University of Idaho

HS 490 Health Promotion

Interventions
Assignment 2

Micaela M Johnson~ April 2018

Micaela M Johnson

Adverse Childhood Experiences, Train Health Professionals in Ada County,

Idaho on Importance of ACE/Implement ACE Module within the State of Idaho
during 2020.

NAME: SAMHSA.GOV #1 Intervention Website

Website and Link:
https://www.samhsa.gov/nctic/trauma-interventions

APA citation of website:

Baylor, C. (2014, April 25). Trauma-Informed Approach and Trauma-Specific Interventions.

Retrieved April 18, 2018, from https://www.samhsa.gov/nctic/trauma-interventions

General Purpose of the Website

• Identifies what the trauma-informed approach consists of: “A program, organization, or
system that is trauma informed”
o Realizes
o Recognizes
o Responds
o Resist Re-traumatization
• Six Principles of Trauma-Informed Approach:
1. Safety
2. Trustworthiness and Transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice and choice
6. Cultural, Historical, and Gender Issues
• Provides 8 well-known trauma-specific interventions, listed for informational and educational
use only. Goes into detail on each one.
1. Addiction and Trauma Recovery Integration Model (ATRIUM)
2. Essence of Being Real
3. Risking Connection®
4. Sanctuary Model®
5. Seeking Safety
6. Trauma, Addiction, Mental Health, and Recovery (TAMAR)
7. Trauma Affect Regulation: Guide for Education and Therapy (TARGET)
8. Trauma Recovery and Empowerment Model (TREM and M-TREM)
• No specific audience identified but general knowledge given. Can be assumed that this is
targeted at a general population.
What did you learn about effective interventions for your topic? Answer the questions below and
add additional comments.

• There were 8 listed intervention methods that SAMHSA listed on their website in relation
to Trauma-Informed Care. They list out each intervention with the advisory to only use
them for educational purposes. The list of them is provided in the overview of the
webpage. It appears that these interventions could be successful for their intended
audiences and that each different intervention listed has differences in the audience focus.
Each have the intention to education or help with recovery for different populations and it
seems to still be open to other populations but specializes in one. There does seem to be
evidence behind the interventions listed on the website. The evidence may not directly
correlate to the interventions but pieces certainly do.

Critical thinking and relation to your health promotion topic

1) Intervention activities that are appropriate for your project

- I feel that most of these interventions are good for the individual level or even the
community level. These programs help address the problems associated with ACEs or traumas.
The TARGET intervention seems most appropriate for my project as it focuses on the
organizational and professionals in any field for understanding trauma. This works well as it can
work for both adults and children affected.

2) Useful tools and resources, including health education/promotion resources

-Each site has resources available but do vary on importance and quality. They do not typically
go into detail without you going into the actual module or program.

3) Other resources- give web links for at least two other helpful resources the web page directed
you to and write 1-2 sentences about what you found was helpful about each site.

-http://www.ptsdfreedom.org/about_target.html

o They provided some samples of the document they distribute in their program.
The website needs to be updated but otherwise is very helpful with peer reviewed
journals the display the importance of addressing PTSD and related illnesses.

-https://www.sidran.org/

o A beautiful website that seems to be well maintained and professional looking.

Very easy to navigate and locate the materials available for loved ones,
professionals, media, and students. The resources are very easy to find and very
specific to who needs them. Will definitely be looking into this site further and in
the future as well.
 #2 Intervention Research Readings- 15 pts.
General Intervention Considerations

1. Health Behavior Theory- The best theory that would work for my interventions at this time
would be the Health Belief Model. If the population doesn’t even perceive there to be a
problem, they likely aren’t going to adhere to any interventions I provide. The more the
population knows, the more receptive to programs, and community events they will be.
Some events may have to be subtle because trauma is a very sensitive subject for many
and we don’t want to push them away. People will be more receptive to resources and
support this way too.

2. Spectrum of Prevention- The most important levels of prevention for this topic seems to
be policy and environment as well as community and group levels. I understand that
education is the first step for these levels, addressing what each level already knows and
going from there. This would allow me to better gear the message for the audiences
applicable.

