Trauma-Informed Care: A Focus on African American Men

African American males experience high levels of violence-related trauma. They lead all racial groups in fatal and nonfatal violence-related injury. Their responses to trauma may be mediated by personal experiences and/or ecological exposures to prejudice or inequality. Caring for these men encompasses some unique challenges, for example, they may have less overall access to mental health care, may be less likely to seek such resources, and may have lower retention rates in treatment. For this reason, they may present more commonly in general medical/primary care settings, often with physical complaints. Trauma-informed care offers a hopeful approach to caring for African American men and could address disparities in mental health treatment through robust individual provider-patient relationships and health system adaptations that are comprehensive, culturally sensitive, and work to understand institutional relationships with the surrounding community. Interventions that are culturally sensitive and multimodal are the most effective. As the existing literature tends to focus on pediatric and youth settings, this chapter will provide perspective on treating adults.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic €32.70 /Month

Buy Now

Price includes VAT (France)

eBook EUR 58.84 Price includes VAT (France)

Softcover Book EUR 73.84 Price includes VAT (France)

Tax calculation will be finalised at checkout

Purchases are for personal use only

Similar content being viewed by others

Healing Hurt People-Chicago: Supporting Trauma Recovery in Patients Injured by Violence

Chapter © 2020

Trauma-Informed Care: a Strategy to Improve Primary Healthcare Engagement for Persons with Criminal Justice System Involvement

Article Open access 25 March 2019

Recognizing and Breaking the Cycle of Trauma and Violence Among Resettled Refugees

Article 13 November 2021

Notes

The crude death rate is the overall number of deaths for a particular population divided by the total number of people in that population. These crude death rates reflect the total number of injury-related death rates.

