tag:theconversation.com,2011:/us/topics/trauma-informed-39941/articlesTrauma-informed – The Conversation2023-10-10T22:53:10Ztag:theconversation.com,2011:article/2133492023-10-10T22:53:10Z2023-10-10T22:53:10ZWhy taking a trauma- and violence-informed approach can make sport safer and more equitable<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/why-taking-a-trauma-and-violence-informed-approach-can-make-sport-safer-and-more-equitable" width="100%" height="400"></iframe>
<p>Spanish football player Jenni Hermoso <a href="https://www.cbc.ca/sports/soccer/jenni-hermoso-sexual-assault-accusation-luis-rubiales-spanish-soccer-1.6957834">accused Spanish football chief Luis Rubiales of sexual assault in September</a> after he kissed her on the lips without her consent during the FIFA Women’s World Cup award ceremony. </p>
<p>Rubiales has since resigned from his job. And the incident has yet again highlighted the pressing need for action to support survivors and prevent sexual and gender-based violence in sports. It also underlined the sheer outrage of the public and <a href="https://doi.org/10.1080/10413200.2018.1564944">fuelled demands</a> for education, interventions and the dire need to overhaul and reform the sport sector here in Canada. </p>
<p>The <a href="https://www.who.int/violence_injury_prevention/violence/status_report/2014/en/">World Health Organization</a> has declared sexual and gender-based violence one of the most ubiquitous and complex global health issues. Canada has been going through its own <a href="https://www.cbc.ca/sports/sports-minister-carla-qualtrough-safe-sport-crisis-1.6959940">safe sport crisis</a>. The recent <a href="https://theconversation.com/hockey-canadas-problems-show-that-the-government-needs-to-regulate-sport-in-canada-192052">Hockey Canada crisis</a> boldly and publicly illustrated the need for better educational activities in youth sport. </p>
<p>In 2022, Hockey Canada’s CEO and entire board of directors <a href="https://www.cbc.ca/news/politics/hockey-canada-board-1.6612582">resigned due to their controversial handling of alleged sexual assaults</a>. Allegations of abuse in varsity sports across Canada have been on the rise, <a href="https://www.tsn.ca/u-sports/western-investigating-misconduct-allegations-within-women-s-hockey-program-sources-say-1.2006658">with the most recent allegations</a> put forth in September by the women’s hockey team at Western University. </p>
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Read more:
<a href="https://theconversation.com/hockey-canada-in-overtime-the-troubled-organizations-next-moves-will-determine-its-future-192304">Hockey Canada in overtime: The troubled organization's next moves will determine its future</a>
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<p>These issues have prompted public discussion around sexual violence, abuse and safeguarding sport. There is a need to develop both innovative interventions and unorthodox approaches at all levels — from the grassroots to the elite level — to truly make sport more equitable, inclusive and safe. </p>
<h2>Trauma- and violence-informed approaches</h2>
<p>Mainstream sport and physical activity programs rarely tackle social and structural inequities. In response, <a href="https://equiphealthcare.ca/files/2021/05/GTV-EQUIP-Tool-TVIC-Spring2021.pdf">a trauma- and violence-informed approach</a> calls for participants, coaches, managers and organizations to better understand the effects of systemic, structural and interpersonal violence. This approach is guided by <a href="https://equiphealthcare.ca/files/2020/01/EQUIP_GTV_TVIC_Principles.pdf">four tenets of trauma- and violence-informed care</a>: </p>
<p>1) trauma awareness; </p>
<p>2) safety and trustworthiness;</p>
<p>3) choice and collaboration; </p>
<p>4) strengths-based and capacity building.</p>
<p>In Canada, calls for a preventive approach to sexual and gender-based violence are loud and clear. There have been demands by <a href="https://www.scholarsagainstabuse.com/">scholars</a>, sport managers, policymakers, <a href="https://doi.org/10.3389/fspor.2022.840221">athletes</a> and coaches for sporting bodies and governments to better understand the <a href="https://www.cbc.ca/sports/scholars-against-abuse-jan23-1.6722975">widespread abuse in Canadian sports</a>. And yet, these issues remain understudied. </p>
<h2>Accounting for violence in sport</h2>
<p>Through our <a href="https://theconversation.com/levelling-the-playing-field-how-a-trauma-informed-approach-can-make-physical-activity-more-accessible-181952">community-based research</a>, we are working with diverse community organizations in Ottawa, Toronto and Vancouver on a multi-level, <a href="https://www.canada.ca/en/public-health/news/2022/10/government-of-canada-supports-projects-to-prevent-and-address-family-violence.html">pilot project that brings an understanding of trauma and violence</a> into their sport and physical activity programs and organizations more broadly.</p>
<p>Through this work, we aim to address and foreground the intersecting effects of systemic, structural and interpersonal violence in the development and delivery of sport and physical activity. To do this, we are using <a href="https://apwld.org/feminist-participatory-action-research-fpar/">feminist participatory action research</a> to better address the diverse voices, needs and concerns of community members. </p>
<p>This research involves piloting trauma- and violence-informed training modules for coaches/providers, alongside sport and physical activity programs that cater to their specific needs and priorities.</p>
<p>We have also explored what we can learn from sport for development programs across the globe. <a href="https://www.sportanddev.org/">Sport for development</a> positions sport as a valuable tool to achieve local, domestic and global development objectives, including those encompassed by the <a href="https://sdgs.un.org/goals">UN Sustainable Development Goals</a>.</p>
<p>For example, Women Win — an international organization that aims to advance girls’ and women’s rights through sport and play — supports <a href="https://doi.org/10.1108/9781838678630">sport, gender and development</a> initiatives to safeguard and support survivors while promoting health equity and safe sport. Their programming has been useful for promoting sexual and reproductive health rights and addressing sexual and gender-based violence. </p>
<p>Women Win has <a href="https://www.womenwin.org/grls/areas-of-expertise/">developed toolkits</a> to help youth address sexual and gender-based violence by transforming their attitudes and behaviours.</p>
<p>Other topics encompassed by the toolkits include using sport and play to build self-confidence, assertive communication, positive body image and self-advocacy. While a notable first step, it is important to ensure these tools don’t place the burden of preventing sexual and gender-based violence on the shoulders of survivors. </p>
<h2>Alternative solutions</h2>
<p>While <a href="https://brocku.ca/applied-health-sciences/kinesiology/faculty-research/faculty-directory/cathy-van-ingen-phd/">scholarship is growing in this area</a>, further research is needed to better understand how trauma- and violence-informed approaches to sport in Canada — alongside sport for development — may address systemic and institutional violence. Indeed, these approaches can potentially help self-identified women who have — and continue to — experience inequities and <a href="https://journals.sagepub.com/doi/pdf/10.1177/10778012221134821">barriers to participation in sport and physical activity</a>. </p>
<p>Managers, coaches and policymakers must gain a deeper understanding of interpersonal, systemic and sexual and gender-based violence, while also providing support to survivors. While Canadian sport for development organizations like <a href="https://shapeyourlifeboxing.com/">Shape Your Life</a> and global entities like Women Win offer promising strategies, additional resources are required to address these issues adequately. </p>
<p>Scholars and stakeholders have an opportunity to generate new ways of thinking about safe sport practices and policies promoted, for example, through sport for development programming that is survivor-led, trauma-informed and grounded in transformative justice. And while sport for development programs aren’t perfect, the sport sector would do well to build on the crucial groundwork organizations like Women Win and Shape Your Life have already laid out.</p>
<p>Trauma- and violence-informed approaches can potentially enhance safety across Canada’s abusive, patriarchal sporting culture. Now, more than ever, we need collaborative, evidence-based and novel solutions to address violence in sport and support survivors of sexual and gender-based violence. Because we can — and must — do better.</p><img src="https://counter.theconversation.com/content/213349/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lyndsay M.C. Hayhurst receives funding from the Social Sciences and Humanities Research Council of Canada; the Canadian Foundation for Innovation and the Public Health Agency of Canada.</span></em></p><p class="fine-print"><em><span>Francine Darroch receives funding from the Public Health Agency of Canada and the Social Sciences and Humanities Research Council of Canada.</span></em></p>A trauma- and violence-informed approach calls for participants, coaches, managers and organizations to understand the effects of systemic, structural and interpersonal violence.Lyndsay M.C. Hayhurst, Associate Professor, School of Kinesiology and Health Science, York University, CanadaFrancine Darroch, Associate Professor, Health Sciences, Carleton UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2077912023-06-22T22:14:58Z2023-06-22T22:14:58ZPreventing and addressing violence in schools: 4 priorities as educators plan for next year<figure><img src="https://images.theconversation.com/files/533292/original/file-20230621-27-llwb2o.jpg?ixlib=rb-1.1.0&rect=0%2C266%2C7396%2C4025&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ontario must prioritize funding for accessing essential social services to address the root causes of students' behavioural issues. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Farewell to another school year. In Ontario, after a return to full activities with academics, clubs and teams after pandemic shutdowns, it seems that schools were constantly in the news for negative reasons. </p>
<p>The public heard about a <a href="https://toronto.ctvnews.ca/york-catholic-district-board-students-deserve-to-be-safe-after-alleged-violence-erupts-at-lgbtq2s-walkout-1.6440138">lack of support for LGBTQ2S+ identities</a>, <a href="https://kitchener.ctvnews.ca/teacher-argues-school-board-violated-her-freedom-of-speech-when-her-presentation-on-library-books-was-cut-off-1.6428140">chaotic and divisive school trustee meetings</a> and a <a href="https://www.theglobeandmail.com/canada/toronto/article-ontario-teachers-violence-schools/">rise in violence</a> in schools.</p>
<p>A major contributing factor to this rise in violence in schools is <a href="https://www.thestar.com/politics/provincial/2023/04/20/there-will-be-an-impact-ford-government-shortchanging-school-boards-unions-say.html">the chronic underfunding of public education and the social service sector</a>. We need more infrastructure in communities that are economically neglected, often racialized communities. </p>
<p>In this challenging context, schools need to think hard about how they allocate resources and staff equitably, particularly now, at a time when they are approving their budgets for September. </p>
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<img alt="People seen lining up outside an apartment building." src="https://images.theconversation.com/files/532960/original/file-20230620-8426-rsjkhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532960/original/file-20230620-8426-rsjkhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532960/original/file-20230620-8426-rsjkhj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532960/original/file-20230620-8426-rsjkhj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532960/original/file-20230620-8426-rsjkhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532960/original/file-20230620-8426-rsjkhj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532960/original/file-20230620-8426-rsjkhj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Schools have faced challenges as students returned to full activities following pandemic shutdowns. Here, residents of Toronto’s Jane and Finch neighbourhood line up at a pop-up COVID-19 vaccine clinic in April 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Cole Burston</span></span>
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<h2>Violence in schools</h2>
<p>In the Toronto District School Board (TDSB), <a href="https://globalnews.ca/news/9705668/tdsb-students-involved-violence-2022-2023/">323 students were involved in violence between September 2022 and April 2023, meaning the year has been on pace to set a new record by the end of the school year</a>. </p>
<p>An alarming three-quarters (77 per cent) of members of the Elementary Teachers’ Federation of Ontario (ETFO), <a href="https://www.etfo.ca/news-publications/media-releases/etfo-member-survey-shows-violence-pervasive-in-schools">said they have “personally experienced violence or witnessed violence against another staff member</a>” in a recent survey conducted by Strategic Communications. Survey results are based on a weighted sample of 24,872 ETFO members’ responses. </p>
<p>Black and other minoritized youth and educators <a href="https://educationactiontoronto.com/articles/systemic-violence-institutional-apathy-and-the-death-of-222-school-aged-students/">are becoming collateral damage by being pushed out of schools due to wilful neglect of institutions in not supporting their needs</a>. For students, the effects can be deadly: there have been 222 homicides of school-aged children (students up to age 21 years old) since 2007 in Toronto, with the victims and perpetrators predominantly Black. </p>
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<figcaption><span class="caption">‘The School to Prison Pipeline in Ontario’ video from Black Legal Action Centre.</span></figcaption>
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<h2>The school-to-prison pipeline</h2>
<p>The school-to-prison pipeline continues to cast a dark shadow over the education system in Ontario. This “pipeline” refers to the systematic processes that push students, particularly those from disadvantaged backgrounds, <a href="https://www.kroegerpolicyreview.com/post/the-school-to-prison-pipeline-an-analysis-on-systemic-racism-with-ontario-school-boards">out of the educational system and into the criminal justice system</a>.</p>
<p>This trend disproportionately affects marginalized communities, particularly Black and Indigenous students, <a href="https://rsc-src.ca/en/covid-19/impact-covid-19-in-racialized-communities/racial-inequity-covid-19-and-education-black-and">perpetuating a cycle of poverty, systemic discrimination and mass incarceration</a>.</p>
<p>When <a href="https://theconversation.com/how-can-we-slow-down-youth-gun-violence-podcast-194145">Jordan Manners died 16 years ago, it was the first time a high school student had been fatally shot inside a Toronto school</a>.</p>
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<span class="caption">Jordan Manners’s mother, Lorraine Small, is comforted by her sister as she speaks at a news conference in Toronto in January 2008.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS</span></span>
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<p>Since that time, despite numerous reports commissioned and recommendations made by various stakeholders, <a href="https://www.falconerschoolsafetyreport.com/finalReport.html">little has been done to address the root causes of violence in schools and racialized communities</a>. There is no national strategy to prevent violence and homicide largely impacting Black and racialized communities. </p>
