Asian American Psychological Association

Thakar Meghani, Dhara

Tummala-Narra, Pratyusha

English

University of San Francisco

The University of San FranciscoUSF Scholarship: a digital repository @ Gleeson Library |Geschke CenterNursing and Health Professions Faculty Researchand Publications School of Nursing and Health Professions2014Trauma and Violence Exposure among AsianAmerican and Pacific Islander ChildrenDhara Thakar MeghaniUniversity of San Francisco, dtmeghani@usfca.eduPratyusha Tummala-NarraAsian American Psychological AssociationFollow this and additional works at: http://repository.usfca.edu/nursing_facPart of the Nursing Commons, and the Psychology CommonsThis Other is brought to you for free and open access by the School of Nursing and Health Professions at USF Scholarship: a digital repository @Gleeson Library | Geschke Center. It has been accepted for inclusion in Nursing and Health Professions Faculty Research and Publications by anauthorized administrator of USF Scholarship: a digital repository @ Gleeson Library | Geschke Center. For more information, please contactrepository@usfca.edu.Recommended CitationThakar Meghani, Dhara; Tummala-Narra, Pratyusha; and Asian American Psychological Association, "Trauma and Violence Exposureamong Asian American and Pacific Islander Children" (2014). Nursing and Health Professions Faculty Research and Publications. Paper73.http://repository.usfca.edu/nursing_fac/73Types of TraumaTic evenTs •	 Physical	abuse/maltreatment•	 Sexual	abuse•	 Witnessing	intimate	partner	violence/family	violence	•	 Emotional/verbal	abuse	•	 Exposure	to	war/conflict	•	 Natural	disaster	exposure	(hurricanes,		earthquakes,	tsunamis)	•	 Target	of	hate	crimes/bullying•	 Witnessing	school	or	community	violence	•	 Loss	or	separation	from	loved	ones		(deportation,	death,	child	welfare)	•	 Living	with	or	taking	care	of	a	parent	or	loved	one	who	has	a	chronic/terminal	illnessComplex trauma	is	the	result	of	experiencing	multiple	or	prolonged	traumatic	events,	which	can	have	a	cumulative	effect	on	children’s	well-being1.	If	left	untreated,	complex	trauma	has	the	potential	to	have	long-term	consequences	on	cognitive,	physical,	socioemotional,	and	spiritual	development.2Trauma and violence exposure among  asian american and pacific islander childrenA Product of the AsiAn AmericAn PsychologicAl AssociAtion leAdershiP fellows ProgrAmPrepared	by	AAPA	Leadership	Fellow	Dhara	Thakar,	Ph.D.			|			Project	Mentor:	Pratyusha	Tummala-Narra,	Ph.D.1WhaT is a TraumaTic evenT? A	traumatic	event	is an	unpredictable,	unanticipated	event	that	renders	an	individual	to	feel	helpless,	fearful,	and	very	concerned	about	his/her	personal	safety	and/or	the	safety	of	others.June 2014  |  www.AAPAonline.org2common sympToms of childhood exposure To Trauma and violence•	 Reenactment	of	trauma	or		violence	in	play•	 Intrusive/disruptive	thoughts	about	the	trauma	during	various	activities	•	 Recurring	nightmares•	 Avoidance	and/or	expressed	fear		of	trauma	reminders	(situations,	places,	and	people)•	 Hypervigilance•	 Depressed	and/or	anxious	mood•	 Increased	aggression	and/or	withdrawal	•	 Regression	in	behaviors/skills		that	were	once	mastered	It is essential to consider that trauma symptoms may manifest differently based on cultural practices, socialization, and meaning, all of which should be taken into account when intervening.Trauma prevalence and key findings regarding asian american pacific islander (aapi) children and families An	estimated	60%	of	children	in	the	United	States	are	thought	to	have	been	exposed	to	violence,	crime,	and/or	abuse	each	year,4	but	there	is	a	lack	of	systematic	research	within	AAPI	communities.		