Screening for Trauma in a Trauma-Informed and Bias Reducing Way in Children’s Mental Health Services

Dr. Dana E. CrawfordDirector, Trauma-Informed Care Program

Assistant Professor, Albert Einstein College of MedicineMontefiore Medical Group, Clinical Pediatric Psychologist

Screening for Trauma in a Trauma-Informed and Bias

Reducing Way in Children’s Mental Health Services

Dr. Dana E. CrawfordDirector, Trauma-Informed Care Program

Assistant Professor, Albert Einstein College of MedicineMontefiore Medical Group, Clinical Pediatric Psychologist

Trauma-Informed Care (T.I.C.) & Crawford Bias Reduction Theory & Training (CBRT)

Reduction Create a safe space to talk about trauma and toxic stress

InvestigationUnderstand how bias, prejudice, and racism and other forms of invalidation manifest in screening

Awareness Effective trauma-informed screening

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Awareness of Trauma & Insidious Poverty/Racism

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

We Learn Through Our Interactions

We Learn Through Our Interactions

Wired Together…Fire Together

Heuristics

‣ A heuristic is a mental shortcut that allows an individual to make a decision, pass judgment, or solve a problem quickly and with minimal mental effort.

Triggers‣ Lack of resources‣ Fear and safety risk‣ Desire to protect‣ Limited exposure to a particular group‣ Status quo, comfort, and change resistance

Trauma Responses And Bias, Prejudice, And Racism

Time pressure

Vague or confusing situations

Too much information at once (“cognitive overload”)

Lack of attention being paid to the task

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Bias & Prejudice…It’s in the air we

breathe

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Culturally Biased AND

a good person

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

We need a sense of understanding and control

‣ Use our previous knowledge, experiences, and things trusted sources share

‣ We blame others because:• Interpersonal and complex experiences are given universal

meaning• Blame is helps you preserve your sense of self-esteem by

avoiding awareness of your own flaws or failings.• Blame is a tool we use when we’re in attack mode. • We’re not very good at figuring out the causes of other people's

behavior, or even our own.• It’s easier to blame someone else than to accept responsibility.

‣ We often seek meaning during stressful times

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Trauma-Informed Care (T.I.C.) & Crawford Bias Reduction Training & Theory

(CBRT)

Reduction Create a safe space to talk about trauma and toxic stress

InvestigationUnderstand how bias, prejudice, and racism and other forms of invalidation manifest in screening

Awareness Effective trauma-informed screening

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Our Community & Work Force*

Economic Indicators–28.4% live at or below the

poverty line–40.1% of children are at or below

poverty–5.7% unemployment rate in 2017–8.9% uninsured in 2019

Bronx:

High Burden of Chronic Disease–16% have diabetes–69% are overweight or obese–36% of children are overweight

or obese–17% have asthma

Source: U.S. Census, U.S., New York State Department of Labor (NYSDOL) Department of Labor, New York State Department of Health, NYC Department of Education

Screening

• Lisa 26 y/o• Jared 28 y/o • Michael 6 y/o• Gabby 5 y/o • Mary, 50 y/o

What’s wrong?To

What happened?How can I access empathy?

Possible Universal Screeners

Pediatric‣ACEs‣PHQ‣ASQ 3‣ASQ:SE 24‣ASQ:SE 36‣PSC-17

What is an Adverse Childhood Experience / ACE?1. Recurrent physical abuse2. Recurrent emotional abuse3. Contact sexual abuse4. An alcohol and/or drug abuser in the household5. An incarcerated household member6. Family member who is chronically depressed, mentally ill,

institutionalized, or suicidal7. Mother is treated violently8. One or no parents9. Physical neglect10. Emotional neglect

ACEs: Adverse Childhood Experiences

CDC and Kaiser 1995-1997 data collectionDomains measured:

Abuse, neglect, household dysfunctionSample:

N = 17,337Results: • More than half the sample had at

least 1 ACE• Significant relationship between ACE

score and risk of adverse health factors later in life (smoking, obesity, depression, suicide attempt, illicit drug use, heart disease, cancer)

ACEs: Summary of major findings

‣ Almost two-thirds of the participants reported at least one ACE, and more than one in five reported three or more ACEs.

‣ The short- and long-term outcomes of these childhood exposures include a multitude of health and social problems.

What about

Culture?

