Hope, trauma and resilience: a conversation about vulnerable children in America
This is William C. Bell’s keynote address at the 2015 Kevin J. Robinson Forum on Social Justice: Resilience in the Face of Childhood Trauma.
In honor of the late Kevin J. Robinson, and to all of you here tonight, welcome. I applaud you for being here, extending your day into the evening hours, when you could be at any number of other places and doing other things. Your being here and being part of this conversation, speaks to your commitment to help build and to become part of a community of hope that must surround all of our vulnerable children.
I want to begin my talk with an astounding number – 35 million.
35 million isn’t such a big number when you think about the number of stars in the night sky.
35 million isn’t so huge next to seven trillion – $7 trillion, the aggregate net worth of the world’s 1,826 billionaires.
35 million doesn’t compare when you consider the grains of sand in a child’s sandbox, the snowflakes in a snowman you and your children may have built this winter, or the blades of grass on the ball fields on which Mo’ne Davis and other little league and youth athletes played baseball, football and soccer this past year.
But 35 million is an astonishing number when you’re talking about the number of children in the United States whose lives are impacted and affected by trauma.
There are a little more than 74 million children in the United States. Nearly half of them, about 35 million, have had at least one – that’s one or more – traumatic experience during their young lives. And a significant portion of those children – nearly 23 percent of that 35 million – live a childhood where they are impacted by two or more types of traumatic or adverse experiences.
As a result these children are more vulnerable than other children to a life of various risks and poor outcomes if the adults in their lives fail to properly help them to address and counter the impact such adverse experiences at a young age can have on them.
Frederick Douglass, former slave and advocate for the abolition of slavery, once said, “It (is far) easier to build strong children than (it is) to repair broken men (adults).”
His words are just as relevant today as they were when he first spoke them more than 150 years ago. Then, he was referring to a nation of children traumatized by slavery, nominal freedom, sanctioned discrimination and Jim Crow once slavery was abolished and Reconstruction abandoned.
There are some who would suggest that still to this day many of our children have had the old Jim Crow replaced in their lives by a new Jim Crow that continues to steal their promise. A new Jim Crow that though dressed differently uses some of the same old tactics remixed but still aimed at interrupting their right to life, liberty, and an uninhibited pursuit of their happiness.
Those words hold meaning today when we talk about the risks associated with failing to secure and maintain child and family well-being and the lifelong impact adverse childhood experiences and childhood trauma can have on a person’s physical health, mental health and life outcomes.
Adverse Childhood Experiences
The National Survey of Children’s Health, conducted during 2011 and 2012, asked parents about nine types of adversity their children, newborn to 17 years old, had lived with at some point in their lives. This is what they found:
|Lived with someone who had an alcohol or drug problem||11%|
|Victim or witness of neighborhood violence||9%|
|Lived with someone who was mentally ill or suicidal||9%|
|Domestic violence witness||7%|
|Parent served time in jail||7%|
|Treated or judged unfairly due to race/ethnicity||4%|
|Death of parent||3%|
What this survey does not capture is the trauma associated with the number of young people who have either:
- Died from violence
- Been wounded by violence, or
- Have a family member or friend killed or wounded by violence
Putting this trauma in context:
On average, every 24 hours in the United States of America 29 young people under the age of 25 die as a result of violence.
- 4 due to child abuse and neglect
- 13 due to homicide, and
- 12 due to suicide
That means that every 15 days in communities across America we lose 435 young lives to violence. Ironically, this is the same number of members in the US House of Representatives.
In certain ZIP codes and communities that means that young people are walking around every day carrying the accumulated trauma of the senseless loss of 10 or more of their family members and friends before they themselves reach the age of 20 or 25.
These adverse experiences occurring at a time when children’s brains are still developing can significantly impact the development of children’s brains and neurological systems. This impact can disrupt the healthy development of a child’s brain and other biological systems associated with growth and development.
Many of you may be aware of the comprehensive Adverse Childhood Experiences study conducted in the mid-90s by the Centers for Disease Control and Prevention and Kaiser Permanente. Findings from this study indicate that adverse experiences endured during childhood are risk factors that can lead to a poor quality of life later in adulthood, including illness and even death.
Children who experience excessive stress and trauma during their childhoods are at an increased risk for:
- Alcoholism and alcohol abuse
- Chronic obstructive pulmonary disease (COPD)
- Fetal death
- Diminished quality of life due to poor health
- Illicit drug use
- Heart disease
- Liver disease
- Intimate partner violence
- Multiple sexual partners
- Sexually transmitted diseases
- Suicide attempts
- Unintended pregnancies
- Smoking at an early age
- Sexual activity at an early age
- Adolescent pregnancy
It has been clearly established that there is a correlation between the degree to which adversity, trauma and stress are present in a child’s life and poor outcomes, even into adulthood. Children with a higher number of adverse experiences have a higher risk of poor health and other life outcomes than children with fewer or no adverse experiences.
