By Sydni Mullen (She/Her)
Over the course of this past summer, I was given the opportunity to conduct community-based research surrounding the topic of trauma and healing. I was ecstatic to be working with organizations that contributed to the strength and growth of the greater Central Valley community that made me the person that I am today. This six-week process has not only been a learning experience for me but a time that I was able to really put my own life into perspective and acknowledge some of my own privileges that I hold and where I want to stand in my community and hopefully my mark on those who know me. I went into this project with my own assumptions and hypothesis about the topic I had chosen and found myself refocusing the purpose of my project with the needs of the community more than being able to prove a hypothesis. My research wasn’t about proving a point, it was about finding the needs of the community and hopefully being able to contribute to the work already being done by others. Because this project was largely dependent on community-based research, I had the opportunity to meet some great individuals who are doing amazing things to strengthen their own community and provide the services and change that they wanted to see. Through this project, I was able to
What Was My Project?
The topic that I chose for this project was Adverse Childhood Experiences (ACEs) and their impacts on the long term physical and emotional health of those exposed to a higher number of adverse experiences. ACEs are broken down into three categories that are defined as abuse, neglect, and household dysfunction. Within those three categories, it can be further specified as physical, sexual, or emotional abuse, physical or emotional neglect, and certain forms of household dysfunction. If one is a witness to domestic violence, substance dependency, mental illness, incarceration, parental separation, or divorce, this will also be considered an ACE (HRSA, 2016). They can manifest as any form of chronic stress or trauma. Can impact an individual’s physical or emotional health. In addition, I wanted to address the idea of trauma and how our experiences impact our wellbeing. Trauma is the psychological, emotional response to an event or an experience that is deeply distressing or disturbing (CTAMD, 2018). In some cases, it happens repetitively and the effects are cumulative meaning the traumatic experience frequently transpires within a particular time frame or within a specific relationship, and often in a specific setting. They result from an experience of extreme stress or pain that leaves an individual feeling helpless, or too overwhelmed, to cope with adversity. It is important to view trauma as a spectrum that can range from an accident, loss, illness, or divorce to more extremes such as rape or torture. Because trauma is experienced subjectively, we all process traumatic events differently and while normal memories fade and change, traumatic memories are vivid, unchanging, and easily triggered. In my project, I wanted to draw connections between the adverse experiences of those living within the Central Valley and their current mental and physical health. As I got further into my project, I realized how one’s identity had played a large role in the experiences of my participants within the healthcare system and even within the shared stories from community leaders. This realization allowed me to rethink and transition my project to another important topic surrounding the identities of BIPOC and health care.
Who Inspired Me?
The original ACE Study conducted by Vincent Felitti in 1998 formally known as the Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study, was the starting of my curiosity for the wellbeing of my own CV community. As a way to quantitatively interpret the impacts and severity of one’s adverse experiences, the ACE survey was created so that those who are studying the impacts of ACEs can assign a numerical value to the self-reported experiences and situations of those who participate. It was observed that a strong graded correlation between the participant’s exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults (Felitti, 1998). Surprisingly, it was observed that more than half of the respondents scored with at least one ACE and one-fourth reported two or more.
Although the data collected and the conclusions drawn from Felliti’s study broadened the conversation of how childhood impacts mortality and long term health, it is important to note that the largest demographic reported as participants for that study were 52.1% female and 79.4% white. In addition, it was reported that 43% of the participants had graduated from college and were at the mean age of 56 years old. One thing to point out from the original ACE study is that the study itself was completely biased. Those who participated in the study were distributed the ACE questionnaire through their private healthcare company meaning that those who did not have healthcare were not accounted for. In addition, if the majority of those who participated identified as white, there was a lack of representation within the study from marginalized communities. It is important to factor in race when considering the experiences of individuals impacted by ACEs and other social determinants to health because one’s race often intersects with their health and potentially, the perception of their needs and behaviors from outsiders.
In more recent studies, an emphasis on how specific racial groups and other forms of marginalized communities has shifted the perspective on who is most is most affected by ACEs and more likely to suffer from certain chronic health issues. One of these grounding studies was conducted by Nadine Burke in 2011. Dr. Burke’s work was centered on 701 child subjects living in an urban community in the bay area and was given the same survey provided by past studies to draw any connections on the health concerns of that urban setting and the adversity many of the subjects faced. It was noted that many of the subjects were victims of a broken healthcare system and faced health disparities within their community. In the study conducted by Burke, the majority of subjects (67.2%) had experienced 1 or more categories of adverse childhood experiences and 12.0% had experienced 4 or more ACEs. This increased the risk of learning/behavior problems and obesity within the lives of those who scored higher. Burke’s decision to make their study identity conscious is what shifted the conversation about ACEs and brought the relevance of one’s situation in relation to healthcare, accessibility, and race as social determinants. Dr. Burke shifted the conversation towards individuals who were not just dealing with adversity in their home atmosphere, but the impacts of the environment on their health and how their identity intersected with their access and level of care. These elements were what inspired the construction of my own project and emphasized the importance of identity within the healthcare system.