References

  1. Black MC, Basile KC, Breiding MJ, Smith SG, Walters ML, Merrick MT, Chen J, Stevens MR. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2011. Accessed 29 April 2018. Available at https://www.cdc.gov/ViolencePrevention/pdf/NISVS_Report2010-a.pdf.
  2. Centers for Disease Control and Prevention. WISQARS™ (Web-based Injury Statistics Query and Reporting System) Atlanta, GA updated 2017. Accessed 3 May 2018. Available from: https://www.cdc.gov/injury/wisqars/index.html.
  3. Centers for Disease Control and Prevention. Web based Injury Statistics Query and Reporting System (WISQARS)[online]. National Center for Injury Prevention and Control, Centers for Disease Control and prevention. Accessed 2018 May 10. Available from: https://www.cdc.gov/injury/wisqars.
  4. Wiseman T, Foster K, Curtis K. Mental health following traumatic physical injury: an integrative literature review. Injury. 2013;44(11):1383–90. ArticlePubMedGoogle Scholar
  5. Smith RN, Seamon MJ, Kumar V, Robinson A, Shults J, Reilly PM, et al. Lasting impression of violence: retained bullets and depressive symptoms. Injury. 2018;49(1):135–40. ArticlePubMedGoogle Scholar
  6. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–58. ArticleCASPubMedGoogle Scholar
  7. Frayne SM, Chiu VY, Iqbal S, Berg EA, Laungani KJ, Cronkite RC, et al. Medical care needs of returning veterans with PTSD: their other burden. J Gen Intern Med. 2011;26(1):33–9. ArticlePubMedGoogle Scholar
  8. Tudiver F, Talbot Y. Why don’t men seek help? Family physicians’ perspectives on help-seeking behavior in men. J Fam Pract. 1999;48(1):47–52. CASPubMedGoogle Scholar
  9. Smith JA, Braunack-Mayer A, Wittert G. What do we know about men’s help-seeking and health service use? Med J Aust. 2006;184(2):81–3. ArticlePubMedGoogle Scholar
  10. Lindsey MA, Marcell AV. “We’re going through a lot of struggles that people don’t even know about”: the need to understand African American males’ help-seeking for mental health on multiple levels. Am J Mens Health. 2012;6(5):354–64. ArticlePubMedGoogle Scholar
  11. Addis ME, Mahalik JR. Men, masculinity, and the contexts of help seeking. Am Psychol. 2003;58(1):5–14. ArticlePubMedGoogle Scholar
  12. Powell W, Adams LB, Cole-Lewis Y, Agyemang A, Upton RD. Masculinity and race-related factors as barriers to health help-seeking among African American men. Behav Med. 2016;42(3):150–63. ArticlePubMedPubMed CentralGoogle Scholar
  13. Ashman JJ, Hing E, Talwalkar A. Variation in physician office visit rates by patient characteristics and state. NCHS Data Brief. 2012;2015(212):1–8. Google Scholar
  14. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048–60. ArticleCASPubMedGoogle Scholar
  15. Casas JM. Male victims of domestic violence and the disparity in treatment trainings [dissertation]: California School of Forensic Studies Alliant International University Fresno; 2016. Google Scholar
  16. Sorsoli L, Kia-Keating M, Grossman FK. “I keep that hush-hush”: male survivors of sexual abuse and the challenges of disclosure. J Couns Psychol. 2008;55(3):333–45. ArticleGoogle Scholar
  17. Parks SE, Johnson LL, McDaniel DD, Gladden M. Surveillance for violent deaths - National Violent Death Reporting System, 16 states, 2010. MMWR Surveill Summ. 2014;63(1):1–33. Google Scholar
  18. Rich JA, Sullivan LM. Correlates of violent assault among young male primary care patients. J Health Care Poor Underserved. 2001;12(1):103–12. ArticleCASPubMedGoogle Scholar
  19. Beard JH, Morrison CN, Jacoby SF, Dong B, Smith R, Sims CA, et al. Quantifying disparities in urban firearm violence by race and place in Philadelphia, Pennsylvania: a cartographic study. Am J Public Health. 2017;107(3):371–3. ArticlePubMedPubMed CentralGoogle Scholar
  20. Riddell CA, Harper S, Cerda M, Kaufman JS. Comparison of rates of firearm and nonfirearm homicide and suicide in black and white non-hispanic men, by U.S. state. Ann Intern Med. 2018;168(10):712–20. ArticlePubMedGoogle Scholar
  21. Corbin TJ, Purtle J, Rich LJ, Rich JA, Adams EJ, Yee G, et al. The prevalence of trauma and childhood adversity in an urban, hospital-based violence intervention program. J Health Care Poor Underserved. 2013;24(3):1021–30. ArticlePubMedGoogle Scholar
  22. Graves RE, Freedy JR, Aigbogun NU, Lawson WB, Mellman TA, Alim TN. PTSD treatment of African American adults in primary care: the gap between current practice and evidence-based treatment guidelines. J Natl Med Assoc. 2011;103(7):585–93. ArticlePubMedGoogle Scholar
  23. Purtle J, Rich LJ, Rich JA, Cooper J, Harris EJ, Corbin TJ. The youth nonfatal violent injury review panel: an innovative model to inform policy and systems change. Public Health Rep. 2015;130(6):610–5. ArticlePubMedPubMed CentralGoogle Scholar
  24. Williams DR. Race and health: basic questions, emerging directions. Ann Epidemiol. 1997;7(5):322–33. ArticleCASPubMedGoogle Scholar
  25. Jones CP. Invited commentary: “race,” racism, and the practice of epidemiology. Am J Epidemiol. 2001;154(4):299–304. discussion 5–6 ArticleCASPubMedGoogle Scholar
  26. Macintosh T, Desai MM, Lewis TT, Jones BA, Nunez-Smith M. Socially-assigned race, healthcare discrimination and preventive healthcare services. PLoS One. 2013;8(5):e64522. ArticleCASPubMedPubMed CentralGoogle Scholar
  27. Williams DR, Lavizzo-Mourey R, Warren RC. The concept of race and health status in America. Public Health Rep. 1994;109(1):26–41. CASPubMedPubMed CentralGoogle Scholar
