(s).
Therefore, the determination of whether maltreatment is
traumatic is based on the reaction of the child in response to

the characteristics of the maltreatment. Reasons for optimism
are many-fold as child health-care professionals are beginning to
realize the transformative potential of "trauma-informed care" -
a seminal concept that involves not only changing assumptions
about how we organize and provide services, but also creating
organizational cultures that are personal, creative, open, and
healing.
A program, organization, or system that is trauma-informed:
realizes the widespread impact of trauma and understands
potential paths for recovery; recognizes the signs and symptoms
of trauma in clients, families, staff, and others involved with the
system; responds by fully integrating knowledge about trauma
into policies, procedures, and practices; and seeks to actively
resist re-traumatization.[5]
Rather than asking "What is wrong with you?" the question
becomes: "What has happened to you?"
The significance of this minute shift in thinking has become
the central focus of a flurry of scientific inquiry generated
from distinct disciplines (neuroscience, behavioral science,
sociology, medicine), with numerous scientific publications as
well as hundreds of conferences and workshop presentations
- all confirming the association between adverse experiences in
childhood and health-risk behavior and disease in adulthood.
Building on the landmark research study known as the
Adverse Childhood Experiences study or ACEs, scientists
continue to reaffirm that when children experience sudden or
chronic adversity, increased levels of stress hormones disrupt
neurodevelopment and alter normal brain structure and
function. We now know on a bio-chemical level exactly how
parents' chronic fights, divorce, death in the family, being bullied
or hazed, and growing up with a hypercritical, alcoholic, or
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