Orenda Dawn: A Transformative Approach in the Healthcare of Diverse Groups Affected by Trauma: A Workbook for the Frontline Healthcare Workforce

Dedication

My work is dedicated to all diverse survivors of violence and trauma. I offer my deepest apologies for all of the heinous experiences you had to endure in your lifetime and for all of the contacts that triggered those experiences again when you sought healthcare.

Please forgive us.

To all those survivors who at their right moment, decided to disclose but yet never returned for help. I hope and pray that you find peace in your heart to come back to us,

for we are truly here for you.

Table of Contents

Dedication

Acknowledgements

Background

The Curriculum

Intended Audience

Mission of This Curriculum

Vision of This Curriculum

The Goal of the Training

Important Considerations for Participants

Training Site

One-Day Agenda

Introduction

Why Learn About Cultural Competence and Trauma-Informed Care?

What is Trauma-Informed Care?

What Occurs When a Survivor is Retraumatized?

How Do We Prevent Retraumatization? (SAMHSA, 2014)

The Principles of Trauma-Informed Care.

What Does the Data Show?

Sexual Violence

How Are the Children Affected?

MODULE 1: The Evidence Speaks

Learning Objectives

The ACE Study

What is your awareness of the ACE Study?

Why is Understanding ACEs So Important?

The Components of the ACE Questionnaire and Scoring

Two Categories of ACEs:

Activities

The Neurobiological Response to Violence

What Trauma-Informed Actions Should I Take as a First Responder?

Epigenetics

MODULE 2: Cultural Competence

Learning Objectives

Sojourner

What is Cultural Competence?

Question to the Audience.

Culture and its Effect on the Response to Violence

Table 1

Becoming Culturally Competent

The Framework of Cultural Competence

Recommended websites.

MODULE 3: Resilience

Learning Objectives

What is Resilience?

Fostering Resilience

Adults

Children

Fostering Resilience in Children

Vicarious Traumatization

Definitions of Terms

References

Appendix A

Appendix B: Cultural Competency Communication Assessment

Appendix C: Cultural Care Plan

Appendix D: Exploring Cultural Concepts: The Culturagram

Appendix E: Devereux Adult Resilience Survey

Appendix F: My Personal Resilience Plan

Appendix G: Parents & Kids on the Road to Resilience

Appendix H: Being Calm

ABOUT THE AUTHOR

Acknowledgements

I want to express my thanks to all of the staff at the domestic violence organizations for welcoming me and guiding my journey in understanding the effects of trauma. I hope that in the future, my work could be an asset to your mission.

I express much gratitude to mi tía Jennie, who has been a pillar of strength within my Boricua culture since I was a little girl. Love you dearly.

Special thanks and love to my extended family, Lee, Tony, and Li Li, for listening to the vicarious effects imposed on me when empathizing with the pain of others and always inspiring me to continue on. You were always willing to listen to my emotional outpourings and offer positivity and sound recommendations at any given time. You are all truly appreciated. Thank you.

To my caring, loving, and supportive family in Arizona, Michigan, and Texas who deserves my utmost recognition. Much love and thanks to my beautiful children, Matt and Briana, for listening, having faith in me, and always inspiring me to keep the momentum going. All that I speak of in this work is for you to understand and to change the course of the future for your children. They are our legacy.

Thank you to my sweet pup, Gizmo, for understanding when I could not pet you enough, for these were the times I was working on my book. Now that you have left this earthly plane, just know how much your fur hugs are profoundly missed.

Finally, to my darling spouse Michael, whom I have adored since childhood. Thank you for your presence, encouragement, patience, and unconditional love throughout this time. I could not have done it without you. Te adoro mucho.

Background

What does our future hold in a world afflicted by violence? Each year, millions of men, women, and children globally, have endured acts of abuse, neglect, and maltreatment, the majority of it at the hands of those of whom they have entrusted their health and lives to. The victims, many of whom have experienced severe and repeated acts of cruelty, believe that their service providers will heal their physical injuries, wounded psyches, and hearts. The unaddressed psychological and physical effects of these adverse experiences, especially early in life, have shown to be connected to many social, emotional, and cognitive impairments, chronic health conditions, and the use of high-risk behaviors as ways of coping (Felitti & Anda, 2010).

Historically, the impact of trauma was either not taken seriously or not viewed as a valid source of suffering (Ringel, 2012). The inflexible rules, lack of confidentiality, and practices that place the victim at blame in traditional healthcare and social service systems can provoke feelings of being revictimized (Jennings, 2008). Regardless, recognizing trauma is of the greatest importance when searching for a solution to deal with human distress for those who are aware and understand its impact (Baillot, Cowan, & Munro, 2013). Staff members may be doubtful and resist practicing trauma-informed care, because they may not know enough about the impact of trauma, are unsure how to respond effectively, or even may have some concerns about their own past or current history of trauma (DeCandia & Guarino, 2015).

The