3. Mostly trying to educate the population on what ACEs are and the impact it has on the
futures of everyone (health and mental wellbeing). This would incorporate the
predisposing factors for the community such as knowledge and beliefs on the topic of
ACEs. Reinforcing factors would be providing resources and social support to those in
need and reinforcing the community around this topic. The enabling factors would be
educating the medical professionals so that the community can benefit off of their input
and assistance.

#3 RESEARCH ARTICLES– PEER REVEIWED- 1 of 3

APA Citation of article

Cameron, L. D., Carroll, P., & Hamilton, W. K. (2018). Evaluation of an intervention promoting
emotion regulation skills for adults with persisting distress due to adverse childhood experiences.
Child Abuse & Neglect, 79423-433. doi:10.1016/j.chiabu.2018.03.002

Participants or population reached

92 Adults

Describe the intervention and its effectiveness

• Briefly describe the intervention – what did they do? What was unique or most interesting
to you?

o Utilized 92 adults that enrolled in a Ace Overcome Program that was community
based. They attended either a religious based version or secular version that lasted
for 12 weeks. The participants were asked to complete a pretest prior to the 12
weeks and a post-test after the 12 weeks.
 • What did you learn about the effectiveness of the intervention?

o The intervention was effective as all areas of quality of life did improve with the
utilization of this program. Older individuals gained improvements regardless of
how high their ACEs were and students had this plus decreased perception of
stress.

• If a health behavior theory was identified, briefly discuss which one was used and how it
shaped the intervention?

o I believe the model that best works for this intervention would be the Social
Cognitive theory. This encompassed the environment that best fit the community
they were addressing and addressed their personal/community factors which then
helped with the behavior change. This was shown through the pre- and post-tests.

• For what were the main conclusions about the interventions reached by the author(s)
including limitations?

o This research intervention helps lead the way with the utilization of comparison
groups and emotional regulation perspective in order to help address high ACEs in
populations.

Critical thinking and relation to your project

• What did you learn from this research/intervention that can be applied to you project?

o There does seem to be evidence that there is success with the use of single group
interventions within community and that breaking it up into groups like secular
and religious and possibly even breaking up age groups may have a positive impact
on an intervention. This ultimately doesn’t help with my specific goals but can lead
to useful research in the future.

• What would you need to do to adapt the intervention to fit your population and why?

o I do feel that this intervention would be good for my population as it is more

community based and I am focusing on ADA county or the whole state. This would
work on county level and breaking it up into different cities or regions of the
county.

#3 RESEARCH ARTICLES– PEER REVEIWED- 2 of 3

APA Citation

Karatekin, C. (2018). Adverse Childhood Experiences (ACEs), Stress and Mental Health in College
Students. Stress & Health: Journal Of The International Society For The Investigation Of Stress,
34(1), 36-45. doi:10.1002/smi.2761

Participants or population reached

College Students
Describe the intervention and its effectiveness

• Briefly describe the intervention – what did they do? What was unique or most interesting
to you?

o They assessed if college students would be at risk mental illness in relation to ACEs
through a short-term longitudinal study. Data was collected on ACEs and mental
health at the beginning of the semester and data was collected on current
stressors and mental health was collected towards the end of the semester. This
was interesting as it doesn’t include more surveying during the middle of the
semester (around midterms) and also only looks at the general college student not
different departments or types of students (first generation, international, LGBT,
nontraditional, etc.). These considerations may be useful within the future for
research into this topic specifically for college students.

• What did you learn about the effectiveness of the intervention?

o ACEs predicted the worsening of student’s mental health over the course of the
semester and also suggested that the number of stressors was a mediator of the
relationship between mental health and ACEs in college students. Results
suggested that ACE screen may be useful for identifying students with high risk for
mental health deterioration.

• For what were the main conclusions about the interventions reached by the author(s)
including limitations?

o Further research is needed in stress-related interventions for students with high

levels of ACEs and more research into strategies to increase help-seeking within
the college populations.

