HealthyMind,HealthyFutureSymposiumVilmaReyes,Psy.D.UCSF

Objectives� Deepentheunderstandingofcomplextraumaanditsimpactonchildren’sdevelopment,learningandrelationalwellbeing

� Exploretheapplicationoftraumatothepresentdayforcibleseparationofchildrenfromtheirparents.Intersectionoftrauma,institutionalracismandxenophobia

� Wheredowestand?What’sourcalltoaction?

Theimpactoftrauma� Theprotectivesystemofanacutestressresponse(changesinourbiologytoactivatefight,flightorfreeze)ismeanttobetemporarywithareturntoacalmstatebaseline.It’snotmeanttobeachronic,pervasivewayofbeing

�  Ifit’schronic,thereisabreakdowninthebody’sstressresponsesystemandtheperson’scapacitytoregulateinternalstatesovertime

� Traumaticeventsoverwhelmthesystemthatgivespeopleasenseofcontrol,connectionandmeaning

Complextrauma� Multiple,ongoingtraumaticeventsofaninterpersonalnature.Inmostcases,suchtraumaincludesexposuretorepetitivechildhoodsexual,physical,psychologicalabuse,and/orfamilyviolence,ofteninthecontextofcoexistingemotionalneglect

� APTSDdiagnosiscapturesonlyalimitedaspectofthetraumatizedchild’scomplexself-regulatoryandrelationalimpairments.Thetemplateforallfuturerelationshipsandtheirsenseofidentityareimpacted.

Singleincidentvs.complextraumaSingletrauma Complextrauma�  Limitedexposureofmostcommonlyexternalthreat

�  Oftenwithincontextofotherwiseprotectivesystem

�  Onsettendstobelaterindevelopment

�  Supportofcaretaker/family�  Secureattachment

�  Multipleexposureofdifferenttypesoftrauma

�  Oftenwithinmultiply-stressedsystem

�  Onsettendstobeearlierindevelopmentstage

�  Oftencaretaker/familyissourceofthreat

�  Insecureattachment

Mediatingfactorsincomplextrauma�  Relationshiptoabuser�  Typeoftrauma,levelofintensityandinvasiveness�  Lossesassociatedwithabuse�  Reactiontodisclosure�  Ageoffirsttraumaexperience�  Communitysafety,poverty�  Accesstotreatment�  EnvironmentalSupports

�  Bestpredictorofoutcomeforchildrenfollowingatraumaticeventisthecaregiver’sabilitytocopewiththetrauma

Youngchildren

Attachmentbasedperspective� Youngchildrendevelopinthecontextofrelationships� Youngchildrenuserelationshipswithcaregiversto

�  Regulatephysiologicalresponse�  Forminternalworkingmodelsofrelationships�  Providesecurebaseforexplorationandlearning�  Modelacceptedbehaviors

Ü Youngchildrenwhoexperienceinterpersonalcomplextraumamaydevelopaviewofrelationshipsas:unpredictable,scary,punitive,andconfusing

Theimpactofcomplextraumaonyoungchildren� Thebrilliantdefensivestructureweareequippedwithisinsufficientforyoungchildrenwhoaretrappedinanabusiveenvironment

� Whenneitherescape(flight),resistance(fight)ordisconnection(freeze)areeffectivestrategiestokeepyousafe,theprotectivesystemdisintegratesanddisorganizes

Thecostsofadaptationforchildren� Adaptingtoaclimateofchronicabuseandtraumarequiresconstantalertness(constantlyscanningforwarningsingsbybeingoverlyfocusedonthemood,facialexpressions,voiceoftheadultsaroundthem)

�  “Frozenwatchfulness”effortstoavoidabusebybecomingimmobile,invisible,non-existent

� Theymaytrytogaincontrolofthesituationbybeingoverlycompliantormaytrytoconstructasystemofmeaningthatjustifiesit(blamingthemselvesandbelievingtheirinnate“badness”isthecause)

Impactonbraindevelopment

(AscitedbyFelitti&Anda,2003;SourceCDC)

ThinkingBrain:PrefrontalCortex

WhatHappensWhenWeAreAfraid

Danger!

Thenervoussystemisre-wired� Thebrainiswiredfordanger.PeoplewithuntreatedPTSDsymptomstakelongertofallasleepandawakenmorefrequentlyduringthenight

� Traumalivesinthebody:Musclememoryandpreverbaltrauma.Thephysicalbodyretainsamemoryofwhatthemindexperiencesandthemind,orbrainandnervoussystem,retainamemoryofwhatthebodyexperiences

Theimpactoftraumaonlearning� Criticalwindowofbraindevelopmentisbetweenbirthandtheageof5

� Neuroplasticityistheprocessbywhichourbrainsareshapedbyexperiences.�  Synapticplasticityisthestrengthoftheconnectionsbetweenthebraincells

�  Cellularplasticityisthenumberofconnectionsbetweenbraincells.

�  0-5isauniquetimeofdevelopmentwherebothtypesofneuroplasticityaretakingplace.

