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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.

BIOETHNOGRAPHY: “Thus, instead of combining objects of inquiry (biology and culture), I conceived of bioethnography as combining two different methods for knowing the world (Mol 2002, 153)—ethnographic observation and biochemical sampling—in order to ask and answer research questions that could not be addressed through either method alone. This methodological focus involves exploring how our data collection and analysis might be shaped if we suspended the nature/culture binary” (Roberts, 2021, p. 2)

“bioethnography asks, what if we created numbers otherwise, upending the cooked data that reinforces inequality? In fact, bioethnography can enable us to identify structural forces, such as NAFTA and the global health apparatus itself, that are part of the bodily processes that make ill health. In other words, while we know that all data is cooked, it matters how it’s cooked.” (Roberts, 2021, p. 5)

Roberts describes their ongoing bioethnographic collaboration with a team of exposure scientists who are working in environmental engineering and health. Though ethnography is not easily enumerated, Roberts emphasizes that integrating it with quantitative data is worthwhile and makes for “better numbers”. As an example, Roberts describes 3 bioethnographic projects on neighborhoods, water distribution, and employment and chemical exposures. These projects were part of a longitudinal birth-cohort study in Mexico City called Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT), created to understand the effects of early-life nutrition and exposure to toxicants (such as lead and phenols). Overtime, this project was expanded to include the study of new toxins (e.g. BPAS, mercury, and fluoride) and new health concerns (e.g. obesity, meopause, sleep).

Roberts’ focus on neighborhoods was produced from the ethnographic observation that neighborhood characteristics might influence exposure levels. Following this observation, Roberts’ and ELEMENT researchers sorted participants by neighborhood and identified significant differences in blood-lead levels. Additionally, Roberts applied previous ethnographic observation and scholarship to argue that high levels of toxicants like lead correlate with the capacity of neighborhoods to withstand other dangers, such as police violence. These findings prompted the development of two new bioethnographic project centered on water and the effect of neighborhood dynamics on health.