Trauma-informed Care: An Essay On Prevalence, Neurobiology, Evidence-based Care, And Implementation.

An essay format is required, so include an introduction and conclusion. I prefer you use the subheadings to signpost your work. This will help ensure you have addressed all parts of the assessment task. With regard to the subheadings you may want to consider the following:

• Prevalence - look at the literature on prevalence of trauma in mental health presentations. You can use either national or international literature as long as it is cited correctly.
• Neurobiology - outline what we know about the effects of trauma on neuroanatomy and neurophysiology (with citations). I covered some of these processes in the VoiceThread on trauma-informed care.
• Critique of the evidence - explain trauma-informed care by describing the key components. Then search for the evidence. See if you can find any randomised controlled trials, systematic reviews/meta-analysis conducted around trauma-informed care.
• Implementation - trauma-informed care is a relatively new approach to practice so discuss how it might be implemented (you will need to look more broadly than just nursing care). 

Trauma is the mental illness that can be defined as the psychological and emotional response or an event that is deeply disturbing or distressing. When people experienced highly stressful or disturbing conditions that left them feeling emotionally out of control and helpless, they may develop psychological trauma. The psychological trauma may leave a person struggling with upsetting emotions. Traumatic events often involve a threat to life or safety. There are various types of trauma such as complex trauma, post-traumatic stress disorder and developmental trauma disorder (McCann, & Pearlman, 2015). Emotional and psychological trauma is caused by One-time events, ongoing and relentless stress, and commonly overlooked causes like surgery, sudden death of close one. In the case study, the patient suffered discrimination, the murder of family member, retention, guilt, sleeplessness, hopelessness, and anxiety due to various stressful events. He also complained about lack of concentrations, therefore he faced issues in getting a job (Sherin, & Nemeroff, 2011). In these essay trauma-related topics like the prevalence of a history of trauma in the mental health presentation, the neurology of trauma, evidence-based trauma-informed care will be discussed. How to implement this model in the case of Mr. Amir will also be mentioned in this particular essay report.  

Psychological and emotional trauma is associated with stressful events that people faces in their lives such as serious accident. This mental health disorder is not restricted to a country or a specific population or community; it is affecting people from all around the world equally. The symptoms of post-traumatic stress disorder have been introduced since the inception of the wars like the epic of Gilgamesh, Homer's Iliad and also described in Shakespeare’s work. During the First World War fatigue, exhaustion and anxiety have been produced (Stallman, 2010). During the Vietnam war (between 01-11-1955 to 30-04-1975) the symptoms like combat-related nightmares, anxiety, anger, depression, alcohol and drug dependence and poor responsiveness has been identified in people. The women’s in the military specifically nurses faced extremely traumatic events suffered from the trauma issues like PTSD. In the United States the lifetime prevenance is 6.8 to 12.3 per cent and one-year prevalence rates are 3.5 to 6 per cent. Women's are four times more likely to develop this disorder (Mealer, Burnham, Goode, Rothbaum, & Moss, 2009). The rates of PSTD are same as among both men and women after the incidents like accidents, natural calamities, or sudden death of loved ones (Breslau, 2009). Mr. Daud experiencing PSTD as he seen the death of a member of his family and other traumatic events. A study conducted by Perkonigg, Kessler, Storz, and Wittchen (2001) in 3021 people it was revealed that nearly 26 % participants and 17. 7 per cent females mentioned at least one traumatic event, only a few members reported having full PSTD. According to that study, PTSD and traumatic events are associated with another mental disease; PTSD occurred as primary and secondary disease. Mental health is a big concern for the whole world. Particularly in America, one in every 4-5 adult meets the criteria for a lifetime mental disease which is associated with the severe role of the severe distress. In 2008 nearly 8.1 per cent adult ages between 12 to 17 and 8.7 per cent between 18 to 25 years old had at least single episode of depression (Richardson, Frueh, & Acierno, 2010). In Australia, the estimated 12 months prevalence of this health condition was 1.33 per cent which can be considered lower compared to America (Slade, Johnston, Oakley Browne, Andrews, & Whiteford, 2009).  Australia allowed nearly 12,349 refugees to enter in 2001 to 2002 and allowed nearly 13000 from 1991 till 2006. Refugees may constitute a specific vulnerable group in terms of mental health results. These refugees evidenced a history of trauma. A study conducted by Schweitzer et al (2006) among refugees revealed that nearly 5 % of refugees reported having post-traumatic stress; however, nearly 25% revealed that they have extreme levels of psychological distress. It was also reported that more than half of the participants reported to experienced 5 or more type of trauma. This data trauma prevalence shows how important it is to concentrate on this health condition (Richardson, Frueh, & Acierno, 2010)