•	 When	compared	to	other	racial	and	ethnic	groups,	AAPI		youth	(age	12	and	older)	have	the	lowest	rates	of	“non-fatal	victimization.”5•	 77.5%	of	Southeast	Asian	American	adolescents	have	witnessed	physical	aggression	and/or	community	violence	and	43.7%	have	been	victims6	during	their	lifetime.	•	 Physical	abuse	among	Asian	American	families	has	been	found	to	be	higher	than	the	general	population,	but	sexual	abuse	and	neglect	rates	are	lower	in	the	AAPI	community.7,8Children	under	five	are	more	likely	to	be	exposed	to	intimate	partner	violence	than	older	children	because	they	tend	to	spend	more	time	with	caregivers	in	the	home.9•	 Prevalence	rates	of	family	violence	in	AAPI	households	are	higher	when	studies	examine	specific	Asian	subgroups	(e.g.,	Indian,	Filipino,	Cambodian,	Korean,	Vietnamese,	etc.)	as	compared	to	national,	aggregate	surveys	with	multiple	ethnic	groups.10	Trauma	prevalence	and	related	symptoms	may	differ	widely	and	systematically	across	Asian	subgroups:•	 Based	on	a	study	examining	child	welfare	referrals,	Southeast	Asian	and	Samoan	families	were	overrepresented	while	Chinese,	Filipino,	and	Japanese	families	were	underrepresented	relative	to	these	groups’	overall	representation	in	the	AAPI	community.113Myth:	“Children are too young to be affected by trauma.”Myth:	“Children will recover on their own—they are resilient.”Myth:	“It is better not to talk with  children about trauma—it will just  re-traumatize them.”FaCt:	Even	preverbal	children	suffer	the	effects	of	traumatic	events	as	is	evidenced	by	subsequent	physiological	symptoms	and	in	some	cases,	“nonorganic	failure	to	thrive”.3		The	way	that	children	react	to	trauma	can	differ	from	adults.	Parents	might	consider	consulting	a	pediatrician	or	a	mental	health	professional	if	they	notice	marked	behavioral	changes	and/or	regression	following	a	traumatic	event,	even	if	they	do	not	believe	their	child	witnessed	or	was	affected	by	it.	FaCt:	While	many	children	do	not	develop	post-traumatic	stress	disorder	following	trauma,	symptoms	related	to	experiencing	or	witnessing	a	highly	traumatic	event	rarely	extinguish	on	their	own	and	may	worsen	over	time	if	not	treated.	FaCt:	On	the	contrary,	when	trauma	is	discussed	in	age-appropriate	and	sensitive	ways,	caregivers	and	professionals	can	support	children	to	feel	validated	and	relieved	after	having	endured	traumatic	events.	Creating	a	space	for	children	to	voice	their	concerns	following	trauma	may	also	help	accelerate	the	recovery	process.				popular myThs aBouT childhood Trauma•	 Differences	in	physical	abuse	prevalence	across	Asian	subgroups	have	been	attributed	to	predictors	such	as	pre-migration	history/post-migration	experiences	and	trauma	(for	refugee	and	immigrant	families);	childrearing	differences;	acculturative	and	adjustment	stress;	availability	of	social	support,	and	understanding	of	the	child	welfare	system	and	policies	in	the	U.S.12	− Southeast	Asian	refugees	may	have	a	higher	risk	for	developing	post-traumatic	stress	disorder	and	depression	due	to	war	and	forced	migration	in	their	home	countries.13Trauma	and	violence	exposure	do	not	necessitate	long-term,	negative	consequences	in	all	individuals.	