Trauma & Resiliency

What is Trauma?

As more attention focuses on the impact of trauma on children, adolescents, and adults, at times it is difficult to differentiate between dangerous or scary situations and traumatic events. In addition, it can be difficult to assess normal versus problematic reactions to those experiences. People live with dangers on a daily basis and, over time, gather information to be able to manage or avoid danger and make their lives safer. However, danger becomes traumatic when the event or situation overwhelms the ability to cope with what has happened and impacts their ability to function in their daily life. 

Individuals can experience trauma when they: experience a serious injury to themselves or the injury or death of someone else; face the imminent threat of harm to themselves or someone else; or endure a violation of personal or physical well-being. These situations are considered acute traumatic events because the situations are short-lived. Examples of traumatic events can include sexual assault, physical abuse, domestic violence, community and school violence, medical trauma, motor vehicle accidents, acts of terrorism, war experiences, natural and human-made disasters, suicides, and/or other traumatic losses. Short-term traumatic situations often bring forward feelings for everyone of terror, horror or helplessness.

In other cases, someone may experience a chronic traumatic situation(s), in which the trauma occurs repeatedly over long periods of time. Examples include long-standing physical or sexual abuse, domestic violence, or living where there is warfare. More prolonged exposure to trauma can lead to feelings of intense fear, loss of trust in others, a decreased sense of personal safety, guilt and shame. Disturbances in activities of daily living such as sleep, appetite, and disturbances in relationships with others are also common long-term responses to suriving a traumatic event(s). Individuals who have experienced traumatic events are at an increased risk of developing post-traumatic stress disorder, depression, anxiety, and other psychiatric conditions. Individuals who have experienced early childhood trauma are also at an increased risk of suffering from depression and anxiety compared to those who have experienced trauma as an adult. (Chu, et al. 2013).

Impact of Trauma

Unfortunately, everyone will experience distressing situations in their lifetime and it is normal to be affected by the emotional and physical reactions to these experiences. More than twenty years of studies have confirmed that school age children and adolescents can experience the full range of post-traumatic stress reactions that are seen in adults. In fact, recent studies have shown that traumatic experiences affect the brains and behavior of even very young children, causing reactions similar to those seen in older children and adults. (Kaminer, et al. 2005). Depending on their age, children respond to traumatic stress in different ways. Many children will experience disturbed sleep or nightmares, difficulty paying attention and concentrating, anger and irritability, withdrawal from family or friends, repeated and intrusive thoughts, and extreme distress when confronted by anything that reminds them of their traumatic experiences. Much like some adults, children may also want to avoid any situation, person or place that reminds them of what happened, or may report “forgetting” some of the worst parts of what they experienced. Finally, as children and adolescents deal with the traumatic stress, they may also experience physical symptoms including recurring headaches or stomachaches, or being more easily startled or jumping at noises more than before. While it is normal to experiences these reactions immediately after a trauma, prolonged distress could indicate that a child needs additional support to heal from the event(s). (Kaminer, et al. 2005).

Some individuals, regardless of age, may develop psychiatric conditions such as Post-Traumatic Stress Disorder (PTSD), depression, anxiety, and a variety of behavioral disorders. According to the National Center for PTSD at the VA, the lifetime prevalence of PTSD for adults was around 7%. While there have not been any studies assessing for lifetime prevalence of PTSD for children, researchers suspect that for high risk children, prevalence rates can be as high as adults or perhaps higher. (National Center for PTSD)

However, many people experience acute or chronic traumatic situations and do not develop PTSD. Researchers have found that individuals who have experienced trauma without developing PTSD have higher levels of “resilience”, which can be influenced by various internal and external factors in an individual's environment.

What is Resilience?

Just as many individuals will face circumstances that they perceive as dangerous, scary or even life threatening, the majority of individuals will overcome that stress without long term lasting impacts. As researchers have come to understand it, the key ingredient is resilience. Resilience is “the process of, or the capacity for, successful adaptation despite challenging or threatening circumstances” (Burton, et al. 2015).

