Compared to Florida, Alachua County has an elevated rate of adverse drinking behaviors such as binge and heavy drinking which are associated with various poor health outcomes like unintentional injuries, violence, and chronic disease (FLHealthCharts, 2020; CDC, 2018). Furthermore, individuals with multiple adverse childhood experiences (ACEs) are at elevated risk for these adverse behaviors. The proposed mechanism behind this association between ACEs and adverse drinking behaviors is as a coping mechanism in response to chronic and toxic stress. My grant proposal outlines a trauma-informed project targeted to young adults with an ACE score greater than two who reside in Alachua County and engage in these adverse behaviors. The project aims to further inform current knowledge about the association between adverse drinking habits and ACEs in addition to educating and developing resilience through mindfulness and yoga techniques as a solution and prevention to adverse drinking behaviors. Trauma-informed yoga brings together the themes of forgiveness, gratitude, and vulnerability with movement and gives individuals the tools to recognize subtle changes in breathing, heart rate and feelings in the body which allows them to correct imbalances and self-regulate emotions (Yoga4Change, 2017). Throughout this process individuals will also participate in peer-mentorship and receive thorough treatment when needed to help realize past traumas and to actively participate in the healing process. Upon completion of the program, participants will be able to join the cause through becoming a trained yoga instructor and/or peer mentor. Overall, this whole program is about developing the skills and knowledge to identify emotions and behaviors that lead to negative outcomes (adverse drinking patterns) and using yoga in combination with mindfulness techniques to redirect these behaviors to a more positive practice. Progress towards the goals will be measured via individual surveys and trending of incidence/ prevalence of adverse drinking behaviors in Alachua County.
My grant proposal further outlines how the program has a public health framework through its focus initially on tertiary level prevention then transitioning to secondary level prevention (Philanthropy Network of Greater Philadelphia, N.D.). The design of the program is focused primarily on tertiary prevention as it concentrates on adults with at least two ACEs who currently participate in adverse drinking behaviors on a weekly basis. At the end of the initial pilot program, the hope is that enough information is gathered to broaden the program to include individuals at risk of adverse drinking behaviors due to their ACE score thus shifting the focus to also include secondary prevention. Moreover, adverse drinking behaviors are not only a negative outcome associated with adverse childhood experiences, but they may also be the instigators of ACEs for the next generation. Consequently, through treatment of these behaviors and skill development the cycle of ACEs may be halted, and protective resilience factors passed on instead. This process aligns with primary prevention of ACEs. In conclusion, the multi-disciplinary program design will tackle the issue of increasing prevalence of adverse drinking behaviors in a trauma-informed manner which incorporates multiple public health entities and professionals.
The CDC’s social ecological model serves as the framework for the development of this project. This model has four primary levels: individual, relationship, community and societal (CDC, 2020). The individual level is addressed through empowerment and development of positive coping skills through frequent yoga and mindfulness practice. The skills, insight and self-awareness learned through yoga and mindfulness target multiple psychological, neural, physiological and behavioral process implicated in addiction behaviors (Khanna & Greeson, 2013). The relational level is addressed through peer-mentorship. Developing trust is difficult to do due to sensitivity and privacy of trauma related issues, these relationships will create a safe environment to voice experiences while gaining knowledge from peers who underwent similar process and struggles. The relationships will also allow the individual to continue participation in the program as a mentor, granting them a chance to portray the skills and capacity that they learned. Furthermore, a community component of the program will be fostered through the participation of the whole treatment team in the yoga and mindfulness exercises. Their participation will allow the participants to feel included on the greater team and construct communal resilience, capacity and solidarity in the purpose of the program. Lastly, the societal level is addressed through the knowledge derived from the focus groups to help inform the association between adverse drinking patterns and ACEs prevalent across the nation. Since adverse drinking behaviors result from the complex interplay between factors at multiple levels, a multifaceted and multilevel intervention such as one described above is needed to combat these behaviors (CDC, 2020).
Also, trauma informed principles, derived from the Trauma-Informed Philanthropy Guide and SAMHSA, are built into various aspects of the program to guide its trauma-informed care goal. The first key principle of safety will be incorporated by ensuring that the physical space and location where the project’s components occur are safe, secure and welcoming. Care will be taken by trained staff to ensure that the verbal and social space is inclusive for all individuals, avoiding divisive or uncomfortable conversations and topics. In the instance of continued adverse drinking behaviors, restorative approaches such as understanding the needs, emotions or unmet desires that led to those behaviors will be employed in place of punitive approaches. The second key principle of peer support and mutual self-help will be included through the central focus on peer mentorship in order to gain knowledge, skills, healing and support to understand motivation of behaviors and transform outcomes. The third key principle of empowerment, voice and choice will be utilized through the development of group programing that focuses on a person-centered, strengths-based curriculum to help identify and cope with stressful experiences. Additionally, during the focus groups individuals will be encouraged to share their opinion openly and when comfortable share their experiences in order to empower them to redefine the narrative surrounding those experiences. The fourth key principle of empowerment collaboration and mutuality will be incorporated through participation of the individual on their treatment team and the participation of the care team in the yoga and mindfulness practices. All staff will be thoroughly trained in trauma-informed care prior to initiation of project so they have the skills to develop rapport, trust and meaningful relationships with the participants. Lastly, peer mentors will have an active role on the overall treatment team and provide necessary knowledge regularly to inform decisions.
In conclusion, my grant proposal uses a trauma-informed approach to education and resilience development to treat and prevent adverse drinking behaviors specifically in populations afflicted with multiple ACEs. The multi-disciplinary team together with peer mentors will help guide and advance individuals through the program and the multi-level intervention aims to enhance individual capacity to identify stressors and redirect adverse behaviors, then further empower individuals by encouraging them to become peer mentors and instructors as the program evolves.
References
Centers for Disease Control and Prevention. (2018). Fact Sheets: Binge Drinking. Retrieved from https://www.cdc.gov/alcohol/fa...s/binge-drinking.htm
Centers for Disease Control and Prevention. (2020). The Social-Ecological Model: A Framework for Prevention. Retrieved from https://www.cdc.gov/violencepr...ecologicalmodel.html
FL Health Charts. (2020). Adults who engage in heavy or binge drinking. Retrieved from http://www.flhealthcharts.com/...spx?bid=10&cid=2
Khanna, S., & Greeson, J. M. (2013). A narrative review of yoga and mindfulness as complementary therapies for addiction. Complementary therapies in medicine, 21(3), 244-252.
Philanthropy Network Greater Philadelphia. Trauma-Informed Philanthropy: A Funder’s Resource Guide for Supporting Trauma-Informed Practice in the Delaware Valley. https://c.ymcdn.com/sites/www....maGUIDE_FinalWeb.pdf. Accessed March 22, 2020
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.
Yoga4Change. (2017). About our Programs. In Bloom. Retrieved from https://www.y4c.org/programs-overview
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