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Impacts of Trauma and Adverse Childhood Experiences

Impacts of Trauma and Adverse Childhood Experiences

Header_screen_shot_2018-07-02_at_7.45.04_pm
July 3, 2018 | Ron Spreeuwenberg
Part two of our trauma series


Episode #103: Part two of our trauma series. The new Salud America!research review shows that Latino youth (77.8 percent) are more likely than all youth (70 percent) to face “adverse childhood experiences” – poverty, neglect, abuse, or household dysfunction such as parental divorce, violence, substance abuse, mental health issues. Amanda Merck is spearheading our new toolkit, tentatively set for release on June 19, that assists schools in becoming trauma-sensitive.

About Amanda:

Public health professional interested in transportation and land use decisions. She curates content for national Latino-focused organization to fuel people to start and support policy, systems, and environmental changes to improve Latino child health, reduce disparities, and promote lifelong well-being.

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Amanda MERCK:
To help them feel safe and connected and have relationships, that's one of the most important buffers for childhood trauma and building resiliency. And then that has such a lifelong impact to reduce these disparities that they're seeing later on in life, too.

Ron SPREEUWENBERG: Hi, I’m Ron Spreeuwenberg, co-founder and CEO of HiMama. Welcome to our podcast about all things “early-childhood education”.


Amanda, welcome to the Preschool Podcast



MERCK:

Hi, thank you so much for having me on.

SPREEUWENBERG:

So today on the show we have Amanda Merck. She is a research area specialist at the Institute for Health Promotion Research at UT Health San Antonio. And we're here to talk to Amanda today about trauma sensitivity in childcare and school programs. Amanda, welcome to the show. Great to have you!



MERCK:

Hi, I'm so glad to be on the Preschool Podcast and talking about this really important issue, kind of known as one of the biggest know public health issues and that no one talks about. So, glad to be here.

SPREEUWENBERG:

So let's start off with the issue. Can you tell us a little bit about what this is, how big the issue is, and why it's something we should be talking about?



MERCK:

Yes. Childhood trauma –and I’ll just kind of explain these terms real quick, we kind of use some of them interchangeably – childhood trauma can refer to childhood abuse, sexual, physical, emotional, also neglect, maltreatment. It can be living with that parent with substance abuse or mental illness or an incarcerated parent. [It] can be death of a loved one. It can also be racism, discrimination, bullying.

And then there's other traumas, like here in Texas with Hurricane Harvey. There's other trauma like that. Some of those traumas in that household setting can also be referred to as “toxic stress”. So kind of looking at neglect, or maybe a parent with substance abuse issues, or just a parent who's maybe not a stable caregiver can create this toxic environment for a child known as “toxic stress”.

And the reason this is such a big issue is it happens a lot younger than most people think. And it's impacting childhood development. When they're exposed to chronic or repeated stress and traumas it delays, it impairs development and delays learning because these kids are in this… almost the kind of thing people are familiar with in survival mode. So they're almost in a survival mode of that fight-or-flight response. And this inhibits development through other neurological pathways that are important for more complex thinking and more cognitive functioning.

And when it happens early in childhood it impacts them throughout adolescence and through their entire adulthood. So they're a higher risk for mental health issues, mental disorders, but also higher risks for physical health issues, higher risk for cardiovascular disease, diabetes, infections.

And then as these kids are growing up and going through school they have some behavioral issues that are often identified as misconduct. And so these kids face higher rates of suspension and expulsion, they are missing school because of trauma they're facing, and then they're missing school because of the disciplinary consequences. And so then they fall behind their peers. And once that gap occurs it's really hard for kids to catch up. And usually they don't – they're at higher risk of dropping out of high school, at higher risk of teen pregnancy, of substance abuse themselves, higher risk of being involved in the juvenile or criminal justice systems. So that's why it's a really big issue. It's not just trauma that we think may impact memories, but this really impacts development and has a lasting impact.

SPREEUWENBERG:

Yeah, it's really crazy. We just did another episode about trauma related to the child migrant challenges in the U.S. and the impact of that on children. And I was so shocked by the extent of the impact on children at that young age. And you mentioned that fight-or-flight, it's just a natural thing.

So when we think about trauma and how it affects children, it's very clear that it has an extreme impact. How about in the school environment, though? A lot of our listeners on the Preschool Podcast work in an educational environment. What can schools and early-childhood education programs do to help students dealing with trauma?



MERCK:

Yeah, it's really important because kids spend so much time in the early-care setting and then in the school setting. And so for all of the providers and educators and really all staff involved it really helps for them to have an understanding of childhood trauma, of toxic stress, of these adverse childhood experiences. And when they understand what's kind of going on in a kid's life, and then beyond that when they have a better understand of the science behind it really is complex and it can be very overwhelming, how our brains work in these neurological pathways that are impacted by these stress response hormones. It can be overwhelming, and the tendency can sometimes be to oversimplify it.