Resilience appears to have a protective effect against risks of depression, anxiety, and PTSD. One study, found in a community sample of women with HIV, concluded that women with higher levels of resilience were less likely to develop symptoms of depression or posttraumatic stress symptoms. (Spies & Seedat 2014). Another study found that resilience was negatively associated with anxiety symptoms in women surviving breast cancer, and may have a “vaccination effect” through hardening individuals against future adverse life experiences (Scali, et al. 2012).

Children also benefit from developing resilience which can help them successfully navigate adversities they will face in life. However, they cannot do it alone. They need adults who know how to promote resilience and who are becoming more resilient themselves. Across studies, the most consistent predictor of resilience for high-risk children is a safe and nurturing bond with at least one person: a grandmother, teacher, sibling, parent, etc. Peer relationships are also important as resilient children have at least one close friend and are able to maintain relationships over time.

Research also illustrates the importance of communicating positive expectations to young people. This can include age-appropriate roles of responsibility as they may help the child develop a sense of efficacy. Other family factors include faith or religious practices, reliable emotional support from caregivers, and encouragement of emotional expressiveness. Additionally, children and families do better when they receive support and connection from the larger community. The availability of family, friends, or neighborhood resources may lessen the burdens of stressed families.

Fostering Resilience

Helping to foster resiliency varies by an individual’s age and abilities. For very young children, it is important that a caring adult is available to them, ideally someone they have a strong attachment with, who can meet their needs and help provide structure and consistency. For elementary school aged children, it is helpful for them to feel that they have some ability to do things on their own, especially things they feel they do well, which can vary from being helpful in the classroom or at home to being recognized for their athletic or creative abilities. As children grow into adolescence, it is especially important that they feel a sense of personal responsibility in their decision making and are able to feel that they can exert control over at least some aspects of their lives. This continues to be true as adolescents grow into adults, and a strong sense of self efficacy and self-control, as well as encouraging individuals to recognize their accomplishments, helps foster resiliency in the face of trauma.

Below, find 10 ways that individuals can work towards fostering resilience, whether for themselves, their family, or the children in their lives when faced with adversity:

  • Make connections. Good relationships with close family members, friends or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper.
  • Avoid seeing crises as insurmountable problems. You can't change the fact that highly stressful events happen, but you can change how you interpret and respond to these events. Try looking beyond the present to how future circumstances may be a little better. Note any subtle ways in which you might already feel somewhat better as you deal with difficult situations.
  • Accept that change is a part of living. Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.
  • Move toward your goals. Develop some realistic goals. Do something regularly — even if it seems like a small accomplishment — that enables you to move toward your goals. Instead of focusing on tasks that seem unachievable, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?"
  • Take decisive actions. Act on adverse situations as much as you can. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.
  • Look for opportunities for self-discovery. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life.
  • Nurture a positive view of yourself. Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.
  • Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.
  • Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.
  • Take care of yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience.
  • Additional ways of strengthening resilience may be helpful. For example, some people write about their deepest thoughts and feelings related to trauma or other stressful events in their life. Meaningful practices can help some people build connections and restore hope.

While experiencing traumatic events is an unfortunate aspect of growing up, individuals who are able to benefit from consistent, positive interactions with others and who develop the skills necessary for resiliency can avoid long term behavioral and emotional impairment. Additionally, friends, family, loved ones, and the greater community can help an individual successfully navigate dangers they may encounter.

References

Blaustein, M. and Kinniburgh, K. (2010). Treating Traumatic Stress in Children and Adolescents. New York: Guilford Publications, Inc.

Burton, M. S., Cooper, A. A., Feeny, N. C., & Zoellner, L. A. (2015). The Enhancement of Natural Resilience in Trauma Interventions. Journal of Contemporary Psychotherapy, 1-12.

