Understanding trauma and resilience through research, real stories and reality… my reality

I’m sure you are all well aware that social factors affect health. This framework was not unfamiliar to me when I first started working at Mountain Area Health Education Center (MAHEC). I understood that social experiences can influence health, but I didn’t realize to what extent until I began a research project at MAHEC on childhood trauma.

You might be wondering how traumatic experiences from childhood are related to clinical medicine? Trauma lives in not only the mind, but also the body. There is a rapidly growing body of evidence to support this. In 1998, Drs. Anda and Feletti published a study, which found a significant correlation between health outcomes and childhood traumas (referred to as “ACEs” or adverse childhood experiences”). Adverse childhood experiences include physical, sexual or emotional abuse, physical or emotional neglect, and household dysfunction, such as losing a parent or immediate family member to death, witnessing domestic violence, or having a parent with mental illness or substance abuse. Even when controlling for variables like socioeconomic status, the researchers determined that a person who has more than three ACEs has an increased risk for liver disease, diabetes, chronic obstructive pulmonary disease, and heart disease among other medical conditions.

After reading the 1998 ACE study, I asked myself, how does this happen? How do childhood experiences from 30 years ago have such a lasting physical imprint on a person? My curiosity prompted me to dive into the medical literature. I yearned for a scientific explanation. Luckily for me, since the initial 1998 study, scientists have made tremendous progress in understanding the physiology and neurobiology of trauma. A lot of the research has explored the role of the fight-or-flight response, which, as many of you probably already know, is an adaptive system in our bodies to help us in threatening or dangerous situations. This response sends energy to your muscles when you need to suddenly slam on the breaks to avoid a car crash. It increases your heart rate and respiratory rate when you see a bear in the woods and need to run. But imagine if that bear was your physically abusive father… imagine if you felt a sense of danger every night when “the bear came home from work,” explains pediatrician Dr. Burke Harris in her Ted Talk on ACEs. When a child is repeatedly exposed to trauma, his or her system of alarm will be continuously activated. The expert psychiatrist Dr. van der Kolk states, “Long after the actual event has passed, the body may keep sending out signals to escape a threat that no longer exists”. These excess hormones, like cortisol and adrenaline, can cause toxic stress and have a lasting impact on the brain and the body. ACEs are both a social issue and a medical concern.

Learning about ACEs flipped a light switch inside of me. I reconsidered my approach to medicine and  began to think about addressing the underlying cause of disease, which involves addressing trauma in many instances, instead of only treating the symptoms. I started seeing connections between childhood trauma and many other public health issues. During my time at MAHEC, I have witnessed the devastating impact of the opioid crisis on individuals, families and communities in western North Carolina. After I learned that opioids and other substances act on receptors in the brain and essentially numb the neurobiological effects of trauma, I began to examine our opioid epidemic with a different lens. What if we also have an ACEs epidemic?

My research on ACEs greatly influenced the way I approached my clinical work at MAHEC. I began to comprehend why people engage in certain behaviors. My mentality shifted from “what’s wrong with you?” to “what’s happened to you?” I began to ask patients more questions. I made a deliberate effort to learn about their backgrounds, to listen to their stories in order to understand. Hearing patients’ personal narratives transformed my abstract understanding of trauma into a tangible reality. ACEs were not a phenomenon in an academic journal anymore; they were real, raw human experiences.

After listening to some truly astounding stories, I felt overwhelmed and helpless. What can I do to address trauma? There isn’t a miracle medication to erase the past. Although there is no magic pill, I learned that experts have developed many specific strategies that can boost patients’ resilience and reduce the effects of trauma. There is currently a movement in public health to teach doctors and other allied health professionals about how to promote resilience strategies and provide “trauma-informed” medical care. Through MAHEC, I learned about an innovative approach called the Community Resiliency Model, which aims to educate not only the patient, but also the surrounding community about the effects of trauma and empower them with the techniques and skills to boost resilience. Some of these resilience techniques can literally reset the nervous system, mitigating the physiological effects of trauma. The Community Resiliency Model is based on the notion that “it takes a village” not only to raise a child, but also to heal one. Helping an individual recover from trauma requires bringing together community members to create a trauma-informed, resiliency-focused support network.

Several months into my fellowship, I gained a new perspective—a highly personal one— on trauma after my own adverse experience. During the fall of 2016, my older brother passed away very suddenly and unexpectedly. When I received the phone call, my fight-or-flight response was activated before my brain could begin to process what had actually happened. Trauma lives in not only the mind, but also the body. As I heard the words “he’s gone” uttered, I felt my heart rate rapidly accelerate. I began to hyperventilate inside the Asheville Target. It was the strangest thing because I had learned all about the physiology of trauma from my research on ACEs. I knew exactly what was happening to my body, but I couldn’t do anything about it.

The weeks that followed my brother’s death are still a blur to me. But one thing I distinctly remember is having a loss of words. When I tried to speak, nothing came out. There weren’t words that could fully capture the horror of what I endured. I thought back to something I learned from my research: when experts used neuroimaging techniques to analyze traumatized brains, they saw that Broca’s area, the part of the brain that controls speech production, was shut off. This happened to me. My brain physically could not produce words (on a side note, I have found writing this blog post to be an empowering way to reclaim my words).

