1/18/18

1

TRAUMA, GRIEF, & COMMUNITY ENGAGEMENT

Dr. Leora Wolf-Prusan

January 18th 2018

CSUS School Psychology Conference presents: A World of Opportunities

WELCOME

OUR JOURNEY

Areas of

focus

• Community – based violence

• Police involved shootings

• School shootings

Baselineconcepts

• Trauma• Resilience• Adverse Childhood

Experiences• Adverse Community

Experiences

Impact • On us• On our students

Where do we go from here?

• The field• Our practice

1/18/18

2

PAIR SHARE

‒ Dr.GeorgeAlbee

“Noepidemichaseverbeen

resolvedbypaying

attentiontothe

treatmentoftheaffected

individual.”

1,576

• In December 2012, a gunman walked into Sandy Hook Elementary School in Newtown, Connecticut, and killed 20 children, six adults, and himself.

• Since then, there have been at least 1,576 mass shootings, with at least 1,788 people killed and 6,333 wounded.

https://www.vox.com/a/mass-shootings-sandy-hook

1/18/18

3

2,902

• At least 2,902 people killed by police since August 9, 2014, the day of the Michael Brown shooting in Ferguson, Missouri.

• Police have killed 1,147 people in the U.S. in 2017 (https://mappingpoliceviolence.org/)

https://www.vox.com/a/police-shootings-ferguson-map

“Anyone who says this isn’t worth talking about is disconnected. You don’t have to come from it to be touched by it... I’m not the only one with multiple deaths. Especially being in this neighborhood, or choosing to teach in this neighborhood, you’re signing on for that. It’s part of the package. Do you choose to be a part of it? It’s going to happen. I anticipate it. Do I look at a kid and say Oh are you going to be one of them? I hope not. But you just don’t know. “

Literature notes three types of exposure to violence:

– Primary (victimization),

– Secondary (violence seen or heard), and

– Tertiary (learning of the violent death).

Literature notes two types of violence, generally speaking

– Episodic

– Chronic/compounded

1/18/18

4

10

Understanding trauma dynamics creates opportunities for new behaviors, new connections, and supports towards adaptation.

Trauma: Experiences or situations that are

emotionally painful and distressing, and that overwhelm people’s ability to cope,

leaving them powerless.

–The Center for Nonviolence & Social Justice

Direct(sociallyvalidated,identifiable)&subtle(chronic,compounded,cumulative,insidious)

Resilience: The processes of, capacity for, or pathways and

patterns of positive adaptation during or following significant

threats or disturbances.

– Ann Masten

TERMINOLOGY OF RELATIONSHIPS: HURTING & HEALING, TRAUMA & RESILIENCE

Systemic: social norms, roles, rituals, language, music, and art that reflect and reinforce the belief

that one social group is superior to another (intentional and unintentional).

Institutional: policies, laws, rules, norms, and customs enacted by organizations and social institutions

that disadvantage some social groups and advantage other social groups (intentional and unintentional).

Collective: attitudes and actions that reflect prejudice against a social group (unintentional and

intentional)-inter & intrapersonal.

Individual: attitudes and actions that reflect prejudice against a social group (unintentional and

intentional)-personal.

EXPANDING ACES

ADVERSE CHILDHOOD EXPERIENCES* Historical Trauma/Embodiment

Early Death, Quality of Life

(Loss)s

Burden of dis/ease, distress,

criminalization, stigmatizaton

Coping

Allostatic Load, Disrupted Neurological

Development

Complex Trauma/ ACE

Race/Social Conditions/ Local Context

Generational Embodiment/Historical Trauma

Trauma and Social Location

Microaggressions, im

plicit bias, epigenetics

EarlyDeath

Disease, Disability, and Social Problems

Adoption of Health-risk Behaviours

Social, Emotional, & Cognitive Impairment

Adverse Childhood Experiences

conception

death

Scientific gaps

*http://www.cdc.gov/violenceprevention/acestudy/pyramid.html

1/18/18

5

Figure2“TheProductionofViolencefromTrauma”inAdverseCommunityResilienceReport,KaiserPermanente,2016,p.21).

Figure5“PromotingCommunityResilience:FromTraumatoWellbeing”inAdverseCommunityResilienceReport,KaiserPermanente,2016,p.29).

• Interpretations of Meaning

• Culturally-specific explanations about how health and wellness are achieved, as well as the causes of distress and illness.