Screening

• Lisa 26 y/o• Jared 28 y/o • Michael 6 y/o• Gabby 5 y/o • Mary, 50 y/o

This is Lisa’s family

This is Lisa’s family

This is Lisa’s family

This is Lisa’s family

Culture guides…

‣ If we survive being born

‣ Where we are born‣ What relationships

we have‣ Our education‣ Our employment‣ Our health‣ Our finances‣ Our lives

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Socially Oppressed Groups (SOG) and Socially Privileged Group (SPG)

FemalePerson of color

LGBTQIANon-European

AmericanPerson with a

disabilityWorking Class

MaleWhite

HeterosexualEuropean American

Physically and Mentally AbledMiddle to Upper

Class

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Triggers

Black infants are 3 times as likely to die from complications related to low birthweight as compared to white infants.

Black women are approximately 3 to 5 times more likely to die related to childbirth than white women.

Development of Traumatic Beliefs1) I am not safe.

2) People want to hurt me.

3) If I am in trouble, no one will help.

4) The world is dangerous.

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Sometimes it might feel like this…

Reduction Create a safe space to talk about trauma and toxic stress

InvestigationUnderstand how bias, prejudice, and racism and other forms of invalidation manifest in screening

Awareness Effective trauma-informed screening

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Trauma-Informed Care (T.I.C.) & Crawford Bias Reduction Training & Theory

(CBRT)

WE ARE MISSION DRIVEN

THE MISSION IS HARD

Working with trauma is triggering

Contributes to:AbsenteeismPresenteeismTurnoverAccidents

BURNOUT

COMPASSION FATIGUE

SECONDARY TRAUMA

Heuristic,Trauma,& Bias

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Now COVID-19

‣ Stress makes it hard for us to access our professional skills

‣ Bias spreads misinformation

‣ Stigma stops us from moving forward

Image Credit @witchtropolis

Emotions are contagious…

‣ People can have an enormous positive influence on a highly aroused individual.

‣ If they can maintain clarity and calmness, this too can be contagious, thus reducing the other person’s level of arousal both emotionally and physiologically.

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Overview of TIC Topics‣ Module 1: Introducing TIC – Understanding of Stress,

Trauma & Cultural Bias, Prejudice and Racism

‣ Module 2: Manifestations of Trauma & Cultural Biases

‣ Module 3: Burnout, Secondary traumatization, Vicarious trauma & coping with institutionalized biases

‣ Module 4: Screening for trauma: ACEs & Exploring intersections of trauma and culture

‣ Module 5: Culture awareness, ACEs & TIC experiential learning

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

Screening during COVID-19

‣ Screening must be responsive to the need‣ Population health focused‣ Focus on functioning‣ Prevention and stabilization

Triggers

Moving from Mind-full to Mindful

(Copyright Dana E. Crawford 347-815-4569 drdanacrawford@gmail.com www.drdanacrawford.com)

The Trauma-Informed Care team at Montefiore

Dr. Dana E. Crawford, Program Director, Content DeveloperDr. Miguelina Germán, Former Director, TIC TrainerDr. Polina Umylny, TIC TrainerDr. Christina Fiorvanti, TIC TrainerDr. Paul Bulman, TIC Assistant DirectorDr. Vanessa J. Pressimone, TIC Assistant DirectorMs. Jayxa Alonzo, TIC Program Manager

Andrew RacineRahil Briggs Matthew McDonoughMiguelina GermanDana E. Crawford Alissa Mallow Jayxa Alonzo Kim Keller Brittany Gurney Kathleen DumpertAll the TIC site trainers from BHIP

Steering Committee & Patient Advisory CommitteeDarlene O'Keefe, Nurse, AstorEve Karkowsky, Medical Director, Obstetrics & Gynecology, CFCCKatie Dumpert, Psychologist, Pediatric BHIPMichael Rinke, Medical Director of Pediatric QualityMichelle Blackmore, Project Director, CMMI BHIP Namita Azad, Transformation Manager, MMGNathalie Pierre, Nurse, CFCCNicole Brown, Pediatrician, FCC/ACES researcherNixon Pena, PSR, FCCSarah Ricketts, Medical Director, Behavioral Health Integration and Rehabilitation Tamika Ayers, Adult Patient, West Farms & Parent of Pediatric Patients, West FarmsValerie T. Ward, Assistant Director of Social Work, MMGApril Rivera, Patient, MAP Bernadine “Joey” Barnett, Patient, WFFPMaira Montero, Patient, CHCCShoshanna Green, Patient, WakefieldTamika Ayers, Patient, WFFPTiffany Rodriguez, Patient, FCCAndrea Rich, Medical Director, CHCC

Acknowledgements

For further information, please contact:

Dr. Dana E. CrawfordDirector, Trauma-Informed Care dacrawfo@montefiore.orgdrdanacrawford@gmail.com

Instagram: @DrDanaCrawfordTwitter: @DanaCrawfordphd

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