I was a living example of everything I had learned about through work. As a result, I was better able to grasp patients’ experiences of trauma. I felt a deeper sense of empathy for them. I had an urge to tell all of my patients, “Your pain is valid. I recognize and understand your suffering and I’m so deeply sorry for your trauma.”

When I returned back to my life in Asheville, I struggled… a lot. I could barely concentrate on simple tasks at work. It felt like my brain was surrounded by a fog of trauma. My grief felt like a heavy backpack full of bricks, an unbearable weight that I carried around constantly. I would frequently break down crying during the middle of the day. Whenever it happened, I would say to myself: Get it together, Natalie. Control yourself. But I couldn’t always. Trauma and grief are incredibly powerful. I felt overwhelmed. Above all, I needed support from the people around me, but I felt guilty and embarrassed asking for help. I prided myself on doing things independently. I can make it through this on my own, I thought. I was also very accustomed to helping and taking care of others, so it was deeply uncomfortable for me to become the patient, to acknowledge that I needed to be healed and cared for. However, once I admitted this to myself, it made all the difference.

With the Community Resiliency Model in mind, I began reaching out to the people around me—to my community in Asheville. Once I asked for their support and help, my trauma became less overwhelming. There were more people to help me carry my heavy load of bricks. Why did I ever try and do this on my own? My community has been unbelievably supportive and kind. I will never forget the compassion I received during this time. I also started using the resilience techniques that I learned about on myself. Over time, it has become easier to breath. Although I am still profoundly sad about my loss, I feel more resilient and connected because of my supportive community. It took a village to help me on my path of healing.

My raw pain is now the underlying force that fuels my passion for medicine, health and healing. After learning about and living through my own trauma during my Davidson Impact Fellowship, I understand that both health and healing are complex processes. Given that social realities impact these processes, I recognize that my situation is one of privilege. It greatly disturbs me to think about the fact that there are so many people, especially young children and socially vulnerable individuals, who experience horrific traumas with less resources and support than I had. I am more determined than ever to combat this injustice and serve as a supportive resource to vulnerable patients; to be present with them on their journey towards healing.

Ultimately, this year has left me inspired to provide trauma-informed care to my patients and to educate my peers (why I chose to write about it in this blog post), colleagues, family and friends about ACEs and resilience. I hope that by spreading this message throughout my medical career, I can help my patients and my community become more resilient. It really takes a village—a resilient, supportive, connected village—not just a person with a stethoscope, to help people heal.

 

Dirty Jobs: Land Conservation and Environmental Management

My time at Catawba Lands Conservancy and Carolina Thread Trail has been split in many different directions, doing many different types of work, and working with all types of people. You can really learn a lot about the society we live in behind stands of pines and hardwoods, in the riparian lands along our creeks and rivers. Last week I went on a site visit to a Catawba Lands Conservancy (CLC) property (I won’t specify the exact location so all landowners may remain anonymous). This conserved land is separated by just a few parcels, and as many landowners from our most popular natural surface trail in the Carolina Thread Trail (CTT) network. To make this connection, would add about two miles onto our existing trail, and is a very tangible goal depending on landowner cooperation. That being said, I and two others went to the site to walk the corridor and assess trail possibilities. What we were met with was both exciting and discouraging.

Our walk started off through a managed forest of loblolly pines, which make for a great trail because of the relatively clean understory and forest floor, and then shifted down to the creek bank where the walking got a bit more laborious, but still had great potential for a trail. The creek wandered through the forest, large native pines and hardwoods on the east bank, and an intimidating wall of invasive privet on the west. Eventually the forest gave way to a wide, beautiful wetland area fed by a creek (name undisclosed) and the flood waters of the lake (name undisclosed). This area was quite pleasant this time of year, but would be a breeding ground for mosquitoes in warmer weather. The wetland area would require a series of bridges or boardwalks to implement a sustainable trail (although bridges and boardwalks would be a nice amenity for users, it can be a very expensive obstacle for us). Back into the woods we went for a short distance until we reached an untouched pool of the lake. This water body encompassed about ten acres, but was only about two feet deep and littered with trees, fallen branches, and exposed islands of grasses—a heaven on earth for wood ducks and other waterfowl. As we approached, sure enough, we bumped up a pair of wood ducks, a blue heron, and three Canadian geese. This was a beautiful sight, and rare to see on a commercialized lake such as this one. Our admiration, unfortunately, soon turned to dismay as we made our way around the water and saw the disgusting scene on the other side.

As we circumvented the pond, we came upon a litter pile of glass and plastic bottles, plastic toys, beer cans, tires, Styrofoam, and old household appliances. This was the largest and most dense litter pile I have ever seen in an undeveloped area. It was amazing amount of trash, and we soon came to realize that to make a trail a reality in this area we would need to have multiple volunteer workdays with many hands working diligently for hours, filling several dump truck loads of trash for removal. Trash pickup is not the most glamorous work in land management, but one that is necessary in many cases. This is one of the “dirty jobs” in land conservation work, and frankly, a job that can be over-looked or brushed under the rug because of the limited resources in small land trusts and other environmental organizations like ourselves.

