I completed my dietetic internship amidst the unique circumstances brought about by the COVID-19 pandemic. To fulfill all 1,200 required supervised practice hours, rotations were shifted to an online, remote format. This change allowed me to become involved with a rotation site that I would not have experienced otherwise. Working remotely with the Food Bank of Central New York’s Community Nutrition Educator, Heather Brubaker (MS 2018), RD, and Community Nutrition Manager, Debra Mimaroglu, RDN, CDN (BS 2014, CAS 2015), I had the opportunity to learn about trauma-informed care and its application in nutrition education and programs.
Trauma-informed care is practiced in other fields, but it is a new concept in nutrition. When we think of trauma in nutrition, we often think of trauma patients suffering from severe physical injuries. However, the trauma in trauma informed care refers to psychological trauma that is not always considered in nutrition. As defined by the Substance Abuse and Mental Health Services Administration, “trauma results from an event, series of events or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social or emotional well-being.”
The Adverse Childhood Experiences (ACE) Study conducted by the CDC and Kaiser Permanente Health Care Company explored sources of trauma experienced during childhood including abuse, neglect and exposure to household dysfunction and their impacts on later-life health and well-being. Repeated exposure to trauma in young children can impact their brain development and re-wire the brain’s response to stressors. As these children grow up, many struggle with emotional regulation including anxiety and depression and face cognitive and social difficulties.
Findings from the ACE Study concluded that individuals exposed to adverse childhood experiences are substantially more likely to engage in health-risk behaviors, develop chronic conditions and face premature death. On average, individuals with six or more ACEs died nearly 20 years earlier than individuals without exposure to childhood adversity. The study also concluded that an individual is more likely than not to have a history of trauma. Two thirds of study participants had experienced at least one ACE. Almost 60 percent of individuals with at least one ACE reported exposure to two or more.
High ACE scores are strongly correlated with diabetes, heart disease, stroke, eating disorders, smoking, alcoholism, obesity, IBS, and cancer. These conditions are common reasons why a person would be referred to a dietitian or seek out nutrition education. Trauma impacts a person’s metabolic health regardless of their diet or activity levels. Current dietetic practices place emphasis on lifestyle change as a means to improve health and nutrition status, but by failing to recognize the physical implications of trauma, we misrepresent the role of lifestyle in determining health outcomes. A trauma informed care approach acknowledges that other factors should be taken into consideration.
ACEs occur across all socioeconomic groups but are more prevalent in low income and
minority populations. Systemic trauma “refers to the contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses.” Systemic trauma is a consequence of long-standing, historical oppression. Certain groups of people are at a higher risk of food insecurity and unfavorable health conditions due to social, economic, and environmental disadvantage. Racism and discrimination are proven root causes of hunger and poverty in the United States. Households of color experience hunger at twice the rate of white households. Food insecurity rates are exacerbated by unfair housing practices, wage gaps and discrimination in hiring for employment as well as limited access to foods in low-income and minority neighborhoods. People of color are disproportionately surrounded by food deserts, face higher unemployment rates, and receive lower wages than their white counterparts. Systemic trauma is a cycle that continues throughout generations.
Adverse Childhood Experiences and systemic trauma and oppression have lasting, devastating impacts on health and nutrition. Understanding trauma and its implications is essential to providing the highest level of nutrition care. A person with a history of trauma may have difficulty regulating stress and other emotions, decreased ability to trust and benefit from interpersonal relationships, impaired memory, concentration, and self-regulation. These difficulties impact an individual’s ability to fully benefit from a nutrition education or counseling session.
Becoming aware of the prevalence of trauma and understanding the impact of trauma on health are the first steps to taking on a trauma
informed approach to nutrition care.
Trauma-informed nutrition professionals assume everyone they work with has a history of trauma, are mindful of their language and the nature of interpersonal interactions, honor the client’s autonomy, communicate clearly and consistently, employ cultural competency, avoid judgement or stigmatization and explore each individual’s needs, strengths, barriers and goals. By practicing trauma-informed care, nutrition professionals can contribute to the healing and recovery of individuals affected by trauma by opposing inadvertent re-traumatization embedded in the policies and procedures of traditional healthcare.
This story was written by BreeAnna Beach and published Fall 2020 in Nutrition@Syracuse on page 7. The article can be read here