Multiple	factors	contribute	to	the	long-term	effects	of	traumatic	stress.•	 Biculturalism,	or	the	ability	to	negotiate	more	than	one	culture’s	beliefs,	values,	and	practices,	emerged	as	a	protective	factor	among	Southeast	Asian	teens	who	had	witnessed	domestic	violence.14•	 In	one	study,	exposure	to	violence	was	not	significantly	associated	with	Asian	American	adolescents’	psychological	functioning.15Definitions	of	what	constitutes	child	abuse,	maltreatment,	and	neglect	can	vary	cross-culturally.	•	 For	AAPI	immigrants,	risk	factors	for	child	maltreatment	can	include	respect	for	authority,	family	hierarchies,	gender	socialization,	differential	acculturation	rates	between	children	and	parents;	traditionally	accepted	childrearing	practices	involving	shaming	and	physical	punishment;	and	values	related	to	suffering	and	fatalism.	•	 However,	no	studies	have	found	a	causal	relationship	between	these	factors	and	abuse.16seeking help for  childhood Trauma  You	do	not	need	to	be	a	professional	or	in	the	mental	health	care	field	to	report	suspected	child	abuse.	Call	the	National	Child	Abuse	Hotline	to	make	a	report: 1-800-4-A-CHILD.culturally sensitive Trauma Treatments • child-parent psychotherapy17:	a	multi-theoretical	treatment	model	designed	specifically	for	young	children	under	the	age	of	six	who	have	been	exposed	to	trauma	and	their	parents.	The	intervention	is	play-based	and	requires	the	participation	of	at	least	one	parent	or	caregiver	of	the	child	to	help	co-construct	a	trauma	narrative	with	the	child.	• Trauma-focused cognitive Behavioral Therapy:	a	structured	treatment	model	used	especially	with	children	exposed	to	sexual	abuse,	terrorism,	disasters,	and	traumatic	grief.	It	is	typically	used	with	school	age	and	older	children	and	includes	individual	and	family	sessions.	Treatment	materials	are	available	in	Mandarin,	Korean,	and	Japanese.		• integrative Treatment of complex Trauma:	an	intervention	for	individuals	between	two	and	21	years	of	age	that	is	particularly	useful	for	children	who	have	experienced	multiple	and/or	chronic	trauma.	Trauma interventions developed for  specific aapi communities • sikh healing collective:	a	community-based	mental	health	response	developed	following	the	2012	shooting	in	a	Sikh	gurudwara	in	Oak	Creek,	WI.	Additional	information	available	at:	http://tinyurl.com/lwa8vj9	• southeast asian Teen village18:	a	program	designed	primarily	for	teenage	girls	in	the	Hmong	community,	and	counseling	is	administered	in	a	group	modality	that	addresses	spiritual,	immigration,	and	trauma-related	factors.	4resourcesNational	Child	Traumatic	Stress	Network	website—www.nctsn.orgBrave	Little	Panda	storybook	and	mobile	app	for	childhood	sexual	abuse	(available	in	many	Asian	dialects)—	http://www.asiansforhealth.org/node/21#.U2glv_ldWSo	Coalition	for	Asian	American	Children	&	Families—http://www.cacf.org/1	 Ford,	J.	D.,	&	Courtois,	C.	A.	(2009).	Defining	and	under-standing	complex	trauma	and	complex	traumatic	stress	disorders. Treating complex traumatic stress disorders: An evidence-based guide,	13-30.2	 Felitti,	M.	D.,	Vincent,	J.,	Anda,	M.	D.,	Robert,	F.,	Nordenberg,	M.	D.,	Williamson,	M.	S.,	...	&	James,	S.	(1998).	