When researcher Elsa Falkenburger thinks about the benefit of trauma-informed communities, she recalls the curb-cut effect.
The concept is well-known in social science — sloped access points in curbs were mandated by the 1990 Americans with Disabilities Act in an attempt to make cities more accessible to people in wheelchairs. But soon, others appreciated them too: parents pushing strollers, delivery people with dollies, kids on scooters.
“By focusing on the deepest need, you’re actually benefiting everyone else,” said Falkenburger, chair of the community engaged methods resource center at the Washington, D.C.-based Urban Institute.
With that philosophy in mind the Monadnock Region is now focusing on a newer method of strengthening the social fabric: building a trauma-informed community.
The Greater Monadnock Community Health Improvement Plan acknowledges that trauma affects both physical and mental health. The plan was updated for 2020 by the Healthy Monadnock Alliance, a partnership of community leaders and organizations dedicated to improving health in the region.
That recognition of the impact of trauma led to conversations about bolstering trauma-informed care in the region, said Phil Wyzik, CEO of Monadnock Family Services and facilitator of the newly formed Monadnock Assembly on Trauma and Transformation.
“There [are] so many people who have been traumatized in some way or another,” Wyzik said. “This cuts across physical health care, housing, politics, economics. It’s an issue that touches many, many sectors.”
An individual and community problem
Trauma is defined by the American Psychological Association as an emotional response to an event, like an assault, war or natural disaster. In recent years, there’s been a movement to prioritize trauma-informed care on the individual level in both mental and physical health care settings.
Trauma-informed care acknowledges the impact of trauma on health, and aims to make the patient feel safe and in control, according to a 2022 study published in the journal Frontiers in Rehabilitation Sciences.
Old tropes — like the idea that it’s best to talk about trauma — have been pushed aside and there’s recognition that talking about trauma can itself be traumatizing, said Corinne Cavender, behavioral health program manager for Tri-County Health Network, a nonprofit dedicated to improving health outcomes in Telluride, Colo.
Cavender recently joined Wyzik and Ray Merenstein, executive director of the Colorado chapter of the National Alliance on Mental Illness (NAMI), to discuss the importance of trauma-informed care at Radically Rural, a summit hosted by The Sentinel and the Hannah Grimes Center in Keene.
Trauma doesn’t just affect individuals, Falkenburger said. It can also impact entire communities, especially those that have faced unique challenges, including rural areas.
“A lot of the trauma is actually a community level of trauma that has been generated from years of disinvestment and historical harms,” she said. Historical harms can include racism, sexism and institutionalization of people with mental illness.
A trauma-informed community approach expands trauma-informed care outside of a health care setting. It focuses not just on helping individuals who have experienced trauma, but addressing its impacts at the community level, according to Falkenburger.
Wyzik said law enforcement, the justice system, schools, faith communities, libraries and other public spaces can all become trauma-informed spaces. That would create more access points to care: For example, someone who was not comfortable in a health care or law enforcement setting could get information on available resources from a librarian, he said.
“There’s a raised bar of general awareness in the population about what trauma is,” he said. “The hope is to make sure that people who have been victimized have pathways to healing and recovery. There are many ways to enter into the healing process.”
Simple changes with big impacts
Ozy Aloziem is a professor of social work at the Metropolitan State University of Denver. She’s also the founder of Heal Inc., where she consults with organizations about trauma, racial justice and healing.
“If we’re not thinking about how trauma could be shaping interactions, we risk pathologizing people,” she said. “If we’re not thinking about how trauma is affecting us as service providers, we risk traumatizing ourselves.”
In a previous role as equity, diversity and inclusion manager at the Denver Public Library, Aloziem worked to create a trauma-informed space. That included internal changes, like guiding management in how to be compassionate toward the trauma workers experienced, while also being clear about expectations at work; and external-facing changes, like helping library workers be better equipped to respond to patrons who had experienced trauma.
