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The Journey to Healthy Minds for Healthy Asian American and Pacific Islander Youth

Posted: July 12, 2018

Too many stories point to the troubled minds and mental struggles of our youth with the tragic event in Parkland, Florida being one of the latest. Even more saddening, these children’s cries for help are often misunderstood or ignored.

Suicide is the second leading cause of death for children between the ages of 10–24 years old, accounting for 17.6% of deaths in this age group 1 The American Academy of Pediatrics recently updated their guidelines to include universal screening for adolescent depression (youth 12 years of age and older). According to the 2016 National Survey on Drug Use and Health, one in eight youth ages 12–17 years old has had a  major depressive episode in the past year, with 70% of them having severe impairment.

For young Asian Americans and Pacific Islanders (AAPIs), the suicide rates are also bleak. AAPI adolescent females (15-19 years old) have a higher rate of suicide deaths (21.9%) compared to non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. AAPI males aged 15–19 years have comparable or higher rates of suicide deaths (27.1%) when compared to all other racial and ethnic groups.

The Model Minority Myth is a stereotype that portrays all Asian Americans as academically gifted and successful. This myth wrongly portrays AAPIs as a prosperous group who have secured economic and educational success, have fewer health problems than the overall population, and do not need public assistance. In reality, AAPIs are a very heterogenous group with immigration from more than 30 different countries and ethnic groups, hundreds of languages and unique dialects, and varying degrees of economic and academic success.

In the U.S., only half of adolescents with depression are diagnosed, and among them, approximately 60% do not receive appropriate treatment.  This situation is amplified in the AAPI community due to stigma and cultural barriers.

Many AAPIs face multiple challenges, including lack of health insurance, limited English proficiency, difficulty of acculturation and lower socioeconomic status. Less than half of AAPIs would seek help for their emotional or mental health concerns than their white counterparts. AAPIs tend to dismiss, psychosomaticize, deny or neglect their depressive symptoms for different reasons, such as different conceptualizations of mental health and illness or avoiding family shame.

These reasons have prevented many AAPIs from seeking mental health counseling or medication. Parental expectations in academic excellence, cultural/family obligations, identity conflicts, societal unconscious bias, and discrimination are some of the daily challenges confronting AAPI youth and young adults.

Parental warmth, family cohesion, and strong intergenerational relationships can help AAPI adolescents in expressing experiences with bullying and minimizing internalizing issues with immigrant parents, teachers, or the education system. It is critical for the AAPI community to continually strengthen family/parenting skills, build resiliency, and reduce risks for adolescent anxiety and depression. Safe, supportive, and nurturing relationships are important to children. Strong and positive self-esteem is extremely vital and can be associated with reduced risk of depression.

There is an urgent need to improve the mental well-being of future AAPI generations. Learning how to cope with various stressors that life throws at them, work productively and fruitfully, and contribute to their community and society are key for the younger AAPI generations to actualize the great potential that lies within them. It is equally important to reduce the stigma about mental health among the AAPI community and encourage seeking help and counseling when needed. We have a lot of work to do.

Parents, teachers and friends need to know the signs of anxiety and depression, and “act early.” The Centers for Disease Control and Prevention (CDC) offers several suggestions on their Children’s Mental Health website:

Anxiety

  • Being very afraid when away from parents (separation anxiety)
  • Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)
  • Being very afraid of school and other places where there are people (social anxiety)
  • Being very worried about the future and about bad things happening (general anxiety)
  • Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Depression

  • Feeling sad, hopeless, or irritable a lot of the time
  • Not wanting to do or enjoy doing fun things
  • Changes in eating patterns – eating a lot more or a lot less than usual
  • Changes in sleep patterns – sleeping a lot more or a lot less than normal
  • Changes in energy – being tired and sluggish or tense and restless a lot of the time
  • Having a hard time paying attention
  • Feeling worthless, useless, or guilty
  • Self-injury and self-destructive behavior

Read more on NIMHD.HIV.gov.



Puerto Rico Ramps Up Mental Health Training in Preparation for the 2018 Hurricane Season

Posted: July 11, 2018

One of the less visible effects of Hurricane Maria has been PTSD. Many Puerto Ricans are dealing with trauma related to the storm, especially as the next hurricane season begins.

MICHEL MARTIN, NPR HOST: It's beautiful here in Puerto Rico. The palms have grown back. The flame-red flamboyan are flowering again. But the beauty cannot hide a hard fact - just about everyone here has a story of loss - of homes, of property, of loved ones, even of faith. Mental health professionals here say that they've seen an increase in depression, anxiety, insomnia - even suicide.

And yet, people have found ways to cope. In Humacao, the volunteer cooks at the Apoyo Mutuo have become defacto therapists, checking in on the well-being of their neighbors who stop by for a hot lunch. Maria Laboy is one of the ladies working here.

MARIA LABOY: After the storm, everybody was depressed, sad and everything.