Chu, D. A., Williams, L. M., Harris, A. W., Bryant, R. A., & Gatt, J. M. (2013). Early life trauma predicts self-reported levels of depressive and anxiety symptoms in nonclinical community adults: Relative contributions of early life stressor types and adult trauma exposure. Journal Of Psychiatric Research, 47(1), 23–32. http://doi.org/10.1016/j.jpsychires.2012.08.006

Grotberg, E. A Guide to Promoting Resilience in Children: Strengthening the Human Spirit. Retrieved August 10th, 2011 from http://resilnet.uiuc.edu/library/grotb95b.html

Kaminer, D., Seedat, S., & Stein, D. J. (2005). Post-traumatic stress disorder in children. World Psychiatry, 4(2), 121–125.

The Melissa Institute for Violence Prevention. Understanding Resilience in Children and Adults: Implications for Prevention and Interventions. Retrieved August 23rd, 2011 from: http://www.melissainstitute.org/documents/resilienceinchildren.pdf

National Center for PTSD. Evidence Based Treatments: http://www.ptsd.va.gov/Public/understanding_TX/CourseList/Course_NCPTSD_...

The National Children Traumatic Stress Network. Defining Trauma and Child Traumatic Stress. Retrieved August 11th, 2011 from: http://www.nctsnet.org/content/defining-trauma-and-child-traumatic-stress

The National Child Traumatic Stress Network. Understanding Child Traumatic Stress. Retrieved August 11th, 2011 from: http://www.nctsnet.org/resources/audiences/parents-caregivers/understand...

The concept of resilience in relation to child abuse is complex. Retrieved July 30, 2015, from http://www.asca.org.au/about/resources/resilience.aspx

Scali, J., Gandubert, C., Ritchie, K., Soulier, M., Ancelin, M.-L., & Chaudieu, I. (2012). Measuring Resilience in Adult Women Using the 10-Items Connor-Davidson Resilience Scale (CD-RISC). Role of Trauma Exposure and Anxiety Disorders. PLoS ONE, 7(6). http://doi.org/10.1371/journal.pone.0039879

Spies, G., & Seedat, S. (2014). Depression and resilience in women with HIV and early life stress: does trauma play a mediating role? A cross-sectional study. BMJ Open, 4(2). http://doi.org/10.1136/bmjopen-2013-004200

Resource Organizations » Trauma and Resiliency

In Massachusetts

Organizations with hotlines

Domestic Violence Services Network

888-399-6111

(978) 318-3421

Email: dvvap@concordma.gov

DVSN works in collaboration with communities to end domestic violence.  They strive to empower and educate all peoples in ways that respect their dignity and choices while promoting their safety. DVSN is a referral service  specifically addressing domestic and dating violence as well as stalking; their services span across 13 communities in Massachusetts including but not limited to Acton, Boxborough, Bedford, Carlisle, Concord, Maynard, Lexington, Lincoln, Stow, Sudbury, Wayland, Weston and Hanscom Air Force Base. They also offer access to specific programs through partnerships with police departments as well as social service agencies in the towns they serve. Programs listed range from informational dinners about legal services, victims assistance, and self-defense training. Other programs exist through partnerships with Emerson Hospital,  Middlesex District Attorney's Office, and Concord District Court. DVSN also has a directory of resources that is easily accessible through their website. 

Massachusetts Advocates for Children:Trauma and Learning Policy Initiative

Helpline: 617-357-8431 ext 3224

617-357-8431

Email: info@massadvocates.org

The Trauma and Learning Policy Initiative's (TLPI) mission is to ensure that children who have been traumatized by exposure to family violence, and other adverse childhood experiences, succeed in school. To accomplish this mission, TLPI engages in a host of advocacy strategies including legislative advocacy, administrative advocacy, coalition building, outreach and education, research and report writing, and limited individual case representation in special education where a child's traumatic experiences are interfacing with his or her disabilities.

Massachusetts Office of Victim Assistance

Hotline: 844-878-6682

Office: 617-586-1340

Email: mova@mass.gov

The mission of the Massachusetts Office for Victim Assistance (MOVA) is to advocate for, and assist all, crime victims, witnesses, their family members, and to direct victim service providers throughout the Commonwealth of Massachusetts. Victims and their families are often traumatized, confused, and uncertain about where to turn for help. Victims can receive assistance through MOVA's Service Programs, the SAFEPLAN Program (for victims seeking protection from abuse), and through the Help Directory. The Victim Services Coordinator can provide referrals to appropriate programs, service providers, information, and advocacy organizations to help victims better understand the justice system.