• Three interpretations (Robbins and Kirmayer, 2001)

• A somatic interpretation is the attribution of a physical sources of wellness or distress

• A psychological interpretation is about emotional sources

• An environmental interpretation posits social or physical environment sources

• Social significance

• Social Context Dynamics

• Availability of resources (group-oriented vs individual oriented)

• Exchange rules (reciprocity vs autonomy)

CULTURAL DETERMINANTS OF HELP SEEKING (ARNULT, 2009)

1/18/18

6

17

https://thinkprogress.org/black-americans-race-based-trauma-counselors-f60624aa8d0c/

Carter coins “Race Based Traumatic Stress Injury”

(2007)

Ethnoviolence & how racism causes trauma

(in Racism and Ethnoviolence as Trauma: Enhancing Professional Training, Helms et al., 2010)

In a American Journal of Public Health study of young urban men,

85 percent of participantsreported being stopped at least once in their lifetime; and those who reported more intrusive

police contact also experienced increased trauma and anxiety symptoms (Geller et al, 2014)

In a 2016 report called “Stress in America,” the American

Psychological Association said that nearly 40 percent of African-

American men reported being treated unfairly by police or law enforcement—unfairly stopped, searched, questioned, and physically

threatened or abused.

1/18/18

7

• Racial trauma may result from racial harassment, witnessing racial violence, or experiencing institutional racism (Bryant-Davis, & Ocampo, 2006; Comas-Díaz, 2016).

• The trauma may result in experiencing symptoms of depression, anxiety, low self-esteem, feelings of humiliation, poor concentration, or irritability.

• Although not everyone who experiences racism and discrimination will develop symptoms of race-based trauma, repeated exposure may lead to the following: • Increased vigilance and suspicion

• Increased sensitivity to threat

• Increased psychological and physiological symptoms

• Increased alcohol and drug usage

• Increased aggression

• Narrowing sense of time

Hardy, K. V. (2013). Healing the Hidden Wounds of Racial Trauma. Reclaiming Children And Youth, 22(1), 24-28.

WHAT’S RACE GOT TO DO WITH IT ANYWAYS?RACIAL TRAUMA

Gateway Feeling

SADNESS: Helps you address loss

and heal

ANXIETY: Helps you protect yourself against threat

ANGER: Helps you defend yourself and make things

right

Signs

Tense musclesFocus on what’s unfair

Frustration, Resentment

Tired, HeavinessFocus on the past/lossRegret, Guilt, Shame

Racing heart, hard to sleepHard to focus; worried

Overwhelmed, panicked

Root Causes

What have I lost?

What do I fear?

How have I been violated?

Gabor Maté

Racial trauma or race-based trauma often goes unnoticed. These hidden wounds that adults and youth of color experience are worn like invisible weights. Hardy (2013) provides the following eight steps to heal:

1. Affirmation and Acknowledgement2. Create Space for Race3. Racial Storytelling4. Validation5. The Process of Naming6. Externalize Devaluation7. Counteract Devaluation8. Rechanneling Rage

WHAT’S RACE GOT TO DO WITH IT ANYWAYS?RACIAL TRAUMA –COPING & HEALING

1/18/18

8

IMPACT & PRACTICE

“What Project Aristotle has taught people within Google is that no one wants to put on a ‘work face’ when they get to the office. No one wants to leave part of their personality and inner life at home. But to be fully present at work, to feel ‘psychologically safe,’ we must know that we can be free enough, sometimes, to share the things that scare us without fear of recriminations.

”Source: What Google Learned From Its Quest to Build the Perfect Team | NYTimes

AND, IT’S MESSY.

1/18/18

9

TRAUMA AS A FORM OF CAPITAL

What skills might we gain from experiencing a trauma?

From traumas?

From working with populations living with traumas?

TURN TO AN ELBOW PARTNER AND DISCUSS:

•How might becoming trauma informed impact your teaching and leading?

•How might becoming trauma informed impact your students’ learning and leading?

•What supports/resources might you need to nurture your trauma capital?

QuantitativeFindings

1/18/18

10

Qua

litativeFind

ings

Teachersreportedadesiretoconnect withcolleagueswhosharedthestudentdeathexperienceforsupport.

Schoolsystems’communicationaboutastudentdeathanditsaftermathinformedhowteachersexperiencedsupport.

Thepracticeofhonoringthedeceasedstudentwasafactorinteachers’abilitytobuildresilience.

