The Praxis Journal

Our research reflects a commitment to translating evidence into practice. From peer-reviewed journal articles to collaborative publications and encyclopedia contributions, Dr. Amber Deneén Chapman-Gray continues to explore how psychology, law, and healthcare intersect to create sustainable systems of care.

  • The 4 Es in Trauma‑Informed Care: Efficiency, Efficacy, Empathy and Equity

    The 4 Es in Trauma‑Informed Care: Efficiency, Efficacy, Empathy and Equity

    Gray’s Trauma‑Informed Care Services Corp (GTICSC) has used Efficiency, Efficacy, Empathy and Equity, the 4 Es, as a guiding formula since its inception in 2017. This demonstrates how the 4 Es can be used to build trauma‑informed systems of care for victims of violence, including survivors of domestic violence and “dark triad” abuse.

    Trauma & Violence‑Informed Care

    Trauma‑informed care (TIC) views service provision through a lens of trauma, requiring an understanding of trauma’s impact, awareness of triggers and vulnerabilities, and a commitment to avoid re‑traumatization (Ferencik & Ramierz-Hammond, 2017). It places the survivor’s experience at the center and emphasizes trust, safety, collaboration and empowerment. Trauma and violence‑informed approaches expand this lens to recognize how systemic violence and discrimination intersect with trauma, calling for organizational changes that increase safety, control and transformative behaviors, while fostering choice and collaboration (Canada’s Public Health Agency [CPHA], 2025). The 4 Es operationalize these principles within GTICSC’s integrated healthcare and educational programs.

    Efficiency: Streamlining Processes to Minimize Harm

    Trauma‑informed services must be delivered efficiently so survivors do not face unnecessary delays or bureaucratic burdens. Lean Six Sigma (LSS) and similar improvement methods are useful in this context. A quality‑improvement study in ophthalmology clinics showed that implementing Lean Six Sigma reduced median patient in‑clinic time from 131 minutes to 107 minutes and increased the number of patients seen per clinic session by 9 % (Kam et al., 2021). The study explained that Lean techniques reduce “waste” and Six Sigma reduces variation by defining, measuring and improving processes (Kam et al., 2021). A systematic literature review found that understanding challenges, readiness and critical success factors is essential for deploying LSS in healthcare and that such deployment can improve operational efficiencies and enhance patient and staff outcomes (McDermott et al., 2022). GTICSC applies these approaches to reduce wait times for services, streamline intake, and ensure survivors receive care without repeated trauma narratives.

    Efficacy: Evidence‑Based & Outcome‑Oriented Care

    Efficacy refers to the effectiveness of interventions in promoting healing and organizational wellness. The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that trauma‑informed approaches improve patient engagement, treatment adherence, health outcomes and staff wellness (SAMHSA, 2025). Trauma‑informed nursing research shows that when nurses adopt a trauma‑informed lens, job satisfaction increases, risk of burnout decreases and patient experiences improve (Fleishman et al., 2019). Implementing organizational and clinical changes, such as staff training, safe environments and patient empowerment, helps transform systems (SAMHSA, 2025). GTICSC’s programs integrate Lean Six Sigma with trauma‑informed competencies, monitoring outcomes to ensure interventions remain effective and adopting continuous improvement cycles.

    Empathy: Understanding Survivors’ Experiences

    Empathy is the heart of trauma‑informed practice. In domestic violence settings, trauma‑informed care requires advocates to respond with supportive intent and to avoid re‑traumatization (Ferencik & Ramierz-Hammond, 2017). Services should respect individual choices, form partnerships that minimize power imbalances and focus on trust and safety. Empathic care is particularly important for survivors of “dark triad” abuse, a term describing relationships with individuals high in Machiavellianism, narcissism and psychopathy. These traits involve manipulation and a lack of empathy (Ferencik & Ramierz-Hammond, 2017). Machiavellianism is associated with controlling behavior, emotional abuse, and psychopathy (Furtado et al., 2024). It is linked to a higher propensity for intimate partner violence. Understanding these dynamics helps providers validate survivors’ experiences and design interventions that prioritize safety, and psychological healing. Education and reflective practice, such as GTICSC’s Transformation Through Education: The Impact of Trauma‑Informed Education on Victim Services Providers, foster empathy by helping providers recognize their own responses and avoid secondary trauma (Gray, 2025).

