Children’s Hospital doctor talks Oakland violence, trauma consequences

Allison Briscoe-Smith, the director of the Center for the Vulnerable Child at Children’s Hospital in Oakland, sees consequences in Oakland’s violence that extend far beyond the victims to become a public health issue for the entire community.

“Chronic trauma is just one of the consequences,” Briscoe-Smith said. “Witnessing a series of deaths over time can affect the psyche of the community, the body and minds of those that live in the communities.”

Briscoe-Smith has treated vulnerable patients for about 15 years, and says her experience as a doctor and research she’s done point to the conclusion that individuals living in circumstances of chronic trauma are likely to develop health problems including brain development issues, cardiovascular diseases, obesity and diabetes.

“When one has always to be worried whether or not you are going to be harmed, then it really impacts the body,” she said. “Because you are so highly traumatized, day to day.”

What is more concerning, Briscoe-Smith said, is that violence within a community can be particularly harmful to children’s development, because  “it disrupts the fundamental trajectory that they are supposed to have.”

She said she is concerned about the issues created by the violence occurring in Oakland, not only as a doctor but as a mother of two. “Kids are not supposed to be growing up in those environments,” she said.

One major consequence for children who constantly witness violence, Briscoe-Smith said, is behavioral challenges, which can lead to school failures. This is usually followed by a negative cycle of breakdowns in the child’s life.

“This child usually ends up being identified and labeled as a bad kid and has high chances of dropping out of school,” Briscoe-Smith said, “typically having further involvement with the juvenile justice system, leading to further incarceration. That’s the typical story.”

In an interview with Oakland North, Briscoe-Smith reflected on neighborhood violence issues and discusses strategies in which she feels would effectively curb the multitude of problems it creates. This interview has been lightly edited for length.

ON: Can you illustrate how witnessing violence impacts the lives of children?

Briscoe-Smith: From little kids all the way up to adolescence, what does it mean to feel chronically unsafe? To see friends or family hurt or die really disrupts the fundamental trajectory that kids are supposed to have. It ends up really undermining their senses of self-safety and the inability to really regulate those. There is also the impact for the family, as it affects family’s functioning. How well can a family do in the context of experiencing a lot of violence?

ON: Can you describe, technically, how violence can damage a child’s trajectory?

Briscoe-Smith: There is some really interesting and new science that is coming out and it’s particularly about young children who have exposure to chronic stress, or trauma. What we find is that it can interrupt the ability of forming connection within parts of the brain, so that’s really important. The purpose of early childhood is to develop new connections and kind of calm down on those that we don’t need. When your body is constantly in flight mode, it washes your brain and your body with hormones that indicate that you need to run, at all times. Actually another way of thinking about this is the “beauty of the body.” Think about what post traumatic stress disorder is. It is really an adaptive means of dealing with chronic trauma. It just doesn’t work when you are out of trauma, and the same thing in terms of our brains and our systems.  They get really used to that environment they are in, but we don’t always want to train our brains to be chronically stressed. We don’t want to always have our immune systems chronically on, because it wears it down.  That’s not what we are supposed to be doing. So, when you start with that early on, what ends up happening is that you wear down the immune system and it is easily triggered. Then you find that kind of cascade of these neurotransmitters gets turned on really quickly in a way that you don’t necessarily need to have it happen because you are not in a dangerous situation. If you think that hearing the gunshot outside makes you worry for your safety that kicks up stuff. Or if hearing the gunshot outside reminds you of when you saw your father shot – that’s a whole other level. When we were talking about walking through many streets and neighborhoods, those stressors are everywhere and this will wear you down. It has a really big impact in terms of cardiovascular diseases and hypertension and the ability to maintain focus in a classroom, those kinds of things.

ON: Can you give us an example of some of the trauma cases you have treated?

Briscoe-Smith: Unfortunately, I have a lot of examples of folks being exposed to trauma violence. I can think about a number of kids I’ve worked with who for example, were in a classroom where the class was interrupted by having police run through the class because there was gun fire outside, or they were chasing somebody – and that was a preschool class. So we have everything from babies crying to teachers crying. There is a lot of impact of violence in those kinds of areas. Unfortunately, a typical case that I am used to seeing is a seven to eight-year-old boy who’s being called out at school for being disruptive. These kids come to the attention of teachers because they are not paying attention, are not focused in the class. Usually, they come to me as a referral for something like an attention deficit. It doesn’t take me too long to find out that this is a kid that’s growing up with a single parent, or has a parent who is incarcerated, has lost family members to violence, or is growing up in an area exposed to violence. That, I have to say, is not just one kid, but many kids I have seen. That tends to be a hard combination for kids. And teachers burn out working with kids that present behavioral challenges and it really sets them up for school failure.

ON: What is your approach, as a doctor, to trauma cases?

Briscoe-Smith: I treat the vulnerable kids by using evidence-based treatment. There is a lot of research that indicates if you use therapy that focus on the fact that these kids are exposed to violence and trauma and if you provide these kids with the right services, that can help.  By understanding what trauma does to kids and families, understanding that trauma can interrupt learning, understanding that schools are environments where kids need to feel and remain safe. If you provide services that help them and provide support, that can actually help kids to do better.  In addition to mentoring, do things that are engaging, entertaining and fun. There is a lot of stuff that can be done to help kids.

