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This document promotes trauma-informed and healing-centered engagement frameworks, practices, and policies as a way to address childhood adversity and trauma in Louisiana. 

With the pupose of creating a "trauma-informed Louisiana", the plan identifies four essential priorities: Collaboration, Awareness, Prevention + Healing, and Workforce. Under each of these, the plan makes a series of recommendations. Some of these include fostering meaningful community engagement; coordinating cross-system collaboration; establishing a framework of shared accountability; and creating shared data infrastructure.

"RECOMMENDATION C2 Establish a Shared Accountability Framework Objective C2.1 | Develop a shared accountability framework to ensure that all relevant systems and entities are held accountable for achieving shared goals and outcomes. ... 

RECOMMENDATION C3 Develop Shared Data Infrastructure Objective C3.1 | Establish shared performance metrics and data tracking systems to monitor progress of the WHL State Plan objectives and improve clarity across entities, with a particular focus on public agencies. ... 

Objective C4.2 | Partner with community-based and local organizations to advance prevention, recognition, and treatment of childhood adversity and its impacts through a community-centered lens. (See PH3)" (23)

The document does not explicitly refer to this discourse, but notably emphasizes the importance of collective action to address childhood adversity and racism.

"Healing justice is a framework that recognizes the impact of trauma and violence on individuals and communities and names collective processes that can heal and transform these forces to free us from the toxic injury." (Denese Shervington, p. 15)

"Achieving healing justice, however, is simply not a matter of behavior change due to awareness of implicit bias. Todd McGowan has posited that racism is not simply a problem of knowing – if it were, it could be summarily corrected and eliminated – we would just need a little diversity training that teaches us that our biases were unfounded. Instead, he notes – “Racism is not the result of a bias in our knowing, but rather we have a bias in our knowing because of racism.”26"  (Denese Shervington, p. 15)

McGowan, Todd. (2021). The bedlam of the lynch mob: racism and enjoying through the other. In Lacan and Race: Racism, Identity and Psychoanalysis (Chapter 1), edited by Sheldon George and David Hook. Routledge. https://doi.org/10.4324/9780429326790. 

In contrast to the discourse on health as a matter of cultural deficit/social dysfunction, the healing-centered engagement framework highlighted in this document uses an asset-driven approach that centers "repair and resilience using a strengthsbased lens that utilizes the knowledge and skills of the individual and their community. The focus is on wellbeing and positive outcomes, rather than pathologizing damage.12 This requires empowering individuals and communities to reclaim their agency and identifying and nurturing individuals’ strengths, resources, and cultural assets as sources of resilience and healing.27" (16). 

Ginwright, S. (2023, January 31). The future of healing: Shifting from trauma-informed care to healingcentered engagement. Medium. Retrieved from https:// ginwright.medium.com/the-future-of-healing-shiftingfrom-trauma-informed-care-to-healing-centeredengagement-634f557ce69c.

Flourish Agenda. (2022, January 28). Our Process. Retrieved from flourishagenda.com/our-process/.

This document outlines a state plan to improve health in Louisiana by addressing childhood adversity through cross-system collaboration. Funding for this plan includes $1 million dollars annually for the first five years, led by a public-private partnership between the Louisiana Department of Health and the Whole Health Louisiana Statewide Lead. The plan began in January 2024 and is set to continue through to December 31, 2028. 

"The WHL State Plan is grounded in the science of early adversity and resilience, the experience of professionals, leaders, and community members throughout the state." (4)

The document refers to metrics from America's Health Rankings, the National Child Traumatic Stress Network, and Substance Abuse and Mental Health Services Administration (SAMHSA). 

Though the document refers to the science of early adversity and resilience, it goes into less descriptive detail into the evidence of toxic stress than California's Roadmap for Resilience. 

When asked about the origins of trauma in their communities, participants “overwhelmingly cited the persistence of extreme concentrated poverty and pollution in neglected areas” (58).

In a paper included in the WHL plan, Dr. Shervington refers to "crumbling built environments with inequitable exposure to environmental toxins" (15) as evidence of the unequal distribution of adversity, and suggests embracing indigenous knowledge to “help Louisianans consciously and explicitly reconnect and recognize the reality that, as humans, our existence is embedded and interconnected with each other and our physical world."

