Victims of Crime Research Digest No. 9

Trauma- (and Violence-) Informed Approaches to Supporting Victims of Violence: Policy and Practice Considerations

By Pamela Ponic, Colleen Varcoe and Tania Smutylo

Dr. Pamela Ponic is a senior policy analyst in family violence prevention at the Public Health Agency of Canada.

Dr. Colleen Varcoe is a professor in the University of British Columbia School of Nursing with a program of research in violence and inequities.

Tania Smutylo, MSW, is a policy analyst with the Public Health Agency of Canada working on family violence prevention.  

The traumatic impacts of violence have long-term effects on victims, whether the violence is ongoing or in the past. When systems and the service providers who work with victims of violence lack an understanding of the complex and lasting impacts of violence and trauma, they risk causing further harm. For example, each time an adult or child re-tells their story of abuse to seek help across multiple service systems, there is a risk of re-traumatization (Herman 2003; Valpied et al. 2014). Trauma-informed approaches are policies and practices regarding the provision of services and programming that—particularly when they are also violence-informed—work to minimize harm to victims of violence, and aid healing and justice.

During the last 10–15 years, there has been a movement to develop and implement policies and practices that are trauma-informed in sectors working directly with people impacted by violence, including in health, particularly in relation to mental health and substance use (Covington 2008; Savage et al. 2007), justice, housing, anti-violence, and social work sectors (Strand et al. 2015; Hopper, Bassuk, and Oliver 2010; Herman 2003; Dechief and Abbott 2012). This movement developed largely in response to a growing understanding of the connections among violence, trauma, negative outcomes in physical and mental health, and substance-use problems, as well as to the need to make systems more responsive to the needs of people who face these challenges (Poole and Greaves 2012). Implementing trauma-informed approaches across sectors provides a common conceptual framework that enhances efforts to develop integrated multi-sectoral responses for children and adults. These approaches also create opportunities for systems, and those who work within them, to improve the services they provide to people impacted by violence.

Trauma-informed approaches are built upon a foundational understanding of the impact of violence and trauma on people’s lives, health and behaviours (Covington 2008; Elliot et al. 2005). Such approaches require fundamental shifts in how systems are designed, how organizations function, and how service providers engage with victims. Trauma-informed approaches are relational; they recognize that individuals’ experiences of violence relate to how systems respond to them. For example, a person’s circumstances (including income, housing, and access to safe transportation and child care) influence both their exposure to violence and their ability and willingness to access supportive services. Services that are approachable and trauma-informed can mitigate these influences. Trauma-informed approaches also recognize that individual behaviours often associated with victimization—such as substance-use problems or future perpetration of abuse—relate to trauma (Watt and Scrandis 2013; Danielson et al. 2009; Hedtke et al. 2008). By integrating understandings of trauma into all elements of policy and practice, trauma-informed approaches prioritize victims’ emotional and physical safety, as well as facilitate victim control over and responses to violence. This integration also builds on their strengths and aids in recovery (Provincial Health Services Authority of BC 2013).

Understanding trauma

Trauma is both the experience of, and a response to, an overwhelmingly negative event or series of events, such as interpersonal violence, personal loss, war or natural disaster. In the context of violence, trauma can be acute (resulting from a single event) or complex (resulting from repeated experiences of interpersonal and/or systemic violence). Trauma can alter human neurobiology: brain and nervous-system function change. While neurobiological changes are not necessarily permanent, they can be long-lasting if not addressed appropriately. Neurobiological changes resulting from trauma can alter behaviour in both children and adults (Green et al. 2015). For example, adverse events in childhood, such as various forms of maltreatment, along with exposure to intimate-partner violence or alcoholism, can have long-term neurobiological effects and are associated with a wide range of negative outcomes, including stress, anxiety, depression and substance use (Anda et al. 2006; Felitti and Anda 2010; Cloitre et al. 2009). Complex trauma can also impact children’s development; it can foster an inability to manage difficult emotions (e.g. anger) or form appropriate attachments with those close to them (Haskell 2012). These negative outcomes can last into adulthood. Similarly, across the life span, experiencing interpersonal and systemic racism (for example, patterns of discrimination that limit education, employment, access to housing) can also change neurobiological patterns, which can have profound impacts on mental and physical health and wellbeing (Krieger et al. 2011).

Neurobiological changes in people who experience complex trauma include responding to potential threats to safety as if they are real, whether they are real or not (Van der Kolk 2000). Such responses can create enduring associations between the traumatic event(s) and particular sensations, emotions or thought processes. Triggers are external events that recreate these traumatic associations; in some instances, situations that seem innocuous and unrelated can activate triggers, creating an overwhelming sense of threat related to past experiences of violence. Even well intentioned services, practices and policies can activate triggers that re-traumatize (Harris and Fallot 2001). For example, touching a person without warning or permission can trigger a neurophysiological flight-or-fight response.

