Breaking the Cycle of Trauma
One girl’s story
One night, when Daniela was 11, her parents scooped her out of bed and, without any explanation, they left El Salvador. Her father was being threatened with death if he didn’t pay off gang members and he feared for his family’s safety.
Being suddenly uprooted was very difficult for Daniela– she felt her parents’ stress and missed her friends and grandparents. Crossing over to the U.S. was hard. The family eventually settled in San Rafael, but going to school in Marin was tough for Daniela – she didn’t speak English, was bullied because of her darker skin, and was teased about her parents being deported. Both parents worked several jobs, so weren’t often at home, and there wasn’t a lot of healthy food on the table. In El Salvador, she shared a room with her little brother; here, three families lived in a small, crowded apartment.
When Daniela and her family became Clinics patients, she was showing clear signs of trauma – flashbacks, nightmares, and mood swings.
Sometimes, she wouldn’t eat because the food wasn’t like what she had at home. She didn’t want to go to school, afraid that her parents might be deported while she was in class.
Trauma and adversity can have life-long impact
Sadly, Daniela is not alone. Many of the children we serve, as well as their parents, are affected by trauma and adversity. In addition to the problems that Daniela faced, children may have experienced or witnessed domestic violence, parental separation due to immigration issues or incarceration, or mental illness/substance abuse in the household.
“Multiple adverse childhood experiences (ACES) are strongly related to development of long-term health issues,” explains Tracey Hessel, MD, lead Clinics pediatrician. “Timely prevention, screening and intervention can foster resilience and help break this cycle.”
Clinics’ Efforts Expanded
At Marin Community Clinics, we are very concerned about the extent of ACES among the families we serve, so recently embarked on a comprehensive program.
“We are very attuned to the signs of trauma and are committed to helping families in any way we can,” reports Heyman Oo, MD. She is working closely with a team of pediatricians and behavioral health specialists that includes Caren Schmidt, PsyD; Elizabeth Horevitz, PhD; Elizabeth Shaw, MD and Dr. Hessel.
This spring, Marin Community Clinics was one of just a few sites in the U.S. selected to participate in a pilot project that screens for trauma in pediatric patients, pregnant moms, and newborns. “Patients can be extremely resilient and don’t always show overt signs of trauma right away, but serious problems can emerge later,” reports Schmidt. “With these screening tools, we will be able to identify more children and parents who might benefit from additional support.”
We are not stopping with screenings – we are also intervening. Any child screened as high risk is referred to our Patient Navigation Team, which determines the best course of action for the child and family.
“Children like Daniela and their families have experienced heartbreaking traumas,” concluded Schmidt. “But they are resilient, and we are here to provide the resources needed to support their
strengths and break the cycle.”
Our thanks to The Center for Youth Wellness, First 5, and the Center for Care Innovation/Resilience Beginnings Program, which fund several of the services.
Our Comprehensive Services
- Individual counseling with the children and/or their parents
- Two special case managers: one follows pregnant women whose babies are at high risk for trauma due to problems such as substance abuse; the other bridges support from obstetrics to pediatrics
- Positive Parenting group sessions
- Stress reduction groups for teenagers
- “Eat, Play, & Grow,” a children’s nutrition group
- Partnering with schools to address a child’s issues
- Referrals to our Health Hubs as well as outside legal and housing agencies
- Everyone at the Clinics, from providers to front office staff, is receiving “trauma-informed” training.
- Participation in efforts to evaluate outcomes and identify best practices that can be shared across the U.S.