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Marginalized with Trauma, In America.

Trauma doesn’t discriminate-every human being alive can be victims of trauma and the treatment and recovery can be a significant challenge to their lives. Individuals who experience trauma that are supported in their lives in various ways might be considered “luckier” than those that are not-such as the case with marginalized populations.


The National Collaborating Centre for Determinants of Health, a Canadian public health community dedicated to closing gaps in inequal wellness, define “marginalized populations” as “groups and communities that experience discrimination and exclusion (social, political and economic) because of unequal power relationships across economic, political, social and cultural dimensions” (nccddh.ca). In plain language, marginalized populations are individuals who have less power to use in their favor due to social, political and economic reasons that put them at a disadvantage for success. If these populations experience trauma, there are usually less resources to help heal, less support from the community and less exposure of the suffering which generates higher risk for these individuals to get the help they need to recover, heal and thrive (Hoven, Dragano, Angerer, Apfelbacher, Backhaus, Hoffmann, Icks, Wilm, Fangerau & Söhner, 2022).




It's imperative that communities understand how some members within are at higher risk for significant impact from trauma-even if these members aren’t crossing paths with them as a general rule of thumb. To address the many challenges of serious trauma within marginalized populations, more awareness needs to be generated. For example, nearly every major metropolitan area will include gang activity and gang members, and their victims are known to have higher risk factors for serious trauma impact. Although there isn’t one way to describe what a “gang” is, there are a few accepted criteria that constitutes as gang behavior: made up of three or more people, having an allegiance to a code of behavior or beliefs, engaging in illegal or criminal activity, a general manifesto of belonging and symbols that represent them (nij.ojp.gov).


Research shows that members of gangs are at much higher risks for violence to include assaulting rivals, assaulting their friends, drive by shootings and homicides. As they are at higher risk to commit crime, they are also at higher risk for being a target of gang related crime-and not just while active as a gang member. Former gang members, gang member associates, family members and friends are grouped into this higher risk, and the trauma they experience is significant. Compared to their non-gang member peers, gang members are exposed to significant traumatic events to include dangerous living conditions (“warzone" like atmospheres), witnessing violence, assault and death, witnessing dead bodies, and rape and unwanted sexual experiences higher among the female population. Gang members are also exposed to pressure to commit crime, assault or deadly attacks on rivals, suffer punishment for breaking rules and engage in initiation or retaliation behavior against their will.


As a result of the trauma experienced and the often, inability to escape it, gang members and their exposed associates are at much higher risks for mental unwellness compared to peers outside of gangs. They are at higher risks for post-traumatic stress disorder (PTSD), depression, chronic anxiety, domestic violence, substance abuse, domestic abuse, lack of education, suicide and more. A huge factor to addressing these issues from trauma, is the lack of inability to seek treatment, for various reasons. One study shows that roughly 29% of gang members experiencing trauma felt that no one would understand what they were going through and weren’t comfortable talking about it, nearly 11% of gang members in the survey felt that gang rules prohibited them from getting help, nearly 18% of members didn’t want to be stigmatized as a result of seeking treatment, and nearly 26% of those surveyed didn’t feel a counselor would be able to understand who they were so treatment would be judged not worth the effort. Lack of resources and lack of peer support are also significant contributors to the lack of seeking help (Valdez, 2021).




One of the challenges to treating gang related trauma, is that even though the trauma is obvious, prevalent and ongoing, few treatments have proven to be effective-outside of the prison system. Once a gang member becomes incarcerated is often the only time a mental health professional has access to working with them and by then, it might be too late (Henry, 2019). Much of the focus then, is how to intervene with youth gang member or at risk youth prior to gang membership to teach them how to navigate their environment either through trauma or before trauma. The National Child Traumatic Stress Network offers guidance for adults suggesting: creating safe environments with normal routines, taking a genuine interest in the youth and demonstrative a protective attitude, provide choices for them that let them feel like they are in control of their own lives, provide opportunities for them to talk and reassure that their feelings are normal, help school aged kids reengage with school, sports or school related activities, get them involved in community or social justice actions, teach them skills like deep breathing and critical thinking (nctsn.org).


Other programs such as GRASP (Gang Rescue and Support Project) are peer run programs that look to intervene and create options for gang member youth in the way of parent awareness trainings, tattoo removal, healing circles, job training, hospital intervention, community and school outreach and more (graspyouth.org).