"Although disasters affect everyone, they often exacerbate long-standing disparities and inequities experienced by people from racial and ethnic minority groups, people with low incomes, and other communities with less power and access to resources. Decades of systemic and environmental injustices have resulted in these groups being disproportionately affected by disasters. A recent study of the impacts of urban flooding found its impacts are most harmful to Black communities,21 and Black neighborhoods are less likely to receive flood protection.22" (12)

"Systemic and structural inequities create disparities in both trauma exposure and impacts by contributing to a greater experience of secondary disaster-related traumatic experiences among Black, Hispanic, and Native American communities related to displacement as a result of the disaster, delays in restoration of infrastructure services, lack of access to health care, and loss of social networks in the weeks and months following the disaster." (12)

Howell, J., & Elliott, J. R. (2018). As Disaster Costs Rise, So Does Inequality. Socius, 4. https://doi. org/10.1177/2378023118816795

SAMHSA. (2022, October 24). Diversity, equity, and inclusion in disaster planning and response. Retrieved October 19, 2023, from https://www.samhsa.gov/dtac/ disaster-planners/diversity-equity-inclusion.

Research for this documented was organized and implemented by the Louisiana Department of Health’s (LDH) Bureau of Family Health and Trepwise, a strategy consulting firm. More than 700 experts and community members participated.

Eexpert individuals and organizations referred to in this document include: Dr. Shawn Ginwright, Substance Abuse and Mental Health Services Administration (SAMHSA), Coalition for Compassionate Schools (CCS), the Power Coalition for Equity and Justice, and Dr. Denese Shervington, MD, MPH, an expert in public health and psychiatry at the Institute of Women and Ethnic Studies. Dr. Shervington is focused on historical, intergenerational, interpersonal, and community trauma and healing practices.

The process of drawing the WHL State plan also included “Community Conversations,” an effort to engaged communities in drafting the plan (organized and facilitated by the Power Coalition of Equity and Justice from January 2023 to November 2023). During these conversations, participants expressed concerns about extractive research projects and lack of followup, as well as a desire for greater access to local and state government. When asked about the origins of trauma in their communities, participants “overwhelmingly cited the persistence of extreme concentrated poverty and pollution in neglected areas” (58).

Resilience is defined as "the learned ability of a child or adult to recover from and show effective adaptation following traumatic events or an accumulation of adverse circumstances.7 A consistent and nurturing relationship with at least one supportive parent, caregiver, or other adult is the single most common factor for children who develop resilience.8 Collective resilience results when individuals with a shared identity band together to support one another and draw on their solidarity to promote healing.9 Systemic resilience refers to policies and practices that promote healing.10" (9)

National Child Traumatic Stress Network. (2016). Resilience and child traumatic stress. Retrieved from https://www.nctsn.org/sites/default/files/resources/ resilience_and_child_traumatic_stress.pdf.

Center on the Developing Child at Harvard University. (2023). Resilience. Retrieved from https:// developingchild.harvard.edu/science/key-concepts/ resilience.

Drury, J., Carter, H., Cocking, C., Ntontis, E., Tekin Güven, S., & Amlôt, R. (2019). Facilitating collective psychosocial resilience in the public in emergencies: Twelve recommendations based on the social identity approach. Frontiers in Public Health, 7, 141. https://doi. org/10.3389/fpubh.2019.00141.

Ungar, M. (2018). Systemic resilience: Principles and processes for a science of change in contexts of adversity. Ecology and Society, 23(4). https://doi. org/10.5751/ES-10385-230434.

This book provides a comprehensive overview of the climate hazards facing Vietnam. Chapter 3 in particular details the effects of climate change on the coast of Vietnam, which is relevant to the Vietnam case study and can serve as a reference for coastal climate hazards that intersect with local industrial hazards. The text notes the effects of the region’s topology—mountainous, with a long coastline—on the types of climate hazards experienced in the country in recent decades. The text describes 6 coastal provinces in North Central Vietnam and 15 provinces in the Northern mountainous region (37). Coastal precipitation, storms, flash floods, droughts, coastal erosion, and landslides affect the agriculture, aquaculture, forestry, industry, and tourism sectors, along with the dense local population. Most of the coast is expected (via climate modeling for different RCPs) to see an increase in rainfall this century. Section 2.1.3: Natural Hazards and Section 2.1.4: Climate Change Vulnerability are quoted extensively below.