Teacherswhoappraisedastudent’shomicide

asnegativeandhighlystressful

experiencedtraumaticstressreactionssuchas

hypervigilance,

hyperarousal,and

self-blame.

1/18/18

11

Teachersreportedthattheir

schools’leadershipstyles

wereacentralmitigationfactorforstressafterthedeathofastudent.

Teachersbecamemoreconsciousincreating

safeclassroomenvironmentsand

buildingpositiverelationships.

ClosingWhat are you taking away from this

conversation?

1/18/18

12

Sowhatdoesthisallmean?

Ingroups,share-1-3takeawaysthatyouwillbringwithyoufromthisconversationtoyourcurrentworkplaceorotherenvironment.

Consider:whatmoredoyouneedtodo,learn,ask,read,investigatetomakethisactionauthenticandpowerful?

WHERE DO WE GO FROM HERE?

Nope,notthis.

1/18/18

13

TheCostofCaring“Theexpectationthatwecanbeimmersedinthesufferingandlossdailyandnotbetouchedbyitisasunrealisticasexpectingtowalkthroughwaterwithoutgettingwet. Thissortofdenialisnosmallmatter.Thewaywedealwithlossshapesourcapacitytobepresenttolifemorethananythingelse.Thewayweprotectourselvesfromlossmaybethewayinwhichwedistanceourselvesfromlife.Weburnoutnotbecausewedon’tcarebutbecausewedon’tgrieve.Weburnoutbecausewe’veallowedourheartstobecomesofilledwithlossthatwehavenoroomlefttocare.”

-Remen inMathieu(2012,p.7)

38

NCTSN’S “3RS OF RECOVERY,” ADAPTED

Readiness:

How prepared is the school & system for all the chronic or episodic traumas…TODAY?• What evidence can we identify that

illustrates how staff and students’ wellness is valued and prioritized?

[Short Term] Response:

The sum of the school’s resources and skill to take decisive and effective action• What practices and policies

respond to staff and student needs?

[Long Term] Recovery:

Restoring social, emotional and physical equilibrium of the classroom, school community.• How does your work culture

heal? • What does equal healing look

like?• What does equitable healing

look like?

39

NAMEIT.

1/18/18

14

40

LIVEINIT.

41

EXPLOREIT.

42

RELEASEIT.

1/18/18

15

43

SEEKIT.

44

SUSTAINIT.

45

REVISITIT.

1/18/18

16

"WE'RE NOT SUPPOSED TO SPEND OUR TIME LIVING TO HEAL, WE'RE

SUPPOSED TO HEAL TO LIVE."

- Nkem Ndefo

THANK YOU.

Leora Wolf-Prusan, EdD

Lwolf@cars.rp-org

@Leorawp

• “Racism’s Psychological Toll” Interview by Jenna Wortham (JUNE 24, 2015)

http://www.nytimes.com/2015/06/24/magazine/racisms-psychological-toll.html?_r=0

• “Racism Impacts Mental Health of Teens” By Rick Nauert PhD

http://psychcentral.com/news/2013/09/18/racism-impacts-mental-health-of-teens/59656.html

• Black Pain: It Just Looks Like We're Not Hurting (Terrie M. Williams, 2009)

• A Conversation on Racial Disparities in Mental Health Treatment: http://wfpl.org/conversation-racial-disparities-mental-health-treatment/

• http://www.beam.community/ (Black Emotional & Mental Health Collective)

• http://www.nqttcn.com/ (The National Queer and Trans Therapists of Color Network)

• To learn more about Dr. Monica Williams’ work in reducing racism, measuring microaggressions, and promoting racial harmony, visit www.mentalhealthdisparities.org.

RESOURCES

1/18/18

17

• Arnault,D.S.(2009).CulturalDeterminantsofHelpSeeking:Amodelforresearchandpractice. ResearchandTheoryforNursingPractice, 23(4),259–278.

• Carter,R.T.(2007).Racismandpsychologicalandemotionalinjury:Recognizingandassessingrace-basedtraumaticstress.TheCounselingPsychologist,35(1),13-105.

• C'de Baca,J.,Castillo,D.,&Qualls,C.(2012).EthnicdifferencesinsymptomsamongfemaleveteransdiagnosedwithPTSD.JournalofTraumaticStress,25(3),353-357.