Riverside Trauma Center

Trauma Helpline: 888-851-2451

Referral Line: 781-433-0672 x 5738

Riverside Trauma Center, a service of Riverside Community Care, helps people in many Massachusetts communities recover from the overwhelming stress caused by traumatic events. Traumatic events can include natural disasters, serious accidents, suicides, homicides, and terrorism. The Riverside Trauma Center provides community outreach and counseling. They also educate communities and organizations about suicide prevention, psychological trauma, and the emotional needs of returning veterans. They serve communities, schools, health and human services providers, organizations, government agencies, workplaces, and individuals.

Organizations without hotlines

Adults and Children Together Against Violence (ACT)

(800) 374-2721

(202) 336-5500

Nearly a half century of research has shown that violence is a learned behavior, often learned when a child is very young. But the skills of violence prevention can also be learned at a young age. ACT emphasizes that the early years are critical for learning and that the adults in children's lives can be the primary teachers of violence prevention. The ACT program mission is to educate communities and adults to create safe, healthy environments that protects children and youth from violence. It accomplishes its mission by disseminating research-based information and skills to adults in simple, accessible, user-friendly messages and materials.

Brain Injury Association of Massachusetts

(508) 475-0032

1-800-242-0030 (Toll-Free)

TTY: (508) 948-0593

Email: biama@biama.org

The Brain Injury Association of Massachusetts provides support services to brain injury survivors and their families, offers programs to prevent brain injuries, educates the public on the risks and impact of brain injury, and advocates for legislation and improved community services.

BRIK (Building Resilience in Kids)

(978) 456-3545

Email: info@brikontheweb.org

Building Resilience in Kids (BRIK) is a small non-profit helping children who have been stressed by poverty and trauma. We help children directly and through their caregivers to build resilience. BRIK offers workshops and programs that allow children to express themselves creatively while building positive relationships with those around them.

Massachusetts Society for the Prevention of Cruelty to Children (MSPCC)

617-983-5800

MSPCC is dedicated to leadership in protecting and promoting the rights and well-being of children and families. To prevent child abuse, MSPCC focuses on the needs of both the child and the parent. MSPCC’s work focuses on preventing or mitigating the effects of Adverse Childhood Experiences (ACEs) including physical, sexual, and emotional abuse, neglect, household substance abuse, household mental illness, and domestic violence.  By promoting social and emotional learning and supports for children as well as tools to improve parents’ skills, MSPCC employs a two-generational approach to improve outcomes for both children and parents. MSPCC combined with Eliot Community Human Services in 2016 to further strengthen the agency’s services and better address the needs of children and families.  Services provided include pregnancy and parenting support, clinical mental health counseling and care coordination, adoptive and foster parent support, and advocacy. The website allows guardians and/or providers to place referrals for clinical services directly as well.

MGH Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program

1-866-449-6779

Email: anxietystudy@mgh.harvard.edu

The Center explores the causes and treatments for Complicated grief, Generalized Anxiety Disorder, Panic Disorder, Post-traumatic stress disorder and social anxiety and seek to also learn more about the underlying causes and course of these disorders.

National Center for PTSD

802-296-6300 (Information Voicemail Line)

Email: ncptsd@va.gov

The mission of the National Center for PTSD is to advance the clinical care and social welfare of America's Veterans and others who have experienced trauma, or who suffer from PTSD.  The National Center for PTSD conducts/provides research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders. This organization is dedicated to excellence in research and education on the prevention, understanding, and treatment of PTSD. Its purpose is to improve the well-being and understanding of veterans and others suffering from PTSD. The website includes the definition of PTSD, fact sheets on topics related to PTSD, and information of finding professional help.