MARTIN: She scoops up a huge slice of steamed pumpkin for one of the regulars, Georgie Ortiz, who makes the trip up the hill every day for lunch and conversation. He used to make his living as an auto mechanic, but people around here aren't maintaining their cars anymore, he says. They're saving their money for more urgent expenses like home repair and fuel for generators. He didn't have any documentation to prove that he owned his home, so he wasn't eligible for emergency funds from FEMA. He says he does have a blue tarp.

GEORGIE ORTIZ: (Speaking in Spanish).

MARTIN: But he lives alone, and he can't install it by himself. During the day, he finds ways to stay busy and distracted from his problems. But at night...

ORTIZ: (Speaking in Spanish).

LABOY: He say he sleep depressful (ph). It won't go down.

MARTIN: Over the past few months, Maria Laboy and the other lunch ladies have become friends with neighbors like Georgie.

LABOY: I really worry about him because he just lost his mother, and he's - he don't have work now. (Unintelligible) and he can't survive like that. And he's down because no help - he haven't have no help from nobody. So, you see, it's not a pretty picture right now.

MARTIN: There was a 29 percent increase in suicide on the island in 2017 according to the Puerto Rican Department of Health. The majority were men and people over 50 years old. Researchers are working to determine how many of those were hurricane-related. Calls to the suicide prevention hotline have spiked, but with so many people without phone service months after Maria, that method of getting help was not a reliable option.

Down the mountain from Georgie Ortiz and the community kitchen, five EMTs are gathered at the emergency management center of Humacao.

UNIDENTIFIED PERSON: (Speaking in Spanish).

MARTIN: They're here for mental health and resiliency training to learn how to cope with their own stress so they can help people struggling in their communities. It starts by acknowledging the fact that they're stressed. One exercise near the end of the session brings the point home. The trainers ask everyone to participate.

ELEXIA SUAREZ: I'm going to go through some phrases, and if anyone has - you have experienced it or touch you, please stand up. (Speaking in Spanish). I have lost a loved one through Hurricane Maria or after.

MARTIN: One EMT stands up. But by the end of the list - if you've had damaged property, if you've seen your community impacted, if you worked through the disaster - everyone in the room is standing. After the session, I asked the EMT supervisor, Frank Torres, why he thought this training was important for his employees.

FRANK TORRES: (Speaking in Spanish).

MARTIN: He says the hurricane was difficult on first responders. He has 18 EMTs to cover the whole city of Humacao, and everyone worked around the clock for four days straight responding to emergencies. The stress of working the hurricane was coupled with the personal stresses the EMTs faced at home.

TORRES: (Speaking in Spanish).

MARTIN: And they've still not rested, Torres tells us. Nobody has had any vacation. They work all the time, and on all their days off, they rebuild. Caesar Rosario was one of the EMTs who stood up when asked if anyone lost their home due to Maria. He lost his home of 20 years but didn't find out for a few days because he was on duty.

CAESAR ROSARIO: (Speaking in Spanish).

MARTIN: He walked from the station to his house once the storm had passed.

ROSARIO: (Speaking in Spanish).

MARTIN: He lost everything, says Rosario. It's not easy.

The training these EMTs are receiving today is part of an island-wide initiative from the nonprofit group Americares to address the mental health crisis in Puerto Rico. Ivalis Morales and Elexia Suarez are the two people leading the session. Both of them are psychologists who practiced in the region before Maria. One's office was destroyed, along with her 25-year private practice. The other's home experienced major damage. They agree that these sessions help them feel useful to the island's overall recovery. Elexia Suarez says that strong communities and relationships are essential for surviving a major event like the hurricane last fall.

SUAREZ: As we have seen and again and again and again, the community leaders, the community resources - between one another, people have become so tight, so together. That is a collective hope, a collective support, because you could not have survived this without someone, even if it is one neighbor - you couldn't.

MARTIN: They end the session by passing around a photo of a mango tree. The trunk is completely severed, but one little branch shoots off the stump. Off the fragile shoot hangs a huge, bright mango. Suarez says this is a symbol for post-Maria Puerto Rico.

SUAREZ: Saying that we have been cut, taken away. Even though we're together, we're standing. We're giving fruits, and we're blooming. We're doing it for ourselves, our family, our communities in Puerto Rico.

Read more and listen to the story on NPR.org.



Making a Difference: How Northwest Alaska is Working to Reduce Youth Suicide

Posted: July 10, 2018

The following article was written by and from the perspective of Northern Public Affairs contributors.

International circumpolar policy leaders are now paying attention to Indigenous youth suicide. In a recent report by the Arctic Council’s Sustainable Development Working Group (2015), they note the global burden of suicide, and write:

"Nowhere, however, does suicide have such an impact and social burden as among indigenous populations, particularly those in circumpolar regions. Historically, Indigenous Peoples in circumpolar regions had very low rates of suicide deaths. Unfortunately, suicide rates in the Arctic are currently among the highest in the world. Youth are especially at risk."

