Good afternoon and welcome. My name is Dr. Leroy Reese, and I am a faculty member at Morehouse School of Medicine, Department of Psychiatry. I'm pleased that you are joining us for today's Striving for Excellence series, Racism, Trauma, and Mental Health, The Inconvenient Truth. Next slide, please. This slide reflects our funding, and disclaimer, we are funded by SAMHSA. Next slide, please. Today's webinar has been designated for one AMA PRA Category 1 Credit for Physicians. Credit for participating in today's webinar will be available for 60 days. Next slide, please. This slide lets you know how to access the handout of Dr. King's presentation, the PDF of the slides will be available in the chat tab. Next slide, please. Captioning for today's presentation is available. To enable the captions, click Show Captions at the bottom of the screen, click the arrow and select View Full Transcript to open the captions in a side window. Next slide. Please feel free to submit your questions throughout the presentation by typing them into the questionnaire found in the lower portion of your control panel. We'll reserve about 10 to 15 minutes at the end of the presentation for Q&A. Next slide. Our speaker today is Dr. Ernestine Briggs King, who serves as the Associate Director of Diversity, Equity, and Inclusion and Network Relations, and is the Co-Director of Data and Evaluation Program for the UCLA Duke National Center for Child Traumatic Stress. She also serves as the Director of Research for the Center for Child and Family Health and is President for the American Professional Society on the Abuse of Children, APSAC. She is a clinical community psychologist, associate professor with tenure, and Director of Equity, Diversity, and Inclusion in the Department of Psychiatry and Behavioral Science at Duke University School of Medicine. Dr. Briggs King's professional expertise focuses on implementation, dissemination, and evaluation of evidence-based treatments, child traumatic stress, resiliency, mental health disparities and equities, quality improvement, and increasing access to care for underserved youth and adolescents. Dr. King. Thank you, Dr. Reese, appreciate you, and thank you for the opportunity to share with you my research today and the work that I'm doing in the space around racism and trauma. I don't have any disclosures to share with you. And I just wanted to take a moment to just acknowledge some of my colleagues in the work, Brianna Woods Yeager, Dr. Rocio Chang Angulo, and Dr. Angela M. Tuna. So here is our roadmap or our plan for today. I'm hoping that we will be able to help you really kind of explore and understand the intersections between racism and trauma, how it shows up and its consequences for youth. And then to really think about three strategies that you can use to reduce mental health disparities, both on the individual level for under-resourced and minoritized communities, but also on the systems level where it is imperative to do to transform care and to promote healing. So the title is The Inconvenient Truth, The Things That Make You Uncomfortable. And we know that racism and trauma and race and trauma have some real connections. We know that there is a disproportionate rate among BIPOC, Black, Indigenous, people of color on all of these things, whether we're talking about trauma, abuse, violence, and adverse childhood experiences. We know that the COVID-19 pandemic has highlighted and exacerbated disparities, and we saw that in terms of rates of infections among communities of colors and the high rates of fatalities due to COVID-19. We know that these communities are also plagued by social injustice, and we see that in numerous incidents of police brutality, unarmed shootings, death among members of the community. And then we also see this show up in other ways. For children, higher involvement in juvenile justice and child welfare systems. And for adults, we see the same thing, criminal involvement and involvement in other systems. We know that estimates of trauma occur fairly regularly, and they are pretty prevalent. There are epidemiological studies that suggest that by the 16th birthday, somewhere between a quarter and 61% of our youth will have experienced a traumatic event. There are other studies that show that these rates are higher in communities of color, and that trauma disproportionately is tied to experiences of racism and other disparities. And so we're going to just kind of unpack that a little bit and talk a little bit about what we're calling race-based trauma or racial trauma. And racial trauma are those things that are ongoing. They could be individual, they could be collective injuries that are due to the exposure and re-exposure to race-based traumatic events or stressors. They can include things like threats of harm and injury, humiliating and shaming events, or witnessing discrimination. And it can also include the psychological and physical symptoms that people of color experience after being exposed directly or indirectly to these stressful or traumatic experiences, and most of them being rooted in racism and oppression. A good example would be what we witnessed when the world saw the death of George Floyd at the hands of law enforcement. And that was captured on images and videos that were shared throughout the world on social media and other things. And to re-watch and to relive those experiences when the court testimony came up for the convictions of the officers was another experience. But we could think of so many countless other incidents from the Holocaust to the Trail of Tears. Dan Hardy in his book describes racial trauma or racial oppression as a traumatic form of interpersonal violence, which can lacerate the spirit, scar the soul, and puncture the psyche. And he goes on to talk about, without a clear and descriptive language to describe this experience, those who experience or suffer cannot coherently convey their pain, let alone heal. And he talks about, in this magnificent book, he talks about how to really get to healing, we have to begin to dismantle racism and begin to address the source of this, and at least acknowledge it as providers of mental health care. Some examples of racial trauma can be things like microaggressions, those everyday traumas, or more incidents of discrimination and bias. You can think about coming to this country and the acculturation stress of, you know, the stress of acculturation can also be forms related to racial trauma. Like I mentioned previously, it can happen directly or indirectly. And so those vicarious experiences, maybe we see them on social media, maybe we see them happening to people we love and care about, our families and friends, those can also be it. But racial trauma can also include those historical traumas, everything from slavery to Jim Crow to redlining and all the other things that have marked our history. And just to give a definition of historical trauma, I think of the work of Maria Braveheart and others that really talks about this cumulative toll, this emotional harm that happens to generations, even those not even born yet. It somehow gets into the DNA, somehow gets into and impacts our descendants. And so really thinking about all those things collectively. This is a nice visual. This is actually from PACE's connections. And for those of you that are familiar with the Adverse Childhood Experiences studies conducted by Vince Felitti and his colleagues, they tend to talk about those 10 things that are in the tree that mirror the household. Things like maltreatment, things like domestic abuse and violence, things like having a parent who is substance using or a parent with severe mental illness. But as we begin to really unpack and understand trauma, we have to put it into the context, right? And we have to understand how things like community impacts, the things that our roots are embedded in, the soil in which these things are so ingrained into our world. Things like poverty and violence and racism and historical trauma. And those community level events and experiences also impact how people cope, how they respond. But you can't take that and not think about other things like the current climate crisis and all these environmental things that we are seeing. So we are experiencing record droughts and heat temperatures. We're seeing wildfires. We're experiencing all sorts of natural disasters at more intense levels. And unfortunately, many of them are directly impacting communities of color. And so you have to understand that at the root of all of this are practices and structural things that are embedded in racism. And its impact is taking its toll. Another framework that might be helpful to understand how historical trauma and oppression really gets under the skin and really begins to impact our health, our well-being, even our life expectancy, is to really kind of look at this racing aces model constructed by our friends at the RISE Center. And it really talks about, again, thinking not only about those 10 adverse childhood experiences and how that might impact social, emotional, and cognitive impairment and the ways we cope and even lead to early death, but then to add on the burdens of structural racism and transmission of trauma and to really think about that from an intergenerational standpoint. And then think of factors like allostatic load and how that might really impact neurological development and our ability to cope. And then the burden of disease that people of color experience. This framework really kind of begins to unpack why so many communities of color are at elevated risk for early death and their quality of life is decreased. So, we've been talking a lot about structural racism and institutional racism. And I'm going to focus on that for today's talk. But the idea is that there are practices, policies, procedures embedded and normalized and legitimized that have historical, cultural, and institutional backgrounds that favor or advantage white people at the detriment of people of color. And so, those are the definitions we're thinking about. It's also included a definition of individual racism. But at the heart of what we're talking about, at the source of what Ken Hardy talks about, you have to be thinking at a systems level. So, what are some of the mental health consequences of racism and trauma? Well, we know that the psychological impact of racism is varied. You'll see everything from anxiety to depression, sleep difficulties, but also feelings of helplessness, powerlessness, hopelessness, a loss of drive, maybe even a lack of accountability. And Joy DeGruy describes symptoms and patterns that mirror PTSD, post-traumatic stress disorder. And so, you can see a range of symptoms that really manifest from racism. We also see it on the systems level, though. Mistrust of the health system. I think about COVID-19 and maybe vaccine hesitancies in