Yale Psychiatry Grand Rounds: September 25, 2020
September 25, 2020Lee Pachter, DO, Professor, Pediatric & Population Health, Sidney Kimmel Medical College of Thomas Jefferson University: "Racism, Adversity and Child Health"
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- 00:00Racial and ethnic minority children and
- 00:03other vulnerable population that we
- 00:05don't always think about it in terms of
- 00:07the impact of racism and discrimination
- 00:10on their health and well being.
- 00:12With that, I'm extremely pleased
- 00:14to introduce Doctor Leap Actor.
- 00:16He is a professor of Pediatrics in
- 00:19population health at Thomas Jefferson
- 00:21University and senior physician,
- 00:23scientist and director of mentorship
- 00:26and professional development at
- 00:28the Value Institute at Christiana
- 00:30care health system in Delaware.
- 00:32Doctor Pachter also is the editor in
- 00:35chief of the Journal of developmental
- 00:37and behavioral Pediatrics.
- 00:39He received his DO degree from the
- 00:42Philadelphia College of osteopathic medicine.
- 00:44He was a pediatric resident at
- 00:47Saint Christopher's Hospital for
- 00:49children in Philadelphia.
- 00:51And completed a fellowship in
- 00:53academic general Pediatrics at
- 00:54Children's Hospital of Philadelphia.
- 00:56He was a faculty member at the
- 00:59University of Connecticut School of
- 01:01Medicine for 20 years before returning
- 01:04to Philadelphia to become chief of
- 01:07general Pediatrics at Saint Christophers
- 01:09Doctor Pachter's research has been
- 01:11in the area of cultural competency,
- 01:14cultural informed care,
- 01:15social determinants of Health,
- 01:17psychosocial stress and adversity,
- 01:19racism and discrimination,
- 01:20and Health Inequities and disparities.
- 01:23He's received grants from the NIH,
- 01:26CDC,
- 01:26hersa,
- 01:26and private foundations for research
- 01:29and program development.
- 01:30He received a grant from the CDC to study
- 01:33the effects of parenting maternal depression,
- 01:37the home environment and poverty are.
- 01:40Children's behavioral health in
- 01:42different racial and ethnic groups.
- 01:45His NIH K Award was used to study
- 01:48racism and minority children,
- 01:50and has resulted in the development
- 01:53of the precis,
- 01:54which is the perceptions of
- 01:56racism in children and youth.
- 01:58A psychometrically validated
- 02:00questionnaire to measure perceived
- 02:02racism and discrimination in youth.
- 02:04As a founding Co leader of the
- 02:07Philadelphia adverse childhood
- 02:09experiences or Asus task force,
- 02:11he was part of a team that developed
- 02:14the ace Philadelphia aces questionnaire,
- 02:17which included community level
- 02:19adversities such as experiences of racism,
- 02:22witnessing community violence,
- 02:23low social capital,
- 02:24and bullying.
- 02:26In addition to the traditional aces.
- 02:29He was also the piona herself funded
- 02:31project aimed at developing clinical
- 02:33an community approaches to trauma
- 02:36informed care in the state of Delaware.
- 02:38We also developed an was founding director
- 02:42of the academic pediatric associations.
- 02:45New scholars century program and
- 02:48national mentor ship program for
- 02:50underrepresented in medicine.
- 02:52Pediatric trainees interested in
- 02:55developing academic careers in
- 02:57health disparities research.
- 02:59The program, now in its 16th year,
- 03:02has been funded by the NIH,
- 03:04the US Office of minority health,
- 03:07the American Pediatric Society,
- 03:09the Kellogg Foundation,
- 03:10and the Aetna Foundation.
- 03:11Please join me in welcoming doctor Lee
- 03:14Pachter who's talk is entitled racism,
- 03:17adversity and child health.
- 03:19Thank you Doctor Cousteau.
- 03:21Thank you
- 03:22so much. First of all for inviting me and
- 03:25also for making sure that this subject is
- 03:28really front and center in your Department.
- 03:32So it's great to virtually be in New Haven.
- 03:35As Cindy said, I spent 20 years in Hartford
- 03:38at Saint Francis hospital as well as the
- 03:42Connecticut Children's Medical Center.
- 03:45And yeah, I have ties to New Haven as well.
- 03:47My wife, who is a psychiatrist,
- 03:49actually went to undergrad and medical
- 03:51school at Yale and my sister in law,
- 03:53who I believe is in the audience today.
- 03:55Heather just retired from the School of
- 03:57Nursing where she was a professor at the
- 03:59school of their scale. So it's great.
- 04:01I wish I was up in New Haven.
- 04:03The one bad thing about this virtual is that
- 04:05by virtual slice of Peppes Pizza isn't as
- 04:07good as my regular slice of Pepi's Pizza,
- 04:09and I really missed that.
- 04:11But anyway, but we'll take,
- 04:12we'll take it from here.
- 04:13I'm going to try to share my screen I.
- 04:16Please give me feedback if you don't
- 04:18see it or if slides are not advancing.
- 04:21You should now see a slide that says racism,
- 04:25adversity and childhood shop
- 04:27will take your fear.
- 04:31So. What my goals today are, first of all,
- 04:35to place this this topic of racism within
- 04:38the context of social determinants of Health.
- 04:41In other words, racism being a psychosocial
- 04:44stressor that can contribute to poor health
- 04:47outcomes in children and adults of color.
- 04:50Like to review the scant literature
- 04:52unfortunately on the relationship
- 04:53between racism and child health,
- 04:55hopefully, maybe advancing that.
- 04:58Also discuss how common is it?
- 05:00How common is racism in the lives of
- 05:03children color in the 21st century?
- 05:06I think what's really important to discuss
- 05:09the potential processes and mechanisms
- 05:11through which stressors such as racism
- 05:13may contribute to sub optimal health.
- 05:16And then finally, propose that racism
- 05:17should be considered within this grouping
- 05:19of adverse childhood experiences or aces.
- 05:21Now, I understand that this audience is very,
- 05:23very diverse in terms of everyone from
- 05:25medical students to America by professor.
- 05:27So I apologize if some of the things I've
- 05:29talked about their background to you,
- 05:31but I just want to make sure
- 05:33that we're on the same page,
- 05:35so we'll start there.
- 05:36But actually where I'd like to start
- 05:38this where I live now in Philadelphia,
- 05:40as much as I love Connecticut,
- 05:42my home now is in Philadelphia.
- 05:43It's a fun town and I'm sure
- 05:45many of you have visited either.
- 05:47For vacations or family or education,
- 05:50and if you've come to Philadelphia,
- 05:53probably at least partially stopped in the
- 05:56area of Philadelphia called society Hill.
- 05:58Very common place for people to go.
- 06:02It's beautiful old cobblestone streets,
- 06:04very much like New Haven colonial buildings.
- 06:07Our Roe homes and a lot of clubs
- 06:10and restaurants.
- 06:11Great place just to walk around.
- 06:13There are large condominiums.
- 06:14This one was designed by IM Pei.
- 06:16It's called Society Hill Towers.
- 06:19Of course we have all the historical
- 06:21stuff that goes on in Philadelphia from
- 06:23Independence Hall and the Liberty Bell.
- 06:25So that's probably with a lot of people.
- 06:27Think about when they visit or
- 06:29when they think about Philadelphia.
- 06:31Now there's another community in Philadelphia
- 06:34with another sort of colorful name.
- 06:36Very very close.
- 06:37Called Strawberry Mansion.
- 06:39Many of you,
- 06:39some of you may have visited them certain.
- 06:42Many of you have not let's,
- 06:43let's talk about a little bit of difference
- 06:45of these two very close communities.
- 06:47In Society Hill,
- 06:49the average adjusted gross income
- 06:51is a little bit over $150,000.
- 06:54In Strawberry Mansion,
- 06:57the average income is $24,000.
- 07:00In Society Hill,
- 07:019% of the residents live below the
- 07:04poverty line in Strawberry Mansion,
- 07:0641% live below the poverty line.
- 07:10In Society Hill,
- 07:12the percentage of residents with a
- 07:14bachelors degree is a little bit over 70%.
- 07:17In Strawberry Mansion's 4%.
- 07:22The unemployment rate in Society Hill
- 07:26is 3.7% in Strawberry Mansion's.
- 07:29It's 25%. 2% of the residents in
- 07:33Society Hill receive food stamps,
- 07:3535% in Strawberry Mansion.
- 07:3878% of the residents of
- 07:40Society Hill are white.
- 07:42And 93% of the residents in
- 07:45Strawberry mansion are black.
- 07:46Now here's the most all
- 07:48those stats are interesting,
- 07:49but here is I think the
- 07:51most interesting stat.
- 07:53In Society Hill,
- 07:54the life expectancy is 88 years.
- 07:58In Strawberry mentioned it's 68 years.
- 08:02So we're not talking about the difference
- 08:04between the US and some third world country.
- 08:06But we're not talking about the difference
- 08:09between New England and Louisiana
- 08:10or Mississippi were talking bout the
- 08:13walkable distance within a city. 20 years.
- 08:15Think about with 20 years is within a
- 08:17walkable distance. Life expectancy.
- 08:19So I guess the question is. Why?
- 08:22These are the usual suspects.
- 08:24Obviously from my slides you've seen
- 08:27that the housing stock is very different,
- 08:29as well as the stats on incoming education.
- 08:32I can tell you that neighborhood safety is
- 08:35quite different in these two communities.
- 08:37An power of neighborhood safety is
- 08:39allowing kids to go outside and do
- 08:42healthy activities like exercise,
- 08:43not that available in Strawberry Mansion.
- 08:46Should I mention is considered a food desert?
- 08:49You know most people get their food
- 08:52from corner stores which don't have
- 08:54the most healthy and nutritious food.
- 08:56A toxic exposures, you know,
- 08:58driving to work everyday.
- 08:59I drive on the Roosevelt Expressway,
- 09:01which is above its its its height
- 09:03and it's above Strawberry Mansion.