“Landfalls of storms usually accompanied by high tide and heavy rain result in long periods of rain and floods. The flood season in Central Vietnam lasts from June to October. Along the rivers between Quang Binh and Binh Thuan, the flood season lasts from September to December. The Central region has short and steep rivers with high debits. Dike systems in this region are relatively low or incomplete. 8-meter-high floods not only occur along the main streams but also spread over the floodplains (Le et al. 2012).” (43)

“Storms moved southward in recent years, though it is widely expected that because of the increasing temperature, the North will face more storms in the near future. Also the intensity of the storms is expected to increase, resulting in more wind and more intense precipitation (CCFSC 2001; IPCC 2007). In particular, more intense storms, representing in more threats to people’s lives, livelihoods, infrastructure, and agriculture, are forecasted.” (43)

“In 2009, storm Ketsana affected provinces along the Vietnamese Central coast, killing 163 people and causing over 600 million $USD of damage (CCSFC 2010)...In 2010, storms and other natural hazards killed or caused missing 173 people. 168 others were injured in October 2010 (GSO 2014)...In 2012, the South China Sea faced 12 storms, of which 4 directly affected Central coast…In 2013, Central Vietnam was hit directly by consecutive storms. The Wutip storm in September 2013 damaged over 1000 houses (Vietnam NCHMF 2013). Over 70,000 people in vulnerable areas were moved to shelters along the central coastline (Al Jazeera America, accessed November 22, 2013). In November 2013, the Haiyan storm forced over 800,000 people to evacuate. Storm Nari in November 2013 destroyed about 12,000 houses in 7 central provinces (The Weather Channel, accessed November 22, 2013)...In 2016, six tropical depressions and ten storms affected the Vietnamese Central coast. Six storms and one tropical depression directly impacted the land…In September 2017, Central Vietnam was hit by the Doksuri storm. Over 100,000 people were evacuated, 4 people died, and 10 were injured. The storm Doksuri caused heavy rains and floods all over the provinces in the Vietnamese Northern Central coast. Thousands of houses were damaged or destroyed. More than 50,000 houses in Ha Tinh, Quang Binh, Quang Tri, and Thua Thien Hue provinces were damaged. Quang Binh People’s Committee reported that about 200,000 houses were flooded or submerged, 5000 lost their roofs and 20 collapsed (updated news on Vietnamnet website, accessed on 15 September 2017).” (43-44)

“By 1996, over 2000 square kilometers of the Vietnamese coast was estimated to be at risk for annual floods. Flood damage is expected to worsen if the daily rainfall increases by 12–19%. …Drought intensified as a result of the increased variation in rainfall and evapora- tion (3% along the coast and 8% inland by 2070). The effect is triggered by rising temperatures (MONRE 2016)...Landslides in the Northern Central coast are often triggered by heavy rains and storms, resulting in large amounts of sliding material downhill. Riverbank erosion is widely spread in this region, in particular during the rainy season. The lower part of the rivers is severely affected. Coastal erosion goes up to 10 meters annually, which worsens with the sea level rise of the recent years.” (44)

“The vulnerability of agriculture in the districts depends on extreme climatic events. Most districts in the Ha Tinh, Quang Binh, and Quang Tri provinces have a high exposure because they suffer storms, floods, and drought. Districts with a high exposure index show also a high vulnerability. For example, the Cam Xuyen district (Ha Tinh province) with the highest exposure in the region (0.57) represents the highest vulnerability (0.56). This underlines that the agriculture in the region with traditional methods mainly depends on the weather conditions.” (45)

“Provinces of the Vietnamese Northern Central coast have a long coastline, many estuaries, lagoons, and bays (Le et al. 2012). Aquaculture is promoted and gradually became a leading economic sector. Shrimp, crab, seahorse, holothurians, and Gracilaria asiatica are the main products. Aquaculture farmers, including both fish and crustaceans, are water-dependent and influenced the quality of coastal resources. Higher temperatures and more droughts affect the yields. This is ongoing as the yields of the spring crops declined drastically during recent years (GSO 2014). Aquaculture along the Vietnamese Northern Central coast shows high vulnerability to climate change: the vulnerability index ranges between 0.33 and 0.73. The highest value (0.73) is for the Gio Linh (Quang Tri province), while the lowest value (0.33) applies to the Thach Ha district (Ha Tinh province). Aquaculture shows a high vulnerability in majority of the districts (25/28), while only three districts (Sam Son, Cua Lo, and Thach Ha) report a moderate vulnerability. The exposure and sensitivity index of aquaculture are the highest of all sectors considered. The districts in the Quang Tri and Thua Thien Hue provinces show the highest vulnerability because of its high sensitivity (Fig. 2.3).” (46) This is section 2.1.4.2: Vulnerability of Aquaculture

