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Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop (2019)

Chapter: 5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities

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Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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5

Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities

The next workshop session focused on the generations of families who have ongoing experiences of historical, intergenerational, and chronic trauma, particularly tribal populations and communities of color. Harolyn Belcher, Kennedy Krieger Institute, and Jennifer Tyson, U.S. Department of Justice, co-moderated the panel. Presenters were Teresa Brockie, School of Nursing at The Johns Hopkins University; Emily Haozous, University of New Mexico College of Nursing; and Reggie Moore, Office of Violence Prevention, Milwaukee Health Department. Each shared research and firsthand accounts to provide a better understanding of how addressing trauma can improve health equity.

HISTORICAL TRAUMA

Teresa Brockie began by providing two definitions of historical trauma. The term was first used by Maria Yellow Horse Brave Heart-Jordan in the 1980s to convey “the collective and compounding emotional and psychological injury over the lifespan that is multigenerational and resulting from a history of genocide.” The Substance Abuse and Mental Health Services Administration elaborated on the definition as follows: “Unresolved grief and anger often accompany this trauma and contribute to physical and behavioral health disorders. This type of trauma is often associated with racial and ethnic population groups in the United States who have suffered major intergenerational losses and assaults on their culture and well-being.”1

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1 For more information, see https://www.samhsa.gov/trauma-violence/types.

Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×

Detrimental Historical Policies

Focusing on historical trauma as experienced by Native Americans in the United States, Brockie began by stating that 95 percent of people indigenous to the present-day United States died during colonization. To better understand the severity of this demographic collapse, she outlined policies that contributed to the assault on cultural identity and health of Native populations, including the Indian Appropriation Act (1851–1880) and the Mandatory Boarding School Era (1878–1920). The adverse effects of these policies were great, said Brockie. Those living on reservations experienced concentrated poverty, food deserts, employment deserts, and intergenerational poverty. These underresourced communities have encountered concerns around neighborhood safety, access to quality education, geographic isolation, and increased morbidity and mortality. Further, mandatory boarding schools “led to the loss of traditional family practices, including parenting; loss of identity, language, and traditions; and a radical change in the role of the Native male.”

Historical Policies in Current Context

Brockie said current living conditions continue to tell the story of the effect of those policies. As an example, she described an isolated rural reservation established in 1851 by the Fort Laramie Treaty where she conducted her dissertation research. The reservation consists of more than 2 million acres, covers four counties, and includes six reservation communities and two Plains tribes with populations of more than 11,000. The reservation is listed among the 100 poorest in the country and among the 10 for least healthy, with nearly one-half of the population living below the federal poverty level. The tribal law enforcement is estimated at 50 percent of what is needed to police this area and population, and the violent crime rate in 2011 was five times higher than the rest of the state and three times higher than the U.S. rate. In 2010, after six suicides and 20 attempts in 5 months, Brockie said that the tribal leadership declared a state of emergency.

With one-half of tribal enrollment on this reservation under the age of 18 and growing up in poverty, Brockie detailed a number of outcomes that emerge among at-risk Native American (NA) youth when compared to U.S. national estimates. First, there is a significantly higher rate of substance use, including the highest rates of alcohol-related deaths (Centers for Disease Control and Prevention, 2008). Suicide is 2.5 times the national rate and has been the second leading cause of death for more than 30 years (Heron, 2016). Violence, including intentional injuries, homicide and suicide, account for 75 percent of deaths for NA youth (Center for Native American Youth, 2015). Three to 10 percent of NA youth drop out before graduat-

Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×

ing high school, the highest dropout rate of any ethnic/racial group in the United States (Stark and Noel, 2015). Finally, adolescent NAs have death rates two to five times the rate of whites in the same age group (Indian Health Service, 2016). Despite these statistics, Brockie said, little is known about the risks or protective factors associated with these outcomes.

INTERGENERATIONAL TRAUMA

Emily Haozous provided the context for what is meant by the term “intergenerational trauma.” She described this type of trauma as cumulative over time and across generations and felt at both community and individual levels. It is also inclusive of natural disasters and other traumatic events that may not have been directed at a specific population but that are particularly significant for marginalized communities.

She shared her family history to illustrate how the trauma experienced by one generation becomes the burden of the next. (See also her account in Chapter 2.) Her great-grandfather’s tribe was put on a train across the country, eventually stopping in Fort Sill, Oklahoma. The children were sent to boarding schools in Carlisle, Pennsylvania. While her great-grandfather returned, Haozous noted that not all the children did. Without knowing what happened to the missing children, there was a general understanding that they died at school. Her great-grandfather was able to start a family, and his son (her grandfather) was the first baby born to the tribe free of captivity. Her grandmother also experienced life at a boarding school.

Haozous reflected on how these experiences presented challenges that affected future generations. Many children taken from their homes and families did not develop parenting skills and were not able to nurture their own children later in life as their ancestors had done. The lives of many families, including her own, have been affected by mental illness, homelessness, and alcoholism. “This is the intergenerational trauma,” she said. “This is what happens to families when you have the burden of atrocities that have happened and afflicted upon you—disrupted attachment.”