It’s no secret that veterans have a higher risk of experiencing trauma and symptoms of PTSD than the non-veteran population (11-30% vs 7-8% ) but veterans who identify as lesbian, gay, bisexual and transgender (LGBT) are at even higher risk. While exposed to the same military or combat trauma potential, they are often exposed to in-unit harassment, discrimination, violence, or victimization and harassment inside of military-based healthcare.

Working within a military culture that has not yet adjusted entirely to the open-door policy of LGBT community, these veterans often experience disproportionate discrimination, harassment and victimization based on their identity. The ongoing debates about the appropriateness and place of LGBT individuals within the military has real-time consequences as it leads to service member polarization on the issue and violence, aggression, harassment and other kinds of victimization might possibly go unnoticed in close quarters, or looked “the other way” by superiors. Research shows that LGBT veterans have greater health issues (such as PTSD, depression, and anxiety disorders) as well as inability to recover from trauma as quickly or effectively as non-LGBT veterans. LGBT veterans often feel the need to conceal their sexual identity, not report hate crimes against other LGBT individuals when they see it in their unit, marry opposite sex partners to look heterosexual, or not report their own experiences of harassment, violence or microaggressions-causing a host of emotional and mental distress (Livingston, Berke, Ruben, Matza & Shipherd, 2019).


The challenge is to empower a LGBT veteran with their rights inside of a culture that is having difficulty moving beyond traditional values. One resource that has paved the way to bring awareness and empowerment to this community is CalVet-A program within the California Veterans Affairs office that leads the nation in focusing on issues of LGBT individuals inside the military. As early as 2015, CalVet led a leadership forum inviting all LGBT veterans to attend to discuss the gaps, needs and challenges of veteran housing, education, employment, healthcare and legal issues. Although they are more focused on life after the military, with various resources and programs that they have created, they are looking to help heal trauma that has occurred through their military career that may lead to hardships in civilian life. They are California based, but have resources available for veterans outside of the state and opportunities to network and connect with other LGBT veterans through their own events-such as the “Do Ask Do Tell” event, celebrating the 10 year repeal of “Don’t Ask, Don’t Tell” mandate. Through CalVet, LGBT veterans have the opportunity to find the community and resources that will support them in trauma healing, restore pride in serving as a LGBT individual and creating a network of peers to move forward with in civilian life (calvet.ca.gov).




Another resource is Modern Military Association of America (MMAA)-a powerful and productive organization whose mission is to create a better life for all LGBT community veterans through empowering them and their rights but also, to educate service providers on the unique challenges of LGBT veterans to offer resources while they are still serving and support with navigating the military life and culture. Through MMAA, a LGBT service member can get support all over the world through global network resources or chapters, retain free and effective legal services, and obtain resources for mental health providers through their Rainbow Shield education program for providers seeking to better understand and serve the LBGT veteran community. MMAA also fights for the rights of service members living and serving with HIV and offers programs to military families with LBGT youth, to promote pride, support and safety (Peters, 2019). Research shows that LGBT veterans are less likely to report their trauma to their own unit or in service health care providers-and having resources to connect with for external support and those willing to fight for their rights within the system is imperative.




Shockingly, across the globe, the prevalence of childhood emotional abuse is about 36%. 45% of mental

disorders in childhood is estimated to be the cause of exposure to childhood adversity (to include abuse and neglect) and is considered to be the biggest threat in children for mental health problems. Unfortunately, children in foster care are at even greater risk for trauma-with about 1 child in every 2 meeting criteria for a mental disorder that would be listed in the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).


Trauma experiences of foster care children can range from physical or sexual abuse, neglect, maltreatment, malnourishment, abandonment, domestic and other types of violence and can unfortunately, also be experienced inside the foster care system. Foster care statistics state that nearly 72% of verified trauma cases were age 10 and younger-causing a severe threat to the future of these children’s mental wellness. Foster care children are at higher risks for serious disorders such as schizophrenia, are more prone to violence, emotional attachment, lack of connection, dissociative disorders, suicide, homelessness, substance abuse, severe depression and anxiety, self-harm behavior and unresolved PTSD.


Foster child reporting of trauma shares the same challenges as gang member or LBGT veteran trauma-it is not being reported as often as it needs to be. Research shows that adults that were traumatized foster children recall that attempts to report the trauma when they were younger resulted in no change being made, or punishment that occurred by angry parents and foster parents acted as deterrents to press the issue (Lehmann, Breivik, Monette & Minnis, 2020). Very little help is available to foster children while in the system-as they are at the mercy of different entities associated with their foster care, but there are resources for youth that are transitioning to adulthood and want to thrive and heal.