There are a lot of kids who are resilient and we, psychologists, therapists and physicians, know how to help support kids, keeping them from heading in the wrong direction. I don’t think enough services are available, but I think there are ways of interrupting that kind of trajectory. But in terms of what is the future like for kids that are exposed to violence, it can be challenging. It can be difficult. There are a number of hurdles that they have to overcome. We try to work on things to make them feel they can be safe, that they can get a good education, and they can avoid these kind of snares of involvement in the juvenile justice system, substance use or gang involvement. Unfortunately, those are some of the only choices that these youth will have: staying safe with a gang—which brings more risks—or getting involved with juvenile justice. I think it’s a lot to overcome, but there are a lot of stories of hope in our community.

ON: Can you talk about a successful case?

Briscoe-Smith: Actually most of the stories that I get chance to bear witness to are stories of success, in some small way, shape and form. Feeling like kids are able to articulate their needs, to say what they want to do when they grow up or kids that are actually graduating from high school, getting jobs. I thankfully, got chances to see a lot of people really benefit and a lot of kids actually have much more hopeful trajectories, getting involved and becoming social advocates. There are a lot of examples of hope.

ON: For parents, what are the main challenges of raising kids in places like Oakland, Richmond, cities marked by violence?

Briscoe-Smith:  I’m a parent of two young children, I live in Oakland and I provide services to parents. This is a parental problem: What does it mean to want to live in Oakland, to want to be part of the solution, to want to be part of a driving vibrant diverse community, but also see that this community is not doing very well in so many ways. I think that the advice that I have is for parents to show up and be present, to try to keep their eyes open to what’s going on. I understand and respect that each parent might have to come to a certain place and decide to leave if they are so blessed to be able to have the ability to. But I also really encourage parents to stay if they can and try to do something themselves to try to make it better. Can you mentor? Can you be a neighborhood watch? Can you help instill in your kids a sense of pride in the area they grew up? Is there a way that we as parents can also contribute to make it a better and safer place? I think it really is our responsibility to make it a better place and I think it is also really hard.

ON: What do you think kids and youth should do to help to curb the problem?

Briscoe-Smith: I was coming out of one of the high schools other day and the kids had shirts on that said, “Respect our city,” and I said, “Yeah, that’s right!”  These big, bright neon shirts with teenagers walking on the streets saying “respect our city” is something so simple that kids can come together and put out a positive message. Also the murals that are done by many youth, or the hip-hop, the Youth Radio. I think these are a kind of fundamentally good start.

ON: In what way do you believe violence is a public health issue?

Briscoe-Smith: I do see violence as a public health issue, everything from the fact that we are losing people that people are dying due to violence. The fact that we are losing a population of brown and black men to institutionalization is a public health issue in terms of “where are black and brown men going?” And then also, in terms of daily chronic stressors and what does it mean to be exposed to chronic violence. Stress and violence actually wears down our immune system, actually interrupts our ability to form connections in our brain cells, and wears down our empathy. These are chronic health stressors that are really, very, very impactful for communities and actually explain the disproportions that we see in our communities. An African American boy born under Macarthur Ave, for instance, is more likely to have a shorter life span than a kid born above Macarthur – I think it’s something anywhere from 7-10 years [shorter]. And we are talking about a span of three to five streets. That, I think, is due to the public health impact of lack of access to good food, education, and it all adds up really quickly when you see something kind of geotropically specific.

ON: Where do you stand on the gun control issue?

Briscoe-Smith: Well, unfortunately gun violence is not a new issue, but a very, very old issue for communities like Oakland and other communities that really struggle with poverty and violence. I have a very simple solution in mind, which is to get rid of guns. I really do think that limiting access to guns may be a way of eliminating this type of violence. I think that there are a lot of other things that can be done. In terms of promoting safer, healthier communities, really promoting nonviolence and connection.  Also having more therapy, and having all those things more available, having healthy foods.  And it would be nicer if there were just fewer, less guns around, less access to guns. What we find in our communities is that gun violence is happening to bystanders and to neighbors and actually relatively targeted small groups of boys who grew up and had the same type of issues. More folks are dying within African American and Latino populations, a large proportion are dying from suicides and guns are a mechanism of completing suicides. I personally haven’t been compelled by arguments about why we need to have this much access to guns when we have lots and lots of evidence. Violence is still going to be an issue for us even if there weren’t any guns. But I’d take my chances getting stabbed by a knife rather than getting shot.

ON: Besides gun control, what other public policy solutions could help curb the problem of violence in communities such as Oakland?

Briscoe-Smith: In relation to promoting healthier environments, making sure we have viable jobs for our community, providing healthy foods, educational system that actually prioritizes in making sure that kids are engaged in the learning, a health care system that is actually responsive to the needs of our community. I love the idea of a kind of full service school that can integrate mental health programs, have good food available and job training. The idea of creating safe communities for our kids might be one thing that we can do to help reduce overall violence. Also, providing economic viability and stability. Much of violence that goes on is because there are not viable options for people to earn, make money and to do things in a way that doesn’t involve robbing, stealing, selling drugs and becoming addicted.