In trauma-informed approaches, those who provide support services understand that any person they encounter may have experienced violence with traumatic effects. They understand that emotional states (such as depression, anxiety, anger, dissociation, difficulty concentrating, fear and distractedness) and behaviours (such as substance use, compulsive and obsessive behaviours, disordered eating, self-harm, high-risk sexual behaviours, suicidal behaviours or isolation) may arise, at least in part, from those experiences (Gutierres and Van Puymbroeck 2006; Schäfer 2009; Nadew 2012). Shifting the fundamental question from "what’s wrong with this person?" to "what happened to this person?" is important. It considers what might have happened and what might be happening to the person, and can result in a profound difference in how people are viewed and treated, and how they will respond (Williams and Paul 2008). Importantly, such approaches take into account that people can also experience growth in the aftermath of traumatic experiences (Shakespeare-Finch and de Dassel 2009; Glad et al. 2013; Birkeland et al. 2015; Katz and Gurtovenko 2015).

Service providers working directly with victims are often and repeatedly exposed to stories of terrifying and inhumane experiences with violence. These experiences can result in vicarious (or secondary) trauma with negative health impacts similar to those experienced by victims (Bartoskova 2015; Hensel et al. 2015; Middleton and Potter 2015; Raunick et al. 2015; van Mol et al. 2015). For example, service providers with vicarious trauma can experience depression, emotional exhaustion, anxiety and sleep disturbances (Cohen and Collens 2013). The negative impacts of vicarious trauma are associated with employment issues such as high turnover rates (Cieslak et al. 2014; Middleton and Potter 2015). Vicarious trauma can also manifest the trigger responses described earlier. Trauma-informed approaches take vicarious trauma into account by actively and intentionally supporting the wellbeing and self-care practices of service providers who are repeatedly exposed to stories of violence and trauma. Importantly, when well supported, service providers can also experience compassion, satisfaction and growth when working with people who have been victimized (Cohen and Collens 2013; Abel et al. 2014; Hyatt-Burkhart 2014).

From Trauma-informed to Trauma- and violence-informed

Recently, scholars have been calling for an important shift in language by referring to this policy and practice as trauma- and violence-informed, rather than only trauma-informed (Browne et al. 2015). This shift in language brings into focus acts of violence and their traumatic impact on victims (and distinguishes violence from other sources of trauma, such as natural disasters). It helps to put the emphasis on a person’s various experiences of past and ongoing violence as the cause of the trauma, and avoids seeing the problem as residing only in an individual’s psychological state. Because this view emphasizes making practices and policies safe, it fosters opportunities for service providers to prevent and limit harm, and to take actions at all levels: in their own practices, within their organizations and more widely in society. Although service providers cannot influence past events and the impact these events have on victims, providers can work to limit exposure to ongoing violence, and to reduce triggering and the potentially traumatizing effects of services.

This shift in language also allows for a more expansive understanding of people’s experiences of violence and trauma. Particularly in cases of complex trauma, histories of violence typically include interconnected experiences of interpersonal and systemic violence. For many victims, interpersonal violence is ongoing; it can be intergenerational and linked to broader historical contexts. For example, family violence and other forms of interpersonal violence in Indigenous communities have been linked to histories of colonization, including residential schools, the reserve system and ongoing child-welfare practices (Brownridge 2008; Daoud et al. 2013; Pedersen, Malcoe, and Pulkingham 2013). The enduring and ongoing effects of residential schools illustrate how systems can perpetuate violence and trauma, for example, through higher rates of incarceration for Indigenous versus non-Indigenous people (Narine 2012). While modern systems may be less blatant in their perpetuation of violence, policies and practices can continue to re-traumatize and harm victims, sometimes subtly and inadvertently. Discrimination, marginalization, and stigma remain an ongoing experience for many people within systems such as child protection, health care and criminal justice.