Impactoncognitivedevelopmentandlearning� Exposuretotraumaislinkedtolearningandbehaviorproblems,includingdifficultiesinthefollowingareas:�  language,communication,andproblemsolvingskills;executivefunctioning;regulatingemotions,andpeerandteacherrelationships.

� Traumaisalsolinkedtoanincreaseinimpulsivityandaggressiveness.Achildexperiencingtraumacanhaveadifficulttimeconcentrating,followinglessons,andsittingstill.

www.nctsn.org

Impactoftraumaontheparent-childrelationship

�  Shattersthedevelopmentalexpectationofprotectionfromtheattachmentfigure

� Theprotectoreitherbecomesthesourceofdanger,isunavailableorcannotprotectthemfromthesourceofdanger

�  “Unresolvablefear”:Nowheretoturnforhelp-Whoissafeandwhoisdangerous?

� Contradictoryfeelingstowardtheparent�  (Pynoos,1993;Main&Hesse,1990;Lieberman&VanHorn,1998)

Impactoftraumaontheparent-childrelationship

� Eitherpartnermaydevelopnewnegativeattributionsbasedontraumaexperience�  Changestointernalworkingmodels�  Traumaticexpectations

� Caregiverandchildmayserveastraumaticremindersforoneanother

Pynoos,1997

Impactoftraumaonparent-childrelationship� Whenthecaregiverhasalsoexperiencedinterpersonaltrauma:�  Thecaregiver’sabilitytoestablishandmaintainanempathicrelationshipwiththechildmaybeimpaired

�  Thecaregivermayhaveadecreasedcapacitytorecognizedangerorstress

�  ParentmayhaveuntreatedPTSDsymptomsthatwouldmakethealreadydifficulttaskofparentinganenormouschallenge(constantstageofvigilanceandirritability,senseofdisconnectionfromothers,feelingsofbadnessasaparent/person,difficultyregulatingemotions,etc.)

StandingbywhatweknowInsummary,wecanconfidentlystandbehindthousandsofscientificstudiesthatsupport:1) Childrenneedastablerelationshipwithaprimarycaregivertodevelopastrongfoundationforhealthydevelopment2) Highandpersistentlevelsofstressistoxictobraindevelopmentandhasseriousnegativeconsequencesonchildren’shealth

Howcanweapplychilddevelopmentandtraumatheorytothecurrentimmigrationpolicy?

Thereisnoquestionthattheimmigrationpolicyofseparatingyoungchildrenfromtheirfamiliesiscausingdeepandlonglastingdamageforboth

theparentsandthechildren

“What’swrongwithmyson?”�  https://www.youtube.com/watch?v=7ZutQCfAqBI�  Reyes-Mejiafamily(apseudonymousnameforthesakeofsafety)cametotheU.S.fromHondurastoescapeviolentcrime.Theypresentedthemselvesatabordercrossingfacilitytoseekasylum.

�  Thefather,Ever,wastoldhecouldbrieflyleavehissonaloneatadetentionfacilitywhilehecompletedsomepaperwork.Whenhereturned,theboywasgone.ImmigrationandCustomsEnforcement(ICE)agentshadtakenhimtofostercareinMichigan.

�  Hisresponseatreunificationwithhismother(after3.5monthsofseparation)isanexampleofthedeeplytraumaticimpacttobothchildrenandparentswhentheyareforcedtoseparate

�  TheACLUestimatesthat528migrantchildrenremainseparatedfromtheirfamiliesinfederalcustody

Mediatingfactorsinforcedfamilyseparations(Accordingtothebiologyofadversity)� Age:Youngerchildrenaremostvulnerableastheirbiologicalsystemsareunderdevelopedandtheyaremostdependentontheirparentsforemotionalco-regulationandprotection

� Previousharm:Refugeefamiliesareescapingpersecution,pervasiveviolence,assaultsandoftendeepdeprivationandpoverty.

� Thedurationofseparation:Prolongedseparationinflictsgreaterharm

Pervasivediscriminationandoppression� Historicaltrauma(Historyofforcedfamilyseparationsforfamiliesofcolorandindigenouscommunities)

�  Anti-immigrantrhetoric�  Constantstateoffear�  Institutionalracism�  Socialinequityandinjustice�  Implicitbiasandmicroagressions�  Theremaynotbeaparticularincident,buttherecouldbeacumulativeimpactfromfeelingfrightenedinyourhome,community,orwitnessingyourparentbeingfrightened/feelingthreatened.

Possibleuniquesourcesoftraumaticstressforimmigrants�  Socialmarginalization�  Isolation� Poverty� Untreatedmentalhealthsymptomsfrompre-migrationormigrationtrauma

� Housingdifficulties(cost,lackofdocumentation/credithistory,overcrowding)

�  Fearofseparationordeportation

Unaccompaniedrefugeeminors68,541unaccompaniedrefugeeminorsmadethejourneyfromCentralAmerica.Themajoritywereescapingviolencefromorganizedgangs(61%inElSalvador,43%inHondurasand31%inMexico).ChildrenfromGuatemala(29%)identifiedextremepovertyandhungerasthemainreasonforfleeing

Familyseparation�  Forcedfamilyseparationduetoimmigrationpolicy� Temporaryplannedseparationwhencrossingtheborder(childrenbeingtransportedbypeopletheydon’tknow)

�  Familiesdividedduetotheforcedexileofcertainfamilymembers(parentsmigratingfirstandleavingchildrenwithfamilymembers,oftenreunifyingyearslater)

� Howarethesefamilieshelpedinhealingthewoundsoftheseparationwhentheyreunite?