• Chae,D.H.,Lincoln,K.D.,&Jackson,J.S.(2011).Discrimination,attribution,andracialgroupidentification:Implicationsfor psychologicaldistressamongBlackAmericansintheNationalSurveyofAmericanLife(2001–2003).AmericanJournalofOrthopsychiatry,81(4),498-506.

• Chou,T.,Asnaani,A.,&Hofmann,S.G.(2012).PerceptionofracialdiscriminationandpsychopathologyacrossthreeU.S.ethnicminoritygroups. CulturalDiversityandEthnicMinorityPsychology,18(1),74-81.

• Cokley,K.,Hall-Clark,B.,&Hicks,D.(2011).Ethnicminority-majoritystatusandmentalhealth:Themediatingroleofperceiveddiscrimination.JournalofMentalHealthCounseling,33(3),243-263.

• Gaertner,S.L.&Dovidio,J.F.(2005). Understanding andAddressingContemporaryRacism:FromAversiveRacismtotheCommonIngroup IdentityModel.JournalofSocialIssues,61(3),615-639.

• Geller, A., Fagan, J., Tyler, T., & Link, B. G. (2014). Aggressive Policing and the Mental Health of Young Urban Men. American Journal of Public Health, 104(12), 2321–2327. http://doi.org/10.2105/AJPH.2014.302046

• Hardy, K. V. (2013). Healing the Hidden Wounds of Racial Trauma. Reclaiming Children And Youth, 22(1), 24-28.• Himle,J.A.,Baser,R.E.,Taylor,R.J.,Campbell,R.D.,&Jackson,J.S.(2009).AnxietydisordersamongAfricanAmericans,BlacksofCaribbeanDescent,

andNon-HispanicWhitesintheUnitedStates.JournalofAnxietyDisorders,23,578–590.• Helms,Janet&Nicolas,Guerda &Green,Carlton.(2010).RacismandEthnoviolence asTrauma:EnhancingProfessionalTraining.Traumatology.16.53-

62.10.1177/1534765610389595.• Hemmings,C.,&Evans,A.M.(2018).IdentifyingandTreatingRace-BasedTraumainCounseling. JournalofMulticulturalCounselingand

Development, 46(1),20-39.doi:10.1002/jmcd.12090• Malcoun,E.,Williams,M.T.,&Bahojb-Nouri,L.V.(2015).AssessmentofPosttraumaticStressDisorderinAfricanAmericans.InL.T.Benuto &B.D.Leany

(Eds.),GuidetoPsychologicalAssessmentwithAfricanAmericans,NewYork:Springer.ISBN:978-1-4939-1003-8.• Pieterse,A.L.,Todd,N.R.,Neville,H.A.,&Carter,R.T.(2012).PerceivedracismandmentalhealthamongBlackAmericanadults: Ameta-analyticreview.

JournalOfCounselingPsychology,59(1),1-9.• Sue,D.W.,Capodilupo,C.M.,Torino,G.C.,Bucceri,J.M.,Holder,A.B.,Nadal,K.L.,&Esquilin,M.(2007).Racialmicroaggressions ineverydaylife:

Implicationsforclinicalpractice.AmericanPsychologist,62(4),271-286.• Williams,M.T.,Chapman,L.K.,Wong,J.,&Turkheimer,E.(2012).TheRoleofEthnicIdentityinSymptomsofAnxietyandDepressioninAfrican

Americans. PsychiatryResearch,199,31-36.• Williams,M.T.,Malcoun,E.,Sawyer,B.,Davis,D.M.,Bahojb-Nouri,L.V.,&Leavell Bruce,S.(2014).CulturalAdaptationsofProlonged

Exposure Therapy forTreatmentandPreventionofPosttraumaticStressDisorderinAfricanAmericans.BehavioralSciences,4(2),102-124.• Zoellner,L.A.,Feeny,N.C.,Fitzgibbons,L.A.,&Foa,E.B.(1999).ResponseofAfricanAmericanandCaucasianWomento CognitiveBehavioral

Therapy forPTSD.BehaviorTherapy,30(4),581-595.