Considerations of gender and culture

Experiences and effects of violence are highly gendered. Although men are the most common victims of violence, including armed violence (World Health Organization 2011), women bear the greatest burden of family violence and men are the most common perpetrators of violence (Statistics Canada 2013). In 2013, 80% of reported cases of spousal violence were against women (Statistics Canada 2015). The rates of most forms of child abuse (i.e., physical, psychological, exposure to intimate partner violence) are similar for boys and girls, except for sexual abuse where rates are higher for girls (18%) than boys (7.6%) (Stoltenborgh et al. 2011). Girls are also at heightened risk of harmful practices, such as child, early and forced marriage and so-called honour-based violence, as well as female-genital cutting (Garcia-Moreno, Guedes, and Knerr 2012; Maryum Anis, Shalini Konanur, and Mattoo 2013; Muhammad 2010). Transgendered people experience alarming rates of violence; a recent Canadian survey showed that 65% of those who identified as transgendered had experienced domestic violence (Wathen, MacGregor, and MacQuarrie 2015).

Victims also experience gendered barriers to disclosure and accessing support, with men and boys being more strongly socialized away from help-seeking and disclosure (Vogel et al. 2011; Sierra Hernandez et al. 2014), and transgendered people facing multiple concomitant forms of discrimination (Logie et al. 2012; Bauer et al. 2015). People who experience child abuse face heightened risks of interpersonal violence in adulthood, with boys being more likely to become perpetrators and girls more likely to become victims (Abramsky et al. 2011; Radford et al. 2013; Sigurdardottir, Halldorsdottir, and Bender 2014). Given these differences, a gender lens is required to make trauma- and violence-informed responses to violence gender inclusive and appropriate.

Trauma- and violence-informed approaches are compatible with, and supported by, efforts to make policies and practices culturally safer. Cultural safety is an approach to working across multiple differences (including, but not limited to, ethnic differences) that shifts attention away from service providers learning about others, to making practices, policies and service environments safer for all regardless of expressed or assumed culture (Varcoe and Browne 2015; Kirmayer 2013). Importantly, the shift to trauma- and violence-informed approaches parallels the shift toward cultural safety; both put the onus on systems to change policy and practice, creating opportunities for policy makers and service providers to optimize support for victims.

Using the idea of cultural safety, service providers consider how power relations and the social, economic, political and historical realities of peoples’ lives shape their behaviors. This is especially imperative in the Canadian context. In Canada, Indigenous peoples experience multiple forms of disadvantage and marginalization, including disproportionately high rates of victimization and pervasive systemic racism, which can deter accessing services. Indigenous women are three times more likely than non-Indigenous women to experience family violence (Statistics Canada 2011), and four times more likely to be murdered or go missing (Royal Mounted Canadian Police 2014). The ongoing legacy of abuse in residential schools, and in foster and adoptive care, also contributes to intergenerational violence (McKenzie et al. 2016) and is an example of how systems of colonization have perpetuated violence against Indigenous peoples.

Cultural safety is also important to consider when supporting newcomers and others from non-Western cultures. Members of these populations may face assumptions about how their culture contributes to acts and experiences of violence, and these assumptions create barriers to effective services and supports. For example, service providers may assume that women who are identified with particular ethnic communities and experience intimate partner violence are well supported by their communities, whereas in reality they may fear and face ostracism for seeking help and disclosing abuse (Roger, Brownridge, and Ursel 2015; Thurston et al. 2013). Refugees are likely to have been exposed to various forms of violence (Guruge, Roche, and Catallo 2012; Bogic, Njoku, and Priebe 2015; Kirmayer et al. 2011). As noted by Pottie et al, "refugees, who are by definition forcefully displaced, are at highest risk for past exposure to harmful living conditions, violence and trauma" (Pottie et al. 2011, E827); this places them in great need of culturally safe and trauma- and violence-informed services.

Trauma- and violence-informed approaches: Principles and strategies

Trauma- and violence-informed approaches aim to transform policies and practices based on an understanding of the impact of trauma and violence on victims’ lives and behaviours. Table 1 outlines key principles and sample implementation strategies at organizational and service-provider levels that can be used in many different sectors, including justice, health, anti-violence, social work and housing.

In public-health and other social-service contexts, we argue that disclosure of an individual’s violence and trauma history is not necessary for the provision of excellent services. Although disclosure is oftentimes necessary in the justice context, the goals of the trauma- and violence-informed approaches are to provide emotional, physical and cultural safety for all, regardless of whether or not a particular history of victimization is known. Embedding these principles and strategies into systems creates "universal trauma precautions" that reduce harm and provide positive supports for all people (Raja et al. 2015). It is important to think about trauma and violence responses on a continuum. At one end of the continuum, trauma- and violence-informed approaches focus on minimizing the potential for service systems to cause harm by triggering and re-traumatizing, and on creating supportive environments that provide universal benefit to both victims and service providers. At the other end of the continuum, trauma-specific approaches strive purposefully to treat trauma and related health outcomes through specific healthcare modalities, such as psychotherapy or chronic-pain interventions (Poole and Greaves 2012). In many instances, specificapproaches require some understanding of an individual’s history of trauma and violence, so that treatment can be tailored to these experiences. Trauma-informed approaches can be implemented widely, but should be complemented by a multi-sectoral approach in which referrals can be made to forensic services, for example, or to specific forms of healthcare or housing services.

