Addressing childhood trauma is increasingly being recognized as a priority in public health, healthcare and health policy sectors. As evidence mounts that the effects of trauma are both graded and dose responsive, stakeholders in healthcare are turning more attention to preventing and addressing experiences of trauma in childhood, commonly referred to as adverse childhood experiences (ACEs). Trauma Informed Care (TIC), is a promising clinical approach attuned to the specific needs of traumatized patients that is still in its infancy with regards to training and evaluation of practitioner skills. Although physicians of all specialties will encounter patients who have experienced trauma, few undergraduate medical education curriculums provide formal training in TIC. Additionally, the approach to TIC in clinical settings has largely been biomedical and individual, with a focus on screening and treatment. This model ignores the role that communities play in both propagating trauma and generating resiliency. Urban academic medical centers, often geographically located in highly traumatized communities, must take a specific interest in developing TIC research, theory and praxis that includes and empowers communities. Service learning, a form of experiential education that cultivates self-awareness in students while simultaneously meeting community objectives, is a pedagogy that aligns with a community driven TIC framework. This thesis outlines the implementation of a community driven, bi-directional TIC learning model designed to serve the needs of medical students and low income K-8th grade students living in the geographic catchment of an urban, academic medical center. / Urban Bioethics

Immigration is a highly politicized topic increasingly on the forefront of the nation’s consciousness. Though news media and academia have drawn attention to evidence of physical health needs of undocumented immigrants being compromised due to their documentation status, relatively less attention is brought to their mental health needs. The purpose of this paper is to review literature about the mental health care needs of immigrants and refugees to the United States, with a particular focus on recent adult immigrants from Latin America and their youth, who may directly or indirectly suffer trauma related to deportation, violence, family separation and/or loss. This paper serves to provide ethical arguments for increased awareness, education and resources towards trauma-informed, culturally sensitive mental health care for immigrants and refugees to the United States. The ultimate aim of this paper is to provide its readers with essential information regarding the impact of trauma and cultural identity in the mental health care (or lack thereof) of Latinx immigrants. / Urban Bioethics

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Early stressors like trauma can lead to developmental changes that have life-long negative health consequences (Merikangas et al., 2010; Anda et al., 2006). Approximately 1 in 4 youth experience substantial trauma during their developmental years (Merikangas et al., 2010; Duke, Pettingell, McMorris, and Borowsky, 2010). Such findings suggest the need for early intervention and treatment for adolescents exposed to traumatic events and adversity. Ideally, adolescents could be treated within primary care settings where parents overwhelmingly seek services for their children. Primary care settings are sought out at a 94% to 97% rate of services as compared to only a 4% to 33% rate of parents seeking out mental health services (Guevara et al., 2001). Unfortunately, no adolescent trauma-informed interventions have yet been adapted for use in primary care (Glowa, Olson, and Johnson, 2016). This study aimed to fill this critical gap between adolescent mental health issues associated with trauma and adverse childhood experiences and the lack of treatment in integrated primary care settings. The need for trauma-informed treatment for adolescents who have experienced trauma and adverse experiences is especially salient as evidence-based treatment for adolescents in this setting is limited. A modified Delphi approach was employed to address this gap in the research. Two rounds of questionnaires and focus groups were utilized with a panel of experts and youth stakeholders to gain consensus on treatment recommendations. Ultimately, expert panelists and youth stakeholders identified 59 recommendations for adolescent trauma treatment to be delivered in integrated primary care settings. / Doctor of Philosophy / Childhood trauma can have negative health, social, and educational outcomes that extend into adulthood and over one’s lifespan (Black, Woodworth, Tremblay, & Carpenter, 2012; Merikangas et al., 2010). Approximately 1 in 4 youth today experience trauma (Duke et al., 2010). Trauma can include a variety of things such as physical, sexual, or emotional abuse; being the victim of a crime; witnessing violence in the home; living through a natural disaster or experiencing an accident (Anda et al., 2006; APA, 2017). The frequency of trauma in adolescence suggests the need for early intervention and treatment. Ideally, adolescents could be treated within primary care settings where parents and adolescents frequently seek care services. Unfortunately, no adolescent trauma interventions have been created for this setting (Glowa, Olson, & Johnson, 2016). This study was designed to improve the treatment of adolescent trauma in primary care settings. For this research study a modified Delphi technique was used. Two rounds of questionnaires and focus groups were utilized with participants that consisted of a panel of experts from the field and youth aged 14-18 years old. Ultimately, the study participants made 59 recommendations for adolescent trauma treatment to be delivered in primary care settings.

Mothers of children with autism have a higher rate of stress than mothers of neurotypical children and mothers of children with other disabilities. This impacts their family quality of life. This study aimed to show that by teaching mothers trauma-informed mindfulness-based stress reduction techniques they were able to switch their perspectives and feel that they had increased the relationships with their child with autism and increased the rating they give their family quality of life. The participants were recruited using word of mouth and through distribution of posters to autism communities following approval of the experiment through the institutional review board (IRB). The participants selected were mothers of children with autism. They interacted with the researcher through Zoom. They completed multiple measures to assess their levels of stress, well-being, mindfulness, and family quality of life. Measures included daily stress self-report, Freiburg Mindfulness Inventory-14 (FMI-14), Beach Center Family Quality of Life (FQOL), and a semi-structured interview. This was a multiple baseline study. Data analysis included visual analysis and changepoint analysis. Mothers of children with autism who utilized mindfulness, defusion, and trauma-informed problem-solving resulted in consistently decreasing levels of stress throughout the intervention. Family quality of life increased, especially in the areas of financial well-being and parenting. The mothers reported the most benefit in the practice of defusion and the least benefit from trauma-informed problem-solving. The research done in this experiment merits further study, especially in the areas of mindfulness and defusion. A larger sample size should be used to identify the benefits more closely from each phase and to identify the impact of a less homogeneous group of people. It can then be generalized to other parents of children with special needs.

The prevalence of distressing content on social media raises concerns about users' mental well-being, prompting the use of trigger warnings (TW) and content warnings (CW). However, varying practices across platforms indicate a lack of clarity among users regarding these warnings. To gain insight into how users experience and use these warnings, we conducted interviews with 15 regular social media users. Our findings show that users generally have a positive view of warnings, but there are differences in how they understand and use them. Challenges related to using TW/CW on social media emerged, making it a complex decision when dealing with such content. These challenges include determining which topics require warnings, navigating logistical complexities related to usage norms, and considering the impact of warnings on social media engagement. We also found that external factors, such as how the warning and content are presented, and internal factors, such as the viewer's mindset, tolerance, and level of interest, play a significant role in the user's decision-making process when interacting with content that has TW/CW. Participants emphasized the need for better education on warnings and triggers in social media and offered suggestions for improving warning systems. They also recommended post-trigger support measures. The implications and future directions include promoting author accountability, introducing nudges and interventions, and improving post-trigger support to create a more trauma-informed social media environment. / Master of Science / In today's world of social media, you often come across distressing content that can affect your mental well-being. To address this concern, platforms and content authors use something called trigger warnings (TW) and content warnings (CW) to alert users about potentially upsetting content. However, different platforms have different ways of using these warnings, which can be confusing for users. To better understand how people like you experience and use these warnings, we conducted interviews with 15 regular social media users. What we found is that, in general, users have a positive view of these warnings, but there are variations in how they understand and use them. Using TW/CW on social media can be challenging because it involves deciding which topics should have warnings, dealing with the different rules on each platform, and thinking about how warnings affect people's engagement with content. We also discovered that various factors influence how people decide whether to engage with warned content. These factors include how the warning and content are presented and the person's own mindset, tolerance for certain topics, and level of interest. Our study participants highlighted the need for better education about warnings and triggers on social media. They also had suggestions for improving how these warnings are used and recommended providing support to users after they encounter distressing content. Looking ahead, our findings suggest the importance of holding content creators accountable, introducing helpful tools and strategies, and providing better support to make social media a more empathetic and supportive place for all users.

BACKGROUND: For years, the trauma of acute inpatient psychiatric treatment has been studied. Trauma-informed models have been created to reduce the trauma of receiving care. These models primarily focus on patient-provider relationships and not the interpersonal dynamics between patients on acute psychiatric units. METHODS: A literature review via Temple University Library and Google Scholar databases as well as interviews with mental health professionals were conducted on the current trauma prevention initiatives in mental healthcare and on strategies to strengthen interpersonal relationships between patients in acute psych units and to quell patients’ perceived risk of harm from one another. RESULTS: A set of five principles is proposed for fostering community and safety in acute adult inpatient psychiatric units as it pertains to the interpersonal relationships between patients. These principles include: 1) Fostering a sense of community within the patient population 2) Rethinking the physical space to reduce patient stress and therefore reduce patient aggression 3) Providing a mentorship program led by peer mentors from the community 4) Providing better mental health education and awareness within society 5) Bridging the gap between the community and inpatient psychiatry. CONCLUSION: The five principles of this thesis can aid in positively transforming patients’ experiences in acute psychiatric units. This transformation requires a significant amount of activism and collaboration in order to stop repeating the cycles of trauma seen within the psychiatric field. / Urban Bioethics

This evidence-informed doctoral project proposes the development and implementation of a digital manual, "Safe Spaces, Stronger Futures: A Digital Guide for School-Based Occupational Therapy Practitioners Working with Children Experiencing Trauma.” In order to equip occupational therapy practitioners (OTPs) with essential trauma-informed practices, this manual offers foundational knowledge on trauma symptomatology, evidence-based strategies, interactive tools, and ongoing support through a professional online community. It aims to enhance school-based OTPs (SB-OTPs) confidence and competence in addressing trauma-related behaviors, fostering environments that support healing and growth for students with trauma histories. A comprehensive literature review was completed by the program author and addressed three key questions: (1) which interventions improve occupational performance in children who have experienced trauma, (2) what design strategies maximize adult learning, and (3) what are effective sensory supports for children with trauma histories. This project aligns with the American Occupational Therapy Association (AOTA) Occupational Therapy Practice Framework (OTPF), emphasizing mental health, sensory processing, and emotional regulation (OTPF, 2020). A pilot study has been designed to measure the program's effectiveness and to identify potential areas of improvement. This study will involve SB-OTPs from various schools in the Boston area using quantitative surveys and qualitative interviews to assess changes in practitioner knowledge, confidence, and the application of trauma-informed strategies. Expected outcomes include significant improvements in SB-OTPs' ability to implement these practices, positively impacting students affected by trauma. Dissemination plans include submitting articles to journals, presenting findings at professional conferences, and leveraging social media and online platforms to reach a broader audience. A dedicated website will ensure ongoing access to the manual and related resources, providing sustained support and professional development for SB-OTPs nationwide.

