Trauma-Informed Healing: Clinicians perspectives on key factors to address Black adolescent gunshot wound survivors physical and mental health needs A qualitative study Open Access

Boykin, Briana (Spring 2020)

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Background: Adverse childhood experiences (ACEs), including trauma exposure, parent mental health problems, family dysfunction, and community-level adversities have negative health effects that persist throughout adulthood including increased risk for disruptive sleep patterns, cardiovascular disease, diabetes, stroke, cancer, and other chronic diseases (Umlauf, Bolland, & Lian 2011). Individuals with a history of trauma within their childhood have a heightened vulnerability towards the harmful effects of long-term toxic stress (Behnke, Rojas, Karabatsiakis, & Kolassa, 2019). Toxic stress is different from other types of stress because it is prolonged, unpredictable, and takes over the brain’s normal stress processes. Toxic stress hinders normal brain development and function and dysregulates the endocrine and immune systems (Sonu, Post, & Feinglass 2019). These higher exposures to trauma immediately put individuals at risk for increased stress, anxiety, and hypervigilance which have been demonstrated to increase rates of cardiovascular disease and other prevalent chronic diseases in the Black community (Janusek, Tell, Gaylord-Harden, & Mathews 2017). To address these issues and improve the care of young Black trauma patients, efforts are needed to understand contextual factors that impact Black patients (Hogarth, 2019). Understanding the multiple effects that trauma has on Black patients can help clinicians work more effectively with this population (Range et al., 2017).

           Methods: Data collected for this study came from a total of 10 open ended qualitative in-depth interviews, conducted with clinicians at Atlanta’s Grady Marcus Trauma Center. The patients’ experiences were contextualized through the perspectives of the clinicians’ primary accounts of interactions with their patients who received treatment at Atlanta’s Grady Marcus Trauma Center Clinician.

           Results: Several themes arose within the data such as: community violence recidivism, psychosomatic health, family matters, and clinician’s role. Clinicians shared their perspective of their patients’ responses to community violence and provided suggestions on how to mitigate its reoccurrence for their patient population. Psychosomatic responses to traumatic injury were described, alongside appropriate methods of care for pain that is unrelated to the gunshot injury. Family relationships, in particular mother support, were highlighted as a strong protective factor in the healing process of the youth. Finally, the clinician’s role was described as slightly challenged to step outside of the norm of treating solely the physical health of the patient and approach healing more holistically including addressing family and community factors. Each theme emerged from clinician interviews.

           Conclusion: Our study suggests that psychological responses to traumatic injury such as night terrors and hyper-vigilance, and psychosomatic responses are prevalent in this population and important for clinicians to address to provide quality care. Further, our data indicates that limited psychological care for youth is provided in this inpatient setting which may contribute to high rates of recidivism in this population. Future work should examine if trauma informed care that addresses traumatic stress, including psychosomatic responses, engages family members, and addresses community risk factors can mitigate re-traumatization, recidivism, and improve patient experience for Black adolescent gunshot wound survivors.

Keywords: Psychosomatic, Trauma-informed care, Black adolescent health, mental health, Gunshot Wound Survivor

Table of Contents

Chapter 1                 1


Theoretical framework         

Chapter 2                 8

Literature Review             

Chapter 3                 16


Chapter 4                 23

Journal article                       

Abstract 24

Tables  50

Chapter 5                54

Public Health Implications    

References. 57

Appendices. 62

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