Table 1: Principles and strategies of trauma- and violence-informed approachesFootnote 1
Principles Organizational/Policy Strategies Individual/Service Provider Strategies
1. Understand trauma and violence, and its impacts on peoples’ lives and behaviours.
  • Develop organizational structures, policies, and processes that foster an organizational culture built on understandings of trauma and violence, for example through hiring practices and reward systems.
  • Train all staff on the connections among violence, trauma, and health outcomes and behaviours, including vicarious trauma.
  • Listen and believe victim’s experiences: "That sounds like a horrible experience"
  • Affirm/validate: "No one deserves…"
  • Recognize strength: "You have really survived a lot…"
  • Express concern: "I am really concerned for your safety…"
2. Create emotionally and physically safe environments for clients and service providers.
  • Attend to the set-up of a safe service-environment, including welcoming intake procedures and signage, comfortable physical space, consideration of confidentiality.
  • Seek client input into inclusive and safe strategies.
  • Provide support for service providers at risk of vicarious trauma and facilitate their self-care (e.g. peer support, regular check-ins with supervisor, self-care programs).
  • Behave in a non-judgmental manner so that people feel deserving, understood, recognized and accepted.
  • Foster a sense of connection to build trust.
  • Provide clear information and predictable expectations about programming.
3. Foster opportunities for choice, collaboration, and connection.
  • Train staff in critical self-reflection on power differences between service providers and clients.
  • Communicate openly.
  • Convey non-judgmental responses.
  • Provide choices as to treatment/service preferences.
  • Consider choices collaboratively.
  • Listen actively to privilege the clients’ voice.
4. Provide strengths-based and capacity-building approach to support client coping and resilience.
  • Provide sufficient time/resources to support meaningful engagement between service provider and client.
  • Provide programming options that tailor interventions to peoples’ needs, strengths and contexts.
  • Support an organizational culture of, and train staff in, emotional intelligence and social learning.
  • Help clients identify their strengths through techniques such as motivational interviewing (a communication technique that improves engagement and empowerment).
  • Acknowledge the effects of historical and structural conditions.
  • Teach and model skills for recognizing triggers, calming, centering and staying present, including developmentally appropriate skills for children and youth.

Conclusion

Moving systems toward new paradigms of policy and practice such as trauma- and violence-informed approaches, cultural safety and gender inclusivity takes time and incremental change. For this shift to be effective, it requires patience and a strategic approach to system-wide change. But doing so can have multiple benefits. First, it provides both systems and service providers with the opportunity to create a support system that responds to victims in safe, compassionate and respectful ways, and thus have a more positive impact on the lives of clients and staff. Second, it provides a common and consistent platform of support across multiple service systems (i.e. health, justice, housing, etc.) that provide support to people who have experienced violence. Third, since past experiences of violence and trauma feed into cycles of abuse, including intergenerational cycles as noted above, a strong multi-sectoral response system can help break these cycles and prevent continued and future violence. Finally, and most importantly, trauma- and violence-informed approaches will better serve everyone by reducing harm and creating better opportunities for recovery and justice.

