Population Health Institute
Translating Research for Policy and Practice

Cultural Humility and Trauma-Informed Practices

Note: This strategy is for anyone working in crisis support and is not limited to those with a formal counseling or therapy title.

 

Strategy Description

Staff trained in crisis support should have skills and knowledge in cultural humility, especially for having effective conversations about firearms. Cultural humility includes principles of mutual learning, critical self-reflection, recognition of power imbalances, and existence of implicit biases serving as a guiding concept for the practice of trauma-informed practices1. Evidence shows that cultural humility and trauma-informed conversations can be used as a vital tool for crisis staff to de-escalate contacts. Recognizing diverse backgrounds allows staff trained in crisis support to address power imbalances and engage in meaningful conversations about firearm ownership as a cultural value.

Action Steps Based on the Literature 

  1. Understand different demographics and engage in culturally humble dialogue: Recognize that firearm ownership rates vary significantly by race, ethnicity, gender, and location2. Crisis staff can tailor their approach and engage in culturally humble dialogues based on these demographic characteristics. For example, firearm ownership is higher in rural areas compared to urban areas, and white Americans and men exhibit higher ownership rates2. Most owners cite self-protection, hunting, and sport shooting as reasons for ownership2. There has been an increasing trend in suicide by firearm among Black youth and other racial minorities, and it’s important to consider their concerns and lived experience regarding contacting law enforcement; for example, interactions with law enforcement can cause visceral and emotional responses among Black youth3.
  2. Listen and validate: Use active listening and emotional validation to guide helpseekers through the autonomous decision-making processes4. This encourages openness and reduces emotional burden4. For example, explain the rationale for secure storage and discuss options that respect individual autonomy and enhance safety.
  3. Promote trauma-informed care: Have trauma-informed conversations with helpseekers who may have experienced violence or trauma in their lives. This includes being exposed to firearm violence, including suicide and homicides, as research indicates that exposure to firearm violence significantly increases risks for suicidal ideation, psychotic experiences, and heightened distress levels5. Important principles of a trauma-informed approach include safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues6.
  4. Have a diverse team of crisis staff trained in providing culturally appropriate and trauma-informed approaches: Consider hiring staff trained in crisis support across (1) diverse race, ethnicity, gender, and locations and (2) lived experiences related to trauma who can provide further support in culturally humble dialogues. SAMHSA suggests that program leadership should support and invest in implementing and sustaining a trauma-informed approach, including the inclusion of peer voice6. Additionally, it is best practice for crisis staff to use and be trained in interventions and providing referrals that are culturally appropriate and reflect the principles of a trauma-informed approach6.

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Evidence Summary

Firearm ownership rates in the U.S varies significantly by race, ethnicity, and gender2. It is important for crisis workers to know their audiences when interacting with helpseekers7. Listening carefully to individuals through active listening and clarifying missing information can help the helpseeker feel heard4. It’s important to address socioecological factors, such as societal, relationship, community and individual factors, with culturally humble dialogues on firearm access while promoting voluntary secure storage measures that respect patient autonomy and enhance safety8.

There is a complex interplay between demographics and firearm culture. For males and females, the firearm death rate is higher in rural areas than urban areas9, and firearm ownership is higher in rural areas compared to urban areas2. Notably, White Americans and men exhibit higher ownership rates compared to women2. Most firearm owners own the gun for self-protection, in addition to hunting and sport shooting10,11. Among veterans, it is important to emphasize personal safety and cherished military experiences12.

In terms of firearm ownership, suicide and race, there is new attention being paid to the impacts on Black youth’s mental health pre- and post-COVID-19 pandemic3. There are increasing trends in suicides rates among Black youth, with a 144% increase in suicide rates for Black youth aged 10-17 from 2007 to 2020, with further increases during the COVID-19 pandemic3. Suicide by firearm is the second most common method among Black youth, with it being more common in boys than girls3. Institutional and interpersonal racism significantly contribute to this crisis, creating barriers for researchers and implementers striving to develop effective interventions3. Research indicates that exposure to firearm violence significantly increases risks for suicidal ideation, psychotic experiences, and heightened distress levels5. Given that Black individuals and their Latinx counterparts are disproportionately exposed to gun violence, including homicides, it may be beneficial to explore strategies for de-escalating situations involving firearm without law enforcement intervention in minority communities5.