<p><a href="https://policyalternatives.ca/sites/default/files/uploads/publications/Manitoba%20Office/2015/09/Tough%20on%20Crime%20WEB.pdf">More policing and the tough-on-crime rhetoric is not the solution</a>, particularly with a mayoral election happening soon in the City of Toronto. </p>
<h2>Tragic impact on marginalized communities</h2>
<p>The school-to-prison pipeline encompasses various interconnected factors including <a href="https://colourofpovertyca.files.wordpress.com/2019/03/cop-coc-fact-sheet-3-racialized-poverty-in-education-learning-3.pdf">zero-tolerance punitive disciplinary practices in schools, over-policing of racialized communities, inadequate resources for students’ social and emotional well-being</a> and a lack of alternative support systems. </p>
<p>This is a result of many institutions and leaders at all three levels of government collectively failing to support the needs of racialized communities. </p>
<p>Suspensions and expulsions <a href="https://www.tdsb.on.ca/Leadership/Boardroom/Agenda-Minutes/Type/A?Folder=Agenda/20210623&Filename=CaringandSafeSchoolsAnnualReport201920204134.pdf">disproportionately affect marginalized students</a>. This is why as of 2020, <a href="https://nationalpost.com/news/students">Ontario’s Ministry of Education mandated no more suspensions for children from junior kindergarten to Grade 3</a>.</p>
<p>Indigenous and Black people are <a href="http://www.intersectionalanalyst.com/intersectional-analyst/2017/7/20/everything-you-were-never-taught-about-canadas-prison-systems">disproportionately overrepresented in the criminal justice system</a>. This disparity is rooted in systemic racism and a culture of institutional apathy which together perpetuates cycles of inequality, poverty and intergenerational trauma. </p>
<h2>Calls to action</h2>
<p>There needs to be long-term funding by all institutions to create infrastructure and access to timely and reflective social services for minoritized communities to mitigate and dismantle <a href="https://springmag.ca/rising-food-insecurity-and-the-cost-of-living-crisis">systemic inequities, such as the housing crisis and food insecurity</a>, contributing to the rise in violence in schools. A comprehensive approach is necessary. </p>
<p>Meanwhile, schools and school boards need to plan for the future. Important considerations include: </p>
<p>1) <a href="https://www.edutopia.org/blog/why-restorative-practices-benefit-all-students-maurice-elias">Implement restorative justice practices within all institutions</a>: Move away from punitive disciplinary measures and <a href="https://www.youtube.com/watch?v=quKa7C-wxZk">embrace restorative justice models that focus on repairing harm through trauma-informed and healing approaches</a>. </p>
<p>2) Allocate staff and resources equitably: <a href="https://peopleforeducation.ca/report/2022-annual-report-on-schools-a-perfect-storm-of-stress/">Ontario must prioritize funding for essential social services to address the root causes of students’ behavioural issues</a>, ultimately preventing students being pushed into the criminal justice system. Redirect funds towards mental health services, counsellors, social workers and community programs that prioritize <a href="https://yaaace.com/initiatives">prevention and timely intervention</a>. </p>
<p>3) Develop culturally responsive programs and services: <a href="https://www.wlu.ca/academics/faculties/faculty-of-education/assets/resources/edi-resources-for-educators.html">Inclusive curricula</a> and <a href="https://yaaace.com/social-inclusion-strategy">programs and services</a> that reflect the histories, cultures and contributions of diverse communities matter. </p>
<p>This helps foster a sense of belonging and connection and reduces the likelihood of student and staff disengagement. There needs to be a more urgent implementation of <a href="https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf">the Truth and Reconciliation Commission of Canada’s 94 Calls to Action</a>. </p>
<p>4) Establish community partnerships to mitigate risk factors during evenings and weekends: Forge collaborations between schools, community organizations and families to provide holistic supports <a href="https://theconversation.com/ontario-can-close-students-access-and-opportunity-gaps-with-community-led-projects-184301">and resources that address local community needs, particularly on evenings and weekends</a>. Such community partnerships create continuity of care for children and youth.</p>
<p>At the end of April, Ontario’s Ministry of Education <a href="https://news.ontario.ca/en/release/1002960/ontario-combating-violence-and-improving-safety-in-schools">announced funding to combat violence and improving safety in schools through community partnerships</a>. Such investments are critical.</p>
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Read more:
<a href="https://theconversation.com/ontario-can-close-students-access-and-opportunity-gaps-with-community-led-projects-184301">Ontario can close students’ access and opportunity gaps with community-led projects</a>
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<p>Yet, according to the Canadian Union of Public Employees, the provincial government has <a href="https://cupe.ca/fords-budget-risks-cutting-7000-education-workers-across-ontario#">used accounting tricks to disguise what amounts to a cut in public school funding for 2023-24</a>. Trustees with the Halton District School Board
say there is a $20-million funding shortfall, and <a href="https://www.insauga.com/school-classroom-cuts-predicted-as-20-million-shortfall-hits-burlington-oakville-and-milton/">funds for 2023-24 won’t support important classroom programs</a>. </p>
<p>If we do not systemically change our approach in how we support marginalized schools, students, parents and teachers, why are we surprised that the system keeps failing them? The effect of such failure is often the tragic outcome of death, being pushed out of schools or receiving a prison sentence. </p>
<p>We all have to do our part to hold institutions accountable, including for failures and neglect.</p><img src="https://counter.theconversation.com/content/207791/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ardavan Eizadirad receives funding from Social Sciences and Humanities Research Council (SSHRC) and is the Executive Director of the non-profit organization Youth Association for Academics, Athletics, and Character Education (YAAACE) in the Jane and Finch community. </span></em></p>A contributing factor to a rise in violence in Ontario schools is underfunding of education and the social service sector. Using trauma-informed responses is part of the solution.Ardavan Eizadirad, Assistant Professor, Faculty of Education, Wilfrid Laurier UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1937262022-11-15T21:41:18Z2022-11-15T21:41:18ZWe know better, so why aren’t we doing better in supporting the health of children and youth in care?<figure><img src="https://images.theconversation.com/files/494896/original/file-20221111-12-56ne9z.jpg?ixlib=rb-1.1.0&rect=550%2C44%2C6354%2C4446&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children and youth in care often have complex health and social issues, but they often struggle to access comprehensive health care.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/we-know-better--so-why-aren-t-we-doing-better-in-supporting-the-health-of-children-and-youth-in-care" width="100%" height="400"></iframe>
<p>Child welfare agencies encounter a higher percentage of children and youth with reported <a href="https://doi.org/10.1037/0735-7028.39.4.396">complex trauma exposure than any other system serving children</a>. </p>
<p>The <a href="https://www.preventchildabusenc.org/resource-hub/aces-study/?adlt=strict">Adverse Childhood Experiences Study</a> showed a correlation between traumatic exposures during childhood — such as abuse, neglect and household dysfunction — and increased health risk behaviours and poor health outcomes in adulthood. Subsequent research in the last two decades has supported the <a href="https://developingchild.harvard.edu/science/key-concepts/brain-architecture/">harmful impacts of childhood adversity</a> and <a href="https://developingchild.harvard.edu/science/key-concepts/toxic-stress/?adlt=strict">toxic stress</a> on <a href="https://doi.org/10.1542/peds.2011-2662">brain development and overall health</a>. </p>
<p>Despite this knowledge and research on protective factors that <a href="https://doi.org/10.1001/jamapediatrics.2019.3007">buffer impacts of childhood adversity</a>, there remains a paucity of supports for the needs of children and youth in the child welfare system. As a result, <a href="https://doi.org/10.1542/peds.2014-1150">these children and youth</a> continue to <a href="https://doi.org/10.1542/peds.2004-1311">experience poor health</a>, with <a href="https://doi.org/10.3389%2Ffpubh.2022.888995">intergenerational consequences</a> as those poor outcomes can later affect their own children.</p>
<p>The <a href="https://www.cwlc.ca/post/equitable-standards-for-transitions-to-adulthood-for-youth-in-care-public-report-policy-brief">Child Welfare League of Canada</a> recently released eight ‘transition pillars’ to support equitable transitions from care. Health and well-being transition improvements for youth with complex needs are mirrored by <a href="https://cps.ca/en/documents/position/transition-to-adult-care-for-youth">the Canadian Paediatric Association</a> as well. </p>
<h2>What do we know?</h2>
<p><a href="https://doi.org/10.1542/peds.2015-2655">Researchers in the United States found that</a> 60 percent of children who enter child welfare systems prior to their fifth birthday have a developmental issue. Between 30 and 80 percent enter care with at least one medical condition and up to 80 percent are living with a significant mental health need.</p>
<figure class="align-center ">
<img alt="A child in a yellow T-shirt looking up at a health-care provider out of frame, who is examining the boy with a stethoscope" src="https://images.theconversation.com/files/494897/original/file-20221111-9652-e2e7q2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494897/original/file-20221111-9652-e2e7q2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494897/original/file-20221111-9652-e2e7q2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494897/original/file-20221111-9652-e2e7q2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494897/original/file-20221111-9652-e2e7q2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494897/original/file-20221111-9652-e2e7q2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494897/original/file-20221111-9652-e2e7q2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is a shortage of supports for the needs of children and youth in the child welfare system. As a result, these children and youth continue to experience poor health outcomes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Across Canada, <a href="https://www.ohrc.on.ca/en/interrupted-childhoods?adlt=strict#4.5.Human%20rights-based%20data%20collection">Black, Indigenous</a>, <a href="http://dx.doi.org/10.1136/bmjopen-2019-030675">LGBTQ2S+</a>, <a href="https://www.cwla.org/the-impact-of-increased-immigrant-enforcement-on-child-welfare/?adlt=strict">newcomer</a> and <a href="https://cwrp.ca/node/3508?adlt=strict">low-income</a> populations continue to be over-represented in the child welfare system. Given this, prioritizing these populations from a health equity perspective could be very beneficial for these children and youth, and could lead to improvements in other government systems, including justice, education and social assistance, where there are also <a href="https://www.homelesshub.ca/sites/default/files/attachments/Exploring%20Youth%20Outcomes%20After%20Aging-Out%20of%20Care%20.pdf">significant inequities for these populations</a>.</p>
<p>Recent research related to “<a href="https://www.cwlc.ca/post/equitable-standards-for-transitions-to-adulthood-for-youth-in-care-evaluation-model">aging out</a>” of child welfare services in Canada highlights the imminent need for change across the continuum of care for our children and youth. Adverse outcomes in British Columbia are estimated to <a href="https://youthrex.com/wp-content/uploads/2022/02/The-Cost-of-Aging-Out-of-State-Gaurdianship-in-Ontario-2021.pdf">cost between $222 and $268 million</a> for the cohort of approximately 1,000 youth who age out of care each year. </p>
<p>Beyond adverse mental and physical health effects, this also adversely affects other areas of their lives, including education, housing and homelessness; criminalization; and unemployment, poverty and income support. What’s not included is the intangible costs, such as these young people’s trauma, hardship and suffering.</p>
<h2>What are we calling for?</h2>
<p>The complex health and social issues faced by children and youth in care call for a <a href="https://doi.org/10.1542/peds.2020-034629">comprehensive cross-sector collaborative approach to health care</a>. However, this population often experiences fragmentation. They often <a href="https://doi.org/10.1503/cmaj.091627">struggle to access comprehensive health care</a> in care homes and may only have access to episodic health care in response to acute illness. Health care is often organized and or provided by a variety of professionals who may not know them well. </p>
<p>Social workers, tasked with the care of these children, may have limited access to children’s health-care records and histories; and despite best efforts, they may be unable to provide health-care professionals with the information necessary to deliver safe and excellent care.</p>
<figure class="align-center ">
<img alt="A mental health worker counselling a young woman with green hair" src="https://images.theconversation.com/files/494898/original/file-20221111-21-mz702h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494898/original/file-20221111-21-mz702h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494898/original/file-20221111-21-mz702h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494898/original/file-20221111-21-mz702h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494898/original/file-20221111-21-mz702h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494898/original/file-20221111-21-mz702h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494898/original/file-20221111-21-mz702h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children and youth in care often have significant mental health needs.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>When there is a necessary change in a child or youth’s continuum of care and residential placement, especially out of their community, they may become disconnected from their primary health-care providers and services. As a result, it becomes difficult to provide the comprehensive health care necessary to support these often vulnerable children and youth. </p>
<p>That means children and youth with child welfare involvement are at risk of bearing a heavier burden of illness than their counterparts who do not have child welfare involvement, as a result of an inequitable system of health-care provision that fails to address their unique circumstances. </p>
<p>The American Academy of Pediatrics recommends that each <a href="https://www.aap.org/en/patient-care/foster-care/fostering-health-standards-of-care-for-children-in-foster-care/?adlt=strictink">child and youth in foster care</a> should have continuity of care and the provision of comprehensive medical, psychological and dental assessments that are co-ordinated by health-care professionals who are well versed in the effects of trauma and neglect on the developing child. </p>
<p>As the legal guardian of children and youth in care, it is critical that governments prioritize a comprehensive, trauma-informed health strategy for children and youth in care that is reviewed and evaluated by a multidisciplinary team. This team needs to meaningfully include members with lived experience in collaboration with families and community. </p>