As a conservationist, this is extremely frustrating to see. Trash is a serious problem in our society and a major concern for the environment through its impacts on wildlife, water quality, etc. Action needs to be taken on this front, and I’m not exactly sure what that will look like. Is it local, state, or federal policy changes? Or is it an effort made through corporate responsibility initiatives from companies producing these products, maybe an effort at the grassroots level? I’m not sure, but if something isn’t done about this soon, the increasing global population combined with the societal obsession with on-the-go products, fast food, and plastic products will be the demise of our natural environment as we know it today.

Seeing is believing. It is hard to wrap the human brain around something of this magnitude from anecdotes and photos, so it is important for organizations like us to get people outside and facilitate this conversation. But remember, non-profit environmental organizations love volunteers and would fall apart without them. So please look into spending some time researching and finding places to get involved in the conservation efforts wherever that may be.

Introduction to Non-Profit Environmental Conservation Efforts in a Diverse and Developing Region

I am currently working for Catawba Lands Conservancy and Carolina Thread Trail in Charlotte, NC. Catawba Lands Conservancy (CLC) is a local not-for-profit land trust dedicated to preserving land to protect water quality, wildlife habitat, and farmland. The final tier to the Conservancy’s mission is to connect lives to nature in the Charlotte region, and this is where the Carolina Thread Trail (CTT) project comes into play. CTT, a separate 501 (c)(3) organization with CLC as its lead agency, is dedicated to weaving communities together through a regional greenway and blueway network. While we are two separate organizations, there is little to be seen of this outside of formal documentation. We share staff, resources, office space, ideas, passion, dedication, and excitement every day.

My fellowship has been splitting time between CLC and CTT: monitoring conservation easements and preserves, performing forest and trail stewardship duties, leading volunteer workdays, organizing three Regional Round Table discussions around trail development, and much more. I have been in the Davidson Impact Fellows program for almost eight months now, and my understanding and outlook on non-profit work, career development, environmental conservation, community intricacies, and personal goals have been sculpted by the ebb and flow of my fellowship. I spend much of my time working with our Community Coordinator, visiting government officials, trail implementation partners, advocates, and adversaries to discuss trail opportunities and issues. This has exposed me to many things that are impossible to emulate in an academic setting. The diversity of our 15-county region has challenged me in many ways and introduced me to the subjective aspects of environmental conservation across the globe.

Struggles are plentiful in our daily work, only to be masked by the few great successes that make all of our efforts seem worth it. Months of headaches and creative problem solving only to conserve a small tract of riparian land, or to implement one mile of natural surface trail, seems a bit disproportionate, and admittedly can be frustrating at times. I’ve asked myself if all of this is even worth it. The answer is yes. Being in the workplace every day with a passionate group of people has allowed me to gain an understanding that our work is vital to land conservation and appreciate the efforts of our counterparts elsewhere. Months ago my answer may have been different. Without overarching support it is sometimes hard to see the good you are doing; however, many battles won around the world can amount to a big victory for the common goal. This position has allowed me to develop in ways that I could have never imagined. Yes, I am gaining technical knowledge of trail development and environmental conservation, but there is more than just that. My fellowship is allowing me to become comfortable in the workplace, participate in real-world land conservation deals in a predominately conservative part of the country, develop my own opinions on how I can make a difference through an environmental career, and gain an appreciation for the work that is being done by organizations just like us all around the world.

I have recently been admitted one of the most prestigious environmental management and forestry programs in the country, and I have this fellowship to thank for it. The Nicholas School of the Environment at Duke University seeks to develop global environmental leaders through their Master of Environmental Management and Master of Forestry programs. A year ago, this task seemed very intimidating and frankly impossible for me. My time at CLC and CTT has allowed me to gain confidence in my knowledge, capabilities, and ambitions because I feel like I have been able to have the experiences of an environmental conservationist of 5 years. Yes, many times I have been completely lost in a conversation or overwhelmed by the complexities of a project, but simply having those experiences has motivated me to be more persistent in my education and career development. Without this fellowship, I would not know what I wanted my next steps to be for graduate school or for starting a career.

My main focus project at the Conservancy and Thread Trail is to help develop and organize annual “Trail Round Tables” for our implementation partners around the region. We will host three of these in the upcoming year, where we divide our region into three sections and focus on issues in a more localized manner. I have been working very closely with our Community Coordinator and Outreach Coordinator to organize these three events and our first Trail Round Table will be on March 16. This is a pilot event for CTT, but we are hoping to integrate it into our annual regime of Thread Trail gatherings. Our staff and I hope that these Trail Round Tables will be another touch point with our partners who are in the trenches of trail development and will be a catalyst for progress on our active projects in the respective areas. More to come on this later, but hopefully this will be a successful addition to our normal practice, and something that can grow through, and alongside the Davidson Impact Fellowship at Catawba Lands Conservancy and Carolina Thread Trail.

In the shoes of a therapist for kids who have caused sexual harm

(For your information: the following stories contain potentially heavy or upsetting material. They are modifications and conglomerations of stories from nearly 200 kids and families throughout North Carolina. The identifying information and situations are fictional and could not be linked to our clients, past or present.)