Neurobiology of Trauma

Trauma is an extremely distressing and depressing experience which is both physiological and psychological response. The psychological trauma damages to the person’s psyche by a stressful or distressing event. Stress and trauma stimulate the HPA axis. The HPA axis is the Hormone and nervous system connection of three different structures that are hypothalamus, pituitary gland and adrenal gland (Heim, & Nemeroff, 2009). Hypothalamus the central part of the brain that communicates with other brains structures like the pituitary gland. This part of the brains stimulates the hormones secreted from the pituitary gland in traumatic events (Gantt, & Tinnin, 2009). Hormones that are released from the pituitary gland triggers hormones secrets form adrenal glands such as catecholamines, cortisol, opiates, and oxytocin. These hormones act as a signal or message when the body face a traumatic event and help the human body to deal with it (Heim, & Nemeroff, 2009). Amygdala is the brain part that specifically processes the emotional information. When a stressor attacks amygdala, it makes a rapid assessment of whether the condition requires a systematic response or not. If it is necessary it triggers the system to deal with this situation. In results of trauma and stressors, the amygdala triggers the sympathetic nervous system that responds by making the body ready for flight or flight condition. This condition includes an impaired heart rate and changes in the breathing pattern and muscle tone. Amygdala is then stimulating the HPA axis which is the circuit of the brain cells HPA (hypothalamus, pituitary, and Adrenal gland). The hypothalamus releases corticotrophin releasing hormone also abbreviated as CRH. This hormone improves the secretion of two other different hormones from the pituitary gland Beta-endorphins and ACTH (adrenocorticotropic hormone). ACTH stimulates the secretion of cortisol which plays an important role in the nervous system of the body by affecting someone’s emotions, memory and learning (Sherin, & Nemeroff, 2011). Various studies have been found that chronic stress and trauma results in deregulation of the HPA axis (Lanius et al., 2010). The beta-endorphins can play an important role to help a person to cope with pain and deal with stressors. When a person experiences trauma and post-traumatic stress disorder the beta-endorphins continuously releases as the result of reoccurrence of the stressors via flashback and intrusive memories of those events (Sherin, & Nemeroff, 2011).

The experience of trauma may cause serious mental issues like stress, depression, and anxiety. Mr. Daud experienced the extremely high stressful event in his life such as the detention time, being a witness of the murder of his family member, discrimination and persecution and being away form family. Trauma-informed care might be the beneficial strategy to deal with traumatic issues he has been facing. This effective framework includes six different components that are safety, trustworthiness & transparency, collaboration, empowerment, and choice. Sometimes the patient with trauma events not very open to discussing the issues they faced in past, therefore their safety and privacy should be maintained (Hopper, Bassuk, & Olivet, 2010). As discussed in the case study Mr. Amir Daud experienced may traumatic event in her life and continuously facing mental health issues, it should ensure that his physical and emotional safety will be safe. A therapeutic relationship should be built with the patient in order to achieve the health goals already set for Mr. Daud. A choice is the second most important component of trauma-informed care according to which every individual or person with trauma issues has choice and control about their treatment. They should be provided with clear and appropriate information about their responsibility and rights. Collaboration is the third component to this framework which includes collaborating with the patient in the decision-making process and sharing the power with him. This component indicated that individuals should be provided with a significant role in the process of planning and evaluating services (Machtinger, Cuca, Khanna, Rose, & Kimberg, 2015). The fourth component is trustworthiness which includes providing task clarity, interpersonal boundaries, and consistency to the patient. According to this component of the TIC, the respectful and professional boundaries between the nurse and the patient should be maintained. The last components that are included in the TIC framework are empowerment which is prioritizing empowerment and building skills. As discussed in the case study Mr. Amir Daud experienced various issues since he left his home like feeling guilty for leaving his family behind, therefore he needs to be dealt with care and his emotions should be prioritized in order to build a good therapeutic alliance so that he can feel like home. The patient should be provided with an environment or atmosphere that allows him to feel validated and affirmed with every healthcare care provider (Hanson, & Lang, 2016).