<p>In addition to our national <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2016-07/Youth_Strategy_Eng_2016.pdf">youth mental health strategy</a> and our <a href="https://www.canada.ca/en/youth/programs/policy.html">Youth Policy</a>, we urgently call for a health strategy for children and youth in care to help bolster cross-system integration and communication. This could enable sharing key health information that would help create unique health and social plans for children and youth in care, which would travel seamlessly with them across their family care, foster/group care and professional care. This specialized focus for children and youth in care is long overdue. </p>
<p>We know better; now we need to do better. </p>
<p><em>This article was also co-authored by Sue McWilliam, Trauma-Informed Care Research and Evaluation Lead at IWK Health Centre in Halifax.</em></p><img src="https://counter.theconversation.com/content/193726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristyn Anderson is affiliated with the Child Welfare Political Action Committee.</span></em></p><p class="fine-print"><em><span>Jacquie Gahagan receives funding from the Social Sciences and Humanities Research Council (SSHRC), the Canadian Institutes of Health Research (CIHR), and Research Nova Scotia. </span></em></p><p class="fine-print"><em><span>Steven Smith receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Tonya Grant is affiliated with Nova Scotia College of Social Work.</span></em></p><p class="fine-print"><em><span>Alyson Holland and Tania Wong do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children and youth in care are more likely to have experienced trauma that can affect future health. A comprehensive, trauma-informed health strategy for these children and youth is long overdue.Kristyn Anderson, Clinical Social Worker and Registered Marriage and Family Therapist, PhD candidate (health), Dalhousie UniversityAlyson Holland, Assistant professor, Departments of Emergency Medicine and Pediatrics, Dalhousie UniversityJacquie Gahagan, Full Professor and Associate Vice-President, Research, Mount Saint Vincent UniversitySteven Smith, Professor of Psychology, Saint Mary’s UniversityTania Wong, Community Pediatrician within Division of Community Pediatrics/Adjunct assistant professor, Department of Pediatrics, Dalhousie UniversityTonya Grant, Provincial Clinical Lead for Trauma Informed Care, IWK/NSH Child/Youth MHA, Sessional Instructor, Dalhousie School of Social Work, PhD Student in Health, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1819522022-05-29T14:43:33Z2022-05-29T14:43:33ZLevelling the playing field: How a trauma-informed approach can make physical activity more accessible<figure><img src="https://images.theconversation.com/files/465572/original/file-20220526-21-asq0gd.jpg?ixlib=rb-1.1.0&rect=221%2C57%2C5242%2C3579&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Physical activity can be an important tool for recovery from the collective trauma experienced and exacerbated throughout the pandemic.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The COVID-19 pandemic <a href="https://doi.org/10.3390/ijerph18052235">resulted in decreased levels of physical activity</a>, which has implications for physical and mental health. Physical activity can also be an important tool for recovery from the collective trauma experienced and exacerbated throughout the pandemic, especially for equity-seeking communities.</p>
<p>During the pandemic, high levels of stress, isolation and inequity have <a href="https://theconversation.com/the-pandemics-disproportionate-impact-on-women-is-derailing-decades-of-progress-on-gender-equality-180941">had a disproportionate impact on women</a>, girls across the globe. Progress that had been made on gender equality and women’s rights has been reversed in areas such as employment and economic setbacks and expanding domestic roles. According to the United Nations, a “<a href="https://www.unwomen.org/en/news/in-focus/in-focus-gender-equality-in-covid-19-response">shadow pandemic” of violence against women</a> emerged during the pandemic that has disproportionately affected <a href="https://doi.org/10.1007/s40615-021-01146-w">racialized women and girls</a>. </p>
<p>There have been <a href="https://medium.com/the-machinery-of-government/recovery-and-regeneration-in-community-sport-9a217bd70aef">multiple calls</a> to address negative effects of the pandemic on physical and emotional well-being, including the impact of increased violence and poverty on sport participation and safety. </p>
<p>As we move into spring and summer, and more people consider taking up physical activity outdoors, it is crucial to centre issues of equity, inclusion, safety and access. One such strategy is promoting trauma- and violence-informed physical activity. </p>
<p>In seeking gender responsive approaches to pandemic recovery, there is a need to improve access to physical activity by creating inclusive opportunities for equity-seeking populations. Our research <a href="https://doi.org/10.7870/cjcmh-2022-002">has used trauma- and violence-informed physical activity as a tool to address inequity in physical activity</a>, and <a href="https://doi.org/10.3390/su11164485">explored the potential for sport to help prevent gender-based violence as part of development interventions</a>. </p>
<h2>Trauma- and violence-informed physical activity</h2>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/tgClXqDxtZg?wmode=transparent&start=1" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How a trauma- and violence-informed approach to physical activity improves access and addresses barriers to sport participation.</span></figcaption>
</figure>
<p>Trauma- and violence-informed physical activity research has highlighted how this approach may be useful to create ways to equitably work with program participants and to reach new participants. Importantly, this approach addresses structural and systemic issues of access in COVID-19 recovery efforts. Given the competing social determinants of health, there is often a lack of political will and/or commitment to sustainable funding for recreational physical activity focused on women living in poverty.</p>
<p>Trauma- and violence-informed physical activity is an <a href="https://doi.org/10.1016/j.ctcp.2020.101224">equity-based approach that considers and actively addresses barriers to exercise</a>. This includes collaboration across systems, such as offering physical activity programming or referrals through health and social services that women are already accessing, as well as removing barriers. Examples may include providing free on-site childcare or children’s attendance at programs, transforming spaces to accommodate self-identified women-only programming and using invitational language that focuses on choices rather than directives. </p>
<p>Recognizing the intersections of trauma with health and social issues, this approach integrates understanding of trauma and marginalization into all aspects of program design and delivery. </p>
<p>Through our previous research, we have considered how culture, historical issues and gender shape our critical thinking for new approaches to physical activity. We believe all individuals involved in developing and implementing physical activity programs should address the key tenets of trauma- and violence-informed physical activity: </p>
<ul>
<li><p>Trauma awareness</p></li>
<li><p>Safety and trustworthiness</p></li>
<li><p>Choice and collaboration</p></li>
<li><p>Peer supports</p></li>
<li><p>Strengths-based and capacity building</p></li>
</ul>
<p>Trauma- and violence-informed physical activity connects important work on <a href="https://doi.org/10.1177%2F10778012211038966">trauma and recovery to sport</a>. It has been identified as a strategy that enhances social connections, community cohesion and collective movement and healing.</p>
<p>Current efforts to engage people in physical activity have focused on individual physical benefits of physical activity and <a href="https://doi.org/10.1186/s12889-022-12590-6">improved mental health</a>. By shifting our focus to address the social determinants of physical activity, there are more options for developing programming and resources designed for specific communities. </p>
<h2>Applying the tenets</h2>
<p>The pandemic has also further underlined the need to examine the structural and systemic issue of access related to physical activity in COVID-19 recovery efforts. A relatively new and promising approach to improve access to the natural environment is through prescriptions such as Canada’s National Parks (<a href="https://www.parkprescriptions.ca/">PARX, A Prescription for Nature</a>). This innovative program allows health-care professionals to connect patients to nature as “Canada’s first national, evidence-based nature prescription program.” </p>
<figure class="align-center ">
<img alt="Three women walking in the woods." src="https://images.theconversation.com/files/465607/original/file-20220526-14-p8y3kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465607/original/file-20220526-14-p8y3kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465607/original/file-20220526-14-p8y3kp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465607/original/file-20220526-14-p8y3kp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465607/original/file-20220526-14-p8y3kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465607/original/file-20220526-14-p8y3kp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465607/original/file-20220526-14-p8y3kp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not everyone has easy access to parks and green spaces.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This strategy could be further enhanced by using a trauma- and violence-informed physical activity lens by clearly identifying and addressing key barriers to participation: </p>
<ol>
<li><p>Transportation, challenging the assumption that people have equal access to green space; and </p></li>
<li><p>foregrounding intersections of race, gender and class in relation to access and perceptions of “safety” in outdoor spaces. For example, studies have demonstrated that racialized women feel unwelcome in “<a href="https://doi.org/10.1080/23251042.2022.2057649">uncultivated green spaces and rural areas</a>,” and that <a href="https://www.nationalgeographic.com/science/article/how-nature-deprived-neighborhoods-impact-health-people-of-color">racialized people are three times more likely than white people to live in places with no access to green spaces</a>. </p></li>
</ol>
<p>Considerations of trauma- and violence-informed approaches may improve access and uptake of physical activity, as mainstream programs may not consider social and structural inequities.</p>
<figure class="align-center ">
<img alt="A girl in a swimsuit and swimming goggles in front of a body of water" src="https://images.theconversation.com/files/465606/original/file-20220526-14-bcjrb0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465606/original/file-20220526-14-bcjrb0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465606/original/file-20220526-14-bcjrb0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465606/original/file-20220526-14-bcjrb0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465606/original/file-20220526-14-bcjrb0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465606/original/file-20220526-14-bcjrb0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465606/original/file-20220526-14-bcjrb0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Unequal access to safe spaces to participate in inclusive physical activity may delay pandemic recovery efforts.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Our research aims to better understand how this approach might be a promising post-pandemic intervention for safely addressing trauma caused by things like stress, isolation and violence. It also looks at how such interventions can be developed and scaled up as a tool to be used by health practitioners, sport managers, non-governmental organizations and policy-makers. </p>
<p>This is particularly critical as Canadians will need to consider how gender inequities in physical activity will continue to be exacerbated as the pandemic continues, and how uneven access to safe spaces to participate in inclusive physical activity may delay recovery efforts.</p>
<p>We recognize that trauma- and violence-informed physical activity is not a cure-all. However, having an equity-based approach that considers and actively addresses barriers to participation is one step towards promoting equitable access to physical activity.</p><img src="https://counter.theconversation.com/content/181952/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francine Darroch receives funding from the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Lyndsay Hayhurst receives funding from the Social Sciences and Humanities Research Council of Canada, Canadian Heritage and the Canadian Foundation for Innovation.</span></em></p>During spring and summer, as more people consider exercising outdoors, a trauma- and violence-informed approach to physical activity can help ensure equity, inclusion, safety and access.Francine Darroch, Assistant Professor, Health Sciences, Carleton UniversityLyndsay M.C. Hayhurst, Assistant Professor, School of Kinesiology and Health Science, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1776762022-03-22T19:23:06Z2022-03-22T19:23:06ZHow adversity impacts the disproportionate suspensions of Black and Indigenous students<figure><img src="https://images.theconversation.com/files/453380/original/file-20220321-17-18hpwdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Black and Indigenous students in North America continue to experience high levels of exposure to adversity.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In North American elementary and high-schools, <a href="https://edu.yorku.ca/files/2017/04/Towards-Race-Equity-in-Education-April-2017.pdf">Black and Indigenous students</a> are disciplined through suspension and expulsion more often than their peers. These same groups of students are also <a href="https://doi.org/10.1016/j.amepre.2015.06.013">more often exposed</a> to <a href="https://doi.org/10.1016/j.amepre.2015.02.001">adversity and trauma</a> such as community violence, racism and inequity.</p>
<p>As a social worker for many years in the Greater Toronto Area and Vancouver, in children’s mental health, child protection, school social work and in classrooms for students who have been suspended or expelled, I have <a href="https://doi.org/10.1007/s12310-021-09481-3">seen firsthand</a> the <a href="https://doi.org/10.1177/08862605211056724">high level</a> of exposure to adversity
these <a href="https://doi.org/10.1016/j.jpeds.2012.03.014">students experience</a>.</p>
<p>In fact, most teachers, school administrators, school social workers and psychologists are not surprised to hear about this level of adversity. Yet <a href="https://doi.org/10.1177/08862605211056724">these experiences are rarely</a> acknowledged in school policy or research.</p>
<h2>Childhood adversity</h2>
<p>Adverse experiences are situations that are harmful or threatening, or <a href="https://doi.org/10.1111/jcpp.12784">where a child does not receive the kind of protection or stimulation that encourages healthy development</a>, such as exposure to violence or neglect. </p>
<p>In the ground-breaking <a href="https://doi.org/10.1016/S0749-3797(98)00017-8">Kaiser Permanente study on Adverse Childhood Experiences (ACEs),</a> a group of researchers, led by Vincent Felitti and Robert Anda, identified specific forms of adversity that can cause long term physical and mental health concerns. These early childhood adversities (ACEs) were defined as: </p><li>
psychological, physical or sexual abuse; </li><li>
physical or emotional neglect; </li><li>
death of a parent; </li><li>
violence against mother; </li><li>
parental separation or divorce; </li><li>
living with caregivers who misuse substances, experience mental illness or suicidal behaviour, or were ever imprisoned.