References

  • Abel, Lisa, Casie Walker, Christina Samios, and Larissa Morozow. 2014. "Vicarious posttraumatic growth: Predictors of growth and relationships with adjustment." Traumatology: An International Journal 20 (1):9-18. doi: 10.1037/h0099375.
  • Abramsky, Tanya, Charlotte H. Watts, Claudia Garcia-Moreno, Karen Devries, Ligia Kiss, Mary Ellsberg, Henrica A. F. M. Jansen, and Lori Heise. 2011. "What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women's health and domestic violence." BMC Public Health 11 (1):109-125. doi: 10.1186/1471-2458-11-109.
  • Anda, Robert F., Vincent J. Felitti, J. Douglas Bremner, John D. Walker, Charles Whitfield, Bruce D. Perry, Shanta R. Dube, and Wayne H. Giles. 2006. "The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology." European Archives Of Psychiatry And Clinical Neuroscience 256 (3):174-186.
  • Bartoskova, Lucie. 2015. "Research into post-traumatic growth in therapists: A critical literature review." Counselling Psychology Review 30 (3):57-68.
  • Bauer, Greta R., Ayden I. Scheim, Jake Pyne, Robb Travers, and Rebecca Hammond. 2015. "Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada." BMC Public Health 15 (1):1-15. doi: 10.1186/s12889-015-1867-2.
  • Birkeland, Marianne Skogbrott, Gertrud Sofie Hafstad, Ines Blix, and Trond Heir. 2015. "Latent classes of posttraumatic stress and growth." Anxiety, Stress & Coping 28 (3):272-286. doi: 10.1080/10615806.2014.956097.
  • Bogic, Marija, Anthony Njoku, and Stefan Priebe. 2015. "Long-term mental health of war-refugees: a systematic literature review." BMC International Health & Human Rights 15:1-41. doi: 10.1186/s12914-015-0064-9.
  • Browne, Annette J., C. Varcoe, M. Ford-Gilboe, N. Wathen, and on behalf of the EQUIP Team. 2015. "EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings." International Journal for Equity in Health.
  • Browne, Annette J., C. Varcoe, S. Wong, D. Littlejohn, V. L. Smye, J. Lavoie, D. Littlejohn, D. Tu, O. Godwin, M. Krause, and P. Rodney. 2012. "Closing the health equity gap: Evidence-based strategies for primary healthcare organizations." International Journal for Equity in Health 11 (15). doi: 10.1186/1475-9276-11-59.
  • Brownridge, Douglas A. 2008. "Understanding the elevated risk of partner violence against Aboriginal women: A comparison of two nationally representative surveys of Canada." Journal of Family Violence 23 (5):353-367.
  • Cieslak, Roman, Kotaro Shoji, Allison Douglas, Erin Melville, Aleksandra Luszczynska, and Charles C. Benight. 2014. "A meta-analysis of the relationship between job burnout and secondary traumatic stress among workers with indirect exposure to trauma." Psychological Services 11 (1):75-86. doi: 10.1037/a0033798.
  • Cloitre, Marylene, Bradley C. Stolbach, Judith L. Herman, Bessel van der Kolk, Robert Pynoos, Jing Wang, and Eva Petkova. 2009. "A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity." Journal Of Traumatic Stress 22 (5):399-408. doi: 10.1002/jts.20444.
  • Cohen, Keren, and Paula Collens. 2013. "The impact of trauma work on trauma workers: A metasynthesis on vicarious trauma and vicarious posttraumatic growth." Psychological Trauma: Theory, Research, Practice, and Policy 5 (6):570-580. doi: 10.1037/a0030388.
  • Covington, Stephanie S. 2008. "Women and Addiction: A Trauma-Informed Approach." Journal of Psychoactive Drugs:377-385.
  • Danielson, Carla K., A. B. Amstadter, R. E. Dangelmaier, H. S. Resnick, B. E. Saunders, and D. G. Kilpatrick. 2009. "Trauma-related risk factors for substance abuse among male versus female young adults." Addictive Behaviors 34 (4):395-399.
  • Daoud, Nihaya, Janet Smylie, Marcelo Urquia, Billie Allan, and Patricia O'Campo. 2013. "The Contribution of Socio-economic Position to the Excesses of Violence and Intimate Partner Violence Among Aboriginal Versus Non-Aboriginal Women in Canada." Canadian Journal of Public Health 104 (4):e278-83.
  • Dechief, Lynda, and Janice Abbott. 2012. "Breaking out of the mould: Creating trauma-informed anti-violence services and housing for women and their children." In Becoming Trauma-informed, edited by N. Poole and L. Greaves, 329-338. Toronto, ON: Centre for Addiction and Mental Health.