- 09:05I'm thinking of all the cartoons that
- 09:07are raining down upon the residence.
- 09:09Also,
- 09:10strawberry mansion has the highest
- 09:11rate of lead exposure in kids.
- 09:13Believing that 21% of children in
- 09:16Strawberry mansion have high lead levels.
- 09:18And obviously access to transportation and
- 09:21access to quality preventive healthcare
- 09:23are all potential reasons why we see
- 09:27this difference in life expectancy.
- 09:29If you take a step back and look at
- 09:31just the overall determinants of Health,
- 09:34they could be grouped into these
- 09:35type of categories.
- 09:36And again, if these slides aren't showing up,
- 09:39someone raised their hand,
- 09:40but there should be a slide that
- 09:42says determinants of Health and
- 09:44fix different categories.
- 09:45We all know biology,
- 09:46genetics and medical care are
- 09:47important determinants of Health,
- 09:49but as as we know as well
- 09:51the physical environment,
- 09:52the social environment and behavior,
- 09:53specifically,
- 09:54health behaviors are also important
- 09:56determinants of health care outcomes.
- 09:58So what was surprising to me when
- 10:01I first looked into these issues
- 10:03is that biology.
- 10:04Genetics, according to most studies,
- 10:06only account for about 30% of the
- 10:08variability in health outcomes.
- 10:10And Healthcare, which were all apart of.
- 10:13And we probably are little bit
- 10:16egocentric about.
- 10:17Many studies have shown that healthcare
- 10:19only contributes about 10 to 20% in
- 10:22the differences in health outcomes.
- 10:24So between biology,
- 10:26genetics and medical,
- 10:27it's really not that much whereas
- 10:30those top three categories,
- 10:31the physical and social environment
- 10:34and health behaviors they contribute.
- 10:36Anywhere from 50 to 70% of the
- 10:39differences in health care outcomes.
- 10:41So if you look at it this way,
- 10:43it really is true that your zip code
- 10:46is more important than your genetic
- 10:48code when it comes to health outcomes,
- 10:51you zip code is more important
- 10:53than your genetic code.
- 10:55Now by far my medical training
- 10:57emphasize those bottom three areas
- 10:59and I think I was woefully unprepared
- 11:01to really practice medicine.
- 11:02Because, you know,
- 11:0380% of my medical education has to
- 11:05do with biology,
- 11:06genetics in the healthcare system.
- 11:08It's changed a lot since
- 11:09I've gone to medical school,
- 11:11but we still have a long way to go.
- 11:14It's not only the professional training,
- 11:16but look at spending.
- 11:17Let's follow the money.
- 11:19Of the two point 9 trillion at
- 11:21the United States spends every
- 11:23year in health related costs,
- 11:2697% of the grows to Healthcare.
- 11:30So what that's saying is that
- 11:3297% of the expenditures is going
- 11:34to a category that only accounts
- 11:37for 10 to 20% of health outcomes.
- 11:41That also means that only
- 11:433% of health expenditures.
- 11:45Go to the areas that attribute that accounted
- 11:49for 50 to 70% of the health outcomes.
- 11:52So it's not surprising that with all
- 11:55the health spending that we have,
- 11:57probably the most in the world,
- 11:59the United States ranks 31st
- 12:01in life expectancy. So.
- 12:07What do we talk about when we talk about
- 12:10these social determinants of health?
- 12:12You know, these include things such
- 12:15as you know, income and wealth,
- 12:17social class, food security,
- 12:19housing, security,
- 12:19preventative and risk taking
- 12:21behaviors and things like Education,
- 12:23Community, neighborhood,
- 12:24which also included in the
- 12:26social determinants of Health.
- 12:27Obviously our race and ethnicity.
- 12:30So race and ethnicity a demographic
- 12:32factors that are mentioned as
- 12:33social determinant of Health.
- 12:34But what we really mean when we
- 12:36talk about race and ethnicity as
- 12:38a social determinant of Health.
- 12:40So we all know now that it's commonly
- 12:42accepted that race is less of a
- 12:44biological issue as a social construct.
- 12:46That's why it's considered a social
- 12:48determinant of health, right?
- 12:50So if we agree that race is mostly,
- 12:53if not all, a social construct,
- 12:55then the next question is through
- 12:57what mechanism do we account for
- 12:59the racial and ethnic factors
- 13:00contributing to health outcomes so well?
- 13:03I would like to propose.
- 13:05So when we talk about race and
- 13:07ethnicity and health care in particular,
- 13:09it's the health disparities in outcomes.
- 13:10What we're really talking about is
- 13:12racial discrimination or racism,
- 13:13and that I hope to make that argument today.
- 13:18So. Common definition of racism.
- 13:21It's the negative beliefs, attitudes,
- 13:24and actions resulting from categorizing
- 13:26individuals or groups based on phenotype,
- 13:28heritage, or culture.
- 13:29Actually divided into 2 racial prejudices,
- 13:32our beliefs, attitudes and assumptions.
- 13:35And discrimination are actions and behaviors.
- 13:37Another way of breaking down racism
- 13:39is in terms of levels of racism.
- 13:42So this comes from a wonderful physician,
- 13:45Public Health Epidemiologist named
- 13:46Kamari Jones, who is the president of
- 13:49the American Public Health Association,
- 13:51and she is divided levels of
- 13:53racism into these three levels.
- 13:55Interpersonal, structural and internalize.
- 13:58So interpersonal racism,
- 13:59what we typically consider as racism,
- 14:01it's racial prejudices and discriminations
- 14:03that car on the personal level between
- 14:06two people or between the person and the
- 14:09group that he or she has prejudice against.
- 14:12Structural racism,
- 14:13which we're talking more about
- 14:14because of the because of the issues
- 14:17happening in the United States today.
- 14:19Structural racism is a system of
- 14:22organization that includes policies
- 14:24and practices and norms that contribute
- 14:27to an reinforce cultural inequality.
- 14:30So unlike interpersonal racism,
- 14:31this is not something that a small
- 14:34group of people or person can decide
- 14:37to participate in or not.
- 14:39It's intimately woven into the
- 14:41fabric of our culture.
- 14:42Basically,
- 14:43it's a pervasive feature of the social,
- 14:45economic, and political environment.
- 14:47So institutional racism is racism is
- 14:51one part of structural racism, and that
- 14:54occurs within large sectors of systems.
- 14:56For example, the education system,
- 14:59health care,
- 15:00or the judicial or correctional systems,
- 15:02and other structural racism component
- 15:05is residential segregation,
- 15:06for example.
- 15:09Now internalize racism is a
- 15:12somewhat controversial term which
- 15:14denotes negative beliefs and
- 15:16attitudes towards one's own group.
- 15:19And it could include beliefs in
- 15:22racial and ethnic stereotyping.
- 15:23Haven't once group,
- 15:24but internalised racism is thought
- 15:27to carve someone unconsciously
- 15:28because of constant exposure to
- 15:31interpersonal in structural racism.
- 15:33You know the classical example
- 15:35of internalised racism.
- 15:36That's partly children is the famous
- 15:38doll studies by Kenneth and Mamie Clark.
- 15:41You may remember that this study,
- 15:43which was conducted actually in the 1940s,
- 15:46demonstrate that African American children,
- 15:47when given the choice between dollars with
- 15:50white skin color or Brown skin color,
- 15:52consistently showed a preference
- 15:54to the white bells,
- 15:55and these results were interpreted
- 15:57as demonstrating internalised racism
- 15:59in these kids who are subject to
- 16:01segregated schools and high degree
- 16:03of structural and systemic racism.
- 16:05And as you probably know,
- 16:07this study was used to as evidence in
- 16:09the Brown versus Board of Education case
- 16:12that struck down school desegregation.
- 16:14So if you think about these levels of racism,
- 16:17they kind of somehow map to those
- 16:19three different categories of
- 16:21social determinants of Health.
- 16:22Structural racism,
- 16:23particularly residential segregation,
- 16:25and its effect on unequal distribution
- 16:27of resources fits within the environment,
- 16:30the physical environment.
- 16:32Interpersonal racism is obviously
- 16:35a social construct.
- 16:37And internalize racism can influence
- 16:39behaviors, particularly health,
- 16:41promoting behaviors and risk
- 16:43taking behaviors.
- 16:46So this is the back on the topic of my talk.
- 16:49Is racism in children?
- 16:50So let's start talking about kids.
- 16:53So does racism affect Children's Health?
- 16:55There's not a lot of data on this,
- 16:58but there is enough to make
- 17:00some assumptions so awhile back,
- 17:02about 10 years ago,
- 17:04we did a systematic review of the literature.
- 17:07On the effects not effects,
- 17:09but the Association.
- 17:10I'm sorry between racism and
- 17:13Children's Health in general.
- 17:15We looked at all the medical literature,
- 17:17the social science literature,
- 17:18and that includes, obviously psychology,
- 17:20public health, etc.
- 17:22And what we found is that in the whole corpus
- 17:25of the medical and social science literature,
- 17:27we found at that point about 2000 seven 2009,
- 17:31only 40 papers that dealt with racism as it's
- 17:34associated with Children's Health outcomes.
- 17:37By far the largest part of the
- 17:39literature had to do with mental
- 17:41health and behavioral health.
- 17:43There was a small literature
- 17:45on birth outcomes,
- 17:46as many of you know,
- 17:47there are black white differences in things
- 17:50such as low birth weights and prematurity,
- 17:53and there was actually one study
- 17:55that showed that when you take into
- 17:57account maternal experiences of racism,
- 17:59the black white difference in pre
- 18:02term birth becomes insignificant.
- 18:03So maybe when looking at these racial
- 18:06ethnic differences in birth outcomes,
- 18:08we really talk about racism.
- 18:09And then there's a very,
- 18:11very small literature on some physical
- 18:13effects in kids mostly having to do
- 18:15with diabetes and cardiovascular health.
