Can treating post traumatic stress disorders solve urban America’s employment crisis?
That’s the theme of an August, 2015, Next City online magazine article by Alexis Stephens, a Philadelphia-based writer focused on urban affairs. It was stimulated by a 2015 report from Drexel University’s Center for Labor Markets and Policy.
It’s also been a question on the minds of a few Trenton city council members, health officials, educators, and this editor — all involved with a city of 84,000 people, unemployment figures fluctuating between 7 and 14 percent, and the highest crime rate in Mercer County.
According to writer Stephens, psychologists in the 1990s started noticing similarities to symptoms exhibited by youth exposed to urban problems, including gun violence (and poverty), to individuals suffering from post traumatic stress disorder (PTSD).
The article did not define PTSD, but Rutgers University does and calls it as an anxiety disorder some people get after experiencing a dangerous event.
There are three categories of symptoms: First, there is a re-experience that causes flashbacks and frightening thoughts and creates problems in an individual’s daily routine; second, avoidance reactions that keep people away from places and events and feelings of numbness, guilt, depression, or anxiety; and third, a state of hyper-arousal where a person constantly feels stressed and angry and has difficulty sleeping, eating, or concentrating.
The Rutgers overview says it affects people of all ages, yet older children and teens “may develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.”
The Trenton Heath Team — a city-wide health initiative that includes St. Francis Medical Center, Capital Health, Henry J. Austin Health Center, and the Department of Health and Human Services of the City of Trenton — brings the message home. “Trauma from exposure to random violence, rape, substance abuse in the home or fear for safety because of street violence and gang activities has taken a terrible toll on Trenton residents,” says James Brownlee, THT officer and the city Health and Human Services director.
The THT website references the organization’s Community Health Needs Assessment (CHNA) conclusion that “trauma is a critical issue impacting the health of Trenton residents.” THT conducted the assessment in 2013 in collaboration with medical, governmental, behavioral, social service, educational, and faith-based organizations and agencies that serve the city of Trenton. The CHNA found “the impact of Adverse Childhood Experiences (ACEs) to be a major underlying factor for many of the community’s poor health outcomes, both psycho-social and physical.”
Stephens connects the effects on education and employment as follows: “When the number of traumatic events that a child goes through begins to pile up, the damaged fight-or-flight response can result in defensiveness in everyday situations and the inability for a young person to de-escalate conflict at school and in the workplace. As the number of traumatic experiences in one’s childhood goes up, the higher the likelihood for negative outcomes.”
The article says individuals experiencing PTSD can be diagnosed by administering the Adverse Childhood Experiences (ACE) test — created through what the Centers for Disease Control calls “one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being.”
Simply put: an increased ACE score has a correlation with job problems, financial problems, and absenteeism. Yet the article says practitioners using trauma-informed information can provide informed guidance.
Robert Abramovitz, co-director of the National Center for Social Work Trauma Education and Workforce Development, says ACE can help understanding. “Sometimes kids are triggered by something that seems totally innocuous. But they are actually automatically re-experiencing a trauma from the past and using survival strategies that were appropriate at that time. But of course, [these behaviors] are not appropriate at the present. So often the person in front of them hasn’t gotten a clue about what’s going on.
“Danger and safety are primary preoccupations of traumatized kids, meaning that every minute you are with these kids, they are expending an enormous amount of energy scanning the environment to make sure they are safe and that nothing bad is going to happen to them.”
Stephens notes that while hyper-awareness may be an important survival strategy for a teenager walking through a dangerous neighborhood on the daily trip home from school, in a “stress-triggering workplace situation like a job interview or a performance review, the teen’s red-alert reflexes could become a major stumbling block to future success.”
The recent Drexel study reflects the conclusions of other studies, including the 2002 JAMA Pediatrics article, “Violence Exposure, Trauma, and IQ and/or Reading Deficits Among Urban Children.” Its authors found “surprisingly high levels of self-reported violence, both via witnessing of and victimization by violent events, are consistently found in young urban children. Children reporting high levels of violence exposure have demonstrated higher levels of both internalizing and externalizing behaviors. In addition, evidence of poor school outcomes among older children affected by violence is also mounting.”
Stephens’ sources said community violence exposure — victimized by a robbery or being threatened with a weapon — was associated with a decrease in school attendance and grades in a large sample of middle and high-school students. Adolescent girls (ages 12 to 21) in a primary care setting and meeting criteria for PTSD were more likely to have failed a school grade.
While PTSD is racially blind, Trenton’s population is mainly African American and Spanish and subject to other considerations. As the U.S. Surgeon General’s 1999 report “Mental Health: Culture, Race, and Ethnicity,” noted “disparities in mental health services exist for racial and ethnic minorities, and thus, mental illnesses exact a greater toll on their overall health and productivity.”
The report was written nearly 20 years ago, but with the economic crisis of 2008, New Jersey’s slow economic recovery, diminishing revenues in the capital city, and a fiscally troubled state, the disparities promise to remain.
“We are not surrogate parents,” says a sympathizing business owner in Stephens’ article. It’s a point that Stephens appreciates. “Employers were challenged by the complications associated with simultaneously running a business, participating in a youth program, conflicting organizational cultures between business and youth organizations, and concerns about adolescent behaviors,” she writes.
So what to do? One avenue, writes Stephens, is for communities to create “trauma-informed” approaches to the outcomes for people struggling with behavioral problems. That includes workforce development, citing the growing membership of the National Child Traumatic Stress Network.
The work of area organizations, including the Trenton Health Team and the Center for Children and Family Advancement (see related story) are a few organizations adopting the trauma-informed approach.
Yet an important first step is for more community leaders and elected officials to join members of the Trenton City Council and to accept the problem — one that won’t be solved by just telling a kid to “sit down!” or an adult to “get a job!”