    Equity: Addressing Systemic Violence & Disparities

    Equity means ensuring all survivors, regardless of race, gender, sexuality or socioeconomic status, have access to trauma‑informed services. Trauma and violence‑informed approaches emphasize understanding how violence and trauma intersect with systemic conditions. Some of these conditions include poverty and discrimination (CPHA, 2025). They call for creating emotionally and physically safe environments, fostering choice, collaboration and connection, and providing strengths‑based support (CPHA, 2025). Domestic violence often leaves victims feeling powerless; recovery requires helping survivors regain control over the areas of their lives impacted by abuse (Ferencik & Ramierz-Hammond, 2017). GTICSC incorporates cultural humility and equity into all programs, courses, projects, and educational materials. This ensures that services for marginalized groups (e.g. immigrants, LGBTQ+ individuals) address unique barriers, as well as, the fact that staff reflect the communities served.

    Applied Practice: Integrating the 4 Es

    Applying the 4 Es in practice involves aligning efficiency, efficacy, empathy and equity. Organizational leaders should: Assess and streamline workflows using Lean Six Sigma or similar methodologies to minimize re‑traumatization and improve service capacity (Kam et al., 2021). Organizations need to learn how to implement evidence‑based interventions and train staff in trauma‑informed principles to enhance outcomes and reduce provider burnout (Fleishman et al., 2019; SAMHSA, 2025). In practice, providers working with victims of violence should foster empathetic relationships with victims by understanding trauma responses, recognizing dynamics of dark triad abuse, and empowering survivors through collaborative decision‑making (Ferencik & Ramirez-Hammond, 2017; Furtado et al., 2024). Providers can also embed equity by addressing systemic violence and ensuring culturally competent care recognizing that trauma intersects with race, gender and socioeconomic status. Dr. Gray’s work highlights the role of integrated healthcare solutions and education in transforming services. By combining process improvement, trauma‑informed training, and cultural humility, organizations can deliver high‑quality care to victims of domestic violence and dark triad abuse, improve provider satisfaction, and build transformative systems that prioritize Efficiency, Efficacy, Empathy and Equity.

    Keywords: Trauma‑informed care, Lean Six Sigma, Efficiency, Efficacy, Empathy, Equity, Domestic violence, Dark Triad, Integrated healthcare, Provider education

    References

    Public Health Agency. (2025). Trauma and violence-informed approaches to policy and practice. Government of Canada. Retrieved on 17 November 2025. https://www.canada.ca/en/public-health/services/publications/health-risks-safety/trauma-violence-informed-approaches-policy-practice.html.

    Fleishman, J., Kamsky, H., Sundborg, S. (2019). Trauma-Informed Nursing Practice. OJIN: The Online Journal of Issues in Nursing, 24(2).

    Ferencik, S.D. and Ramirez-Hammond, R. (2017). Trauma-informed approaches promising practices and protocols for Ohio Domestic Violence Network. Retrieved on 18 November 2025. https://www.odvn.org/wp-content/uploads/2020/05/ODVN_Trauma-Informed_Care_Manual_2020.pdf

    Furtado, B. F., Anacleto, G. M. C., Bonfá-Araujo, B., Schermer, J. A., & Jonason, P. K. (2024). Conflict in Love: An Examination of the Role of Dark Triad Traits in Romantic Relationships among Women. Social Sciences, 13(9), 474. https://doi.org/10.3390/socsci13090474

    Gray, A. D. (2025). Transformation Through Education: The Impact of Trauma-Informed Care Training on Victim Services Providers [Doctoral Dissertation]. ProQuest

    Kam, A.W., Collins, S., Park, T., Mihail, M., Stanaway, F.F., Lewis, N.L., Polya, D., Fraser-Bell, S., Roberts, T.V., Smith, J.E.H. (2021). Using Lean Six Sigma techniques to improve efficiency in outpatient ophthalmology clinics. BMC Health Serv Res 21(38). https://doi.org/10.1186/s12913-020-06034-3

