of Social Welfare Improving lives and strengthening communities - - PowerPoint PPT Presentation

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Helen Bader School

• f Social Welfare

Improving lives and strengthening communities through research, education and community partnerships

• Criminal Justice
• Social Work

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Poverty and Trauma

Dimitri Topitzes, PhD, LCSW Associate Professor, UW-Milwaukee Clinical Director, ICFW Poverty Matters Conference Appleton, WI September 15, 2016

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Agenda

• Define psychological trauma
• Discuss relationship between trauma and poverty
• Explore implications for policy and programs

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Trauma Definition

• Trauma is a two-fold phenomenon: exposure and symptoms
• Trauma: An extremely upsetting or even life-threatening event

that in the moment temporarily overwhelms coping skills

• Leads to symptoms and functional impairments

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Simple vs Complex PTEs

• Single Incident: Type I

– Often adulthood & recovery probable – Childhood, recovery probable with support

• Multiple Incident: Type II

– Often prolonged or enduring or chronic – Relational field – Context of social exploitation – Leads to complex symptom presentation – Often in childhood (due to vulnerable nature of children): CDT – Can be adulthood: DV, POWs, Victims of Sex Trade – Those with significant mental health/bx health issues exp Type II

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Primary Symptoms of Trauma (I or II)

• Intrusion (re-experiencing, intrusive memories, nightmares,

dissociative flashbacks)

• Avoidance (effortful or automatic, thoughts and feelings and

external reminders)

• Cognition &/or mood alterations (memory disturbance, self and

world schemas, negative mood)

• Hyperarousal (hypervigilance, sleep disturbance, aggression

and irritability, concentration problems)

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Secondary Symptoms of Trauma (II)

• Secondary Symptoms or Trauma Consequences

– Short and long-term – Extensive (domains)

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Short Term Secondary Symptoms

• Attention regulation
• Affect regulation
• Cognitive development
• Social adjustment
• Self-concept

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Long-Term Effects of Complex Trauma

• Mental health impairments
• Behavioral health impairments
• Physical health impairments
• Educational attainment
• Human capital
• Criminality

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Trauma and Poverty

• Correlation: Poverty increases risk of exposure to

childhood and adulthood trauma: (e.g., neglect, IPV, community violence)

• Increased risk of trauma symptoms and PTSD: fewer

external protective factors (CJ vs MH, education)

• Poverty as Index Trauma: Jack Shonkoff’s research,

Seth Pollack’s research

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Poverty as Trauma

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Brain Volume Effects

• Frontal Lobe: Higher order or executive functioning
• Hippocampus: Mediates memory, learning, and stress

response

• Amygdala: Processes emotional and social information
• Conclusion: Same areas of brain affected by trauma!

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Adverse Childhood Experiences (ACEs)

• Akin to trauma
• Abuse (physical, sexual, and psychological)
• Neglect (physical and emotional)
• Household dysfunction
• Divorce, IPV, household substance abuse,

household mental illness, and

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Jobs Programs

• Two samples of only men
• Seeking job services and of low income status
• Majority with history of incarceration
• Milwaukee and St. Louis Sample
• Compared to Original ACE Sample

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ACEs and Poverty (Men)

Prevalence (%) ACE Study* Site One (MKE) Site Two (SL) (N = 3,955) (N = 199) (N = 213) ____________________________________________________________________ Abuse: Verbal 7.8 38.2 21.6 Physical 27.9 41.2 33.3 Sexual 17.1 21.6 17.4 Neglect: Emotional 12.5 38.2 4.2 Physical 10.7 29.1 32.4 Household dysfunction: IPV 2.1 29.6 36.2

• Subst. Abuse 11.2

48.2 46.0 Mental Illness 14.3 19.1 39.4 Divorce 22.6 60.8 66.7 Incarceration 5.0 51.3 49.8

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ACEs and Poverty (Men)

____________________________________________________________________ ACE Index Score, ACE Study Site One (MKE) Site Two (SL) Prevalence (%) (N = 3,955) (N= 199) (N= 213) _____________________________________________________________________ 37.7 15.6 4.7 1 27.6 11.6 20.8 2 15.2 17.1 15.1 3 8.2 8.0 16.0 4 or more 11.4 47.0 43.4

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WI Home Visiting Sample

Sample Description (N = 1,241) Caucasian 33% African American 29% Hispanic/Latina 25% American Indian 7% Low income 98% Child welfare history 25%

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ACEs and Poverty (Women)

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ACEs and Poverty (Women)

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ACE Score

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Additional ACEs

Adverse Childhood Experience FFHV Program (%) Victim of Violent Crime 15.9 Prolonged Absence of Parent 57.5 Death of Parent/Sibling 24.4 Homelessness 22.5

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ACEs/Trauma/Health

• With original ACE study.
• How about studies here in WI with low-

income samples?

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Jobs Program Sample

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 Low general health Current smoking Drug abuse Depression high Anxiety high Employment problems Arrest or incarceration ACE 0 ACEs 1-2 ACEs 3-4 ACEs >5

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Home Visiting Sample

Outcome N < 5 ACEs (%) ≥ 5 ACEs (%) Perce nt Chan ge Prenatal Edinburgh Score ≥13 449 18.4 35.3 +92% Postnatal Edinburgh Score ≥ 13 476 10.8 21.1 +95% Perceived Stress Scale ≥ 20 584 24.7 45.9 +86%

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Implications

• Health/Wealth Gradient something to do with

ACEs, trauma and stress?

• Integrate trauma care into educational, health

and economic services for families facing economic hardship.

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Policies and Programs

• Early Interventions!
• Center-Based preschool (Heckman)
• Home Visiting (Intergenerational Trauma)
• Trauma care into healthcare

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Thank you

Dimitri Topitzes, PhD, LCSW topitzes@uwm.edu 414-229-3004