BMoC Trauma Project results presentation for the National Network of Hospital-based Violence Intervention Programs Annual Conference.

1. Linnea Ashley
National Training and Advocacy Manager, Youth ALIVE!
Nicky MacCallum
Clinical Director, Youth ALIVE!
Anne Marks
Executive Director, Youth ALIVE!
Vincent Chong, MD
Surgery Resident, Highland Hospital/UCSF-East Bay
John Rich, MD
Director, Center for Nonviolence and Social Justice
Ted Corbin, MD
Medical Director, Healing Hurt People

2. Screening Tool for Awareness and Relief of Trauma

3. Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A

4. Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A

5. Some people have symptoms from trauma
Those symptoms are often undiagnosed
Symptoms make people vulnerable to violent trauma
Young men of color are disproportionately exposed to violence and trauma

6. People See:
What it is:
Hostility
Callousness/
coldness
Anger
Hyperarousal
Numbing
Reliving

7. Understand BMoC experiences with systems
◦How and where do they seek care?
◦What helped them heal from trauma?
Learn appropriate language to use/avoid
Create a trauma symptoms tool
Provide short but effective interventions

8. Goal: a practical application of Trauma- Informed Care
Even if you don’t have PTSD, trauma symptoms disrupt your life.
Create “aspirin” for the daily aches and pains of trauma

9. Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A

10. Assembled/convened the research team and Advisory Board
Prepared a literature review
Conducted 4 focus groups with GSW survivors
69 structured survey and intervention pilot interviews with local young men of color
Advisory Board
Literature review
Focus Groups
Structured Interviews

11. Youth ALIVE!
Alameda Health System / Highland Hospital
Center for Nonviolence and Social Justice
Consultants & volunteers
Advisory Board
Literature review
Focus Groups
Structured Interviews

12. Advisors represented:
Study population
Public hospital system
Private hospital system
Children’s hospital
Public health department
Courts
Probation
School district
Service provider
Policy advocate
Subject matter experts
Advisory Board
Literature review
Focus Groups
Structured Interviews

13. Purpose: To summarize research related to the health challenges facing BMoC, where they seek care, and how they can better be served, specifically as it relates to their trauma symptoms.
Topics:
Portals of Care
PTSD
Screening Tools and Interventions
SBIRT
Advisory Board
Literature review
Focus Groups
Structured Interviews

14. 4 Focus Groups with:
18-25 year olds
Current/former clients (GSW survivors)
African-American and/or Latino
Topics:
Where they seek care
Who they trust to provide care
What support they would want after trauma
How they experience and talk about trauma symptoms
What interventions work for them
Advisory Board
Literature review
Focus Groups
Structured Interviews

15. 69 interviews with:
18-30 year olds
African-American and/or Latino
Snowball sample
Survey:
2 versions each of screening questions for 6 trauma symptoms
Where and with whom they would answer screening questions
Pilot:
How they experience and talk about trauma symptoms
What interventions work for them
Advisory Board
Literature review
Focus Groups
Structured Interviews

16. 6 screening questions:
Focus
Re-experiencing
Dissociation
Hyperarousal
Physical manifestations
Sleep issues
Advisory Board
Literature review
Focus Groups
Structured Interviews

17. 7 brief interventions:
Common symptoms of trauma Psychoeducation handout on Every day ways trauma is impactful
Belly breathing Calming/Grounding exercise
Domino Grounding exercise
Progressive relaxation Relaxation/Grounding exercise
Advisory Board
Literature review
Focus Groups
Structured Interviews
Continued..

18. Hand massage Relaxation/Grounding exercise
B.E.T.T.E.R. Sleep Psychoeducation handout on healthy sleep hygiene practices
Safety or “S.O.S.” plan Booklet of self-care activities utilized to develop an individualized plan for symptom management.
Advisory Board
Literature review
Focus Groups
Structured Interviews

19. 5
9
5
8
9
5
7
5
3
4
4
2
2
0
2
4
6
8
10
18
19
20
21
22
23
24
25
26
27
28
29
30
Age
Participant Age
African- American, 48
Latino, 15
Mixed, 5
Racial Breakdown

20. Oakland Neighborhoods by Zip Codes
94603
= Areas with most participants

21. Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A

22. Larger Themes
◦Provider-patient misalignment of expectations
◦Different provider characteristics
i.e. “Children’s treats you…”
i.e. “Highland treats you…”
◦Nontraditional providers
i.e. Cannabis Clubs
◦Issues of trust
◦Manifestations of Trauma and Stress
What patients need to seek for help
Coping mechanisms
How young people talk about stress

23. Re- experiencing
◦Replay
◦Surviving
◦Scars
◦Déjà vu
Avoidance
◦Staying under (the radar)
◦Laying low
Hyperarousal
◦Mental pain
◦Insomnia
◦Being on Ps and Qs

24. Self medication (Smoking weed)
Disrupted sleeping patterns
Discomfort waiting in the same spot

25. “And I don’t gang-bang or anything like or have any enemies. That’s why I still living…I still live in the location where I got shot and it’s a trauma just passing by like every time. It’s crazy. I don’t even want to talk about it.”