communities of color. Mistrust of the child welfare system, the legal and justice system, even educational and mental health systems, right? We see among children, adolescents, and transition-age youth, higher rates of risk behaviors, including the use of alcohol and other substances, suicidality and self-injurious behaviors, and violence and trauma. We also see higher rates of chronic disease and untreated mental health problems in shorter lifespans. So kind of going back to what we saw in that racing ACEs model. And their idea is that you can't be trauma-informed, you can't provide trauma-informed care without acknowledging the source, without acknowledging and being anti-racist, right? Acknowledging the role of racism in all of this. It also shows up in our mental health services as barriers to accessing care and equities and receiving effective mental health services. So the research suggests that communities of color are more likely to not get involved in mental health treatment. They are more likely to drop out early from service when engaged and the quality of services that they tend to receive are far inferior to other forms of treatment provided in other communities. And we know that racism, bias, discrimination, cultural stereotypes really contribute to these inequities in mental health service provision and the treatment settings that are accessible and in our service systems. And so really, really understanding how to provide good quality mental health care in communities of color in order to understand how do we begin to address these disparities and disproportionalities, we really have to think about the root cause and really kind of understand that. There is this great guide that was actually designed for child welfare that really has application to organizations and communities and other service systems that really gives some guidelines around how to reduce these disparities. I'll talk about a few of these, but I'll also like to give you some additional ideas. If you're a mental health provider, if you're doing research in this area, if you are an educator around ways in which we can do better in terms of addressing these disparities and really kind of get at some of the root causes and systemic issues. So, you know, of course, everything starts with a really good assessment, and I'll talk a little bit later about some resources for assessment, but thinking about ways in which to invest in assessments, training, and technical assistance that is culturally responsive, that really kind of thinks about the communities, its strengths and assets, and its needs, and really thinking about ways in which to create some metrics to measure racial equity in agency programs and to really assess how are you doing in terms of your outcomes. We want to be able to identify and track agency goals and to disaggregate the data by ethnic groups so that we can understand what's really going on in different communities, because not all communities of color operate the same way. And to really think about the unique needs of children and families based on their demographics, in their settings, and really kind of including the voice of lived experience, those impacted communities, in whatever process that you develop in reviewing it and revising it and improving it. And so those are some strategies that are recommended by that resource, and all of these resources are available to you at the end of my talk as well. I think another way to really think about addressing racism and dismantling it to address disparities is to really think about strategies to promote racial equity. And I think that could be on the individual level, it could be on the organizational level, it could be on the systems level. But thinking about strategies that really kind of promote equity, and equity is not equality, it is not doing the same thing for everyone. Equity is about getting what you need to get the same outcomes. There's a great resource, a report that was, a practice guide that was developed by the Annie Casey Foundation called the Framework for Racial Equity and Inclusion Action Guide. And this really has a nice set of steps, seven steps that they really kind of break down all of this information in bite-sized bits and give you practical tips on how to really kind of address and understand race equity, and to really kind of understand what the principles are, how to engage folks with lived experience, how to engage leaders and decision makers and in the process, how to really think about gathering and analyzing data in a way that really helps you understand what's truly going on, and to really kind of get to the root causes of inequities, and to try to begin to do those system level analyses that are so important and vital to really kind of changing and transforming systems so you can transform care. There are other strategies around impact assessments and really kind of how to think about policies in different ways, and to continue to engage in a quality improvement kind of process so that you are not just making changes, but you're making improvements. This is another resource, and I've put on a QR code for this. This is a resource developed by the National Child Traumatic Stress Network in partnership with Evidence Watch, Wisdom Powell and her group, Dr. Wisdom Powell, and it talks about principles of anti-racism, anti-racist trauma-informed organizations, and it has lots of rich strategies and tips around how