For many, merely their area code stands between them and accessibility to necessary healthcare. In a policy brief submitted by the National Health Committee, HRSA, the committee emphasized the importance of including and accounting for rural-urban differences in ACE-related outcomes. In addition, the committee pointed out that the Indigenous population, which only makes up 2% of the total U.S. population, still holds the highest rate of health disparities in the nation, and more than half are living in rural or small towns. This goes to show how the intersection of race and geography can leave marginalized groups silenced and inaccessible by a healthcare system. In a study done by the Maine Rural Health Search Center, researchers noted that ACEs are more likely to co-occur and expose economic hardship significantly more than children living in urban areas do with 21.3% of urban children. Studies like these help to build a greater understanding between one’s relationship with their location, adversity, and long term health.
ACEs and the Central Valley
In my study this summer, out of those who responded, 53.1% were from a rural or urban area. Of those living in a rural area, 15 out of 20 identified as Latinx (75%). In addition, Black and Latinx individuals made up the largest percentage of urban residence (74.1%). White participants made up 70% of suburban residents and of those who identified as E/SE Asian and Filipinx, 80% came from a suburban area. This is important when factoring in an individual's accessibility with the healthcare system and opportunities to reach out for health care support. This project consisted of 97 participants who answered an online survey. Within that survey, participants were given the original ACE Score questionnaire for the first half and an additional ten questions about their physical or emotional health and their overall feelings about the healthcare system. When analyzing the data collected from this project, it became clear that the majority of my participants fell into the age group of transitional age youth (TAY). This term originated from the Substance Abuse and Mental Health Services Administration (SAMHSA), because of early awareness of the lack of developmentally appropriate services and support for youth exiting foster care by “aging out.” The age groups are either considered 16-24 or 18-26 years of age.
The average age for my participants was 23 with 20 being the most common response. I found that this was a significant distinction in my data because this period of transition in many people’s lives can leave them feeling disconnected without the safety net of childhood or the experience of later adulthood. It was found that the average ACE score for those who participated was 3.5 with 85.4% of respondents having one or more ACEs (ACE≥1). In addition to average the ACE scores, I was able to average the score by race. I found that those who identified as Indigenous/ Native Alaskan had the highest ACE score at 5.3 followed by those who identified as Filipinx having an average score of 4.8. Of all the racial
categories, those who identified as Non-Hispanic White had the lowest average ACE score of 1.3. In addition to having participants tally their ACE score, I asked whether or not my participants felt that their childhood experiences impacted their current health or mental state. To my surprise, 82.3 percent believed that their childhood did impact their current mental state. Furthermore, I asked if my participants felt secure as a child seeking out support for any emotional or physical needs. A majority of my participants (78.1%) felt that they only moderately or not at all secure when seeking out support. For the majority of responses to confirm that folks not only believed that their childhood impacts their current mental state but that they felt a lack of security when seeking help in that period of life was one of the sadder discoveries in my survey. Just like a physical wound, left untreated you run the risk of impacting your health and wellbeing long term, this is no different for emotional wounds.
When addressing the current physical and mental health of my participants I was surprised to discover that the most common response in relation to any current or chronic health issue was depression. In response to having other health conditions, 13 out of 22 who responded yes replied with PTSD, anxiety, or depression. Of those who responded with depression/anxiety, 33% were Latinx, 27% were white, 22% were Filipinx, and 16% were Black. In addition, 83% fell within the age group of 18-26 years of age. The second most common response was asthma as a chronic issue. This was not surprising because the Central Valley is known for having poor air quality but I think this data is also a good example of how the environment impacts our health, especially in more rural parts of the Central Valley. 48% of those living with a chronic health condition were dealing with asthma and 15% were from a rural location.