</li><p></p>
<p>While this research was indeed ground-breaking, the study <a href="https://doi.org/10.1016/j.amepre.2015.02.001">included mostly white, middle class participants and focused on experiences within the home</a>. </p>
<h2>Need more research</h2>
<figure class="align-center ">
<img alt="A group of school children talk in a circle while another student stands alone, leaning on a school locker." src="https://images.theconversation.com/files/453105/original/file-20220318-21-g96mc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453105/original/file-20220318-21-g96mc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453105/original/file-20220318-21-g96mc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453105/original/file-20220318-21-g96mc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453105/original/file-20220318-21-g96mc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453105/original/file-20220318-21-g96mc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453105/original/file-20220318-21-g96mc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Peer victimization, isolation and rejection are some of the many adversities Black and Indigenous students face today.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Researchers, community members, teachers and practitioners are calling to <a href="https://www.ajpmonline.org/article/S0749-3797(15)00050-1/fulltext">expand</a> the <a href="https://doi.org/10.1016/j.chiabu.2015.07.011">definition </a>of <a href="https://doi.org/10.1016/j.chiabu.2020.104522">adversities</a> to include those that occur outside the home and disproportionately impact marginalized students. </p>
<p>Such adversities include things like: </p><li> peer victimization, isolation and rejection;</li><li> exposure to school and community violence; </li><li> experiencing racism; </li><li> living in an unsafe neighbourhood;</li><li> close network member being seriously ill or attempting suicide; </li><li> low socioeconomic status; </li><li> and having lived in foster-care. </li><p></p>
<p>Expanded forms of adversity — things like community violence, racism and inequity — have not traditionally been viewed as ACEs. The lack of attention, resources and research on expanded forms of adversity experienced by students who have been suspended or expelled results in a lack of understanding of how different group of students are <a href="https://doi.org/10.1177/08862605211056724">coping</a>.</p>
<p>Students who experience these forms of adversity are too often seen as perpetrators of adversity, rather than children who are coping with the profound impacts of trauma.</p>
<p>And tragically, schools too often respond to these students with <a href="https://doi.org/10.1016/j.chiabu.2019.104149">discipline</a> rather than as children who have experienced adversity.</p>
<h2>Disproportionate school discipline</h2>
<p>According to a <a href="https://edu.yorku.ca/files/2017/04/Towards-Race-Equity-in-Education-April-2017.pdf">recent study</a>, Black students in Southern Ontario were twice as likely as white students to be suspended and four times as likely to be expelled. Indigenous students were expelled at over three times their representation in schools.</p>
<p>Male students are suspended most often making <a href="https://www.tdsb.on.ca/Portals/0/docs/Caring%20and%20Safe%20Schools%20Report%202017-18%2C%20TDSB%2C%20Final_April%202019.pdf">up 77 per cent of students who are suspended</a>.</p>
<p>Research indicates that this racial disproportion is <a href="https://doi.org/10.1093/sf/soz095">not primarily caused by differences in behaviours</a>, but rather, differences in the way that students are treated and supported and differences in the characteristics of the schools that Black and white students attend.</p>
<p>Students feel they are <a href="https://doi.org/10.1007/s12310-021-09481-3">more often disciplined</a> based on <a href="https://doi.org/10.1177/08862605211056724">gender, race and the neighbourhoods where they live</a>. There are hopeful signs that <a href="https://www.tdsb.on.ca/Portals/0/docs/Caring%20and%20Safe%20Schools%20Report%202017-18%2C%20TDSB%2C%20Final_April%202019.pdf">the racial opportunity gap in education is improving</a> but much more must be done. </p>
<p>The disproportion in suspensions and expulsions pushes certain students away from post-secondary education and toward <a href="https://doi.org/10.1016/j.avb.2018.04.002">systems of criminal justice.</a> It is important to note that as many as two thirds of incarcerated adults <a href="https://doi.org/10.1177/0034355218774844">have experienced significant and multiple early adversities resulting in severe trauma.</a> </p>
<h2>Institutional change</h2>
<p>While universal approaches aimed at reducing suspension and expulsion overall are important, they <a href="https://doi.org/10.1111/edth.12173">don’t address broader social factors</a>, the impact of expanded forms of adversity on students and the <a href="https://www.infoagepub.com/products/Lets-stop-calling-it-an-achievement-gap">racial</a>, <a href="https://www.policyalternatives.ca/publications/reports/role-race-and-gender-ontarios-growing-gap">gender</a> and <a href="https://www.jstor.org/stable/23594746">socioeconomic gaps</a> within education. </p>
<p>Therefore, institutional change should focus on the conditions that allow early exposure to expanded forms of adversity. This requires a <a href="https://doi.org/10.1086/669608">critical and intersectional</a> approach. </p>
<h2>Trauma-informed and culturally attuned schools</h2>
<figure class="align-center ">
<img alt="A lady helps a school child with his school work." src="https://images.theconversation.com/files/453103/original/file-20220318-15-csrcie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453103/original/file-20220318-15-csrcie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453103/original/file-20220318-15-csrcie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453103/original/file-20220318-15-csrcie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453103/original/file-20220318-15-csrcie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453103/original/file-20220318-15-csrcie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453103/original/file-20220318-15-csrcie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A trauma-informed and culturally attuned approach developed through training, resources and support can equip educators to acknowledge and address the reality of adversity for their students.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Where exposure to adversity can be reasonably assumed, such as systemic racism or areas with high community violence, schools should be places of refuge. This means school staff <a href="https://doi.org/10.1007/s12310-021-09481-3">have time, training, resources, policies and ongoing support</a> for the difficult task of recognizing and connecting with students, families and communities who may be coping with adversity.</p>
<p>A <a href="https://doi.org/10.5070/B85110003">trauma-informed and culturally-attuned</a> approach can equip educators to acknowledge the <a href="https://doi.org/10.1007/s12310-021-09481-3">reality of adversity for their students</a>. </p>
<p><a href="https://doi.org/10.1177/0042085920909165">Culturally-relevant disciplinary interactions</a> engage students as learners, provide positive messages about who they are, what they are capable of and build connection and belonging within their schools. When expanded forms of adversity are acknowledged, educators are better able to <a href="https://doi.org/10.1093/cs/cdy017">understand, listen and connect with their students</a>, <a href="https://doi.org/10.1016/j.childyouth.2019.05.027">well in advance of, as well as at the point of, discipline.</a></p>
<p>Adversity negatively influences academic outcomes, yet its pervasive impact is rarely acknowledged as traumatic for students who have been suspended or expelled. Greater focus on this issue may help ensure schools are adequately resourced to meet the needs of all our students, providing a truly trauma-informed and culturally aware approach to discipline.</p><img src="https://counter.theconversation.com/content/177676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane E. Sanders received funding from the Social Sciences and Humanities Research Council grant number 767-2017-1521. </span></em></p>A trauma-informed approach to education can help educators acknowledge and address the adversities faced by Black and Indigenous students.Jane E. Sanders, Assistant Professor, School of Social Work, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1645392021-08-11T12:29:14Z2021-08-11T12:29:14ZMillions of kids get suspended or expelled each year – but it doesn’t address the root of the behavior<figure><img src="https://images.theconversation.com/files/414387/original/file-20210803-16-13tt3lj.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5617%2C3658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kids who've had traumatic experiences are more likely to act out at school.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/want-to-go-home-royalty-free-image/1160693779">LumiNola/E+ Collection via Getty Images</a></span></figcaption></figure><p>Each school year, <a href="https://nces.ed.gov/programs/digest/d17/tables/dt17_233.28.asp?referer=raceindicators">nearly 3 million K-12 students</a> get suspended and over 100,000 get expelled from school. The offenses range from simply not following directions, to hitting or kicking, to more serious behaviors like getting caught with drugs or a weapon.</p>
<p>And it starts early in students’ education – it’s <a href="https://www.americanprogress.org/issues/early-childhood/news/2017/11/06/442280/new-data-reveal-250-preschoolers-suspended-expelled-every-day/">not uncommon for preschoolers</a> as young as 3 years old to be suspended or expelled from their childcare program.</p>
<p>A big part of the problem has to do with implicit biases. Black students, <a href="https://eric.ed.gov/?q=source%3A%22Office+for+Civil+Rights%2C+US+Department+of+Education%22&id=ED577231">especially boys</a>, are suspended and expelled at much higher rates than white students. Teachers tend to see the behavior of boys in general and students of color as more difficult, and they respond in harsher ways. This is true <a href="https://doi.org/10.1177/0956797615570365">even if it is the exact same behavior</a>.</p>
<p>But it’s also important to understand what leads to behaviors that end in suspension and expulsion. As a <a href="https://scholar.google.com/citations?user=OzxM5HsAAAAJ&hl=en">licensed clinical social worker</a> for over eight years, I’ve worked with children of all ages who struggled at school. Many of them had been kicked out temporarily or permanently for things like spitting, running out of the classroom or fighting. One thing most of these students had in common was their experience of trauma at home and in their neighborhoods. </p>
<h2>Childhood trauma</h2>
<p>Trauma includes things like child abuse and neglect or witnessing violence at home or in one’s neighborhood. It can lead to challenging behaviors. In my practice, I witnessed how children who saw hitting or heard yelling at home would hit or scream when they got frustrated at school. Or a child who experienced severe neglect might hoard food in their desks or seem detached or hard to connect with.</p>
<p>While researching what leads to school discipline, I found that elementary school <a href="https://doi.org/10.1080/26904586.2020.1734516">teachers report</a> more disruptive behaviors – like arguing and temper tantrums – among children who have reported experiencing more frequent violence, such as adults in the home beating each other up. More disruptive behaviors were also related to <a href="https://doi.org/10.1080/26904586.2020.1734516">more days suspended</a> in the last year.</p>
<p>Among teenagers, <a href="https://doi.org/10.1177/0886260520959635">colleagues and I found</a> that students who reported being beat up, attacked with a weapon or sexually assaulted also had more problem behaviors at school. They got in trouble more often for cheating, fighting or disturbing class. And, similar to the other study, they were suspended and expelled from school more frequently.</p>
<p>Recent work by other researchers has found this to be true for preschoolers, too. One study of more than 6,000 parents of preschool children found that for every additional type of childhood adversity a preschooler experienced, they had an <a href="http://www.doi.org/10.1016/j.chiabu.2019.104149">80% higher risk</a> of being suspended or expelled. Childhood adversity includes things like witnessing violence in the home and being abused or neglected. The World Health Organization warned that added stress and anxiety for caregivers, on top of lockdown and social distancing measures, <a href="https://www.unicef.org/media/70731/file/Global-status-report-on-preventing-violence-against-children-2020.pdf">greatly increased the risk</a> of experiencing violence at home during the pandemic.</p>
<h2>Punishing kids who are hurting</h2>
<p>What makes this issue even harder is that children’s behaviors generally <a href="https://doi.org/10.3102/0162373716652728">don’t improve after being suspended</a>, and the <a href="https://www.doi.org/10.3386/w22042">research is mixed</a> on whether suspension <a href="https://doi.org/10.3102/0162373718794897">helps classmates</a>. </p>
<p>Childhood trauma and adversity is not an uncommon experience. In a 2013 <a href="http://www.doi.org/10.1001/jamapediatrics.2013.42">national study</a> of 4,503 kids ages 1 month to 17 years, 41% had been physically assaulted in the past year and over 1 in 10 had experienced maltreatment at the hands of a caregiver. Over a third of American children – <a href="https://doi.org/10.2105/AJPH.2016.303545">37%</a> – have had an official child maltreatment investigation at some point in their lives.</p>
<p>For a child who has experienced trauma, suspension or expulsion from school may be particularly harmful. As I saw in my clinical practice, being suddenly cut off from teachers and peers can be hard for students who have had sudden losses of other relationships in the past, such as a parent being deported or incarcerated. Suspension and expulsion can also disconnect students from a potentially safe environment and lead to more time in an abusive or dangerous environment, as well as loss of trust in the school system in general.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p>
<h2>New discipline policies</h2>
<p><a href="https://doi.org/10.3102/0091732X18821123">Many schools</a> are now incorporating what’s called a “trauma-informed lens” into their training and education policies. </p>
<figure class="align-center ">
<img alt="Two adults comfort a second grade student" src="https://images.theconversation.com/files/414881/original/file-20210805-17-yrjxtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/414881/original/file-20210805-17-yrjxtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414881/original/file-20210805-17-yrjxtp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414881/original/file-20210805-17-yrjxtp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414881/original/file-20210805-17-yrjxtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414881/original/file-20210805-17-yrjxtp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414881/original/file-20210805-17-yrjxtp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some schools are using mindfulness and meditation as an alternative to discipline.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/holistic-life-foundation-employees-michelle-lee-and-oriana-news-photo/623129340">Linda Davidson / The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p>Being “<a href="https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf">trauma-informed</a>” involves understanding the effects of past trauma and recognizing the signs and symptoms of trauma. Trauma-informed approaches also focus on providing mental health or other resources to address traumatized students and making efforts not to re-traumatize them. This may include training teachers to understand and recognize what trauma looks like, and making referrals for students to mental health counselors. Incorporating an understanding of racial trauma, or the painful effects of racism and discrimination, can also help <a href="https://doi.org/10.3102/0034654320938131">combat bias and racial inequities</a> in schools. </p>