26. “Sometime you do need a prescription and just by how you acting, how you look, the doctor would be like, ‘No, you need it because you wanna get high.’ I’m gonna get high if I need it. You haven't been knowin’ what I went through.”

27. “Let me holler at you, let me see your paperwork. How you feelin’? Good. Alright, bam. Throw it back out. Do whatever you gotta do.
Come back. “Oh, you still here” “Yeah, you haven't seen me.” “Ok. Let me see you.’ Bam, bam, bam. “Okay you cool. Come back in two- three weeks.”
Say what the fuck? (cont.)

28. They just write stuff on the paper. This what was wrong with you last time. This what’s wrong with you this time. This is getting better.
Okay. Bam. Two week check-up, see how you’re doing’. Come back and that’s it.
Ain’t nobody gonna come back because you didn’t do nothin’ while I was there.”

29. M4: We can talk to him,
everyone, like in the slang
or in our accents like how we is --
M3: Straightforward --
M4: And then he can still talk to us cool. Not like everybody else. Not like these guys came from somebody else.
After listenin' to him,
getting advice or stuff.
I'm gonna help you out.
They never call you back or nothin'. You call at four shit and forget about you. All that.
He don't. He just be,
"Alright, I'm gonna try to do this.”
And if not then he'll just give you a call back.
"Oh, I can't do it today.
Just give me two, three more days or somethin’
and I'll get back at ya'.”

30. Male3: 'Cause he cool.
You ain't gotta be nobody different, man. You just be yourself. No matter if you bad, good, sick, green, purple, ugly, man.
If you know how to talk,
he understandin'. He gonna talk to you.
If not, he's just gonna be like,"I can't help you."
Or he gonna tell you why he can't help you because this person is being a cat or this, this, this.
He ain’t speakin' down to you
he just said, "Well we can't do it because of this reason."
If you can be the bigger person
like okay, that's it, then when the next time maybe it be better for you.

31. Moderator: When you went back, what would you expect or would you want out of the doctors or the nurses who were helping you?
M5: Shit, just to check me. Check me. Check my injury. Check it right
M4: Do it faster, huh.
M5: Not faster,
but take care of it.
M4: Not to check it faster
but take care of business faster.
M5: Yeah.

32. Sometimes you do need a prescription
and just by how you actin', how you look, the doctor would be like, "No,
you need it because you wanna get high."
I'm gonna get high if I need it.
You haven’t been knowin what I went through.
You seen it or I gotta get to know you. What do you gotta get to know me for? You already seen my record
that’s all you need to know about me.

33. Shit, just tell them man,
we was born to live.
One day we gotta die.
So today's your day,
shit, you gotta die.
There's nothin' you can do about it.
If it's your day,
it's your day.
M1: For real.
M3: For real.
If it is,
it's gonna come
how it's gonna come --
M4: That's how your destiny is
M3: 'cause you kickin' it with us
you gonna make your bed
and lay in it
in the same time.
So if this what you doin' wrong,
this is what's gonna come wrong.

34. P1: Because I’ll be up all night. Yeah.
P2: If you sleep during the day.
P1: If I take a nap during the day, I’ll be up. I ain’t going to sleep ‘til late.
P2: What’s strange is babies sleep all day and night, but as you grow older, you sleep, like you said, during the day. Nighttime is when you’re not gonna sleep.

35. P1: The effects.
Effects.
P2: It’s probably like
when it just flashes in and out
like every now and then.
P1: Yeah.
When you just have flashbacks
and stuff…
P2: Dreams.

36. Nightmares…
ooh,
I’ve been having nightmares…
I have a lot of nightmares too.
That ain’t no joke.
Nightmares…
they be causing you cold sweats.

37. Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A

38. No Symptoms, 3%
1 symptom, 6%
2 symptoms, 20%
3 symptoms, 17%
4 symptoms, 25%
5 symptoms, 9%
6 symptoms, 20%
Number of moderate to severe trauma symptoms in study population
97% had at least one moderate trauma symptom

39. never 3%
rarely 26%
sometimes 54%
often 17%
1. focus
never 12%
rarely 39%
sometimes 27%
often 22%
3. dissociation
never 7%
rarely 32%
sometimes 34%
often 27%
2. re-experiencing
never 10%
rarely 10%
sometimes 30%
often 50%
4. hyperarousal
never 23%
rarely 41%
sometimes 27%
often 9%
5. physical
never 15%
rarely 17%
sometimes 29%
often 39%
6. sleep
Trauma Screening Results

40. never 3%
rarely 26%
sometimes 54%
often 17%
1. focus
never 12%
rarely 39%
sometimes 27%
often 22%
3. dissociation
never 7%
rarely 32%
sometimes 34%
often 27%
2. re-experiencing
never 10%
rarely 10%
sometimes 30%
often 50%
4. hyperarousal
never 23%
rarely 41%
sometimes 27%
often 9%
5. physical
never 15%
rarely 17%
sometimes 29%
often 39%
6. sleep
Trauma Screening Results

41. 0
0
0
0
0
4
4
2
6
6
4
11
5
5
7
3
2
1
3
3
3
0
0
0
0
0
0
4
2
5
4
5
4
6
5
8
8
5
0
2
5
4
1
1
0
2
4
6
8
10
12
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Trauma Symptom Screening Scores
Version A # of responses
Version B # of responses

42. Yes, no matter what 55%
Yes, if they're trying to help 36%
No 9%
mentor
Yes, no matter what 29%
Yes, if they're trying to help 49%
No 22%
social worker
Yes, no matter what 33%
Yes, if they're trying to help 56%
No 11%
psychiatrist
Yes, no matter what 40%
Yes, if they're trying to help 41%
No 19%
counselor
Yes, no matter what 47%
Yes, if they're trying to help 47%
No 6%
therapist
Would you answer these questions if this person asked you?

43. Answer 1-on-1, 57%
Answer alone, 14%
Don't Know, 1%
Either, 23%
Not at all, 3%
Would you prefer if someone asked you these questions, or to read and answer by yourself?

44. 30%
37%
29%
60%
62%
57%
64%
54%
45%
46%
31%
30%
38%
32%
Domino
Hand Massage
Tensing
Breathing
Common
Symptoms
Sleep
Safety Plan
Was This Intervention Helpful?
a lot
some-what
=96%
=95%
=92%
=91%
=75%
=84%
=82%
SOS Plan
Progressive Relaxation

45. a lot 64%
some- what 32%
not at all 4%
SOS Plan
a lot 56%
some- what 38%
not at all 6%
Sleep
a lot 60%
some- what 31%
not at all 9%
Breathing
a lot 62%
some- what 31%
not at all 7%
Common Symptoms
a lot 37%
some- what 45%
not at all 18%
Hand Massage
a lot 30%
some-what 54%
not at all 16%
Domino
a lot 29%
some- what 46%
not at all 25%
Prog. Relaxation
Was this relaxing/
useful/
helpful?

46. Yes 77%
No 16%
Maybe 7%
Domino
Yes 90%
No 6%
Maybe 4%
Hand Massage
Yes 78%
No 16%
Maybe 6%
Prog Relaxation
Yes 90%
No 4%
Maybe 6%
Breathing
Yes 99%
No 1%
SOS Plan
Would you feel comfortable doing this exercise again?

47. Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A

48. Screening Tool for Awareness and Relief of Trauma

49. Universally applied:
Six-question screening questionnaire (2-3 minutes)
Brief psycho-education and a handout on common trauma symptoms (3-4 minutes)
Potentially applied, based on screening score:
Structured discussion of sleep hygiene tips and patient selection of next steps (3-5 minutes)
Short breathing/relaxation or hand massage/grounding exercise (2-4 minutes each)
Patient creation of a personalized stress reduction (S.O.S.) plan (10-18 minutes)
Referral to mental health assessment for PTSD

51. Each of the START interventions can be done discreetly at home
START kit materials provided free to patient
We are working with partners to create a START smartphone app

52. Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A

53. Disseminate completed research
Prepare START Kits – training and implementation materials
◦Conduct trainings for others to use START
◦Create smartphone app
Pilot START at multiple locations
◦Health clinics
◦Schools
◦Juvenile justice
◦HVIPs

54. If you are interested in participating in the expanded pilot please contact: