The June 2014 Shared Prosperity Philadelphia Roundtable, titled The Trauma – Poverty Connection, featured complementary presentations on the topic of trauma and poverty from Dr. Roy Wade, Instructor of Pediatrics (Children’s Hospital of Philadelphia) and Diane Wagenhals, Program Director for Lakeside Educational Network. Eva Gladstein, Executive Director of the Mayor’s Office of Community Empowerment and Opportunity (CEO), opened the roundtable with an introduction of the Shared Prosperity Philadelphia anti-poverty plan and remarks on the enormous potential that the research on trauma has to transform the ways that we think about and intervene in the lives of the poor. Suzanne O’Connor (United Way of Greater Philadelphia and Southern New Jersey) introduced the speakers and the topic of trauma informed care. She also talked about the important role of programs such as the United Way’s Healthy Family Initiative and the Institute for Family Professionals in educating social service providers on the principles and techniques associated with trauma informed care.
Dr. Roy Wade: Dr. Wade’s talk opened with an overview of the findings from the first published study on the correlation between exposure to Adverse Childhood Experiences (or ACEs) and adult health outcomes. The research, which was sponsored by the Centers for Disease Control and Kaiser Health in 1998, identified ten kinds of events or situations that defined Adverse Childhood Experiences:
- Abuse (psychological, physical, or sexual);
- Household dysfunction (substance abuse, mental illness, domestic violence, criminal behavior /incarceration, divorce); and
- Neglect (emotional, physical).
The ACE score was constructed to capture the incidence of exposure to each of the ten types of adverse childhood experiences, and yielded an index ranging from a minimum of 0 to a maximum of 10. The study revealed both a surprisingly high prevalence of adverse childhood experiences in the surveyed population (which consisted of middle aged, middle class residents of San Diego) and a positive correlation between the ACE score and poor health outcomes later in life, including cardiovascular disease, diabetes, and mental health problems. Dr. Wade’s presentation also touched on the science of early childhood trauma and its effect on brain development (such as damage to the amygdala and delayed development of the pre-frontal cortex), as well as the biology of stress responses through the inflammatory effects of excess cortisol.
Dr. Wade’s own research has involved investigating the nature and incidence of ACE in urban populations. The Philadelphia ACE study was conducted to capture a wider range of traumatic experiences and to understand the impact of ACE in typical urban environments. The Philadelphia ACE study added five new definitions of trauma to the original ten: (1) experiencing racism, (2) witnessing violence, (3) living in an unsafe neighborhood, (4) being placed in foster care, and (5) experiencing bullying. The Philadelphia ACE score ranges from a minimum of 0 to 14.
Like the original ACE study, the Philadelphia ACE Score was found to have a positive correlation with health problems and risky behavior. The one notable exception was cardiovascular disease. However, Dr. Wade indicated that this was likely due to the significantly lower mean age of the Philadelphia study participants (34 years) compared to those in the original study (56 years). After taking the audience through the complexities of brain chemistry and development, gene theory, and epi-genetics, Dr. Wade shared the implications of these findings for those living in conditions of concentrated poverty, the poor, and minorities who may have experienced the trauma of racism, and the potential for lingering impacts of stress and trauma across generations.
Diane Wagenhals’ presentation began with a brief overview of the Institute for Family Professionals, which provides training to service providers in the trauma informed care approach, and its work with the City’s Department of Human Services, United Way programs (the Healthy Parenting Initiative and Success by 6), and the School District of Philadelphia. Her talk placed the study of trauma in a historical context and offered detailed definitions of trauma and its most common symptoms. She defined trauma in the following terms:
- An overriding emotional event involving deep distress, alarm, fear or terror;
- The event is perceived as inescapable
- The person’s neurological landscape…is suitable for an event to be encoded as a traumatic memory or imprint.
- Unresolved trauma leaves a person vulnerable to triggers, flashbacks, re-enactments, poor self-regulation, inabilities to focus, learn, and reach potentials.
Wagenhals used a device called a “trauma shroud” to illustrate the way in which unresolved trauma forms an invisible barrier that often hinders treatment. The barrier may stem from behavior patterns of hyper-arousal, which can cause traumatized children to get labeled as troublemakers or “difficult.” Without intervention, secondary issues emerge creating a second shroud of hopelessness, shame, powerlessness, chronic anger and hyper-vigilance. She shared findings from several studies showing the social problems, financial cost, and personal harm that can be linked to unresolved trauma.
Wagenhals highlighted several promising interventions, such as Trauma Focused Cognitive Behavioral Therapy (TFCBT); Emotion-Focused Therapy (EFT); the Sanctuary Model (developed by Dr. Sandra Bloom); as well as “somatic approaches,” which involve music therapy, meditation, and rhythmic exercises such as rocking, bouncing, or drumming. She described trauma informed care as a new paradigm that is slowly finding acceptance in the medical establishment, and raised the example of the eventual triumph of germ theory with the discovery of penicillin, after decades of resistance from physicians.
In the round table discussions, the participants were challenged to consider the ways in which living in a state of poverty could lead to experiences of trauma and, conversely, the ways in which unresolved trauma can contribute to chronic poverty. The questions posed and the content of the discussions served to illustrate the potentially critical role that a trauma informed care approach could have in breaking the cycle of poverty.
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