Handout 1

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Handout 1

Trauma Informed
Approach:
ENGAGING
AFRICAN AMERICAN MEN
SAM SIMMONS, LADC
BEHAVIORAL CONSULTANT
Objectives
• Discuss the link between the intergenerational
trauma and current challenges of African American
men.
• Discuss trauma informed best and/or promising
practices being used to work with African American
men.
• Discuss the importance of being aware of the trauma
link by both clinician and client.
Engaging African American Men
2
Intergenerational
Trauma
• Intergenerational trauma happens when
the effects of trauma are not resolved in
one generation. When trauma is
ignored and there is no support for
dealing with it, the trauma will be
passed from one generation to the next.
• Intergenerational trauma was first
observed in 1966 by clinicians alarmed
by the number of children of survivors
of the Nazi Holocaust seeking treatment
in clinics in Canada.
3
Historical Trauma
• Historical (Intergenerational) Trauma
is cumulative emotional and
psychological wounding, over the
lifespan and across generations,
emanating from massive group trauma
experiences.
• Dr. Maria Yellow Horse Braveheart,
PhD, conceptualized historical trauma
in the 1980's, as a way to develop
stronger understanding of why life for
many Native Americans is not fulfilling
"the American Dream".
4
Historical Trauma
• Post Traumatic Slave Syndrome
(P.T.S.S.) is a condition that exists as a
consequence of centuries of chattel
slavery followed by institutionalized
racism and oppression have resulted in
multigenerational adaptive behavior,
some positive reflecting resilience, and
others that are harmful and destructive.
• Theory of P.T.S.S. was developed by
Dr. Joy DeGruy as a result of twelve
years of quantitative and qualitative
research.
5
The Five Trauma Points
American
Chattel Slavery
(1619-1865)
Post-slavery and
Jim Crow
(South, 1865-1965)
Ghetto (Northern Migration,
1915-68)
Ghetto and welfare (1968-1975)
Hyperghetto, “War on Drugs” and Prison
(1975-present)
6
Trauma Points
• 1619-1865 Chattel Slavery (personal
property, bred, bought and sold as
commodities) first arrived in
Jamestown, Virginia in 1619
Duluth
June 15, 1920
• 1865-1965 Jim Crow South
– State-sponsored terrorism, lynching (at
least 4,742 in south and 219 in north) and
Ku Klux Klan
– Slavery Abolished The 13th Amendment
1865 - except as a punishment for
crime…one year later prisons overflowing
with Black inmates.
7
Trauma Points
• 1915-68 Northern migration and
Ghetto leaving the farm or share
cropping
– Menial and manufacturing jobs.
– Segregated housing and employment.
• 1968-1975 Welfare and Ghetto “no
men in the home”
– Drugs, crime and family disintegration (all
inter-related) took a heavy toll on the
inhabitants of the inner city.
– The exodus of middle class
8
In Minnesota, a black man
is 26.8 times more likely to
be in prison than a white
man.
Trauma Points
• 1975-present Hyper-ghetto and
Prison
– Hyperghetto is the extreme concentration
of underprivileged groups in the inner cities
– The exodus of middle class
– The exodus of low education industrial
manufacturing jobs
– “War on Drugs” and Prison Blacks and
whites use and sell drugs at about the
same rate, but blacks are 20 times more
likely going to Jail.
– Concentrated police presents
9
Trauma and Trauma
Response
• Threat Response Cycle
– Interruption in Threat Response Cycle
– Stuck in “Fight or Flight” or Survival Mode
– Struck in Freeze and Dissociation
• Effects of Historical Traumas
• A Current Look….
10
Threat Response Cycle
Charge:
Discharge:
• Muscle contraction
• Adrenalin and Cortisol
secretion
• Increased heart rate
• Survival energy production
•
•
•
•
Tingling
Trembling
Tears
Completion of defensive
movements
Adapted from Somatic Experiencing®, a school of somatic (i.e., body-focused) therapy for healing trauma.