But there are so many incredible resources out there and training programs out there, and speakers. And so kind of at first step in the early-care setting and the school setting is workforce development and professional development and training staff. And I definitely want to kind of wave the white flag here: there's no expectation that early care-providers or teachers need to become psychiatrists or psychologists. It doesn't need to be that extensive of an understanding of the science.

But there's a huge gray area that can help them better understand the science and easily, digestible ways and see. And when they do they see almost immediately they can identify 10 kids in their own class that they see, like, “Oh my gosh, this makes perfect sense. I know these kids must be going through something like this. I see how it impacts them.”

So that's kind of one of the first big steps, is to build up this workforce of understanding of this trauma. And that helps to break the segment. There is already so much stigma around mental health. And there's a lot of stigma, too, around this idea of grit and willpower and obedience, and you just “suck it up”, or the bootstrap mentality, cowboy mentality.

So a huge part of it is to build this workforce, to understand the science, to kind of break that stigma, to change this culture of understanding. And there's a lot of ways to go about doing that. It can seem overwhelming, but it can start with certain staff immediately, start with small presentations. And then there's a lot of resources out there for online training, for conferences to go to.

And then it gets them to kind of more systemic changes within the school governance policies and within early-care providers for, say, social emotional learning as they're bringing curriculum in to teach kids, social emotional learning to kind of build those skills. And then changing the school setting to improve access to behavioral and mental health services, it’s kind of another systemic change that can help build up that school environment. And that definitely includes collaboration with community, being a part of and knowing who out there in the community is working with kids and working with families and having that connection with them.

So those are all kind of… it’s a process, for sure. There are some organizations out there that work for a couple of years to be truly trauma-informed. But it starts with that understanding, for sure.

SPREEUWENBERG:

Yeah, that makes a lot of sense. The training piece, I can see that being so important. And then also the governance piece, and I know you mentioned a little bit earlier about things like suspensions. And we've had even on the podcast parents and families, which is why I think it's worth reiterating that parents who have said to us that oftentimes these challenges fall back on them. And the school or the childcare programs see a child with behavioral issues and they're just pushing that back on the family and saying, “It's your problem,” where in reality there's a lot of support that schools and childcare programs can provide. And I think, like, the access to the behavioral mental health services is a really good example of that. So that's a very excellent feedback.

I guess I'll just give you a moment to comment on that before I go on to my next question about another project you're working on, which is specific to Latino childhood challenges with adverse experiences.



MERCK:

Yeah, like you said, how school can kind of push back and put the onus back on the parents. But schools really are in a unique and powerful position to better help support kids and families. And part of that culture shift is to pull back from the idea that educators are just in it for academics, because learning is driven and then it’s guided by emotion. So I like to ask: Ron, tell me, what’s one word that comes to mind when you think of a really good teacher you had in elementary school?

SPREEUWENBERG:

I would think the biggest thing is that they genuinely cared about me. Like, I got a feeling that if I had a question or an issue or I was challenged at a certain day school like they genuinely care to help me and talk to me and make me feel better, basically.



MERCK:

Yeah, okay, see, I love that. When I’ve asked other people that, and then when I reflect on my own experience, is, like you say, care and help. These are emotional words; these are emotional feelings that we connect with that academic setting. And it's something we feel when we think about it. We feel that it's got to be a safe, emotional environment to learn, to build on those academic indicators. And without addressing that, teachers and any educators and childcare providers are just going to come up against the wall, because if kids are in that safe setting then their brain is closed for business for learning.

So it doesn't do so much good for educators just to kind of put the onus on the parents to do more after hours if the whole day the kid is in this school or early-care setting and they're in a state of stress response and they're not able to learn. So that's where getting schools to see this important role they have is… learning experiences are not just academic. They are very much emotional and relational-driven.

SPREEUWENBERG:

Totally. I do want to ask you about Salud America, and I'm just looking here at my notes where it's saying your latest research review shows that Latino youth, 77.8% are more likely than all youth to face adverse childhood experiences, some of which you mentioned. And so can you tell us a little bit more about that, and about Salud America?



MERCK:

Yeah. Our project here in the whole Institute for Health Promotion Research is to look at health disparities and the research behind those, and then looking at maybe some inequity that is related to them or connected to them, and then looking at policies and programs to help reduce those disparities.

And so nationwide about 46% of youth are exposed to these adverse childhood experiences. However, among Latinos, was a study done on Latino adults asking them to look back at their childhood, it was like you said, about 77.8% were exposed to these early-childhood experiences. So already they're experiencing more of these that adversities, the trauma, the toxic stress that's impairing development and increasing their risk for mental and physical health problems later in life.

And we’re seeing that unfortunately Latinos have higher rates of obesity and diabetes, and some of these other disparities are connected to this and what happens in the early-care setting and in the early-school setting to help them heal from whatever trauma they may be facing. But also it’s just to provide that safe, supportive environment to where they can obtain all the academic benefits and they're not in that state of stress response where their brains are shut down.

But to help them feel safe and connected and have relationships, that's one of the most important buffers for childhood trauma and building resiliency. And that has such a lifelong impact to reduce these disparities that they're seeing later on in life, too.

