Trauma-informed neighborhoods: Making the built environment trauma-informed

Schroeder, Krista; Noll, Jennie G.; Henry, Kevin A.; Suglia, Shakira F.; Sarwer, David B.

doi:10.1016/j.pmedr.2021.101501

Cited by 13 publications

(13 citation statements)

References 39 publications

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“…Future work is needed to better understand whether neighborhood-level intervention, public policy, and urban planning may mitigate ACEs’ harmful effects. For instance, efforts to translate tenants of trauma-informed practice to neighborhood’s physical built environments—creating “trauma-informed neighborhoods”—could be explored as a complement to individual-level interventions to promote health among individuals affected by ACEs (Schroeder et al, 2021). In addition, trauma-informed building design, appropriate lighting, construction and traffic noise restrictions, and presence of healing green spaces could make physical built environments more likely to promote feelings of safety, foster healing, and avoid retraumatization, though more research is needed (Bell et al, 2018; Garcia, 2020; Huffman, 2018; Jewkes et al, 2019; Shopworks Architecture, Group 14 Engineering, & University of Denver Center for Housing & Homelessness Research, 2020; Ulrich, 1999).…”

Section: Discussionmentioning

confidence: 99%

The intersection of adverse childhood experiences and neighborhood determinants of health: An exploratory spatial analysis.

Skiendzielewski¹,

Forke²,

Sarwer³

et al. 2024

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Adverse childhood experiences (ACEs) are associated with elevated risk for poor physical and psychological health outcomes. Nearly all of the literature on the association between ACEs and poor health focuses on the individual and family level; the potential role of neighborhood environment is overlooked. Understanding the relationship between ACEs and characteristics of the neighborhood environment is a necessary first step in determining if and how place-based, trauma-informed interventions might mitigate the negative effects of ACEs. The purpose of this exploratory study was to describe the neighborhood environment of adults who have experienced $ 4 versus # 3 ACEs. Method: An exploratory secondary analysis of cross-sectional and geospatial data was conducted during 2021. Data sources included 2011/2012 Philadelphia ACE Survey data, a telephone survey of 1,784 randomly sampled Philadelphia adults, linked with geospatial data on 21 neighborhood-level determinants of health. Neighborhood was defined as participant's home census tract at the time of survey. The sample for this secondary analysis included the 1,679 Philadelphia ACE Survey participants for whom home census tract was available. Bivariate logistic regression examined differences between groups (# 3 ACEs vs. $ 4 ACEs). Results: Individuals with $ 4 ACEs lived in neighborhoods with higher neighborhood poverty rates, less socioeconomic resources, worse food access, poorer perceived physical and mental health, more substance overdose deaths, higher crime, and less green space. Conclusions: Findings suggest future work may benefit from considering neighborhood environments when examining and intervening upon the association between ACEs and poor physical and psychological health.

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Section: Discussionmentioning

confidence: 99%

The intersection of adverse childhood experiences and neighborhood determinants of health: An exploratory spatial analysis.

Skiendzielewski¹,

Forke²,

Sarwer³

et al. 2024

Psychological Trauma: Theory, Research, Practice, and Policy

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“…Given the plethora of high-quality individual-and family-focused ACEs research, the field is now well-poised to build a body of evidence around how neighborhood characteristics and social determinants of health influence experiences of and outcomes associated with ACEs [36]. Consideration of neighborhood environment in ACEs-focused initiatives could align with other efforts to approach adversity at higher levels of ecology, such as creating trauma-informed built environments [83], trauma-informed community development [84,85], and focusing on how social determinants of health influence ACEs [36]. Doing so would align with efforts for promoting healing and well-beingpromoting neighborhood spaces, such as therapeutic landscape theory [86,87] and could complement individual and family-level efforts to promote well-being among individuals who experience ACEs.…”

Section: Discussionmentioning

confidence: 99%

“…A better understanding of the neighborhood context associated with ACEs exposure can shift a narrative away from a narrow focus on an individual's role in ACEs-associated outcomes and toward the potential influence of the environments in which individuals are experiencing ACEsassociated health risks. Structural factors that shape the neighborhood context could then be interrogated as an effort to promote upstream, trauma-informed policies that shift the inequities-promoting status quo [83]. An upstream approach recognizes ACEs not as a failing of parents, families, or individuals, but as occurring within a broader context of social determinants of health that synergize with and lead to disproportionate experience of ACEs [36].…”

Section: Discussionmentioning

confidence: 99%

The Intersection of Neighborhood Environment and Adverse Childhood Experiences: Methods for Creation of a Neighborhood ACEs Index

Schroeder

Dumenci

Sarwer

et al. 2022

IJERPH

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This study evaluated methods for creating a neighborhood adverse childhood experiences (ACEs) index, a composite measure that captures the association between neighborhood environment characteristics (e.g., crime, healthcare access) and individual-level ACEs exposure, for a particular population. A neighborhood ACEs index can help understand and address neighborhood-level influences on health among individuals affected by ACEs. Methods entailed cross-sectional secondary analysis connecting individual-level ACEs data from the Philadelphia ACE Survey (n = 1677) with 25 spatial datasets capturing neighborhood characteristics. Four methods were tested for index creation (three methods of principal components analysis, Bayesian index regression). Resulting indexes were compared using Akaike Information Criteria for accuracy in explaining ACEs exposure. Exploratory linear regression analyses were conducted to examine associations between ACEs, the neighborhood ACEs index, and a health outcome—in this case body mass index (BMI). Results demonstrated that Bayesian index regression was the best method for index creation. The neighborhood ACEs index was associated with higher BMI, both independently and after controlling for ACEs exposure. The neighborhood ACEs index attenuated the association between BMI and ACEs. Future research can employ a neighborhood ACEs index to inform upstream, place-based interventions and policies to promote health among individuals affected by ACEs.

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“…While it can be difficult to predict why some individuals develop these traumatic stress reactions and others do not, some variables have been identified ( Magee et al, 2011 ). Several social determinants of health (poverty, neighborhood crime), mental health problems in others in the home, and a lack of social support are associated with less positive reactions to trauma ( Schroeder et al, 2021 ). The experience of adverse childhood experiences includes situations of physical, emotional, or sexual abuse, physical and emotional neglect, as well as exposure to household stressors including family member’s substance use, mental illness, incarceration, intimate partner violence, divorce/separation, or death also is associated with greater psychological difficulties with later life trauma ( Felitti et al, 1998 ).…”

Section: Psychological Response To Traumatic Injurymentioning

confidence: 99%

The psychosocial burden of visible disfigurement following traumatic injury

et al. 2022

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Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation (VCA) procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types (skin, muscle, bone, nerves, and blood vessels) as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures.

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Trauma-informed neighborhoods: Making the built environment trauma-informed

Cited by 13 publications

References 39 publications

The intersection of adverse childhood experiences and neighborhood determinants of health: An exploratory spatial analysis.

The intersection of adverse childhood experiences and neighborhood determinants of health: An exploratory spatial analysis.

The Intersection of Neighborhood Environment and Adverse Childhood Experiences: Methods for Creation of a Neighborhood ACEs Index

The psychosocial burden of visible disfigurement following traumatic injury

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