Children, Culture and Trauma Larke Nahme Huang, Ph.D. American Institutes for Research for Congressional Briefing Nov 16, 2005

Key Messages Our children are increasingly exposed to trauma and at early ages We know how to intervene to prevent negative outcomes Culture makes a difference in the experience of trauma and the intervention

Key Questions: Key Questions: Do we as a society value all of our children? Will we provide the resources to support and intervene early to prevent negative outcomes for our children exposed to trauma?

What do we know about prevalence of trauma for children? Startling rates National sample of year olds: –8% reported sexually abused –17% physically assaulted –39% witnessed to violence North Carolina Study –25% children ages 9-16 experienced at least one traumatic event by age 16

What do we know about the impact of trauma on children? Real neurophysiologic changes –Research has identified numerous malleable influences on child’s development –non-invasive imaging techniques can show impact of psychological trauma, maltreatment, sensory neglect, and the role of experience on developing brains of children. (actually see underdevelopment and smaller size of brain, and changes following careful, continuous intervention. Psycho-social impairments –PTSD; Anxiety, Depression; Impulsive, Aggressive Behavior Academic/school disruptions

What do we know about the impact of trauma on children? Intergenerational effects –Protective shield of parents disrupted; parental depression; parent experience of trauma – transmitted to children Developmentally-based outcomes Some children cope well, others have negative short- and long-term reactions

What do we know about prevention and intervening early for children exposed to trauma? Intervene before problems become intractable. –Many adult disorders have their origins childhood (Kessler) Children best served in their natural settings, e.g., home, school, health care clinics Psychological First Aid – Developmental Interventions Increasing fiscal analyses showing return on prevention investment

What do we know about trauma and ethnic minority children? Triply jeopardized by –Minority status and risk factors such as stigma & discrimination, less access to resources –Disproportionate rates of poverty –Linguistic isolation - 35% Asian American families Culturally-based explanations of trauma and help-seeking Compounds difficulties finding appropriate resources and assistance

Hurricane Katrina and the Asian American Population Over 50,000 Asian Americans in Louisiana; ½ Vietnamese; over 10,000 relocated to Houston Re-traumatization –“Many immigrants, refugees – survivors of war, political turmoil” –“refugees” again, facing language and cultural obstacles” Unfamiliarity with accessing public assistance and navigating public agencies –“seek help from families and churches first” –“don’t know how to make our way through the different services and offices” Unfamiliarity with concept of “insurance” –“Came from a country that did not have insurance, this is foreign idea to us.”

Challenges Intergenerational conflict –“ elders want to return to homes, where it is familiar, children enrolled in new schools in Houston, no schools open in New Orleans…” Sense of “punishment” and confusion –“Children feel what did we do to deserve this? Why did it happen to us” –“Children feel isolated and uncomfortable in the new schools” Children’s anxieties about “fate”, fears, what will happen to them, their parents –“children have a sense of insecure future and parent’s can’t give them the answer…”

Challenges Language and Cultural Barriers –Outreach –Vital public information Breakdown of social fabric of community through dispersal and relocation – loss of critical asset –“we’re talking about 60-year olds knowing each other from the same villages in Vietnam… the core around which their lives evolve is gone now.”

Challenges Lack of connection between public service agencies and culturally-based community entities Getting resources to natural community supports –“people drove all around Houston, using precious gas, trying to find the service centers, they give up… services should have been located in Hong Kong Mall East…. Everyone knows about this place…”

What do we need to do for these children and families?

Infrastructure Issues Build relationships across agencies and ethnic community groups during times of non-crisis. Build on existing community strengths; own community as first-line of support –“many people dispersed by hurricane have been taken in by their own people….so the view of FEMA is that since they are not in shelters, they could not be a priority.” –“Parishioners gather at Father Vien’s church… they are fighting to stay united and connected.” Improve infrastructure for language and cultural services and explicit language service contracts –“churches and Buddhist temples, important gathering places for evacuees… volunteers translated FEMA forms for housing aid” Include representatives of community into disaster relief and preparatory team

Address the Interface of Physical and Mental Health Engage community health centers – less stigma- laden –Bridge Programs linking community counselor in health centers for Asian American populations Promote “connectedness” of these youth to their new schools; improve capacity of receiving teachers and schools –“sense of isolation and missing home makes it difficult to concentrate in school” Re-establish parents/adults as “protective shield” –Teach Culturally Competent Psychological First Aid Anticipate/ prepare for higher incidence of PTSD, given previous exposure to trauma and violence Access: language issues; 27% lack health insurance

How can these needs be addressed in legislation? Many of these services involve “case management” – retain as Medicaid service Health Disparities legislation – critical to include mental health/behavioral health services Support federal disaster relief Medicaid and SCHIP coverage (vs. state Medicaid waivers) to ensure benefits travel with evacuees

How can these needs be addressed in legislation? Provide flexible and full reimbursement through Medicaid/SCHIP for health care and behavioral health care clinicians, particularly bilingual providers, who cross state lines to provide services to evacuees Support agency contracts for ethnic community organizations that provide critical community support and language services Build the disaster/trauma infrastructure to meet language and cultural needs of diverse populations

The measure of a society is how it cares for its most vulnerable citizens…. We must- most urgently- care for the future of ALL of our children.

Thank You. Larke Nahme Huang, Ph.D