In this dissertation, I sought to understand foster parents’ perceptions of giftedness, how foster children’s strengths, gifts, and talents affect their experiences and those of their foster parents, and what resources and information foster parents have for supporting their foster children’s education and gifts. To understand these beliefs, I analyzed quantitative and qualitative survey data from 53 foster parents throughout the United States and analyzed interviews from 14 of those foster parents. Most foster parents surveyed perceived their foster children as a little or very different academically and in other ways than their peers not in foster care, and perceived they had different educational experiences than their peers, largely attributed to their lived experiences prior to entering and during foster care. Most participants felt their foster children’s abilities, strengths, and talents affected foster parents a little or very much. Interviewed and surveyed foster parents defined giftedness as including the following attributes: academic achievement, natural ability or innate talent, intelligence, domain-specific capabilities, performance or skills above average for their age or above their peers, unique approaches to learning, and motivation for learning. Interviewees also addressed non-academic forms of giftedness, socioemotional characteristics of children with gifts and talents, and noted that these students may have some difficulties in school. Foster parents explained the adaptations they have made to their parenting because of their foster children’s strengths, talents, and abilities, and highlighted the unique life experiences of foster children, which were not only hinderances but also could help them succeed academically and in life. Participants also expressed why they think foster children are not identified for gifted education programming. Foster parents had many needs related to their foster children’s education and strengths, talents, and abilities. They made recommendations to those who train new foster parents and provide ongoing training to current foster parents; to schools and teachers of foster children; and to new foster parents about how to best meet the needs of foster children and encourage their gifts and talents.

[pt] Estudos sobre as primeiras interações das crianças com seu ambiente apontam para possíveis efeitos do estresse tóxico na infância, como facilitador de comportamentos de risco na adolescência, além de prejuízos para o desenvolvimento de habilidades cognitivas e socio emocionais (Van der Kolk, 2003). Pela necessidade de as escolas estarem preparadas para atenderem crianças que experimentam altas e frequentes taxas de estresse no início de suas vidas e precisam lidar com seus efeitos, a escola como um todo precisa ser um espaço de segurança e resiliência para que as crianças possam experimentar um processo de aprendizagem. A partir de uma perspectiva ecológica da Psicologia do desenvolvimento, o objetivo do presente trabalho foi realizar uma revisão narrativa de literatura para identificar práticas e modelos da educação sensível ao trauma, voltados para proteção contra os efeitos do estresse tóxico sobre o desenvolvimento cognitivo na educação infantil e primeiros anos do ensino fundamental. Foram selecionados 50 artigos sobre diferentes modelos de educação sensível ao trauma nos primeiros anos de escolarização e com abordagens voltadas para a escola como um todo. A partir da análise desses artigos, foram identificados nove aspectos principais dentre os diferentes modelos apresentados: autorregulação emocional, treinamento dos(as) profissionais de educação, engajamento comunitário, preparação de ambientes psicologicamente seguros, apoio emocional para os(as) educadores(as), rotinas e rituais na prática pedagógica, vínculo seguro, atendimento individual ou em grupo e contato regular com as famílias. Acredita-se que esses elementos podem orientar intervenções voltadas para primeira infância em contextos de vulnerabilidade, no âmbito da educação. / [en] Studies on children s first interactions with their environment point to possible effects of toxic stress in childhood, as a facilitator of risky behavior in adolescence, in addition to impairments for the development of cognitive and socioemotional skills (Van der Kolk, 2003). Due to the need for schools to be prepared to serve children who experience high and frequent stress rates early in their lives and need to deal with its effects, the school as a whole needs to be a space of safety and resilience so that children can experience a learning process. From an ecological perspective of developmental psychology, the objective of the present study was to carry out an integrative literature review to identify practices and models of trauma informed education, aimed at protecting against the effects of toxic stress on cognitive development in preschool and early years of elementary school. Fifty articles were selected on different models of trauma informed education in the first years of schooling and with approaches aimed at the school as a whole. From the analysis of these articles, nine main aspects were identified among the different models presented: self-regulation, professional training of trauma and toxic stress, community engagement, psychologically safe environments, emotional support for teachers, routines and rituals in pedagogical practice, secure attachment, individual or group therapy and regular contact with families. It is believed that these elements can guide interventions aimed at early childhood, in the context of education.