    McDermott, O., Antony, J., Bhat, S., Jayaraman, R., Rosa, A., Marolla, G., & Parida, R. (2022). Lean Six Sigma in Healthcare: A Systematic Literature Review on Challenges, Organisational Readiness and Critical Success Factors. Processes, 10(10). https://doi.org/10.3390/pr10101945

    SAMHSA. (2025). Advancing trauma-informed care issue brief key ingredients for successful. Retrieved on 18 November 2025. https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf

  • Word Salad and the Perils of Pseudo‑Intellectualism

    Word Salad and the Perils of Pseudo‑Intellectualism

    Picture this: you’re at a dinner party, and every guest is armed with an arsenal of buzzwords they’ve picked up on social media. Someone casually drops “psy-op” to describe a viral TikTok video, another confuses “subsidiary” for “subservience,” and by dessert, someone has called the host “far-left” because she serves vegan cheese. Welcome to the modern lexicon, where meanings are alternative facts and ideological spice makes even the most mundane statement taste like political intrigue.

    We’ve become linguistic magpies, swiping shiny terms like “Benghazi,” “deep state,” “diversity,” “equity,” and “inclusion,” and plunking them into conversations without a clue about how they fit. Socialism? Communism? Antifa? Those words are  just seasoning to be sprinkled liberally (or conservatively) over any dish we do not like. Privilege? That’s when your phone battery lasts all day. Psy-ops? Sounds scary, let’s label every marketing campaign as one! After all, why let facts get in the way of a good rhetorical flourish? The result? Intellectual heartburn for anyone who knows what these words mean.

    So, grab a glass of something strong and settle in as we dissect the linguistic stew that’s being ladled into public discourse. We’ll look beyond the buzzwords and unmask how they’ve been stretched, twisted, and misused to the point of absurdity. Think of this as a detox for your vocabulary, because if society’s going to get a grip on reality, we’ll need to start by giving our language a long-overdue reality check.

    People throw around loaded political buzzwords the way teenagers throw around slang: fast, confidently, and often without the faintest idea what they actually mean. “Benghazi,” “psy-op,” “privilege,” “subsidiary,” “far-left extremist,” “socialism,” “communism,” “antifa,” “deep state,” “diversity, equity, and inclusion,” in everyday discourse, these terms function less like precise concepts and more like emotional sound effects. The phenomenon you’re describing isn’t just annoying for intellectuals; it’s well-documented in the cognitive and political psychology literature.

    A good starting point is the illusion of explanatory depth (IOED). Rozenblit and Keil (2002), showed that people systematically overestimate how well they understand complex phenomena; they rate their understanding highly, but when forced to explain in detail, their confidence collapses. That bias applies especially to explanatory knowledge, the kind of causal understanding that terms like “socialism” or “psy-op” require. People feel fluent because the words are familiar, not because they can lay out, for example, the institutional structure of a socialist economy or the operational criteria for a psychological operation (Alter, Oppenheimer, & Zemla, 2010). Political psychologists have extended IOED into the political domain. For example, there are some people who sign onto or agree with strong, polarized opinions while holding only sketchy, scripted mental models of the policies or ideologies they name. Layered on top of that is overconfidence and motivated reasoning.

    Work on political misperceptions shows that citizens’ factual beliefs are often shaped less by ignorance than by identity-protective cognition. What is identity-protective cognition? These are the facts that humanity bends. These are the agreed upon “facts,” that we utilize to fit into the tribe we belong to. Flynn, Nyhan, and Reifler (2017), review evidence that misperceptions are widespread, stubborn, and closely tied to partisan and ideological identity. Schaffner and Roche’s (2016), experimental work on economic statistics finds that when new information threatens partisan narratives, people don’t simply fail to update; they selectively reinterpret or reject it, which is an example of motivated reasoning.

    That same pattern appears in conspiracy thinking. Vranic and colleagues (2022) found that overconfidence in one’s own reasoning, paired with low trust in science, strongly predicts endorsement of COVID-19 conspiracy theories like the faction of individuals who claimed they did their own “research” by regurgitating social media posts or using confirmation bias and selection bias when reviewing articles and information. An example of this is pulling information from meme-driven content posted on social media. Overconfident individuals were worse at an objective reasoning task yet more certain they were right. This is similar to the cognitive profile of people who casually label every uncomfortable news event a “psy-op” or invoke “the deep state” without any operational definition of intelligence services, secrecy, or state capacity (Vranic et al., 2022).