Finally, I was able to ask about the personal experiences of my participants in relation to seeking out healthcare or with healthcare professionals. When asking whether or not my participants felt validated when voicing their concerns, 43% felt that they had been invalidated. Of those who responded with yes, 35 out of 42 who responded with yes were BIPOC. 50% of those who identified as Black responded with yes as well as 40% of Latinx folk. Of those who responded yes and chose to comment, 27% felt like it was due to their gender or sexuality, 9% felt it was due to a language barrier, and 40% felt like it was due to race. The intersection of one’s racial identity with access to care was a recurring topic within my conversations with community organizations as well. After hearing the stories of those who were misdiagnosed, invalidated, or even brought to the point of criminalization for questioning the expertise of a physician concerning their body, I began to rethink the direction I like to take for the majority of my project. This idea of race transitioned into another big issue brought up through my discussions with community leaders and that was racialized trauma and intergenerational trauma. In addition, we talked about some of the racialized trauma that is perpetuated in our healthcare system as black, brown indigenous, and people of color are constantly let down and left unprotected by our healthcare system when our identities impact our level of care. Racial trauma, or race-based traumatic stress (RBTS), refers to the mental and emotional injury caused by encounters with racial bias and ethnic discrimination, racism, and hate crimes (MHA, 2020). Black, Indigenous People of Color (BIPOC) are most vulnerable due to living under a system of white supremacy. This racialized trauma can come directly from other people or can be experienced within a wider system. If left unresolved, this trauma can also be passed both consciously or subconsciously intergenerationally. It is also important to note how trauma-induced social divisions can form the basis of historical myths that can come to be a central part of a group’s identity.
I believe our identities can also create barriers when it comes to seeking out health care as well. Some of these barriers could potentially be cultural mistrust and lack of representation in policy-making. Because of the historical relationship between BIPOC and their level of care within the healthcare system, individuals may not feel supported or want to seek out professional care when it is needed. In addition, bad experiences can leave a person feeling less inclined to seek out health care when another issue arises. Similarly, individuals could feel as though professional care is not something that they need nor believe is necessary if they come from an environment where professional care is not a normal solution to the issues others may be facing. I also strongly believe that a lack of representation is a lack of perspective. If there is not enough representation from policy-makers or professionals within the field, there is a lack of perspective and understanding of the situations of those whose identities suddenly become their own barrier to care. I believe these barriers are especially relevant when considering the mental health and mental health care of BIPOC.
Where Do We Go From Here?
In processing all that I have learned from the past several weeks, I began to think about what I can do, what's in my control, and what's a possible way that I can contribute. One inspiring action that all of the community organizations made a point of when talking about their missions was with bringing awareness for marginalized groups within their communities and creating space for their voices to be heard. Each community connection found ways to create spaces for people who don’t always have a place they feel they could go. Whether it was for uplifting the often silenced voices of young black women of the black diaspora or through creating an outlet for self-expression for individuals with disabilities. I admired that these inclusive environments also heavily emphasized the mental health of those involved through weekly check-ins. This inspired my own ideas of what outreach after this project could look like.
When thinking about what potential outreach could look like, I want to create something that aligned with my own passions and interests and gave individuals with similar interests the opportunity to unpack their opinions, thoughts, and experiences without judgment. Because of this, I hope to create a free and accessible program that would introduce the concepts of holistic health and living. Holistic health is caring for the whole person and providing for their physical, mental, spiritual, and social needs. This concept is rooted in the understanding that all these aspects affect your overall health, and being unwell in one aspect affects you in others. In the program, those who join could gain in-depth knowledge about what it means to live more holistically and hopefully how to integrate aspects of what they've learned into their own lives. In addition, the program would also be based on discussion topics relevant to the experiences and unique intersections our identities often sit at. I would want it to be a space where people could have light mental check-ins, form meaningful connections with others in the group, and learn to take care of their entire self. With all that is going on in the world around us, it can be hard to juggle all that life throws at us. By learning to re-center ourselves and bring back the importance of caring for ourselves first, we can open ourselves up to deeper healing and understanding.
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References
Burke, N. (2011, June 8). The impact of adverse childhood experiences on an urban pediatric
population. Child Abuse & Neglect: The International Journal.
Felitti, Vincent J., et al. (1998). Relationship of childhood abuse and household dysfunction
to many of the leading causes of death in adults: The adverse childhood experiences
(ACE) study. American Journal of Preventive Medicine. Retrieved from
https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext
Racial Trauma. (2020, June). In Mental Health America. Retrieved from
https://mhanational.org/racial-trauma
Sedlak, Andrea J., et al. (2010). Fourth National Incidence Study of Child Abuse and Neglect
(NIS–4): Report to Congress. U.S. Department of Health and Human Services,
Administration for Children and Families. Retrieved from
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Talbot, Jean A., Donald Szlosek, and Erika C. Ziller. (2016, April). Adverse childhood
experiences in rural and urban contexts. Research & Policy Brief. Maine Rural Health
Research Center.
What is Trauma. (2018, September 25). In The Center for Treatment of Anxiety and Mood
Disorders. Retrieved from https://centerforanxietydisorders.com/what-is-trauma/