The high rates of Indigenous youth suicide coincide with the rapid, imposed social changes, forced settlement, rapid modernization and national policies of cultural assimilation of the past several decades (Allen, et., al., 2011; Fraser, et al., 2015; Hicks, 2007; Kral, 2012; Kvernmo & Heyerdahl, 2003). Now, Indigenous youth suicide is an all-too-common tragedy disproportionately impacting Indigenous communities across the Arctic (Ragnhild Broderstad, et al., 2011; Oliver, et al., 2012).

Although this picture is grim, Indigenous communities are responding in innovative and impactful ways. In Northwest Alaska, from 1990 to 2000, Iñupiat young people—aged 15 to 19—had a suicide rate of 185 per 100,000 (10-year average for 1990 thru 2000), significantly higher than the rate for the United States as a whole of 10.7 per 100,000 (Wexler, Hill, Bertone-Johnson, & Fenaughty, 2008). After the tribal health organization, school district, for-profit Tribal Corporation and others initiated and sustained a variety of community-based, self-determined programs and activities focused on young people, recent statewide data shows a significant drop in youth suicides in the last five years. Although the link between these programs and reduced rates of suicide is only correlational, this article briefly highlights several initiatives informed by research and led by local, predominantly tribal institutions to address suicide in Northwest Alaska over the past decade. Northern Public Affairs believes that these programs are contributing to the reduced suicide rates we now see in the region. This reduction in suicide rates is promising, and is conceptually linked by other studies documenting similarly hopeful trends after sustained and multi-level suicide prevention efforts (May, et.al., 2005). The marked drop in youth suicide rates in Northwest Alaska corresponds with these various prevention efforts, and is not found in other, similar regions, which strengthens this belief. We hope this catalogue of activities will inspire other communities to take self-determined, strategic actions to prevent and reduce suicide.

Context

Located mostly north of the Arctic Circle, Northwest Alaska has approximately 40,000 square miles of tundra, mountains, and two main inland rivers: Noatak and Kobuk (see Figure 1). There are 11 communities with no roads connecting them, accessible by small commuter aircraft year-round, by boat in the summer months, and snow machine for 7 to 8 months of the year. The regional hub community, Kotzebue, is home to about 3,000 people, over 70% of whom are Alaska Native (State of Alaska, 2010). The outlying small villages range in population from 90 to 1000, with over 95% of the people living in these communities being Iñupiat. Alaska has a unique tribal political structure compared to other Indigenous peoples in North America. Alaska’s tribal health services have a comparatively sovereign structure, which operate under compact agreements with the U.S. federal Indian Health Service in order to provide self-determined, tribally-governed services to their beneficiaries (Warne & Frizzell, 2014).

Wellness and suicide prevention

Community-based and clinical initiatives focused on wellness, resilience and suicide prevention have been sustained in Northwest Alaska since 1999. We describe some of these recent efforts below, emphasizing two important considerations. First, local community members sought out, developed and championed these efforts, often using available resources such as research, clinical protocols, and/or community infrastructure to make them work. These endeavours reflect local sensibilities, community strengths and traditional culture, and underscore self-determination in conceptualizing and implementing community wellness initiatives. The second important element in these programs and events is that they are informed by research and engage many people and various sectors of the community in doing different levels of prevention work. In reflecting on these efforts, we believe these two aspects – local control and multiple institutional, family and individual involvements – are paramount to sustainable and effective suicide prevention in Arctic Indigenous communities.

Multiple efforts within the region and communities

Maniilaq Association, the tribal health and social service nonprofit organization serving Northwest Alaska, initiated a variety of the wellness and suicide prevention efforts occurring in the region over the last two decades. The organization developed the first-recorded tribal suicide surveillance system in an Indigenous region, starting in 1990 (Wexler, et al., 2008). This system documents suicidal behaviour and correlates, and has shaped targeted, clinical interventions, as well as sparked community programming (Hill, et al., 2007; Hagan, et al., 2007; Wexler & Graves, 2008). Supported by the federal Substance Abuse and Mental Health Administration (SAMHSA), the Indian Health Service (IHS) and the Department of Justice (DOJ) over the years, this programming includes media campaigns promoting culturally-specific messages about the importance of life, family, responsibility to tribe, and young people as valuable community members, as well as the more typical prevention message about the importance of help-seeking (and giving) (Fishbein, et al., 2002; U.S. DHHS, 2001). The universal media campaigns focused on messages of prevention and hope evolved to support a region-wide, annual Walk for Life, where community members create signs or just walk to show solidarity and commitment to wellness, suicide prevention and appreciating life. These events are supported by all of the major regional organizations with growing participation over the years.

Although turnover of health professionals continues to plague Maniilaq Association in ways that are similar to other rural and remote regions, the organization has developed several innovative approaches to suicide prevention through clinical care. Replicating Motto and Bostrom’s (2001) supportive, post-suicide crisis letter-writing campaign, Maniilaq initiated and implemented supportive correspondence between health and wellness staff members and those who attempted suicide from 2007-2010 (Wexler, 2010), and more recently, is developing a process to reach out through text messaging to those who exhibit suicidal behaviour. Maniilaq clinical staff are trained in cultural-specific risks for suicide that are based on the local surveillance system as well as cultural strengths, idioms and practices that clinicians need have in mind.

Local leadership development and self-determination of village communities is a priority in all the wellness activities. Since 2009, village leaders have attended retreats for healing, inspiration and leadership training, and they return to their communities to develop local wellness teams and initiatives. Maniilaq Association’s Wellness Program supports these village-based efforts with resources, which include regular village gatherings, community-wide potlucks, recovery support groups, and subsistence opportunities for people who do not have access to boats, camps or snow machines.

More recently, Maniilaq’s regional efforts support local facilitators who bring together representatives from local, village health, law enforcement, religious, and educational institutions to participate in learning circles to decipher “what we know” from suicide prevention research in order to assess and apply it to their local context. The program, called PC CARES (Promoting Community Conversations About Research to End Suicide), aims to translate research to strategic, locally-determined personal and collective actions for prevention (Wexler, et al., 2016; Wexler, et al., 2017). The “bite-size” research information shared in these learning circles includes findings from local research (Wexler & Goodwin, 2006) as well as general injury prevention information (e.g., lethal means restriction) (Roscoät et al., 2013) (see pc-cares.org) (Wexler, et al., 2016).

In a unique partnership, NANA Native Corporation resource technicians made up the bulk of local facilitator teams, making good on the organization’s commitment to “promoting healthy communities with decisions, actions, and behaviours inspired by our Iñupiat Ilitqusiat values consistent with our core principles.” Preliminary evaluation results from this program show participants gained knowledge and skills and increased their prevention activities on personal and professional levels (Wexler, et al., 2017).

Youth-focused programming through the years includes opportunities for reflection and self-expression through digital storytelling. Maniilaq wellness staff traveled to the 11 villages of the region plus Point Hope to offer week-long digital storytelling workshops for young people. From 2007-2014, youth crafted over 500 digital stories that highlight the multi-faceted reasons for living, cultural expression and pride, and commitment to family (Wexler, et al., 2012; Wexler, Eglinton, Gubrium, 2014). Community-wide screenings feature these digital stories. Through follow-up interviews, we know that young digital storytellers shared their stories with important adults and Elders in their lives, thus strengthening intergenerational support. Such support fosters a sense of mentorship, cultural identity and continuity: all of which are protective factors for suicide (Alcántara & Gone, 2007).

The Northwest Arctic Borough School District has also been involved in suicide prevention through a peer leadership program in the area’s schools. Begun in 2008, the Teck John Baker Youth Leaders Program takes a primary prevention approach to reduce risks of substance abuse and bullying through peer-led education and bystander training. The program also aims to increase protective factors of school attendance and engagement, academic success, and personal and cultural identity development. School personnel, community members and students tend to agree that the program is positive for those involved and for the schools in which youth leaders function. Outcomes from an evaluation of the program suggest increases in protective factors for suicide. More specifically, an evaluation of the program showed that participants believe they matter to others, feel positive about themselves, think they can make a difference in their community and school, and very rarely do drugs and drink alcohol. Additionally, they have higher grades and attendance than their peers. All of these factors are known to protect against suicide (Wexler et al., 2017).

Independent village efforts focused on suicide prevention and wellness include hosting youth conferences that bring together Elders and young people to learn, engage in mentoring and learn leadership skills. One village, Kiana, created a group – Opt-In – which initiated a multi-village event to empower young people to take leadership within their communities (Frost, 2017). Another initiative, sponsored by the Kotzebue Tribal Council, invited young people to initiate inquiry with their Elders to learn about leadership, culture and community (Weinronk, 2017). Also, two villages in the region successfully competed for federal suicide prevention funding to create their own suicide prevention activities, which are in development now.

Several village communities run traditional summer camps for youth each year, and regional camps are offered to younger and older youth. Camp Pigaaq, run by Maniilaq Wellness, is a week-long subsistence camp for young people aged 13-18 typically involving 15 at risk Iñupiat youth from the region. Camp Sivuñiġvik offers four, week-long sessions to young people ages 8-16 from the region. Aqqaluk Trust, a nonprofit foundation aimed at “empowering the Iñupiat through language, culture and education” offers this experience as well as scholarships to Iñupiat young people to go to college.

Change in suicide rates

Due to the complexity of the issue, preventing suicide takes time and multiple kinds of efforts before showing an impact (White, 2012). Although there have been concerted and strategic efforts to prevent suicide in Northwest Alaska as catalogued here, the correlated aimed-for outcomes are just now discernable. This finding offers reason to celebrate. The multifaceted efforts undertaken by Northwest Alaska seem to be having a positive impact on youth suicidal behaviour in the remote and rural, Iñupiat region. This reduction in suicide rates between these two, five-year periods stands out in marked contrast to the suicide rates of other, similar regions.

