Data_Sheet_2_Key features of a trauma-informed public health emergency approach: A rapid review.PDF

COVID-19 is a major threat to public safety, and emergency public health measures to protect lives (e.g., lockdown, social distancing) have caused widespread disruption. While these measures are necessary to prevent catastrophic trauma and grief, many people are experiencing heightened stress and fear. Public health measures, risks of COVID-19 and stress responses compound existing inequities in our community. First Nations communities are particularly at risk due to historical trauma, ongoing socio-economic deprivation, and lack of trust in government authorities as a result of colonization. The objective of this study was to review evidence for trauma-informed public health emergency responses to inform development of a culturally-responsive trauma-informed public health emergency framework for First Nations communities. We searched relevant databases from 1/1/2000 to 13/11/2020 inclusive, which identified 40 primary studies (and eight associated references) for inclusion in this review. Extracted data were subjected to framework and thematic synthesis. No studies reported evaluations of a trauma-informed public health emergency response. However, included studies highlighted key elements of a “trauma-informed lens,” which may help to consider implications, reduce risks and foster a sense of security, wellbeing, self- and collective-efficacy, hope and resilience for First Nations communities during COVID-19. We identified key elements for minimizing the impact of compounding trauma on First Nations communities, including: a commitment to equity and human rights, cultural responsiveness, good communication, and positive leadership. The six principles guiding trauma-informed culturally-responsive public health emergency frameworks included: (i) safety, (ii) empowerment, (iii) holistic support, (iv) connectedness and collaboration, (v) compassion and caring, and (vi) trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. These findings will be discussed with First Nations public health experts, together with data on the experiences of First Nations families and communities during COVID-19, to develop a trauma-integrated public health emergency response framework or “lens” to minimize compounding trauma for First Nations communities.

新型冠状病毒肺炎（COVID-19）是公共安全的重大威胁，旨在守护生命的公共卫生应急举措（如封控、社交距离措施）已造成大范围的社会运转中断。尽管这些举措对防止灾难性创伤与悲痛而言至关重要，但许多民众正承受着愈发强烈的压力与恐惧。公共卫生举措、新冠疫情风险与应激反应，进一步加剧了社群中业已存在的不公平现象。原住民社群（First Nations）因历史创伤、持续的社会经济剥夺，以及殖民历史导致的对政府机构的信任缺失，面临尤为严峻的风险。
本研究旨在梳理创伤知情的公共卫生应急响应（trauma-informed public health emergency responses）相关证据，为制定适配原住民社群的创伤知情公共卫生应急框架提供参考。本研究检索了2000年1月1日至2020年11月13日（含首尾日期）的相关数据库，最终纳入40项原创研究（及8篇相关参考文献）用于本次综述。提取的数据采用框架合成与主题合成方法进行分析。暂无研究报道针对创伤知情公共卫生应急响应的评估工作。但纳入的研究明确了“创伤知情视角”的核心要素，这些要素可助力考量新冠疫情期间的相关影响、降低风险，并帮助原住民社群构建安全感、幸福感、个体与集体效能感、希望与韧性。
本研究明确了可降低叠加创伤对原住民社群影响的核心要素，包括：对公平与人权的承诺、文化适配性、良好的沟通机制，以及正向的领导力。指导创伤知情且文化适配的公共卫生应急框架的六项原则分别为：（一）安全保障；（二）赋权赋能；（三）全方位支持；（四）联结与协作；（五）共情与关怀；（六）在多层级响应中秉持信任与透明原则、构建运转良好的社会体系，以及保障基本服务供给。
本研究将与原住民公共卫生专家，结合新冠疫情期间原住民家庭与社群的经历数据，共同探讨上述研究结果，以制定创伤整合型公共卫生应急响应框架或“视角”，最大程度降低叠加创伤对原住民社群的影响。