  • Elliot, Denise E., P. Bjelajac, R.D. Fallot, L.S. Markoff, and B.G. Reed. 2005. "Trauma-informed or trauma-denied: principles and implementation of trauma-informed services for women." Journal Of Community Psychology 33 (4):461-477.
  • Felitti, Vincent J., and Robert F. Anda. 2010. The Relationship of Adverse Childhood Experiences to Adult Health, Well-being, Social Function, and Healthcare: Cambridge University Press.
  • Garcia-Moreno, Claudia, Alessandra Guedes, and W. Knerr. 2012. "Understanding and addressing violence against women: Femicide." World Health Organization. http://apps.who.int/iris/bitstream/10665/77421/1/WHO_RHR_12.38_eng.pdf.
  • Glad, Kristin Alve, Tine K. Jensen, Tonje Holt, and Silje Mørup Ormhaug. 2013. "Exploring self-perceived growth in a clinical sample of severely traumatized youth." Child Abuse & Neglect 37 (5):331-342. doi: 10.1016/j.chiabu.2013.02.007.
  • Green, Bonnie L., Pamela A. Saunders, Elizabeth Power, Priscilla Dass-Brailsford, Kavitha Bhat Schlbert, Esther Giller, Larry Wissow, Alejandro Hurtado-de Mendoza, and Mihriye Mete. 2015. "Trauma-informed medical care: CME communication training for primary care providers." Family Medicine 47 (1):7-14.
  • Guruge, Sepali, Brenda Roche, and Cristina Catallo. 2012. "Violence against Women: An Exploration of the Physical and Mental Health Trends among Immigrant and Refugee Women in Canada." Nursing Research & Practice:1-15. doi: 10.1155/2012/434592.
  • Gutierres, Sara E., and Christina Van Puymbroeck. 2006. "Childhood and adult violence in the lives of women who misuse substances." Aggression & Violent Behavior 11 (5):497-513. doi: 10.1016/j.avb.2006.01.010.
  • Harris, Maxine, and Roger D. Fallot. 2001. "Envisioning a trauma-informed service system: A vital paradigm shift." New Directions for Mental Health Services 89:3-22. doi: 10.1002/yd.23320018903.
  • Haskell, Lori. 2012. "A developmental understanding of complex trauma." In Becoming Trauma Informed, edited by N. Poole and L. Greaves, 9-28. Toronto, ON: Centre for Addiction and Mental Health.
  • Hedtke, Kristina A., Kenneth J. Ruggiero, Monica M. Fitzgerald, Heidi M. Zinzow, Benjamin E. Saunders, Heidi S. Resnick, and Dean G. Kilpatrick. 2008. "A longitudinal investigation of interpersonal violence in relation to mental health and substance use." Journal of Consulting and Clinical Psychology 76 (4):633-647. doi: 10.1037/0022-006X.76.4.633.
  • Hensel, Jennifer M., Carlos Ruiz, Caitlin Finney, and Carolyn S. Dewa. 2015. "Meta-Analysis of Risk Factors for Secondary Traumatic Stress in Therapeutic Work With Trauma Victims." Journal of Traumatic Stress 28 (2):83-91. doi: 10.1002/jts.21998.
  • Herman, Judith Lewis. 2003. "The mental health of crime victims: impact of legal intervention." Journal Of Traumatic Stress 16 (2):159-166.
  • Hopper, Elizabeth K., E.L. Bassuk, and J. Oliver. 2010. "Shelter from the Storm: Trauma-Informed Care in Homelessness Services Settings." The Open Health Services and Policy Journal 3:80-100.
  • Hyatt-Burkhart, Debra. 2014. "The Experience of Vicarious Posttraumatic Growth in Mental Health Workers." Journal of Loss & Trauma 19 (5):452-461. doi: 10.1080/15325024.2013.797268.
  • Katz, Lynn Fainsilber, and Kyrill Gurtovenko. 2015. "Posttraumatic stress and emotion regulation in survivors of intimate partner violence." Journal of Family Psychology 29 (4):528-536. doi: 10.1037/fam0000128.
  • Kirmayer, Laurence. 2013. "Embracing Uncertainty as a Path to Competence: Cultural Safety, Empathy, and Alterity in Clinical Training." Culture, Medicine & Psychiatry, 06, 365-372.
  • Kirmayer, Laurence, Lavanya Narasiah, Marie Munoz, Meb Rashid, Andrew G. Ryder, Jaswant Guzder, Ghayda Hassan, Cécile Rousseau, and Kevin Pottie. 2011. "Common mental health problems in immigrants and refugees: general approach in primary care." Canadian Medical Association Journal 183 (12):1-8.
  • Krieger, Nancy, Anna Kosheleva, Pamela D. Waterman, Jarvis T. Chen, and Karestan Koenen. 2011. "Racial Discrimination, Psychological Distress, and Self-Rated Health Among US-Born and Foreign-Born Black Americans." American Journal of Public Health 101 (9):1704-1713. doi: 10.2105/ajph.2011.300168.
