In the United States, 61 percent of men and 51 percent of women have reported exposure to at least one traumatic event in their lifetime, and more than 66 percent of children report at least one traumatic event by age 16. As a risk factor for behavioral health and substance abuse, trauma impacts an individual’s self-worth, and those feelings are exacerbated when combined with the negative effects of social determinants and poverty. To be a survivor of trauma does not merely mean removing oneself from a traumatic situation but is a daily trial to monitor its impact as you move forward in life.
Shenandoah Chefalo is a survivor of trauma. She is the author of Garbage Bag Suitcase, a memoir about her life as a child of neglect, and personal experience navigating the foster care system and its long-term effects. She has been challenged to survive her entire life, having faced abuse from those responsible for protecting her. To health equity leaders, her story begs us to examine why trauma occurs, how it impacts children and how we can prevent and mitigate it for vulnerable populations.
Chefalo shared her story as one of the plenary speakers at the Root Cause Coalition’s Fourth Annual National Summit on the Social Determinants of Health. The conference brought together more than 660 leaders from across sectors who are passionate about reversing the ill-effects of poor health through social determinant interventions. The Coalition recognizes that offering a venue for leaders to share lived experiences and personal narratives is a driving force toward achieving health equity.
Traumatic events, or “Incidents that make you believe you are in danger of being seriously injured or losing your life,” are experienced by most of the population and shape adult outcomes, including self-esteem, professional and personal relationships says William Copeland, professor of psychiatry at the University of Vermont. A study published November 2018 in the Journal of the American Medical Association found that subjects who survived trauma were more likely to experience poverty, family instability, dysfunction and more likely to be bullied. Patients from the study experiencing childhood trauma were also more likely to experience psychiatric disorders, depression and substance abuse disorder.
At a time when her focus should have been on careless self-discovery, at a young age Shenandoah Chefalo was learning how to combat poverty, hunger and housing insecurity. When her mother, who suffered from drug and alcohol addiction, sent her to live with her grandmother and disappeared for over a week, Chefalo learned self-reliance. When her grandmother was faced with eviction and Chefalo encountered the foster care system, she learned to lie, “to teachers, to doctors, to nurses, and especially to police officers” because she knew those individuals all expected her to turn out like her mother, and although she believed that she would, she learned to protect herself. Her day to day survival as a child navigating the foster care system included worrying about necessities like what she would eat and whether she had enough money for feminine hygiene products. Moving from home to home, she attended over 35 schools before she reached high school.
Although her high school guidance counselor told her, “People like you do not go to college,” Chefalo was able to attend Michigan State University. But as years of trauma developed feelings of worthlessness, she attempted suicide three times within her first 90 days as a freshman. Chefalo survived and received an Interdisciplinary Studies degree in Social Science from the university. When encountered with the opportunity to choose a job as a receptionist at a law office that paid $3.25 an hour or a risky job that paid more, Chefalo fortuitously chose the $3.25 an hour job, a decision which changed her life trajectory. Her job as a receptionist led to a promotion to legal assistant, paralegal and law office administrator.
Of the nearly 400,000 children in the foster care system, nearly 61% face housing insecurity after they turn 18, almost 50% are incarcerated within two years of leaving the system and only 3% attend college.
Because trauma impacts all aspects of life and relationships, Chefalo explained to the audience why she believes all sectors across institutions should be trauma-informed. “When we really talk about being trauma-informed, it is not just for those that we serve, but I would argue it is an internal policy and practice first,” she said. “All of us have suffered trauma and adversity. We bring that unresolved adversity with us, and then it becomes workplace tension.” Chefalo says trauma may bring about behavior like workplace gossip and competitiveness that leads to low morale and absenteeism at work. She also acknowledges that there is a system in place that puts people in a position where they have to make decisions that may be harmful to themselves or others, and educating all employees of this reality helps develop workplace empathy, productivity and better employee morale.
Although trauma education can benefit institutions as a whole, it is still a lifelong personal battle to reach a resiliency where one believes they are capable of navigating their trauma in a healthy way. Currently, no “science of resilience” exists and it can be difficult to measure how an individual’s trauma will impact them in their lifetime. The Adverse Childhood Experience (ACE) questionnaire uses 10 quiz questions to measure how traumatic experiences in childhood affect health later on in life. The higher the ACE score, the greater the risk for certain health conditions. For example, high ACE scores lead to a greater chance of lung cancer or asthma. Chefalo said those who work in fields helping others tend to have higher than average ACE scores and feel a calling of service to reverse the cycle. The summit audience echoed this sentiment that although trauma is an unfortunate experience, we are capable of using our stories to build the compassion that creates a healthier society.
Chefalo envisions a world where we are better able to recognize trauma and alleviate it so those who share her experience may live productive lives. She encourages us all to educate ourselves on the systems put in place that disadvantage others and affect all of us. Listening and understanding what drives people to make decisions means we stop pointing the finger to blame and instead look internally for proactive solutions, particularly for the number of vulnerable children who are unable to make healthy decisions for themselves.
Toward the end of her talk, Chefalo asked the audience to take on a challenge of empathy. “The first stranger you see, what would happen if you went to live with them today? How long until you are comfortable there? How long would that take for you? That is what you are asking 500,000 kids to do on a daily basis,” Chefalo said as she delivered her closing remarks. “My challenge for you is not to think about what’s wrong with you or what’s happened to you, but to really embrace what’s strong in all of us…so that we come together and change the outcome of children for generations to come.”