Building Trust: Engaging Communities of Color Trauma 101: Men of Color and the Anatomy of Healing National Resource Center for Reaching Victims logo Workshop objective ¥ To understand trauma and its affects ¥ To understand how trauma affects people of color today ¥ To identify ways to address trauma in our service delivery The ACEÕs effect ¥ The Adverse Childhood Experiences Study: Epidemiological study involving more than 17,000 individuals. Analyzed the long-term effects of childhood and adolescent traumatic experiences on adult health risks, mental health, healthcare costs, and life expectancy. (CDC, 2013) 10 question quiz Adverse Childhood Experiences Graphic from the Wave Trust 70/30 Campaign Household Challenges includes: Domestic Violence, Substance Abuse, Mental Illness, Parental Separation or Divorce, and Incarcerated Parent. Abuse includes: Emotional Abuse, Physical Abuse, and Sexual Abuse Neglect includes: Emotional neglect and physical neglect. 4 Prior to your 18th birthday: ¥ Did a parent often or very often swear, insult, made you afraid that youÕll be hurt? ¥ Did a parent often or very often push, grab, slap, or hit you? ¥ Did an adult or person older than you ever touch or fondle you or have you touch them, or have oral, anal, or vaginal intercourse with you? ¥ Did you often or very often feel that no one in your family loved you or your family didnÕt look out for or support each other? ¥ Did you often or very often feel that your parents were too drunk or high to take care of you? Prior to your 18th birthday: (continued) ¥ Were your parents ever separated or divorced? ¥ Was your mother often or very often physically abused or battered? ¥ Did you live with a someone who was chemically dependent? ¥ Was a household member depressed or mentally ill, or did a household member attempt suicide? ¥ Did a household member go to prison? Now add up your ÒYesÓ answers: ___ This is your ACE Score How Common are ACEs? Circle Chart Showing the Number of ACEs: 36% of people have zero ACEs 26% of people have 1 ACE 16% of people have 2 ACEs 9.5% of people have 3 ACEs 12.5% of people have four or more ACEs. Almost 2/3 adults surveyed reported at least 1 Adverse Childhood Experience (ACE) and the majority of respondents who reported at least one ACE reported more than one. ACEs and Gender Gender and ACEs Infographic: 60% of male identified people have ACEs and 14% of them have 4 or more ACEs. 63% of female identifited people have ACEs nd 18% of them have 4 or more ACEs. 8 Who participated in the ACE Study? 4 circle charts about ACEs Study Demographics 54% of participants are females and 46% are males 5% of participants are African American, 7% are Asian or Pacific Islander, 11% are Hispanic or Latino, 75% are white, and 2% are other 5% of participants are ages 19-29 10% are ages 30-39 19% are ages 40-49 20% are ages 50-59 and 46% are over 60 years of age. 7% of participants did not graduate high school, 18% are high school graduates, 36% have attended some college, and 39% are college graduates. So what does that mean for Communities of Color? ¥ What does the ACE survey tell us about our communities? ¥ How are our communities handling this trauma? ¥ What concerns does this bring up for you around boys and men of color? ¥ What additional actions can we take? ¥ American Psychological Association defines trauma as an emotional response to a terrible event like an accident, rape or natural disaster. ¥ An intense and overwhelming experience that involve serious loss, threat or harm to a personÕs physical and/or emotional wellbeing. What is trauma? ¥ Overwhelms a personÕs coping resources. Leads the person to find a way of coping that may work in the short term but may cause serious harm in the long term. ¥ Can lead to a sense of vulnerability and/or fear. Effects of trauma Symptoms of trauma ¥ Reliving the experience ¥ Avoidance and emotional numbing ¥ Hyper vigilance Reliving the experience ¥ Intrusive thoughts, images, perceptions ¥ Recurring nightmares/ lack of sleep ¥ Dissociative experiences ¥ Exaggerated physical and emotional reactions Avoidance & emotional numbing ¥ Detachment-people, things, etc. ¥ Lack of emotions, flat affect Hypervigilance ¥ Exaggerated startle response ¥ Being on guard at all times ¥ Distrustful of certain environments ACEÕs Pyramid ACE's Pyramid Infographic: The bottom of the period is the foundation and the pyrimid goes from bottom (birth) to the top (death). In order from Bottom to Top: Adverse Childhood expereinces social, emotional, and cognitive impairment adoption of health-risk behaviors disease, disability, and social problems, and early death. Philadelphia ACE study questions Conventional ACEs ¥ Physical, Emotional, and Sexual abuse ¥ Emotional & Physical neglect ¥ Domestic