For example, compared to children who have no adverse experiences, children with prolonged or a high number of adverse childhood experiences are at triple the risk for heart disease and lung cancer and have a life expectancy of 20 fewer years.
Children with four or more adverse childhood experiences had:
- 2 ½ times the risk for COPD versus a person with no adverse childhood experiences
- 2 ½ times the risk for hepatitis
- 4 ½ times the risk for depression
- 12 times the risk for suicidal ideation
And a person who had seven or more adverse experiences during childhood was three times more likely to develop lung cancer and 3 ½ times more likely to contract heart disease than those who had no adverse childhood experiences.
Repeated activation of a neurological response to stress and trauma in a child’s not-yet-fully-developed brain:
- Impairs the part of the brain that responds to pleasure and rewards – such impairment is connected to substance dependence
- It impairs the part of the brain that is responsible for impulse control and executive function – such an impairment is connected to difficulty in learning
- It also impairs that part of the brain that controls our response to fear
There is a neurological reason why children who have experienced excessive stress, trauma and adversity growing up, are susceptible to risky behaviors.
When you consider that the National Survey of Children’s Health found that nearly 23 percent of our nation’s children have two or more adverse childhood experiences and that 38 percent of the respondents in the CDC-Kaiser Permanente study reported having experienced two or more ACEs.
This data point suggests that somewhere between 1 out of 4 and 1 out of 3 of all of our nation’s children have 2 or more adverse childhood experiences.
I would suggest to you that what is not captured here is the high concentration of children with much more exposure to ACE’s who live in certain ZIP codes and communities across America.
Children whose daily lives are more an act of survival that an act of living the American Dream.
When you consider the interconnectedness and relationship between the multiple layers of adversity – the adverse experiences of the child, the adversity in that child’s parents’ lives and the adverse conditions present in the child’s immediate surrounding environment or community we must challenge ourselves to step away from this notion that we are only talking about trauma to children.
In many respects, the conversation about getting from trauma to hope and from hope to resiliency, is a conversation about reimagining our social response intervention framework.
The history of our social welfare response system in this country has been one of intervening with individuals through categorical methods of funding and siloed methods of intervention.
If we are willing to have the real conversation about getting from trauma to hope and from hope to resiliency, then we must ask ourselves, how much are we willing to change?
Can we give up the isolation and territories we have created by the use of words like confidentiality and client and patient privacy when we are all working with the same families?
Whether it is health care, mental health, child welfare, juvenile justice, education, or any other child- and family-serving systems in any given depressed community we are all working with the same children and families.
If we are serious about changing the life outcomes that we currently see from traumatized children, families, and communities we might want to consider asking them a simple question.
Do you want to continue working with each one of our silos one at a time, or would you rather have an integrated conversation about how we can help you succeed at improving the well-being and future outcomes for you and your family?
I would suggest to you that if we are serious about keeping the policy promises that we have made as a nation to vulnerable families and children we must be willing to reframe the way we think about intervention approaches, outcome improvement strategies, and finding community solutions.
Some of the very measures that we take in the name of reducing and removing trauma from the lives of our children may in fact be adding to the trauma in their lives.
Think about our criminal justice response system:
- We have increased incarceration in the name of taking the bad guys off the streets.
- But we have all but eliminated any effort at rehabilitation while they are incarcerated, which means that we took a bad guy off the street but when his time is served we send a worse guy back to inflict more trauma on his community.
Think about our education system:
- In the name of zero tolerance, rather than recognizing the impact of trauma on a student’s behavior and learning capacity we over-emphasize our strong commitment to discipline and order in the classroom by suspending and expelling students in record numbers (particularly young men of color) without regard for the direct connection between these decisions and the drop-out rate.
I would suggest to you that if we are serious about getting from trauma to hope and from hope to resiliency we must be willing to change the way we behave as caring and compassionate adults.
Taking a Look at Children in Foster Care
Children and youth in the foster care system have multiple adverse experiences. In some of the birth homes of foster children, there may have been issues and challenges stemming from socioeconomic hardship endured in the family, such as not enough food to eat, leaving children alone while the parent goes to work on a job that doesn’t pay enough to pay for a baby sitter. In some homes, there could have been mental health, substance abuse, or domestic violence issues present.
Our social response is to inflict even more trauma on the child or children by forcefully removing them from their parents, sometimes with armed police officers involved.