Caleb, Stage II, Affect regulation and Attachment, Family

Caleb and his dad both report that they have never gotten along. Caleb’s older brother, Shawn, is currently incarcerated for selling drugs. Shawn coerced Caleb into watching pornography from the ages of 5 to 8 with him and would laugh when Caleb said he didn’t like the show or wanted to watch something else. Caleb was really close with his mother who died of cancer three years ago. A year after his mother’s death, he approached a classmate in the bathroom and touched him inappropriately. He has been in treatment for the last 5 months. Since Caleb’s offense, dad confided in you that he wants to be more involved in his son’s life. Caleb is currently living in foster care and he spends his time playing video games during home visits. Caleb’s dad does not want to stop Caleb from playing video games so there is little interaction during home visits. Family reunification is critical for treatment success and it is promising that Caleb’s dad is engaged in the treatment process.

Welcome to our bi-weekly TASK (Treatment Alternatives for Sexualized Kids) Program staff meeting where we discuss case files of our clients. TASK is a treatment model designed to meet the complex, heterogeneous needs of youth who have caused sexual harm. As the newest member of the team, you will be presenting background information for your 4 kids and current barriers you are experiencing in treatment. We will offer guiding questions to develop an action plan that could overcome the barrier. Your current clients are Matthew, Samantha,  Albert, and Rashawn. Go ahead and tell us about how treatment is going:

 

Matthew, Stage V, Risk mitigation, Affect regulation

Matthew, age 17, is in Stage V and has led conversation and offered honest responses to others during group therapy. His primary caregiver, grandma, is supportive and cooperative. She has mastered strategies on how to enforce boundaries for Matthew while still encouraging him. He wants to get a job but his grades are well below average and he is skipping class every few days, a violation of his safety plan. He told you a neighbor offered him a job mowing lawns. You would like him to be able to get a job but know that he has a pattern of starting projects and stopping halfway. You are excited about the overall progress throughout the past year of treatment and want to set him up for success as we approach his program graduation date.

Questions and action steps offered by the clinicians:

Review his safety plan and utilize motivational interviewing. Does he recognize any connection between skipping class and the rigor involved in maintaining a job? What are some of his big goals? What obstacles, like poor grades, might prevent him from reaching his goals?

Does grandma have influence in his life? Is she able to challenge him to attend school?

Has he established supportive friendships since starting treatment?

 

Samantha, Stage III, Conflict resolution and healthy sexuality, Family

Samantha is 13. She called last week during school and told you she felt like she was going to have a panic attack. You deescalated the situation by phone and she was able to function the rest of the day. During this week’s family meeting, you realize that adopted mom and dad are unaware that Samantha has struggled with anxiety. Instead, they are upset that she has not cleaned her room every day and washed the dishes like they had discussed.  They spend the first 20 minutes of the meeting describing everything Samantha has not done since your last meeting. Based on your conversations with adopted mom and dad from early on, they have tightened up their discipline and increased Samantha’s chores considerably. After 40 minutes have passed, mom announces that they caught Samantha with inappropriate pictures on her phone 2 weeks ago. Since then, they have checked Samantha’s phone every night before bed. Lastly, Samantha told them she might be interested in a boy in her class but mom and dad inform you that she is not allowed to talk to him anymore.

Questions to consider:

Have you had a conversation with mom and dad about their perspectives around healthy relationships and attitudes towards sex?

Can you provide mom and dad with specific suggestions about how to handle crises?

At the end of the meeting, inform mom, dad, and Samantha that you are going to work together to review Samantha’s safety plan in the next family meeting. Provide time for all 4 of you to contribute and ask questions. Ideally, a reviewed safety plan will address the insecurity and doubt felt by her adopted parents, provide age-appropriate autonomy to Samantha, and ensure she is progressing towards her stage goals without causing harm.

 

Albert, Stage II, Family, Affect Regulation

Albert lives with his aunt and uncle. He is in Stage II and this is your 3rd family meeting. From the beginning, aunt has requested he be moved to therapeutic foster care, unaware that some of Albert’s mood fluctuations are a result of the family system. Albert has been diagnosed with ADHD and has broken a few dishes and a chair since you started meeting with the family. The uncle drinks frequently and Albert’s outbursts coincide with alcohol related outbursts. Additionally, Albert has a history of abandonment and his parents are no longer involved in his life. During individual therapy, Albert admits he is often unable to control his anger and has had trouble sleeping recently. He has a few friends but no one he is close with. When you try to gauge whether the aunt and uncle have motivation to change, they impatiently bring up the idea of foster care.

Questions to consider:

Are there pro-social opportunities in which Alex can get involved? Would he consider joining a sports team or other intramural activity? How can he gain a sense of belonging outside of home?

Have you tried talking to the aunt and uncle about their lives apart from Alex? Showing interest in them could foster an engaged relationship that would allow them to feel more comfortable participating in the treatment process.

Could there another diagnosis besides ADHD? Could you screen for other signs of depression or bipolar?

 

Rashawn, Stage II, Crisis at school, Trauma

At school this week, Rashawn got angry during class and walked out. He was not cooperating with his teacher and the teacher grabbed him and tried to make him sit down. Rashawn responded by screaming and cursing and nearly punched the teacher. The school called you after Rashawn had calmed down a little bit and was sitting in the principal’s office. Rashawn was verbally and physically abused by an aunt from the age of 7 to 9. He has no other trauma history as far as you know.