violence ¥ Household substance abuse ¥ Incarcerated care provider ¥ Mental illness in the home Expanded ACEs ¥ Witnessing violence ¥ Living in unsafe neighborhoods ¥ Experiencing racism ¥ Living in foster care ¥ Experiencing bullying Boys and men of color & trauma ¥ Most recognize trauma as involving violence, abuse, or a disaster. ¥ Often factors such as poverty, racial discrimination, and incarceration are not recognized as potentially being equally traumatic. ¥ Many fail to accurately respond to the trauma boys and men of color experience. Social Determinants of Health Infographic about the social determinants of health Elements include: neighborhood and built environment, health and healthcare, social and community context, education, and economic stability. ¥Neighborhood & Built Environment¥Health & Health Care¥Social & Community Context¥Education¥Economic Stability Factors that impact health infographic about factors that influence health and wellbeing: Childhood experiences, housing, education, social support, family income, employment, our communities, and access to health services. What makes people sick infographic 50% of what makes people sick involves your life: income, early childhood development, disability, education, social exclusion, social safety net, gender, employment and working conditions, race, aboriginal status, safe and nutritious food, housing and homelessness, and community belonging. 25% of what makes people sick is your health care: access to health care, health care system, and wait times. 15% of what makes people sick is your biology, which includes genetics. and 10% of what makes people sick is your environment: air quality and civic infrastructure. What makes people sick? Social Determinants of Health What makes people sick? infographic Culture: Cross-Cutting Factors ¥ Language & Styles of Communication: verbal and nonverbal ¥ Geographic Location: rural, urban, region ¥ Worldview, Values, & Traditions: ceremonies, subsistence way of life, collective vs. individualistic ¥ Family & Kinship: hierarchy, roles, rules, traditions, definition of family ¥ Gender Roles & Sexuality: Gender norms, attitudes toward sexuality, and sexual identity. Culture: Cross Cutting Factors (2) ¥ Socioeconomic Status & Education: Access and ability to use resources and opportunities, such as healthcare, schools, neighborhood, employment ¥ Immigration & Migration History & Patterns: seasonal, refugees, legal status, current generation in country ¥ Cultural Identity & Degree of Acculturation ¥ Heritage & History: Cultural strengths, traditions, generational wisdom, historical trauma ¥ Perspectives on Health, Illness, and Healing Practices What is racial trauma? ¥ Physical and psychological symptoms POC experience after exposure to particularly stressful experiences of racism ¥ A cumulative experience, where every personal or vicarious encounter with racism contributes to chronic stress a chalk drawing of a child's body outline on a paved road that says, "Am I next?" ÒRacial oppression is a traumatic form of interpersonal violence which can lacerate the spirit, scar the soul, and puncture the psyche.Ó Kenneth V. Hardy Racism is trauma ¥ Negative, rejecting, and/or demeaning societal messages that undermine self-esteem ¥ Internalized racism is where people accept the negative messages about themselves and to reflect that negativity in their behavior ¥ Links to hypertension, cardiovascular disease, diabetes and infant mortalities What is historical and generational trauma? ¥ Multicultural trauma experienced by a specific cultural group cumulative and collective and can manifest itself emotionally and psychologically ¥ The expanded ACEs pyramid accounts for oppression and historical trauma where the cumulative impact is fundamentally life-altering Racial Socialization Experiences civil rights demonstration protest and racist counter protest civil rights demonstration signs say, "We demand voting rights now" and "an end to police brutality now!" racist counter protest includes signs that say, "race mixing is communist" and "stop race mixing". For many people of Color, early racial socialization experiences often include listening to their parentsÕ and grandparentsÕ stories of living through different periods of racial tension in the U.S., including the Civil Rights movement, Jim Crow laws, and for some slavery. Carrying Trauma Educating and socializing the younger generation about race and racism is essential, yet racial trauma is often carried across multiple generations and Intergenerational trauma can lead to higher rates of mental health and physical health issues. a person's hand passing off the baton to another person's hand Symptoms of Historical Trauma Infographic Depression, anxiety, isolation, loss