  • Logie, Carmen H., Llana James, Wangari Tharao, and Mona R. Loutfy. 2012. " ‘We don't exist’: a qualitative study of marginalization experienced by HIV-positive lesbian, bisexual, queer and transgender women in Toronto, Canada." Journal Of The International AIDS Society 15 (2):17392-17392. doi: 10.7448/IAS.15.2.17392.
  • Maryum Anis, Shalini Konanur, and Deepa Mattoo. 2013. "If, Who, and When to Marry: The incidence of forced marriage in Ontario." South Asian Legal Clinic of Ontario. Accessed April 29, 2016 at http://salc.on.ca/forced-marriage/
  • McKenzie, Holly A., C. Varcoe, A. J. Browne, and L. Day. 2016. "Disrupting the continuities among residential schools, the ‘sixties scoop’ and child welfare: An analysis of colonial and neocolonial discourses, policies and practices and strategies for change." International Indigenous Policy Journal 7 (2).
  • Middleton, Jennifer Sean, and Cathryn C. Potter. 2015. "Relationship Between Vicarious Traumatization and Turnover Among Child Welfare Professionals." Journal of Public Child Welfare 9 (2):195-216. doi: 10.1080/15548732.2015.1021987.
  • Muhammad, Amin A. 2010. "Preliminary Examination of so-called "Honour Killings" in Canada." Justice Canada. http://www.justice.gc.ca/eng/rp-pr/cj-jp/fv-vf/hk-ch/index.html.
  • Nadew, Gelaye T. 2012. "Exposure to traumatic events, prevalence of posttraumatic stress disorder and alcohol abuse in Aboriginal communities." Rural and Remote Health 12 (4):1667.
  • Narine, Shari. 2012. "Residential school related to increased female incarceraton." Windspeaker 30 (4):11-11.
  • Pedersen, Jeanette Somlak, Lorraine Halinka Malcoe, and Jane Pulkingham. 2013. "Explaining aboriginal/non-aboriginal inequalities in postseparation violence against Canadian women: application of a structural violence approach." Violence Against Women 19 (8):1034-1058. doi: 10.1177/1077801213499245.
  • Poole, Nancy, and L. Greaves, eds. 2012. Becoming Trauma Informed. Toronto, ON: Centre for Addiction and Mental Health.
  • Pottie, Kevin, Christina Greenaway, John Feightner, Vivian Welch, Helena Swinkels, Meb Rashid, Lavanya Narasiah, Laurence J. Kirmayer, Erin Ueffing, Noni E. MacDonald, Ghayda Hassan, Mary McNally, Kamran Khan, Ralf Buhrmann, Sheila Dunn, Arunmozhi Dominic, Anne E. McCarthy, Anita J. Gagnon, Cecile Rousseau, and Peter Tugwell. 2011. "Evidence-based clinical guidelines for immigrants and refugees." CMAJ: Canadian Medical Association Journal 183 (12):E824-E925. doi: 10.1503/cmaj.090313.
  • Provincial Health Services Authority of BC. 2013. "Trauma-informed practice guide." http://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf.
  • Radford, Lorraine, Susana Corral, Christine Bradley, and Helen L. Fisher. 2013. "The prevalence and impact of child maltreatment and other types of victimization in the UK: findings from a population survey of caregivers, children and young people and young adults." Child Abuse & Neglect 37 (10):801-813. doi: 10.1016/j.chiabu.2013.02.004.
  • Raja, Sheela, Memoona Hasnain, Michelle Hoersch, Stephanie Gove-Yin, and Chelsea Rajagopalan. 2015. "Trauma informed care in medicine: Current knowledge and future research directions." Family and Community Health 38 (3):216-236. doi: 10.1097/FCH.0000000000000071
  • Raunick, Cara Berg, Deborah Lindell, Diana Lynn Morris, and Theresa Backman. 2015. Vicarious Trauma Among Sexual Assault Nurse Examiners. Baltimore, Maryland: Lippincott Williams & Wilkins.
  • Roger, Kerstin Stieber, Douglas A. Brownridge, and Jane Ursel. 2015. "Theorizing Low Levels of Reporting of Abuse of Older Immigrant Women." Violence Against Women 21 (5):632-651. doi: 10.1177/1077801214545021.
  • Royal Mounted Canadian Police. 2014. "Missing and Murdered Aboriginal Women: A National Operational Overview." Accessed September 16, 2015 at http://www.rcmp-grc.gc.ca/pubs/mmaw-faapd-eng.pdf.
  • Savage, Andrea, Laura Quiros, Sarah-Jane Dodd, and Diane Bonavota. 2007. "Building trauma informed practice: appreciating the impact of trauma in the lives of women with substance abuse and mental health problems." Journal of Social Work Practice in the Addictions 7 (1-2):91-116.
  • Schäfer, Ingo. 2009. "Posttraumatic disorders in patients with substance use disorders: A German multi-center study." European Psychiatry 24:S247. doi: 10.1016/S0924-9338(09)70480-8.
