Recognizing the Role of Health Care Providers in Dismantling the Trauma-to-Prison Pipeline.

Abstract

Trauma responses are normal reactions to abnormal or violent events, yet many health care providers treat the challenging behavioral manifestations of trauma with judgment or misunderstanding. As providers who care for vulnerable children, it is our obligation to understand and interrogate our roles within systems that perpetuate the overcriminalization of developmentally appropriate responses to trauma and abuse, which create the trauma-to-prison pipeline. By understanding this pipeline and its impact, we as health care providers can better support our trauma-exposed patients and advocate for systemic change to dismantle and disrupt it. Exposure to trauma and abuse can impact the reactivity of the prefrontal cortex’s “fear circuitry,” perpetuating a prolonged or sudden stress response even if a tangible danger is not present.1 Fear responses can be difficult to manage, particularly in youth, and can lead to substance use, emotional outbursts, self-harm, truancy, or other challenging behaviors to cope with underlying activation.2 Unfortunately, many institutions, including health care, augment the negative impacts of trauma by pathologizing these behaviors rather than recognizing and treating them for what they are: manifestations of trauma. Here we discuss 2 well-described pathways that health care providers should recognize, in which existing systems increase the likelihood for traumatized children to be incarcerated and … Address correspondence to Yuan He, MD, MPH, School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall, Philadelphia, PA 19147. E-mail: yuan.he{at}pennmedicine.upenn.edu