Changing Minds Changing Lives Fostering Resilience Among Diverse

Changing Minds, Changing Lives: Fostering Resilience Among Diverse Student Populations Genevieve Chandler, RN, Ph. D College of Nursing Jim Helling, LICSW Athletic Counseling Office

Trauma-Informed Means Resilience-Focused In both treatment and wellness promotion contexts, the goal is to facilitate development of higher level adaptive action capacity.

I am from a house of mixed emotions from anger, hopes and wishes. I am from an empty mind and body once filled with life’s emotions. I am from the football field where I free my mind. From a basement where it’s quiet and [full of] thoughts From a son of a bitch who couldn’t take care of me. I am from isolation and I grew accustomed to that. I am from a life of hide and seek where my feelings hide and you seek them.

Overview • College Mental Health Systems • Black Student Mental Health @ PWIs • ACE, Identity & Equity • Resilience & Resilience Training • CMCL Research Findings • Cultural Resonance

Black Men & College Athletics (Harper et al, 2013) 3% of students 57% of football players 64% of basketball players 97. 4% of NCAA institutions graduated Black male student-athletes at lower rates.

First Generation College Students • 9% of students • 12% of White NCAA athletes • 26% of all non-White NCAA athletes • 25% of NCAA football players National Center for Education Statistics, 2013; NCAA, 2016

Black Students @ PWIs • Racism on campus • Overt and subtle hostility • Stereotype threat • Imposterism • Academic worthiness • Presumed conduct & help -seeking norms (Steve Fund and Jed Foundation, 2017; Harper, 2015 a; Beamon & Bell, 2006; Benson, 2000)

Elite College Athletes and Student Engagement • Fewer interactions with faculty • Fewer connections with non-athlete peers • Less frequent extracurricular activities • Less time in academic-related activities • Completing coursework did not lead to comparable improvements in communication and learning skills (Gayles & Hu 2009)

Psychological Health Effects • Perceived racism associated with higher levels of psychological distress (Pieterse, Todd, Neville & Carter, 2012) • Invalidating identity messages lower resilience (Brown & Tylka, 2011) • Depression more common among Black college students at PWIs (Eisenberg, Hunt & Speer, 2013) • Inverse relationship between depression and academic persistence (Eisenberg, Golberstein & Hunt, 2009)

College Mental Health: Disparities “…racial and ethnic health care disparities persist even in this setting with improved access and nearly universal insurance coverage. ” (Hunt et al, 2015)

College Mental Health: Who’s In & Who’s Out • Focus on crisis of overutilization of clinical services • Insufficient attention to students not well served by existing systems of care • Risk of perpetuating existing health disparities

Resilience & the Environment Changing the odds stacked against the individual contributes far more to changes in outcome than the capacity of individuals themselves to change Ungar et al, 2013

Opportunity Structures • Features of the environment that facilitate the expression, embodiment and realization of latent individual capacities • Promote growth, development & thriving (Ungar, et al, 2013)

Cultural Factors, Help Seeking & Success • Mental health stigma among US Blacks (Etzel, Ferrante, & Pickney, 2002) • Identity, culture and power differences with providers • Stigma against professional help-seeking • Preference for family, faith-based & community support • “I got this. ” • John Henryism (Bennett et al, 2013) • Athletic and masculine norms (Steinfeldt & Steinfeldt, 2012)

Institutional Seriousness (Harper, 2015) Clinical interventions promote individual persistence and engagement Environment for Black students at PWIs is often culturally hostile Think outside the pathologizing and culturally dissonant clinical box

Steve Fund, 2017

Representation (MH Equity Recommendation # 3) • 2% APA members identify as African-American (Center for Workforce Studies, 2018) • 7% of US clinical social workers identify as Black (Reetz, Bershad, Le. Viness &Whitlock, 2017) • College counseling staff: 15% social workers

Cultural Sensitivity and Cultural Specificity • No evidence for cultural competency training & outcomes (Papadopoulos, Tilki & Ayling, 2008; Prescott-Clements, Schuwirth, Van der Vleuten et al, 2013; Renzaho, Romios, Crock & Sønderlund, 2013; Govere & Govere, 2016) • Culture-specific models more effective than culture-sensitive (Smith, Rodriguez & Bernal, 2011)

ACE STUDY (FELITTI, ANDA ET AL. , 1998) • Joint project of Kaiser & CDC • 17, 000 HMO patients studied • Longitudinal health-effects • 10 categories of ACE • 18 negative health-related outcomes

ACE STUDY (Felitti, Anda et al, 1998) • ACE is common • ACE tends to cluster • Strong & dose-specific relationship • Physical, emotional & behavioral health ACE & Health Risk Felitti & Anda, 2007

ACE: The Original Study • • • Average of respondents: 51 75% White 4. 5% Black 100% privately insured Household dysfunction measured Reviewed lifetime health at middle age

ACE & Young Men of Color (Mersky et al, 2013) • 25% higher rate of exposure • More multiple exposures • Poorer self-rated health and life satisfaction • Anxiety & depression • Substance use & abuse

Philadelphia Urban ACE Study (Wade, Cronholm et al, 2016) • Urban ACE Original ACE • 40. 5% Witnessed violence • 34. 5% Felt discrimination • 27. 3% Unsafe neighborhood • 7. 9% Experienced bullying • 2. 5% Lived in foster care • Not measured • Not measured

