Transcript N/D Evaluation and TA Center: Leveraging Our Resources

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:
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 12-17 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 stigmaladen
– 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.
[email protected]
202-403-5180