Relationship	of	childhood	abuse	and	household	dysfunction	to	many	of	the	leading	causes	of	death	in	adults:	The	Adverse	Childhood	Experiences	(ACE)	Study. American Journal of Preventive Medicine, 14(4),	245-258.3		 Eldridge,	A.,	&	Schmidt,	E.	(1990).	The	capacity	to	parent:	A	self	psychological	approach	to	parent—child	psychotherapy. Clini-cal Social Work Journal, 18(4),	339-351.4	 National	Task	Force	on	Children	Exposed	to	Violence	(US),	Listenbee,	R.	L.,	&	Torre,	J.	(2012). Report of the Attorney Gen-eral’s National Task Force on Children Exposed to Violence.	Attorney	General’s	National	Task	Force	on	Children	Exposed	to	Violence.5	 U.S	Department	of	Justice.	Bureau	of	Justice	Statistics.	(2012).	Prevalence of violent crime among households with children, 1993-2010. Appendix Table 2	(NCJ	238799).	Retrieved	1	May	2014	from	http://www.bjs.gov/content/pub/pdf/pvchc9310.pdf6	 Ho,	J.	(2008).	Community	violence	exposure	of	Southeast	Asian	American	adolescents. Journal of Interpersonal vio-lence, 23(1),	136-146.7	 Ima,	K.,	&	Hohm,	C.	(1991).	Child	maltreatment	among	Asian	and	Pacific	Islander	refugees	and	immigrants.	Journal of Inter-personal Violence 6, 267-28	 Kenny,	M.	C,	&	McEachem,	A.	G.	(2000).	Racial,	ethnic,	and	cultural	factors	of	childhood	sexual	abuse:	A	selected	review	of	the	literature.	Clinical Psychology Review 20(7),	905-922.9	 Fantuzzo,	J.	W.,	&	Fusco,	R.	A.	(2007).	Children’s	direct	expo-sure	to	types	of	domestic	violence	crime:	A	population-based	investigation. Journal of Family Violence, 22(7),	543-552.10	 As	cited	in	Leong,	F.	T.	L.	(2011). Asian American and Pacific Is-lander children and mental health: Volume 1, Volume 2.	Santa	Barbara,	Calif:	Praeger.11	 Pelczarski	Y.,	&	Kemp,	S.P.	(2006).	Patterns	of	child	maltreat-ment	referrals	among	Asian	and	Pacific	Islander	families.	Child Welfare, 85(1),	5-31.	12	 Ima,	K.,	&	Hohm,	C.	(1991).	Child	maltreatment	among	Asian	and	Pacific	Islander	refugees	and	immigrants, Journal of Inter-personal Violence 6, 267-213	 Hinton,W.	L.,	Chen,	Y.	C.,	Du,	N.,&Tran,	C.	G.	(1993).	Disorders	in	Vietnamese	refugees:	Prevalence	and	correlates.	Journal of Nervous and Mental Disease, 181,	113–122.14	 Sirikantraporn,	S.	(2013).	Biculturalism	as	a	protective	factor:	An	exploratory	study	on	resilience	and	the	bicultural	level	of	acculturation	among	Southeast	Asian	American	youth	who	have	witnessed	domestic	violence.	Asian American Journal of Psychology, 4(2),	109-113.15	 Chen,	W.	(2010).	Exposure	to	community	violence	and	adoles-cents’	internalizing	behaviors	among	African	American	and	Asian	American	adolescents.	Journal of Youth and Adoles-cence,	39,	403-413.16	 Larsen,	S.,	Kim-Goh,	M.,	Nguyen,	T.D.	(2008).	Asian	American	immigrant	families	and	child	abuse:	Cultural	considerations.	Journal of Systemic Therapies, 27(1),	16-29.	17	 Lieberman,	A.	F.,	&	Van	Horn,	P.	(2004).	Don’t	Hit	My	Mommy:	A	Manual	For	Child-parent	Psychotherapy	With	Young	Wit-nesses	Of	Family	Violence.	18	 National	Child	Traumatic	Stress	Network	(n.d.).	Empirically	Sup-ported	Treatments	and	Promising	Practices.	Southeast Asian Teen Village. Retrieved	from	http://www.nctsnet.org/sites/de-fault/files/assets/pdfs/SoutheastAsiaTeenVillage_21105.pdf.references5

Trauma and Violence Exposure among Asian American and Pacific Islander Children

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Trauma and Violence Exposure among Asian American and Pacific Islander Children

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