<p>Knowing the link between past trauma and the difficult behaviors that get kids suspended and expelled, schools can revise their discipline policies to better support young students. The 2015 documentary “<a href="https://kpjrfilms.co/paper-tigers/">Paper Tigers</a>” shows how discipline policies can change after taking a trauma-informed approach. <a href="https://www.doi.org/10.1007/s10643-021-01159-4">Over a dozen states</a> are trying to do away with expulsion entirely, particularly in preschools.</p>
<p>Trauma-informed approaches can flip the script on “<a href="http://kirwaninstitute.osu.edu/implicit-bias-training/resources/From-Punitive-to-Restorative1.pdf">zero-tolerance</a>” policies by going from a “no questions asked” approach to one where teachers try to figure out <a href="https://doi.org/10.1073/pnas.1523698113">what is behind the student’s behavior</a>.</p>
<p>Without these approaches, I believe schools risk further hurting children who have already been hurt.</p><img src="https://counter.theconversation.com/content/164539/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alysse Loomis does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Abuse, neglect or witnessing violence at home can lead kids to misbehave. Some schools are doing away with expulsions to focus on childhood trauma instead.Alysse Loomis, Assistant Professor of Social Work, University of UtahLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1400452020-06-10T17:16:43Z2020-06-10T17:16:43ZWhat it takes to record a Black person’s death<figure><img src="https://images.theconversation.com/files/340358/original/file-20200608-176560-7mk33e.jpg?ixlib=rb-1.1.0&rect=274%2C26%2C4068%2C2884&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Malaysia Hammond, 19, places flowers at a memorial mural for George Floyd at the corner of Chicago Avenue and 38th Street on May 31, 2020, in Minneapolis. </span> <span class="attribution"><span class="source">(John Minchillo/AP Photo)</span></span></figcaption></figure><p>On July 17, 2014, <a href="https://www.nytimes.com/2019/07/16/nyregion/eric-garner-case-death-daniel-pantaleo.html">Eric Garner’s murder by NYPD officers</a> was captured by Ramsey Orta on his mobile phone camera. Choked, handcuffed and pinned face down to the ground, Garner’s repeated calls for help, encapsulated by the phrase “I can’t breathe,” were ignored by the arresting officers.</p>
<p>Nearly six years later, the killing of George Floyd by Minneapolis Police Department officers was recorded by Darnella Frazier, a young Black woman who captured the final moments of Floyd’s life on her mobile phone. Her video shows Floyd handcuffed with his head pinned underneath the knee of a police officer, repeatedly yelling, “I can’t breathe.”</p>
<p>Like Orta’s video, the footage that Frazier uploaded to Facebook has since gone viral. Used by many media outlets, Frazier’s video has led to <a href="https://www.nbcwashington.com/news/local/dc-george-floyd-protest/2316832/">public outrage and ongoing mass protests</a>. It also assisted in the decision to fire the four arresting police officers, and <a href="https://www.usatoday.com/story/news/nation/2020/06/03/george-floyd-death-charges-derek-chauvin-police/3134766001/">to subsequently charge</a> one with second-degree murder and the other three with aiding and abetting.</p>
<h2>Bearing direct and indirect witness to trauma</h2>
<p>Often forgotten in these far too common acts of police violence and fatal police-civilian encounters, involving unarmed Black people, is the dangerous, emotional and traumatic labour of bearing witness. </p>
<p>Following Garner’s death, <a href="https://www.theverge.com/2019/3/13/18253848/eric-garner-footage-ramsey-orta-police-brutality-killing-safety">Orta’s life took a drastic turn for the worse</a>. From 2014 to 2016, Orta was arrested three times for a series of charges, which activists maintain stem from <a href="http://amsterdamnews.com/news/2020/apr/23/ramsey-orta-transferred-prison-infirmary-due-sickn/?page=2">retaliatory set-ups by the NYPD for filming the video</a>. Despite providing the footage that served as the <a href="http://amsterdamnews.com/news/2020/apr/23/ramsey-orta-transferred-prison-infirmary-due-sickn/?page=2">catalyst for the “I can’t breathe” slogan and movement</a>, Orta remains incarcerated to this day.</p>
<p>The day after Floyd’s death, Frazier returned to the scene of the killing, crying and emotionally distraught. <a href="https://www.youtube.com/watch?v=GXKMih20Ur0&has_verified=1&bpctr=1591295910">In a video</a> that has been viewed nearly 2.5 million times, Frazier pleads, “They killed this man. And I was right there! I was like five feet away! It is so traumatizing.” </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/GXKMih20Ur0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Darnella Frazier, who recorded the death of George Floyd, describes the trauma of doing so.</span></figcaption>
</figure>
<p>If the emotional and traumatic consequences of bearing witness to Floyd’s killing were not enough, Frazier has also encountered online harassment for recording and posting the video. In the comments section of the video Frazier uploaded to Facebook, some have <a href="https://www.kansascity.com/news/nation-world/national/article243063836.html">chastised her for recording the footage without intervening</a>. Frazier comes to her own defence, writing: </p>
<blockquote>
<p>“I don’t expect anyone who wasn’t placed in my position to understand why and how I feel the way that I do. MIND YOU I am a minor! 17 years old, of course I’m not about to fight off a cop.” </p>
</blockquote>
<p>Attempts to diminish the profound effects of bearing witness to traumatic events aim to dismiss the notion of shared trauma. As literary critic Shoshana Felman and psychoanalyst Dori Laub argue, the listener or, in this case, the viewer, becomes “<a href="https://doi.org/10.4324/9780203700327">a participant and co-owner of the traumatic event</a>.” In this sense, viewing the deaths of Garner and Floyd behind a screen can be different but equally traumatic experiences for both the person recording and for the viewer. </p>
<h2>The effects of bearing witness</h2>
<p>Viewing race-based trauma can be particularly traumatic for Black people for whom police violence is a <a href="https://www.latimes.com/science/story/2019-08-15/police-shootings-are-a-leading-cause-of-death-for-black-men">leading cause of death</a>. This realization is intensified by the danger that the mere <a href="https://global.oup.com/ushe/product/a-space-for-race-9780190858919?cc=us&lang=en&">occupation of public space</a> poses for Black lives. </p>
<p>In part, this stems from a refusal on behalf of white folks to recognize the <a href="https://fernwoodpublishing.ca/book/policing-black-lives">extensive history of race-based policing in both the United States and in Canada</a>. There is also a pressing need for white people to understand that <a href="https://www.nationalobserver.com/2020/06/05/news/calls-defund-police-grow-torontos-mayor-not-buying">policing itself is a form of harm</a>, especially for people of colour. As writer and activist Desmond Cole reminds us, police violence committed against Black people is too often treated as a “<a href="https://www.cbc.ca/radio/thecurrent/the-current-for-june-1-2020-1.5592953/police-brutality-continually-treated-like-a-one-off-in-canada-says-desmond-cole-1.5592954">one off</a>.”</p>
<p>Some suggest that using mobile phone cameras to watch the police is a means of “<a href="https://www.cogitatiopress.com/mediaandcommunication/article/view/292">prevent[ing] police violence from being used against other community members or oneself</a>.” But given that <a href="https://theconversation.com/police-kill-about-3-men-per-day-in-the-us-according-to-new-study-100567">Black men are far more likely to be killed by police than white men</a>, bearing witness on camera as a form of cop-watching has not prevented further police violence from occurring. Instead, bearing witness involves race-based trauma that attempts to hold police accountable for the pain they have long inflicted against Black people and communities. </p>
<p>As writer Kia Gregory says, acts of police violence and deadly police-civilian encounters “<a href="https://newrepublic.com/article/153103/videos-police-brutality-traumatize-african-americans-undermine-search-justice">are so pervasive, they inflict a unique harm on viewers, particularly African Americans, who see themselves and those they love in these fatal encounters</a>.” </p>
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<img alt="" src="https://images.theconversation.com/files/340348/original/file-20200608-176542-1s94iko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/340348/original/file-20200608-176542-1s94iko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/340348/original/file-20200608-176542-1s94iko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/340348/original/file-20200608-176542-1s94iko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/340348/original/file-20200608-176542-1s94iko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/340348/original/file-20200608-176542-1s94iko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/340348/original/file-20200608-176542-1s94iko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A young boy holds a sign during a vigil demanding justice for Eric Garner.</span>
<span class="attribution"><span class="source">(John Minchillo/AP)</span></span>
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<p>The trauma of bearing witness extends from the person experiencing, recording or witnessing violent or fatal police encounters, to those who subsequently view and witness the recording through a digital medium, and most often <a href="http://eyewitnessmediahub.com/research/vicarious-trauma">through social media platforms</a>. Viewing such videos can induce <a href="https://dx.doi.org/10.1016%2Fj.amepre.2014.09.013">stress, fear, frustration, anger and anxiety</a>. There is medical evidence to suggest that viewing footage of race-based trauma can lead to a physical ailments, <a href="https://doi.org/10.1111/josi.12251">including eating and sleeping disorders, high blood pressure and heart problems</a>. </p>
<p>Bearing witness to these acts of deadly police violence can be traumatizing for anyone. Keenly aware of the mental health toll that police violence and race-based trauma can take, a GoFundMe campaign has raised <a href="https://www.gofundme.com/f/peace-and-healing-for-darnella">nearly US$500,000 for Darnella Frazier’s “peace and healing.”</a> </p>
<p>For Black folks, in particular, the terrifying and everyday reality that they encounter at the hands of police is a trauma that endures long after the initial act of witnessing has occurred. It is a trauma that is relived and re-experienced not only in person but behind the screen.</p><img src="https://counter.theconversation.com/content/140045/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Constantine Gidaris receives funding from the Social Sciences and Humanities Research Council. </span></em></p>Recording and bearing witness to a Black person’s death from police violence is in itself traumatizing.Constantine Gidaris, PhD Candidate, English and Cultural Studies, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1221122019-09-02T16:37:30Z2019-09-02T16:37:30ZTrauma-informed classrooms can better support kids in care<figure><img src="https://images.theconversation.com/files/289956/original/file-20190828-184252-16fokl9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A trauma-informed lens asks people to shift from thinking 'What is wrong?" to 'What happened?"</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As teachers return to school, they’re thinking about the students who they’ll be getting to know. In our province, Manitoba, there are some students who are becoming more prominent in the minds of teachers, particularly the students who arrive at school in the care of Child and Family Service agencies. </p>
<p>Our team of researchers from the faculties of education and social work at the University of Manitoba are learning about how educators in one school division are working to better support children in care. </p>
<p>In part, that is through understanding and enacting trauma-informed practices in classrooms and schools. That means engaging children in ways that acknowledge how trauma may have shaped their experiences. </p>
<h2>Children in care and trauma</h2>
<p>Manitoba has among the <a href="https://nationalpost.com/opinion/marni-brownell-neeta-mcmurtry-we-know-that-canada-has-one-of-the-highest-rates-of-kids-in-care-in-the-world-what-we-dont-know-may-be-worse">highest rates of children in care in the world</a>. In 2015, Marni Brownell, a professor at the department of community health sciences and a researcher at the Manitoba Centre for Health Policy (MCHP) at the University of Manitoba, led a team that studied <a href="http://mchp-appserv.cpe.umanitoba.ca/reference/CIC_report_web.pdf">the educational outcomes of children in care in the province</a>.</p>
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Read more:
<a href="https://theconversation.com/canada-guilty-of-forging-crisis-in-indigenous-foster-care-90808">Canada guilty of forging crisis in Indigenous foster care</a>
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<p>The MCHP provided clear data on what many families, students and education and child welfare professionals already knew: that the educational outcomes for children in care were abysmal. The study found that whereas 89 per cent of Manitoba’s students graduate on time, only 33 per cent of students who are or who have been in care realize that same achievement.</p>
<p>We collaborated with one Manitoba school division that has decided to prioritise the needs of children in care in order to improve their educational outcomes and experiences. </p>
<h2>Trauma and hyperarousal</h2>
<p>Many children, adolescents and families who are involved with the child welfare system have been exposed to multiple and chronic traumatic experiences. These can range from witnessing domestic violence and addiction, to experiencing neglect and emotional, physical, sexual or psychological abuse and intergenerational trauma. This includes the legacy associated <a href="https://www.cbc.ca/news/canada/british-columbia/study-links-trauma-from-residential-schools-to-overrepresentation-of-indigenous-youth-in-care-1.5199421">with Indian Residential Schools</a> and systemic underfunding of First Nations infrastructure. Canada’s <a href="https://www.macleans.ca/news/canada/trc-offers-94-ways-to-redress-cultural-genocide/">Truth and Reconciliation Commission</a>, advocates and researchers have linked both to <a href="https://thetyee.ca/News/2018/05/09/Canada-Crisis-Indignenous-Welfare/">cultural genocide</a>.</p>
<p>Children and youth have made it clear that <a href="https://doi.org/10.1007/s10560-010-0198-5">when they are removed from what is assessed as an unsafe environment like their home, this does not result in feelings of safety</a>. </p>
<p>The trauma associated with allegations and investigations of abuse, being separated from family and siblings, being placed with strangers and having to conform to different expectations all act to maintain a state of <a href="https://childmind.org/article/how-trauma-affects-kids-school/">hyperarousal in the child</a>. </p>
<p>Trauma has pervasive physiological, psychological and emotional impacts: research from the <a href="https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma/effects">National Child Traumatic Stress Network</a> shows that children who have experienced trauma can have difficulties identifying and managing their feelings, controlling their impulses, forming relationships and concentrating and interpreting social situations, among other things. </p>