you can achieve that work, and things that you can bring into your organizations and into your systems to really kind of not only honor lived experience but think about your organizational values, your governance, and how you do strategic oversights, to how you partner and collaborate and think about systems change, and then at the bottom it's talking about human resources, staff support, and leadership development, but really thinking about workforce development, capacity, leadership, and things that are needed to really kind of make sustainable changes in systems and communities. I think as we think about dismantling racism, there are other things that are equally as important, and so I'm going to give you some frameworks and other ideas that may be helpful as you think through this, and I hope that that you can apply some of these in the work that you're doing. One framework that has been growing and really kind of gets at the nexus of racism and trauma is this notion of radical healing, and radical healing involves being or becoming whole in the face of identity-based wounds, which are the injuries sustained because of our membership in oppressed racial or ethnic groups. It is really about addressing the root cause of trauma in many instances and really thinking about the strengths of communities and bringing that in a way that really kind of supports healing. It's a great framework if you're interested in learning more. I'd say Google the work of Helen Neville and so many others who have been doing work in this space. Another framework that many of you may have heard of is the shift from cultural competence to what many are talking about as cultural humility, and cultural humility is a respectful approach that really kind of honors continuous learning and ways in which we continue to challenge our biases, and I think for many of us is often overlooked part of trauma-informed care, but it is a central piece. You have to be able to really honor aspects of cultural identity that are most important to the individual that you're working with and really be aware of what you're bringing to the table in your own suitcases, right? Here's a way to think about some of the aspects of cultural humility and empowerment, safety, transparency, mutuality, responsiveness to cultural, historic, and gender issues all have to be a part of that framework, so you have to pair ongoing learning with critical self-reflection. You have to think about those power imbalances and strategies to mitigate those and think about ways in which you can engage in institutional advocacy to really kind of address inequities, disparities, and disproportionalities. Here's another resource developed by the NCTSN, the National Child Traumatic Stress Network, and this was just kind of an infographic. If you want to learn more about culturally responsive care, if you want to learn more about racial trauma and strategies to address it, you can go onto our website at www.nctsn.org and put in racial trauma, cultural responsive, and it will come up. It's a great tool. I think as individuals, I think sometimes people think, I don't know where to start. What should I do? How should I begin to do this work? I'm not an expert in this work, and so we often recommend that folks use wonder and curiosity to begin to have conversations, to begin to engage in this work, to begin to learn about all the things you don't know, and the Center for Truth and Reconciliation has these touchstones that were created by Parker J. Palmer and the Center for Courage and Healing, and a good buddy of mine, Dawn Henderson, did a talk for me, and she opened it up with these touchstones as kind of community guidelines and agreements, and these are things that I often use when I'm having difficult conversations with colleagues or having community and partnering conversations with community partners, and so I love this way of thinking about and holding all these things, and you probably guessed my favorite one is when the going gets rough, turn to wonder, so using curiosity, thinking about strategies to kind of include those questions into the work that you're doing. Another thing that I think is really, really important is to challenge implicit bias. Now, implicit bias refers to attitudes and beliefs that occur outside of our conscious awareness and control. Everybody has them, and we're not avoid, we're not avoid, no one can avoid them, but what we can do is learn about them, educate ourselves about the biases we hold, and begin to make different decisions about how we respond, right, so our brains are plastered with millions and millions of pieces of information, and so biases are just ways to kind of take in all that information and make it usable. It's really rapid the way it happens, but I think once you know and understand what are some of those things that you hold, what are some of those beliefs that you hold, I think you can begin to challenge and change them. There is a great Procter and Gamble video that I'd love to show in this part of my conversation around implicit bias called Widen the Screen, and the link for that video is at the end, but it's a real good opportunity to just kind of think about those things that we tend to internalize, and those those things that may just not be at the forefront of our brains, but that we hold, and that impacts our decisions, it impacts how we feel, or how we judge, how we behave, so I think another critical part