Social work researcher advocates for multi-system interventions to address perinatal and mental health

By Tiffany J. Nhan

Community-based practices that address individual, family and community-level trauma must also address multiple risk factors of trauma in the environment and other social stressors, according to a new study led by a University at Buffalo School of Social Work researcher. 

The study addresses the impact of trauma in individuals, families and groups, and neighborhoods in marginalized communities of Rochester and Syracuse, New York, and advocates for changes in social policies and services to best serve people with trauma.

Led by Robert Keefe, PhD, associate professor in the UB School of Social Work, the paper is available online in the Journal of Behavioral Sciences. Keefe’s co-authors on the paper were Robert A. Rubinstein, PhD, Kiara Van Brackle, Zikora Nnam and Sandra D. Lane, PhD, of Syracuse University, and Sanid Music of Liverpool High School.

Keefe and his colleagues reviewed the findings of seven studies they conducted over the past 20 years with low-income Rochester and Syracuse residents. Using Bronfenbrenner’s ecological systems theory, the authors explored how people’s experiences of trauma are interrelated and connected, affecting their families, neighborhoods and communities over time. 

At the individual level, participants reported trauma via intimate partner violence and social isolation. Birthing people exposed to intimate partner violence were 14 times more likely to experience pregnancy trauma. People living in high-crime neighborhoods were more likely to experience social isolation.

At the family level, participants reported trauma arising from missing men due to incarceration and premature death of fathers, as well as fear of children being killed. 

The researchers found men of color faced a higher risk of incarceration due to racially biased sentencing; incarceration, in turn, was a key factor in why some unmarried fathers could not sign a paternity declaration after their child’s birth. In cases where fathers did not sign declarations, infants were nearly four times more likely to die between their first month of life and first birthday. 

The fear of children being killed was directly connected to exposure to neighborhood violence in Syracuse, where 25% of murder victims were teens and children and nearly 30% of perpetrators were minors.

At the community level, participants reported trauma arising from neighborhood violence and food apartheid. Because of exposure to community violence via gunshots, 52% of participants screened positive for post-traumatic stress disorder (PTSD). Participants who did not have access to healthy foods were more than three times as likely to experience intrauterine growth restriction, or have babies who were born smaller than expected.

The authors also analyzed data from refugees who experienced trauma before or during resettlement. They found, despite the extreme trauma refugees faced, they had lower rates of depression and fewer low birth-weight births compared to U.S.-born people. 

“Individual trauma is rarely a one-time event. Trauma occurs within a larger context and is frequently ongoing,” Keefe says. 

“Many residents residing in high-crime communities often live with ongoing and untreated PTSD, a risk factor for premature death,” he continues. “Trauma-informed community interventions are needed to address the multiple, systemic problems of living in high-crime communities.”