To illustrate, the State of Alaska Department of Health Analytics and Vital Records compiled age-adjusted rates of suicide per 100,000 from 1995 to 2014 in five-year periods. Northwest Arctic Borough (NAB) showed a significant reduction in suicide rates from 2005-2009 to 2010-2014 based on a 95% confidence interval (See Figure 2). This trend was compared to other rural and remote regions in Alaska with historically similar suicide rates including the Nome Census Area, North Slope Borough, and Yukon-Koyukuk Borough, combined. Our analysis found no significant differences in suicide rates between time points within similar northern regions combined or in the state overall (95% confidence interval).

Alaska Native youth under the age of 25 appears to be driving this reduction in suicides in the Northwest Arctic Borough (See Figure 3), and corresponds with the local and regional efforts outlined above. These findings contribute to a hopeful perspective that Indigenous communities, in partnership with service providers and researchers, can make a significant impact on the seemingly intractable problem of youth suicide. This recent reduction in youth suicides between these timeframes is noteworthy particularly because this age group experiences much higher rates of suicide in Indigenous circumpolar communities (Ragnhild Broderstad, et al., 2011; Oliver, et al., 2012; Lehti, et al., 2009). Continuing to monitor suicide rates will help to determine if ongoing multi-level suicide prevention efforts in Northwest Alaska are able to bring about a lasting and sustained decrease in suicide deaths over time, particularly among Alaska Native youth and young adults who are at highest risk.

Conclusions 

Although suicide is complex and the result of a myriad of structural, historic, social and psychological issues, this regional example offers some reason for hope. Although causal assertions cannot be made, the correlation between this rural region’s reduced suicide rates and their consistent, multilevel programming and self-determined practices is promising. Standing out as a hopeful example, Northwest Alaska has sustained a myriad of evidence-informed and self-determined suicide prevention initiatives for over 10 years, and is now showing a reduction in youth suicide rates. Interestingly, similar multi-level approaches to suicide prevention in Indigenous communities elsewhere have shown decreases in suicidal behaviour (May, et al., 2005). The correlation is promising and can offer other regions a hopeful perspective to spur multi-level and self-determined efforts. We believe other Indigenous communities may find inspiration in this example, and policy makers can find evidence for sustaining support of multiple kinds of community-driven prevention and intervention programming.

Read more on NorthernPublicAffairs.ca.



The Future of Healing: Shifting From Trauma Informed Care to Healing Centered Engagement

Posted: July 09, 2018

The following was written by and from the perspective of Dr. Shawn Ginwright, Associate Professor of Education, and African American Studies at San Francisco State University and the author of Hope and Healing in Urban Education: How Activists are Reclaiming Matters of the Heart.

From time to time, researchers, policy makers, philanthropy and practitioners all join together in a coordinated response to the most pressing issues facing America’s youth. I’ve been involved with this process for long enough to have participated in each of these roles. I recall during the early 1990s experts promoted the term “resiliency” which is the capacity to adapt, navigate and bounce back from adverse and challenging life experiences. Researchers and practitioners alike clamored over strategies to build more resilient youth.

The early 2000’s the term “youth development” gained currency and had a significant influence on youth development programming, and probably more importantly how we viewed young people. Youth development offered an important shift in focus from viewing youth as problems to be solved to community assets who simply required supports and opportunities for healthy development. Since that time, a range of approaches have influenced how we think about young people, and consequently our programmatic strategies. I have, for the most part, attempted to nudge and cajole each of these approaches to consider the unique ways in which race, identity and social marginalization influence the development of youth of color.

More recently, practitioners and policy stakeholders have recognized the impact of trauma on learning, and healthy development. In efforts to support young people who experience trauma, the term “trauma informed care” has gained traction among schools, juvenile justice departments, mental health programs and youth development agencies around the country. Trauma informed care broadly refers to a set of principles that guide and direct how we view the impact of severe harm on young people’s mental, physical and emotional health. Trauma informed care encourages support and treatment to the whole person, rather than focus on only treating individual symptoms or specific behaviors.

Trauma-informed care has become an important approach in schools and agencies that serve young people who have been exposed to trauma, and here’s why. Some school leaders believe that the best way to address disruptive classroom behavior is through harsh discipline. These schools believe that discipline alone is sufficient to modify undesired classroom behavior. But research shows that school suspensions may further harm students who have been exposed to a traumatic event or experience (Bottiani et al. 2017). Rather than using discipline, a school that uses a trauma informed approach might offer therapy, or counseling to support the restoration of that student’s well-being. The assumption is that the disruptive behavior is the symptom of a deeper harm, rather than willful defiance, or disrespect.