to really working towards racial healing, beginning to think about strategies for dismantling racism, is the importance of support. We know for trauma, one of the most effective ways in which we can promote healing is to foster connection, and to also recognize what is happening in our bodies, and in our thoughts and so really thinking about ways in which we can get support, whether that's family and friends or more formal forms of mental health treatment that those opportunities are things that we need to make sure that our mind and body are really healing. We often talk about us as providers just also needing to take a step back and evaluate what we're feeling inside, what our needs are emotionally. And we'll do this for the clients we serve as well. There are lots of opportunities for us to and strategies to really think about how to address what's going on with our feelings. And one thing that we have really identified as this pandemic continues to persist and evolve is the notion that our workforce is overwhelmed. It is taxed, it is burnt out and that we often need to think about strategies to help people take a step back, relax and reset. And so there's a great resource available through the nctsn.org as well. It's called Pause, Reset and Nourish, P-R-N. And it gives just such great tips on how we can slow down, how we can kind of recalibrate ourselves and take note of where we are and then what strategies we can do to nourish ourselves and our souls and to really take care of ourselves and to refill our buckets if we're providers and to really think about other ways to kind of help keep the trains moving. If you are a provider, there's other resources around wellness and taking care of yourself that you can find on the NCTSN website. Another thing that has been, I think, incredibly helpful in the bucket of wellness is to really think about trauma-informed supervision and ways or reflective forms of supervision to really think about strategies for really helping you as a provider do your best work. There's lots and lots and lots of other things that we could talk about. One is really thinking about strengths and thinking about factors that promote resilience, things like connection that really foster positive outcomes and ways in which to increase those. There's a lot in the literature around healing racial trauma in particular that really relies on narrative forms and storytelling is one way in which you can do that. There's lots of great researchers looking at the importance of telling stories. Howard Stevenson, for example, he has a podcast called Hearing the Lion's Story, Learning for Justice. He uses, he often refers to this African proverb that says the lion's story will never be known as the hunter if the hunter is the one to tell it, right? And so being able to tell your story is a powerful way of healing and being able to tell the stories of your families or your communities is another way. And so there is strength in that. Certainly there are lots of other things that one can do. With power comes voice. And so you can use your voice to commit to social justice, to think about ways in which you can advocate, vote, commit to changing your communities and your systems is an important part of that process. So I'm gonna end here with a video from Proctor and Campbell and it is called The Choice. ♪ All are one with inverted tongue ♪ ♪ From whence death's fulfillment come ♪ ♪ When I expel from this mortal shell ♪ ♪ Where I die for living now ♪ ♪ Though you're someone I can't see ♪ ♪ Cry over me and I'll do you wrong ♪ So, I'm going to share some resources, Dr. Reese, and then we can go on to the Q&A. Is that okay? Sounds good. All right. So, all the things that I have kind of shown you in my webinar today are linked, so you can feel free to get some of these there. I often get a question about, like, how do you do assessment around racial trauma? So, I put in some resources there just in case folks ask about that as well. Some of my favorites are the UConn's unrest trauma screen. I learned, I was actually with Monica Williams last week and learned about some new ones that have come out since then. And then here are some links to the videos that, the choice that I showed just a minute ago, but other ones that are really about bias and ways in which you challenge it. There's actually one from Robin D'Angelo called Big Think that really kind of says, I don't know where to start. And she gives you some ideas about how to start. And then finally, the references for the information that I showed. Here's my contact information, Ernestine.Briggs at think.edu. Dr. Briggs-King, that was wonderful. Thank you so much. It's wonderful and just slightly overwhelming. It's such a big topic and such an important one. One of the... So I had a question. So your data says that half of all kids before the age of 16 experience some type of trauma and that that may even be more particularly true for children of color, Black kids in particular. I'm wondering, in your view, how do we, particularly in the space of precision medicine, do you have thoughts about how we quantify or capture the impact of trauma generally and racial trauma in particular as we try to understand its impact on risk for disease? You referenced earlier that there's a higher potential for mood disorders and chronic disease as a function of racial trauma. But how do we, you know, like on the front end of our assessments, our diagnostic