Up to 60 percent of American adults have experienced at least one traumatic event in their life, such as child maltreatment, interpersonal violence, natural disaster, war or serious accident. Although most people who experience a traumatic event do not have long-term negative consequences, a substantial minority develop significant health difficulties.
Traumatic exposure has been implicated as a risk factor for numerous mental disorders, including depression, substance abuse and post-traumatic stress disorder (PTSD). Trauma is also associated with such physical health problems as heart, chronic lung and liver diseases; negative health behaviors, such as smoking and overeating; poor social and occupational functioning; and overall decreased quality of life.
As a result of the 9/11 terrorist attacks, Hurricane Katrina, the Iraq and Afghanistan wars and other recent tragedies, policymakers now recognize trauma and its consequences as serious public health risks. Growing awareness is expected to increase the number and proportion of trauma survivors who seek treatment for trauma and its effects.
Most mental health professionals — including psychologists — do not have formal education and training in trauma mental health. To address this problem, APA members Joan Cook, PhD, of Yale University, and Elana Newman, PhD, of the University of Tulsa, spearheaded a national effort to articulate empirically informed knowledge, attitudes and skills that mental health practitioners should have to treat trauma survivors competently.
In April, the two hosted 60 national experts in psychology, social work and psychiatry for "Advancing the Science of Education, Training and Practice in Trauma," a consensus conference at Yale School of Medicine in New Haven, Conn. The conference was modeled after previous national psychology conferences on training issues such as the Hilton Head conference on child clinical psychology, the Houston conference on neuropsychology, the Arden House conference on health psychology and the Pikes Peak conference on geropsychology.
"Like other national psychology conferences on training issues, we are naming the competencies after the city in which we held the conference," Cook says. "It is our hope that if providers use these competencies to guide their clinical practice, then trauma survivors will have indeed found a clinical refuge or shelter." Over the three-day event, participants rotated among five working groups on the topics of scientific knowledge about trauma, psychosocial assessment, psychosocial intervention, professionalism and relational systems. Using the nominal group technique — a comprehensive method for problem-solving — the participants independently generated ideas for competencies in the five domains and then recorded, discussed and voted on ideas.
A core competency model in trauma mental health should serve as a valuable resource for a wide variety of providers, Cook and Newman say. For example, practicing mental health providers who want to develop competencies to work with traumatized children and adults may find the New Haven Trauma Competencies guidelines helpful for planning their own professional development. Similarly, health-care administrators, graduate school faculty and training directors who are planning to review or develop trauma training programs will find these evidence-based core competencies a useful resource.
Cook and Newman are working with APA's Catherine Grus, PhD, deputy executive director of the APA Education Directorate, to seek the association's approval of the competencies. In addition, they are hopeful that trauma psychology can gain specialty or proficiency status within APA.
Primary funding for the conference was provided by the Agency for Healthcare Research and Quality, with support from APA's Div. 56 (Trauma), its Board of Educational Affairs, the Department of Veterans Affairs (VA), the National Center for PTSD and the VA's National Center for Homelessness.
Colleen Wilson is a writer in College Park, Md.
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