<p>In the short term, children may not have the coping or social skills to engage with teaching staff or peers. Children who have experienced trauma often have <a href="https://doi.org/10.1177/1524838014537908">impaired academic performance</a> and are likely to internalise these difficulties as failure. In the long term, these challenges are likely to result in low academic achievement and higher rates of absenteeism both of which are <a href="http://www.dropoutprevention.org/wp-content/uploads/2017/10/dropout-prevention-and-trauma-2017-10.pdf">significant factors influencing school drop outs</a>. </p>
<p>Clearly, teachers must be sensitive to the trauma experienced by children and their families who are involved with the child welfare system.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289970/original/file-20190828-184192-81k8ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289970/original/file-20190828-184192-81k8ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289970/original/file-20190828-184192-81k8ap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289970/original/file-20190828-184192-81k8ap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289970/original/file-20190828-184192-81k8ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289970/original/file-20190828-184192-81k8ap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289970/original/file-20190828-184192-81k8ap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Educators discussed making sure children had a number of places they could go if they were feeling overwhelmed.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<h2>A trauma-informed lens</h2>
<p><a href="https://doi.org/10.1007/s11469-011-9323-8">Through practice and research</a> and in response to the lived experiences and advocacy of the families, social workers’ conceptual understandings of children and families involved with the child welfare system are shifting. </p>
<p>A <a href="https://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf">trauma-informed perspective</a> prompts professionals to shift from asking what is wrong with people involved with the child welfare system, to considering what has happened to the child and family. </p>
<p>The question “What is wrong?” implies that once identified, the problem can be fixed by focusing on the individuals. It also may imply a fault of the individuals rather than systemic inequities, approaches and issues. </p>
<p>Conversely, the question “What happened?” recognizes that the seemingly challenging behaviours, maladaptive coping responses and interpersonal relationship difficulties are responses to traumatic experiences. </p>
<h2>Sense of safety</h2>
<p>In our preliminary research, we are documenting schools’ collaborations with various child welfare agencies and their efforts to better support children in care.</p>
<p>Educators are starting to engage in trauma-informed practices as a way to recognize that the most urgent need is to establish the child’s sense of safety in the school. </p>
<p>What makes a school environment feel safe? According to Australian psychologist Howard Bath, the <a href="http://www.fosteringfutureswisconsin.org/the-three-pillars-of-trauma-informed-care-2/">consistency, reliability, predictability, availability, honesty and transparency of adults</a> who care for children contribute to both emotional and physical safety of children. </p>
<p>When children feel safe, they can form trusting relationships. It is only in the context of these connections that they can then learn to understand and manage their trauma responses. </p>
<p>School leaders that we interviewed shared many examples of how they are enlisting what Bath identifies as <a href="https://books.google.ca/books/about/The_Three_Pillars_of_Transforming_Care.html?id=BSpowAEACAAJ&redir_esc=y">the three pillars of care into their school and classrooms: safety, connections and coping</a>. </p>
<p>Educators described making sure that children had a number of “go-to” adults in the building in addition to their classroom teachers, as well as “go-to” places if they felt overwhelmed. Others talked about the importance of making space for and really listening to kids’ questions, such as “Where are my siblings?” Then, these educators would work with the social worker to find answers for children. </p>
<h2>Connections and envisioning the future</h2>
<p>Educators also spoke of the importance of children forming connections with others and building trusting relationships. They talked about the importance of making sure kids were connecting to other kids and setting aside time and space to ensure that happens, for example, in the form of supportive recess groups. </p>
<p>Some educators organised regular lunches with children. One high school principal explained how he worked to get children in care involved. He described one student whose confidence was excelling as she led the environmental club’s campaign to ban plastic bags. </p>
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<img alt="" src="https://images.theconversation.com/files/290110/original/file-20190829-106504-43s1ss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290110/original/file-20190829-106504-43s1ss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290110/original/file-20190829-106504-43s1ss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290110/original/file-20190829-106504-43s1ss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290110/original/file-20190829-106504-43s1ss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290110/original/file-20190829-106504-43s1ss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290110/original/file-20190829-106504-43s1ss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">In one school, educators supported a group of high school youth in care who formed their own advocacy club.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Another school told us how they supported a group of high school youth in care in forming their own advocacy club where the youth could bring allies. This led to these students supporting each other in their advocacy, academic pursuits and in conversations about life after high school. </p>
<p>Sometimes trauma manifests in what looks like to adults as misbehaviours. The educators we spoke to recognized how children or youth who have been traumatized often need support in learning how to identify, cope with and manage emotions. These educators reassured children that their school was a place where all of their feelings were welcome and worked with them to better understand and express these feelings. </p>
<p>We encourage all educators to think about the variety of experiences students may have had this summer. </p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=thanksforreading">Thanks for reading! We can send you The Conversation’s stories every day in an informative email. Sign up today.</a></em> ]</p><img src="https://counter.theconversation.com/content/122112/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melanie Janzen receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Dawn Sutherland receives funding from Social Sciences and Humanities Research Council. </span></em></p><p class="fine-print"><em><span>Kathryn Levine receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p>In some Manitoba schools, educators are working to recognize that the most urgent need for children who have experienced trauma is to establish the child’s sense of safety in the school.Melanie D. Janzen, Associate professor, Faculty of Education, University of ManitobaDawn Sutherland, Professor and Department Head of CTL, Faculty of Education, University of ManitobaKathryn Levine, Associate Professor, Faculty of Social Work, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1149102019-06-05T22:55:05Z2019-06-05T22:55:05ZEquity in health care improves people’s health<figure><img src="https://images.theconversation.com/files/277291/original/file-20190530-69051-h1qnrv.jpg?ixlib=rb-1.1.0&rect=176%2C550%2C7150%2C4352&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are testing an equity-based model in emergency departments, mental health agencies and hospital units.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Promoting equity in health care improves people’s health. Doing so can be low cost and have high impact. Based on more than 15 years of research, we provide concrete examples of actions that can be taken by people working in health care — and the impact on patients.</p>
<p>Our interdisciplinary team of <a href="https://equiphealthcare.ca/about/">EQUIP Health Care</a> researchers from universities across Canada has been studying strategies for improving care. We are among the first to show that providing more equity-oriented health care predicts improvements in important patient health outcomes across time. </p>
<p>This benefit occurs despite the negative toll of poverty, racism and other forms of discrimination on peoples’ health.</p>
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Read more:
<a href="https://theconversation.com/9-ways-racism-impacts-maternal-health-111319">9 ways racism impacts maternal health</a>
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<h2>Equity affects mental health</h2>
<p>All over the world, people face <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/science-research/key-health-inequalities-canada-national-portrait-executive-summary/hir-full-report-eng.pdf">barriers to health care</a> stemming from <a href="https://doi.org/10.1016/j.socscimed.2016.09.005">poverty</a>, <a href="http://dx.doi.org/10.1146/annurev-publhealth-040218-043750">discrimination</a> and the ongoing effects of trauma and <a href="http://dx.doi.org/10.1016/S0140-6736(17)30569-X">violence.</a> This leads to <a href="http://dx.doi.org/10.1016/j.annepidem.2016.02.003">health inequities</a>, <a href="http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/">defined by the World Health Organization</a> as avoidable and unfair differences in people’s health. </p>
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<img alt="" src="https://images.theconversation.com/files/277111/original/file-20190529-171421-1qvr9di.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277111/original/file-20190529-171421-1qvr9di.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277111/original/file-20190529-171421-1qvr9di.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277111/original/file-20190529-171421-1qvr9di.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277111/original/file-20190529-171421-1qvr9di.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277111/original/file-20190529-171421-1qvr9di.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277111/original/file-20190529-171421-1qvr9di.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Equity-oriented health care involves trauma- and violence-informed care.</span>
<span class="attribution"><span class="source">(Annette. J. Browne)</span>, <span class="license">Author provided</span></span>
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<p>Our evidence shows that <a href="https://dx.doi.org/10.1186/s12939-015-0271-y">when care is more equity-oriented</a>, patients feel <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1468-0009.12349">more comfortable and confident about the care they receive</a>, leading to more confidence in their own ability to prevent and manage health problems. <a href="https://dx.doi.org/10.1186/1475-9276-11-59">They also report</a> fewer depression and trauma symptoms, less chronic pain and improved quality of life. </p>
<h2>A focus on harm reduction</h2>
<p>Equity-oriented health care means <a href="https://doi.org/10.1177/0886260518820818">paying particular attention to those at greatest risk of poor health</a> and that typically means people who are most affected by the negative impacts of social conditions such as <a href="https://doi.org/10.1016/j.socscimed.2017.04.045">poverty, lack of affordable housing, stigma, racism and other forms of discrimination</a>.</p>
<p>It <a href="https://doi.org/10.1186/s12939-018-0820-2">involves trauma- and violence-informed care</a>. That is, understanding and working to limit the effects of trauma and violence on peoples’ lives, their health and their health-care experiences.</p>
<p>It also involves culturally safe care: reducing power imbalances, racism and discrimination that often play out in health-care encounters.</p>
<p>The dimension of harm reduction is also important. This involves a focus on preventing the harms of substance use, including stigma.</p>
<p>In our model, these three key dimensions overlap and can be tailored to any health-care setting. We have isolated 10 strategies that flow from these key dimensions to guide health-care workers and their organizations in <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1707-9">increasing their ability to provide equity-oriented health care</a>. They include attending to power differentials and actively countering racism.</p>
<h2>Hiring an Elder, reducing stigma</h2>
<p>Equity-oriented health care <a href="https://doi.org/10.1186/s12913-018-3501-3">does not have to be expensive or time-consuming</a> — many of the strategies are about <a href="https://www.justice.gc.ca/eng/rp-pr/cj-jp/victim/rd9-rr9/p2.html">helping people feel safe and comfortable</a>.</p>
<p>They include avoiding judgemental language, not limiting visits to “one problem” and greeting people warmly and promptly when they call or visit. They can be as simple as providing water or coffee in the waiting room. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277115/original/file-20190529-171492-1p59oui.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277115/original/file-20190529-171492-1p59oui.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277115/original/file-20190529-171492-1p59oui.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277115/original/file-20190529-171492-1p59oui.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277115/original/file-20190529-171492-1p59oui.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277115/original/file-20190529-171492-1p59oui.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277115/original/file-20190529-171492-1p59oui.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A friendly face in reception can make all the difference.</span>
<span class="attribution"><span class="source">(Colleen Varcoe)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Here are some examples of how the clinics involved in our first EQUIP study, all in different cities and towns, <a href="https://doi.org/10.1186/s12939-018-0820-2">refined their practices to be more equity-oriented</a>:</p>
<ol>
<li><p>Reception staff decided to change their phrasing and tone of voice in response to phone calls from patients to book appointments. They wanted to ensure that people did not feel dismissed or demeaned when they called.</p></li>
<li><p>A clinic serving high numbers of Indigenous people decided to hire a part time Elder who could talk with people as they waited to see a doctor or nurse.</p></li>
<li><p>Staff initiated a chronic pain group to help patients learn about pain management. This was meaningful for people, because of how living with chronic pain is impacted by, and deepens, poverty, substance use and loneliness.</p></li>
<li><p>Staff developed new harm-reduction policies and practices to reduce stigma and improve support for people living with substance use issues.</p></li>
<li><p>Staff purposely used new trauma- and violence-informed approaches to provide better care for new immigrants and refugees arriving in Canada with significant histories of trauma and violence.</p></li>
</ol>
<h2>Adapting for emergency departments</h2>
<p>Given the impact of the EQUIP model, we have developed free online <a href="https://equiphealthcare.ca/toolkit">Health Equity Tools</a> and <a href="https://equiphealthcare.ca/modules/">Equipping for Equity Modules</a> designed to help health-care policy-makers, organizations and providers deliver equity-oriented health care.
