2. Immigration & PTSD Tammy Shaffer Ed.D., LPCC, LPC, NCC, ACS, KCA Conference October 26, 2007

3. Interest in Trauma Research

4. U.S. Census Bureau, 2000.

6. One in four low-income children lives in an immigrant family (Urban Institute 2001). Three in five low-income non- citizens are uninsured (Brown et al. 1999). One in five K-12 school children is an immigrant or has an immigrant parent (Hernandez et al. 1998).

7. Hippocrates – 400’s BC A crisis is a sudden state that gravely endangers life.

8. Sigmund Freud 1920 Trauma occurs when the ego is overwhelmed “as a consequence of an extensive breach being made in the protective shield against stimuli.”

9. History of Posttraumatic Stress Disorder Civil war Nostalgia World war I Shell shock World war II Battle fatigue Vietnam Thousand mile stare PTSD – DSM-III (1980)

10. Accident vs. Disaster “…in a disaster, the social structure and processes are affected sufficiently to threaten the existence and functioning of the community. The resource needs are greater than the resources available.” Eranen & Liebkind, cited in Ursano, Fullerton, & Norwood, 1995

11. High Risk Groups Rescue workers and heroes Injured Children

12. Initial Intervention Safety Respite Physiological recovery Easing symptoms Food and water Outreach programs Ursano et al., 1998.

13. Later Interventions Differential diagnosis Debriefing Psychotherapy Individual, Family, or Group Treatment for disorders Media-based recovery education (Ursano et al., 1995)

14. Disaster Exposure Lifetime U.S. Prevalence 39.1% 1 Survivor PTSD 3% - 58% 1 Risk of developing PTSD in course of emergency worker career = 16% 2 1 DSM IV, 1994 2 Everly & Mitchell, 1993

15. Determinants of Trauma Severity Type of disaster Degree of sustained injury Amount of damage Degree of life threatened Duration of community disruption Attribution of meaning

16. Psychiatric Responses to Disaster Organic mental disorders Posttraumatic stress disorder Acute stress disorder Major depression Adjustment disorder Generalized anxiety disorder Alcohol abuseDrug abuse

17. PTSD Time Frame Specify if: Acute: if duration of symptoms is less than 3 months Chronic: if duration of symptoms is 3 months or more Specify if: With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

18. Symptoms of PTSD Repeated dreams or recurrent flashbacks Traumatic dreams Sleeping problems Psychological numbing Intense distress if exposed to anything resembling the event Anger outbursts Hypervigalence

19. Symptoms of PTSD (cont’d) A preoccupation with possible unknown threats Chronic physical symptoms Pain Headache irritable bowel Efforts to avoid people or activities that may arouse recollection of the trauma Feelings of guilt No sense of a future

20. DSM -IV-TR, 2000 Common Feelings & Behaviors of Children Fears and anxieties Sleep disturbances School avoidance Somatic complaints Feelings of loss Regression Restricted range of affect

21. American Heritage Dictionary Stressor An agent, condition, or other stimulus that causes stress to an organism.

22. Seyle Distress

23. Seyle Eustress

24. (Taylor, 2006) PTSD and Refugees/Immigrants Many refugees/immigrants have experienced … Traumatic events in their country of origin Humiliation, torture, starvation, illness Exodus of their country Refugee camps

25. (Taylor, 2006) Narrative Exposure Therapy (NET) with Refugees 4 sessions (90 minute sessions) Psychoeducation—problem-solving about current concerns Recording client’s biography of traumatic events Discussion of traumatic events—client asked to relive distressing emotions Client given a copy of the biography and discussion

26. (Taylor, 2006)

27. Benefits of NET with Refugees/Immigrants Willing to enter treatment Fewer drop-outs Efficacy with traumatized children

28. Implications for School Counselors Classroom behavior Repetitive play reenacting event/theme Disorganized or agitated behavior Academic Performance Increased need for counseling services Family and school integration Awareness of psychopharmacology Educate faculty Flexibility Easing transitions

29. Resources Professional Organizations Colleagues Libraries Internet Yourself

30. What Did I Learn?

31. Questions