11
Threat Response Interruption
Some Causes:
• Not wanting to feel out of control: stop ourselves “get
a grip (literally)” and “Just get over it,”
• Situational priorities: (attend to a child’s needs)
• Ongoing threats (recurring abuse/violence, racial
microaggressions, oppression)
• New situations that prompt more Threat Responses:
(denial of traumatic events by others)
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Stuck in Fight/
Flight or Survival
Trauma Symptoms include: (“re-living” and “hyperarousal” PTSD)
•
•
•
•
Anxiety, agitation, hypervigilance, irritability, anger outbursts
Difficulty with staying engaged in relationships/jobs/projects
Difficulty relaxing, resting or sleeping, insomnia, nightmares
Tendency to connect the dots that do not belong together
(S/he must be cheating on me,” “he is disrespected me,” etc.)
• In Children: Hyperactivity, difficulty sitting still/concentrating,
compulsive talking, truancy, runaway, bullying
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Stuck in Fight/
Flight or Survival
Historical Traumas Effects
• Having to work hard to manage anger/fear in daily
encounters with prejudice, discrimination and lack of
equality.
• Conscious/unconscious expectations of being treated
unfairly because of one’s race, sexual orientation,
gender, etc.
• Distrust/judgment against people in one’s own
community (i.e., internalized oppression)
14
Struck in Freeze and
Dissociation
Trauma Symptoms include (“avoidance” PTSD)
• Depression, feelings of emptiness, detachment and
difficulty defending self or facing conflicts
• Inability to connect the dots that are right in front of
them (fails to notice child is missing for hours)
• In Children: difficulty processing information, “loner,”
excessive shyness/fearfulness, clinging
15
Struck in Freeze and
Dissociation
Historical Traumas Effects
• Hopelessness/powerlessness and resignation about
prejudice, discrimination and inequity (a
conscious/unconscious belief that things/people cannot
change)
• A pattern of not speaking up about prejudice,
discrimination and inequity followed by a sense of
resentment /shame/selfblame.
• Indifference, withdrawal from relationships in one’s own
community
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Current Example
• African-American men, between the
ages of 18 to 40 (effected by “Crack
Era” 1984-1990).
• Have experienced frequent traumatic
experiences as both perpetrator and
victim.
• Them often feel socially, economically
and educational systems excluded.
• Have little or no healthy involvement in
mainstream life that foster health selfesteem, success and hope for a future.
17
Current Example
• Hyper-masculine identity featuring:
– emotional numbness
– fear/shame inducement
– misogyny
– a high physical pain threshold
– sexual prowess
– The negative parts of Hip Hop life.
18
Resulting in….
•
•
•
•
•
poor emotional regulation
attachment issues
raised by a single parent
female-dependent
rite of passage involves an traumatic or
stressful event (incarceration,
unplanned for pregnancy, etc.)
• Feel they have nothing to lose.
• Not responding successfully to
traditional programs.
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Resulting in….
Self-destructive behavior that can be
strongly connected to depression,
regarded as suicidal called ”indirect
suicide” or “slow suicide”:
• Use of drugs and alcohol - selfmedicating
• Homicide and Glorification of death little respect for life, more praise in death
i.e. Biggie and Tupuc
• High-risk behaviors – Gangs, risky sex,
etc.
• "Suicide by cop” - death by showdowns
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Resulting in….
• Survival Stress Management: A process of attempting
to bring balance or adapting to stressful situations by
acting or reacting without thinking of the
consequences of our choices; immediate satisfaction
or instant self-gratification; resulting in increased stress
and/or depression:
– Judgmental and distorted thoughts and feelings,
impatience, exploitation, aggression, abuse and violence
directed against one’s self or others.
– Addictive substances and behavior (i.e., drugs, alcohol,
sex, shopping, gambling, food, video games, etc.)
produces a limited sense of relief requires repetitions.
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Resulting in….
• Untreated Trauma and Symptoms: When trauma and
other mental health disorders aren't treated, African
American Men are more vulnerable to incarceration,
homelessness, substance abuse, homicide and suicide.