interviews, do you have thoughts about how we begin to bring these topics into our conceptualizations? Yeah, I think the easiest thing is to bring it into the room. Some of the authors that I talked about, like Ken Hardy, says, you know, we don't even talk about or acknowledge the role of racism in many of our encounters in the therapeutic space, right? We tend not to think about asking our patients about their experiences with racism or discrimination or how that might be impacting them. In the world of trauma, we tend to think about the big ones, abuse and violence, but not so much about the context in which many people of color live, the things that they experience, maybe even daily, right? And so really thinking about strategies to start to assess that and to understand that. Hence the reason why I put in the unrest, really kind of beginning to have some ways to ask about experiences of racism and discrimination or other forms of oppression and how that shows up, both for kids and adults, right? So those are some initial things that I'm thinking. Thank you. Thank you. I wonder, given your reference to systems-level conceptualizations, you know, there's not enough of us doing this work. How do we, we're doing a school consultation for a young person, but we understand that part of what's been happening is the environment that they go to school in is a trigger activator for racial trauma. What happens when the school is the patient or the workplace is the patient or the police department is the patient? How do we begin those conversations in ways that don't activate defensiveness? To some of the suggestions you made earlier, allow us to hear a truth without taking it personal. Yeah, I think having those conversations and creating opportunities to generate some awareness about system impacts and what they, how they show up, right? You know, part of my job as a trauma therapist or consultant is to really kind of help families understand the impact of trauma on their brains, on their behaviors, on the way they feel, right? And so I think we have to do similar work in these systems that we navigate through and that we journey through, thinking about ways to have a conversation in the school setting, for example, about what might be serving as a reminder or a trigger for a child. Helping them understand how things are contributing to what they see and really also being there to help them think about, okay, so these are things that are happening, but what are some potential solutions as well? Thank you. And then as a last question, because we want to get to the evaluation, you talked in your presentation about intergenerational transmission of racial trauma. So most folks won't find their way to a psychologist or psychiatrist or social workers therapy room. What can we be doing for lay people that helps to interrupt that transmission? Educating, partnering, learning, listening are all things that just immediately come to mind. I think about even for us as providers, just thinking about how we're showing up in different communities and what we're bringing and our judgments and values, right? And also thinking about how do we begin to challenge those, even for ourselves? So I think there's lots that we can do in partnership with communities, but I think we have to start somewhere. And so maybe even having those tough conversations, looking at things a little differently, bringing in some innovation, right? And really looking for root causes of things are ways to then get to strategies that are more systems-based and that really kind of tackle the bigger issues. Yeah, so it sounds like that the actors here are not just going to be behavioral health providers, but are going to be the communities in which we live and play and work. Yeah. So another question here for you. You know, just on a roll here. So you talked about the touchstones a little bit earlier. Can you talk a little bit about how you experience using those with clients? So with clients, I tend to have just some agreements and really kind of being clear about my role. My role is to support. You know, oftentimes as psychiatrists, psychologists, or mental health providers, we're seen as the expert. But really empowering our patients to be the experts of themselves and to really share from that and to really, I might have some curious questions so that I can learn more about you. But really kind of just being transparent about who I am and what I am doing in the room and what I'm doing with the information I gather as we talk. And their role as well as being an active participant in the healing process. Gotcha. Gotcha. Well, thank you. Again, this has been wonderful. I appreciate the volume of resources that you've provided. Folks won't be able to say they don't know where to go next. And the Hardy book is brilliant. So absolutely encourage folks to check that out when they can. I think what's next here, if you go to the next slide, and that is a presentation that is tomorrow. Coping While Black, Racism's Impact on Mental Health. A nice timely follow up to Dr. Briggs-King's presentation today. That presentation will take place at noon tomorrow. And our presenter will be Dr. Brianna Brownwell. So we hope that we will see you tomorrow. And again, thank you for your time. Transcribed by https://otter.ai

racism

trauma

mental health

disproportionate rates

racial trauma

cultural humility

implicit bias

clinical settings

narrative therapy