Critical thinking and relation to your project

• What did you learn from this research/intervention that can be applied to you project?

o Once again, consideration for different populations does stick out to me. I feel that
breaking down the county into smaller sections may prove to be more helpful in
analyzing what is needed. I do agree that analyzing the population at different
time periods may also have an impact on results. Implementing the census would
be able to give a good idea of where the population already stands and what areas
are really in need. Unfortunately, there can only be speculations based off data
such as income, violence, health and other factors that are reported.

• What would you need to do to adapt the intervention to fit your population and why?

o I am focusing on a more generalized population and feel that this intervention is

more analysis of the population through an intervention versus educating health
professionals or implementing the census or program for communities within my
county.
 #3 RESEARCH ARTICLES– PEER REVEIWED 3 of 3

APA Citation

Currier, J. M., Stefurak, T., Carroll, T. D., & Shatto, E. H. (2017). Applying Trauma-Informed Care to
Community-Based Mental Health Services for Military Veterans. Best Practice In Mental Health,
13(1), 47-64.

Participants or population reached

Veterans

Describe the intervention and its effectiveness

• Briefly describe the intervention – what did they do? What was unique or most interesting
to you?

o “Trauma-informed intervention therefore does not merely consist of selecting the

most scientifically supported intervention at the time; instead, clinicians need to
make clinical judgments about how and when to deliver the intervention in a
manner that is consistent with the veteran’s available resources, preferences,
degree of distress, and specific trauma triggers” (Currier et al., 2017).

o This article goes over some of the barriers that happen when there is random
interventions and the population isn’t taken into consideration when it comes to
trauma informed care. Discusses the quality and adaption of trauma informed care
to veterans due to the lacking services (due to increased demand) provided from
the Veterans Health Administration. This is also to identify how to help veterans
outside of VHA.

• What did you learn about the effectiveness of the intervention?

o Many barriers were identified such as type of treatment provided (community

versus individual). PTSD may be different depending on each scenario experienced
by the individual therefore showing if there will be progress in the help or not.

• If a health behavior theory was identified, briefly discuss which one was used and how it
shaped the intervention?

o There wasn’t a specific intervention listed during this article, mostly conceptual
approaches to how trauma informed care can be helpful for veterans.

• For what were the main conclusions about the interventions reached by the author(s)
including limitations?

o The main conclusion that did aid in my assessment of Trauma Informed Care is that
they found that there isn’t sufficient scientific evidence that supports the use of
Trauma Informed Care so this means that physicians aren’t as likely to pick it up
yet. There needs to be more research done in this area and that may also include
ACEs as I feel they are connected now.
 Critical thinking and relation to your project

• What did you learn from this research/intervention that can be applied to you project?

o I found out that Adverse Childhood Experiences and PTSD actually have similarities
and could be beneficial to research in the future before implementation of part of
my project. I still wish to have Idaho participate in the ACE module in 2020 Census
report.

• What would you need to do to adapt the intervention to fit your population and why?

o The population doesn’t specifically fit Ada County but the general take away is that
there needs to be different populations taken into account when contemplating
this project and veterans are one of the sections of the population that I hadn’t
already considered. There is more research that needs to be done to link TIC and
ACE as well as just more recent research on ACEs.

Pulling it All Together

1. Select a performance measure target based on the Healthy People 2020 objectives or
Healthy Campus 2020 as appropriate.

IVP-38: 8.5 maltreatment victims per 1,000 children, a 10% decrease by 2020.

2. Deciding on strategies for interventions

Adverse Childhood Experiences (Targeting and Educating the Community)

▪ Environmental Change Interventions

(Strategies)
▪ Bring public awareness to the concept of ACEs through media campaigns.
▪ Ensure that students have enough time outside of class outdoors and that
trauma is included within health class materials.
▪ Enroll state of Idaho up for the ACE module for the 2020 Census Report to
provide the state with a baseline for ACEs.
▪ Form coalition and share valuable research and information to leaders of the
community (religious, political, medical, funding, etc). Ask for feedback and
take into consideration when planning next move.

