The Trauma of Poverty

1. The Trauma of Poverty How living with poverty is toxic for children and families Patty McCook, LCSW, DCSW

2. Our discussion will cover three broad topics: • What is poverty in America? • What constitutes poverty? • Who are the poor? • Why are they poor? • What impact does poverty have on children and families and how does this sometimes turn into chronic and/or toxic stress? • How do we incorporate this understanding in order to practice trauma informed care with children and families impacted adversely by poverty? How do we address the stereotyping of the poor and the perpetuation of negative attitudes that impact self worth and create very real barriers for the poor?

3. Trauma Informed CareTreatment Model • Our framework today is Trauma Informed care. TIC is a structure and treatment attitude that emphasizes understanding, compassion, and responsiveness to persons affected by all kinds of trauma. Trauma Informed Care takes into consideration physical, psychological, and emotional safety for children and families and provides tools to empower people on the path to stability.Becoming “trauma-informed” means recognizing that people have many different traumatic experiences which often intersect in their lives.  Well-meaning service providers can often re-traumatize clients who need understanding, support, and individually-conscious care.

4. Trauma and Poverty In March of 2016, the American Academy of Pediatrics declared poverty as the single most pressing, chronic health issue for children in the United States. The number of children living in poverty has increased from 39% in 2008 to 44% in 2014.

5. Kids in the U.S. experience higher poverty rates than most developed nations. Only Greece, Mexico, Israel and Turkey have higher child poverty rates than the U.S.— ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT

6. Wealth in America • We think of ourselves as an affluent society. There is an abundance of wealth in the US, certainly… In 2017 Americans spent 33 billion dollars on pet toys In one MONTH, Americans spend 1.5 billion dollars on video games A Pew study found that 46% of Americans spend more money than they make every month. Nearly HALF.

7. Average spending for a household with a $57,311 annual income • Americans aren’t necessarily spending their money on luxury items • On the average… • Each household spends about 6,602 on entertainment, food away from home and clothing in 2016. This is about a third of what we spend on housing which is 18,886 • So what do we spend all our money on? • Transportation and Healthcare are the budget killers. The average American spent $9,049 on cars, $4,612 on health care ($3,160 on health insurance premiums. The cost of housing in America continues to rise. There has been a 50% rise in the cost of housing (inflation-adjusted) since the 1960s.

8. Income Percentiles US (2016 and 2017)

9. What level of income is considered poverty in the United States? 2019 figures: 2019 Poverty Guidelines for the 48 Contiguous States and the District of Columbia Persons in family/household Poverty guideline 1 12,490 2 16,910 3 21,330 4 25,750 5 30,170 6 34,590 7 39,010 8 43,430 For families/households with more than 8 persons, add $4,420 for each additional person.

10. Alaska 2019 Poverty Guidelines for Alaska Persons in family/household Poverty guideline 1 15,600 2 21,130 3 26,660 4 32,190 5 37,720 6 43,250 7 48,780 8 54,310 For families/households with more than 8 persons, add $5,530 for each additional person.

11. Hawaii • 2019 Poverty Guidelines for Hawaii • Persons in family/household Poverty guideline • 1 14,380 • 2 19,460 • 3 24,540 • 4 29,620 • 5 34,700 • 6 39,780 • 7 44,860 • 8 49,940

12. 2016 figures…last figures where data has been thoroughly analyzed • What is the 2016 federal poverty threshold (FPT)? • $24,339 for a family of four with two children • $19,318 for a family of three with one child • $16,543 for a family of two with one child

13. The Demographics of Poverty in the US

14. Family income by age

15. How many children…

16. Percentage by race and ethnicity

17. Does employment matter?

18. Education?

19. Family structure

20. Location…

21. Food insecurity…

22. Impact: • Poor kids are more likely to experience hunger. And food insecurity has a lifelong effect: lower reading and math scores, more physical and mental health problems, more emotional and behavioral problems and a greater chance of obesity. — Feeding America

23. Why and how does poverty traumatize children and their families?

24. https://www.youtube.com/watch?v=WDXJyydDyvk

25. The Minimum Wage Challenge • Weekly budget $290 (Based on 40 hours @ $7.25 an hour X 4 is a monthly budget of $1160.) EXPENSES: Taxes (35.06 weekly, $140.24 month) Housing Utilities Transportation expense Medical Groceries Phone TV, entertainment Laundromat, haircut, grooming products Health Insurance Savings Medication Copays for Dental and Medical…hospital/emergent care • If you have children… Childcare Diapers/formula Field trips School clothes Uniforms Transportation to daycare or school Medication Entertainment Groceries Remember…ONE out of TEN minimum wage workers is a single parent.