We must change the response construct.
Even when child removal is obviously the right thing to do given the circumstances, we must be willing to recognize, acknowledge, and respond to the fact that the act of removal creates and exacerbates trauma.
Unfortunately, the trauma often doesn’t stop once a child has been removed from the adverse conditions that precipitated the child’s placement in foster care. Many children in foster care are often re-traumatized through multiple foster home placements. On average, during a child’s stay in foster care, they will move to at least three different foster homes. As a result, they are forced to repeat the trauma of removal and placement all over again – multiple times.
This can result in a significantly impaired capacity to bond and build relationships throughout their lives.
While foster care is supposed to be a temporary situation, with the goal of placing children in a safe permanent home as quickly and safely as possible, 29 percent of the youth in foster care in 2013 had been in care at least two years; of this group 17 percent had been in care three years or more.
Also, in 2013 approximately 24,000 young adults aged out of foster care. They became legal adults for whom the state was no longer obligated to ensure their care and safety or continue to focus on the impact of trauma in their lives.
While many maltreated youth show resilience in the face of adversity, others struggle with:
- Mental Health issues
- Risk-taking behaviors
- Social disadvantage
- Physical health challenges
Casey Family Programs, 10 years ago, conducted a study of young adults who used to be in foster care, and found that foster care youth had Post-Traumatic Stress Disorder at twice the rate of U.S. war veterans.
History of Child Welfare, a History of Re-Traumatization
Unfortunately, in many cases, the systems this country has put in place to protect children from the trauma caused by neglect and physical harm have unintentionally re-traumatized the very children we were seeking to help and protect.
From the very beginning our approach has been to isolate the child from his or her family and community. The original architects of our social response models believed isolation and separation in the name of protection was the acceptable thing to do. This goes all the way back to the colonial period – from the 1600s on up to middle of the 19th Century. It was customary to take children from their families and place them somewhere else to “fix” them so that they wouldn’t become like their parents and other family members.
It is important to acknowledge here that during this period of time we are talking about a child protection system that was mainly for white children. You see, black children were considered property at that time.
Well into the middle of the 19th Century, we continued to believe that removing the child from the family, away from any harmful or bad influences from the family, was the best practice. But by the mid-1800s, there was a general agreement that families, not institutions, do a better job of raising children, and the system we now call foster care began to take shape.
Tens of thousands of poor, homeless, destitute and “street” children were put on orphan trains and relocated far away from their birth families and communities to live with families in farming and rural communities in the South and Midwest.
Imagine the trauma associated with being picked up from the streets and given a one-way train ticket to what must have seemed like the middle of nowhere.
By the turn of the 20th Century, general concern about the neglect and maltreatment of children and the bleak outcomes of children growing up in orphanages prompted greater involvement of the government to ensure the safety and well-being of children.
In 1909, there was an unprecedented White House Conference on Children.
In 1912, the U.S. Children’s Bureau was created to investigate and report on the welfare of children and child life in the United States.
And states passed laws to respond to child abuse and neglect – to respond after trauma had occurred.
For the better part the 1900s, the role of the federal government in child welfare increasingly expanded, starting with the Social Security Act and its provisions for Aid to Dependent Children, ADC, and supplemental funds for state child welfare programs and services.
ADC, provided to white mothers who were expected not to work, became AFDC in 1962 because there was concern that ADC encouraged women not to marry.
- States were given wide discretion in how they administered their federal dollars and many used their federal ADC funds to primarily assist families whose father or breadwinner had died and other “deserving” poor mothers and their families. These funds were primarily provided to white women and their children.
- During the 1950s, it became common practice for many states to require that only children living in “suitable” homes could receive assistance, excluding what they called “undesirable” families: unwed mothers, “immoral” parents, African American mothers, families with an able-bodied, working-age man living in the house, regardless of how inadequate his income or whether or not he was temporarily between jobs and seeking employment – the man-in-the-house rule was the prevailing tenet in the implementation of this policy.
- One of the most notorious cases involves Louisiana removing 23,000 children from receiving assistance because it was determined that their mothers had a child out of wedlock.
These kinds of state practices were eventually abolished with the passage of the 1960 Flemming Rule. States could no longer deny income assistance to children living in homes they considered “unsuitable.” The Flemming Rule required states “to either provide appropriate services to make the home suitable or move the child to a suitable placement while continuing to provide financial support on behalf of the child.”
Guess which one of these options was the most heavily emphasized in traumatized communities.