  28. Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212–5. ArticleCASPubMedPubMed CentralGoogle Scholar
  29. Chin MH, Walters AE, Cook SC, Huang ES. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev. 2007;64(5 Suppl):7S–28S. ArticlePubMedPubMed CentralGoogle Scholar
  30. Yoo S. Racial threat to Salem Hospital Manager prompts a broader look at community. Statesman Journal [online] 2013 March 9. Accessed 17 June 2018. Available from: statesmanjournal.newspapers.com. Google Scholar
  31. Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, et al. Implicit racial/ethnic Bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105(12):e60–76. ArticlePubMedPubMed CentralGoogle Scholar
  32. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(1):19. ArticlePubMedPubMed CentralGoogle Scholar
  33. Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51(Suppl):S28–40. ArticlePubMedGoogle Scholar
  34. Link BG, Phelan JC. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;35(Extra Issue):80–94. ArticleGoogle Scholar
  35. Kramer T, Evans N, Garralda ME. Ethnic diversity among child and adolescent psychiatric clinic attenders. Child Psychol Psychiatry Rev. 2000;5(4):169–75. ArticleGoogle Scholar
  36. Van Voorhees BW, Fogel J, Houston TK, Cooper LA, Wang NY, Ford DE. Attitudes and illness factors associated with low perceived need for depression treatment among young adults. Soc Psychiatry Psychiatr Epidemiol. 2006;41(9):746–54. ArticlePubMedGoogle Scholar
  37. Zhang AY, Snowden LR. Ethnic characteristics of mental disorders in five U.S. communities. Cultur Divers Ethnic Minor Psychol. 1999;5(2):134–46. ArticleCASPubMedGoogle Scholar
  38. Cooper LA, Gonzales JJ, Gallo JJ, Rost KM, Meredith LS, Rubenstein LV, et al. The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Med Care. 2003;41(4):479–89. PubMedGoogle Scholar
  39. Spoont M, Nelson D, van Ryn M, Alegria M. Racial and ethnic variation in perceptions of VA mental health providers are associated with treatment retention among veterans with PTSD. Med Care. 2017;55(Suppl 9 Suppl 2):S33–42. ArticlePubMedGoogle Scholar
  40. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, US Department of Health and Human Services.1979. Accessed 2 March 2019. Available from: https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html.
  41. Powell W. How masculinity can hurt mental health [Internet]. Washington, DC: American Psychological Association (APA); 2016. Accessed 31 March 2019. Available from: https://www.apa.org/research/action/speaking-of-psychology/men-boys-health-disparities.
  42. Hudson DL, Neighbors HW, Geronimus AT, Jackson JS. Racial discrimination, John Henryism, and depression among African Americans. J Black Psychol. 2016;42(3):221–43. ArticlePubMedPubMed CentralGoogle Scholar
  43. Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–16. ArticleCASPubMedPubMed CentralGoogle Scholar
  44. Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;345(2):99–106. ArticleCASPubMedGoogle Scholar
  45. Fox GL, Benson ML. Household and neighborhood contexts of intimate partner violence. Public Health Rep. 2006;121(4):419–27. ArticlePubMedPubMed CentralGoogle Scholar
  46. Chae DH, Powell WA, Nuru-Jeter AM, Smith-Bynum MA, Seaton EK, Forman TA, et al. The role of racial identity and implicit racial bias in self-reported racial discrimination: implications for depression among African American men. J Black Psychol. 2017;43(8):789–812. ArticlePubMedPubMed CentralGoogle Scholar
  47. Powell WA, Taggart T, Richmond J, Adams LB, Brown A. They can’t breathe: why neighborhoods matter for the health of African American men and boys. In: Burton LM, Burton D, McHale SM, King V, VanHook J, editors. Boys and men in African American families. National Symposium on Family Issues 7. 2016. p. 227–42. Google Scholar
  48. Brown CA. Therapy utilization levels in African Americna men. [dissertation]. Ann Arbor, MI: Alliant International University; 203, 112 p. Google Scholar
  49. Van Voorhees BW, Walters AE, Prochaska M, Quinn MT. Reducing health disparities in depressive disorders outcomes between non-Hispanic Whites and ethnic minorities: a call for pragmatic strategies over the life course. Med Care Res Rev. 2007;64(5 Suppl):157S–94S. ArticlePubMedGoogle Scholar
  50. Victor RG, Ravenell JE, Freeman A, Leonard D, Bhat DG, Shafiq M, et al. Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial. Arch Intern Med. 2011;171(4):342–50. ArticlePubMedGoogle Scholar
  51. Kohn LP, Oden T, Muñoz RF, Robinson A, Leavitt D. Adapted cognitive behavioral group therapy for depressed low-income African American women. Community Ment Health J. 2002;38(6):497–504. ArticlePubMedGoogle Scholar
  52. Purtle J, Dicker R, Cooper C, Corbin T, Greene MB, Marks A, et al. Hospital-based violence intervention programs save lives and money. J Trauma Acute Care Surg. 2013;75(2):331–3. ArticlePubMedGoogle Scholar
  53. Wilson A, Rich J, Rich L, Bloom S, Evans S, Corbin T. Healing the hurt: trauma-informed approaches to the health of boys and young men of color. Philadelphia, PA: Center for Nonviolence and Social Justice and Department of Medicine, Drexel University; 2009, October 1. Google Scholar
  54. Arean PA, Ayalon L, Hunkeler E, Lin EH, Tang L, Harpole L, et al. Improving depression care for older, minority patients in primary care. Med Care. 2005;43(4):381–90. Google Scholar

Author information

Authors and Affiliations

  1. Emory University School of Medicine, Atlanta, GA, USA Marshall Fleurant
  1. Marshall Fleurant