Race, Exclusionary School Discipline, and the Cycle of Trauma - - PDF document

2/27/2019 Race, Exclusionary School Discipline, and the Cycle of Trauma - Connecting the Dots Camila Cribb Fabersunne, MD MPH Dannielle McBride, MD No DISCLOSURES 1

2/27/2019 Objectives ● Understand the epidemiology of trauma and its interaction with race in the US ● Recognize symptoms of trauma in pediatric populations ● Describe mass incarceration and school disciplinary actions as agents of trauma and racism in pediatric minority populations ● Explore the links between these structures and health + education outcomes ● Determine the physician’s role in interrupting this cycle Trauma 2

2/27/2019 “An event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” - Substance Abuse and Mental Health Services Administration (SAMHSA) Adverse Childhood Events Defined Financial hardship Victim or witness to neighborhood violence Parental divorce/separation Lived with mentally ill person Parental death Lived with someone with alcohol/drug Parental imprisonment problem Witness to domestic violence Treated unfairly because of race/ethnicity Abuse 3

2/27/2019 Adverse Childhood Events Defined Victim or witness to neighborhood Financial hardship violence Parental divorce/separation Lived with mentally ill person Parental death Lived with someone with alcohol/drug Parental imprisonment problem Witness to domestic violence Treated unfairly because of race/ethnicity Abuse Epidemiology 49% of children are exposed to at least one adversity 23% are exposed to two or more 4

2/27/2019 Minorities and trauma Individual adversities 5

2/27/2019 “When adjusted for child age, sex, number of children in the household, and highest parental education, adversities among black and Hispanic children were 33% and 38% higher than those of white children.” Income/SES 6

2/27/2019 Racism: a system of structuring opportunity and assigning value base on the social interpretation of how we look; unfairly disadvantages some individuals and communities Racism Framework ● Material Conditions ● Access to power ● Access to resources ● Voice Levels of Racism: A Theoretical Framework and a Gardener's Tale by Camara Jones 7

2/27/2019 Racism Framework ● Lack of respect ● Suspicion ● Devaluation ● Scapegoating ● Dehumanization Racism Framework ● Not believing in others who look like you ● Accepting limitations to your full humanity ● Embracing whiteness ● Self devaluation ● Resignation/Helplessness/Hopelessness 8

2/27/2019 Unmeasured trauma Institutional - Interpersonal - Internalized Microaggressions Frequent dehumanizing interactions Police violence Bias/Discrimination Racial bias that is institutionalized (CPS, justice system, housing, etc) Symptoms of trauma Anxiety Anger or aggression Impulsiveness Distractibility Withdrawal Clinginess Forgetful Difficulty Solving problems Hyperactive Difficulty following directions 9

2/27/2019 Manifestation of trauma in school Emotional Dysregulation Classroom Fidgety, social withdrawal, defiant, perceived as moody or angry, poor concentration Impulsive, poor emotional control, hyper reactive Academic Performance Lower GPA, lower attendance, increased suspensions Summary Trauma/ACEs are not spread equally within the US population and higher rates are seen in POC One mechanism through which this occurs is racism (structural, interpersonal, internalized), producing social and structural trauma Trauma produced through this mechanism can have lasting behavioral effects which manifests in school settings, placing children at risk for retraumatization 10

2/27/2019 School to Prison Pipeline and Mass Incarceration Objectives ● Understand the epidemiology of trauma and its interaction with race in the US ● Recognize symptoms of trauma in pediatric populations ● Describe mass incarceration and school disciplinary actions as agents of trauma and racism in pediatric minority populations ● Explore the links between these structures and health + education outcomes ● Determine the physician’s role in interrupting this cycle 11

2/27/2019 The black community is affected most by mass incarceration 12

2/27/2019 Blacks and Hispanics are overrepresented in the prison population Prison Policy Initiative 13

2/27/2019 School failure increases the risk of incarceration in the US School to Prison Pipeline 14

2/27/2019 The School to Prison Pipeline Affects Students of Color ● Suspensions: By adulthood 16% black students have been suspended. That’s three times more than whites! (US DoE Office for Civil Rights). ● Arrests: Black students represent 16% of public school enrollment (whites are 51% nationally), but 31% of school-related arrests. (ACLU 2018). ● Students suspended or expelled for a discretionary violation are nearly three times more likely to be in contact with the juvenile justice system the following year. (Council on State Governments Justice Center 2012). Zero Tolerance/ School Site law Willful Defiance enforcement Policies Key components of the school to prison pipeline Lack of Diversity in Implicit Biases School Workforce 15

2/27/2019 Zero Tolerance and Willful Defiance Zero tolerance policy : being suspended/ expelled for breaking school rules Willful defiance: defying your teachers or administrators School Site Law Enforcement ● 24% of middle schools and 42% of high schools with school based law enforcement ● Increased in-school arrests particularly for ‘ disruptive conduct ’ or disturbance of the peace ’ ACLU’s “School to Prison Pipeline Talking Points”; “Putting more cops in schools won’t make schools safer…” Washington Post February 2018 16

2/27/2019 Implicit Biases ● Implicit (and explicit biases) affect the subjective nature of assigning citations, blame and punishment ● Biases impact how a child’s behavior is interpreted Roundfield,Lee, Kersten and LeWinn, UCSF Dept Psychiatry 2018 Lack of Diversity in School Workforce ● Few students are taught by teachers of color in the US. ● Black teachers suspend black students less often (Wright 2015) 17

2/27/2019 Impacts of Exclusionary School Discipline ● Lost classroom time. ● Increased truancy and poorer attendance. ● Decreases educational attainment, increases school failure. ● Increased juvenile interaction. Fabelo et al. Breaking Schools’ Rules.A Statewide Study of How School Discipline Relates to Students’ Success and Juvenile Justice Involvement. Shollenberg. Racial Disparities in School Suspension and Subsequent Outcomes. Connecting the Dots 18

2/27/2019 Objectives ● Understand the epidemiology of trauma and its interaction with race in the US ● Recognize symptoms of trauma in pediatric populations ● Describe mass incarceration and school disciplinary actions as agents of structural trauma and racism in pediatric minority populations ● Explore the links between these structures and health + education outcomes ● Determine the physician’s role in interrupting this cycle 19

2/27/2019 Physician’s Role - How do we help? 1. Advocate for a trauma informed approach in schools 1. Use your privilege and expertise - interactions with patients, families, teachers to empower 1. Advocate Advocate Advocate 1. Trauma Informed Approach in Schools Setting the stage - creating an environment that decreases risk Preparation for when a trauma occurs, a student is triggered, etc 20

2/27/2019 Setting the Stage ● Maintain a sense of normalcy and routine ● Give students a sense of control by allowing choices when appropriate ● Develop boundaries for behavior which incorporates a positive behavior model ● Be mindful of environmental factors that may trigger a stress response after trauma ● Be aware of risk behaviors and refer students to identified services ● Have designated support staff for children exposed to trauma Addressing Symptoms of Trauma ● Provide time to have youth process the trauma as behavior might be transient ● Clarify misconceptions about the trauma verbalized by student ● Employ practices proven to address behavior and underlying cause: ○ Restorative justice methods ○ Mindfulness ○ Resilience building practices 21

2/27/2019 Change Labs Solutions: bit.ly/2CPQUzf 2. Use Your Privilege and Expertise ● Maintain awareness of the prevalence of bias and discrimination in schools ● Solicit family’s experiences in schools; screen for absenteeism, disciplinary action, suspensions and expulsions 22