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October 2019Vol. 20, No. 8Getting to the Roots of Trauma

Written by Melissa T. Merrick, Ph.D., president and CEO, Prevent Child Abuse America

I am a clinical psychologist by training. That means I am very comfortable helping one child, one family at a time, and that will always be critically important work in our quest for providing trauma-informed services. I also received 9 years of on-the-job training in public health and population-level best practices at the Centers for Disease Control and Prevention (CDC), and for 7 of those years I served as the lead scientist for the adverse childhood experiences (ACEs) portfolio of work. At the CDC, we focused our work on building and disseminating the best available evidence for preventing early adversity like child abuse and neglect before it begins, prioritizing primary prevention solutions. And now, in this new role as the president and CEO of our nation's oldest nonprofit focused on preventing child abuse and neglect, I realize that our collective efforts as a multidisciplinary, multisystem field have not gotten deep enough into the roots of what breeds trauma and its many ugly, unhealthy outcomes. 

Just last week, Prevent Child Abuse America held its national conference, with nearly 1,000 practitioners, researchers, and policymakers in attendance from our nearly 600 Healthy Families America sites and affiliates and our nationwide state chapter network, with a guiding theme of "Moving Upstream." With more than 100 symposia, workshops, poster presentations, and other sessions, we were intentional to call for a new narrative—that child abuse and neglect and other ACEs could be prevented in the first place through comprehensive approaches and trauma-informed systems. We intentionally acknowledged that prevention can only happen in partnership and that we all have a role to play in stopping early adversity before it begins. All of that is true, and we are so proud of the energy and conversations that took place in support of thriving children, families, and communities. But I think my biggest lesson of the week came unintentionally, during the last session of the conference.

What we had planned as a sharing session on policy and practice considerations that our home visiting network and state chapters have been experiencing turned into an overwhelming and courageous sharing of the breadth of traumatic experiences children and families are facing every day in our country. For example, family support specialists detailed how helping a family that fears deportation to apply and secure passports for their young children is often the most immediate need for the achievement of family emotional stability and security; or how it is hard to recommend nutritious foods or connect families with social support in their communities when some families fear being racially profiled while at the grocery stores and parks in their communities; or how family support specialists themselves, members of the communities in which they serve families, are subject to these sorts of fears and discrimination, too. It was a sobering conversation that will bind everyone in that room forever because it turned our evidence-based practices and trauma-informed approaches on their heads.

If we are to ever be truly trauma informed in our care, we must first get to the roots of trauma. The last time I checked, fear of immigration raids and being racially profiled and discriminated against were not items on the ACE scale, nor were growing up in poverty or without access to affordable high-quality child care and education. Yet, our kids and families are increasingly exposed to these types of traumatic experiences that set them on trajectories for poor health and decreased productivity and prosperity in and of themselves—never mind the exacerbating impact these unmeasured, unspoken adversities have on ACEs. It struck us all in that room that even our most tested and rigorously researched prevention efforts cannot begin to take effect until the immediate needs of families are met, and I would argue we can never truly meet those immediate needs until we make our work about getting to the roots of trauma—the roots of discrimination, racism, income inequality, poverty, historical trauma and oppression, and other structural and social determinants of health and prosperity.  

A trauma-informed approach, therefore, requires that we identify and address the many barriers to thriving communities, families, and children that exist and repeat across generations. And we must do this trauma-informed work together, across sectors and disciplines and all party lines. We know that children, families, and communities can be resilient and can thrive if we create the conditions and context for such resilience and prosperity. Prevention is possible if we work in partnership, not only with other professionals and sectors but with families and communities so that their lived experiences are reflected in our interventions and prevention approaches. 

Until we get to the roots of trauma, we cannot be truly trauma informed.