Components of Trauma-informed Care

Implementation of this model in the case of Mr. Daud will be a crucial step in order to achieve the health goals for the patient. Trauma-informed care implementation process includes four different ingredients involving the patient in the treatment process, screening for trauma, training staff in trauma-specific treatment approaches, and engaging referral sources and partnering organizations. Involving the patient in their treatment planning and providing them with an active role in the decision-making process is their right. The feedback of patient drives direction of a care plan for him. In case of the traumatic patients, engaging them in the treatment process and decision making may develop a trust with the health care providers. Screening for trauma provide a clear understanding of the patient’s trauma history, helps to decide intervention, provide adequate data, and quantifies the risk of diseases in the future (Muskett, 2014). Screening can reduce the risk of racial and ethnic bias. Screening of the patient is basically a set of the question asked to the patient related to the Past experience. It allows them to decide what and how much information they want to share. Some of the aspects of screening are: treatment setting should guide practices, screening should benefit the patient, re-screening should be avoided, ample training should precede the screening. Training the staff for trauma-specific treatment approach is necessary to share all the information related to the approach as it is not the conventional strategy it might be unknown to some of the staff members.  Patients with Trauma often have complex clinical, behavioural health, and needs for social services, therefore involving the referral sources and partnering organizations might give a boost to the treatment process (Hummer, Dollard, Robst, & Armstrong, 2010). In the case of Mr. Amir Duad, these steps should be followed in order to implement the Traumatic informed care.

Conclusion:

Trauma is the problem associated with mental health and can be described as the psychological and emotional response of the traumatic events that are extremely disturbing and distressing. It left the people feeling out of control emotionally and helpless. It can be caused by some stressful events like accidents, natural disasters, and death of a family member. In the United States, the lifetime prevalence of this health condition is 6.8 to 12 % and annual prevalence rates were 3.5 to 6 per cent. In Australia, the 12 months prevalence was 1.33 per cent. The neurology of trauma includes stimulation of the HPA axis by stress and trauma. I traumatic events hypothalamus stimulate secretion of hormones that act as a signal for the body. Amygdala is the part of the brain that rapidly assesses whether the condition requires system response and stimulating the sympathetic nervous system for fight or flight condition. Due to stressors through intrusive memories and flashbacks, beta-endorphin continuously releases. Key components of trauma-informed care include safety, collaboration, trustworthiness & transparency, empowerment, and choice. Successful implementation of trauma-informed care model in case of Mr. Daud should include the key ingredient like engaging patient in the treatment process, providing training to the staff, screening for trauma and involving the referrals sources and partnering organization in the treatment.

References:

Breslau, N. (2009). The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma, Violence, & Abuse, 10(3), 198-210.

Gantt, L., & Tinnin, L. W. (2009). Support for a neurobiological view of trauma with implications for art therapy. The Arts in Psychotherapy, 36(3), 148-153.

Hanson, R. F., & Lang, J. (2016). A critical look at trauma-informed care among agencies and systems serving maltreated youth and their families. Child Maltreatment, 21(2), 95-100.

Heim, C., & Nemeroff, C. B. (2009). Neurobiology of posttraumatic stress disorder. CNS spectr, 14(1 Suppl 1), 13-24.

Hummer, V. L., Dollard, N., Robst, J., & Armstrong, M. I. (2010). Innovations in the implementation of trauma-informed care practices in youth residential treatment: A curriculum for organizational change. Child Welfare, 89(2), 79.

K Hopper, E., L Bassuk, E., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(1).

Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010). Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry, 167(6), 640-647.

Machtinger, E. L., Cuca, Y. P., Khanna, N., Rose, C. D., & Kimberg, L. S. (2015). From treatment to healing: the promise of trauma-informed primary care. Women's Health Issues, 25(3), 193-197.

McCann, L., & Pearlman, L. A. (2015). Psychological trauma and adult survivor theory: Therapy and transformation (2^nd ed.). New York: Routledge.

Mealer, M., Burnham, E. L., Goode, C. J., Rothbaum, B., & Moss, M. (2009). The prevalence and impact of post-traumatic stress disorder and burnout syndrome in nurses. Depression and anxiety, 26(12), 1118-1126.

Muskett, C. (2014). Trauma?informed care in inpatient mental health settings: A review of the literature. International journal of mental health nursing, 23(1), 51-59.

Richardson, L. K., Frueh, B. C., & Acierno, R. (2010). Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Australian and New Zealand Journal of Psychiatry, 44(1), 4-19.

Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in clinical neuroscience, 13(3), 263.

Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in clinical neuroscience, 13(3), 263.

Slade, T., Johnston, A., Oakley Browne, M. A., Andrews, G., & Whiteford, H. (2009). 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Australian and New Zealand Journal of Psychiatry, 43(7), 594-605.

Stallman, H. M. (2010). Psychological distress in university students: A comparison with general population data. Australian Psychologist, 45(4), 249-257.