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PHC6534: Addressing Depression in Lee County Through the Lens of ACEs and Trauma

Project Goals

  • Goal 1: Increase awareness of ACEs and their effects on mental health in the target audience (adults 18 years or older) and clinicians.
  • Goal 2: Understanding the extent of ACEs in the county and their connections with depression and depressive symptoms throughout the lifespan.
  • Goal 3: Increase the rate and frequency of young people attending and utilizing mental and social health services in the community.
  • Goal 4: Increase communication between healthcare providers and the target population with their families.
  • Goal 5: Advocating for trauma-informed policy change via community action.

Public Health Framework

As the goals of this project are multi-faceted in nature and attempt to impact childhood trauma on different social levels, there are going to be multiple frameworks utilized in the implementation of the interventions. Part of the goal of this program is to raise awareness of ACEs and actively prevent them between individuals and the community, and the Theory of Planned Behavior will guide the team in addressing this goal. This framework posits that behavior is directly affected by intent, and that this intent is based on attitudes towards the health issue (in this case, trauma-induced depression), the subjective norms regarding the concern, and perceived behavioral control, a subjective evaluation of one’s ability to engage in the said behavior (Simons-Morton et al., 2012). These attitudes, norms, and perceived behavioral control will be addressed by looking at the currently held beliefs of ACEs and mental health, individuals' and the community’s perceived efficacy and power in addressing the issue, the anticipated outcomes of ACEs, and the individual’s motivation to comply (Simons-Morton et al., 2012).

The other major theory that will be used for this project is community capacity. According to Simons-Morton et al. (2012), community capacity is a set of dynamic community traits, resources, and associational patterns that can be brought to bear for building the community and community health improvement. There are seven dimensions of this framework that will be assessed throughout the duration of the program: level of skills, knowledge, and resources; the nature of social relationships; the structures, mechanisms, and spaces for dialogue and action; the quality of leadership and its development; extent of current civic participation; value systems; and the culture of learning (Simons-Morton et al., 2012). The purpose of using community capacity is in part a means of institutionalizing the program, but primarily, it will assist in understanding current policies and the actions that citizens of Lee County can take.

Levels of the Social Ecological Model

As there are many different interpretations of the Social Ecological Model (SEM), the one that will be utilized for this program is the 1988 model proposed by McLeroy et al. (Simons-Morton et al., 2012). This interpretation of the SEM presents five different levels of intervention, including individual, interpersonal, organizational, community, and political domains (Simons-Morton et al., 2012). The other reason why this SEM was chosen is because this model was uniquely designed for the use of establishing interventions (Zori, 2022). For this project, the main levels of intervention that will be addressed are the individual domain, the interpersonal domain, and the community domain, with some attention to public policy via grassroot efforts.

The individual level of this program will utilize the Theory of Planned Behavior, as this framework allows for changes in the attitudes, beliefs, and perceptions of people to affect behavior. The reason this level of the SEM is being addressed is because project goals one and three require changes in normative beliefs and values to be accomplished. The same reasoning can also be applied to the interpersonal level, but with the additional caveat that this intervention also tries to mend the client-therapist relationship, related to the fourth goal. Clients will work with their mental health service provider to learn more about their depression, how to best cope with it, and how their condition is potentially linked to trauma in childhood. The reason why the community level is being addressed as well is due to this level of intervention helping in succeeding the second and third goals of the program, particularly the former. Finally, the political level addresses the fifth major goal of the program, as community members will work together to institute the changes that have been made on the ground level.

Trauma-Informed Principles That Will Be Addressed

According to the Substance Abuse and Mental Health Services Administration (SAMHSA) (2014), there are six major principles that guide the trauma-informed approach. The first of these principles is safety, or having clients feel physically and psychologically safe (SAMHSA, 2014). Two of the program goals are to increase the rate of attendance for individuals seeing their mental health practitioner and communication between practitioners and their clients. In order to achieve these goals, rapport between the counselor and their patient is essential, and this is especially true for individuals who have experienced ACEs and other forms of trauma. To make clients feel safe, their service provider will begin treatment by getting to know their client, along with maintaining a professional and empathetic posture and tone. Additionally, this method will also aid in promoting the second principle of the trauma-informed approach, trustworthiness and transparency (SAMHSA, 2014). Once a client feels safe and rapport is established, clients can begin to “open up” about their experiences with depression and trauma.

The next principle that was proposed by SAMHSA (2014) is peer support and mutual self-help. Two of the goals of this project are to increase communication on ACEs and mental health between community members and self-advocation for policy changes to alleviate trauma and toxic stress. By promoting openness and trustworthiness about mental and social health and their effects on one another, the aim is to increase interpersonal dialogues not just between client and counselor, but also between community members themselves. Consequently, the fourth principle of collaboration and mutuality should also be addressed by these goals and activities (SAMHSA, 2014). Principle five, voice, choice, and empowerment, will be addressed via a combination of all the goals and activities that came before them (SAMSHA, 2014). By this, it is meant that both receiving therapy and positive reinforcement from service provider and peers alike, along with the qualitative writing activity, community members will feel more empowered and be able to critically engage with the trauma that befell them. Finally, the sixth principle, cultural, historical, and gender issues, will be addressed by including a diverse set of practitioners from various backgrounds and providing incentives to providers to work with marginalized individuals.

If you have any more questions about this grant, please refer to the attached document. Thank you!

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