Socio-ecological model for violence and trauma prevention strategies

In applying the comprehension of a multilevel approach to understanding health I am looking, from my lense in trauma care, at trauma and violence as a public health concern that has large costs associated with the individual and society (Magruder, K, McLaughlin, K, & Elmore, B, 2017); in fact a problem that can be understood and changed (Mercy, K, Krig, E, Dahlgerg, L & Zwi, A, 2003). Research shows public health policies and prevention programs have a greater effect on reducing rates of violent crime and associated trauma then incarceration. Further, it is said that traumatic events do not only occur at random, but can be influenced by individual characteristics, peer group relationships, community characteristics, and socio-political factors (Magruder et al 2017). The idea of stopping violence before it beings is the most sustainable approach to reducing violent crime; in using the socio-ecological model as a framework for prevention (CDC, 2019) we understand the part that the society, community, relationships and the individual have on health.

`The health and social consequences of violence are much broader, however, than death and injury. They include very serious consequences for the physical and mental health and development of victims. Studies indicate that exposure to maltreatment and other forms of violence during childhood is associated with risk factors and risk-taking behaviors later in life (depression, smoking, obesity, high-risk sexual behaviors, unintended pregnancy, alcohol and drug use) as well as some of the leading causes of death, disease, and disability (heart disease, cancer, suicide, sexually transmitted diseases)’ as stated in the article by Mercy et al in the American Journal of Public Health, 2003.

After looking further into the global, professional and local response to this health concern and with the development of various prevention strategies, stakeholder groups and approaches to reduce trauma and violence there is also an underlying move to treat all who seek healthcare using trauma informed care (Klincr, 2013). Appreciating the long term and wide reaching effects that exposure to violent crimes has, either directly or indirectly, on the individual and how it can also influence their perceptions of care, access to care and impact their overall health and wellness.

In the City of Toronto, formed in 2014, modeled after a similar program in Europe, FOCUS was formed (Furthering Our Community by Uniting Services) to bring 30+ agencies to the at risk community. This group of service providers and experts in trauma care, public policy and outreach meet once per week at a situation table to discuss individuals identified as at risk of violence, either as the victim or the perpetrator, to mobilize resources to help this person leave a situation of interpersonal violence, and to address the underlying issues such as: employment, mental health, physical health, poverty, gang involvement (Caton, 2016).

It is the obligation of Trauma Centres such as Sunnybrook to focus on trauma care, research and also on injury prevention as driven by the data from the traumas we provide care for. The City of Toronto and its partners including Sunnybrook Health Science Centre have a heightened awareness around the increase in gun violence in the City of Toronto and surrounding areas; looking at prevention programs and community supports; recognizing that prevention programs have a greater effect on reducing rates of violent crime and associated trauma (Magruder et al 2017). In understanding the society and community our patients come from and the relationships within these communities, the effects of their prior experiences and exposures to violence, and a more socio-ecological model/approach, we can build a more sustainable response while focusing on violence and trauma prevention.

REFERENCES

Caton, H Toronto Police Initiative FOCUS comes to 14 Division. Toronto.com July 19, 2016.

Retrieved from https://www.toronto.com/news-story/6774199-toronto-police-initiative-focus-comes-to-14-division/

CDC National Center for Injury Prevention and Control, Division of Violence Prevention (2019) Factors that Influence Violence. Retrieved from https://www.cdc.gov/violenceprevention/publichealthissue/social-ecologicalmodel.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Foverview%2Fsocial-ecologicalmodel.html

Klinrc Community Health Centre Trauma Informed- the Trauma Tool Kit 2nd Edition 2013. Pg 5

Retrieved from trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf

Magruder, K. M., McLaughlin, K. A., & Elmore Borbon, D. L. (2017). Trauma is a public health issue. European journal of psychotraumatology, 8(1), 1375338. doi:10.1080/20008198.2017.1375338

Mercy, J. A., Krug, E. G., Dahlberg, L. L., & Zwi, A. B. (2003). Violence and health: the United States in a global perspective. American journal of public health, 93(2), 256–261. doi:10.2105/ajph.93.2.256

Socio-economic Model of Health (WHO, 2019)