Questions to consider:

Is the school and the teacher aware of Rashawn’s safety plan?

Have the teachers had trauma-informed training on how to handle crises?

Does Rashawn recognize when his emotions are escalating?

Does he feel comfortable or able to call you or another support person when his emotions start escalating?

 

After this meeting, you have time with Samantha and her family,  Matthew and his grandma, and with Rashawn, individually. Additionally, you have group tonight so after staffing, you get ready to hit the road to meet up with Samantha. You take a few minutes to make sure you and the other therapist are on the same page about the group agenda tonight. You are excited to hear updates from the kids. Looking forward to a full day!

Thank you for reading more about what the day to day is like for our TASK clinicians. The research projects are still underway. We are currently revising the project plan in order to incorporate more preliminary steps before a more rigorous investigation. The therapists, business team, data team, and countless others have become a cohesive, engaged working group as we bring together our questions, experiences, and expectations for this project!

Inside a Room of Secret Agents at Children's Hope Alliance

The LCSW’s (licensed clinical social workers), QP’s (qualified professionals), and LMFT’s (licensed marriage and family  therapists) are the staff members on the ground with our clients who have caused sexual harm. These TASK (Treatment Alternatives for Sexualized Kids) agents are less known to the rest of the world but celebrity to our kids and the communities impacted by their actions. They meet clients at school, over a basketball game, or with a mouthful of McDonald’s fries. Neither traffic, round-a-about Charlotte city routes, backcountry western Carolina roads, and unlisted addresses prevent them from spending time with the clients’ families. Trashcans, Jenga blocks, and snack packs are their weapons of choice to teach concepts like the difference between consent, compliance, coercion, and cooperation. TTFOFLA(two-three-four-or-five letter acronyms)is their language of choice:

TF-CBT: trauma-focused cognitive behavioral therapy

SA: substance abuse

CFT: child and family therapy

PCP: person-centered plan

DSS: Department of Social Services

DJJ: Department of Juvenile Justice

They encounter stories about clients stealing dirty underwear, experiencing daily emotional abuse, and getting into fights at school. And yet, our TASK staff find ways to laugh and continue to serve kids another day. As a result, our teenage clients and their families trust the agents who jump right into the mess of their real lives. In the short few months since joining the TASK and CHA (Children’s Hope Alliance) team, this physics major has watched people bring hope to hurting children and families when the world can’t always be explained with formulas and algorithms.

An update on our project

The TASK team has been working hard to establish a manual that reflects the diverse experiences of our staff from Charlotte to Guilford. Staffing and time with the kids allow us to watch the TASK model in action. Data collection is underway as we determine what TASK elements are most effective and efficient in bringing change to the lives of our clients’ and families. We are developing research procedures and structures to produce relevant and rigorous results. Those will be presented to our field and related subfields which include child psychology, sexual abuse, trauma care, child development, and juvenile delinquency.  The more research we do, the more excited we are about TASK and its potential to reach others who have caused sexual harm.

Justice is not so simply dealt out: walking with kids who cause sexual harm

My name is Grace Watt. As I transition into my new job, which I will describe later, I have had to ask some complicated and emotionally distressing questions.  The following essay is part of an ongoing, maturing conversation with myself as I process what I am learning and how I might more effectively respond to the issue of sexual offense. This essay contains heavy and unsettling material; humility, an open mind, and hope are a good tools to tackle it all…

Let me begin with a thought experiment:

  1. Think about the worst thing you have ever done to someone.
  2. Go find someone in the room with you right now and tell them about that event.
  3. Have them ask you more specific questions about that experience. Specifically, have them ask you questions about your selfish underlying motives and the way your actions affected everyone around you.
  4. Now, role play the situation; except I want you to take the role of the person you hurt. In that way, you can more fully explore the consequences of your actions and how you made that other person feel.
  5. Only one more step! I want you to take that event, a brief description of the worst thing you have ever done to someone, and put it at the very top of your resume. Be ready to provide full disclosure to all future employers and friends and family about why that situation happened.

It does not matter that there may have been a reason for your actions. Maybe your best friend was shot. Maybe your daddy beat your momma. Maybe you are just doing what your older brother’s friend taught you to do.

That was a sexual offense. You are a sexual offender. A danger to the public;  despised by society. You should not have a job. You cannot be at parks. When you travel, find routes that avoid all schools.  You are disgusting.

With these common responses to people labeled as “sex offenders,”  we should not wonder why it might be difficult for someone to admit to a sexual offense. If they admit they did something, will they find support? Or will they become something less than human with a one dimensional story?

What might be some barriers to changing harmful behavior? How do our natural stereotypes, preconceptions, and attitudes create another insurmountable obstacle for people already trying to tackle the daunting task of change?  Putting ourselves in the shoes of a person who has committed a sexual offense helps us imagine what it would be like if we were defined by the worst thing we’ve ever done; if we had to wonder whether our mistakes were so big that we’re never allowed to move on from them.

