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Ethics are important in every aspect of our professional lives. Actions have consequences and in the Human Services field, decisions that we make will potentially directly impact our clients. A human services professional’s responsibility is to care for their clients and provide them with the appropriate resources needed to succeed in their daily lives. When a professional begins working with a trauma victim, they must be sure to assess their ethical behaviors and provide proper resources to the victim. This work is often referred to as trauma informed care which goes beyond the typical helping process of professionals. It is a unique kind of care that requires a great deal of time and dedication in order to help the client through the difficult experience of trauma.

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Medical schools around the country are utilizing service-learning as a method of promoting cultural humility among future physicians and strengthening partnerships between academic institutions and their surrounding communities. Critical service-learning (CSL) is an approach which emphasizes the need to address the power dynamics inherent to service through guided critical self-reflection for student learners, and centers autonomy and self-determination for community stakeholders. STEM Stars is an afterschool STEM enrichment program at a community center in North Philadelphia which was piloted in the 2019-2020 academic year. It was created with a trauma-informed design to address the social and emotional needs of K-6 students at the community center and to introduce trauma-informed practices to staff at the center. STEM Stars also served as a more intensive CSL opportunity for medical student volunteers and a model for future service-learning programs at the medical school. This thesis is a gap analysis of STEM Stars: it will provide a background of the program, review the pilot year, assess its successes and shortcomings, and propose changes to be made in the coming years. / Urban Bioethics

Trauma has been described as a pressing public health concern and research evidence demonstrates how unresolved trauma can lead to multiple co-morbidities including chronic medical conditions such as cardiovascular disease. Furthermore, epidemiological evidence demonstrates the high prevalence of trauma histories amongst service users seeking care across a range of systems including child welfare, education, health, social services and the criminal justice system. In response, the concept of trauma-informed care (TIC) has emerged, but how TIC can be conceptually defined and utilized remains unclear in the scholarly literature. This dissertation utilizes a variety of methodological approaches to explore how and under what conditions TIC can be utilized within and across systems of care to address the prevalence of trauma-affected individuals seeking care. First, a critical interpretive synthesis of the TIC literature provides an overview of how TIC can be defined and utilized through the development of a conceptual framework situating TIC within and across systems of care. A theoretical framework outlines important contextual factors, such as system arrangements as well as the political system, that can act as either barriers or facilitators to the operationalization of TIC. Second, a document analysis examines how and under what conditions TIC is utilized in adult mental health policy documents in Ontario, Canada. Finally, a case study explores what factors led to the exclusion of TIC from Ontario’s first province-wide strategy on mental health and addictions. Collectively, these three studies add several substantive, methodological and theoretical contributions regarding a cohesive understanding of what is trauma, how TIC can be defined and operationalized and the role of TIC at various levels within and across systems of care. Mobilizing sustainable and effective TIC has been demonstrated to improve the overall health and well-being of both service users and services providers, leading to stronger systems of care and healthier communities and societies at large. / Thesis / Candidate in Philosophy / The concept of trauma-informed care (TIC) has emerged in response to increased awareness regarding the prevalence and impact of trauma. A growing body of empirical literature has demonstrated the effectiveness of TIC within specific programs and services as well as at the organizational and system levels. What constitutes trauma, however, and how TIC can be defined and operationalized at various levels remains unclear. This thesis aims to address these gaps in the literature by: (1) developing a conceptual framework on TIC and a theoretical framework outlining the barriers and facilitators of TIC (2) examining how and under what conditions can TIC be utilized in mental health policy documents (3) exploring what are the political factors that can lead governments to decide against utilizing TIC.

The past few decades of research support both the impact of trauma (e.g., abuse, neglect, violence) particularly in childhood, and the ability to lessen its effects through the implementation of trauma-informed care (TIC). We have successfully developed a communitywide system of TIC enhancing collaboration and common language across sectors and organizations within sectors. The collaboration involved more than 100 individuals from more than 45 organizations including healthcare, education, children’s services, the faith community, behavioral health providers, criminal justice, law enforcement, private businesses, and others. The process for developing a system of care has been evaluated through community surveys and focus groups, verifying its ability to increase understanding and implementation of TIC principles, replication in a nearby city, and the development of an instructional toolkit to aid other communities in creating such systems of care.

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Abstract available through the Annals of Behavioral Medicine.

Trauma-informed Care (TIC) is a paradigm that has gained much traction in medical and human services settings over the past decade, motivated by the recent research findings that many poor physical, mental, and behavioral outcomes are more likely in individuals who experienced trauma in childhood (Adverse Childhood Experiences [ACEs]) such as abuse and neglect. The TIC paradigm, offered as novel, seems to be a secular repackaging of the biblical mandate to love our neighbors (Mark 12:31; Gal 5:14). The central tenets of TIC include feeling empathy with and demonstrating empathy toward others in their suffering; understanding that having experienced past traumatic events changes a person physically, mentally, and emotionally; that efforts should be made to prevent retraumatization; and that every person is valuable and has strengths that can be cultivated. Empathy, or feeling what other feel, is taught in Rom 12:15, “Be happy with those who are happy, and weep with those who weep,” and Gal 6:2, “Share each other’s burdens, and in this way obey the law of Christ.” Having an understanding of the pain experienced by those who have experienced trauma and caring for that suffering part of the body is clearly a biblical concept. Paul states, in 1 Cor 12:25-26, “This makes for harmony among the members, so that all the members care for each other. If one part suffers, all the parts suffer with it, and if one part is honored, all the parts are glad.” This supports the emphasis on empathy as well. The ACE Study which sparked the development of the TIC paradigm, highlights the likely impacts of adversity on children who have been treated unjustly. Throughout the Bible, those who follow God’s principles are instructed to care for the child, the weak, and those experiencing injustice (Isa 1:17, “Learn to do good; seek justice, correct oppression; bring justice to the fatherless, plead the widow’s cause.”). Finally, in teaching the tenets of TIC, we foster a belief that everyone has value and we should help each other to capitalize on strengths. Hebrews 10:24 echoes this by saying, “And let us consider one another to provoke unto love and to good works.” How do we know people have strengths to be capitalized upon? Rom 12:6 says, “In his grace, God has given us different gifts for doing certain things well,” and 1 Pet 4:10 says, “Each of you has received a gift to use to serve others. Be good servants of God’s various gifts of grace.” ​ I and a colleague have been teaching TIC principles to health care professionals and human service workers over the past two years. We have trained almost 2,000 people in these concepts. It has been embraced like nothing I have seen in my three decades in the psychological and counseling profession. Is it that our secularized society is hungry for biblical wisdom? Is it that He who created us knows best what we need? I can’t say, but our current research seeks to verify effects as organizations implement TIC.

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