Looking at Trauma Through Culturally Diverse Lenses

1. Looking at Trauma Through Culturally Diverse Lenses Vanessa Berens Pat Acosta Encuentro Latino National Institute

2. Trauma Definition • Experiencing a serious injury to yourself • Witnessing a serious injury to or death of someone • Facing imminent threats of serious injury or death • Experiencing a violation of personal physical integrity • An emotional wound or shock often having long-lasting effects (The Workgroup on Adapting Latino Services, 2008)

3. Responses to trauma • Immediate responses to trauma + Terror + Psychological Reactions + Shock + Horror + Helplessness +Fear • Post-traumatic symptoms • Intrusive • Hyper-arousal reactions • Avoidance and withdrawn reactions (Cook, Blaustein, Spinazzola, and Van Dr Kolk, 2003)

4. Children’s Responses to Trauma Separation Anxiety Young Children Developmental Regression Sleep Disturbance Poor Attention Somatic Complaints School Aged Children Internalizing Problems Externalizing Problems Heightened Shame Guilt Adolescents Withdrawn Self-destructive/High risk behavior (The Workgroup on Adapting Latino Services, 2008)

5. Cultural Difference in Dealing with Trauma Trauma occurs across the full spectrum of racial, ethnic, and cultural groups and greatly varies between and within ethnicities and cultures Pendulum

6. Help Seeking Trends for Trauma (National Child Abuse and Neglect Data System, 2006)

7. Issues in Utilizing Services for Latino Population • Lack of health insurance • Transportation issues • Lack of bilingual services providers • Lack of culturally appropriate information • Unfamiliar with mental health treatment • Self-consciousness • Distrust of the system • Shame and stigma (The Workgroup on Adapting Latino Services, 2008)

8. Common Risk Factors for the Latino Population • Poverty • Inadequate housing • Single-parent families • Substance abuse problems • Stress related to acculturation and discrimination • Lower levels of education • Cultural history of oppression (The Workgroup on Adapting Latino Services, 2008) Environment Factors

9. Additional Risk Factors Immigration Experience Anti-Immigration Discrimination History of Civil War or Oppressive Dictatorship Culture-Related Intergenerational Conflicts (The Workgroup on Adapting Latino Services, 2008)

10. Holistic Approach Alternative Healing Traditional Healing Folk Healing

11. Hierarchy of Lay Healers Señora/Abuela Yerbero Sobador(a) Partera Espiritualistos(as) Curandero(a) Neff, N. (n.d.).

12. Common Values among Latino Groups Familismo Simpatica Respecto Personalismo Religion/ Spirituality Machismo/Marianismo (The Workgroup on Adapting Latino Services, 2008; National Child Traumatic Stress Network, 2007)

13. Folk Healers Yerbero (herbalist) Sobador (massage therapist) Partera (mid-wife, who also treats problems with young children). Espiritualistos(as) (psychic mediums) Curandero (healer who may use multiple modalities). (Trotter & Chavira, 1997)

14. Common Folk Illnesses Susto (soul loss; literally “fright of the soul”) Empacho (Digestive blockage) Caida de la mollera, espanto (soul loss) Mal De ojo (Evil eye) Brujeria (witchcraft)/ Embrujado (Hexed) Ataque de nervios (Attack of the nerves) Bilis, colera, muina (Rage) Locura (chronic psychosis) (American Psychiatric Association, 2000)

15. Spiritual Healing Altares (alters) Saints (Specific Roles) Los milagritos (Miracles) Amuletos (Amulets) Mandas (negotiations) Veladoras (Candles) (Trotter & Chavira, 2000)

16. Cleansing Limpias or Barridas (Cleansing) *Bring back the body and spirit *Draw out illness and negative forces into the objects used *Cleansing prayer brings healing energy into the person *Used for Spiritual imbalances Smudging/Sahumerio/Incensing (Trotter & Chavira, 2000; Krajewski-Jaime, 1991)

17. Herbal Remedies Treatment of minor illnesses The retention of a locus of self control Spiritual cleansings Used in teas, herbal baths, or poultices Imbalances of heat and cold, Dry and wet (Trotter & Chavira, 1997; Neff, N., n.d.)

18. Energy Balancing Hot and cold balance Material and Spiritual balance Vibrating energy Crystals Massage/Reiki Biofeedback Hypnotherapy Acupuncture and acupressure (Trotter & Chavira, 1997; Neff, N., n.d.)

19. Relaxation Meditation Deep breathing Progressive relaxation Visual Imagery Aroma therapy Exercise/Tai Chi/Yoga Mindfulness Visit with loved ones Smile for one minute

20. How to Become Culturally Competent • Self awareness: Allow examination of your own beliefs and values. • Institute cultural knowledge: Take time to learn the culture, language, and values of minority populations. • Value diversity: Consider different backgrounds and viewpoints as strengths. • Be conscious of cultural dynamics: Diversity can cause feelings of uneasiness and conflict when different cultures interact. Such issues can be resolved through empathy.

21. Incorporating Culture and Language Level of Acculturation Language Assess Language Culture (Values, norms, customs, etc.) Psychological & Physical Health Assess degree of pathology Perceptions of health issues and services Culturally Appropriate Treatment Plan Intervention Strategies (Language, cultural themes, cultural scripts) Resources (Latino mental health, folk healers, clergy, family, other professionals) (Santiago-Rivera, A, 1995)

22. Treatment Recommendations • Make a good first impression • Take acculturation into account • Conduct a thorough, culturally modified assessment • Integrate cultural values into the therapeutic process • Engage Families • Incorporate Evidence-Based Practices (EBPs) to fit the cultural context (National Child Traumatic Stress Network, 2007)

23. Cultural Values Recommendations • Become familiar with Latino specific values and the moderating factors that may lead to value differences • Conduct a value focused assessment and feedback session of the values • Assist families in understanding how their values shape their perceptions • Assist families in reframing their perceptions that might hinder them (The Workgroup on Adapting Latino Services, 2008)

24. Cultural Values Recommendations • Provide assurance to undocumented families • Ask specific questions to the client’s immigration, acculturation, or assimilation process and/or stressors • Assess for acculturation differences within the same family • Familiarize yourself with immigration laws, policies, and resources (The Workgroup on Adapting Latino Services, 2008)

25. References: Cook, A., Blaustein, M., Spinazzola, J., and Van derKolk, B. (2003). Complex trauma in children and adolescents. National Child Traumatic Stress Network Complex Trauma Task Force. Retrieved August 30, 2009 from www.nctsnet.org/nctsn_assets/pdfs/edu_materials/ComplexTraum_All.pdf. Ford, J. D. (2008). Trauma, posttraumatic stress disorder, and ethnoracial minorities: Toward diversity and cultural competence in principles and practice. Clinical Psychology: Science and Practice, 15(1), 62-67. National Child Abuse and Neglect Data System. (2006). National data archive on child abuse and neglect. Retrieved August 30, 2009, from the National Data Archive on Child Abuse and Neglect Web site: http://ndacan.cornell.edu/NDACAN/Datasets. National Child Traumatic Stress Network. (2007). Preliminary Adaptations for working with traumatized Latino/Hispanic children and their families. NCTSN Culture & Trauma Briefs, 2(3). www.NCTSN.org. National Child Traumatic Stress Network. (2005). Promoting culturally competent trauma informed practices. NCTSN Culture & Trauma Briefs, 1(1). www.NCTSN.org. The Workgroup on Adapting Latino Services. (2008). Adaptation guidelines for serving Latino children and families affected by trauma (1st ed.). San Diego, CA: Chadwick Center for Children and Families.