- 18:17When you look at the behavioral mental
- 18:20health literature on kids and racism,
- 18:22you know the suspects are, you know,
- 18:24higher degree of perceptions of racism,
- 18:26higher depression and anxiety.
- 18:28Lower self esteem,
- 18:30more behavioral problems.
- 18:32Delinquent in conduct disorder problems.
- 18:35Racism in adults have been shown to
- 18:38be associated with worse parenting
- 18:40practices and maternal depression,
- 18:42and it's also been associated
- 18:44with substance and alcohol use.
- 18:49So from a methodological perspective,
- 18:51I found something really interesting.
- 18:52When all these studies having
- 18:54to do with racism and kids,
- 18:55when you look at how they actually measured
- 18:57races and how they operationalized it,
- 18:59it was all over the board.
- 19:01There were 30 different questionnaires.
- 19:03An most importantly,
- 19:04most of the questionnaires were developed
- 19:06and tested in adults and they really
- 19:08didn't show there was no validity,
- 19:09reliability and kids.
- 19:10And as we all know,
- 19:12kids aren't little adults so this was
- 19:14something we'll talk about a little bit
- 19:16later when we talk about the crazy,
- 19:18but this is what we found.
- 19:20About 10 years ago,
- 19:22not a lot of literature,
- 19:24and the literature really was using.
- 19:28Questionnaires which were
- 19:30inappropriate for kids.
- 19:32So we know there is some Association
- 19:34between racism and kids health outcomes,
- 19:37but how common is racism in children?
- 19:39Is this something that's really
- 19:41common or not that common?
- 19:43So again as part of my K Award
- 19:46in developing our instrument,
- 19:47we interviewed alive kids and we
- 19:50did a study of 277 kids in actually
- 19:53in Hartford and Providence.
- 19:55These kids were between 17
- 19:56and 18 years of age.
- 19:58Most of them were Latin X,
- 20:00an African American.
- 20:00Although we did have some West
- 20:02Indian Caribbean kids and some
- 20:04multiracial multicultural kids.
- 20:06And what we did is that through
- 20:09our instrument development,
- 20:10we identify common situations where
- 20:12kids have been have been told us
- 20:16to that they experience racism.
- 20:18So we asked them quite.
- 20:20We asked him 24 questions, questions such as.
- 20:22Will you ever watch closely or
- 20:25followed around by security guards
- 20:27or clerks at the store at the mall?
- 20:29Do teachers assume you're not smart
- 20:32or intelligent because of your race?
- 20:35Are you watch more closely by
- 20:37security at school? Will you be?
- 20:39Will you treated unfairly by
- 20:41a police officer?
- 20:42When you're walking down the street
- 20:44to people, hold their bags tight.
- 20:47When you pass them.
- 20:48Has someone made an insulting or
- 20:50bad remark about you, your race,
- 20:53your atmosphere language?
- 20:55And did you get poor service
- 20:57at the restaurant?
- 20:58This is just an example of the
- 21:0024 questions that we asked, so.
- 21:02Usually when I'm in the audience,
- 21:04Tyler asked for show of hands.
- 21:06I won't do it today, but how many?
- 21:09How many kids do you think of the 277?
- 21:11What percentage of kids said that they
- 21:14experience at least one of these situations?
- 21:16I know I see some of you smiling,
- 21:18so I think you all know that's
- 21:20on the lower end of this scale.
- 21:22Actually it was 88%.
- 21:25245 of the 277 kids experienced
- 21:28at least one of these situations.
- 21:31In this group,
- 21:32the average number of experiences
- 21:34were six out of the 24,
- 21:35and really concerning is at 12%
- 21:37answered at least half of these
- 21:39questions positively.
- 21:40So this is the elephant in the room.
- 21:42This is really a very common experience.
- 21:44This study provides data that
- 21:46confirm what we already knew.
- 21:48That racial discrimination,
- 21:49even today is all too common in
- 21:52children of color.
- 21:53So if you wanna know what some
- 21:55of the other questions were,
- 21:57the most common with someone
- 21:58made a racial remark to you
- 22:00called you an insulting name,
- 22:01again security guards.
- 22:02Being accused of something
- 22:04you didn't do at school.
- 22:05Now this one is really concerning
- 22:07to me as as a developmentalist.
- 22:09Did you have you?
- 22:11Have you ever seen your parents be
- 22:13treated badly because of the color of
- 22:15their skin because of their race etc.
- 22:17So these are kids who are seeing
- 22:19their their their authority
- 22:20figures being treated this way.
- 22:22It's pretty sad.
- 22:24So these were some of the
- 22:26some of the answers now.
- 22:28So these 24 questions were part
- 22:30of our instrument development,
- 22:31so we wanted to develop an
- 22:33instrument that measured perceptions
- 22:34of racism in children that that
- 22:36was developmentally appropriate,
- 22:37and we used mixed methods
- 22:39where we first started by doing
- 22:41key informant interviews.
- 22:42Qualitative key informant interviews
- 22:44with a number of children to I
- 22:46just identified talk about their
- 22:48lives and talk about how they
- 22:49perceived discrimination and
- 22:50racism and whether some of the
- 22:53context with which they would.
- 22:54With which they experienced it.
- 22:56From that from those key informant
- 22:59interviews we developed this
- 23:01proto questionnaire of 24 items.
- 23:04And then from those 24 items we did
- 23:06some psycho metrics to tighten it
- 23:07up and to make a much smaller and
- 23:10more clinically and research useful
- 23:12instrument of Justice. 10 questions.
- 23:14And that's what the prices.
- 23:16So the crazy is the perceptions
- 23:18of racism in children and youth.
- 23:20And we actually have two different forms.
- 23:23We have a precis for younger kids,
- 23:25meaning between, let's say,
- 23:26the ages of eight and 13.
- 23:29An adolescent version between
- 23:3114 and 20 or whatever.
- 23:33I'll show you what the we did
- 23:35factor analysis and confirm atory
- 23:37factor analysis and different
- 23:39type of psychrometrics,
- 23:40item response theory etc and he
- 23:42came up with these questions as
- 23:44being the most psychometric valid.
- 23:46So for this crazy 17 younger
- 23:48version again there are similar
- 23:50questions to what we just went over
- 23:52having to do with school stores,
- 23:54restaurants and again,
- 23:55have you seen your parents or other
- 23:58family members being treated unfairly?
- 24:01There wasn't much difference between the
- 24:02younger version in the older version.
- 24:04The only two questions that were in
- 24:06the older version where you're being
- 24:08treated unfairly by a police officer.
- 24:10And people assume you're
- 24:11not smart for intelligent.
- 24:13So these are the 10:10 items on
- 24:15the different crazy versions.
- 24:16Now many people just use it as a score.
- 24:19You know a scale of 1 to 10.
- 24:21What we do in addition to that,
- 24:23for every item that a child says yes to,
- 24:25we asked additional questions to get a
- 24:27little bit more into the experience itself.
- 24:29So the first thing we asked
- 24:31is how often did it happen?
- 24:32What was the frequency?
- 24:33Is this a one time deal or
- 24:35did it happen more often?
- 24:37You know weekly, once a month, once a year.
- 24:40Secondly,
- 24:40we asked about Attribution.
- 24:41I'm interested in racial discrimination,
- 24:43but as we know, kids can be discriminated
- 24:45against for many, many different reasons.
- 24:47So the 1st, four or five have to
- 24:49do with racial discrimination.
- 24:51I was it happened because of
- 24:52the color of my skin, my race,
- 24:55my culture, language and accent,
- 24:56but it could be because of my age,
- 24:58my gender, the clothes I wear,
- 25:00the music, I listen to, etc.
- 25:02So we got frequency.
- 25:03We have Attribution.
- 25:06Emotional response when this happens
- 25:09you has it make you feel I got angry,
- 25:13sad, depressed, hopeless, powerless,
- 25:15strengthened, etc.
- 25:16And finally, after emotional response,
- 25:19we asked about coping response.
- 25:20How did you deal with it?
- 25:23I ignored it. I accepted it.
- 25:26I spoke up, I kept it to myself.
- 25:29I lost interest in things.
- 25:31I prayed in this positive and
- 25:33negative coping responses right?
- 25:34I tried to change things.
- 25:36I hit someone I worked
- 25:37harder to prove them wrong.
- 25:39So these,
- 25:39you know,
- 25:40for those people who are just interested
- 25:42in associations and Correlations,
- 25:43you can use the one to 10 scale
- 25:45if you're more interested in some
- 25:47of these more dynamic variables,
- 25:49you can look at coping response.
- 25:51Emotional response because I truly
- 25:52think that racism is a toxic stressor
- 25:55that all children of color experience.
- 25:57What makes some sort of not rise above it,
- 25:59but I think that coping emotion response
- 26:02really kind of separates out some of the.
- 26:04Outcomes, and there's very very common
- 26:07psychosocial stressor of kids. So.
- 26:11We know that racism effects health.
- 26:15We know that it's common in kids lives.
- 26:18We decide to do with just a
- 26:19few really basic studies on the
- 26:22Association between racism and health,
- 26:24and the first one we did I actually
- 26:26a medical student in mind who
- 26:28now is a pediatric gastro.
- 26:30Inter ologist did this with me.
- 26:32We looked at the relationship
- 26:33between racism and depressive
- 26:35symptoms in some children.
- 26:36So we interviewed 52 minority youth.
- 26:38Actually at the boys and
- 26:40girls clubs in Hartford,
- 26:41and we want to look at the relationship
- 26:43between racism and oppression.
- 26:45But also we want to look at Self Esteem.
- 26:48Lation ship between self
- 26:49esteem racism and oppression.
- 26:51My hypothesis going in is that there
- 26:53would be a relationship between racism
- 26:55and oppression which would be mediated
- 26:57through self esteem and interesting Lee.
- 26:59Although there was a significant
- 27:01relationship between racism and oppression
- 27:03and self esteem and depression,
- 27:04there wasn't a significant Association
- 27:06between racism and self esteem.