While trauma informed care offers an important lens to support young people who have been harmed and emotionally injured, it also has its limitations. I first became aware of the limitations of the term “trauma informed care” during a healing circle I was leading with a group of African American young men. All of them had experienced some form of trauma ranging from sexual abuse, violence, homelessness, abandonment or all of the above. During one of our sessions, I explained the impact of stress and trauma on brain development and how trauma can influence emotional health. As I was explaining, one of the young men in the group named Marcus abruptly stopped me and said, “I am more than what happened to me, I’m not just my trauma”. I was puzzled at first, but it didn’t take me long to really contemplate what he was saying.

The term “trauma informed care” didn’t encompass the totality of his experience and focused only on his harm, injury and trauma. For Marcus, the term “trauma informed care” was akin to saying, you are the worst thing that ever happened to you. For me, I realized the term slipped into the murky water of deficit based, rather than asset driven strategies to support young people who have been harmed. Without careful consideration of the terms we use, we can create blind spots in our efforts to support young people.

While the term trauma informed care is important, it is incomplete. First, trauma informed care correctly highlights the specific needs for individual young people who have exposure to trauma. However, current formulations of trauma informed care presumes that the trauma is an individual experience, rather than a collective one. To illustrate this point, researchers have shown that children in high violence neighborhoods all display behavioral and psychological elements of trauma (Sinha & Rosenberg 2013). Similarly, populations that disproportionately suffer from disasters like Hurricane Katrina share a common experience that if viewed individually simply fails to capture how collective harm requires a different approach than an individual one.

Second, trauma informed care requires that we treat trauma in people but provides very little insight into how we might address the root causes of trauma in neighborhoods, families, and schools. If trauma is collectively experienced, this means that we also have to consider the environmental context that caused the harm in the first place. By only treating the individual we only address half of the equation leaving the toxic systems, policies and practices neatly intact.

Third, the term trauma informed care runs the risk of focusing on the treatment of pathology (trauma), rather than fostering the possibility (well-being). This is not an indictment on well-meaning therapists and social workers many of whom may have been trained in theories and techniques designed to simply reduce negative emotions and behavior (Seligman 2011). However, just like the absence of disease doesn’t constitute health, nor the absence of violence constitute peace, the reduction pathology (anxiety, anger, fear, sadness, distrust, triggers) doesn’t constitute well-being (hope, happiness, imagination, aspirations, trust). Everyone wants to be happy, not just have less misery. The emerging field of positive psychology offers insight into the limits of only “treating” symptoms and focuses on enhancing the conditions that contribute to well-being. Without more careful consideration, trauma informed approaches sometimes slip into rigid medical models of care that are steeped in treating the symptoms, rather than strengthening the roots of well-being.

What is needed is an approach that allows practitioners to approach trauma with a fresh lens which promotes a holistic view of healing from traumatic experiences and environments. One approach is called healing centered, as opposed to trauma informed. A healing centered approach is holistic involving culture, spirituality, civic action and collective healing. A healing centered approach views trauma not simply as an individual isolated experience, but rather highlights the ways in which trauma and healing are experienced collectively. The term healing centered engagement expands how we think about responses to trauma and offers more holistic approach to fostering well-being.

The Promise of Healing Centered Engagement

A shift from trauma informed care to healing centered engagement (HCE) is more than a semantic play with words, but rather a tectonic shift in how we view trauma, its causes and its intervention. HCE is strength based, advances a collective view of healing, and re-centers culture as a central feature in well-being. Researchers have pointed out the ways in which patients have redefined the terms used to describe their illnesses in ways that affirmed, humanized and dignified their condition. For example, in the early 1990s AIDS activists challenged the term “gay-related immune deficiency” because the term stigmatized gay men and failed to adequately capture the medical accuracy of the condition. In a similar way, the young men I worked with offered me a way to reframe trauma with language that humanized them, and holistically captured their life experiences.

A healing centered approach to addressing trauma requires a different question that moves beyond “what happened to you” to “what’s right with you” and views those exposed to trauma as agents in the creation of their own well-being rather than victims of traumatic events. Healing centered engagement is akin to the South African term “Ubuntu” meaning that humanness is found through our interdependence, collective engagement and service to others. Additionally, healing centered engagement offers an asset driven approach aimed at the holistic restoration of young peoples’ well-being. The healing centered approach comes from the idea that people are not harmed in a vacuum, and well-being comes from participating in transforming the root causes of the harm within institutions. Healing centered engagement also advances the move to “strengths-based’ care and away from the deficit based mental health models that drives therapeutic interventions. There are four key elements of healing centered engagement that may at times overlap with current trauma informed practices but offers several key distinctions.

  • Healing centered engagement is explicitly political, rather than clinical.

