Adverse Childhood Experiences (ACES) have been shown to increase the risk of young adults engaging in risky sexual behaviors, these behaviors may lead to other negative health outcomes such as acquiring an STI or HIV. Risky sexual activities are often associated with being under the influence of alcohol or drugs, leading to cognitive impairment and unsafe sexual decision-making. Young men who have sex with men (YMSM) are disproportionately affected by HIV and have increasingly shown higher rates of infection compared to other populations. Experiencing childhood trauma during adolescence can lead to participating in negative health behaviors such as substance use to cope with stressful situations and managing difficult times as an adult. By providing YMSM with the knowledge and skills surrounding safe sexual practices and the impact of ACES on behavior through education and therapy, YMSM can be given the tools they need to heal through traumatic childhood events.
Trauma-Informed Principles
To ensure we’re providing trauma-informed care to all participants of our program, components from the Substance Abuse and Mental Health Administration (SAMHSA, 1014) and Trauma Informed Philanthropy will be incorporated (Philanthropy Network Greater Philadelphia, 2016). Volume 1 of the Trauma Informed Philanthropy will be used as a project guide to better serve our community and clients.
Peer support and mutual self-help will be included through our family support group where parents/ guardians can freely share their stories and be supported and encouraged by their peers. All organizational employees and representatives including Duval County Public Schools (DCPS) staff, JASMYN health educators, and Gateway behavioral therapists will all be professionally trained in trauma-informed care before program implantation begins. Through collaboration and sharing of responsibilities, DCPS staff will not need intensive training around trauma-informed care since they will not be providing direct client care. Instead, DCPS staff will receive training on screening, assessment, and the referral process for treatment of ACES and trauma since teachers and staff already have an established relationship built with students. Trustworthiness and transparency will first be established during the planning places of our intervention to guarantee there is a shared relationship of power between participants, organizational staff, and participating stakeholders. Our organization will create a Community Advisory Board (CAB) at the beginning of the intervention to receive community input on intervention plans as well as gather feedback for suggestions for improvements.
Lastly, safety measures will be implemented by providing clients with a safe space to share their stories, especially because this may be the first time, they have ever felt comfortable sharing or even been granted the opportunity to share their experiences. Utilization of these trauma-informed principles into our program will create a safe and nurturing environment of healing through a cross-sectional approach.
Levels of the Social Ecological Model
Our program will use McLeroy’s Social Ecological Model to address four different levels; the individual, intrapersonal, institutional, and community interventions (McLeroy et al., 1998). The McLeroy Social Ecological model is centered on interventions directed at changing unhealthy behaviors as well as providing support factors that maintain these behaviors (McLeroy et al., 1988). We will address the individual needs of the McLeroy Social Ecological Model by referring YMSM needing substance use treatment and enrolling them in outpatient rehab care for 12 weeks which will include weekly individual cognitive behavioral therapy. Intrapersonal interventions will include parental peer support groups for the parents/ guardians of our YMSM participants. The parent support group will offer family education courses focused on the importance of keeping communication open in the household because this conversation can greatly impact YMSMV attitudes and behaviors surrounding sex as an adult. Our programs will use community interventions by partnering with community organizations such as JASMYN to offer HIV education courses and collaborating with Duval County Public Schools to identify students who are dealing with one or more adverse childhood experiences. Lastly at the institutional level project activities will be given to organizational staff and representatives to complete cultural competency training to ensure that all clients are receiving effective trauma-informed care.
Public Health Framework
Our intervention will use a public health framework to help mitigate substance abuse problems among young men who have sex with men who have experienced at least one adverse childhood experience. Throughout the intervention, we will be applying multiple stages of prevention including, both secondary (screening) and tertiary (treatment) of the public health sectors. According to the Philanthropic Foundation, ACES and trauma have been called the worst public health crisis of our time, therefore our organization will utilize a trauma-informed approach that encourages a cross-sector multi-level program to ensure our program is effective at preventing adverse childhood experiences and promote healing (Philanthropy Network Greater Philadelphia, 2016).
Our program will collaborate with Duval County Public Schools teachers and staff to help identify students who experience at least one or more ACES with substance abuse problems who may be eligible to participate in the intervention. Treatment is also an essential element of addressing trauma and ACES (Philanthropy Network Greater Philadelphia, 2016). By providing participants with cognitive behavioral therapy through certified addiction counselors, participants will be given support and develop positive ways to respond to negative life events. These shifts in behaviors can address how YMSMs process their thoughts and help influence their response patterns of using drugs and alcohol to cope and engage in unsafe sexual activities. By developing appropriate response mechanisms and shifting negative behaviors we hope to improve participants’ well-being and reduce the incidence of trauma.
References:
Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, and United Way of Greater Philadelphia and Southern New Jersey (2016). Trauma-Informed Philanthropy: A Funder’s Resource Guide for Supporting Trauma-Informed Practice in the Delaware Valley. file:///C:/Users/aliar/Downloads/FINAL_TraumaGUIDE-single.pdf
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health education quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
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