Abstract
Trauma is pervasive in the USA, but disproportionately present in individuals and communities burdened by poverty, violence, and exposure to the criminal justice system. Engagement in clinical care, especially community-based primary care, is particularly important in the immediate period following community reentry from incarceration, where opportunities to engage clients in services are essential for improved health and reduced recidivism. Trauma-informed care offers an important and innovative opportunity for healthcare systems and primary care providers to improve quality of care and the patient experience, thereby increasing longitudinal engagement of marginalized and hard-to-reach patient populations like persons with criminal justice system exposure. Trauma-informed care implementation includes educating providers and transforming practices to incorporate safety, trust, peer support, collaboration, empowerment, and cultural perspectives into everyday operations and care delivery. While comprehensive trauma-informed care involves transformation on a system level, trauma-informed approaches can also be adopted by the individual provider to improve the clinical consultation. By recognizing the role of trauma and its impact on an individual’s physical, emotional, and behavioral health, providers and clients can build mutual trust, focus on individual growth, and begin to foster healing.
Highlights
Michael, a 48-year-old man, came home 6 weeks ago after being in prison for 15 years
Trauma is pervasive across income and demographic groups, but is disproportionately present, and has a disproportionate impact, in individuals and communities burdened by poverty, violence, social isolation, racism, and exposure to the criminal justice system (CJS)
Rates of lifetime exposure to trauma are elevated among persons with justice involvement (PWJI) compared to the general population,[4,5,6,7] as a direct result of incarceration or via cumulative trauma across the life course in communities marked by structural racism and violence.[3, 8]
Summary
Individual trauma results from an event or series of events that are physically or emotionally harmful and have lasting adverse effects on mental, physical, social, and emotional well-being.[1]. Rates of lifetime exposure to trauma are elevated among persons with justice involvement (PWJI) compared to the general population,[4,5,6,7] as a direct result of incarceration or via cumulative trauma across the life course in communities marked by structural racism and violence.[3, 8] PWJI are defined as individuals who have had contact with the police or criminal court system, which can range from a series of brief interactions like being stopped, questioned, and frisked; being detained or incarcerated in jail or prison; or being under. Chaudhri et al.: Trauma-Informed Care for Justice Involved supervised release in the community via probation or parole They are among the most medically and socially complex populations[9,10,11] due to a unique combination of traumatic early life experiences, cumulative disadvantage in their communities and lived experiences,[12] and circumstances faced when reentering the community after jail or prison.[13]. Trauma exposure among incarcerated persons has been associated with a range of behavioral health conditions, including alcohol and substance use and mental illness.[6, 7] In general, exposure to traumatic life events in childhood and adulthood is associated with psychological and mood disorders, decreased physical health, increased risk-taking behaviors (such as tobacco use and unsafe sex), obesity and disordered eating, chronic diseases, and reduced engagement with healthcare services.[1, 14,15,16] Further, for marginalized communities disproportionately exposed to the CJS, these adverse outcomes are often compounded by the trauma of everyday stigma, discrimination, and racism, which has been shown to increase the risk of stress, depression,[17] hypertension,[18] cardiovascular disease,[19] specific cancers,[20] and overall mortality.[21]
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