• Poverty, racism and the impact of past trauma
(particularly violence) are the primary contributing factors
to the mental health disorders of young African American
men.
22
Promising Practices
• Trauma-Informed Approach
• Cognitive Behavioral Programs
• Healing Generations Curriculum for African
American Men
• Taking treatment to the men
• The Adverse Childhood Experiences (ACE) Study
23
Trauma-Informed Approach
• Trauma-informed care is an approach to engaging
people with histories of trauma that recognizes the
presence of trauma symptoms and acknowledges the
role that trauma has played in their lives.
• Recognizing that trauma includes physical, sexual and
institutional abuse, neglect, intergenerational trauma,
and disasters that induce powerlessness, fear, recurrent
hopelessness, and a constant state of alert.
24
Cognitive Behavioral
• Thinking for a Change (T4C) is an integrated, cognitive
behavior change program for offenders that includes
cognitive restructuring, social skills development, and
development of problem solving skills.
– Modified for community use (stories, role play
examples, etc.)
• Other approaches to cognitive-behavioral therapy,
including Rational Emotive Behavior Therapy, Rational
Behavior Therapy, Rational Living Therapy, Cognitive
Therapy, and Dialectic Behavior Therapy.
25
Healing Generations
• The Healing Generations Curriculum aims to break the
intergenerational cycle of violence by allowing African
American Men the opportunity to safely explore the links
between traumatic experiences and violence, while
building skills to assist them in refraining from violence
and start personal healing.
–
–
–
–
–
Family Story (Family Story DVD)
Importance of Stories and Why
Family Trees
Stress Management
Simplicity
26
Taking Treatment to
the Men
• Engaging fathers through cognitive and
emotional health focused
empowerment group in concert with
one to one counseling, 20 minute
sessions. (Father Project & AAFS)
• Emotional Health and Stress
management training to help African
American men learn better coping
methods.
27
The Adverse Childhood
Experiences (ACE) Study
• Major American research project that poses the
question of whether and how childhood experiences
affect adult health decades later
• Provides compelling evidence that:
– Adverse childhood experiences are surprisingly
common
– ACE’s happen even in “the best of families”
– ACE’s have long-term, damaging consequences
• Findings reveal powerful relationships between
emotional experiences as children and physical and
mental health as adults
Source: The Adverse Childhood Experiences Study website: www.acestudy.org,
28
Significant Life Events
Screening
• African American Family Services screened African
American 197 African American male clients for
possibility of experiencing trauma over the last three
years. The men completed their 18 questions Significant
Life Events Screener, which a “yes” answer indicates the
possibility of experiencing a traumatic event. All, or
100% of the 197 men answered “yes” to 4 or more of
the 18 questions. 120 of these men or 61% answered
“yes” to over half of the questions.
29
Obstacles
• Invisible Trauma
• Diagnosing And Treatment
• African American Community Beliefs
• Affordable and Accessible Care
• Compassion Fatigue
30
Invisible Trauma
Racial Microaggressions: Are brief and commonplace
daily verbal, behavioral and environmental indignities,
whether intentional or unintentional insults to the target
person or group. Seem to appear in three forms:
• Microassault: an explicit racial derogation
• Microinsult: rudeness, insensitivity or racial slights
• Microinvalidation: exclude, negate, or nullify the
psychological thoughts, feelings, or experiential
reality of a person of color.
31
Responding to
Microaggressions
• The Catch-22: How should I respond? What are the
consequences if I do?
• Clash of racial realities: “Did the person of color simply
misinterpret the action?
• The Invisibility of Unintentional Expressions of
Bias: How do we make the perpetrator aware of it?
• Perceived Minimal Harm of Racial
Microaggressions: The perpetrator usually believes that
the victim has overreacted, is being overly sensitive and/or petty.
32
Diagnosing And
Treatment
• High rates of misdiagnosis.
– Often, depression is diagnosed as
schizophrenia and disproportionately underdiagnosed mood disorders.
– Diagnosis affected by bias diagnostic
instruments.