Communities, and individuals who experience trauma are agents in restoring their own well-being. This subtle shift suggests that healing from trauma is found in an awareness and actions that address the conditions that created the trauma in the first place. Researchers have found that well-being is a function of control and power young people have in their schools and communities (Morsillo & Prilleltensky 2007; Prilleltensky & Prilleltensky 2006). These studies focus on concepts such as such as liberation, emancipation, oppression, and social justice among activist groups and suggests that building an awareness of justice and inequality, combined with social action such as protests, community organizing, and/or school walk-outs contribute to overall wellbeing, hopefulness, and optimism (Potts 2003; Prilleltensky 2003, 2008). This means that healing centered engagement views trauma and well-being as function of the environments where people live, work and play. When people advocate for policies and opportunities that address causes of trauma, such as lack of access to mental health, these activities contribute to a sense of purpose, power and control over life situations. All of these are ingredients necessary to restore well-being and healing.

  • Healing centered engagement is culturally grounded and views healing as the restoration of identity.

The pathway to restoring well-being among young people who experience trauma can be found in culture and identity. Healing centered engagement uses culture as a way to ground young people in a solid sense of meaning, self-perception, and purpose. This process highlights the intersectional nature of identity and highlights the ways in which culture offers a shared experience, community and sense of belonging. Healing is experienced collectively, and is shaped by shared identity such as race, gender, sexual orientation. Healing centered engagement is the result of building a healthy identity, and a sense of belonging. For youth of color, these forms of healing can be rooted in culture and serves as an anchor to connect young people to a shared racial and ethnic identity that is both historical grounded and contemporarily relevant. Healing centered engagement embraces a holistic view of well-being that includes spiritual domains of health. This goes beyond viewing healing only from the lens of mental health, and incorporates culturally grounded rituals, and activities to restore well-being (Martinez 2001). Some examples of healing centered engagement can be found in healing circles rooted in indigenous culture where young people share their stories about healing and learn about their connection to their ancestors and traditions, or drumming circles rooted in African cultural principles.

  • Healing centered engagement is asset driven and focuses well-being we want, rather than symptoms we want to suppress.

Healing centered engagement offers an important departure from solely viewing young people through the lens of harm and focuses on asset driven strategies that highlight possibilities for well-being. An asset driven strategy acknowledges that young people are much more than the worst thing that happened to them, and builds upon their experiences, knowledge, skills and curiosity as positive traits to be enhanced. While it is important to acknowledge trauma and its influence on young people’s mental health, healing centered strategies move one step beyond by focusing on what we want to achieve, rather than merely treating emotional and behavioral symptoms of trauma. This is a salutogenic approach focusing on how to foster and sustain well-being. Based in positive psychology, healing centered engagement is based in collective strengths and possibility which offers a departure from conventional psychopathology which focuses on clinical treatment of illness.

  • Healing centered engagement supports adult providers with their own healing.

Adult providers need healing too! Healing centered engagement requires that we consider how to support adult providers with sustaining their own healing and well-being. We cannot presume that adulthood is a final “trauma free” destination. Much of our training and practice is directed at young peoples’ healing but rarely focused on the healing that is required of adults to be an effective youth practitioner. Healing is ongoing process that we all need, not just young people who experience trauma. The well-being of the adult youth worker, also is a critical factor in supporting young peoples’ well-being. While we are learning more about the causes and effects of secondary on adults, we know very little about the systems of support required to restore and sustain well-being for adults. Healing centered engagement has an explicit focus on restoring, and sustaining the adults who attempt to heal youth- a healing the healers approach. Policy stakeholders should consider how to build a systems that support adult youth worker’s well-being. I have supported organizations in creating structures like sabbaticals for employees, or creating incentives like continuing education units for deeper learning about well-being and healing.

A Note for Practice and Policy

Marcus’s comments during our healing circle “I am more than what happened to me” left with me with more questions than answers. What blind spots do we have in our approaches to supporting young people who experience trauma? How might the concepts which are enshrined in our language limit rather than create opportunities for healing? What approaches might offer “disruptive” techniques that saturate young people with opportunities for healing and well-being? The fields of positive psychology and community psychology offers important insight into how policy makers, and youth development stakeholders can consider a range of healing centered options for young people. Shifting from trauma informed care or treatment to healing centered engagement requires youth development stakeholders to expand from a treatment based model which views trauma and harm as an isolated experience, to an engagement model which supports collective well-being. Here are a few notes to consider in building healing centered engagement.

  • Start by building empathy

Healing centered engagement begins by building empathy with young people who experience trauma. This process takes time, is an ongoing process and sometimes may feel like taking two steps forward, and three steps back. However, building empathy is critical to healing centered engagement. To create this empathy, I encourage adult staff to share their story first, and take an emotional risk by being more vulnerable, honest and open to young people. This process creates an empathy exchange between the adult, and the young people which is the foundation for healing centered engagement (Payne 2013). This process also strengthens emotional literacy which allows youth to discuss the complexity of their feelings. Fostering empathy allows for young people to feel safe sharing their experiences and emotions. The process ultimately restores their sense of well-being because they have the power name and respond to their emotional states.

  • Encourage young people to dream and imagine!