The answer is not to go easy on sexual offense. Sexual offense can cause long term and multifaceted damage to the victim; the goal is not to delegitimize the necessary and potentially arduous healing process for survivors of sexual harm.  If you are a survivor of sexual offense, efforts to help offenders should not take away your dignity or self-worth. My hope is that these two separate, but related conversations would prevent further harm and lead to full life for you as a past survivor and also for anyone who might be a past perpetrator.

In order to prevent a person from causing further sexual harm, we must patiently try to understand the dynamics behind minimization of offenses and the mechanisms that could motivate someone to change their behavior. Many people who commit sexual offense might stop hurting others and also avoid the ostracization from friends and family if they knew how to stop the thoughts and situations that can lead them to harming other people.  They might not know how to cope with life because few people beyond mental health professionals have more than a basic understanding of what causes a person to sexually harm others and what could help them change. People who know that they committed a sexual offense may believe there is no hope for love and acceptance if anyone else knew. They might be right until we can better respond and listen without reducing them to their offense.

People who cause sexual harm are not just sex offenders.  Yet, we don’t swing to the other extreme and remove all responsibility by blaming their action entirely on past abuse done to them. They are human and we are all a complicated mix of victim and perpetrator. We all cause harm to others and we ourselves are hurt by others. It would be much simpler if there was one evil person and one victim. Then we could just get rid of the evil person.

As I have spent the past two weeks learning about the development of the TASK Program (Treatment Alternatives for Sexualized Kids), it has become abundantly clear that justice is not so simply dealt out.  The stories and lives of these kids are complex.  When the mug or paparazzi shot of an adult sex offender flashes across the screen, that person is dehumanized and met with little compassion.  As the age of the offender drops below 18, we are often more willing to ask what extenuating circumstances might have led a child to commit an act.

My role at Children’s Hope Alliance

I am working with the TASK program at Children’s Hope Alliance. Children’s Hope Alliance offers a wide range of services beyond TASK including foster care, adoption, and outpatient therapeutic services throughout North Carolina. Since it’s founding date in 1891, CHA has provided hurting children and their families with a safe place to heal and have hope for the future.

TASK is a more recent addition to Children’s Hope Alliance that meets the particular treatment needs of youth who have committed offenses and require sexual harm specific treatment.  In it’s 10 years of existence, TASK has successfully reduced rates of reoffending and allowed kids to have a meaningful relationship with their community and their family. Because there are few effective programs available for this population, we are hoping to expand our program nationally and internationally.  In order to do that, we will demonstrate TASK’s effectiveness and validity by being identified as an evidence based practice. My job is to coordinate this effort and I have just completed my second week in this role.

The Impact Fellowship Program

This opportunity is part of the Impact Fellowship program offered through Davidson College that places it’s graduates in substantial roles at non-profit organizations. The program is allowing us a front row seat in dealing with questions of considerable complexity, urgency, and potential for significant systemic changes in society.  It has been humbling to see that our supervisors have confidence in us as demonstrated by the scope of our projects and our clearance and autonomy.  The daunting nature of this project could lead to anxiety and paralysis. However, I have a renewed sense of power and control in a role like this because I have tools to tackle a project of this scale. Davidson equipped me to problem solve by breaking down large goals, being relentless in finding the necessary resources, and leaning heavily on other people’s collaborative expertise. Instead of fear, the size of my project excites me because  I know it will have substantial and lasting impact.

This is the first taste at how Davidson prepared me to handle real world situations. At the time, I lacked confidence and security because I rarely felt finished and always was more aware of how I could improve than of what I had done well.  I became more convinced I could not handle nor had any control over the problems and tasks required of me.   Yet because I lost a sense of self-understanding and self-empowerment that worked for me as I child, I now have a clearer view  of a world greater than myself. I have increased capacity to understand problems beyond my limited personal experience and skillset. I am more aware of a rumbling, sturdy foundation under my feet, made up of the vast community of people addressing similar problems from different angles with different experiences and expertise.  I step without hesitancy into a battle bigger than myself because I understand that sustained strength must come outside of myself.  In order to face inconceivably difficult problems, I must find a source of inconceivable wonder and hope.

As I undertake this fellowship, I lean upon the resources, wisdom, and support of many others and with that, I am excited to share with you in this adventure.

Thinking Pink: Ladies Night Out and the World of "Breast Cancer Kitsch"

We’d talked for about a minute and a half when Wanda yanked an extra chair closer to her computer monitor (perched amidst hallmark figurines, inspirational slogan magnets, and family photos) in her gray health department cubicle. She pledged:

“Now this is guaranteed to make you cry.”

She was talking about Ladies Night Out, a monthly program that provides uninsured women below a certain income level with annual bloodwork, mammograms, and breast cancer screenings. The date was July 29th, 2014.

breast cancer nyt

From 2013 NY Times article “Our Feel-Good War on Breast Cancer.” Photo: PR Newswire, via Associated Press; Tom DiPace/Associated Press; Gabrielle Plucknette/The New York Times (apron, sunglasses, flip-flop); Simon Fergusson/Getty Images.

This week I’ve been thinking a lot about breast cancer.

About 1 in 8 U.S. women (12.5%) will develop invasive breast cancer in addition to about 1 in 1,000 men.*

It’s a devastating disease with devastating implications I’ve seen echo in the lives of colleagues, friends, and family.