• Multigenerational trauma continue to
be treated as secondary.
• Historical Impact of Slavery
– This tends to get dismissed as irrelevant.
– European Americans will often try to define
the experience of African Americans
33
Affordable and
Accessible Care
• African Americans are less likely to be
treated with newer medications, than
Whites. When they do receive
medications, they often receive higher
dosages.
• African American men are more likely
to lack insurance or coverage for
mental illness.
34
African American
Beliefs
• The stigma attached to mental illness:
“It’s considered a weakness”, “should
be able to shake it off”, “part of African
American life” or turn to faith to help you
through.
• Mistrust of health professionals and
psychiatry in particular rooted in racism
that has taken the form of research
projects.
• Difficulty addressing intergenerational
trauma
35
Compassion Fatigue
• Compassion Fatigue can result from handling the pain
and suffering of others for too long.
• Symptoms:
– energy depletion;
– reduced effectiveness;
– decline in compassion towards others;
– avoidance; detachment;
– irritability; etc.
• If you cannot generate compassion for your clients you
should not be in the room with them
36
Intervention and Prevention
• Provider Education/Service Delivery
• Community Education/Intervention and Prevention
• Research
37
Provider Education & Service
• Develop and support mental health intervention
initiatives that are specifically geared to African American
males.
• Incorporate Trauma from a cultural perspectives as part
of the assessment and treatment process.
• Understand specific cultural behaviors factors, the extent
to which alcohol and drugs are used to cope with racism
and other forms of trauma.
38
Counseling Staff
• Listen to the stories of our patients about trauma and
how it affects their complex lives
• Be aware not to add to the trauma with your beliefs (it’s
just excuse, they should know better.) Compassionate
Accountability
• Be aware of compassion fatigue as a provider.
• Educate our patients about what is normal in the
aftermath of trauma.
39
Community
Intervention
• African American institutions,
community leaders and health
professionals must encourage and
promote participation of Black men in
Mental health services both traditional
and non-traditional.
2% of psychiatrists, 2% of
psychologists and 4% of
social workers.
• Conduct stigma awareness training at
faith and community organizations, etc.
• Development of more African American
Professionals
40
Research
Adverse Childhood
Experiences Study:
Largest study of its kind
ever done to examine the
health and social effects
of ACEs over lifespan
(17,421 participants,
1995-97) Most were 50 or
older (62%), white (77%)
and college educated
(72%) www.acestudy.org
• Increase the representation of people
of color in the research in order to
develop more culturally effective
interventions. ACEs Study included
less then 5% African American.
• Fund research to consider racism as a
form of trauma that could account for
health disparities.
41
Conclusion
• There is a need to develop and support initiatives that
is sensitive to historical/generational trauma as a way
to improve our intervention and prevention efforts.
• By understanding our own biases and prejudices, we
can eliminate the harm that they can cause.
• We are shaped by our stories and healing can start
by embracing them.
42
Questions and Answers
Instead of "What's wrong with you?"
lets ask,
"What happened to you?“
“Some change is just about being brave enough to get out
the box.”
Thank You
Have a great conference!!!
43
References & Resources
Movies and Documentaries:
•
•
HIP-HOP: beyond beats and rhymes: The documentary explores the issues of
masculinity, violence, homophobia and sexism in hip hop music and culture, through
interviews with artists, academics and fans. produced and directed by Byron Hurt
(2006)
The Slavery by Another Name: a searing examination of how the enslavement of
African-Americans persisted deep into the 20th century based the book Slavery by
Another Name: The Re-Enslavement of Black Americans from the Civil War to World
War II by Pulitzer-Prize winning Douglas A. Blackmon (2012) PBS Programming
Websites:
•
•
•
•
The ACE Study http://www.acestudy.org/
Somatic Experiencing®: www.traumahealing.com
SAMHSA's National Center for Trauma-Informed Care (NCTIC):
www.samhsa.gov/nctic/
The Suicide Prevention Resource Center
(SPRC),http://www.sprc.org/library/black.am.facts.pdf
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References
•
•
•
•
•
•
•
Ancharoff, M.R., Munroe, J.F. & Fisher, L.M. (1998). The legacy of combat trauma.