An important ingredient in healing centered engagement is the ability to acknowledge the harm and injury, but not be defined by it. Perhaps one of the greatest tools available to us is the ability to see beyond the condition, event or situation that caused the trauma in the first place. Research shows that the ability to dream and imagine is an important factor to foster hopefulness, and optimism which both of which contributes to overall well-being (Snyder et al. 2003). Daily survival and ongoing crisis management in young people’s lives make it difficult to see beyond the present. The greatest casualty of trauma is not only depression and emotional scares, but also the loss of the ability to dream and imagine another way of living. Howard Thurman pointed this out in his eloquent persistence that dreams matter. He commented, “As long as a man [woman] has a dream, he [she] cannot lose the significance of living” (p. 304). By creating activities and opportunities for young people to play, reimagine, design and envision their lives this process strengthens their future goal orientation (Snyder et al. 2003). These are practices of possibility that encourage young people to envision what they want to become, and who they want to be.

  • Build critical reflection and take loving action.

Healing and well-being are fundamentally political not clinical. This means that we have to consider the ways in which the policies and practice and political decisions harm young people. Healing in this context also means that young people develop an analysis of these practices and policies that facilitated the trauma in the first place. Without an analysis of these issues, young people often internalize, and blame themselves for lack of confidence. Critical reflection provides a lens by which to filter, examine, and consider analytical and spiritual responses to trauma. By spiritual, I mean the ability to draw upon the power of culture, rituals and faith in order to consistently act from a place of humility, and love. These are not cognitive processes, but rather ethical, moral and emotional aspects of healing centered engagement.

The other key component, is taking loving action, by collectively responding to political decisions and practices that can exacerbate trauma. By taking action, (e.g. school walkouts, organizing peace march, or promoting access to healthy foods) it builds a sense of power and control over their lives. Research has demonstrated that building this sense of power and control among traumatized groups is perhaps one of the most significant features in restoring holistic well-being.

Read more on Medium.com



How Gardening Can Improve the Mental Health of Refugees

Posted: July 06, 2018

After spending many years living in refugee camps, gardening can provide a safe space to establish identity, rebuild lives and attain happiness.

new study on the Myanmar former refugee community in the regional city of Coffs Harbour revealed the importance of gardening, and in particular how this connection has a positive impact on the mental health of people who have faced severe trauma and are now settling in an unfamiliar place.

What did the study find?

People from refugee backgrounds face many complex challenges when they arrive in a new country. Engagement with food can present both a challenge, in terms of unfamiliar foods and foreign ways of cooking, as well as a way to be happy when traditional foods can be found and shared.

Previous studies have shown how migrants often adopt poor food habits when settling in a new country. A key finding of this new study is that traditional, often healthier foods are preferred. One way to access these foods is through gardening.

The sub-tropical climate and fertile soil in Coffs Harbour make it an ideal place to grow foods like those from Myanmar.

All participants in this study had home gardens where they grew traditional foods such as “very hot” chillies, rosella (a type of hibiscus grown for their leaves), a big variety of Asian eggplants, as well as other “jungle” foods. Growing these rare (in Australia) plants was possible through the well-developed Myanmar community network that shared seeds, seedlings and crops.

Having a garden provided preferred foods but also contributed to good mental health and wellbeing by creating a place where people who had faced considerable trauma could feel safe and happy.

How is gardening good for mental health?

Research has found spending time in nature can significantly improve mental health. Gardening offers a way to be in nature that is both productive and relaxing. Like all forms of exercise, it is also a source of “happy hormones” (serotonin and dopamine).

Gardening has been shown to provide clear mental health benefits for people from refugee backgrounds. Everyday activities such as gardening offer meaningful experiences and a way to reconnect with positive memories of home that can help to make a refugee’s new country feel more like home.

Participants spoke of how gardening made them happy because it helped them re-imagine their homeland, families and culture.

Feeling at home in unfamiliar surroundings is important for people who have experienced ongoing uncertainty. One man spoke about how his garden in a rental property was not only a source of food but also a way to recreate a familiar place:

"The plants, fruit and vegetables we grow in our garden, it’s like we’re eating food in Burma."

Participants in this study spoke of how gardens provided an income and a way to be independent, but also offered a means to feel happy and purposeful. One man said:

"If I hadn’t been doing gardening it would be so bad. So I love my gardening. It helped a lot with my mental health and well-being."

Another man, after suffering a stroke and spending several months in hospital, longed to be back in his garden. He described how gardening was an essential part of his recovery:

"It is therapy, yes. Also, for my left side I do exercise. I weeding slowly, good exercise […] when I come home from the hospital I go into my garden and I look around my garden, my feeling is good."

The foods we choose to eat have health impacts, but the physical act of growing our own food also has positive effects on our mental health.

Gardening is a way for people who have faced considerable trauma to feel safe and with nature, as well as re-establish their identity and reconnect with their culture. As summed up by one participant:

"Gardening is going to give happiness for a lifetime."

Read more on TheConversation.org.



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