These include multi-media resources and organizational self-checks.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277254/original/file-20190530-69079-xkfaw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277254/original/file-20190530-69079-xkfaw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=364&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277254/original/file-20190530-69079-xkfaw5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=364&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277254/original/file-20190530-69079-xkfaw5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=364&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277254/original/file-20190530-69079-xkfaw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277254/original/file-20190530-69079-xkfaw5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277254/original/file-20190530-69079-xkfaw5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Waiting rooms are an important part of the health-care experience.</span>
<span class="attribution"><span class="source">(Cara Urbshott)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>New studies are underway to adapt and test EQUIP in emergency departments, mental health agencies and hospital units — as we generate new evidence about the transformative potential of this approach to improve care for everyone.</p><img src="https://counter.theconversation.com/content/114910/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Annette J. Browne receives funding from the Canadian Institutes of Health Research. </span></em></p>When care is equity-oriented, patients report fewer depression and trauma symptoms, less chronic pain and improved quality of life.Annette J. Browne, Professor & Distinguished University Scholar, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/982982018-06-19T10:27:02Z2018-06-19T10:27:02ZHow to heal African-Americans’ traumatic history<figure><img src="https://images.theconversation.com/files/223666/original/file-20180618-85825-1jv0u6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Names of lynching victims at the National Memorial for Peace and Justice in Montgomery, Ala.</span> <span class="attribution"><span class="source">AP/Brynn Anderson</span></span></figcaption></figure><p>Do you smell it? That foul odor that floats in the air, when something you thought was dead is unearthed.</p>
<p>That’s the smell of <a href="https://ferris.edu/jimcrow/what.htm">ole man Jim Crow</a> crawling back into our daily lives. </p>
<p>One of the most horrendous and abhorrent forms of <a href="http://www.pbs.org/wgbh/americanexperience/features/freedom-riders-jim-crow-laws/">Jim Crow violence</a> – the racial caste system that operated between 1877 and the mid-1960s, primarily in Southern states – was the publicly sanctioned use of “<a href="https://lynchinginamerica.eji.org/report-landing">racial terror lynchings</a>.” These killings were perpetrated by those who enjoyed the <a href="https://www.theguardian.com/us-news/2018/apr/26/lynchings-memorial-us-south-montgomery-alabama">protection of white supremacist social policies</a> designed to maintain strict control of African-Americans through the systemic use of terror.</p>
<p>Documenting those lynchings is the goal of the <a href="https://eji.org/national-lynching-memorial">National Memorial for Peace and Justice</a>, or NMPJ, which opened on April 26, 2018. </p>
<p>But our question is: How do memorials to that dehumanizing violence help the African-American descendants of such treatment heal from their history?</p>
<h2>History as trauma</h2>
<p>Jim Crow was grounded in the lie of Black inferiority. Dismantling the impacts of that lie on individuals and communities has been an ongoing effort of members of the <a href="http://www.abpsi.org/EEC.html">Association of Black Psychologists</a>, of which we both are members. The organization was founded almost 50 years ago so that “psychologists of African descent … can assist in solving <a href="http://www.abpsi.org/about_mission.html">problems of Black communities</a> and other ethnic groups.” </p>
<p>As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045759/">psychologists</a>, we ask the complex question: Can memorials to a <a href="http://journals.sagepub.com/doi/abs/10.1177/1532708616634839">dehumanizing and traumatizing history</a>, the Jim Crow history, provide a path to restorative justice, psychologically, socially and politically? </p>
<p>For African-Americans, history and trauma aren’t just in the past. Indeed, it would be simpler to help our communities heal if Jim Crow were but a memory. </p>
<p>In the last 50 years or so, black Americans thought ole Jim Crow had died. But really, ole man Crow had simply gone to finishing school and <a href="https://www.theatlantic.com/politics/archive/2016/02/jim-crows-new-legal-career/459879/">emerged as James Crow, Esq</a>. He had polished up his language and was operating in an alleged system of diversity and multiculturalism, soft-selling his system of exclusivity as “traditions.” </p>
<p>Those traditions were called “<a href="https://www.vox.com/2015/7/3/8888375/rick-perry-states-rights">states’ rights</a>” and “customs,” “<a href="https://www.chalkbeat.org/posts/us/2017/07/23/critics-of-a-vouchers-say-theyre-marred-by-racism-and-exacerbate-segregation-are-they-right/">school choice</a>” and “<a href="https://www.npr.org/2016/07/28/487560886/is-trumps-call-for-law-and-order-a-coded-racial-message">law and order</a>.” Then there are the <a href="http://newjimcrow.com/about">Jim Crow practices</a> that disproportionately target Black Americans: mass incarceration, police brutality and the war on drugs. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/223668/original/file-20180618-85869-iv8xuu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223668/original/file-20180618-85869-iv8xuu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223668/original/file-20180618-85869-iv8xuu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223668/original/file-20180618-85869-iv8xuu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223668/original/file-20180618-85869-iv8xuu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=482&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223668/original/file-20180618-85869-iv8xuu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=482&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223668/original/file-20180618-85869-iv8xuu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=482&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Covered up but still there: Concrete water fountains in the front of the Jones County Courthouse in Ellisville, Miss., have metal plaques covering signs designating that one was for whites and the other for blacks during the Jim Crow era.</span>
<span class="attribution"><span class="source">AP/Rogelio V. Solis</span></span>
</figcaption>
</figure>
<p>One of the clearest examples of ole man Jim Crow resurfacing has been the documented <a href="https://www.vox.com/cards/police-brutality-shootings-us/us-police-racism">public assaults and assassinations</a> of Black bodies during the last 10 years. Men, women and children of African ancestry are being <a href="https://www.nytimes.com/interactive/2017/08/19/us/police-videos-race.html">beaten, bruised and executed</a> by police across the country simply for being Black and alive. Our communities experience direct and vicarious trauma every day.</p>
<p>Now, to this daily terror, add historical trauma for Black Americans.</p>
<p>Historical trauma is the cumulative phenomenon where those who never directly experienced trauma (enslavement, rape, lynchings, murder) can still exhibit signs and <a href="https://www.researchgate.net/publication/232897229_Historical_Trauma_Among_Indigenous_Peoples_of_the_Americas_Concepts_Research_and_Clinical_Considerations">symptoms of the trauma</a>.</p>
<p>That historical trauma can be observed <a href="https://www.researchgate.net/publication/232897229_Historical_Trauma_Among_Indigenous_Peoples_of_the_Americas_Concepts_Research_and_Clinical_Considerations">in African-Americans’</a> unresolved grief, expressed as depression and despair and their harboring of unexplained anger, expressed as aggression and rage. Often they internalize oppression by accepting the lie of inferiority, which can then lead to self-loathing. </p>
<p>This historical trauma must be addressed. It functions as a persistent sickness, a deadly virus – in the family, in the African-American community and in the larger society.</p>
<h2>Memory as medicine</h2>
<p>The establishment of the National Memorial for Peace and Justice begins a long-awaited process of healing from the <a href="http://journals.sagepub.com/doi/abs/10.1177/1532708616634839">unspeakable and unacknowledged acts</a> in our history, whose echoes can still be heard today. It is an excellent example of one step towards the process of <a href="https://www.theroot.com/mlk-decried-the-psychological-enslavement-of-blacks-1790874210">healing historical trauma</a> for persons of African ancestry. </p>
<p>By accurately documenting the gravity of the massacres, the NMPJ names the nameless, counts the uncounted and frees the victims, who were savagely desecrated, from the perpetrators of the atrocities of racial terror lynching. </p>
<p>The NMPJ was established in an effort to promote social justice that can be liberating and validating to African-American people. Its mission aligns with that of the Association of Black Psychologists, which is the <a href="https://books.apa.org/pi/oema/resources/communique/2012/11/black-psychologists.aspx">“liberation of the African Mind</a>, empowerment of the African Character, and enlivenment and illumination of the African Spirit” – all with the goal of restoring humanity, promoting optimal functioning and insuring psychological wellness.</p>
<p>Most trauma experts recognize that the <a href="https://www.researchgate.net/publication/247737046_Healing_Requires_Recognition_The_Case_for_Race-Based_Traumatic_Stress">restoration of memory is healing</a>. Developing a story in which the victim is held blameless from the infliction of abuse is essential for rebuilding a sense of independence and self efficacy. </p>
<p>In our work as psychologists, we understand that helping our clients manifest resilient, powerful stories can help them negotiate the <a href="https://guilfordjournals.com/doi/abs/10.1521/jsyt.2005.24.1.5">distress of historical trauma</a>. </p>
<p>Focusing on strengths can help descendant African-Americans learn to overcome challenges and tap into reservoirs of strength and self-determination. For example, understanding that many of the African-Americans represented in the NMPJ were killed because they stood up for injustice, had the strength to resist and fought for the freedoms of subsequent generations can be healing. </p>
<h2>Stories that heal</h2>
<p>In an <a href="http://sk.sagepub.com/books/overcoming-unintentional-racism-in-counseling-and-therapy-2e">earlier work</a>, we advanced an argument that there is a set of general healing goals that are important to consider for persons of African ancestry. Those healing goals, taken together, allow us to reconstruct understandings our community and ourselves. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/223683/original/file-20180618-85849-1dmvjrm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/223683/original/file-20180618-85849-1dmvjrm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=826&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223683/original/file-20180618-85849-1dmvjrm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=826&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223683/original/file-20180618-85849-1dmvjrm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=826&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223683/original/file-20180618-85849-1dmvjrm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1038&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223683/original/file-20180618-85849-1dmvjrm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1038&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223683/original/file-20180618-85849-1dmvjrm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1038&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Christening ceremony for Noah Maasai Woodson Reed, which echoes a practice during enslavement, when black babies were held to the sky to ask for protection and blessing.</span>
<span class="attribution"><span class="source">Kamilah M. Woodson</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>This is done through helping us take back our individual and collective identities and stories, especially those that replicate and reflect our true and righteous African heritage. The goals also allow us to restore our spirits, sense of self, sense of wonderment and potential. </p>
<p>We then can recognize the divine within, as well as promote our community members’ interdependence and interconnectedness – truly embodying the African proverb, “<a href="https://motivationinspirationandlife.wordpress.com/2012/06/02/ubuntu-i-am-what-i-am-because-of-who-we-all-are/">I am because we are and since we are, therefore I am.”</a></p>
<p>Recently, scholar <a href="https://medium.com/@ginwright/the-future-of-healing-shifting-from-trauma-informed-care-to-healing-centered-engagement-634f557ce69c">Shawn Ginwright</a> argued that addressing the ongoing exposure of African-Americans to dehumanizing experiences calls for a shift to healing-centered engagement instead of trauma-informed care. That departure shifts the focus from “what’s wrong with you” to “what’s right with you.” </p>
<p>For example, rather than locating the trauma within the individual, a healing-centered engagement would address the issues that created the trauma in the first place, and would view the individual holistically, highlighting strengths and resilience. </p>
<p>The National Memorial for Peace and Justice helps restore memories that demonstrate the violence perpetrated against black people during the horrific epoch of publicly sanctioned lynching was not the fault of the victims and survivors of African ancestry. </p>
<p>The memorial defies the lie of Black inferiority. </p>
<p>The danger of accurately retelling the horrific stories of people of African ancestry in the U.S. is that it may create new trauma. Pairing accurate histories with healing-centered engagement can limit this risk. </p>
<p>For example, the Association of Black Psychologists, in partnership with the Community Healing Network, conducts <a href="http://www.abpsi.org/EEC.html">Emotional Emancipation Circles</a>. These national self-help groups focus on overcoming the lie of black inferiority and the emotional legacies of enslavement and racism. </p>
<p>We believe that the restorative memories developed in public spaces like the National Memorial for Peace and Justice create a shared story that can inoculate African-Americans from ongoing dehumanization.</p><img src="https://counter.theconversation.com/content/98298/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taasogle Daryl Rowe, Ph.D. is affiliated with the Association of Black Psychologists, Inc.</span></em></p><p class="fine-print"><em><span>Kamilah Marie Woodson, Ph.D. is affiliated with the Association of Black Psychologists, Inc </span></em></p>The National Memorial for Peace and Justice helps demonstrate that the lynching of black people was not the fault of victims. But telling this history risks re-traumatizing the black community.Taasogle Daryl Rowe, Professor of Psychology, Pepperdine UniversityKamilah Marie Woodson, Associate Professor of Counseling Psychology (Clinical Psychology by Training), Howard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/907562018-04-04T21:27:44Z2018-04-04T21:27:44ZHow compassion can triumph over toxic childhood trauma<figure><img src="https://images.theconversation.com/files/212866/original/file-20180402-189795-keekl0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New research shows that when mothers who have experienced childhood trauma feel supported by the people around them -- such as therapists, physicians, friends and neighbours -- their risk of pregnancy complications is substantially reduced.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In a recent piece on the television show <em>60 Minutes</em>, Oprah Winfrey discussed <a href="https://www.cbsnews.com/news/oprah-winfrey-treating-childhood-trauma/">childhood trauma</a> — shining a public spotlight on the lasting effects of abuse and adversity in childhood. Oprah herself is a survivor of childhood abuse. </p>
<p>Adverse childhood experiences, commonly called ACEs, include witnessing verbal or physical conflict between parents and having a parent with a mental illness or substance-abuse issue. They also include parent separation, divorce and incarceration and the experience of neglect or abuse (sexual, physical or emotional) as a child. </p>
<p>ACEs are common. Approximately <a href="http://europepmc.org/abstract/med/21160456">60 per cent of the general population</a> report experiencing at least one before the age of 18. More than eight per cent of the population report experiencing four or more ACEs. </p>
<p>Research has consistently found that the more adverse childhood experiences a person has, the greater their risk for later health problems. </p>
<p>Our <a href="https://www.sciencedirect.com/science/article/pii/S0749379717306517">research group</a> investigates how ACEs affect women’s physical and psychological health in pregnancy. We study how adversities are “inherited” or <a href="http://pediatrics.aappublications.org/content/early/2018/03/16/peds.2017-2495">passed from parent to child</a>, as well as how the risks of ACEs in pregnant women can be reduced. </p>