SAMHSA suggests that program leadership should support and invest in implementing and sustaining a trauma-informed and culturally appropriate approach, including the inclusion of peer voice6. Although many people who experience a traumatic event will go on with their lives without lasting negative effects, others will have more difficulty and experience traumatic stress reactions6. Important principles of a trauma-informed approach include safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues6. For considering implementing a trauma-informed approach regarding training and workforce development, SAMHSA proposes the question “How does the workforce development/staff training address the ways identity, culture, community, and oppression can affect a person’s experience of trauma, access to supports and resources, and opportunities for safety?”6 

References

  1. Ranjbar, N., Erb, M., Mohammad, O., & Moreno, F. A. (2020). Trauma-informed care and cultural humility in the mental health care of people from minoritized communities. Focus, 18(1), 8–15. https://doi.org/10.1176/appi.focus.20190027
  2. Pew Research Center. (2017). America’s Complex Relationships with Guns. Retrieved from https://www.pewresearch.org/social-trends/2017/06/22/the-demographics-of-gun-ownership/
  3. Johns Hopkins Bloomberg School of Public Health. (2023). Still Ringing the Alarm. Retrieved from https://publichealth.jhu.edu/sites/default/files/2023-08/2023-august-still-ringing-alarm.pdf
  4. Substance Abuse and Mental Health Services Administration [SAMHSA]. (2024) Advising People on Using 988 Versus 911: Practical Approaches for Healthcare Providers. Retrieved from https://library.samhsa.gov/product/advising-people-using-988-versus-911-practical-approaches-healthcare-providers/pep24-06-009
  5. Smith, M. E., Sharpe, T. L., Richardson, J., Pahwa, R., Smith, D., & DeVylder, J. (2020). The impact of exposure to gun violence fatality on mental health outcomes in four urban U.S. settings. Social Science & Medicine, 246, 112587. https://doi.org/10.1016/j.socscimed.2019.112587
  6. Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-informed Approach. https://library.samhsa.gov/product/samhsas-concept-trauma-and-guidance-trauma-informed-approach/sma14-4884
  7. Department of Defense [DOD]. (2021). Prevention of Suicide by Firearm: A Communication Guide for Military Leaders and Support Providers. Retrieved from https://www.resilience.af.mil/Portals/71/Documents/Time%20Based%20Prevention/20210726_DSPO_Lethal%20Means%20Safety_A%20Communication%20Guide_v.3.pdf
  8. Allchin, A., Chaplin, V., & Horwitz, J. (2019). Limiting access to lethal means: Applying the social ecological model for firearm suicide prevention. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, 25(Suppl 1), i44–i48. https://doi.org/10.1136/injuryprev-2018-042809
  9. Centers for Disease Control and Prevention [CDC]. (2024). Suicide in Rural America. https://www.cdc.gov/rural-health/php/public-health-strategy/suicide-in-rural-america-prevention-strategies.html#:~:text=In%20the%20past%20two%20decades,to%2027.3%25%20in%20metro%20areas.
  10. Pew Research Center. (2024). Key facts about Americans and guns. https://www.pewresearch.org/short-reads/2024/07/24/key-facts-about-americans-and-guns/ 
  11. Anestis, M. D., Bond, A. E., Moceri-Brooks, J., Bandel, S. L., & Semenza, D. (2024). Perceptions of the utility of secure firearm storage methods as a suicide prevention tool among firearm owners who currently store their firearms loaded and unlocked. Suicide & Life-threatening Behavior, 54(1), 122–128. https://doi.org/10.1111/sltb.13023 
  12. Simonetti, J.A., Azrael, D. and Miller, M. (2019), Firearm storage practices and risk perceptions among a nationally representative sample of U.S. Veterans with and without self-harm risk factors. Suicide & Life-threatening Behavior, 49: 653-664. https://doi.org/10.1111/sltb.12463 
  13. Hoyt, T., Holliday, R., Simonetti, J. A., & Monteith, L. L. (2021a). Firearm lethal means safety with military personnel and Veterans: Overcoming barriers using a collaborative approach. Professional Psychology: Research and Practice, 52(4), 387–395. https://doi.org/10.1037/pro0000372 
  14. Leininger’s Theory of Culture Care Diversity and Universality. (2017). Encyclopedia of Nursing Research. https://doi.org/10.1891/9780826150332.0122 

Implementation Examples

  • This evidence-informed article provides culturally-grounded guidance and illustrative case vignettes to address challenges with firearm discussions with service members and veterans. The experts advocate for a collaborative approach that engages patients, providers, and family members in shared decision-making and centers patient preferences, values, and traditions13.

Implementation Resources

  • In addressing firearms as the leading method of suicide, crisis staff should identify the cultural aspects of firearm possession for culturally diverse individuals, groups, and communities. Cultural accommodation and negotiation, knowledge of culture and cultural aspects enhance the ability to provide culturally competent care. Leininger culture care theory explores the commonalities of values, norms of behaviors, and life patterns that are similarly held among cultures about human behavior and lifestyles.
  • SAMHSA has a guide on the Concept of Trauma and Guidance for a Trauma-Informed Approach. The Zero Suicide initiative has presentation slides about trauma-informed care in suicide prevention.
  • This guide shares insightful steps that focus on strategic communication with service members regarding the critical issue of firearm safety as a means of suicide prevention. The resource offers valuable tools tailored to individuals’ backgrounds, emphasizing the importance of secure storage and communication. It includes evidence-based recommendations and statistics that could enhance the crisis staff’s understanding of how to engage effectively with military personnel on this vital topic. The guide also discusses that service members living with their family are more willing to practice personal firearm safety to keep their loves ones safe from accidents.

Related Strategies

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