    When we look specifically at ideological labels, like socialism and communism, survey data suggest a sharp gap between self-perceived knowledge and definitional accuracy. A large 2020 survey by the Victims of Communism Memorial Foundation [VCMF] found that 85% of Americans say they know at least “a little” about socialism and 38% say they know “a lot,” yet 68% do not define socialism as government or collective ownership and control of the means of production, the traditional core definition (VCMF & Yougov, 2020). Instead, many respondents treat “socialism” as a vague synonym for “taking everything I have away”, “more welfare programs”, or “what Democrats like.” This is a textbook case of the illusion of explanatory depth combined with motivated reasoning. The motivation comes from the fact that people feel they understand the word, but their “definition” drifts toward whatever matches their political affect.

    A similar story plays out with terms tied to harm and injustice. When looking at the terms, “privilege,” “trauma,” “gaslighting,” “abuse,” and “extremism,” this can be seen clearly (Haslam, 2016). Haslam’s work on concept creep (2021), shows that many harm-related concepts in psychology (e.g., trauma, bullying, mental disorder) have expanded over recent decades to cover ever-milder phenomena (Haslam, 2016). He argues that this semantic stretching has moral and political roots. One can look at the fact that societies become more sensitive to harm, so categories widen to capture previously neglected experiences. In later work, Haslam et al., 2020, describe “harm inflation,” where the boundary between serious harm and ordinary discomfort becomes fuzzy (Haslam et al., 2020).

    Concept creep helps explain why “privilege” might denote anything from structural, intergenerational advantage to simply owning a smartphone, or why “far-left extremist” can get lobbed at both Marxist revolutionaries and moderately progressive social democrats (Haslam et al., 2020). As these terms expand and detach from clear criteria, they become discursive weapons rather than analytic tools. For scholars and practitioners who rely on those concepts to track meaningful differences in power, risk, and harm, the result really is a kind of intellectual nausea. Categories that once carved reality at the joints now slice everything into mush. The media and information environment amplifies all of this.

    Lazer et al. (2018) characterize the current landscape as one of “fake news” and information disorder, where low-quality or deceptive content circulates rapidly and is processed through the same motivated reasoning circuits (Himmelroos & Rapeli, 2020). Anson’s research on epistemic confidence (2022), finds that people who are most certain they are right about politics are also the least responsive to corrections of misinformation. In other words, the more confidently someone throws around “deep state” or “psy-op,” the less likely they are to engage with actual intelligence studies scholarship, legal definitions, or declassified case histories that might refine their understanding.

    Can we do anything about this, beyond sighing into our coffee? There is some cautious evidence that structured deliberation and explicit reflection on ignorance can help. Experiments in deliberative democracy suggest that mixed-viewpoint discussion under good conditions can modestly reduce certain factual misperceptions, even without simply handing people the “right answer (Lazer et al., 2018). Rozenblit and Keil’s (2002) IOED work also hints at an intervention. When one examines when people are asked to explain in detail how a policy, ideology, or process works, they often recognize the gap between their confidence and their knowledge. This is a humbling, but potentially productive, shock (Rozenblit & Keil, 2002).

    From an intellectual standpoint, the problem is not that non-experts use technical or ideological language; inclusive discourse requires shared concepts. The problem is when those terms are untethered from their definitions, used primarily as an identity marker, and individuals are resistant to being corrected about their misinformation. The triad, illusion of understanding, motivated reasoning, and semantic drift, is what makes misuse of these terms feel so corrosive to serious thinkers. It undermines our ability to distinguish between different systems of government, different levels of harm, or different policy tools. Everything collapses into “vibes” or simply how everyone feels or intuits (Rozenblit & Keil, 2002).

    A healthier language politic would normalize three moves: (1) define your terms before weaponizing them, (2) be willing to say “I’m not sure I fully understand this concept,” and (3) treat words like “socialism,” “privilege,” or “psy-op” as hypotheses to be unpacked, not grenades to be thrown. For the working intellectual, that might not cure the headache, but it at least points toward a culture where words are used to think with, not to weaponize ad nauseum.