It also included concrete physical adjustments, like providing additional signage and clearly marked exits in the library.
“In Colorado, there has been a lot of instances of mass shootings. Depending on a person’s proximity to that, they may have a fear of being in public spaces,” Aloziem said. “By ensuring proactively that exits are clearly outlined, we can provide comfort to someone who is looking for that.”
Merenstein, the director of NAMI Colorado, said simple measures like that can be significant for people who have experienced trauma.
In an ideal trauma-informed community, more people understand trauma, and can connect people to resources if needed. People who have experienced trauma are able to engage with the community while feeling safe and in control, which allows them to function at their best.
“Imagine if we did this with librarians, bus drivers, pharmacists,” Merenstein said. “How big that universe can get with trauma-informed care is infinite.”
A message of hope
Trauma is common — more than half of Americans will experience at least one trauma in their lives, according to the National Center for PTSD. Understanding that can bring a feeling of doom and gloom or helplessness, said Susan Stearns, executive director of NAMI New Hampshire, but it shouldn’t.
“The reality is trauma-informed care works, so the message is really one of hope,” she said.
Falkenburger said the language around trauma-informed care can be problematic. After all, few people want to see their community as broken.
“The point is not to label a community as traumatized,” she said.
Rather, the goal is to make everyone — from policymakers to the general public — more aware of the effects of trauma and the resources available to address it, Falkenburger said.
The events of the past two years may be making people more receptive to that. In a way, everyone has been through trauma in the past few years due to the pandemic, Aloziem said. It’s also been a time of increased awareness around racial trauma, especially after the murder of George Floyd. That’s led to increased interest in trauma-informed care and communities, Aloziem said.
“Any crisis can be an opportunity,” she said. “There’s a shifting in the culture to be mindful that we’re all experiencing collective trauma, and we’re being called to help mitigate that.”
Many people and institutions are looking for ways to mitigate past trauma and injustice, she said. Creating trauma-informed spaces and communities is a way to do that.
Breaking down stigma with conversation
Part of the power in trauma-informed communities is in more open discussion about trauma and its impact, experts say.
“If we’re all able to have that trauma-informed lens, it’s going to create a community [where people are] less quiet about the struggles they’re going through,” Cavender said. “If I assume the community has my back, maybe I’m going to be able to talk about [my struggles] more openly.”
Stearns has seen that start to happen in New Hampshire, particularly since the pandemic.
In the past nine months she’s noticed a significant increase in the number of families mentioning mental illness and depression in the obituaries of people who have died by suicide, she said. More families are also directing mourners to make memorial donations to NAMI.
“Those are bittersweet, heartbreaking donations,” Stearns said.
To Stearns, part of the value of a trauma-informed community is in combating stigma. Too often, she said, people create a false dichotomy between those with mental illness and successful members of the community like doctors, law enforcement officers and politicians.
“But we know that’s not how mental illness works: It doesn’t say the doctors are exempt,” she said.
Breaking down stigma allows people to connect with their peers — say, those with similar careers and mental health challenges — and acknowledge that mental illness touches all areas of a community. In turn, that makes people better able to respond to someone in crisis.
“Whatever we can do to foster connection between people and improve individual and community resilience is really important,” Stearns said. “That’s how we move forward toward being healthy.”
Creating a trauma-informed Monadnock Region is still in the early stages, Wyzik said. He’s currently working to identify organizations within the region that are already delivering trauma-informed care. After that, he hopes to begin expanding trauma-informed services.
“If I could have a map of the Monadnock Region, all 34 towns, within six months I hope we can put pins in that map that signify places where there’s trauma-informed care going on,” he said. “At the moment, I would guess there are 10 pins in that map. In five years, I want there to be 50 pins.”
That effort, Wyzik hopes, will result in a more vibrant and healthy region for future generations.
“We should live in a community that has a greater understanding of what trauma is,” he said, “and maybe we can prevent some of that trauma from happening.”