Safe Havens: Interfaith Partnership Against Domestic Violence

617- 951-3980

Email: info@interfaithpartners.org

Safe Havens works with diverse faith congregations across the Commonwealth of Massachusetts and across the U.S. to promote safe and effective faith-based responses to domestic violence. Safe Havens' staff and Advisory Board include faith community members, domestic violence service providers, and business experts. Safe Havens works collaboratively to help faith communities, and faith leaders identify domestic violence, as well as elder abuse, and respond appropriately.  They also help to support and coordinate access to Domestic Violence Shelters across the state.

Outside Massachusetts

Organizations with hotlines

ChildHelp National Child Abuse Hotline

1-800-4-A-Child

(480)-922-8212

The Childhelp National Child Abuse Hotline 1-800-4-A-CHILD (1-800-422-4453) is dedicated to the prevention of child abuse. Serving the United States and Canada, the hotline is staffed 24 hours a day, 7 days a week with professional crisis counselors who, through interpreters, can provide assistance in over 170 languages. The hotline offers crisis intervention, information, literature, and referrals to thousands of emergency, social service, and support resources. All calls are confidential.

National Sexual Assault Telephone Hotline

800.656.HOPE (4673)

When you call 800.656.HOPE (4673), you’ll be routed to a local RAINN affiliate organization based on the first six digits of your phone number. Cell phone callers have the option to enter the ZIP code of their current location to more accurately locate the nearest sexual assault service provider. Services are confidential and also include information on medical concerns, legalities, as well as resources and referrals to providers in your area. The hotline also offers a live chat as an alternative to a telephone call. 

 

Organizations without hotlines

American Trauma Society

Toll Free: 800-556-7890

Local: 703-538-3544

Email: info@amtrauma.org

The American Trauma Society (ATS) is a leading spokes-organization for trauma care and trauma prevention in the United States. The ATS has been the foremost advocate for trauma victims and their families for the past 30 years and continues to seek optimal care for all trauma victims. The ATS has dedicated its time and resources to the formation and operation of trauma systems across this country. Many members of the ATS are members of trauma teams in communities across the country. They are active in their communities and often are politically active, advocating trauma systems to their governments; federal, state and local. The ATS strongly supports national and state legislation that creates and maintains trauma systems. It works closely with the U.S. Congress, various federal agencies and with the office of the President, supporting legislative and administrative efforts that address the financial and legal issues surrounding trauma. The ATS provides critical information on trauma to its members, to policy makers, and to the public. It supports the needs of families. It is also a strong supporter of injury prevention, creating and producing programs and providing these programs to its members.

BrainLine

703.998.2020

Email: info@BrainLine.org

BrainLine is a national multimedia project offering information and resources about preventing, treating, and living with Traumatic Brain Injury (TBI). BrainLine includes a series of webcasts, an electronic newsletter, and an extensive outreach campaign in partnership with national organizations concerned about traumatic brain injury. BrainLine serves anyone whose life has been affected by TBI. That includes people with brain injury, their families, professionals in the field, and anyone else in a position to help prevent or ameliorate the toll of TBI.

Childhood Violent Trauma Center (CVTC)

Toll Free: 877-496-2238

Phone: 203-785-7047

It is the mission of the National Center for Children Exposed to Violence (NCCEV) to increase the capacity of individuals and communities to reduce the incidence and impact of violence on children and families; to train and support the professionals who provide intervention and treatment to children and families affected by violence; and, to increase professional and public awareness of the effects of violence on children, families, communities and society. The NCCEV serves as a national forum for exploring issues surrounding children's exposure to violence and a partner in national collaborations across the country in urban, suburban and rural areas. The NCCEV offers training, technical assistance and consultation to a variety of collaborative community programs. It also provides a wide range of specialized interventions and services. The NCCEV website includes comprehensive information on children and violence.

Immigrant Women and Domestic Violence

1 800 537-2238

"While there are differences in domestic violence experienced by immigrant women, there may be commonalities, such as patterns of abuse, challenges, and barriers to seeking help. Similarly, domestic violence service providers may face common challenges in offering services to immigrant women survivors. These challenges and barriers could be related to the survivors’ immigration status, eligibility for public assistance, cultural practices, English language proficiency, etc. This special collection explores the complex experiences of immigrant survivors and includes resources to support their path to safety and justice. It also includes resources that help service providers respond effectively and appropriately to immigrant women who are experiencing domestic violence." 