Clinical implications of inter-generational transmission. In Y. Danieli, (Ed.),
International handbook of multigenerational legacies of trauma (pp. 257-276). New
York: Plenum.
“Being Black and Feeling Blue” was funded by the National Institute of Mental Health
and the National Institute on Aging. Funding for the Monitoring the Future Study is
provided by the National Institute on Drug Abuse.
Bell CC. Treatment issues for African-American men. Psychiatric Annals. 1996;26:3336.
Black Mental Health Alliance for Education and Consultation, Inc. The primary mission
of the organization is to provide and promote a holistic, culturally relevant approach to
the development and maintenance of optimal mental health for African Americans and
other people of color.
Bradshaw, John (2005) Healing the Shame that Binds You (Recovery Classics)
Brave Heart, M. Y. H. (2000) Wakiksuyapi: Carrying the historical trauma of the
Lakota. Tulane Studies in Social Welfare, 21-22, 245-266.
Carter RT. The Influence of Race and Racial Identity in Psychotherapy. New York:
Wiley & Sons; 1995.
45
References
•
•
•
•
•
•
•
•
•
Carrillo, Ricardo, Ph.D. (Editor) & Tello, Jerry (Editor) Family Violence and Men of
Color: Healing the Wounded Male Spirit (Springer Series: Focus on Men)
Case, Ellis (2003) The Envy of the World: On Being a Black Man in America.
Washington Square Press: New York, NY
Denham, Aaron R. (2008). Rethinking Historical Trauma: Narratives of Resilience,
Transcultural Psychiatry. Sage Publications
Franklin, A. J. (2004 ). From Brotherman to Manhood-How Black Men Rescue Their
Relationships from the Invisibility Syndrome. New York: John Wiley.
Joe, S. & Kaplan, M. (2001) Suicide among African American Men. Suicide & Life
Threatening Behavior (31), 106-121.
Johnson, Ernest (1998). Brothers on the Men-Understanding and Healing Anger for
African American Men and Women. New York: Pocket Books.
Journal of Counseling and Development( 22-JUN-08) Racial microaggressions against
Black Americans: implications for counseling. (Innovations in Multicultural Research)
Leary, DeGruy, Joy. Post Traumatic Slave Syndrome: America’s Legacy of Enduring
Injury and Healing, Uptone Press, 2005
Levine, P., & Kline, M. (2007). Trauma through a child’s eyes. Berkeley, CA: North
Atlantic Books.
46
•
•
•
•
•
•
•
•
•
•
Oliver, William (2006). The Streets: An Alternative Black Male Socialization Institution.
Journal of Black Studies, 36 (6): 918-937
Poussaint, Alvin F. & Alexander, Amy (2001) Lay My Burden Down: Suicide and the
Mental Health Crisis Among African-Americans. Beacon Press
Reid, Omar et al., (2005). Post Traumatic Slavery Disorder-Definition, Diagnosis and
Treatment. Charlotte, NC: Conquering Books.
Reya, Eran (2007) The Death of Black America, AuthorHouse
Rich, J. A., C. M. Grey, et al. (2005). “Pathways to recurrent trauma among young
Black men: traumatic stress, substance use, and the “code of the street”.” American
Journal of Public Health 95(5): 816-24.
Source: Race, Ethnicity and Health Care: Young African American Men in the United
States, Henry J. Kaiser Family Foundation, 2006
The Mental Health of African American Men Fact Sheet, a Community Voices
Publication, was funded by the W.K. Kellogg Foundation.
Washington, Harriet A. (2007) Medical Apartheid: The Dark History of Medical
Experimentation on Black Americans from Colonial Times to the Present.
White, Joseph & Cones, James (1998). Black Man Emerging-Facing the past and
seizing a future in America. New York: W.H. Freeman.
Williams, Terrie Black (2008) Pain: It Just Looks Like We're Not Hurting.
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