UWM CIO Office Helen Bader School of Social Welfare Improving lives and strengthening communities through research, education and community partnerships • Criminal Justice • Social Work
UWM CIO Office Poverty and Trauma Dimitri Topitzes, PhD, LCSW Associate Professor, UW-Milwaukee Clinical Director, ICFW Poverty Matters Conference Appleton, WI September 15, 2016
UWM CIO Office Agenda • Define psychological trauma • Discuss relationship between trauma and poverty • Explore implications for policy and programs
UWM CIO Office Trauma Definition • Trauma is a two-fold phenomenon: exposure and symptoms • Trauma: An extremely upsetting or even life-threatening event that in the moment temporarily overwhelms coping skills • Leads to symptoms and functional impairments
UWM CIO Office Simple vs Complex PTEs • Single Incident: Type I – Often adulthood & recovery probable – Childhood, recovery probable with support • Multiple Incident: Type II – Often prolonged or enduring or chronic – Relational field – Context of social exploitation – Leads to complex symptom presentation – Often in childhood (due to vulnerable nature of children): CDT – Can be adulthood: DV, POWs, Victims of Sex Trade – Those with significant mental health/bx health issues exp Type II
UWM CIO Office Primary Symptoms of Trauma (I or II) • Intrusion (re-experiencing, intrusive memories, nightmares, dissociative flashbacks) • Avoidance (effortful or automatic, thoughts and feelings and external reminders) • Cognition &/or mood alterations (memory disturbance, self and world schemas, negative mood) • Hyperarousal (hypervigilance, sleep disturbance, aggression and irritability, concentration problems)
UWM CIO Office Secondary Symptoms of Trauma (II) • Secondary Symptoms or Trauma Consequences – Short and long-term – Extensive (domains)
UWM CIO Office Short Term Secondary Symptoms • Attention regulation • Affect regulation • Cognitive development • Social adjustment • Self-concept
UWM CIO Office Long-Term Effects of Complex Trauma • Mental health impairments • Behavioral health impairments • Physical health impairments • Educational attainment • Human capital • Criminality
UWM CIO Office Trauma and Poverty • Correlation: Poverty increases risk of exposure to childhood and adulthood trauma: (e.g., neglect, IPV, community violence) • Increased risk of trauma symptoms and PTSD: fewer external protective factors (CJ vs MH, education) • Poverty as Index Trauma: Jack Shonkoff’s research, Seth Pollack’s research
UWM CIO Office Poverty as Trauma
UWM CIO Office Brain Volume Effects • Frontal Lobe: Higher order or executive functioning • Hippocampus: Mediates memory, learning, and stress response • Amygdala: Processes emotional and social information • Conclusion: Same areas of brain affected by trauma!
UWM CIO Office Adverse Childhood Experiences (ACEs) • Akin to trauma • Abuse (physical, sexual, and psychological) • Neglect (physical and emotional) • Household dysfunction • Divorce, IPV, household substance abuse, household mental illness, and
UWM CIO Office Jobs Programs • Two samples of only men • Seeking job services and of low income status • Majority with history of incarceration • Milwaukee and St. Louis Sample • Compared to Original ACE Sample
UWM CIO Office ACEs and Poverty (Men) Prevalence (%) ACE Study* Site One (MKE) Site Two (SL) (N = 3,955) (N = 199) (N = 213) ____________________________________________________________________ Abuse: Verbal 7.8 38.2 21.6 Physical 27.9 41.2 33.3 Sexual 17.1 21.6 17.4 Neglect: Emotional 12.5 38.2 4.2 Physical 10.7 29.1 32.4 Household dysfunction: IPV 2.1 29.6 36.2 Subst. Abuse 11.2 48.2 46.0 Mental Illness 14.3 19.1 39.4 Divorce 22.6 60.8 66.7 Incarceration 5.0 51.3 49.8
UWM CIO Office ACEs and Poverty (Men) ____________________________________________________________________ ACE Index Score, ACE Study Site One (MKE) Site Two (SL) Prevalence (%) (N = 3,955) (N= 199) (N= 213) _____________________________________________________________________ 0 37.7 15.6 4.7 1 27.6 11.6 20.8 2 15.2 17.1 15.1 3 8.2 8.0 16.0 4 or more 11.4 47.0 43.4
UWM CIO Office WI Home Visiting Sample Sample Description (N = 1,241) Caucasian 33% African American 29% Hispanic/Latina 25% American Indian 7% Low income 98% Child welfare history 25%
UWM CIO Office ACEs and Poverty (Women)
UWM CIO Office ACEs and Poverty (Women)
UWM CIO Office ACE Score
UWM CIO Office Additional ACEs Adverse Childhood Experience FFHV Program (%) Victim of Violent Crime 15.9 Prolonged Absence of Parent 57.5 Death of Parent/Sibling 24.4 Homelessness 22.5
UWM CIO Office ACEs/Trauma/Health • With original ACE study. • How about studies here in WI with low- income samples?
UWM CIO Office Jobs Program Sample 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Low general health Current smoking Drug abuse Depression high Anxiety high Employment problems Arrest or incarceration ACE 0 ACEs 1-2 ACEs 3-4 ACEs >5
UWM CIO Office Home Visiting Sample Perce ≥ 5 < 5 nt Outcome N ACEs ACEs Chan (%) (%) ge Prenatal Edinburgh 449 18.4 35.3 +92% Score ≥13 Postnatal Edinburgh 476 10.8 21.1 +95% Score ≥ 13 Perceived Stress 584 24.7 45.9 +86% Scale ≥ 20
UWM CIO Office Implications • Health/Wealth Gradient something to do with ACEs, trauma and stress? • Integrate trauma care into educational, health and economic services for families facing economic hardship.
UWM CIO Office Policies and Programs • Early Interventions! • Center-Based preschool (Heckman) • Home Visiting (Intergenerational Trauma) • Trauma care into healthcare
UWM CIO Office Thank you Dimitri Topitzes, PhD, LCSW topitzes@uwm.edu 414-229-3004
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