26. Let’s take the minimum wage challenge on $12 an hour Based on $12 for a 40 hour week $480 Monthly income will be $1920a month, $24,960a year Expenses: Taxes per month @230.40 SS 211.20 Rent 650. Utilities 75. Health Insurance 120. Medication Doctor and Dentist Co-pays Transportation cost Car Payment 219. Insurance 89. Maintenance Gas Personal Property tax Phone Groceries Clothing Entertainment Laundry, haircuts, etc Basic Cable Vet Day Care 458. Internet • Julia: Single mom works at an Insurance Company answering phone. High School and one year of college. Unmarried with an 11 month old. • Works 10 miles away. Daycare takes her 10 blocks out of the way. Car payment $219. Insurance $89. • Julia’s company provides Health Insurance. They take out $60 every two weeks when she gets paid. Julia’s baby is covered by ARKIDS-B. Because her annual income is over $23,378.88 by about $1600,ARKIDS-B will require a copay. Medication also requires a copay. Fortunately, little Aiden is pretty healthy. • Julia and Aiden have a one bedroom apartment in Midtown. She has tried to get into the Section 8 program but there is a waiting list. She pays her electricity and gas but the landlord pays the water. $650 for 500 sqft. • Julia inherited her grandmother’s cat when grandma died. It is old and sometimes there are vet bills. • Day Care $458 per month. • Julia gets WIC but her monthly income is over the $1,784 for SNAP so she receives no food Stamps. • She has no sick leave.

27. Calculating Julia’s Budget Some things are static like rent, taxes, social security and day care. Some are expendable like the car. If you eliminate items, you have to come up with a plan such as monthly bus pass. Remember to consider all that this means for a single mom with a child who does not yet walk…stroller, car seats, what time does the day care open and close? Will she have time to get back and forth? Moving? How much will that cost and where will she find the money. First and last month’s rent…can she find cheaper digs?

28. Spend Julia’s Money • Classroom…in the envelope provided, you have money from Julia’s monthly paycheck. • Once you have decided how to distribute her money, please put the cash from your envelope into the appropriate bag at the front of the classroom. • Webinar participants…make a budget, balance the totals and see how much you have left over. If you eliminated categories because you ran out of money, what was your justification?

29. INCOME: Salary: $1920.

30. Raising a family on minimum wage. • https://www.youtube.com/watch?v=9-Y7BPqj_G0

31. Not all children growing up in poverty experience toxic stress. • The extent to which parents can serve as a buffer is the difference between a child who experiences growing up poor as a more-or-less normal condition or as a child traumatized by poverty. Optimally, the parents… • Provide a buffer that fortifies a child’s ability to cope and adapt. • Creates a sense of consistency and safety for the child. • Emphasizes family and community relationships so that even outside the family home, the child has safe adults to connect with under stressful situations. • Are adaptive so that even with minimal financial resources, the family can utilize programs, services and their own resourcefulness to maximize their assets and minimize the stress that accompanies poverty.

32. So why are poor people “demonized?” • Examples: Drug testing recipients of public benefits. Even though the states that are doing this have had very few positive drug tests, Arkansas is now drug testing. The first year we spent $33,000. testing. • Stories of buying lobster prompted Missouri legislators to enact a law prohibit the use of foods stamps for lobster as well as cookies, chips, energy drinks, and steak. (The average SNAP benefit in MO is $121 per month)

33. Stereotyping plays out in many ways • Children of poverty are more likely to be expelled from school or have a police record than a middle class or wealthy child who makes the same choices as the poor child. • There is a value judgement about “worthy” and “unworthy” poor based on the perception of person’s ability to work, “pull herself up by the bootstraps” and compete with others. • There is a myth of an equal playing field. • Poor understanding of the entrenchment of multigenerational poverty. • Poor people don’t need…(fill in the blank).

34. “So maybe rather than getting that new iPhone that [poor Americans] just love and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care. They’ve got to make those decisions themselves.” — Rep. Jason Chaffetz, March 7, CNN

35. https://youtu.be/xbqA6o8_WC0

37. Children at the most risk… Children of parents who themselves were traumatized by the circumstances of their poverty, abuse, neglect, RAD, abandonment, mental illness, addiction, foster care and/or DHS involvement, homelessness, domestic violence and/or the impact of violence and criminal activity in their neighborhood growing up.

