James “Dimitri” Topitzes, PhD
Professor of Social Work, Clinical Director Institute for Child and Family Well-Being*
Linda Britz, PhD
Senior Lecturer of Social Work, Trauma-Informed Care Certificate Program Director*
Lynne Woehrle, PhD
Associate Professor in College of Nursing, Director of Masters of Sustainable Peacebuilding*
Virginia Stoffel, PhD
Associate Professor of Occupational Science and Technology, Past President American Occupational Therapy Association*
*University of Wisconsin-Milwaukee
Trauma arises through impersonal events and interpersonal dynamics that undermine individual, family, and community well-being, particularly when recurrent and/or severe. Because trauma is nearly universal, addressing and preventing it is a human rights imperative. However, socioeconomically disadvantaged people worldwide bear a disproportionate trauma burden, meaning that trauma is also a social justice concern. Increasingly it is a topic of relevance for peace and conflict studies; but integrating trauma studies into university curricula poses many challenges in part because the topic is so interdisciplinary.
Recognizing the high prevalence and serious consequences of trauma exposure among all peoples, but particularly among vulnerable groups, faculty at the University of Wisconsin-Milwaukee (UWM) launched the Trauma-Informed Care (TIC) Graduate Certificate program in 2013. The TIC program serves master’s students from multiple disciplines, including social work, counseling psychology, nursing, occupational therapy, and sustainable peacebuilding. Since its inception, nearly 250 students from multiple fields have graduated from the TIC program. Students fulfilling TIC program requirements complete 15-credits of coursework, which includes two required courses – “Trauma Counseling I: Theory” and “Trauma Counseling II: Practice”- along with three TIC elective courses. Trauma-informed field placement typically comprises one of these elective courses.
The program has three essential aims:
- To familiarize participants with the phenomenon of trauma in all its varied manifestations.
- To introduce students to the prevalence and consequences of trauma, illuminating the myriad ways in which trauma exposure affects development and functioning.
- To teach students effective means by which they can mitigate the effects of trauma, facilitate healing, promote post-traumatic growth, and interrupt intergenerational trauma transmission.
Below we elaborate on these program goals.
In defining the phenomenon of trauma, the program takes a relatively expansive view. It recognizes the conventional definition of trauma: a discrete overwhelming event such as exposure to a natural disaster or to a single occurrence of violence. However, it also characterizes trauma as a multi-incident event that recurs over time, such as child abuse and intimate partner violence. Perhaps most importantly, the program also characterizes potential traumatic experiences as ongoing stressors such as poverty, community violence, and racism stress. In addition, the TIC program understands that trauma can extend beyond the realm of the physical and involve threats to psychological integrity. For example, emotional abuse from adults or psychological bullying from peers constitutes a potential traumatic experience that often yields similar if not more severe consequences than physical abuse or assault. Finally, the TIC Graduate Certificate program conceptualizes trauma and its attendant consequences as highly individual and subjective. In other words, not all who endure the same potential traumatic experience will respond similarly or even consider the experience traumatic. The program’s inclusive approach to the definition of trauma is therefore reflected in its broad array of elective course options, which include “Working with Traumatized Families,” “Death and Dying,” “Child and Adult Psychopathology,” and “Women and the Criminal Justice System.”
In discussing the prevalence of trauma, the program relies on a growing body of research suggesting that trauma exposure throughout the life course is normative (Kilpatrick et al., 2013). TIC course instructors therefore explore distinctions between tolerable types and levels of trauma versus corrosive types and levels of trauma. Instructors also incorporate research from scholars across the globe and from UWM to examine patterns of trauma exposure among various population subgroups. One firm conclusion emerges, i.e., while trauma is ubiquitous, it is also concentrated in severe form and high levels among socio-economically disadvantaged communities (Mersky et al., 2013; Topitzes et al., 2016). Consequently, to the extent that it is preventable, trauma is both a human rights and a social justice issue. It is clearly a topic of relevance for many and an important area of concern for those who serve disenfranchised individuals and communities, such as social workers, counseling psychologists, nurses, occupational therapists, and peacebuilders.
The TIC program combines exploration of the prevalence of trauma with in-depth examination of its consequences. Instructors present a number of different frameworks that help illuminate the potential effects of childhood or adulthood trauma exposure, including neurobiological, developmental, psychological, and integrative. TIC courses reveal that organisms often marshal complex bio-psycho-social responses to traumatic experiences, successfully protecting the individual from harm in rather brilliant ways. However, success often comes with a cost, which appears as trauma consequences. The consequences manifest in very different forms across individuals, a phenomenon known as multifinality. They can also emerge as complex problems within one individual, a phenomenon known as cascades effects in children and co-morbidities in adults. Insight into the ways in which trauma exposure influences childhood development and adult functioning informs the most critical focus of the TIC program: solutions.
Throughout many of its course offerings, the TIC program earnestly investigates solutions to the problem of trauma, which include individual-, family-, community-, and policy-level approaches. Instructors and students explore trauma prevention strategies along with interventions to ameliorate trauma effects. The TIC program devotes much attention to these topics and arrives at good news, i.e., frameworks and models exist that effectively reduce the impact of trauma and promote recovery from it, e.g., post-traumatic growth.
Two program courses, as examples, cover the topic of trauma solutions almost entirely. The first, “Trauma Counseling: Practice,” dives deeply into a model of trauma-responsive practice that can be applied across many contexts. The model suggests that the following direct practices can effectively address trauma within social and health services: screening for trauma exposure and symptoms; giving information about trauma exposure, trauma consequence and trauma recovery; forging strong working relationships through motivational enhancement; facilitating coping skills; and referring to trauma-focused treatment. The course subsequently explores these trauma-focused treatments, including multiple models and their common elements. Students learn that innovative and effective treatments not only diminish the consequences of trauma exposure but also clear the path for renewed motivation and vision. Common elements of such models include coping skill development, identity repair, and trauma narrative.
The second course example, “Mindfulness and Community Building,” helps students reflect on their own experience of adversity. It also helps students strengthen and/or develop protective processes or practices that can enhance resilience, promote post-traumatic growth, and prevent vicarious trauma. These personal practices include mindfulness and community building, introduced with the help of the Center for Healthy Minds app and the Community Building Milwaukee initiative. Finally, the course also helps students consider collective and historical trauma, exploring strategies to address trauma on the community level.
In sum, the TIC Graduate Certificate program tackles a widespread, consequential, and intractable problem: trauma. It provides graduate students with insights and frameworks that deepen understanding of: a) the scope of the problem, and b) the havoc it wreaks across individuals, families, and communities. Most importantly, however, the program announces good news: trauma is now treatable and in many instances preventable. Not only can its effects be reduced, they can be reversed and transformed such that subsequent generations can enjoy life without exposure to unnecessary adversities including abuse and neglect. Healing among individuals and communities, including students, is possible and can cultivate insight into the precious nature of life, compassion for those who suffer, and a sense of personal meaning. More than ever, these perspectives are needed among our helping professionals and population at-large. Because the discipline of peace and conflict embraces these visions when promoting human rights and social justice, TIC is garnering attention within the field. In fact, the TIC program at UWM attracts a number of Master of Sustainable Peacebuilding students, and we hope that peace and conflict studies will consider TIC as a crucial pillar of its discipline. We also invite all prospective graduate students of social work, counseling psychology, nursing, occupational therapy, peace and conflict studies and other related fields to inquire into UWM and its TIC Graduate Certificate program.