OVC Provider Forum Transcript

Inner City Posttraumatic Stress
Dr. John Rich, Linnea Ashley  -  2016/2/24
In order to reduce trauma for all children, have you considered or even heard of the Pax Good Behavior Game. Pax GBG has evolved from a research program in the Baltimore elementary schools around 1986. A fairly easy teaching technique reduces daily classroom disruptions by up to 90%. But 15 years later, it reduced substance abuse, violence, delinquency, special services, depression, suicide, even smoking, by 35 to 70%. It also increased grades, graduation rates and college admissions. And that was after only one year of use in first grade. Pax has strategies for including families and showing parents how to deal with their children better. Reduces victims by reducing violence. Helps heal victims by a positive school and home environment.
1.  John Rich
 Thanks for your comment. The Good Behavior Game is indeed an evidence based classroom management program that has been shown to decrease aggressive behavior among elementary school youth ages 5-11. While not specific to post traumatic stress, the program has been shown, as you point out, to decrease a range of risk behaviors and improve outcomes.
I am curious about how much trauma in children is misidentified as ADD, ADHD or oppositional defiance disorder? Esp. as it relates to discipline in schools and incarceration rates.
1.  Linnea Ashley
 Trauma symptoms can include mismanagement of emotions, sleep issues, and inability to focus, among other things. Those can occur with other diagnoses as well as being misinterpreted. We find at Youth ALIVE! trauma symptoms are sometimes are interpreted as simply bad behavior which leads to discipline rather than the care that is actually needed. Discipline can be triggering and it can exacerbate the existing symptoms. Also, trauma makes it harder for people to learn and focus. So, again, people can misinterpret a person's willingness to engage as disinterest when it isn't.
Information on training programs for clergy and leaders of faith communities on trauma informed practices. Model programs that integrate prevention and direct services for victims of crime
1.  Carlos Velazque
 Thank you I will look up the link. Let me comment that I have found the book "Risking Connections in Faith Communities : a training curriculum for faith leaders supporting trauma" a useful tool. Thanks again .
2.  John Rich
 Thanks for raising the faith community as critical resources for trauma. While not specifically limited to clergy, the Sanctuary Institute in Yonkers NY conducts training in the Sanctuary Model, which provides an organizational framework that can be adapted to the specific environments. Typically a group of leaders from a faith community will attend the training together to not only learn about trauma, but to work together on a process for implementing trauma-informed practice in their setting. Information about the Sanctuary Institute can be found here: http://thesanctuaryinstitute.org/
Greetings from windy, snowy Chicago today! As the community violence epidemic here in Chicago grows daily, we've been working diligently on launching a Violence Prevention Campaign aimed at preventing the devastating, traumatizing and deleterious effects of violence in our most vulnerable communities. What you would you suggest we should focus on primarily, and what do you think people in these communities want addressed most? How can we help them most through this campaign?
1.  Linnea Ashley
 I am not familiar with this particular program but I will look into it. I am curious, has it been used in low income communities and communities of color with similar results. A lot of the research around trauma does not focus on people of color and that is problematic. Youth ALIVE! is developing a trauma symptoms screening tool called START that we created in part to fill that research gap. It was created with young men of color to make sure it worked for them.
2.  Dina
 Thank you so much! I will definitely look into this. I don't think I'm familiar with Pax GBG. I really appreciate it.
3.  Richard Seitz
 Your program sounds great for the victims in hospitals. For true prevention, a proven universal strategy called the Pax good Behavior Game can reduce/prevent violence, delinquency, conduct disorders, drug abuse, even ADHD severity. Problem is that it is not a curriculum but a simple teaching strategy. Schools think it is a behavior mod system and every principal has their own favorite, none of which has the gold standard research of GBG. Violence prevention people, drug abuse people, anti-smoking people, etc, all operate in silos and want "their" money spent on flyers, brochures, speakers, "education" on the dangers of (fill in blank),town hall meetings, campaigns, task forces, PSAs and other mostly useless things specific to the ill.
4.  Dina
 Oh wonderful! If you don't mind, I can definitely e-mail you about this. I would greatly appreciate it! Thank you, Linnea!
5.  Linnea Ashley
 I am definitely the person you should talk to. I am out of the office (mostly) through Monday but I'd be happy to chat with you or email with you about whatever questions you have.
6.  Dina
 Thank you so much for all your help! I really appreciate it! I would definitely love to learn more about Youth ALIVE! and its interventions, especially its high school program. Can I find this information on your website? Would that be the best resource?
7.  Linnea Ashley
 Finally, trauma informed care in schools and detention centers (and just in general) can be helpful to provide services for people who may have symptoms of trauma that make them vulnerable to violence.