- 27:08You know,
- 27:08it's a very very small sample size,
- 27:11so I'm not going to put a lot into that,
- 27:14but this is what we found.
- 27:17Another study that we did which didn't
- 27:19then use the pricey but we looked at
- 27:21the National Survey of American life,
- 27:23the NSA L,
- 27:24which is a very very large data
- 27:26set mostly in minority individuals,
- 27:28and they have an adolescent supplement.
- 27:31And what we want to look at is
- 27:33the Association between racism
- 27:34and mental health in teens.
- 27:36So the NSA L had about a little bit over
- 27:39thousand African American and Afro Caribbean
- 27:43youth between the ages of 13 and 17,
- 27:46and according to this questionnaire,
- 27:48again, 85% discriminates.
- 27:49Xperience discrimination as expected,
- 27:51and when we did analysis
- 27:53logistic regressions,
- 27:54we found that discrimination was
- 27:57associated with major depression.
- 27:59With anxiety and with social phobia,
- 28:01both lifetime and last 12 months.
- 28:05Interesting Lee.
- 28:05When we set out to do this, I really.
- 28:08My hypothesis was that.
- 28:11We're gonna see these associations,
- 28:12but they be different among African
- 28:14American Afro Caribbean Youth.
- 28:15I mean, there are some data to suggest
- 28:18that the social context between Africa
- 28:20Caribbean and an American born African
- 28:22Americans might be a little bit different.
- 28:25But interesting,
- 28:26we didn't find any differences
- 28:27between these two groups.
- 28:29Now the sample of Afro Caribbean
- 28:31were second generation living
- 28:32in the United States for awhile,
- 28:34and further so that might be the
- 28:36thing that you know living in a
- 28:38racist society as United States
- 28:40Trump's any positive potential.
- 28:42Positive cultural aspects of effort.
- 28:44Caribbean youth culture.
- 28:48OK. So now I guess the question
- 28:50is how does racism affect health?
- 28:53You know, we we see that their associations
- 28:56were not quite sure you know what it is,
- 28:59but. You know what?
- 29:01How we have to look at different
- 29:03levels of how racism affects health.
- 29:05Really, from the macro to the micro,
- 29:08from neighborhoods to neurons, really.
- 29:10So if you think about it,
- 29:11let's go down these levels.
- 29:13The first level is the macro level as
- 29:15we discussed as we started this talk,
- 29:17you know separate residential segregation.
- 29:19Segregation increases exposure to
- 29:20things that are unhealthy and that could
- 29:23contribute to poor health outcomes.
- 29:24In addition,
- 29:25in addition to residential segregation,
- 29:28structural racism causes resource inequities,
- 29:30resources such as jobs, education,
- 29:32health care and Justice.
- 29:34Again, these can all contribute
- 29:37to poor health outcomes.
- 29:39Let's take it down to the intermediate level.
- 29:42Again, interpersonal racism
- 29:43causes psychological distress.
- 29:44As the data shows,
- 29:46as well as risk taking behaviors.
- 29:49And for me, the real interesting
- 29:51points of this micro level.
- 29:52Psychosocial distress,
- 29:53such as racism, can actually,
- 29:55as you will know,
- 29:57cause physiologic dysfunction.
- 30:00So it's talking about is that racism
- 30:02is a chronic psychosocial toxic
- 30:04stressor that can cause dysregulation
- 30:06of normal Physiology and biology.
- 30:07We all know about allostatic load, right?
- 30:10So this is the allostatic load
- 30:12theory as pertaining to racism.
- 30:13Now again,
- 30:14I don't need to talk about
- 30:16allostatic load to this audience,
- 30:17but there may be some who may
- 30:19not be as familiar with it,
- 30:22so I'll just give a general overview of
- 30:24Al Allostasis and allostatic load we
- 30:26all know about the stress response system,
- 30:28right?
- 30:29This is the normal stress response system.
- 30:31You're exposed to a stressor.
- 30:32Annuar system ramps up to
- 30:34address the stressor.
- 30:35OK,
- 30:36usually it's cortisol.
- 30:37Sympathetic with ever and then
- 30:39once that stress was out of your
- 30:41environment you get recovery.
- 30:43You get ramped down and shut
- 30:44off and you wait until the next
- 30:47stressful episode karsan again.
- 30:49This up and down occurs so this is
- 30:51adaptive its physiologic you know.
- 30:54Think about you know the greatest
- 30:56example high school example is you know
- 30:58prehistoric men and the wooly mammoth.
- 31:01You know you come.
- 31:02You come across a predator.
- 31:04Yeah,
- 31:04your stress response system
- 31:05jumps up and fight or flight.
- 31:07You know your cortisol goes up,
- 31:08your heart rate goes up,
- 31:10your respiration goes up.
- 31:11You either fight the mammoth
- 31:12or you hightail it out.
- 31:13When that man myth is out of your
- 31:15environment it shuts off and you
- 31:17back to normal until the next
- 31:18exposure to the woolly mammoth.
- 31:20So that's why it's been adaptive
- 31:22and physiologic.
- 31:23The problem is,
- 31:24is that stress these days isn't
- 31:26like that anymore.
- 31:27It's not as acute as we notice
- 31:29in the Strawberry Mansion's case.
- 31:31Yes, stress is more chronic,
- 31:33unremitting an unbuffered,
- 31:34so it happens overtime.
- 31:36Is that when that happens,
- 31:37there's not enough time for this
- 31:39recovery of the stress response system.
- 31:41OK,
- 31:42this normal allostatic stress
- 31:43response system.
- 31:44So you have a stressful response.
- 31:46You're bout to come down,
- 31:48it goes back up again and up
- 31:50and up and up and up enough,
- 31:52and one of two things happen.
- 31:56If you get a prolonged hyper response.
- 31:59Or you burnout?
- 32:00OK, so these two these two ways of dealing
- 32:04with stress is called allostatic load,
- 32:07which is this regulatory and non
- 32:09physiologic pathophysiologic.
- 32:10So again, you know all these chronic
- 32:13psychosocial stressors which every
- 32:15now and then you could you know the
- 32:18stress response works well you have
- 32:21the possibility of either having
- 32:23a hyper response or burning out.
- 32:27I'm going to very quickly because this
- 32:29audience knows exactly the role of
- 32:31stress on brain structure and function,
- 32:33but if you think about it with kids,
- 32:35you know the stress and the
- 32:37changes that the brain changes
- 32:38occur in areas which are really,
- 32:40really important for development
- 32:41in education.
- 32:42It makes a little hippocampus,
- 32:44the Prefrontal Cortex we talking
- 32:45about executive function,
- 32:46emotional regulation, etc.
- 32:47So obviously you you've done the
- 32:49cutting edge work on all this work,
- 32:51so I don't need to talk about that.
- 32:53But as you also know,
- 32:55there are other allostatic systems.
- 32:57Immunity, inflammation,
- 32:58endocrine and metabolism and growth hormone,
- 33:00as well as, you know,
- 33:03epigenetic changes changes in
- 33:05Metalation and teal in your life.
- 33:08So basically,
- 33:09in summary,
- 33:10you have these allostatic systems such as
- 33:14the HPA sympathetic immunity metabolism.
- 33:17Which get disregulated because of
- 33:18this chronic psychosocial stress
- 33:20or any type of stress and overtime
- 33:22results in dysfunction and disease.
- 33:24So So what are the diseases that
- 33:27these systems may be able make
- 33:30contribute to by becoming dysregulated?
- 33:32Well.
- 33:33Things such as diabetes, obesity,
- 33:36asthma and inflammatory disease.
- 33:39Cardiovascular disease and depression.
- 33:41So aside from these diseases
- 33:43in these chronic illnesses,
- 33:45being potentially caused by dysregulation
- 33:48of these allostatic mechanisms,
- 33:49what else groups these diseases together?
- 33:54Well,
- 33:54one thing is that these are the
- 33:58exact diseases that we see racial
- 34:00and ethnic health disparities in.
- 34:03So here we have a model where we
- 34:05have a chronic psychosocial stressor.
- 34:09Which gets under the skin.
- 34:11To cause physiologic dysregulation
- 34:14which overtime.
- 34:16Contributes to chronic illnesses.
- 34:18The same chronic illnesses that
- 34:20we see higher rates in racial
- 34:22and ethnic disparities.
- 34:23So I believe this model can be
- 34:26used these to be racism as that
- 34:31psychosocial stressor shuttle.
- 34:33Here's a conceptual model for
- 34:35how racism may decrease.
- 34:37May increase I'm sorry.
- 34:38Disease risk.
- 34:42I think that you process
- 34:44the social environment.
- 34:45You have perceived racism
- 34:46with other moderators,
- 34:48such as individual and community moderators.
- 34:50Throughout time, causes physiological
- 34:54and psychological stress.
- 34:56And through chronic unbuffered experiences.
- 35:00Cause physiologic dysregulation.
- 35:04Allostatic load.
- 35:06Altering HPA sympathetic
- 35:10inflammation immunity epigenetic.
- 35:13Which contributes to increase incidents.
- 35:15An increase morbidity in
- 35:17these chronic illnesses.
- 35:18Again the same chronic illnesses where we
- 35:20see racial and ethnic health disparities.
- 35:22So this is my model on how racism
- 35:26actually gets under the skin.
- 35:28Be cause health disparities and increase
- 35:30prevalence of health conditions now.
- 35:32This doesn't happen overnight.
- 35:34This allostatic mechanism takes years and
- 35:36years, and maybe that's the reason why.
- 35:39If you look at the literature.
- 35:41Um?
- 35:42The effects of racism in children are
- 35:46mostly psychological and behavioral.
- 35:48Where is the literature in adults
- 35:51show that in addition to racism's
- 35:53effect on psychology and psychiatry,
- 35:56it also affects physical health.
- 35:58So again this allostatic mechanism
- 36:00Hopsin and overtime these kids,
- 36:03when they become adults,
- 36:05suffer the consequences of allostatic
- 36:07load due to psychosocial stressors.