  • Shakespeare-Finch, Jane, and Therese de Dassel. 2009. "Exploring Posttraumatic Outcomes as a Function of Childhood Sexual Abuse." Journal of Child Sexual Abuse 18 (6):623-640. doi: 10.1080/10538710903317224.
  • Sierra Hernandez, Carlos A., Christina Han, John L. Oliffe, and John S. Ogrodniczuk. 2014. "Understanding help-seeking among depressed men." Psychology of Men & Masculinity 15 (3):346-354. doi: 10.1037/a0034052.
  • Sigurdardottir, Sigrun, Sigridur Halldorsdottir, and Soley S. Bender. 2014. "Consequences of childhood sexual abuse for health and well-being: Gender similarities and differences." Scandinavian Journal of Public Health 42 (3):278-286. doi: 10.1177/1403494813514645.
  • Statistics Canada. 2011. Violent victimization of Aboriginal women in the Canadian provinces, 2009. Ottawa: Canadian Centre for Justice Statistics.
  • Statistics Canada. 2013. Family violence in Canada: A statistical profile 2011. Ottawa: Canadian Centre for Justice Statistics.
  • Statistics Canada. 2015. Family violence in Canada: A statistical profile 2013. Ottawa: Canadian Centre for Justice Statistics.
  • Stoltenborgh, Marije, Mavinus H. van IJzendoorn, Eveline M. Euser, and Marian J. Bakermans-Kranenburg. 2011. "A global perspective on child sexual abuse: meta-analysis of prevalence around the world." Child Maltreatment 16 (2):79-101.
  • Strand, Virginia, Marciana Popescu, Robert Abramovitz, and Sean Richards. 2015. "Building agency capacity for trauma-informed evidence-based practice and field instruction." Journal of Evidence-Informed Social Work:1-19. doi: DOI:10.1080/23761407.2015.1014124.
  • Thurston, Wilfreda E., Amrita Roy, Barbara Clow, David Este, Tess Gordey, Margaret Haworth-Brockman, Liza McCoy, Rachel Rapaport Beck, Christine Saulnier, and Lesley Carruthers. 2013. "Pathways Into and Out of Homelessness: Domestic Violence and Housing Security for Immigrant Women." Journal of Immigrant & Refugee Studies 11 (3):278-298. doi: 10.1080/15562948.2013.801734.
  • Van der Kolk, Bessel. 2000. "Posttraumatic stress disorder and the nature of trauma." Dialogues in Clinical Neuroscience 2 (1):7-22.
  • van Mol, Margo M. C., Erwin J. O. Kompanje, Dominique D. Benoit, Jan Bakker, and Marjan D. Nijkamp. 2015. "The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in Intensive Care Units: A Systematic Review." PLoS ONE 10 (9):1-22. doi: 10.1371/journal.pone.0136955.
  • Varcoe, Colleen, and Annette J. Browne. 2015. "Culture and cultural safety: Beyond cultural inventories." In Fundamentals: Perspectives on the Art and Science of Canadian Nursing, edited by C. D. Gregory, L. Raymond-Seniuk, L. Patrick and T. Stephen, 216-231. Philadelphia: Lippincott Williams & Wilkins.
  • Valpied, Jodi, Abigali Cini, Lorna O'Doherty, Ann Taket, and Kelsey Hegarty. 2014. "Sometimes cathartic. Sometimes quite raw": Benefit and harm in an intimate partner violence trial. Aggression & Violent Behavior 19(6); 673-685. doi:10.1016/j.avb.2014.09.005
  • Vogel, David L., Sarah R. Heimerdinger-Edwards, Joseph H. Hammer, and Asale Hubbard. 2011. " ‘Boys don't cry’: Examination of the links between endorsement of masculine norms, self-stigma, and help-seeking attitudes for men from diverse backgrounds." Journal of Counseling Psychology 58(3):368-382. doi: 10.1037/a0023688.
  • Wathen, C. Nadine, Jennifer C. D. MacGregor, and Barbara MacQuarrie. 2015. "The Impact of Domestic Violence in the Workplace: Results From a Pan-Canadian Survey." American College of Occupational and Environmental Medicine 57 (7):E65-71.
  • Watt, Margaret E., and Debra A. Scrandis. 2013. "Traumatic Childhood Exposures in the Lives of Male Perpetrators of Female Intimate Partner Violence." Journal of Interpersonal Violence 28 (14):2813-2830. doi: 10.1177/0886260513488694.
  • Williams, Jennie, and Jenifer Paul. 2008. "Informed Gender Practice: Mental health acute care that works for women." National Institute for Mental Health in England. Accessed April 29, 2016 at http://www.scie-socialcareonline.org.uk/informed-gender-practice-mental-health-acute-care-that-works-for-women/r/a11G00000017zXQIAY
  • World Health Organization. 2011. "The global burden of armed violence." http://www.genevadeclaration.org/measurability/global-burden-of-armed-violence/global-burden-of-armed-violence-2011.html.
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