As the world faced stay-at-home orders in March 2020, communities across the country witnessed expanded attention that was called to what is essentially dual pandemics, the COVID-19 pandemic and racism as a public health crisis. Inequities that contribute to the social determinants of health were already present, but the pandemic further widened disparities that continue to contribute to poor social and health outcomes in marginalized communities.
While great awareness has been raised around trauma-informed policy and practice over the past few years, we must acknowledge that this approach is incomplete. Today, communities across the state are raising their voices on behalf of much needed acknowledgment of the systemic inequities that perpetuate toxic systems and policy, and practices that reinforce the root cause of trauma and cause harm. Equality gives everyone the same exact resources. Equity acknowledges the disparities affiliated with oppression and inequality and, therefore, distributes resources based off of the needs of the recipients so that everyone can achieve their full potential in life regardless of race, ethnicity or the community in which they live.
While the COVID-19 pandemic presents economic challenges, Virginia is poised to reconcile hundreds of years of exacerbated inequities in order to correct the disparities that are further heightened today. Our talking points for the 2021 legislative session will focus on these themes:
According to a 2019 Pew Research survey, roughly eight in ten people who identify as Black with some college experience (81 percent) reported that they have experienced some form of racial discrimination from time to time with 17 percent reporting that this happens to them regularly. The American Public Health Association defines racism as a social system with multiple complex dimensions, including internalized or interpersonal individual racism, institutional or structural systemic racism, which unfairly disadvantages some individuals and communities and unfairly advantages other individuals and communities. It ultimately decreases the strength of our whole society through investments that do not address the root cause of trauma, which further contributes to multi-disciplinary disparities.
Racism As A Public Health Crisis: Delegate Aird introduced a resolution during special session to declare racism as a public health crisis. It included numerous steps that Virginia can take to address systemic racism and its impact on public health, including the examination of racial inequity in Virginia law, implicit bias training for public employees and officials, a glossary of terms specific to racism and health equity and engagement with communities most impacted.
A prolonged activation of an individual’s stress response system in the body and brain without buffering can cause toxic stress to a child’s brain, which can disrupt the immune system, the ability to learn, and even the way DNA is read and transcribed. This is referred to as trauma. In addition, racial trauma refers to the ongoing impact of racism, racist bias, and the exposure to racist abuse. This can impact a person’s ability to develop authentic relationships, feel safe, and even live a long and healthy life.
According to the KIDS COUNT Data Center’s indicators, which include socioeconomic hardship, family violence, neighborhood violence and racist bias, 19 percent of Virginia’s children experience two or more adverse childhood experiences (ACEs). However, in 2017 to 2018, 37 percent of Black children experienced two or more ACEs, which is almost double the rate of trauma that all children experienced. ACEs can contribute to toxic stress in the brain, which is known as trauma. According to the CDC-Kaiser Permanent Adverse Childhood Experiences (ACE) Study, trauma is connected to long-term negative physical, social and emotional health outcomes.
Governor’s Children’s Cabinet: The Governor’s Children’s Cabinet, which is chaired by First Lady Pamela Northam has made great strides in promoting wraparound services that children need, including food insecurity, trauma-informed systems and school readiness. Virginia should make the Governor’s Children’s Cabinet permanent and create a position for a Chief Advisor in order to continue this momentum in ensuring children and families have access to the services they need to thrive.
In 2019, Virginia Mercury reported that Black women in Virginia were three times more likely to die after giving birth than a white women, a disparity that Governor Northam made a goal to eliminate by 2025. Home visiting is a voluntary, evidence-based program that supports low-income pregnant women and parents of children birth age to five to access the resources needed to raise children who are healthy and ready to learn. Governor Northam’s 2021 budget proposal includes $2.4 million to increase access to doula care for pregnant women, which also reduces racial disparities in maternal health. What the COVID-19 pandemic has proven is that racial and ethnic disparities already contribute to poor health outcomes. Investing in these supports is a step in the right direction to shorten that gap.
Foster Positive Health Outcomes: Virginia is poised to support the Governor’s budget proposal to increase access to doula care for pregnant women through Medicaid. In addition, Virginia can take additional steps to liaise the gap in maternal and infant health disparities by fostering familial resiliency through Medicaid reimbursement for home visiting services.
The Virginia Heals goal is to bring healthcare, child welfare, justice and other systems together to coordinate and align efforts to ensure a timely and seamless response to young victims, their families, and caregivers regardless of the system that they may engage with or enter. The program offers a number of services, including resource mapping, screening for trauma, referral and response, agency assessments, family engagement, grant development and more, including COVID-19 interventions.
The Governor’s budget proposal includes $517,553 in FY22 to provide general fund support to the Virginia Helping Everyone Access Services (HEALS) program.
Support Early Identification and Intervention: We know that our communities and public entities are facing challenges in adjusting to the hardships of the COVID-19 pandemic. Now, more than ever, our systems of care should be cohesive and easy to navigate for those who need them. Virginia can adopt and support early identification and intervention as it relates to easing the trauma and victimization that community members may experience.
The Family and Children’s Trust (FACT) Fund is the only public/private entity that addresses trauma across a lifespan and the only organization that provides funding to Virginia’s 27 trauma-informed community networks across the state. These are multi-disciplinary networks that convene professionals in order to develop community-level trauma-informed approaches to services and best practices. Trauma is caused by an acute event or a combination of events. Virginia’s history includes historical, cultural, and intergenerational trauma that is passed down through generations, including the arrival of the first enslaved Africans to Old Point Comfort, now Ft. Monroe in Hampton, Virginia.
Today, communities face compound trauma in the wake of the pandemic as a trauma, economic trauma and more. Epigenetics is the study of how one’s behavior and environment can cause changes that affect the way their genes work, which can further impact a child’s stress response system and contribute to challenges, such as anxiety and stress. However, a loving, healthy and safe environment can promote intervention. Community networks have played an imperative role in fostering family economic security through COVID-19 interventions, including educational programming to foster community resilience, in addition to facilitating referral and response programs to help families meet their basic needs through emergency grant funds and services.
Fund Community Partnerships: While funding for community-based networks occurred during the 2020 General Assembly through approval for five communities to decide to allow casinos through a voter referendum, this funding will not be seen immediately and instead in about four to five years. However, Virginia is poised to promote the urgent financial stability communities need now through investments in FACT funding for community partnerships, which will include technical assistance to community networks and funding for COVID-19 interventions through referral and response resources to combat economic challenges and break cycles of intergenerational trauma.
In 2019, when accounting for the population of children that were chronically absent from school in the 4th grade, of that population 9 percent are Asian and Pacific Islander, 30 percent are Black, 31 percent are Hispanic or Latinx, 23 percent are Non-Hispanic white, and 28 percent are two or more races. Several factors contribute to chronic absenteeism, including chronic illness, poor transportation, a lack of access to mental health services, involvement in juvenile justice systems, negative school experiences, a lack of engagement and misconceptions that absences are only a problem if they are unexcused. Contributing to community-level prevention and wraparound resources that increase family engagement will contribute to an authentic solution rather than punitive policy and zero tolerance interventions.
Address unintentional biases that can lead to additional trauma for children: As our systems seek solutions to liaise disruptions in educational settings that lead to chronic absenteeism, such as housing and other supports, we must ensure these interventions do not inadvertently widen cultural, racial and ethnic disparities. We need to ensure policy responses do not contribute to unintended consequences, such as the school-to-prison pipeline.
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