- 36:10Such as racism.
- 36:12Now I have perceived racism in this
- 36:14model and I've come to understand
- 36:15that you don't have to perceive
- 36:17racism for it to affect you.
- 36:19There are as many people know
- 36:21microagressions that happen everyday
- 36:22that many people of color aren't quite
- 36:25sure whether it's racism or whether
- 36:27it's them and it's just like this.
- 36:29It's all these.
- 36:30Microaggressions is micro hits is weathering.
- 36:32Whether it's perceived as racism or
- 36:34not certainly affects the allostatic
- 36:36Michalis static load mechanisms.
- 36:39OK, I'll give you a.
- 36:41I'll give you an example.
- 36:43I came across this article
- 36:46in the in the early 2000s.
- 36:49It was basically an epidemiological model
- 36:52about cortisol variation in adolescent,
- 36:54white, black and Latina Latin X Kids.
- 36:58So basically,
- 36:59these researchers you may know
- 37:02Amy DeSantis and I'm blanking
- 37:04on her name Amy DeSantis and.
- 37:06And Adam.
- 37:07Did salivary cortisol levels on a
- 37:10large group of adolescents and what
- 37:13they found cutting to the chase is
- 37:16that compared to white adolescents.
- 37:18Black and Hispanic adolescents
- 37:20had blunted cortisol slopes.
- 37:21As you know,
- 37:22there's a diurnal variation in cortisol,
- 37:24and it appears as if black,
- 37:26an lat next individual teenagers had blunted,
- 37:29and usually their cortisol
- 37:30started lower in the morning or
- 37:33ended up higher in the evening,
- 37:34and this was basically an
- 37:36epidemiological study.
- 37:37They really insane much about the
- 37:39causes of it by the end of their
- 37:42discussion they talk about they maybe,
- 37:44maybe this might be a stress issue
- 37:46and difference in stress among the
- 37:48different racial ethnic groups.
- 37:50The light bulb went off in my head.
- 37:52Well yeah, stress racism.
- 37:53So when I got to send Chris,
- 37:56I got a little bit of money just
- 37:57to do a feasibility pilot study to
- 37:59actually look at cortisone levels and
- 38:01perceptions of racism in children.
- 38:03And this has never been published
- 38:04'cause we didn't get a lot of
- 38:07people is really just to see
- 38:08whether we are able to do it,
- 38:10whether we were able to go into the community
- 38:12and get salivary cortisol's from adolescence.
- 38:14So basically what we did is that we got a
- 38:16few samples from adolescent black males.
- 38:19And we also gave them the precis,
- 38:21the perceptions of racism
- 38:23in children and youth scale.
- 38:24And when I wanted to see, is that
- 38:27actually within a African American sample.
- 38:30Whether those individuals that
- 38:32had high perceptions of racism?
- 38:34May have different quarters or slopes
- 38:36compared to African Americans who
- 38:38had low perceptions of racism.
- 38:39Again, we never really went forward on this,
- 38:41but I'll give you an example
- 38:43of two of the kids.
- 38:44So this is one of the children again,
- 38:47African American teenager who had.
- 38:49Who scored low in the precis
- 38:51Hadlow perceptions of racism?
- 38:52Compare this variation,
- 38:53which is normal high at the morning,
- 38:56low in the evening to another adolescent
- 38:59African American who had scored
- 39:01like off the charts on the pricing.
- 39:04That's his cord so slow as you can see,
- 39:07it's blunted.
- 39:08Again, this is an end of two.
- 39:10I would never publish this,
- 39:11but hopefully someone will pick
- 39:13up on this and maybe we will also.
- 39:15But anyway,
- 39:16this just gives you an example of that.
- 39:18You know,
- 39:18perhaps that difference in corso
- 39:20slopes we're seeing among different
- 39:21racial ethnic groups may be due to
- 39:22a Psycho Psychosocial Stressor, I.e.
- 39:24Racism.
- 39:25Maybe it's one of the one of
- 39:27the psychosocial stress is it's
- 39:29not the be all and end all.
- 39:31So again,
- 39:32we're talking bout how these things
- 39:34occur through long periods of time,
- 39:35and when I want to end up in
- 39:37talking about is that the effects
- 39:39of racism certainly have health
- 39:41consequences during childhood,
- 39:42but also throughout the life
- 39:43course into adulthood.
- 39:44Which brings us to the adverse
- 39:46childhood experience literature.
- 39:47Again, I'm sure all of you know about aces,
- 39:50but just to review it a little bit.
- 39:53You know the original ace study
- 39:55was done in San Diego at Kaiser
- 39:58Kaiser Permanente back in the 1990s,
- 40:01actually.
- 40:02And what they did is that they
- 40:04interviewed 17,000 adults,
- 40:06typically between 40 and 70 years of age.
- 40:09And they asked us adults retrospectively,
- 40:11historically about the stresses
- 40:13they experienced in childhood.
- 40:15And the traditional ace study
- 40:17their tank questions having to
- 40:20do with too many physical,
- 40:22emotional and sexual abuse.
- 40:25Physical and emotional neglect.
- 40:28And family dysfunction as defined
- 40:30by parental mental illness.
- 40:33Interpersonal violence,
- 40:34substance use, divorce, separation,
- 40:36or having an incarcerated relative.
- 40:38So this is the traditional standard.
- 40:42Ace questions.
- 40:43There are 10 of them.
- 40:46And what they found,
- 40:47not surprisingly,
- 40:48is that aces are extremely common.
- 40:50OK,
- 40:50almost 2/3 of the adults surveyed
- 40:52reported at least one ace and most who
- 40:55reported one actually had more than one.
- 40:58OK,
- 40:58so the majority had aces and the
- 41:00majority of people at aces actually
- 41:03had to the four to six or whatever.
- 41:06Would they did then?
- 41:08Is that they tried to
- 41:10associate correlate ascore?
- 41:12With adult illnesses again.
- 41:13So looking at childhood experiences and
- 41:16how they relate to adult illnesses
- 41:18and what they found is that the
- 41:21more adverse childhood experiences,
- 41:23the more health problems these individuals
- 41:25as adults, mental health problems,
- 41:27risk taking behaviors, reproductive health.
- 41:29Victimization, suicide, and also physical
- 41:31health and chronic health issues.
- 41:33Again, using that allostatic load
- 41:35model the same things, heart disease,
- 41:38cancer, stroke, emphysema, you name it.
- 41:41The list has gotten gigantic even since then.
- 41:45So this happened in the 90s and it
- 41:48really just started taking hold
- 41:50in the medical kind of community,
- 41:53probably around 2000.
- 41:54And what they also found was that
- 41:57people with six or more aces.
- 41:59Died nearly 20 years earlier on
- 42:01average than those who had no aces.
- 42:03So 20 year difference in life expectancy.
- 42:05Sound familiar?
- 42:07Now, I'm not saying that the
- 42:09difference in life expectancy between
- 42:11strawberry mansions and Society Hill
- 42:12I do to ace exposure, but you know,
- 42:15think of base as a psychosocial stressor.
- 42:17Think of a psychosocial stressors
- 42:18part of those social determinants.
- 42:20It all fits.
- 42:21The model probably contributes to it.
- 42:24So the study was really,
- 42:25really important,
- 42:26but you know those 10 items weren't
- 42:28like the 10 Commandments of ace.
- 42:30You know they didn't come down
- 42:32from the mountain as you know,
- 42:33so written in stone,
- 42:35they are really important,
- 42:36but it's only a small proportion of the
- 42:38adversities and stresses that kids can
- 42:40experience having to do with the abuse,
- 42:42neglect, and family violence.
- 42:43How about community?
- 42:44How about you know,
- 42:46outside of the family,
- 42:47so there are a number of people
- 42:48that I work with in Philadelphia
- 42:50that we're really interested in.
- 42:52Kind of expanding the concept of
- 42:54adversity as it pertains to children.
- 42:56As well as it pertains to the
- 42:57adults that the children become.
- 42:59So we did an ace project where
- 43:01what we did was.
- 43:03We took the traditional aces,
- 43:06which were abuse,
- 43:08neglect and household dysfunction, and we.
- 43:12Added to that,
- 43:14additional aces mostly community level aces.
- 43:18When you were a child,
- 43:19did you witness violence in your community?
- 43:21Social capital,
- 43:22did you live in an unsafe neighborhood or
- 43:24neighbourhood without love connectedness?
- 43:26I was able to advocate for including
- 43:29racism and discrimination into this.
- 43:31Were you bullied and were you in foster care?
- 43:35So this,
- 43:36you know,
- 43:36we kind of expanded the questionnaire
- 43:39on aces and what we did was we
- 43:42gave it to about 1700 adults in the
- 43:45Philadelphia area and we kind of related
- 43:48our findings to the initial Kaiser study.
- 43:51So just to give you background,
- 43:53emotional abuse was extremely much higher
- 43:55in Philadelphia compared to Kaiser.
- 43:57Remember, we're talking bout
- 43:59San Diego versus Philadelphia.
- 44:01Substance using household Bender
- 44:04members were higher in Philadelphia.
- 44:07Mentally ill household member 20.
- 44:08About 25 versus 20% and having
- 44:10incarcerated household member much higher.
- 44:12Now when you look at the additional
- 44:15aces is what we found again,
- 44:17the Kaiser sample didn't have these,
- 44:19so we couldn't see.
- 44:21But as you can see.
- 44:2340% of our sample witness
- 44:26violence as children.
- 44:2735% experienced discrimination.
- 44:31They have to understand this.
- 44:33Philly sample was a multicultural,
- 44:35multiracial sample included whites everybody.
- 44:37If you look at just the minority
- 44:41subsample it was way over 50%.
- 44:44Experiencing discrimination,
- 44:44so I'm happy to say that most not most,
- 44:47but a lot of researchers now
- 44:49are using this expanded idea
- 44:50of aces when they do studies.
