Key features of a trauma-informed public health emergency approach: A rapid review

Abstract

COVID-19 is a major threat to public safety, and emergency public health measures to protect lives (e.g., lockdown, social distancing) have caused widespread disruption. While these measures are necessary to prevent catastrophic trauma and grief, many people are experiencing heightened stress and fear. Public health measures, risks of COVID-19 and stress responses compound existing inequities in our community. First Nations communities are particularly at risk due to historical trauma, ongoing socio-economic deprivation, and lack of trust in government authorities as a result of colonization. The objective of this study was to review evidence for trauma-informed public health emergency responses to inform development of a culturally-responsive trauma-informed public health emergency framework for First Nations communities. We searched relevant databases from 1/1/2000 to 13/11/2020 inclusive, which identified 40 primary studies (and eight associated references) for inclusion in this review. Extracted data were subjected to framework and thematic synthesis. No studies reported evaluations of a trauma-informed public health emergency response. However, included studies highlighted key elements of a “trauma-informed lens,” which may help to consider implications, reduce risks and foster a sense of security, wellbeing, self- and collective-efficacy, hope and resilience for First Nations communities during COVID-19. We identified key elements for minimizing the impact of compounding trauma on First Nations communities, including: a commitment to equity and human rights, cultural responsiveness, good communication, and positive leadership. The six principles guiding trauma-informed culturally-responsive public health emergency frameworks included: (i) safety, (ii) empowerment, (iii) holistic support, (iv) connectedness and collaboration, (v) compassion and caring, and (vi) trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. These findings will be discussed with First Nations public health experts, together with data on the experiences of First Nations families and communities during COVID-19, to develop a trauma-integrated public health emergency response framework or “lens” to minimize compounding trauma for First Nations communities.

Community health nurses leadership in advancing health equity

“…Significant structural upstream solutions were suggested and attended to the SDOH through improvement in housing, food security, and accessibility to community services by instituting guaranteed basic income and housing access policies. Aligned with our findings, these solutions have been recognized in the recent literature (Abrams et al., 2020; Burrage et al., 2023; Heris et al., 2022; NCCDH, 2023). In a rapid review highlighting a trauma‐informed public health emergency response, policy interventions such as financial support and safe housing are one approach which allows people to comply with stay‐at‐home orders (Heris et al., 2022).…”

“…In a qualitative study, grassroots approaches with community leaders were one important community response in the pandemic that contributed to resilience (Burrage et al, 2023). Likewise, (Heris et al, 2022) reports in their rapid review that collaborative approaches were found to improve outcomes like increased engagement and motivation.…”

“…CHNs further elaborated on solutions that underscored the value of partnerships and collaboration in addressing the health inequities. Again, a focus on partnering and collaborating with community agencies and services is strongly supported in the literature in advancing health equity for future health crises (Burrage et al., 2023; Heris et al., 2022; Markham et al., 2021; McGrail, Morgan and Siddiqi, 2022; NCCDH, 2023). Not only are essential community health nursing resources required to advance health equity but also available, adequate, and an efficient use of community resources.…”

A Culturally Responsive Trauma-Informed Public Health Emergency Framework for Aboriginal and Torres Strait Islander Communities in Australia, Developed during COVID-19

“…Firstly, a rapid review was conducted to identify key features of previously developed trauma-informed public health emergency frameworks [ 40 , 41 ]. We searched relevant databases from 1 January to 30 November 2020, which yielded approximately 10,000 studies, of which 40 were included.…”

“…The principles guiding trauma-informed culturally responsive public health emergency frameworks included: safety, empowerment, holistic support, connectedness and collaboration, compassion and caring, trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. Detailed methods are outlined elsewhere (the review has been accepted for publication) [ 40 ].…”