▪ Group Interventions
(Strategies)
▪ Prior to birth of new child, have parents go through ACE module with
physician or medical professional and talk about repercussions for parent’s
future and the future of their child. Provide resources and support.
▪ For any disease management courses or programs, educate staff and
professionals on the importance of ACEs and how that may impact their
clients. Educate the clients and use Trauma informed care approach.
▪ Work site health displays media campaigns, newsletters, advertisements on
ACEs and coverage for getting help.
 ▪ Hospital classes ensure that patients know about ACEs and their potential
impact on their health now or in the future. Provide education and resources
for support.

▪ Direct Community Interventions

(Strategies)
▪ Introduce community event on wellness such as a fun run on the health and
wellbeing of all. Don’t name after trauma, but do have booths and smaller
events that can cater to both adults, children, and teens. Should include
stress management, wellness centers, resources for classes, self-help but
nothing obviously “Trauma”.
▪ Incorporate ACEs and Trauma Informed Care into how educational
professionals handle students and classroom situations. Educate and train
and provide support.
▪ Provide churches with ACEs materials and even the Module. Incorporate into
discussions with parents, newlyweds and other groups. Bring into youth
groups and provide education, resources, and support.
▪ Provide information within the community Newsletter, (If 2020 Census ACE
Module is successful) advertise to complete the module in there as well.
Advertise wellness centers and support for those who may need it. Also
include importance and basic information on Trauma Informed Care and
Adverse Childhood Experiences and Post Traumatic Stress Disorder (how
they are related).

3. Potential for Success

a.) Discuss why your intended approaches would work
a. Education within the community would at least make the information spread to
the population more quickly and widely. This would make the acronym stick out
more in advertisements or if students came home with a permission slip to
attend the discussion on ACEs or TIC, the parents wouldn’t be as threatened by
the unknown topic. Targeting the different parts of the population is key to
applying the appropriate intervention as the needs will differ (Currier, 2017 and
Karatekin, 2018). The census would be beneficial as that is analyzing the
population on a better and wider scale, the whole state of Idaho would benefit
from this information as we could see how prevalent this is in Idaho.

b.) Discuss sustainability of the intervention plan- what will help this work continue? Think
about reinforcing factors in the community- organizations, leaders, schools, etc.
a. Establishing the coalition would help continue this information being improved
and passed around through the community. The more main-stream this becomes
the better interventions can be taken and self-help seeking behaviors may start
to change over time. Students can take control of their environments and help
make a different in their communities at school. Overall the information that the
Census can give us would give a great idea of where to focus these efforts in the
future but for now the general distribution of the information is the most helpful
as most people don’t know what ACEs is. This would also help make it easier for
policies to be put in place for medical professionals to conduct the ACE module to
patients.
References
Baylor, C. (2014, April 25). Trauma-Informed Approach and Trauma-Specific Interventions. Retrieved
April 18, 2018, from https://www.samhsa.gov/nctic/trauma-interventions

Cameron, L. D., Carroll, P., & Hamilton, W. K. (2018). Evaluation of an intervention promoting
emotion regulation skills for adults with persisting distress due to adverse childhood experiences.
Child Abuse & Neglect, 79423-433. doi:10.1016/j.chiabu.2018.03.002

Currier, J. M., Stefurak, T., Carroll, T. D., & Shatto, E. H. (2017). Applying Trauma-Informed Care to
Community-Based Mental Health Services for Military Veterans. Best Practice In Mental Health, 13(1),
47-64.

Karatekin, C. (2018). Adverse Childhood Experiences (ACEs), Stress and Mental Health in College
Students. Stress & Health: Journal Of The International Society For The Investigation Of Stress, 34(1),
36-45. doi:10.1002/smi.2761

PTSD and Dissociation Resources for Survivors, Supporters and Professionals. (2016). Retrieved from
https://www.sidran.org/

Trauma Affect Regulation: Guide for Education and Therapy. (2011). Retrieved from
http://www.ptsdfreedom.org/