- 44:52And by the way,
- 44:53I don't think that these five additional
- 44:55cases are the be all and end all.
- 44:58Also, I really take a contextual
- 45:00approach to adversity ifeel that any
- 45:02researcher or any educator or any
- 45:04provider needs to look at what the
- 45:06adversities are in your own community
- 45:07or in the community of your clients.
- 45:09And really,
- 45:10you're able to modify and adapt accordingly.
- 45:13We could talk later on about
- 45:15a scores versus not ace,
- 45:17'cause I'm not big a score person,
- 45:19but that's really not part of this talk,
- 45:21but I'm happy to discuss later.
- 45:23So we also did some bivariate analysis
- 45:25of the associations between that racism
- 45:27question on the ace questionnaire
- 45:29and some adult health outcomes.
- 45:30And again, these are just by variant,
- 45:33so I'm not this is nothing to take home,
- 45:36but in general, if you,
- 45:38if you answered positively to
- 45:40this childhood racism exposure,
- 45:41you are more likely to have
- 45:43depression as an adult.
- 45:45Suicide.
- 45:46Tobacco use substance use,
- 45:49sexually transmitted illness,
- 45:51number of sexual partners.
- 45:53Unintended pregnancy fractures and emphysema.
- 45:58So we were hoping to do by Barry the analysis
- 46:00of multivariate analysis to really see.
- 46:02And the other thing that we're
- 46:03planning on doing is that I really
- 46:05don't like this idea of an ace score.
- 46:06So what we're planning on doing is
- 46:08a cluster analysis to see whether
- 46:09there are clusters of aces which
- 46:11are more predictive of outcomes,
- 46:12and just like a score of six or one or three,
- 46:15or whatever else.
- 46:16OK, I'd like to just summarize
- 46:18what we've talked about.
- 46:19First of all,
- 46:20racism is a stressor that's commonly
- 46:23experienced by minority children and youth.
- 46:25Yeah,
- 46:2560 years after Brown versus
- 46:26the Board of Education,
- 46:28it's still part of people's lives.
- 46:31Is a small book growing literature
- 46:34on the associations between
- 46:35racism and child health outcomes?
- 46:40Hopefully I've convinced that
- 46:41racism can be conceptualised as a
- 46:43toxic stressor that contributes
- 46:45to physiologic dysregulation.
- 46:47Allostatic load and subsequent
- 46:50chronic illness.
- 46:51The illnesses that are linked through
- 46:53this allostatic mechanism on the
- 46:54same illnesses that we see racial
- 46:56and ethnic health disparities.
- 47:00And that racism experienced in childhood
- 47:02should be thought of as an adverse
- 47:05childhood experience that affects
- 47:06health throughout the life course. Now.
- 47:09I often feel bad about giving this talk
- 47:12because it's it's such gloom and doom.
- 47:15You know, we talked all about how
- 47:17high loads of adversities, specially
- 47:19in racial and ethnic minority groups.
- 47:23Contribute to poor outcomes,
- 47:24but I've really only given you half of the
- 47:27equation you if you think about outcomes.
- 47:29Outcomes are a function not only
- 47:31of adversity, but the relationship
- 47:33between adversity and assets,
- 47:34so this is this is my new like mean,
- 47:37you know, assets over adversity,
- 47:38equal outcome.
- 47:39And although unfortunately,
- 47:40this adversity of racism is systemic
- 47:42and structural answer take a lot
- 47:44to read it out of our society,
- 47:46we need to work in that way.
- 47:48But as we're doing that,
- 47:50I think we need to work on
- 47:52the individual client level.
- 47:53To make sure that we increase
- 47:55the assets that are individuals
- 47:57has event so that they can.
- 47:59Can thrive despite being subject
- 48:02to this toxic stresser.
- 48:04His assets include include external assets.
- 48:06Obviously for children,
- 48:07family and parents and adults are the most
- 48:10important thing that peers and friends,
- 48:12coaches, mentors,
- 48:13an community.
- 48:14OK, these are assets that we need to build
- 48:17up in our clients as well as internal assets,
- 48:20coping style,
- 48:21locus of control,
- 48:22and epigenetics.
- 48:23So I'm hoping that as we weed out
- 48:26racism from our society were able
- 48:27to work on an individual level
- 48:29to make sure that we can pay
- 48:32the healing centered approach.
- 48:33These adversities.
- 48:34So thank you all for your listing.
- 48:37To me.
- 48:37I'd be happy to answer any questions
- 48:39that you have now an I appreciate
- 48:42the opportunity to thank you.
- 48:48Thank you so much for a wonderful talk.
- 48:50We're going to open it up for questions
- 48:53that you can also use the chat feature.
- 48:57Should I stop sharing? Sure,
- 48:59that'd be great, OK? Here we go. But
- 49:06see Carmen, Where are you?
- 49:11There you are. Hi, good morning.
- 49:13Carmen has a question.
- 49:15Hi, I'm sorry I'm using my phone today.
- 49:20I appreciate the efforts to
- 49:23quantify our racial trauma.
- 49:26It's bittersweet to a degree because I
- 49:28feel like so much of the presentation
- 49:31was what the black community,
- 49:34an black colleagues have been screaming at
- 49:36the top of our lungs for generations before
- 49:40an external source put a number to it.
- 49:43If that makes sense.
- 49:45I I'm very proud to come from Georgia,
- 49:48and I feel like when black communities
- 49:51try to advocate for ourselves of the
- 49:54disparities that you're able to quantify.
- 49:56It's met with societal resistance.
- 49:59In the South it was lynching historically.
- 50:01Now that's the black lives matter
- 50:04movement that's being misconstrued
- 50:05as terrorist organizations.
- 50:07And all these things from people who
- 50:10don't want to hear our racial story,
- 50:13but one of the things I in some
- 50:17other black colleagues were chatting
- 50:19about as we were listening is.
- 50:22There is concern that.
- 50:23As we try to quantify are my
- 50:27communities racial trauma?
- 50:29I want to caution against.
- 50:32Kind of typecasting it as if we don't
- 50:36express trauma in a certain way.
- 50:39That's quantified by XY zed measure.
- 50:41Then we're back to being.
- 50:44Silenced two degree.
- 50:45I really feel like our communities have
- 50:49been expressing this trauma for ages,
- 50:52but getting punished.
- 50:53And as you talk about assets,
- 50:56that one asset I didn't see was
- 51:00wage disparities in financial.
- 51:02I,
- 51:03as a black single mom I'm having
- 51:05to produce financial and physical
- 51:08and emotional assets to give my
- 51:11kids the same opportunities as the
- 51:14equivalent non black child and so.
- 51:17Money and targeted interventions
- 51:19is a huge part of that.
- 51:22I trained in Philadelphia,
- 51:24I lived in Claymont, Delaware,
- 51:26so you probably passed my former
- 51:29residents everyday on your way to work
- 51:32and I just want to put into this open
- 51:35space that as we're talking about things,
- 51:38black communities have
- 51:40been saying for centuries.
- 51:42And in the context of the pandemic
- 51:44where everyones publishing oh,
- 51:46black communities have more
- 51:47cardiovascular disease,
- 51:48well these are the reasons
- 51:49why personally speaking with
- 51:51my racial trauma and stress,
- 51:53I've gained 30 pounds and I am helpless
- 51:55to get rid of it because my stress
- 51:58level is always out of 10 and so just
- 52:01to my colleagues into this space.
- 52:03Thank you for the quantification,
- 52:05but I also want to make sure
- 52:08that we're being mindful that.
- 52:10We've been saying it all along.
- 52:15Alright, thank you I couldn't agree more.
- 52:19I'm just hoping maybe just bring to light
- 52:21in from it from a different perspective
- 52:23and you know all the perspectives being
- 52:26put together maybe will change something.
- 52:28How do you think that we as scientists and
- 52:31his researchers can help that perspective?
- 52:35What I think a lot of it is experiential,
- 52:40in addition to quantifying,
- 52:43I targeted interventions
- 52:44for wage disparities,
- 52:46targeted interventions like not just
- 52:49passively documenting my community's demise,
- 52:52'cause That's hurtful.
- 52:53I was sharing with my colleagues.
- 52:57Not that it's the same intentional
- 53:00harm is Tuskegee.
- 53:02But watching passively the natural
- 53:04progression of the disease course
- 53:06without intervention is what black
- 53:09communities have endured before.
- 53:11So I mindful of the history.
- 53:14Just documenting all the ways
- 53:17that racism is killing us.
- 53:19Without an intervention is not.
- 53:22It's not the step forward,
- 53:24not just documentation,
- 53:25but doing something 'cause as black
- 53:27faculty is getting increasingly
- 53:29harder to show up to these spaces.
- 53:31Well, I'm not even able to afford
- 53:33the resources for my kids.
- 53:35I need to afford because I have
- 53:37to overcome 400 years of all
- 53:39the things you just quantified
- 53:41and it's just frustrating.
- 53:42I would very much like to do something.
- 53:46Couldn't agree more.
- 53:47I if if I see one more epidemiologic
- 53:50studies telling me that poor people
- 53:52do worse or my noise it works,
- 53:55I'm going to blow my mind's going to blow.
- 53:58We don't need that anymore.
- 53:59What we need now, as you say,
- 54:02our interventions but also understanding
- 54:04the processes and mechanisms so
- 54:06that the interventions that we
- 54:08developed are based on some sort of.
- 54:10Evidence based approach.
- 54:11But I agree with you completely.
- 54:14An actually doesn't even
- 54:15need to be evidence based.
- 54:17It needs experience based
- 54:19right money. Isn't this just just paying
- 54:21us what we need to survive is a great
- 54:25the 400 years at you're describing has
- 54:28a price in emotional tag to it. You
- 54:32have no argument with me, thank you.
- 54:43Other questions comments.
- 54:49So I would like to to
- 54:52ask us something. Doctor
- 54:56Lim so sorry if my questions.
- 54:59It's very simple, but. And you were
- 55:02talking about the Philadelphia Studies an
- 55:05you bring this components of the community.