SPREEUWENBERG:

And so you're talking a lot about disparities and that being a big focus of your work. Do you have any information or [have you] seen any information about disparities in participation rates in early-childhood education through any of your work? Have you seen that?



MERCK:

Yeah. So Latinos kind of historically have lower participation rates in a lot of assistance programs. And so that can be early-learning, early-childhood education, too. And that in itself can be connected to some other disparities seen later on. So [a] lack of kindergarten readiness, and so maybe they're already behind in kindergarten and then that gap continues to grow, linked to health disparities later in life.

And there's a lot of reasons contributing to Latinos’ lack of participation in early-learning. Some of it has to do with location. You've heard of “food deserts”? Well, there's “childcare deserts” as well. Some of it has to do with affordability and hours. And then some of it's cultural as well with more focus on the family, on having that family connectedness, on that family support. So they may rely on help and support of loving family members rather than going, seeking an outside source. So there's definitely a lot of a lot of underlying and complex social, environmental as well as economic and cultural issues connected to lower participation.

SPREEUWENBERG:

And so if you have a really strong family support network, I'm sure that will result in strong development at that young age. If, however, you are in an environment where you are exposed to some more adverse experiences, whether that be poverty, neglect, substance abuse or mental health issues and you do not have any access to early-childhood education, what is the impact of that, do you think?



MERCK:

Multiple issues are kind of compounding some of these negative effects. So if there are issues at home and issues at school and there's not a stable, caring adult or these connected relationships, that can have bigger implications later on. Even, say, in the future when a stable, caring adult does enter their life – which would normally act as a buffer – they're less receptive and less able to obtain the benefits from it because of that disconnect earlier in life.

So that disconnect in the home or the early care or the home in a school setting almost sets them up to miss out on that, the one thing that is the most profound support, which is a relationship. So it's almost a “double whammy”. And that's kind of another reason why we need this culture shift and change from academics being such a silo’d curricula, instead to look that social and emotional and that connectedness, because teachers never know – or anyone in a school setting never knows – what a child is going through.

And it may not be the home environment that is the source of the adversity or the trauma. It might be the school setting with potential discrimination or biases, and that could be what's setting these children in a state of feeling unsafe, in this survival mode where they're unable to learn.

SPREEUWENBERG:

Yeah, absolutely, and I think one of the huge, huge themes that I hear through the Podcast is how important relationships are. And you've really hit that point home today, too, with the relationships that you can build with your students and the children in your programs is just so important. Yes, curriculum is important, and yes, education and learning is important. But the relationships are just so critical. And especially when you look at some of these numbers that are shocking in terms of how widespread adverse childhood experiences are… like, I didn't realize the extent: 78.8% of Latino youth, for example. And then also the extent of the impact of that is just also so shocking, that the relationship piece is just so important.



MERCK:

Yeah, it really is, it's shocking. And with that early intervention, and sometimes it seems like people discredit relationships because it seems too simple or it doesn't have… I'm not sure what it is, but there almost seems to be that discredit of it. But it is, it's so powerful and so important. And for that… I keep calling it kind of that “bootstrap mentality”, for adults later in life that are maybe less receptive to the science and the messaging, the importance of a stable adult to prevent some of these impacts of childhood trauma.

So some of those adults that are less receptive to this, they tend to think that they got over it themselves and they got through just fine. And what a lot of research points to is, it's probably because they did have those relationships. That's what they had. And maybe they can't point them out specifically later on in life, but they had them early in life and that's how they got through that. And so we want to make sure that everyone dealing with kids understands this because it can be them, it can be about interaction of just creating safety. And then the brain is way more ready to learn.

SPREEUWENBERG:

Yeah, and you know what the other thing is about relationships is that it's a very intangible thing. And you can't measure it, right? So oftentimes we look at things that we can measure, so we can say, “Okay, this is how children are doing on this test,” and then we can test them again later and we can see what the impact was of our curriculum, or whatever. But it's so hard to measure the level of care in relationships when, in fact, maybe that is even more important. But because it's not measurable we don't really look as closely.

So certainly a lot of things we could continue the discussion on, but we're out of time so unfortunately we're going to have to wrap it up. But a lot of really awesome takeaways here, Amanda. If people are listening to this Podcast episode and they want to get in touch with you or learn more about your work, where should they go?



MERCK:

Yeah, go to visit our website: www.Salud-America.org. And right now we recently launched a toolkit with some actions that schools can take to start training, building this workforce and then start going towards some implementing social-emotional learning in their curriculum, alternative disciplines. So we have this toolkit to help them do that. So please visit our site, again it’s www.Salud-America.org.

And thank you so much, Ron. You were spot-on when you're saying that about [how] you can’t measure relationships that are kind of intangible then it is harder to put more support and momentum behind them.

SPREEUWENBERG:

Right, yeah, it's an interesting conversation. Amanda thanks so much for coming on the show. It's been a great pleasure having you.



MERCK:

Yeah, thank you so much, Ron.

Resources in this episode:

- Learn more about Amanda's work here.




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