Adverse childhood experiences (ACEs) are linked to poor health and well-being outcomes related to poor mental health, antisocial behavior, chronic stress, and chronic diseases in adulthood (Manyema et al., 2018). Research has shown that African Americans are disproportionally vulnerable to cardiovascular disease and chronic stress due to increased adverse childhood experiences and are least likely to access resources and strategies to cope appropriately to decrease their risk (Harris et al., 2021). A 12-month trauma-informed public health project among African American women who have experienced adverse childhood experiences and are at risk for cardiovascular disease in Charleston, South Carolina, will address the relationship between cardiovascular disease and adverse childhood experiences. The program will support African American women by implementing a wellness program by providing education about ACEs and its short and long impacts on cardiovascular health and strategies to cope effectively with past trauma resulting in decreased risk for cardiovascular disease.
The aim of the project to improve overall health and well-being for African American women at risk for cardiovascular disease with increased adverse childhood experiences using the Eight Dimensions of Wellness with a trauma-informed, culturally sensitive approach (8 Dimensions of Well-Being, n.d.). The program seeks to reduce risk factors that contribute to their risk for cardiovascular disease by promoting a healthy lifestyle, social support, and positive coping strategies. In addition, the program will provide strategies for the women to confront the effects of childhood adversity, build health awareness, and empower the women to live a long and healthy life.
Trauma-Informed Principles
The project will utilize the following trauma-informed principles: safety and trustworthiness (SAMHSA’s Trauma and Justice Strategic Initiative Workgroup, 2014). First, the project will create a safety plan to address the physical and socio-emotional environments. The project will emphasize the importance of safety within the physical environment by encouraging welcoming language, low and calm noise levels, lighting, and appropriate entrance and exit doors. To build a rapport with the participants, it is important to focus on the social-emotional factors of an individual, such as a space where participants feel safe to share their feelings and are aware of the boundaries between the group and the project. Finally, there is a need for a proper level of trust between the project leaders and participants to create a consistent and appropriate project for the participants. The project will establish trust by emphasizing the importance of confidentiality and clear expectations related to how adverse childhood experiences contribute to overall health instead of focusing on the experience itself and providing opportunities for the participants to voice their needs (Menschner & Maul, 2016).
Level(s) of the Social-Ecological Model
The project will focus on McLeroy’s Social-Ecological Model’s intrapersonal and interpersonal levels (Golden & Earp, 2012). The intrapersonal level of the social-ecological model is addressed through education to provide knowledge and skills about trauma and its impact on cardiovascular disease, which will help participants cope effectively throughout life and after the program. The knowledge and skills will increase the participants’ readiness to make life changes. Additionally, the project will discuss participants’ biological, psychological, and demographic characteristics (King & Gonzalez, 2018). The interpersonal level of the social-ecological model is addressed through positive social support systems through accountability partners within the group, family, and friends. At the interpersonal level, each participant will receive health education about the impact of trauma on their well-being through group sessions and by building social networks with other project participants. Additionally, the project will encourage participants to interact with their families and friends to share their journey, express their overall outcomes, and receive ways to manage positive and negative interactions with family when communicating about the project (King & Gonzalez, 2018).
The intra- and interpersonal levels were chosen for this project to emphasize how the factors of an individual and their social support can impact their achievement towards optimal well-being and progression towards coping effectively with trauma and stress.
Public Health Framework
The project will utilize the public health framework by creating a diverse team knowledgeable of the social determinants of health among the population. The team will explore factors that impact the population's health and the community's needs, investigate the health outcomes, and provide education about those health programs (CDC - 10 Essential Public Health Services - CSTLTS, 2021). It includes instruction on cardiovascular disease risk among African American women. The program will establish partnerships with those specializing in mental health, trauma, women's health, and population health. The program will result in a trauma-informed policy in which health care professionals address how trauma increases the risk for cardiovascular disease during annual screenings or cardiovascular-related appointments.
The primary level of prevention aims to provide education about the impact of ACEs on health among African Americans and provide strategies to address existing negative health outcomes and reduce the risk of cardiovascular disease (Pyle et al., 2016). The secondary level of prevention aims to encourage each participant to receive a health screening from a local health clinic free of charge (Pyle et al., 2016). In addition, the health care professionals will provide medical advice on addressing the findings and connecting participants to this wellness project. Finally, the tertiary level of prevention aims to encourage participants to visit their health care provider if health outcomes do not improve to discuss the impact of trauma. In addition, encourage participants to seek mental health services to address their personal experiences with trauma (Pyle et al., 2016).
References:
8 Dimensions of Well-Being. (n.d.). Colorado State University. https://www.csupueblo.edu/heal...2C%20and%20financial.
CDC - 10 Essential Public Health Services - CSTLTS. (2021). Centers for Disease Control and Prevention. https://www.cdc.gov/publicheal...lhealthservices.html
Golden, S. D., & Earp, J. A. L. (2012). Social Ecological Approaches to Individuals and Their Contexts. Health Education & Behavior, 39(3), 364–372. https://doi.org/10.1177/1090198111418634
Harris, R. M., Kesaraju, A., Jordan, J. J., McDade, R., & Brassell, J. (2021). Do Right! Relax and Restore: An African American Community-Based Holistic Health Initiative. Journal of African American Studies, 25(1), 65–81.
King, K. M., & Gonzalez, G. B. (2018). Increasing Physical Activity Using An Ecological Model. ACSM’S Health & Fitness Journal, 22(4), 29–32. https://doi.org/10.1249/fit.0000000000000397
Manyema, M., Norris, S. A., & Richter, L. M. (2018). Stress begets stress: the association of adverse childhood experiences with psychological distress in the presence of adult life stress. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5767-0
Menschner, C., & Maul, A. (2016, April). Key Ingredients for Trauma-Informed Care Implementation. Center for Health Care Strategies. https://www.chcs.org/resource/...care-implementation/
Pyle, J., Bloom, S., Cawley, J., Feuer-Edwards, A., O’Brien, C., & O’Connor, S. (2016). Trauma-Informed Philanthropy: A Funder’s Resource Guide to Supporting Trauma-Informed Practice in the Delaware Valley. Thomas Scattergood Foundation. https://philanthropynetwork.or...raumaGUIDE_Final.pdf
SAMHSA’s Trauma and Justice Strategic Initiative Workgroup. (2014, July). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/sites.../priv/sma14-4884.pdf
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