<p>Our latest finding suggests that <a href="https://link.springer.com/article/10.1007/s00737-018-0826-1">when mothers who have experienced ACEs feel supported by the people around them, their risk of having pregnancy complications is substantially reduced</a>. In essence, feeling supported by friends and family can counteract the negative effects of having ACEs. </p>
<h2>From liver disease to early death</h2>
<p>Adverse childhood experiences increase the risks of many health challenges later in life. These include mental health problems like <a href="http://www.jad-journal.com/article/S0165-0327(04)00028-X/abstract">depression</a>, <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.456.757&rep=rep1&type=pdf">alcohol and drug abuse and suicide attempts</a>.</p>
<p>They also include health risk behaviours, such as <a href="https://doi.org/10.1016/S2468-2667(17)30118-4">smoking, sexually transmitted diseases</a> and <a href="https://dx.doi.org/10.1038/sj.ijo.0802038">obesity</a>, as well as diseases like <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.456.757&rep=rep1&type=pdf">heart, lung and liver disease</a>. </p>
<p>For example, an individual who has experienced four or more ACEs is <a href="https://doi.org/10.1016/S2468-2667(17)30118-4">four times more likely to experience a mental health problem</a> than someone who has not. </p>
<p>People with <a href="http://dx.doi.org/10.1016/j.amepre.2009.06.021">a high number of ACEs may even be at risk for early death</a>.</p>
<h2>Toxic stress and the body</h2>
<p>When children are exposed to abuse and adversity, they experience heightened levels of stress without a strong support system to help them through these difficult experiences. This is <a href="http://www.albertafamilywellness.org/resources/video/toxic-stress">often referred to as “toxic stress.”</a> </p>
<p>This stress is different from the tolerable types of stress that can help with development — such as learning to make new friends, going to a new school or taking a test. </p>
<p>Experiencing high levels of toxic stress during abusive or traumatic experiences can alter how our brain and body process future experiences and stressful events. Toxic stress impacts how we think and learn. </p>
<p>How does this happen? Toxic stress can cause excessive “wear and tear” on the body. It primes our system to be hyper-sensitive to stressors. This wear and tear builds up over time and can lead to both physical and mental health problems throughout our life. </p>
<p>When adults become parents, the effects that ACEs have had on their own body, mind and behaviour can influence how they experience their pregnancy and their pregnancy health. It can affect how they are able to interact with, and care for, their children. </p>
<h2>Babies with developmental delays</h2>
<p>In our work, we’ve shown that <a href="https://doi.org/10.1016/j.jpeds.2017.04.052">mothers who experience a higher number of ACEs are more likely to have gestational diabetes and hypertension</a>. </p>
<p>They are also more likely to deliver a baby who is born too small or too soon or needs intensive care. </p>
<p>Even if the baby is born full term, children born to mothers with ACEs are at risk of developmental delay. For each additional maternal ACE, there is an <a href="http://pediatrics.aappublications.org/content/141/4/e20172826">18 per cent increase in the risk</a> that their child will be identified as delayed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/212868/original/file-20180403-189801-q1w4yt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/212868/original/file-20180403-189801-q1w4yt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/212868/original/file-20180403-189801-q1w4yt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/212868/original/file-20180403-189801-q1w4yt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/212868/original/file-20180403-189801-q1w4yt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/212868/original/file-20180403-189801-q1w4yt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/212868/original/file-20180403-189801-q1w4yt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Health professionals can help new parents burdened by childhood adversity simply by supporting and listening to them.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Ultimately, we have found that the effects of adversity can be passed down from one generation to the next. </p>
<p>However, with the right supports in place, our work also reveals that mothers can show remarkable resilience to adversity. </p>
<h2>Compassion is protective</h2>
<p>What helps promote resilience in the face of stress and adversity? How do we help families triumph over past experiences?</p>
<p>For some, even just being aware of how past adversities and traumas can impact their current functioning, including physical and mental health, is an important first step. This can start the road to recovery. Some people may benefit from additional counselling and professional support to launch them into a brighter future. </p>
<p>For others, it’s the compassionate response they receive when they talk to someone about their early experiences. </p>
<p>Oprah Winfrey and others have wisely encouraged people to replace saying “what’s wrong with you?” with “what happened to you?” — to allow for a more compassionate and understanding approach to individual experiences, including trauma and adversity. </p>
<p>Oprah describes her main protective factor from adversity as school, and pinpoints certain teachers who encouraged her intellectually and creatively. School and caring teachers helped her to feel valued and gave her a sense of belonging, helping heal the emotional wounds of abuse. </p>
<h2>How to foster resilience</h2>
<p>Supportive relationships are indeed a key ingredient for change. Support from friends, family, spouses or neighbours can boost the quality and security of life for people. </p>
<p>Community supports also matter. For example, our work suggests that when women participate in low-cost community programs and recreation, such as story time at the library, and <a href="http://dx.doi.org/10.1136/bmjopen-2016-012096">when they can be encouraged to develop or engage in social support networks, their children do better</a>.</p>
<p>Investing in families with young children makes financial sense too. Strategies that <a href="https://heckmanequation.org/resource/invest-in-early-childhood-development-reduce-deficits-strengthen-the-economy/">help new parents develop supports and parenting skills have a particularly high return on investment</a> — improving outcomes for parents, children and their families and avoiding later, higher-cost interventions.</p>
<p>Whether we have been affected by ACEs or not, we can all play a role in fostering resilience by being the buffering support to our friends, family members and neighbours. </p>
<p>Using <a href="https://store.samhsa.gov/shin/content/SMA14-4884/SMA14-4884.pdf">a trauma-informed approach to patient care</a>, health professionals can also play a central role simply by supporting and listening to patients burdened by childhood adversity. </p>
<p>The silver lining is that ACEs don’t define who we are or who we can become. </p>
<p>With supports, people who have endured ACEs can achieve emotional and physical well-being. It is compelling to realize that many people struggling with past adversity can identify support from teachers, neighbours, spouses and friends as instrumental in overcoming their adversities. </p>
<p>Each and every one of us can help make a difference in someone’s life. </p>
<p><em>Individuals are encouraged to speak to a physician or health care professional if they have concerns about how their adverse experiences might be impacting their functioning. For helpful resources and information on the science of early adversity visit The <a href="http://www.albertafamilywellness.org/">Alberta Family Wellness Initiative</a> or Harvard University’s <a href="https://developingchild.harvard.edu/">Center on the Developing Child</a>.</em></p><img src="https://counter.theconversation.com/content/90756/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheri Madigan receives funding from Social Sciences and Humanities Research Council, the Canada Research Chairs program, and the Alberta Children's Hospital Foundation.</span></em></p><p class="fine-print"><em><span>Nicole Racine receives funding from the Social Sciences and Humanities Research Council, the Alberta Children's Hospital Research Institute, and the University of Calgary Cumming School of Medicine. </span></em></p><p class="fine-print"><em><span>Suzanne Tough receives funding from the Alberta Childrens Hospitial Foundation, the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Owerko Centre and the Max Bell Foundation </span></em></p>Childhood trauma impacts women’s health and can be passed from parent to child. New research shows that when new mothers feel supported, the risk of pregnancy complications is reduced.Sheri Madigan, Assistant Professor, Canada Research Chair in Determinants of Child Development, Alberta Children’s Hospital Research Institute, University of CalgaryNicole Racine, Postdoctoral Research Fellow, University of CalgarySuzanne Tough, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/784482017-06-27T23:02:40Z2017-06-27T23:02:40ZWar, terror, neglect: How Canadian schools could tackle child trauma<figure><img src="https://images.theconversation.com/files/175071/original/file-20170621-4662-1orbf5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A new model for trauma-informed schools can help teachers support children who have experienced war, terror, and maltreatment. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The callous bombing at an Ariana Grande concert in Manchester in May has focused Western eyes on the alarming trend of <a href="https://theconversation.com/the-islamic-state-group-has-weaponized-children-78217?sr=2">deliberate targeting of children by terrorists</a>. Meanwhile, child refugees from Syria’s war suffer trauma so extreme that a new term has been coined for it: “<a href="http://www.globalresearch.ca/war-crimes-against-syrias-children-human-devastation-syndrome-syrian-doctor-coins-new-term-for-childrens-extreme-war-trauma/5577017">human devastation syndrome</a>.” And every year many thousands of Canadian children are victims of crime, <a href="http://cwrp.ca/sites/default/files/publications/en/CIS-2008-rprt-eng.pdf">abuse and neglect</a>. </p>
<p>Schools in Canada urgently need to become trauma-informed — to respond to the growing number of children who have experienced war, terrorism, crime and maltreatment. Educators, school staff and administrators need basic training on how to recognize and respond to trauma and how to provide trauma-informed care. </p>
<p>As a professor of education at the University of Winnipeg, and a former school counsellor, I have been teaching, conducting research and writing educational resources on mental health and wellness for more than 25 years. I focus on education, refugee resettlement and teacher development in post-conflict countries. I have also been working on how best to prepare teachers in Canada to meet the needs of Canadian and refugee children who have experienced war, trauma and maltreatment. </p>
<p>As part of my research I have developed a model for educators. This incorporates guidelines for creating a trauma-informed school and steps for teachers to provide basic mental health support to students. </p>
<h2>The scope of the problem</h2>
<p>Some children have never lived without conflict. Violence and suffering has scarred their past and shaped their future. UNICEF estimates that <a href="https://www.unicef.org/media/media_81172.html">14 million children</a> are affected by conflict in Syria and Iraq or as refugees in neighbouring countries. Of the current 21 million refugees globally, half are children. More than 20,000 of these children have been <a href="http://www.cbc.ca/radio/thecurrent/the-current-for-december-21-2016-1.3905467/syrian-refugee-children-learn-to-be-kids-again-in-canada-1.3905524">settled in Canada</a>.</p>
<p>While some of these children will respond with conviction to right the wrongs they have experienced, others will become perpetrators of the violence they once received.</p>
<p>The escape from violence and the search for safety can also have perilous consequences for refugees. Arrival in a host country such as Canada, can represent a new beginning and hope for a better future but <a href="http://www.utppublishing.com/Supporting-Refugee-Children-Strategies-for-Educators.html">challenges often persist and memories are not simply forgotten</a>. Approximately <a href="http://hprt-cambridge.org/education/gmh-textbook/">30 per cent of refugees will suffer from post-traumatic stress disorder or depression</a>.</p>
<p>Statistics Canada data from 2012 reported that in Canada too, thousands of children struggle with violent crime and maltreatment. In 2010, an estimated 74,000 Canadian children and youth were victims of crime. Research by the Public Health Agency of Canada reported that <a href="http://cwrp.ca/sites/default/files/publications/en/CIS-2008-rprt-eng.pdf">1.4 per cent of Canadian children</a> experienced significant maltreatment including exposure to violence and neglect, physical abuse, emotional maltreatment and sexual abuse. </p>
<p>Children who have experienced these traumatic events are also <a href="https://www.ncbi.nlm.nih.gov/pubmed/12924674">at higher risk of post-traumatic stress disorder</a>, depression and substance use disorders as well as mental health related concerns. Most children who have been exposed to trauma are never identified and consequently <a href="http://www.apa.org/pi/families/resources/children-trauma-update.aspx">do not receive psychological treatment</a>. </p>
<h2>Why schools need to be prepared</h2>
<p>The Government of Canada has committed to support more refugees. The demographics of Canadian schools and communities are changing. Educators need to be properly trained to support children and youth who have been exposed to trauma. This does not mean that educators need to be therapists or counsellors. Rather, all school staff need to know how to approach children who they see are suffering or hurting. They need to know how to listen, comfort and respond without causing harm.</p>
<p>When children feel acceptance and trust, they choose the person with whom they want to talk. And <a href="http://www.cea-ace.ca/education-canada/article/culture-care-and-compassion-refugee-students">as research in Canada revealed</a>, this is often a member of the school environment. Teachers need to be prepared to respond, refer and recommend strategies to support these students. </p>
<p>Our research revealed that in some cases the teacher may be the only trusted adult in a child’s life. It is imperative, therefore, that teachers are equipped with the appropriate knowledge and skills to respond appropriately.</p>
<h2>A model for trauma-informed schools</h2>
<p>While conducting a three-year national research program investigating best practices for supporting refugee students in Canada, I developed a model for teachers. The model is based on an adaptation of the <a href="https://www.youtube.com/watch?v=mn6XmYpnIG8">11-Point Toolkit for Primary Health Care</a> developed by Richard Mollica and colleagues in the Harvard Program in Refugee Trauma. It includes 15 steps organized around three general stages.</p>
<p>Stage 1: <em>Creating a Climate of Care</em> is designed to help develop the kind of atmosphere that is essential for establishing trust and safety in any classroom or school environment. </p>
<p>Stage 2: <em>Gathering Facts</em> provides some suggestions for approaching and talking with students who might need additional support.</p>
<p>Stage 3: <em>Healing and Support</em> provides strategies for teaching and learning new skills to promote healing. This stage also includes a commitment for follow up work, a plan for the future and a process of reflection for the caregiver.</p>
<p>One of the first steps in the model is to develop a supported plan for teacher networking and self-care. Working with children who have experienced trauma can be exhausting. Compassion fatigue, or burnout, is common. Establishing a solid resource network of professionals, both within and outside of the school community, is paramount.</p>
<h2>Healing our children — a societal obligation</h2>
<p>We must now confront the reality that when violence occurs there is not only damage to the individual, but also to society. As an old African proverb states, “when elephants fight, the grass gets hurt.” Educators need to start asking, “What happened to or what hurt this child?” as opposed to, “What is wrong with this child?” </p>
<p>Resolutions and frameworks that champion the protection of children exist on paper, yet the international community has largely ignored the devastating impact that conflict and displacement can have on children.</p>
<p>Our collective failure to protect children from violence and our inability to provide children with basic human rights should be a pressing policy issue for educators, politicians, practitioners and world leaders. It is one of the most serious mistakes a society can make. There is, after all, no better reflection of humanity than the way it cares for its children.</p><img src="https://counter.theconversation.com/content/78448/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jan Stewart receives funding from Social Sciences and Humanities Research Council, Canadian Education and Research Institute for Counselling and Mitacs Canada. </span></em></p>A new model shows how the Canadian school system can play a healing role - for children traumatized by war, displacement and abuse.Jan Stewart, Professor of Education, University of WinnipegLicensed as Creative Commons – attribution, no derivatives.