Waking Up the Brain with Trauma-Informed Care
“Science of Trauma” workshop graphics by Leon Fry.
Did you know that there is no word for “trauma” in Kiswahili? Yet, Sub-Saharan Africa, where Kiswahili is most spoken, hosts more than 26% of the world’s refugee population.
Refugees often experience complex forms of trauma created by fleeing their homes, witnessing violence, or being separated from loved ones. In order to support more than 26 million refugees to flourish and become healthy and financially secure, we need to develop a nuanced understanding of the trauma they have experienced and its impact on their lives.
In our work at RefuSHE, we have seen firsthand how deep trauma manifests itself in the everyday lives of the refugee girls we serve, from difficulty with long-term financial planning to adhering to class timelines. Planning ahead can often seem like a fruitless effort in the face of complex trauma.
While self-described “trauma-informed” programs are becoming increasingly common, many programs are still missing the mark and potentially doing more harm than good. Since RefuSHE’s inception, we’ve been committed to providing young refugee women with essential trauma-informed care. But what does authentic trauma-informed care look like? What does implementing authentic trauma-informed services really require? To improve our own understanding, and subsequently the care we provide to refugee girls, our team reached out to the experts.
Rachael Miller is a seasoned mental health clinician, specializing in the neurobiology-informed clinical practice of trauma recovery including psychotraumatology and neuropsychosocial interventions for social change. She is currently the owner and clinical director of a private practice in Chicago, Illinois and a provider-consultant in Eye Movement Desensitization and Reprocessing (EMDR). She is a Board Certified Counselor, Licensed Clinical Professional Counselor, and Pastoral Counselor. Her work has had a global impact in the development of innovative community programs, education seminars, and intervention optimization.
Teddy Chakee Mutisya is a private consultant and holder of an MA in counseling studies from Durham University in the United Kingdom. He has more than 22 years of experience working in mental health care and workplace wellbeing and resilience programs for some of the most reputable international non-governmental organizations within East Africa. For more than 20 years, Teddy has consulted for INGOs working in conflict and post-conflict regions of Somalia, South Sudan, Ethiopia, and the Democratic Republic of Congo to provide therapeutic outfits for traumatized employees and program beneficiaries. He is currently a Peace and Conflict Ph.D. candidate.
Trauma-Informed Care Requires Formal Training
While it’s certainly best to build a program around mental health from the start, it is possible to integrate trauma-informed practices into most existing programs. However, doing so is a delicate process that requires the expertise of someone with formal trauma training – typically a mental health clinician, doctor, or counselor.
Good intent cannot compensate for a lack of professional training in trauma-informed practices. Trauma-informed care is a quickly evolving science that can be challenging to keep up with. If provided incorrectly, poor mental health care can not only stall, but actively damage a person’s progress toward addressing their trauma. The wrong approach can have severe effects which is why only trained practitioners familiar with the science of trauma and its impact on the brain should lead training sessions of this kind.
While securing this kind of formal training can be challenging, especially for smaller nonprofits, the reward of long-term impact on beneficiaries pays itself back. If everyone involved in program design and implementation is trained to understand trauma, it transforms our ability to recognize its symptoms and heal the source.
We took this step seriously at RefuSHE by engaging two experts with deep experience serving populations who have experienced severe trauma. Together, Rachael Miller and Teddy Chakee have helped our team better understand the science behind trauma. They’ve introduced us to the latest neuroscience-backed therapies for mental health and informed how we can improve the services we offer our community of refugee girls and young women.
Trauma-Informed Care Must be Holistic and Rooted in Mental Health
Our mental health shapes every facet of our being, including our relationships, self-care, finances, and intellect. When traumatized, our mental health, and subsequently our physical and emotional health, becomes compromised. Severe trauma of the kind that refugees often experience can even shut down parts of our brain, making it challenging to fully engage with the world around us. Any organization hoping to help people improve their lives or overcome poverty must understand how trauma and mental health factor into people’s behaviors. You may be surprised to find how often trauma and mental health are the root cause of what may seem like poor or short-sighted decision-making.
Put simply, trauma-informed care requires that we center mental health, or “brain health,” throughout our programming in order to truly transform someone’s behavior for long-term impact. Asking people to adopt healthier, more responsible behaviors becomes an endless cycle if we do not address mental health along the way.
Trauma-Informed Care Must be Culturally Relevant
Traditional mental health practices have usually been taken from Western medicine and applied in Africa without adjusting to different cultural contexts. For those of us working in cultures beyond the Western world (upon which most mental health research is based), we must consider cultural norms and sensitivities.
For example, when RefuSHE launched the development of a “Science of Trauma” workshop with refugee girls, Rachael and Teddy worked together to create new definitions and ways of explaining “trauma” that would resonate with girls from South Sudan, Somalia, and the Democratic Republic of Congo who had no word for “trauma” in their local languages. Rachael, a US-based licensed therapist with deep expertise in neuroscience-based trauma interventions including Eye Movement Desensitization and Reprocessing (EMDR), and Teddy, a Kenyan-based counselor and trainer with years of experience working with refugees across East Africa, collaborated to find ways to bridge the communication gap and ensure that the material was adapted to the local context. After all, a problem is near impossible to solve if it cannot be communicated.
Together, Rachael and Teddy defined “trauma” for RefuSHE participants as a condition that can harm your physical, emotional, and mental health. To better communicate what the girls may be experiencing and to give them the language to talk about it, Rachael and Teddy broke the concept of “trauma” into three categories:
Kihisia: “Emotions”
Kifikra na Mawazo: “Thoughts and Ideas”
Kitabia: “Behaviors”
They also assigned specific words to traumatic events that refugee girls may have experienced. By naming "war” or “death of a loved one” as examples of traumatic events, participants can connect how they may be feeling or thinking with particular events in their lives.
Another common cultural barrier is the understanding of mental health as a practice. In Kenya and much of Africa, mental health care is typically limited to traditional talk therapy. Yet, the latest research shows us that trauma can also be effectively treated through physical activities, including art and exercise. As practitioners, we must not only challenge ourselves to identify the most culturally appropriate way for people to manage their trauma, but also educate beneficiaries about the benefits of these non-traditional methods and encourage acceptance.
At RefuSHE, Rachael and Teddy helped our team ask questions with important considerations for culturally relevant care:
Are there language barriers for the technical concepts or Western-based practices?
What cultural stigmas surround mental health for this person?
Are there any limiting factors in their lifestyle that could keep them from healing long-term?
Trauma-Informed Care Embraces Alternative Practices
While RefuSHE already offers physical therapies like trauma-informed yoga and dance, we are constantly looking to implement new innovations in this field. Many emerging methods can help counselors address and tackle trauma much faster in populations who desperately need it.
For example, our team is currently exploring EMDR, a psychotherapy treatment proven successful in addressing complex trauma, and introducing it as an emerging part of our holistic mental health care model.
Beyond the 18 million refugees present in Sub-Saharan Africa, the world faces an immense trauma crisis that has been further exacerbated by the COVID-19 pandemic. If we do not face this crisis head on, it will not resolve itself. It will only get worse.
Freed from the grips of trauma, refugees have the potential to become the health providers, educators, business owners, and policymakers who are the foundations of all sustainable, resilient communities. Economic empowerment and trauma-informed care go hand-in-hand. We have the tools. Now let’s put them to use.