38. The Physical And Emotional Costs Of Poverty • Kids growing up in poverty are constantly releasing the stress hormone cortisol, which can give them short attention spans and short tempers. Physically, they feel the same kind of heart-pounding stress an adult feels after a car wreck. And they feel it all the time. This can result in more chronic behavior problems, difficulty attending to task, impulsivity, disruptiveness, attachment issues and/or anxiety.

39. What is it about living in poverty that causes trauma Living in poverty creates stress Insecurity (shelter, schools, income, property, food) Instability (family composition, parental attentiveness, attachment, friendships, important influences, extended family) Emotional wellbeing (helplessness, loss of control depression, usual coping mechanisms don’t work so sometimes utilize drugs, control such as IPV) Inability to utilize programs due to challenges with transportation, stability of shelter, lack of appropriate clothing, maintaining good hygiene, diet or even time if working more than one job, situational or chronic depression/mental illness.

40. Poverty and victimization • People living in households in the US that have an income level below the Federal poverty threshold have more than double the rates of violent victimization compared to individuals in high-income households. • For both whites and blacks in the US the overall pattern of being in poverty with the highest rates of victimization is consistent. • Urban poverty increases the risk of violence and crime for US households, but did not change the racial risk factor balance.

41. Poverty and intimate partner violence Intimate partner violence is about control. When you live in poverty there are very few things over which one has control: Job market Price of housing Minimum wage Constraints of location Having a two parent family But you can physically control your partner.

42. Lifetime Cost Studies estimate that the lifetime cost of intimate partner violence including the cost of related health problems, lost productivity and criminal justice costs at $103,767 for women and 23,414 for men. In addition to the direct costs, survivor impact such as lost educational opportunities, diminished ability to work and loss of control over the choice and timing of childbearing, make it difficult to build economic security.

43. In the United States, more than one in three women experience sexual violence, physical violence, and/or stalking by an intimate partner in her lifetime (Smith et al. 2017)

44. IPV Intimate partner violence crosses all socioeconomic barriers, but the economic impact of IPV is long-term, the role of which impacts the survivor’s decisions about whether to end an abusive relationship. The more impoverished a survivor is, the less likely to end the abusive relationship. One in three women in the United States will experience some form of IPV in her lifetime.

45. Drug Use • Myth: Drug use is higher in poor communities • The connection between drugs and poverty is the same for alcohol and poverty. A 2010 study found that 81% of respondents who earn over $75,000 a year drink alcohol, versus 66% of those earning $30,000 to $49,000, and just 46% of those earning under $20,000. http://www.promises.com/articles/cocaine/cocaine-users-higher-incomes-study-finds/ consulted on Feb 26, 2018 • The real connection between drugs and poverty is that poor and homeless are more likely to be arrested. Drug-related incarceration itself contributes to and reinforces poverty. ttp://www.nyu.edu/about/news-publications/news/2015/02/19/-powder-vs-crack-nyu-study-identifies-arrest-risk-disparity-for-cocaine-use.html retrieved on Feb 26 2015

46. Incarceration and the economic and emotional impact on families

47. 2.7 million children in the US have at least one parent in prison • Studies show that the growth in incarceration of men with children contributes to higher rates of homelessness among black children in particular by thinning the family finances and placing additional strain on the mothers • When a mother is incarcerated, her children often end up in foster care, separated from their family • Stays in jail may cause a person to lose wages or get fired • The stigma of an arrest record, even without conviction, limits work opportunities • Policies that ban people with certain convictions from receiving public benefits such as food stamps and subsidized housing create a financial hardship for the entire family, not just the offender • These instabilities take an emotional toll on children, especially if their parents are going in and out of jail

48. Homelessness, poverty and trauma • Trauma associated with homelessness is pervasive • Higher rate of acute and chronic illness, depression, anxiety and loss • Lack of family support. Especially harmful for youth • Frequent victimization…assault, rape, robbery • For children, strongest predictor of emotional and behavioral problems in poor and homeless children is the mother’s level of emotional distress

49. Homelessness • Access to health care • No permanent address for mail, banking, keeping your possessions safe • Safety is always a risk • Exposure to elements • Bathroom availability • Shelters won’t allow substance abuse or the mentally ill • Chronic illness goes untreated

50. PTSD • There is a high correlation between PTSD and homelessness • PTSD is most commonly associated with combat vets, but many homeless experience PTSD symptoms.