Posttraumaticstrengthandresilience

OptimismandBravery� Theimmigrantstoryisnotonlyofthetraumaonehaslivedthroughortheoftenhorrificjourneygettinghere…it’salsoastoryofhope.It’sastoryofbelievingthatsomethingbetterispossibleforyouandyourchildren.Thereyouwillfindtheprotectivenarrative.

� Restoringtheprotectiveshield

Transformingtrauma

Relationship-basedwork� Themainhealingagentinyourworkistherelationshipyoucanbuildwiththem

�  Itisanhonorforpeoplewhohavebeenhurtinthepasttotrustyou.Youmayhavetoearnthattrust;theirdefensivestructureisalertingthemtobecautiousofclosenesswithothers

�  Seeandreflectthebestinthem;trulybelievethattheycanfindtheirpath

� Whenthereisarupture,makeattemptstomodelrepairinrelationships

Speakingtheunspeakable� ParentsUNDERSTANDABLYneedtobelievethattheirchildren/youthwerenotimpactedbytraumaticevents.Onefirsthastoshowparentsyouunderstandandalignwiththiswish.

� Acknowledgementofthechild/youth’sexperience:Whenit’snottalkedabout,children/youthareleftwiththeirsensoryexperiences,fears,andquestionswithoutaguideastohowtounderstanditandtalkaboutit.Howwouldyoulikeyourchildtounderstandyourfamily’sstory?

Theelephantintheroom•  Whenchildren/youtharenotgivenanarrativeinwhichto

understandtheirexperience,theymaymakeuptheirownexplanationstotheviolencetheywitnessed.

•  Children/youthtendto:•  Believeit’stheirfaulttheviolencehappened(egocentricstageincognitivedevelopment)

•  Formgeneralizedworries(ifoneparentabruptlyleft,theymayworrythattheothercaregivermayalsoabruptlyleave)

•  Mayreceivethemessagethatit’snotoktotalkabouttheirexperiences/feelings/memories.Mayfeelburdenedandalonebyholdingthissecret

•  Mayfeelinvalidatediftheyaskaboutwhathappenedandaretoldthat“everythingisok”whentheyknowthatit’snot

Whatyoucandoifacaregiverisnotinvolved/present�  Sometimeschildren/youthareremindedofatraumaandstartsharingpartoftheirstorywithmedicalproviders,teachers,couches,childcareproviders,casemanagers,etc.

�  Ifyoudon’thaveimmediateaccesstoacaregiveranddon’tknowhowthecaregiverwouldlikethechild/youthtounderstandwhathappened,justreflectbackwhathe/sheistellingyouandhighlightthefeelingstheymayhaveasaresult.Refrainfromaskingquestions

�  Ifpossible,followupwiththecaregiverlaterandassesswhethertheywouldlikeyoursupport

Family-basedinterventions�  Studiesshowthatlessparentaldistressandmorefamilialsupportmitigatesthenegativeimpactoftraumaonchildren.Interventionsthathelptheparentresolveemotionaldistressaboutthechild’strauma,andwhichenhancetheparent’sabilitytosupporttheirchild,willmaximizethechild’soutcomeintreatment(Cohen,Mannarino,andDeblinger,2003).

CulturalHumility

� Lifelonglearningandcriticalself-reflection� Recognizingandchangingpowerimbalances� Developinginstitutionalaccountability

(Tervalon&Murray-Garcia,1998)

“Morethanaconcept,CulturalHumilityisaprocessofcommunalreflectiontoanalyzetherootcausesofsufferingandcreateabroader,moreinclusiveviewoftheworld.”

Vicarioustraumatization�  Itisaprivilegetohearaboutotherpeople’spain,butitcomeswithacost.Beingexposedtoothers’traumaticmaterialmayresultinpsychologicaldistressandsymptomsthatmimicPTSD

� ThisisdifferentthanBurnout-whichisagradualprocessofphysical,emotional,andmentalexhaustioninresponsetojobstressors.Burnoutisgradual,whereVicariousTraumatizationtendstobemoresudden

Vicarioustraumatization� Payattentiontoyourinternalreactionswhenworkingwithfamilieswhohaveexperiencedtrauma� Whataresignsyoucanidentifyinyourselfwhenyouneedextrasupport?

� Howcanyouregulateyourfeelingsinthemomentwhenfamiliesevokeemotionsinyou?

� Whatdoyoudoregularlytoremainbalanced?

Wrappingup1)Howdoesthisinformationinformyourcalltoaction?Takeaminutetoreflectonthewaysyoucanbeanagentofchangeandhopeinwhateverroleyouarein2)Supportandaccountability:Weareinthistogether.Turntothepersonnexttoyouandshareoneofthereflectionsthatcameupforyou(inquestion1)

� Questionsandcomments?