Culturally sensitive trauma-informed care: Healing the mind through the heart
Unfortunately, trauma exists across all cultures and communities, but there are some cultures that inherit the pain of their forebears. This is particularly true for Alaska Natives/American Indians whose hearts are intertwined across generations and losses of loved ones. That experience, coupled with a vanished way of life, perpetuates a sense of grief and trauma into present day.
In fact, up to one-third of American Indians indicate that they are still bothered daily by thoughts of their historical losses. The addition of high suicide rates, environmental destruction, substance use and lived experiences further contributes to a communal sense of trauma. For example, many American Indians were forced into boarding schools developed by non-Natives to assimilate individuals into the “American” way of life. In 1918, steamboats carried the Spanish Influenza to Alaska, wiping out entire villages, along with a long-standing culture; more than 80 percent of all pandemic deaths were related to Alaska Native people. The impact of such events didn’t stop with individuals but has been passed down to their children and grandchildren as inherited trauma.
The addition of high suicide rates, environmental destruction, substance use and lived experiences further contributes to a communal sense of trauma. . . . The impact of such events didn’t stop with individuals but has been passed down to their children and grandchildren as inherited trauma.
Often, it is non-Natives providing professional therapeutic supports to indigenous people, and yet it is these same non-Natives who share a responsibility in the trauma experienced by these individuals. How can non-Native clinicians overcome an immovable history in order to provide culturally sensitive support to the people who now turn to the system for care?
Trauma-informed care provides a foundation of trust
Acknowledging and validating the experience of a patient is a critical step in the therapeutic alliance, especially if the clinician is an outsider to the patient’s culture. We know that being trauma-informed begins with asking “What happened to you?”, but it also means we have to be open to hearing about historically-earned distrust and validating the role it may play in treatment. Doing so is no different than working with individuals of one’s own culture who have been let down by the systems purported to support them. It takes time to build and earn trust when, as clinicians, we are often part of the system the person associates with his/her mistreatment.
Trauma-informed care provides a foundation for all professionals and non-professionals to provide support that is sensitive to all cultures. The key components of trauma-informed care are:
- Trustworthiness and transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice and choice
- Cultural, historical and gender Issues
To build a therapeutic alliance and trust with individuals, clinicians must learn about their patients’ history, culture, religion, spirituality and way of life prior to engaging in clinical recommendations or diagnoses. All too often, clinicians rely on their own historical and cultural context, which can lead to invalidation of the person’s uniqueness of experience. Assume nothing and begin as a blank slate to be taught by the people before you about who they are and what they need.
It’s also important to remember that trauma has a profound impact on the body as well as the mind. Thanks to the groundbreaking work of the Adverse Childhood Experiences study, we know that trauma exposure is linked to many physical health issues (such as heart problems, diabetes, hepatitis, COPD and hypertension). The rates of these physical sequela of trauma are even more pronounced in cultural groups such as the Alaska Native/American Indian. Therefore, coordination of care and collaboration with physical health supports, traditional and non-traditional, should be the center of treatment as well.
Beacon Health Options has been providing training to its clinical staff on trauma-informed care through webinars and evidence-based reference material. Our goal is to be sensitive to people’s differences and to match the best care to individual needs and preferences. As we continue to evolve, we need to appreciate that each new opportunity will bring a time to learn about new cultures and to be taught new ways of managing care and partnering with communities. At Beacon, our aim is to heal the heart and the mind, so we must remember to ask, ‘Who are you?’, ‘What happened to you?’, and to listen to their stories as a vital piece of who they are.