Yet even as I contemplate all that loss, the dearth of pink-themed products from my last Google Images search floods my mind: water bottles, key chains, backpacks, hair straighteners, Kit Kats, flip-flops, eyelash curlers, perfume, iPods, pepper spray, margarita glasses, compact mirrors, M&Ms, charm bracelets, hairspray, and snuggies – all pink and be-ribbon-ed.

What does all this stuff have to do with breast cancer? Is this awareness? Is this fundraising? Is this exploitation?

Seeking answers, I turned to Barbara Ehrenreich’s essay Welcome to Cancerland. In an incisive consideration of her own breast cancer diagnosis, Ehrenreich explores links between breast cancer culture and industry, the hyper-association of breast cancer with traditional femininity, and the infantilization of women living with the disease. She expresses the fury she feels at being met with peppy slogans of hope and survivorship and an expectation to adopt them as badges of her unwanted membership in the breast cancer sisterhood.

You can read her article here, and I recommend that you do.

Barbara Ehrenreich. Photograph: Steven Voss

Back at the health department, Wanda clicked play on the YouTube video showcasing Ladies Night Out. Just like she predicted, I cried. And then I became a volunteer, translating once a month for the Spanish-speaking women who access the program.

Ladies Night Out is executed with an individual sort of aplomb that nearly a year in, I’m still grasping to understand – a juncture of gooey sentimentality, straightforward conviction, and needed services. There is not an ironic bone in the body of this operation – “Ladies! Flowers! Pink!” the program seems to shout, self-assured in its style and its mission.

When a “lady,” the name reserved for all program clients, arrives, a volunteer hands her a pink flower and a reusable pink bag. Sandwich boards with program information feature hot pink text and decorative stars. The satisfaction surveys are often printed on pink paper. Volunteers all don the same cotton zip-up printed with pink ribbons.

They’re the kind of details that make me roll my eyes in solidarity with Ehrenreich, but predictably, it’s just as my eyeballs have nearly finished their dramatic arc that I catch sight of a woman who’s grinning from ear to ear and staring at the carnation in her hand. It’s at that moment that the woman who I’ve just translated through a mammogram tells me how much she loves Ladies Night Out.

There’s a distinction to be drawn between “breast cancer kitsch” and the lived experiences of people. There has to be. Otherwise we’re left with a choice between either affirming merchandise in order to affirm the women who find comfort in their pink flowers and newfound sisterhood or disparaging real people in order to criticize an industry – a choice which seems as artificial as it is unkind.

The women who use Ladies Night Out are deeply grateful, and the volunteers and staff are deeply committed. I love translating here, and you’ll find me at Ladies Night Out next month, too.

Still, I’m not sure what to do with all this pink.

 

Musings from the Mountain

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During my time at ASC, I have had the opportunity to attend two retreats with my team. Initially, I was very apprehensive about this experience and the thought of spending three days on top of a mountain with zero cell service and zero personal space.  Nonetheless, I packed up my car, and my work, and prepared myself for a few days of intensive analysis of our intersession camp at Wildacres. Although I returned home exhausted, I found that there was a major benefit to spending some time away from the office. Here are some of my reflections on the experience:

1.) In the modern workplace, technological tools have advanced our ability to organize, communicate and work. And while this technology serves to make us more efficient workers, many times the constant bombardment of email requests, calendar reminders and text messages can stall productivity. At Wildacres, wifi and cell phone service (not to mention LTE) is virtually non-existent. Knowing this from our Fall retreat, I chose to unplug completely and turn my cellphone off for the duration of our time. This decision certainly increased my professional productivity, but more importantly, I found this break from likes, swipes, and push notifications to be highly refreshing. NOTE: If you choose to do this, be sure to text your mom & let her know that you made it to the top of the mountain safely first.

2.) Do not underestimate the importance of socializing with your team. Although I was admittedly anxious about sharing breakfast with my coworkers before at least two cups of coffee, I think the informal moments on our retreat were very beneficial to our team dynamic and rapport.

3.) The Arts & Science Council works to build appreciation, participation and support for the arts, sciences, history and heritage throughout Charlotte, with the hope of creating a vibrant cultural life for all. I have found that ASC is equally invested in fulfilling this mission and cultivating creativity within our workplace. On our fall retreat, I got to spend time in the lapidary studio cutting rocks. In the spring, we did evening multi-media and paint projects. In my opinion, opportunities to play and create help us become innovative leaders and creative problem solvers.

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A Touch of Program

Participants of third annual Cutler Fellows Program

2015 Cutler Fellows, Faculty and Staff gather for a group photo in the United States Institute of Peace atrium.

Over the course of my Fellowship with Salzburg Global Seminar, I have focused the majority of my time in fundraising. Juggling the many projects in support of both institutional and individual giving for Salzburg Global keeps me busy, to say the least. Solicitations, grant proposals and reports are constantly circulating among the members of our team. We are always looking ahead to what is next on our fundraising plates and rarely do we have the time to stop and reflect about the end product – yes, the actual seminars.  So, witnessing the development team’s fundraising efforts come to fruition in successful, dynamic programs has been one of the most rewarding parts of my Davidson Impact Fellowship – first through the Young Cultural Innovators Forum in Salzburg and, more recently, in the third annual Salzburg Cutler Law Fellows Program in Washington D.C.

