For my Master of Public Health class, I created a trauma-informed approach to address the relationship between ACEs and ADHD incidence. I have included the abstract, trauma-informed principles used, the socio-ecological model levels addressed, and the public health framework I used in the following sections.
Abstract: It is incredibly important that the effects of adverse childhood experiences (ACEs) on health and wellbeing are understood so that adequate primary prevention measures can be taken. The emotional regulation program proposed here is one way in which the adverse effects of ACEs will be combated. By teaching elementary-aged kids emotional regulation methods and tools through one-on-one counseling, mediation and mindfulness after-school activities, and peer appreciation sessions, this program will mitigate the toxic stress levels caused by ACEs. This is necessary because toxic stress in childhood can lead to a multitude of adverse behavior, physical, and mental outcomes, such as the development of attention deficit hyperactivity disorder (ADHD). This program will take a trauma-informed approach when designing, implementing, and assessing program activities for second-grade age students, utilizing the professional skills from mental health experts as well as the insight provided by local teachers.
Public Health Framework: The activities included in this intervention (i.e., one-on-one counseling, mediation and mindfulness after-school activities, and peer appreciation sessions) target the individual level of the CDC’s Social-Ecological Model (SEM) and are a form of primary prevention. They aim to protect students against developing future health conditions such as ADHD. The main aim of teaching social-emotional learning and life skills to young students is to increase their resilience capacity by creating both healthier individual practices and supportive environments. Both of these outcomes will help prevent the onset of unhealthy behaviors and health conditions like ADHD (Crawley, 2013).
The Continuum of Change is important to keep in mind when developing and implementing this program. The Continuum is often defined by four parts: trauma-aware, trauma-sensitive, trauma-responsive, and trauma-informed (Crawley, 2013). This intervention will move participating schools through the first stage of being trauma-aware by educating teachers, administrators, and staff on the importance of trauma-informed spaces and how trauma might be affecting or resonating within their students (Crawley, 2013). Hopefully, participating schools will build internal consensus around the ways in which they can become more trauma-informed by adopting new principals and programs and planning for change. This would move them through step 2 of the Continuum of being trauma-sensitive (Crawley, 2013). Lastly, becoming trauma-responsive and trauma-informed would require the schools to adopt some of the programming introduced to students by the intervention, and call upon the institutions to make it a self-sustaining norm (Crawley, 2013).
Level(s) of the Social-Ecological Model: As previously mentioned, the individual level of the CDC’s SEM is targeted in this intervention. This level encompasses the individual's characteristics, including attitudes, beliefs, and behaviors, that change a health behavior or health outcome (CDC, 2021). The activities included in this intervention (i.e., one-on-one counseling, mediation and mindfulness after-school activities, and peer appreciation sessions), are an example of social-emotional learning and life-skills training. The reason for targeting the individual level of the Social-Ecological Model is to increase the likelihood of participants experiencing an increased level of self-efficacy towards stressful situations.
By introducing this intervention to select schools, this intervention will also secondhandedly affect the community level of the SEM. The community-level encompasses settings such as schools and workplaces and interventions at this level aim to identify the characteristics of these settings that can result in harmful health outcomes (CDC, 2021). Although this intervention will not specifically analyze the characteristics present within selected schools, it is predicted to impact the social environment present. By exposing participating schools to the intervention, organizational leaders such as teachers, administrators, and principals, will directly observe benefits associated with social-emotional learning and life-skills training and will be motivated to incorporate these practices into their everyday environment. As mentioned by Golden & Earp, the “changes in communities derive from partnerships with agencies, churches, neighborhoods, and other mediating structures” (2012). Although the individual level primarily targets in this intervention, introducing the intervention through schools is an example of how a mediating structure can facilitate community-wide change.
Trauma-Informed Principles Utilized: Safety will be prioritized by approving the physical spaces by which all three activities occur (SAMHSA, 2014). Participants will be asked to identify which spaces within the school’s grounds they feel the safest. A short survey would be conducted to identify these spaces and ensure participants feel calm and stress-free within these environments before activities begin.
Trustworthiness and transparency will be achieved by explaining the entire research process to participants and facilitators (SAMHSA, 2014). The appropriate language will be used when describing program activities to youth participants to ensure that their participation is entirely voluntary. It will be made clear that participants can choose to discontinue the programming whenever they choose.
Peer support and mutual self-help will take place during the focus group reflection sessions held at the end of the 6-month intervention (SAMHSA, 2014). These focus groups will call upon students to reflect and voluntarily share their own experiences and opinions regarding the programming. Students will be asked for suggestions about continuing emotional regulation in their daily lives and offer advice to their peers about what worked for them.
As briefly mentioned above, the voluntary nature of the programming will help create a sense of empowerment, voice, and choice amongst participants (SAMHSA, 2014). Furthermore, the utilization of teachers as facilitators and informed leaders of the community is a person-centered approach, focusing on the already existing relationships teachers have with their students and empowering them to tailor interventions to their student’s needs. Empowering teachers to adapt activities and participate as primary facilitators will also ensure that activities are culturally, historically, and gender-sensitive for each student population.
Collaboration and mutuality will be achieved from the preliminary training and meet-and-greet day before the intervention’s implementation (SAMHSA, 2014). These sessions will promote a connection between participating schools and foster awareness about emotional regulation and trauma-informed practices amongst the larger community.
References:
Adler, K., Salanterä, S., & Zumstein-Shaha, M. (2019). Focus Group Interviews in Child, Youth, and Parent Research: An Integrative Literature Review. International Journal of Qualitative Methods, 18, 1609406919887274. https://doi.org/10.1177/1609406919887274
Alachua School District. (2021). Retrieved February 13, 2021, from https://www.publicschoolreview...-district/elementary
Asmussen, K., Fischer, F., Drayton, E., McBride, T. (2020). Adverse childhood experiences: What we know, what we don’t know, and what should happen next. Early Intervention Foundation.
CDC. (2021). The Social-Ecological Model: A Framework for Violence Prevention. Centers for Disease Control and Prevention. Retrieved March 2, 2021, from https://www.cdc.gov/violencepr...ecologicalmodel.html
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CDC. (2014). ADHD Long-term Outcomes: Comorbidity, Secondary Conditions, and Health Risk Behaviors. Centers for Disease Control and Prevention. Retrieved February 13, 2021, from https://www.cdc.gov/ncbddd/adh...kshops/outcomes.html
Crawley, J., Pyle, J., Bloom, S. (2013). Trauma-Informed Philanthropy. Retrieved March 2, 2021, from file:///Users/meganbohan/Downloads/FINAL_TraumaGUIDE-single%20(1).pdf
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Image from MedicineNet, https://www.medicinenet.com/ca...be_cured/article.htm
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