- 55:08I think that's so important. We have
- 55:12been studying listing an following
- 55:15research base in the first
- 55:18days and at the first time I'm
- 55:21seeing that you brought this
- 55:24component. I would like
- 55:26to know a little bit more because
- 55:30I strong believe that community
- 55:33is a huge company. Each of
- 55:36our lives and. The
- 55:39participatory resorts that bring the voice of
- 55:43the community. To say things,
- 55:46to show to us that there is options to
- 55:51develop interventions that's not necessary
- 55:54happening on the clinical setting,
- 55:56but community based settings
- 55:59where people has the freedom
- 56:02to talk about deep feelings.
- 56:04Special for African Americans in my
- 56:08team community from Brazil. Seems
- 56:11to me that the conversation the
- 56:15The Open is to bring matters for
- 56:19this specific two populations to
- 56:23be address in the sense that we can
- 56:28talk. You can express and the
- 56:31community has a responsibility
- 56:34for your health in your
- 56:37well being seems to be very important.
- 56:41So would like to know if you
- 56:44can talk a little bit more about that.
- 56:47You'll be great also if you have
- 56:50literature review, I'm looking
- 56:51forward for that. Thank you.
- 56:55Thank you, that's a big topic and yeah.
- 57:01We'll be obviously have medical centric
- 57:04view of both the research and interventions,
- 57:07and I think that that's changing a
- 57:10little bit, not enough obviously,
- 57:12to give you an example where
- 57:15I'm working in Delaware,
- 57:17we Delaware is a state that doesn't have
- 57:20large NIH funding, unlike New Haven.
- 57:23So we have opportunities for an H funding on
- 57:27a state level to help increase the crease.
- 57:31Research that's called.
- 57:33Idea State C TR.
- 57:36Where the central components of that
- 57:38clinical and translation are research
- 57:40grant is community engagement and outreach.
- 57:43So every grant that goes through
- 57:47the CTR needs to be.
- 57:50Needs to be assessed through
- 57:51community engagement outrage,
- 57:52and that's not just at the end point where,
- 57:56like you know,
- 57:57the researcher needs to bring the frame.
- 58:00You know the information
- 58:01back to the community.
- 58:03We require that any researcher actually at
- 58:05the time that they develop their proposal.
- 58:08Consulates with CEO or the
- 58:10community gagement outreach core
- 58:11because even bench researchers,
- 58:13there's a community that will eventually
- 58:15benefit from your work OK and we
- 58:18need to start thinking about that.
- 58:20From the beginning,
- 58:21and that's moving along is that
- 58:22that's the minimum.
- 58:23I mean,
- 58:24we also have community based,
- 58:25participatory research where you
- 58:27know between is actually an active
- 58:28participant from the beginning and
- 58:30actually has control and owns owns.
- 58:32The Dayton owns the research
- 58:33so we're making little steps.
- 58:34You know it's not as quick
- 58:36as I would like it to be,
- 58:38but that's one example.
- 58:40I see where we
- 58:41have two people have raised their hands,
- 58:43but I can't tell who they are.
- 58:46So if you just want to speak up,
- 58:48oh Charles, there you go. Ask
- 58:51Doctor Lee.
- 58:51I just said my name is Charles decay.
- 58:53I'm one of the faculty here.
- 58:55I'm also forensic psychiatrist and
- 58:57I want to thank you so much for
- 59:00bringing together some of this.
- 59:02Difficulties disparities I want to try
- 59:05and link it with forensic psychiatry.
- 59:09In the criminal justice system.
- 59:12We are expected to provide
- 59:16objective assessment.
- 59:17In a system that is patently unfair,
- 59:21unjust, discriminatory.
- 59:22And it's really hard to jump in
- 59:25with closed eyes to all of these
- 59:29difficulties that lead people to
- 59:31behave a certain way or that cause
- 59:33people to act out in a certain way
- 59:36that crosses the legal boundaries
- 59:38and to close our eyes to all of that
- 59:42and just provide a straightforward,
- 59:44objective assessment.
- 59:45And I know that a lot of my
- 59:48colleagues struggling with that and
- 59:50and one of the other areas that I
- 59:53think has become really important
- 59:55for us is the issue of mitigation.
- 59:58So you're doing an assessment to try
- 01:00:00to provide an explanation for why an
- 01:00:03individual could turn out this way,
- 01:00:05for why an individual could behave
- 01:00:08in something that you call whatever
- 01:00:10a criminal behavior or whatever,
- 01:00:12and to be able to sit down and craft
- 01:00:15all of what you've written down.
- 01:00:18Ask potential issues that when
- 01:00:20people react to them or respond
- 01:00:22to them in certain ways,
- 01:00:24they could come across as being criminal.
- 01:00:28And how can you craft on an explanation
- 01:00:31that shows people that this behaviors
- 01:00:34are actually not unexpected given all
- 01:00:37these adverse childhood experiences
- 01:00:38and the prices and all of that?
- 01:00:42And if you expose people to this
- 01:00:44level of dysfunction and crisis and
- 01:00:47structural racism and individual racism,
- 01:00:50or through their lives that
- 01:00:52they react in certain ways,
- 01:00:55and therefore they should
- 01:00:57be punished even more.
- 01:00:59And we're trying to find a way to
- 01:01:01change that narrative to say in
- 01:01:03fact they should be punished less
- 01:01:05because of all of these things
- 01:01:07that they're dealing with.
- 01:01:09Maybe if we can find a way
- 01:01:11to address these things,
- 01:01:12then maybe they can have a better
- 01:01:14outcome in along the lines of what
- 01:01:17doctor Carmen Barker was saying,
- 01:01:18where there's so much and you're
- 01:01:20trying to come to come at a certain
- 01:01:23level with your colleagues who are
- 01:01:25looking at you as if you haven't
- 01:01:27experienced all of these disparities.
- 01:01:29And all these difficulties.
- 01:01:30So I just want to thank you again
- 01:01:32and I wanted so use that as a
- 01:01:35point to say that it's more acute
- 01:01:38in the criminal justice system.
- 01:01:40The influence on the negative
- 01:01:42impact to black lives.
- 01:01:44Thanks.
- 01:01:46Thank you, I couldn't agree more.
- 01:01:50Need to look at behaviors in context.
- 01:01:52Anan I, I understand this completely.
- 01:01:54My Wi-Fi says the psychiatrist is
- 01:01:55in the criminal justice system,
- 01:01:57sees the psychiatrist for
- 01:01:58the Philadelphia jail system,
- 01:01:59so she lives every day and I see the
- 01:02:02wear and tear on her just being able
- 01:02:04to knock her head against the wall.
- 01:02:06Not being able to move anything.
- 01:02:08So I thank you for what you're doing,
- 01:02:10and I think your comments.
- 01:02:14Ishwara hit die pronounce your
- 01:02:17name incorrectly. I apologize.
- 01:02:20Hi, I'm a medical student that was
- 01:02:22watching the didactic session so
- 01:02:23something I'd like to say is that I
- 01:02:26think Yale and probably most medical
- 01:02:28schools at this point does a really
- 01:02:30good job of educating us on these
- 01:02:33types of topics and so coming into it.
- 01:02:35I was a little. I was surprised
- 01:02:37to hear you
- 01:02:38say that you were surprised by
- 01:02:40some of the findings that you
- 01:02:42saw because I think for
- 01:02:44us in our training these
- 01:02:45are things that
- 01:02:46were taught about every
- 01:02:48year, multiple times a month sometimes.
- 01:02:50Depending on our rotation and I think one
- 01:02:52of the things that I personally was hoping
- 01:02:55was that when I got to this level and
- 01:02:58I was watching you know resident
- 01:02:59rotation or resident didactics
- 01:03:01and attending didactics,
- 01:03:02it would be less about this problem
- 01:03:04exists because I feel like at this
- 01:03:06point it's really been established
- 01:03:08and more about. Here's what we
- 01:03:10can actually do about it.
- 01:03:11Here are interventions that we can have.
- 01:03:13'cause again I think.
- 01:03:15But no one's questioning that it exists.
- 01:03:18No ones questioning that it has bad effects,
- 01:03:22medically and sociologically
- 01:03:23or socially, but.
- 01:03:25No one's really giving an answer to what.
- 01:03:28What do we do?
- 01:03:30How does it change treatment?
- 01:03:32What should we be saying to
- 01:03:34patients to mitigate that?
- 01:03:35And so I'm a little frustrated
- 01:03:38by that lackof.
- 01:03:39Of. Education,
- 01:03:40because I feel like every
- 01:03:42time This has been presented,
- 01:03:45it's been presented as look at
- 01:03:46this new idea or look at this
- 01:03:48new topic and it's really not.
- 01:03:53Hello Cindy, do you wanna comment on that?
- 01:03:58I mean, it's great to hear that
- 01:04:01medical students are getting this,
- 01:04:03I can think 5 years ago,
- 01:04:05where they would say that they
- 01:04:07weren't at all in terms of
- 01:04:10social determinants of Health.
- 01:04:11So I guess efforts to change the
- 01:04:14curriculum have been successful.
- 01:04:16I had heard it that stated
- 01:04:19that strongly that.
- 01:04:20Change in progress has been made so,
- 01:04:22so that's great.
- 01:04:23I think for me I think there's still
- 01:04:26a gap in what people know about how
- 01:04:28this impacts children and their
- 01:04:30health and how it impacts behavior.
- 01:04:32So that was my goal for today that
- 01:04:35there's actually a way that you can
- 01:04:37measure this that you can study
- 01:04:39it more that you can understand
- 01:04:41the mechanisms at various levels
- 01:04:43and develop interventions.
- 01:04:44And I would say that there are.
- 01:04:47There are lots of interventions
- 01:04:49that are out there both for aces,
- 01:04:52so there's the Philadelphia based project,
- 01:04:54which doctor Pachter talked about that
- 01:04:57looks set this at multiple levels.