Just a couple of weeks ago, the Cutler Salzburg Fellows Program brought together 45 law students from the ten of the top American law schools; University of Chicago, Columbia, Duke University, Georgetown University, Harvard, New York University, University of Pennsylvania, Stanford, University of Virginia, and Yale. This two-day session was built around a unique workshop opportunity for students writing papers on topics within international law and legal practice. Students circulated their papers among their working groups and Faculty members before arriving in Washington. The program provided a platform for every student to receive approximately 30 minutes of critique on his or her paper from a group of individuals with fresh eyes and ideas.

I served as the photographer for Cutler Fellows program, floating between the workshop groups to capture snapshots of new interactions and lively discussions. I also attended the lectures and panels dispersed throughout the program from law school Faculty and other leaders in international law, including John Bellinger III (former Legal Advisor to the US Department of State and National Security Council under the George W. Bush administration),  Jeffrey Rosen (President and CEO, National Constitution Center) and The Honorable Justice Richard Goldstone (former Chief Prosecutor to the UN International Criminal Tribunals for the former Yugoslavia and Rwanda). The students seemed excited to network with each other and engage with the program’s special guests. Seeing the program from start to finish was not only a nice break from the typical day in the office but also a nice reminder for why I do the work I do with Salzburg Global.

Faculty Panel from Cutler Fellows Program

International Investment & Trade Negotiations panel with law school faculty members Rachel Brewster (Duke), moderator William Burke-White (University of Pennsylvania), Mark Wu (Harvard) and Jose Alvarez (NYU).

Cutler Fellows in working groups

Cutler Fellows discuss their own papers in break-out groups. Each paper received an estimated 30 minutes of critique from students and faculty of other law schools.

Justice Richard Goldstone

The Honorable Justice Richard Goldstone speaks on ‘Personal Reflections on Law and Public Service’ at NYU Washington DC.

Happy Valentine's, Darling?

From November 2014:*

I’ve spent the last week eyeballs glued to the computer screen editing a grant application. Which. In the long run could be a very big deal for my community. Which. In the long run would mean victims of sexual assault and domestic violence would access live-saving services better. Which is inspiring and needed and worth working for.

Which. In the short run means sculpting a true and compelling story out of 500 character slots and a budget question. Which means writing 1,500 words of stories you love and then deleting all but the four sentences you need to prove your claim. My day is spent ruthlessly slicing adverbs and eliminating oxford commas.

In some ways, editing is amazing. Sometimes it feels like archaeology: scraping away until this thing full of meaning emerges. Sometimes it feels like magic: well, mysterious, arduous, time-consuming magic, anyway.

The adage “Murder your darlings” comes to my mind.

Often attributed to William Faulkner, the advice most likely comes from writing expert Arthur Quiller-Couch in his 1913-1914 Cambridge lectures “On the Art of Writing.” Quiller-Couch proffered, “If you here require a practical rule of me, I will present you with this: ‘Whenever you feel an impulse to perpetrate a piece of exceptionally fine writing, obey it—whole-heartedly—and delete it before sending your manuscript to press. Murder your darlings.” (See more here.)

I usually hear this phrase in my mother’s voice. As a research attorney turned yogi, she’s got a wide-ranging arsenal of maxims. Much to the chagrin of my adolescent self, this expression has stuck, perhaps because it’s the exact advice I struggle to put into practice, and perhaps because the image the phrase evokes is so alarming.

The notion, too, is arresting: the very phrases you’re most proud of yourself for conjuring up are most likely the ones you’ll have to, you should delete.

This seems especially true in grant-writing, which as I’m learning is not really about you the writer or your ability to create apt analogies and use GRE-worthy words. It’s about the narrative you can immediately and concretely convey. It’s an important skill that I’m glad to be building… but I’m also really enjoying not doing it right now.

In comparison, blog posts feel luxurious – here I have no mission except to process my experience and share with a hypothetical audience. What freedom! Look at how many adjectives I am using (Some of them even mean the same thing; they’re repetitive and inefficient! I might even make some up.); earlier I ended a sentence with a preposition. Here, you will find no vision statement or action plan. Weep on ye masters of succinct, practical writing: it’s grant season, and I aspire to develop your skills, but today’s post is full of darlings, alive, well, and decidedly un-murdered!

valentine baby

*I wrote this post in December and then delayed publishing it for another two months thinking that:

1). It echoes many of the same thoughts expressed by Catawba Lands Conservancy fellow and dear friend, Rebecca Mckee in her post, Writing Post-Davidson. (If you haven’t read her reflection yet, start there. My favorite of her observations begins, “Unsurprisingly, writing grants is a little different from writing that essay I wrote on the metaphorical significance of Lorca’s Yerma and my research paper on the adverse health effects of exposure to the pesticide, 1,2-Dibromo-3-chloropropane.”)

2). Who quotes hundred-year-old writing advice?

Then I decided that Rebecca wouldn’t care and that who am I kidding – this is a Davidson audience, a group uniquely equipped for a pithy remark from Academia. So … Happy Valentine’s Day, Darling!

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