To accommodate the option of placing children in a suitable home while continuing to provide support on behalf of the child, the federal government provided states with matching funds for foster care payments made on behalf of children who were removed from unsuitable homes once the courts determined that remaining at home harms the well-being of the child. As though removing children from their families had no adverse impact on their well-being.
Federal reimbursement, however, was limited to cases in which the child would have received AFDC, Aid to Families with Dependent Children. To this day, in 2015, even though AFDC no longer exists as a federal policy, federal financing for kids in foster care is still linked to the 1996 AFDC standard of poverty.
And despite landmark federal legislation establishing the nation’s commitment to family preservation and support in 1993 and to promoting safe and stable families in 2001, child deaths, the continued debate about safety and the prevailing mindset at the time pushed the foster care population further upward.
The size and magnitude of foster care as the most significant response system to the trauma and child abuse and neglect grew from approximately 100,000 children in the 1970s to an all-time high of 567,000 children in care in 1999 and remained above the half-million mark until 2007.
A Word about Funding
And even today our funding dollars are still out of step with our policy promises of family preservation and promoting safe and stable families.
Our funding policies say a lot about where we are today. Funding dollars influence our solutions, and following the money oftentimes reveals what’s driving our actions. The fewer solutions we fund, the more limited our options are that we offer to children and families.
Historically, and as late as 2013, the latest year for which we have complete data, 80 percent of the cases reported to child welfare were cases of neglect and about 18 percent were physical abuse cases. Of the 1.3 million new children who began receiving child welfare services in 2013, about 1 million received services at home and approximately 239,000 were placed in foster care that year. But our funding policies do not reflect this reality. Our funding policies are not structured to address this reality.
Within the past decade, Congress has taken steps to amend what dollars pay for, for example relative care givers and tribal foster care and authorizing waivers that allow local child welfare agencies flexibility in how they spend their foster care-designated dollars – using those dollars to pay for other family and child support services besides foster care.
- Fostering Connections to Success and Increasing Adoptions Act (2008)
- The Child and Family Services improvement and Innovation Act (2011)
In large part, due to the innovative practices that some local child welfare agencies are now funding, the past decade has seen a decline in our nation’s foster care population. At the end of Fiscal Year 2013, there were 402,000 children, youth and young adults in foster care.
Funding for many of our current innovative practices is still limited and in the demonstration phase. While we are more than 130 years removed from indentured servitude, poorhouses and orphan trains, we are not close enough to the time and place where every child grows up surrounded by a community of hope. We are still not close enough to the promise of a more perfect Union for all of our children.
What we still have in place is a system that continues to place its primary focus on helping children by isolating them from their families.
If we are serious about moving from trauma to hope and from hope to resiliency we need to build a response system that is focused more on healing than highlighting the wrongs of parents and the child welfare systems.
If we are serious about moving from trauma to hope and from hope to resiliency, we need to build a response system that is focused more on prevention than on responding after the trauma has occurred.
We need to build a response system that provides hope, not more trauma.
One that helps children and families see that they have reason to hope for a better future.
Moving from Trauma to Hope – Identifying Solutions
There are several things we can do as a nation to move children and families from trauma to hope.
A good place to start is to go back and re-commit to the promises we made to American families in our policy evolution during the past century – such as the promise to preserve and support families and to promote safe and stable families. The framework and ideals are there. We need to line up our practices and funding with those ideals and priorities.
Secondly, we need a greater focus on trauma-informed learning and training so we can develop trauma-informed practices and provide trauma-informed care and services to children and families.
Third, we have to build communities of hope around vulnerable children and families. Building communities of hope is a multi-faceted approach that begins with the recognition that we have allowed, over time, certain communities to become more and more traumatized.
“The ZIP code of a child’s birth should not be one of the most determinant factors for his or her success or failure in life.”
– William C. Bell
We live in a world where we know that where children live tells us a lot about their life’s trajectory and where they will end up in life.
The neighborhood or ZIP code a child is born in should not be one of the most determinant factors of that child’s quality of life or that child’s success or failure in life.
For the most part, the disparities we see in society are not distributed evenly across the country, but are found in pockets concentrated in certain neighborhoods, communities and ZIP codes.
It is a relatively small number of communities that produce the overwhelming majority of the young people who go into foster care.
They produce most of our nation’s 2 million-plus prisoners.
These communities are home to most of the country’s underperforming schools and underachieving students.
And it is these few communities where the predominant number of this country’s 16,000 murders occurs every year.
And we know where these neighborhoods are in our cities.
Of the roughly 33,000 residential ZIP codes across the country, 20 percent – about 6,600 ZIP codes – are home to approximately 80 percent of the nearly 16 million children who live in poverty in this country.
It is my belief that the greatest challenge facing America today is the increasing level of a sense of hopelessness that is growing in communities across the country.
It is a hopelessness that is fueled by inequality, injustice, disparity and isolation.
It is a hopelessness that we must address:
- Because hope heals.
- Because hope can help heal a traumatized child.
Hope is the lifeblood of resilience. True hope is not passive as in that hope that does not invoke a full expectation of that which is hoped for.
True hope is having that inner capacity which has been nurtured and fully developed to the point of conviction.
True hope is that inner conviction and determination that will cause you to keep moving forward even while the darkness shields your eyes from the light that everything inside tells you is just around the bend.
True hope, is having that internal capacity to see no obstacle or challenge as being greater than you.
True hope was present when the slaves looked forward and knew that one day a mighty people would grow out of them …. True hope can look any momentary setback in the eyes and say with conviction … I will!!
Hope builds resilience.
The National Survey of Children’s Health found that children with a history of two or more ACEs and a high level of hope and resilience were better able to control their behavior in school which resulted in better school attendance and performance than children who were less resilient and less equipped and able to control behavior.
Building Communities of Hope
If hopelessness is a condition of our circumstances and is reinforced by what surrounds us, then communities and building communities of hope must be part of the solution.
Building communities of hope will require that we:
- Serve children in the context of their families and communities, and
- Implement cross-systems integrated responses and interventions
- Nurture hope
Community-Based Integrated Response/Intervention
Our approach has to include working together – across systems, across all branches of government, on all levels of government, with non-profits, with philanthropy, and with community institutions and organizations – and mustering the public and political will to bring our laws and policies in line with the direction of our work and to enhance our ability to achieve success.
This means that we continue to engage the family, expecting and encouraging parents and other family members to participate and lead in identifying their own solutions. We also must engage children and youth in solution building, helping them to realize that they play a key role in their own destiny. Their voices must be heard and respected.
Such a response system means we will have to change the policies that dictate how our child welfare dollars are spent so that we can accommodate a broader approach, a broader array of services. In addition, grantmaking foundations have to realize that we can’t continue to try to solve life cycle issues on a grant cycle mentality. Giving reform and finance reform are both required so that we purchase the impact and improved life outcomes that children, families and communities need.
But hope isn’t a naturally occurring frame of mind or way of thinking. Hope doesn’t just happen or appear on its own. Hope has to be nurtured and nourished. We hope because there is reason to hope. Our hope is based in evidence; it is based on actions and the effects of those actions happening around us.
A psychologist and senior scientist at Gallup noted that in order to move hope forward in America, we have to:
- Help people envision a future they can get excited about and work toward, and
- Encourage them to spend as much time as possible with the most hopeful person or people they know – in other words, to surround themselves by hope.
And when we talk about vulnerable children and families, it is we who have to be part of that hope in their lives. Coaches, teachers, mentors, social workers, community leaders, clergy, parents, aunties and uncles – a whole community of hopeful people have to be present in the lives of vulnerable children and families.
The more that hope and resilience is nurtured in children and modeled and provided to them by their family and community, the more they are able to respond well to the stress they experience, which builds more hope and resilience.
This graphic comes from the Administration for Children and Families. Factors that build hope and resilience in children include:
- Living with a caring and healthy adult
- Having social connections
- Being involved in community or school activities
- Having family and friends who believe in a better future
- Learning and developing social skills to form and sustain positive and healthy peer relationships
- Developing a sense of right and wrong, and a sense of self – building self-esteem and self-efficacy through one’s contributions and accomplishments
- Being taught how to calm one’s self and regulate emotions
It is time for us to strengthen communities and build communities of hope. It is time for us to create communities that support children and families. It is time for us to restore hope in ourselves, in our work and in our ability to create change and make a difference in the lives of vulnerable children and families.
We live in a land of great wealth and luxury; a land that subscribes to the enduring ideals of liberty and justice for all. We live in a nation of problem solvers and big ideas; a nation of immense possibility; a nation that has welcomed and changed so many lives for the better.
It is time for us to have a real conversation about working together to implement strategies and measures that will help uplift all children and families when they believe they have nothing to hope for; when they believe they have nothing more to expect from life than what is currently in front of them.
The communities, families and children that make up the 6,600 ZIP codes that lag behind the rest of America in income, wealth, education, employment, safety, health and well-being – they deserve to have hope. They deserve to believe that they can make a better future for themselves like everyone else.
It is time for us to have a real conversation about moving children and families from a system predicated upon and often reinforcing of trauma to a system that is truly designed to restore hope to the hopeless and to nurture the capacity for resilience in all of our children, their families, and their communities.
Thank you and God bless.