For example, Foster Club is an Oregon based organization that is dedicated to supporting transitioning foster youth into adulthood and offer resources and connections all over the country. They offer mentorship, youth peer clubs, leadership clubs that get active in the community, job training, assist with understanding their Medicaid access, classes, events and peer relationship building to grow together as a family while they learn how to survive and thrive in their newfound independent life (fosterclub.com).


A little more formal than Foster Club, the Children’s Bureau, a division of the Department of Health and Human Services, offers a plethora of resources for foster children transitioning into independence. They offer resources for accessing their healthcare, getting help in paying rent and finding housing, and connections to various other parts of the division that help with finding training for work, education options, legal help and connections to organizations like the Big Brother program to help mentor other children that might be in similar situations (acf.hhs.gov).


It's important that transitioning foster children know how to set up life as an independent adult-so that further trauma is not acquired through homelessness, unemployment, or lack of understanding of medical care and the options that are available to them. There’s a real possibility that many transitioning foster kids don’t have a support system to help them with how to “do life” as an adult-so the resources are imperative-provided the individual can find them.


But like gang members and LGBT veterans, getting help for trauma while it is occurring, continues to be a crisis-often an “after the fact” approach is too late for the mental wellbeing and thriving of a victim who deserves more from their community.



References

Gang Rescue and Support Project. GRASP. (n.d.). Retrieved January 21, 2023, from https://graspyouth.org/

Glossary of essential health equity terms. Marginalized populations | National Collaborating Centre for Determinants of Health. (n.d.). Retrieved January 20, 2023, from https://nccdh.ca/glossary/entry/marginalized-populations#:~:text=Marginalized%20populations%20are%20groups%20and,political%2C%20social%20and%20cultural%20dimensions.

Henry B. F. (2019). Treating Gang-Involved Patients: Embodied Trauma & How to Heal from Life on the Street. Professional development (Philadelphia, Pa.), 22(2), 3–1

Hoven, H., Dragano, N., Angerer, P., Apfelbacher, C., Backhaus, I., Hoffmann, B., Icks, A., Wilm, S., Fangerau, H., & Söhner, F. (2022). Striving for Health Equity: The Importance of Social Determinants of Health and Ethical Considerations in Pandemic Preparedness Planning. International journal of public health, 67, 1604542. https://doi.org/10.3389/ijph.2022.1604542

Lehmann, S., Breivik, K., Monette, S., & Minnis, H. (2020). Potentially traumatic events in foster youth, and association with DSM-5 trauma- and stressor related symptoms. Child Abuse & Neglect, 101. https://doi.org/10.1016/j.chiabu.2020.104374

Livingston, N. A., Berke, D. S., Ruben, M. A., Matza, A. R., & Shipherd, J. C. (2019). Experiences of trauma, discrimination, microaggressions, and minority stress among trauma-exposed LGBT veterans: Unexpected findings and unresolved service gaps. Psychological Trauma: Theory, Research, Practice, and Policy, 11(7), 695–703. https://doi.org/10.1037/tra0000464

Minority Veterans Lesbian, gay, bisexual, transgender, and ... - California. (n.d.). Retrieved January 21, 2023, from https://www.calvet.ca.gov/MinorityVets/Pages/LGBT.aspx

Nctsnadmin. (2018, May 15). Trauma in the lives of gang-involved youth: Tips for volunteers and community organizations. The National Child Traumatic Stress Network. Retrieved January 20, 2023, from https://www.nctsn.org/resources/trauma-lives-gang-involved-youth-tips-volunteers-and-community-organizations

Peters, S. (2019, June 20). Programs. Modern Military Association of America. Retrieved January 21, 2023, from https://modernmilitary.org/programs/

Valdez, C. (2021). Posttraumatic Distress and Treatment Barriers Among Former Gang Members: Implications for Improving Access to Traumatic Stress Resources in Marginalized Populations. Journal of Traumatic Stress, 34(2), 309–321. https://doi.org/10.1002/jts.22651

What available supports and resources are in place for youth transitioning from Foster Care? The Administration for Children and Families. (n.d.). Retrieved January 21, 2023, from https://www.acf.hhs.gov/cb/faq/foster-care7

What is a gang? definitions. National Institute of Justice. (n.d.). Retrieved January 20, 2023, from https://nij.ojp.gov/topics/articles/what-gang-definitions

What we do. FosterClub. (2020, May 7). Retrieved January 21, 2023, from https://www.fosterclub.com/what-we-do


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