VIOLENCE PREVENTION

Reggie Moore discussed the efforts of Milwaukee to gain a better understanding of historical and intergenerational trauma and incorporate it into the city’s violence prevention work. He began by sharing some of his own background growing up in public housing with a single mother. She was originally from the South Side of Chicago, where she grew up active in the Civil Rights movement. Moore recounted, “My apartment, even when we didn’t have much, was sort of a community center.” He reflected on how his mother made their home a safe space for all. Seeing other families suffer

Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×

from drug, alcohol, and domestic violence issues provided a foundation for the work he is now doing.

Moore recalled a conversation he had with one of his mentors early in his career as a community organizer. The mentor said, “Imagine a room where men sat around and created and talked about what’s best for women.” This, he said, is what has happened, and is happening, with young people and indigenous people around the world. Moore became committed to the idea that policy conversations must become more inclusive. He said, “We’re going to deal with violence, and we’re going to deal with unemployment, and we’re going to deal with health issues in the city, and young people have to be part of that.”

In 2016, Moore was appointed by the mayor to lead the Office of Violence Prevention, an office created in 2008. For the first time, the city developed a public health–driven violence prevention plan, and the budget and staff for the office were tripled as proof of the commitment. Further, Moore expressed that the communities across the city galvanized around the issue of taking a different, broader approach to public safety. A major concern for the current approach to public safety across the country is sustainability, Moore noted. Law enforcement budgets often exceed tax funding. In 2015, when Milwaukee saw a spike in homicides, many people were not shocked. Rather, they were more curious about what had driven the previous decline, said Moore.

To better understand why the rates of violence were going up and figure out how to stop the “pipeline of pain,” Moore said, the city worked closely with community residents to develop the Blueprint for Peace. Together, they agreed that preventing homicide alone is not a sufficient end goal. It was important to include equity, trauma, and a vision for “what should be” in the conversation, Moore related.

In shifting the focus from what they wanted to stop (i.e., gun violence) and thinking about what they wanted the community to be (i.e., safe, strong employment opportunities), Moore said the community adopted the following vision for the Blueprint: “Milwaukee is a safe and resilient city where the lives of our residents are valued and promoted and protected.” With this statement, the community also established six goals: stopping shooting and violence; promoting healing and restorative justice; supporting children, youth, and families; increasing economic opportunities; fostering safe neighborhoods; and strengthening the capacity and coordination of violence prevention efforts.

To accomplish these goals, the community identified several risk and resilience factors, such as limited employment and economic opportunities, lack of access to resources, segregation from opportunity, and disconnectedness among residents and institutions. Moore said the process of identifying these risk and resilience factors was a careful and exhaustive one whereby a

Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×

large portion of community members (young and old) ranked their priorities from a list of options provided and offered other options not included on the list. He noted that among young people, racism and segregation came out as the strongest factor for risk and resilience, higher than more concrete items like access to guns and illicit drugs.

Moore provided some concluding remarks. First, he said, intergenerational trauma will need to be addressed using a multigenerational approach. Second, communities should take account of the resources they lack but also the resources they possess, which may speak more to the strengths of a culture that is uniquely theirs and that can be used for improving the issues that plague them. Third, social issues like violence should be looked at through a public health lens and should be part of the conversation in building health care systems.

DISCUSSION HIGHLIGHTS

As expressed by the workshop presenters, the trauma that one person experiences has a ripple effect across a family and across generations. The Native American and African American trauma narratives paralleled each other, with presenters sharing insight on the importance of using place-based and two-generation approaches. Some participants expressed concern that there are people in this country who do not believe or understand the depth of what trauma presents for many others, but said this is why these conversations need to continue. A final comment by a participant was to encourage community members and policy makers to focus on resilience factors, with the understanding that communities may have strengths that can be shared across cultures and that can contribute to building capacity in those communities most affected.

Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×

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Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×
Page 37
Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×
Page 38
Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×
Page 39
Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×
Page 40
Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×
Page 41
Suggested Citation:"5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
×
Page 42
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In November 2017, the The Forum on Promoting Children's Cognitive, Affective, and Behavioral Health, in collaboration with the Roundtable on the Promotion of Health Equity, convened a workshop on promoting children's behavioral health equity. The workshop used a socio-ecological developmental model to explore health equity of children and families, including those with complex needs and chronic conditions. Particular attention was paid to challenges experienced by children and families in both rural and urban contexts, to include but not limited to poverty, individual and institutional racism, low-resourced communities, and hindered access to educational and health care services. Workshop participants also engaged in solution-oriented discussions of initiatives, policies, and programs that aim to improve social determinants of health, opportunities for behavioral health promotion, and access to quality services that address the behavioral health of all children and families. This publication summarizes the presentations and discussion of the event.

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