SELECTED REFERENCES

APPENDIX QUOTES

“OX Y TO C IN I S A N EU RO -H O RM O N E . IT F IN E -TU N ES YO U R BRA IN 'S SO C IA L IN ST IN C TS . IT PR IM ES YO U TO D O TH IN G S TH AT ST R EN G T H EN C LO SE R ELAT IO N SH IPS . OX YTO C IN M A KES YO U C R AV E PH YS IC A L C O N TAC T W IT H YO U R FR IEN D S A N D FA M ILY. IT EN H A N C ES YO U R EM PATH Y. IT EVEN M A KES YO U M O RE W ILL IN G TO H ELP A N D SU PPO RT TH E PEO PLE YO U C A RE A BO U T. SO M E PEO PLE H AV E EV EN SU G G EST ED W E SH O U LD SN O RT OX YTO C IN . . . TO BEC O M E M O RE C O M PA SS IO N ATE A N D C A R IN G . BU T H ERE 'S W H AT M O ST PEO PLE D O N 'T U N D ERSTA N D A BO U T OX YTO C IN .

IT ' S A STRESS H O RM O N E . YO U R P ITU ITA RY G LA N D PU M PS TH IS STU FF O U T A S PA RT O F TH E STRESS RESPO N SE . IT ' S A S M U C H A PA RT O F YO U R STRESS RESPO N SE A S TH E A D REN A L IN E TH AT M A KES YO U R H EA RT PO U N D. A N D W H EN OX YTO C IN I S REL EA SED IN TH E STRESS RESPO N SE , IT I S M OT IVAT IN G YO U TO SEEK SU PPO RT. YO U R B IO LO G IC A L ST R ESS R ESPO N SE IS N U D G IN G YO U TO TELL SO M EO N E H OW YO U FEEL , IN STEA D O F BOTTL IN G IT U P. YO U R STRESS RESPO N SE WA N TS TO M A KE SU RE YO U N OT IC E W H EN SO M EO N E ELSE IN YO U R L I FE I S ST RU G G L IN G SO T H AT YO U C A N SU PPO RT EAC H OT H ER . W H EN L IFE I S D IF F IC U LT, YO U R STRESS RESPO N SE WA N TS YO U TO BE SU R RO U N D ED BY PEO PLE W H O C A RE A BO U T YO U …

H OW YO U TH IN K A N D H OW YO U AC T C A N TRA N SFO RM YO U R EX PER IEN C E O F ST R ESS . W H EN YO U C H O O SE TO V IEW YO U R ST R ESS R ESPO N SE A S H ELPFU L , YO U C REATE TH E B IO LO G Y O F C O U RAG E . A N D W H EN YO U C H O O SE TO C O N N EC T W ITH OTH ERS U N D ER ST R ESS , YO U C A N C REATE RES IL IEN C E .”

Kelly McGonigalHow to make stress your friend

1/18/18

18

"WE'RE NOT SUPPOSED TO SPEND OUR TIME LIVING TO HEAL, WE'RE

SUPPOSED TO HEAL TO LIVE."

- Nkem Ndefo

“WE HAVE LEARNED THAT TRAUMA IS NOT JUST AN EVENT THAT TOOK PLACE SOMETIME IN THE PAST; IT IS ALSO THE IMPRINT LEFT BY THAT EXPERIENCE

ON MIND, BRAIN, AND BODY. THIS IMPRINT HAS ONGOING CONSEQUENCES FOR HOW THE

HUMAN ORGANISM MANAGES TO SURVIVE IN THE PRESENT. TRAUMA RESULTS IN A FUNDAMENTAL

REORGANIZATION OF THE WAY MIND AND BRAIN MANAGE PERCEPTIONS. IT CHANGES NOT ONLY

HOW WE THINK AND WHAT WE THINK ABOUT, BUT ALSO OUR VERY CAPACITY TO THINK.”

― Bessel A. van der Kolk,The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

“TRAUMA IS NOT WHAT HAPPENS TO US, BUT WHAT WE HOLD INSIDE IN THE ABSENCE OF AN EMPATHETIC

WITNESS.”

― Peter A. Levine

1/18/18

19

“VIOLENCE IS WHAT HAPPENS WHEN WE DON'T KNOW WHAT ELSE TO DO

WITH OUR SUFFERING.”

― Parker J. Palmer

"WE DON’T HEAL ONLY FOR THE SAKE OF FEELING GOOD. WE HEAL SO THAT

WE CAN ACT AND ORGANIZE. WE HEAL SO THAT WE CAN USE THE LESSONS GAINED THROUGH THE

WOUNDS OF OUR TRAUMA TO MAKE NECESSARY CHANGE IN OUR WORLD."

- Prentis Patrice Hemphill