- 01:04:59So I mean, I'm great to hear that people.
- 01:05:04In the medical school, here are.
- 01:05:06You know?
- 01:05:07Have had this information now 'cause
- 01:05:10it hasn't always been that way.
- 01:05:13And I was wondering,
- 01:05:14doctor factor,
- 01:05:15if you could talk about recent
- 01:05:18editorial that you wrote about the
- 01:05:20role of the academic Journal in
- 01:05:23promoting racial equity in health.
- 01:05:26Sure. So in addition to
- 01:05:29my my my day job work,
- 01:05:32I'm a Journal editor and.
- 01:05:35I've been very perplexed.
- 01:05:39At the way that.
- 01:05:42Race and ethnicity as a
- 01:05:45social determine has been
- 01:05:46used in health research.
- 01:05:48I think that.
- 01:05:52We need to find a way to educate.
- 01:05:57Researchers as well as reviewers and Borhan.
- 01:06:00Journal Board members to understa
- 01:06:01really understand that when
- 01:06:03we talk about race ethnicity,
- 01:06:05what we're really talking,
- 01:06:06the operational term really is racism.
- 01:06:09And I'm really hoping to get past that.
- 01:06:11When I called the table,
- 01:06:13one use of race and ethnicity as
- 01:06:14just one of those other demographic
- 01:06:16variables that you enter into your
- 01:06:18regression model and you know.
- 01:06:19And that's the be all and end
- 01:06:22all we need to get past that.
- 01:06:24If in fact we do find in research
- 01:06:26that race ethnicity is an important
- 01:06:28component of whatever study we're doing,
- 01:06:30we need to dig down deeper and
- 01:06:33think about it in the lens of OK.
- 01:06:35If this is a social determinant,
- 01:06:37health, you know,
- 01:06:38is it racism and how that might,
- 01:06:40how that how we might be able to
- 01:06:42explain our results based on it as a
- 01:06:45social as opposed to a biological?
- 01:06:47Structure, so with with.
- 01:06:49I'm proposing for our Journal
- 01:06:52number one is is totally revamp
- 01:06:54our approach to peer review.
- 01:06:57I'm hoping that.
- 01:06:58We get peer reviewers who are.
- 01:07:01Knowledgeable and sensitive to the
- 01:07:04issues of race and racism in research,
- 01:07:07just as if I have a reviewer who is
- 01:07:10expert in structural equation modeling,
- 01:07:13I need to find reviewers that our
- 01:07:16expertise or expert in racism
- 01:07:18as a social determinant.
- 01:07:20So we're actually proposing to.
- 01:07:23Create a new position at the Journal.
- 01:07:25A associate editor for equity
- 01:07:27inclusion and diversity.
- 01:07:28Who will help me help us develop
- 01:07:30a systematic approach so that we
- 01:07:32can train researchers before they
- 01:07:34submit papers to us to think about
- 01:07:36race and ethnicity in a much more
- 01:07:38sophisticated way than it is now,
- 01:07:40and to also train peer review it now.
- 01:07:43Not every peer reviewer needs
- 01:07:45to become a social scientist,
- 01:07:46but again,
- 01:07:47when I when I have a paper and I
- 01:07:49sort of choose peer reviewers,
- 01:07:51I'll choose a content expert that.
- 01:07:53I statistical expert different types,
- 01:07:55so I need to get a cadre of
- 01:07:57social scientists or clinicians
- 01:07:58or whatever who really understand
- 01:08:00the importance of looking at race
- 01:08:03ethnicity as a social construct,
- 01:08:04not biological culture.
- 01:08:05So that's kind of like the call.
- 01:08:08I'm making the other journals to do the same.
- 01:08:11Can I see Pamela Pamela? Hi
- 01:08:17Hi. I I work in the
- 01:08:20intensive outpatient program.
- 01:08:22And I'm a social worker,
- 01:08:23have a Masters in public health,
- 01:08:25and have worked both in the
- 01:08:27adolescent and the adults.
- 01:08:28But I just want to say that I.
- 01:08:31Then I'm familiar with the research
- 01:08:34and that I what I found and what
- 01:08:39I've been doing is using brain
- 01:08:42based research an integrating that
- 01:08:46with dialectical behavior therapy,
- 01:08:49cognitive behavioral therapy.
- 01:08:51In in the track that I run,
- 01:08:54because I think that it helps people
- 01:08:57understand more concretely how behaviors,
- 01:08:59how lifestyle, how choices.
- 01:09:01I mean, we both talk about.
- 01:09:04Initially we talk about stressors
- 01:09:06an we talk about racism,
- 01:09:08as you know,
- 01:09:09as a major stressor and persistent,
- 01:09:12pervasive stressor.
- 01:09:13But we talk about all the isms
- 01:09:16upfront when we introduce each other.
- 01:09:18Every time we get a new member.
- 01:09:22And we talk about that so that
- 01:09:24we can put it out there an an we
- 01:09:26attribute that to the levels of
- 01:09:28stress and anxiety and depression
- 01:09:30psychosis and the other things that
- 01:09:33people bring to IO P you know and
- 01:09:36how it impacts their mental health.
- 01:09:38And so you know one of the things that
- 01:09:40I found is that incorporating you know.
- 01:09:44Not incredibly technical, I mean,
- 01:09:46I'm I'm not a neurologist
- 01:09:48or anything like that,
- 01:09:50but but using integrating brain,
- 01:09:52brain basics and understanding of
- 01:09:54the brain for people really helps.
- 01:09:57I think helps to motivate people
- 01:10:00to want to understand more.
- 01:10:06Do do deep breathing.
- 01:10:08You know what I mean?
- 01:10:10We do a lot of mindfulness.
- 01:10:13We do a lot of motivation.
- 01:10:15I mean, well, motivation yes,
- 01:10:17but I meant physical activation
- 01:10:19and things like that.
- 01:10:21But we also attribute that to the
- 01:10:24stressors and help people identify
- 01:10:26how those connections feed their
- 01:10:28stress and then how they can
- 01:10:31help to ameliorate it and help
- 01:10:33them develop stronger coping.
- 01:10:35You know, healthier coping.
- 01:10:37Skills so I only bring that out.
- 01:10:39Not that you know I'm doing not to
- 01:10:43count myself so much as just that.
- 01:10:45I think you know we're talking about this.
- 01:10:48I think the audience is predominantly,
- 01:10:51you know except for Doctor Childs
- 01:10:53who I I saw is here, you know,
- 01:10:56is predominantly researchers
- 01:10:57and professors etc.
- 01:10:58But I think you know taking this
- 01:11:01information and actually applying it in
- 01:11:04the therapy is the way or is one of the ways.
- 01:11:08Certainly that we're going to
- 01:11:10be able to have,
- 01:11:11you know,
- 01:11:12to make changes and to help people
- 01:11:14use this information and apply it
- 01:11:17to their daily lives in a way that
- 01:11:20can bring some meaningful personal
- 01:11:22change and hopefully change to
- 01:11:25families and ultimately communities.
- 01:11:27So.
- 01:11:29Thank thank you.
- 01:11:32I I agree and yeah. I think.
- 01:11:37I'm glad that trauma informed care
- 01:11:40has become very commonly used
- 01:11:43term and people are applying it.
- 01:11:47And like all good things,
- 01:11:49once it's used, we find what
- 01:11:52some of the deficiencies are and.
- 01:11:55In many ways I hear a lot of I don't
- 01:11:57want to be defined by my trauma,
- 01:12:00which I think is really true,
- 01:12:01so this isn't my idea,
- 01:12:03but but we need to move from a trauma
- 01:12:05informed perspective to healing
- 01:12:06centered perspective and those
- 01:12:08the Little Trope about that is,
- 01:12:09you know, trauma informed care
- 01:12:11is not what's wrong with you,
- 01:12:12but what happened to you?
- 01:12:14Well, in healing center care,
- 01:12:15the next step is what's right with you.
- 01:12:18Three people don't want to
- 01:12:19be defined by their traumas,
- 01:12:21they won't be defined by what's
- 01:12:23right with him.
- 01:12:24Absolutely,
- 01:12:25and you know. So dealing with
- 01:12:27the stigmatization of mental
- 01:12:28illness and mental health care
- 01:12:30in the 1st place is at the root.
- 01:12:32But also I I felt I feel like one of the
- 01:12:36one of the assets that I am repeatedly.
- 01:12:39Struck by that that.
- 01:12:41The communities of people of
- 01:12:44color have is resilience and I
- 01:12:47don't feel like that gets enough,
- 01:12:50you know, gets enough playtime
- 01:12:52because when you consider,
- 01:12:54I don't and I don't mean in any way
- 01:12:57to minimize the poor health outcomes
- 01:13:00and the negative the negative.
- 01:13:02The negative experiences or the negative?
- 01:13:05The negative outcomes that are
- 01:13:07caused by these stressors,
- 01:13:09but I think you know there is that people
- 01:13:12of color in African Americans in particular,
- 01:13:16that that they're resilience
- 01:13:17and their strength.
- 01:13:19You know,
- 01:13:20in the in the in the midst.
- 01:13:23This diversity is.
- 01:13:24Is not amazing,
- 01:13:26but it's so powerful and I feel
- 01:13:29like that's an asset that often gets
- 01:13:32overlooked an is understated so.
- 01:13:37So we're we're out of time.
- 01:13:39I appreciate everyone coming
- 01:13:41in all of your comments,
- 01:13:42and certainly there's lots more
- 01:13:44discussion to be had and grand rounds
- 01:13:47and other aspects of where we meet in
- 01:13:50come together and address these topics.
- 01:13:52So certainly to be continued,
- 01:13:54but I really want to thank doctor
- 01:13:57Pachter for being here and
- 01:13:59sharing a body of work with us.
- 01:14:02And I think it's really helpful
- 01:14:04and informative to all of us on
- 01:14:07personal and professional levels so.
- 01:14:09Thank you so much.
- 01:14:10Thank you, thanks for having me.