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Trauma Informed Care

Domestic violence, child sexual abuse, and child neglect are devastating problems in many communities. Southcentral Foundation’s Family Wellness Warriors Initiative (FWWI) has the goal of ending these abuses within the state of Alaska within a generation. FWWI works to build resiliency in communities and equip organizations and individuals to address the physical, mental, emotional, and spiritual effects of domestic violence, abuse, and neglect. Studies done after FWWI’s programs have shown positive outcomes for participants in both health care utilization and health outcomes.

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FWWI addresses traumatic experiences as the root cause of family violence and builds on cultural strengths. Trauma survivors often develop behaviors that disrupt family life and affect the next generation; FWWI heals this trauma to prevent its transmission. FWWI’s evidence-based intervention for complex trauma differs because it is Alaska Native created and led, is culturally and spirituality rooted, and uses peer leaders and modeling rather than clinical hierarchy.

FWWI offers a number of different training programs designed to heal trauma and support those impacted by violence. These trainings include Beauty for Ashes, a five-day training where participants work in Learning Circles with others impacted by trauma to understand their own trauma and receive support for the healing process; Arrigah House, a version of Beauty for Ashes held in communities seeking FWWI’s support at their request; and Advanced Leadership Education and Training (ALET), which teaches participants how to lead in FWWI trainings and support those impacted by trauma.

Participants in FWWI trainings work in groups to understand their story, the root causes of abuse, and how to stop the cycle. Participants return home after their trainings, many to rural villages off the road system, with skills to create new norms and support the families and communities in which they live.

FWWI’s trainings emphasize how healing from the pain and shame of trauma leads to transformative healing; building self-esteem, improving family relationships, making positive life changes, and helping others. Participants gain insights into how past harm, anger, and fear play into their interactions with others, and how the next generation’s behaviors and choices often mirror what they have seen and heard. To help participants in healing, FWWI has designed its training and education programs based on the strengths of Alaska Native culture, including:

  • Sharing story. This replicates Alaska Native oral traditions and involves exploring trauma one has experienced in order to heal and develop a more positive sense of self.
  • Listening and responding. This reflects Alaska Native traditions of respectful words, and empowers participants to create a safe environment to help in healing each other.
  • Facilitator preparation. This comes from the Alaska Native tradition of sharing what you learn and learning by doing, and involves presenters and Learning Circle leaders (who have completed FWWI trainings and are often themselves people who have experienced trauma) model the sharing of story and demonstrate listening and responding as full participants.
  • Building healthy relationships. This is key to the healing process and draws on Alaska Native traditions of collaborative activities such as harvesting, food preparation, or dancing.

FWWI has found through its trainings that healing from trauma works in stages. First, participants work to heal and understand themselves by sharing their stories. This healing leads to increased self-esteem and self-efficacy, which in turn helps participants build healthy relationships. Finally, they become able to support others, and are able to use their own experiences to support the healing of others.

Implementation in other communities

FWWI has found that trainings rooted in Alaska Native culture can not only help individuals heal from trauma, but also build resiliency in communities affected by trauma. FWWI’s implementation model has demonstrated successful replication of FWWI programs in other communities. In addition to FWWI supporting rural communities in Alaska, the program has worked internationally with tribes in culturally adapting and implementing the model. The implementation model is in four phases, as follows:

  1. Engage the community. FWWI will not enter any community without an invitation. Once invited, in the first implementation phase, FWWI establishes relationships with tribal leadership and works with them to form a Community Based Steering Committee (CBSC) to address community problems. FWWI also holds workshops and public forums to engage the community and identify potential stakeholders to lead the process of change.
  2. Create a community development plan. In this phase, FWWI works with the CBSC to create a plan for the community to be able to replicate and carry out FWWI trainings. As each aspect of the plan is phased in, it is evaluated by the CBSC and modified as necessary based on the needs of the community.
  3. Implementation. During phase three, the CBSC begins to implement the community development plan, and FWWI works to engage the community to confront its most serious issues with minimal dependence on others, and to change community behavior in confronting and dealing with family violence and child maltreatment.
  4. Transition and sustain. In phase four, FWWI ensures that community leaders have the knowledge and skills to continue the community’s efforts to eliminate family violence and child maltreatment. FWWI continues to offer support and consultation as needed.

Evidence Supporting the FWWI Approach

Considerable evidence indicates that adverse experiences, such as domestic violence/abuse and other forms of harm, can have lifelong health effects, including higher rates of chronic diseases, medically unexplained symptoms, and unhealthy substance use. Groups experiencing health disparities often have higher rates of exposure to adverse experiences. In recognition that many health disparities are driven by high rates of traumatic experiences, a study was completed on the FWWI model’s focus on building health by first healing trauma.

In the study, the hypothesis that participation in FWWI can reverse negative health effects of adverse experiences was tested. A propensity-matched retrospective cohort study compared post-training health care utilization changes for 90 FWWI participants to health care utilization changes for a 90-person comparison group. All cohort members were Alaskans. FWWI participants showed a 55% reduction in emergency department visits (visit count ratio 0.45, 95% CI 0.25-0.83) and a 79% reduction in substance use related visits (visit count ratio 0.21, 95% CI 0.07-0.64).

This study indicates that an indigenous program that helps adults heal from past adverse experiences can significantly reduce emergency department and substance use visits. This suggest a novel approach to public health and to health disparities: improving physical health by helping adults to heal from trauma through the generations.

In addition, FWWI evaluations have shown statistically significant results for health outcomes for FWWI training participants. Evaluation data has shown significant reductions in unhealthy substance use, trauma symptomology, depression, and anxiety in FWWI participants. For example, 67 percent of men and 71 percent of women who attended FWWI trainings showed a reduction in depression. One participant said that because of BFA, they would “Stop emotional abuse to my family.”

55%

Reduction in emergency department visits

79%

Reduction in substance use related visits

67%

Of men who attended FWWI trainings showed a reduction in depression

71%

Of women who attended FWWI trainings showed a reduction in depression