8.  Linnea Ashley
 Greetings to you! I think working directly with communities to find out what their needs are is always a good start. Communities differ and so solutions must be tailored to them. Youth ALIVE! and programs all over the world, offer Hospital-based Violence Intervention Programs. Those are interventions directed at violently injured people while they are in the hospital. They are an extremely vulnerable group and working with them can also help tamp down retaliation if that is a problem. Mental health services through peers or providers who understand community violence and are transparent and open has also been helpful. Also, we offer a high school program that teaches violence is preventable, reaches down to younger kids, and gets students engaged in their community.
Have either of the hosts ever been involved with and/or aware of any evaluations on these types of programs/service approaches?
1.  Linnea Ashley
 I can speak to Hospital-based Violence Intervention Programs (HVIPs). We have done some research and are in the process of doing more right now. You can find research about HVIPs here: http://nnhvip.org/research-information-for-resource-page/. And if you are interested in learning more about them please feel free to contact me directly.
have inner city people been going thru ptsd since the end of slavery,is this the reason we're so numb to violence
1.  Linnea Ashley
 There has been some research as of late about trauma being passed through generations and there is a book about slavery and trauma specifically: http://joydegruy.com/resources-2/post-traumatic-slave-syndrome/. That said, numbness to emotion can be a symptom of trauma either through direct experience of trauma or witnessing it. In homes or communities with extensive trauma people may appear to be numb. It isn't a lack of caring so much as an inability to access those emotions.People can work through that but it requires care and attention.
I love the topic, can you give a brief explanation as to what Inner City Posttraumatic Stress is and how its different from other forms of Posttraumatic Stress?
1.  Karen Hall
 In that scenario, it appears that health professionals need to be educated. This is also were health disparity comes into play, when one group is treating differently than another. Thanks for your response. One final note, I grew up in the City of Detroit and my friends who lived in the suburbs called me paranoid. Very interesting.
2.  Linnea Ashley
 One more thing to consider is how people perceptions of the same symptoms vary depending on who is exhibiting them. A colleague in Boston talked about the Boston marathon shooting and how people arrived screaming and cursing and generally bewildered, as you might expect, and they were tended to with care and patience. But she noted that on the weekends when someone was shot and people presented acting in similar ways, security is called and the same patience and understanding is not extended.
3.  Linnea Ashley
 Often times when people talk about PTSD it is in reference to circumstances that people experiencing the trauma, come home from or are able to escape. In violent communities, there is often difficulty in escaping it because it happens where they live. If you are shot in your community or someone you know was, you still have to live and function there which can be triggering. It also changes the dynamic some, when people talk about paranoia being a symptoms- someone who experienced trauma where they live is not being paranoid so much as learning from a previous experience.
Are there any specific resources you wouldn't mind sharing with us here in Chicago, addressing public health disparities as they relate to the community violence epidemic? Any specific rates as well as proposed, sustainable solutions for those most vulnerable?
1.  Dina
 Most definitely that would be amazing!! We are working on our webpage, but we have a Facebook page that we're hoping to make stronger so we can really get the message out. Chicago's communities have been plagued with so much violence and trauma and pain. It's the Urban Youth Trauma Center and our page is at https://www.facebook.com/UrbanYouthTraumaCenter/?ref=bookmarks
2.  John Rich
 Your work sounds very powerful. Please share what you learn with the broader community of people who are working to heal the hidden wounds of violence so that young people can reach their true potential.
3.  Dina
 Thank you, Dr. Rich! Yes, this is definitely what we strive to do here at the Urban Youth Trauma Center. To use trauma-informed practice and apply our 5 Best Practices. We're hoping to galvanize people in the communities here in Chicago that have been impacted the most by violence, and launch a Prevention Campaign to get people to participate and remain involved. It's called the "If Youth Can, then I Can!" Violence Prevention Campaign.
4.  John Rich
 Most, if not all of these programs have incorporated a degree of trauma-informed practice, so that young victims receive not only concrete services, like case management, but also trauma-related services.
5.  John Rich
 Healing Hurt People currently operates in Philadelphia, PA, Chicago, IL and Portland OR. However there are a number of hospital based violence intervention programs across the country. You can see a map of program locations here: http://nnhvip.org/
6.  Participant
 Dr. Rich, Is Healing Hurt People only in the Chicago area? Cleveland, Ohio
7.  Dina
 Yep! Love them. Dr. Stolbach does such wonderful work! Thank you for mentioning that.
8.  John Rich
 Part 2: I have also seen the school-based program Becoming a Man (BAM) in action in a number of Chicago schools. This program takes a broad healing approach to school aged boys from neighborhoods where trauma and violence are common. The evaluations of the program have been positive.
9.  John Rich
 Part 1: There are a number of resources that I can mention. The first is a program called Healing Hurt People, that operates out of Stroger Hospital. The program works with youth who have been victims of violence to help heal their trauma and prevent them from being injured again. They specifically focus on youth who come to the hospital with violent injuries.
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