“The majority of economic zones locate near the shoreline. This makes them vulnerable to climate change hazards. However, industry is less affected as compared to agriculture, forestry, and aquaculture. The industrial zones resist the effects of natural disasters easier. This explains that the industry is moderately vulnerable to climate change: this relates to the moderate qualification of exposure, sensitivity, and adaptation capacity of most of the districts. The high vulnerability in seven districts is related with the high exposure. Industrial plants in new areas which do not offer solid constructions and modern equipment are more at risk from natural hazards than other areas.” (48)

“The Vietnamese Northern Central coast shows its uneven distribution of the population, which reflects a difference between the eastern coastal plains and the western hilly and mountainous areas (Le et al. 2012). Most of the population is located along the national road no. 1A and in the eastern coastal plain, which accounts for over 70% of the population and which is more dense than the national average. Hilly and mountainous areas in the West account for 60% of the area, but only 30% of the people live in this region. Consequently, the average density in the western moun- tains of the country is only about 10–50 people per square kilometer (GSO 2014)...Natural hazards damage habitats of locals in hilly and mountainous areas as well as coastal areas, while storms and flash floods impact both uplands and lowlands. These latter are affected by a combination of storm, floods, sea level rise, and coastal erosion. This explains why the region has a moderate to high vulnerability of the population to climatic change.” (49)

“Currently, the government invests in developing marine tourism, ecotourism, speleo-tourism, and heritage tourism along the Vietnamese Northern Central coast. However, climate change affects the cultural monuments. Also the water supply in the region is under stress; biodiversity will decrease, and the hot season is expected lasting longer. All this will have a significant impact on the assets and the revenue from tourism. Tourism experiences the lowest vulnerability as compared to the other sectors in the region due to its low exposure.” (51)

“The likely effects of climate changes are most tangible in this province [Ky-Anh coast]. They include: 1. The average temperature during the period 2000–2010 increased by 0.6 °C as compared to the period 1970–1980. 2. Extreme weather events: Unusual cold periods (the spring of 2009 was the cold- est of the last 40 years) alternate with heat waves (in July 2010, the province experienced during 10 consecutive days temperatures over 40 °C); storms are frequently accompanied by heavy rains (the 2010 flood lasted for more than 20 days). 3. Changes in the frequency, the timing, and the intensity of the tropical storms are part of the changing weather profile. While traditionally storms occurred during the period September–November, the storm season now extends from August to December. Floods occur from April to December. They become stronger and faster, with more peak events and more devastating impacts (IPONRE 2009)...In short, prolonged periods of high and low temperatures, drought, sea level rise, storms heavy rains, and (sudden) floods are considered the main weather drivers affecting the livelihood of these communities in coastal Ha Tinh. Consequently, Ha Tinh faces four main problems: 1. Changes in water supply: Drinking water supply and irrigation are critical all over the province. In 2010, 27% of the agricultural land was irrigated. The provincial policy goal is irrigating 70% of the fields. Also by 2010, 70% of the population had access to piped water. The daily per capita consumption ranges from 80 to 100 liters on average. The policy goal is supplying 100% of the urban and 80 to 90% of the rural population with safe drinking water (HTG 2013). The increasing pressure on the water supply hampers realizing these goals. 2. Changing land use and urbanization: By 2001, 10% of the land in Ha Tinh was urban area, while the remaining surface was rural. By 2010, the urban land cov- ered 15% of the province, while the rural area decreased to 85% (HTG 2013). The figures illustrate the conversion of agricultural and bare land into urban areas. Consequently, the area is also increasingly affected by the urban heat island effect. 3. Progressing shoreline erosion: Depending on the inclination of the beaches, Ha Tinh loses beaches at a rate of 0.2–15.0 meters per year. 4. Changing livelihoods: Both urbanization and the changing climate affect the way of life in Ha Tinh. Especially farmers, aquaculturists, and fishermen change their habits, adapting to the increasing storms. Urbanization is associated with changes in consumption lifestyles, the size of the families, the ways of commuting, the gender roles, and the time residents spent at home.” (64)