International Society for Traumatic Stress Studies

847-686-2234

Email: info@istss.org

ISTSS is an international organization that promotes advancement and exchange of knowledge about severe stress and trauma. This knowledge includes understanding the scope and consequences of traumatic exposure, preventing traumatic events and ameliorating their consequences, and advocating for the field of traumatic stress. ISTSS is dedicated to the discovery and dissemination of knowledge about policy, program and service initiatives that seek to reduce traumatic stressors and their immediate and long-term consequences. ISTSS provides a forum for the sharing of research, clinical strategies, public policy concerns and theoretical formulations on trauma in the United States and around the world. The ISTSS website provides multimedia information and resources for the general public on traumatic stress.

National Child Traumatic Stress Network

(310) 235-2633 (CA Office)

(919) 682-1552 (NC Office)

Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN) is a unique collaboration of academic and community-based service centers whose mission is to raise the standard of care and increase access to services for traumatized children and their families across the United States. Combining knowledge of child development, expertise in the full range of child traumatic experiences, and attention to cultural perspectives, the NCTSN serves as a national resource for developing and disseminating evidence-based interventions, trauma-informed services, and public and professional education. The website includes information on the types of traumatic stress and resources for parents and caregivers whose children are experiencing traumatic stress.

National Native Children's Trauma Center

(406) 243-2644

Email: marilyn.zimmerman@mso.umt.edu

The mission of the National Native Childhood Trauma Center is to address high rates of traumatic stress amongst American Indian/Alaska Native (AI/AN) children by working under the guidance of U.S. tribal nations in implementing, adapting and evaluating trauma interventions. This work requires understanding, respect and honoring of tribal sovereignty, specific community needs and the use of traditional healing practices. The goals of the Center are to significantly increase and disseminate the number of culturally-relevant, evidence-based interventions for use with AI/AN children (particularly interventions to be delivered in schools) and disseminate these interventions nationally, both on and off reservations and within NCTSN; develop a network of culturally competent, trained educators, mental health providers, and law enforcement personnel who can meet the needs of AI/AN children who experience traumatic stress; and increase the amount of research detailing the processes through which AI/AN children experience and cope with traumatic stress.

Solace for Mothers: Healing After Traumatic Birth

Solace for Mothers is an organization designed for the sole purpose of providing and creating support for women who have experienced childbirth as traumatic. The resources available through this site offer immediate, personal support to mothers and others who are struggling with birth trauma, PTSD after childbirth and anxiety caused by their birthing experiences. If you believe that you have been traumatized by your experiences of giving birth to your child, or by witnessing a birth of someone else’s child, Solace for Mothers has resources and supportive communities available for you. They host two online communities where women and those who support them can connect around birth trauma concerns.

The Birth Trauma Association

The Birth Trauma Association (BTA) was established in 2004 to support women suffering from Post Natal Post Traumatic Stress Disorder (PTSD) or birth trauma. The organization's staff are not trained counsellors or therapists or medical professionals; they are mothers who wish to support other women who have suffered difficult births.  The BTA aims to offer advice and support to all women who are finding it hard to cope with their childbirth experience.  The website includes information for mothers, fathers, and family members about Post Natal PTSD, information about how to connect with other Mom's who have had similar experiences to get support, as well as lists of resources, including books and websites, that may be helpful to families experiencing Post Natal PTSD.

Trauma Survivors Network

800-556-7890

Email: admin@traumasurvivorsnetwork.org

The Trauma Survivors Network (TSN) is a community of patients and families who are looking to connect with one another and rebuild their lives after a serious injury. The TSN is committed to providing valuable, practical information and referral; connecting survivors with peer mentors and support groups; enhancing survivor skills to manage day to day challenges; developing on-line communities of support and hope for trauma survivors and their families and friends; and training health care providers to deliver the best care and support to patients and their families and friends. Membership in the TSN is free for trauma survivors and their friends and families.