of sleep, anger, discomfort around white people, shame, fear and distrust, loss of concentration, substance abuse, and violence and suicide. Symptoms of Historical Trauma Depression Anxiety Isolation Loss of Sleep Anger Discomfort around white people Shame Fear & Distrust Loss of Concentration Substance Abuse Violence & Suicide 31 Organizational and Institutional Trauma Institutional trauma ¥ We live in the world where human frailty and pathology is viewed in individual terms. When we see sickness we imagine that the person must have some weakness in biology, faith, or behavior ¥ Research suggests environmental response to an individualÕs trauma experiences may be a determining factor in whether PTSD or chronic traumatic reactions form People going into a funnel and coming out the other end with the message: No matter what you look like coming in... the desired outcome is the same. ÒInstitutional action and inaction that exacerbate the impact of traumatic experiencesÉÓ Smith and Freyd 34 Trauma informed care systems Systems without Trauma Sensitivity ¥ Misuse or overuse displays of power Ð keys, security, etc. ¥ Higher rates of staff turnover and low morale ¥ Disempowering and devaluing consumers ¥ Consumers are labeled and pathologized ¥ Focused on whatÕs wrong with the victim Four System models Chart: 1. Paternalistic Model says, "I decide for you" 2. Deliberative Model says, "In Addition, I tell you my preferences" 3.Informative Model says, "I give you facts" 4. Interpretive Model says, "I give you facts and help you find your preferences" Poster Trauma-Informed Care wtihin Systems Scroll that lists the Effects of Trauma: Hyperarrousal, Nervousness, Jumpiness, Quickness to Startle. Re-experiencing Intrusive Thoughts, images, sensations, dreams, or memories Avoidence or withdrawl, feeling numb, show down, or separated from normal life Pulling away from relationships or activities Scroll that lists Faulty Systems: misusing or overusing displays of power, keys, security, etc. higher rates of staff turnover and low morale disempowering and devaluing survivors survivors are labeled and pathologized focusing on what's wrong with the victim The Helper prevents further harm by: Recognizing that coercive interventions cause trauma and re-traumatization and vicarious trauma. Valuing survivors voice in all aspects of care staying all inclusive when it comes to a survivors's perspective and recognition of a person as a whole focusing on what has happened to the victim Poster created by the Sacred Hoop Coalition, Minnesota Institutional advocacy: polices and practices Trauma- informed practice and policy are relevant at all of these levels. Concentric Circles Chart Largest Circle: Influencing Social conditions creating need for trauma-informed practice second circle: Inter-agency and inter-sectoral collaboration third circle: Service cultures Smallest Circle: Interactions with our clients Influencing Social conditions creating need for trauma-informed Inter-agency and inter-sectoral collaboration Service cultures Interactions with our clients 38 NS TIC Practice Brief, 2015 What do Trauma Informed Policies look like in: ¥ Advocacy Programs ¥ Shelters ¥ Law Enforcement ¥ Jails ¥ Prosecution ¥ Courts ¥ Probation Impact of trauma on boys and men of color ¥ On average have fewer sessions and terminate services earlier than European Americans ¥ Safety and coping ¥ Often times self-medicate to cope with their traumatic experiences. ¥ Can reinforcement stigma that they are drug seeking. ¥ Validating resilience is important even when past coping behaviors are now causing problems Masculinity and trauma ¥ Ideas about masculinity have an effect on how and when boys and men of color access health care. Mostly seen as a weakness ¥ When men do seek trauma support services they often find providers who are unsympathetic or unfamiliar with the issues they face Supporting boys and men of color in their healing journey ¥ As with other forms of trauma, we ask the wrong question about struggling youth of color. Instead of asking ÒWhat is wrong with them?Ó we need to ask the trauma-informed question, ÒWhat has happened to them?Ó ¥ Building trust is the first step to creating healthy relationships and can significantly impact treatment outcomes. Provide culturally relevant services ¥ To understand how trauma affects an individual, family, or community, you must first understand that individualÕs life experiences and cultural background. ¥ Staff should receive appropriate training to ensure that they are providing culturally relevant interventions Issues that impactparticipation in therapy ¥ Racial similarity ¥ Perception of provider competence ¥ Perceptions of the quality of the services ¥ Comments ¥ Questions Conclusion