ACE, Identity & Allostasis % BLACK Kaiser-CDC 5% Chicago Young Adult Male 93% Philadelphia Household* 43% 1 +ACE 64% 80% 70% 1 -3 ACE 51% 68% 48% Philadelphia Community* 83% 46% 43% * Philadelphia studies did not include question about parental separation or divorce. 3+ACE 22% 27% 32% 4+ ACE 13% 12% 22% 37%

ACE on Campus Single school n=2500 4% Black 6 questions household exposure 50% at least 1 ACE 23% multiple ACEs mean exposure 1. 77 (Forster et al, 2018) Single school NCAA athletes n=300 20% Black 10 questions household exposure 31% at least one ACE 25% multiple ACEs mean exposure 2. 1 (Kaier et al, 2015)

ACE in College Football • Single campus • NCAA Division I • n= 40, 85% Black • Mean ACE score: 4. 57 • Higher stress load with community adversity included (Chandler, Helling et al 2018)

I am from darkness From shutter windows and police sirens I am the definition of resilience. I am full of life. I am from where killings is normal.

Adversity & Resilience • Effectively coping with stressful life events builds resilience • Strengthens the action of brain systems involved in emotion regulation and behavioral control Maier & Watkins, 2010

Allostatic Load, Resilience & Health • Health is ability to respond effectively and efficiently • Repeated or prolonged stress responses degrade body • Wear & tear reduces body’s ability to respond adapt (Mc. Ewen & Stellar, 1993)

Race & Allostasis: Weathering • Disparities in ACE exposure & chronic stress • Disparities in morbidity and mortality • Not attributable to family income or wealth (Geronimus, Hicken, Keene, & Bound, 2006)

Being black in today’s society puts fear in a lot of our hearts but… If today’s my last day I am going to grind until I shine. Living in America It's the land of the free But being black you gotta be all you can be

Felitti & Anda, 2007 Many health risks & health problems are based on attempted solutions to chronic stress.

What is resilience? • Drive to thrive • Adapting successfully in the environment • Rebounding from adversity • Self-righting process (Ungar, Ghazinour, & Richter, 2013)

Changing Minds, Changing Lives (Chandler, 2009; Chandler, Roberts & Chiodo 2015) • Resilience is teachable • Builds on strengths • Appreciative Inquiry (Watkins, Mohr, & Kelly, 2011) • Experiential learning • Skills-based • Academic seminar format

My resilience story happens everyday. I am constantly bouncing back. I don’t sleep at night, bounce back, have a 6 am lift, bounce back, just got assigned so much homework I don’t even want to do it, bounce back. wasn’t a good son today bounce back, wasn’t a good boyfriend, bounce back doubt myself bounce back worry too much bounce back, then the cycle repeats…

ABCS of Resilience • Active coping • Building strengths • Cognitive awareness • Social support (Chandler et al. , 2015)

CMCL Class • Relaxation • Research • Writing • Response • Reflection

I am from somewhere I yet to understand Places I shall not go, love ones I barely know. I am from a frighten place A place where memories were hard and tough.

Methods/Results • Pre-Post design • N=13 • Outcomes included: Resilience, emotional awareness, and belonging Resilience 35 30 25 20 Pre Post • RM-ANCOVA • N=13, controlled for ACE • Age/gender not included • (homogeneous) § Resilience slightly reduced (Figure A) § comparable to other groups § Figure B shows reduction in control group

Results F = 3. 4, p = 0. 046, one-tail F = 2. 1, p = 0. 089, one-tail • Emotional awareness and sense of belonging increased across the intervention • Although sense of belonging increase was not significant, effect size was large

Emotional Decision-Making • Significant improvement pre/post • Sustained at follow-up despite higher distress • Reduced conduct violations

Narratives of Change • Time structure: “before & after” • Identity shift: from “I” to “we”

Qualitative Data: Major Themes • Opening up • Knowing oneself • Living with adversity • Deepening connections • Lasting change

We are more than football players. Individually we all have our strengths that we can use to help change the world.

CMCL and Resilience Black male athletes during the transition to college • • • Effective wellness promotion Buffers stress Improves emotion regulation Enhances coping Promotes belonging Supports self-efficacy

Institutional Seriousness: CMCL Scaffolds peer group-based cultural mirroring & resonance Shows promise as a culturally resonant resilience model Equity in Mental Health Framework Recommendations #7 & #9 Further research in process

I opened up more than usual as I found a mind clearing tool. Learned about life This class has shown me that taking your time to about sleep Being able toon seeyour these guys slow down. Learned and look and reflect life grow in is well worth while. Learnedwritings, aboutresiliency, peace and mindfulness is a thing of beauty. The stuff that we have learned in this class I have My experience I learned about me implemented it into my everyday life in this class has helped me In cope with stress class a lot of days. through daily. I go people went deep I feel like I can go and lean on people… I am proud to be a Minuteman. I can count on my team for anything now.

Mirroring “…see[ing] oneself in the face of another, a process of being shown and knowing oneself through interactions with another” (Winnicott, 1989)

Folks were talking about serious and personal things and everyone was open. Everyone was like “We are all ok with this, we can do this and support each other. ”

Resonance Emergent, mutual, facilitative influence Allows presence of the other to serve as opportunity structure

The transition from high school to college is really difficult and to have people you really get along with is helpful, to have someone you can really lean on. We need a class to help adjust. It’s hard to transition and be around thousands of new people and be comfortable because it’s hard to even be comfortable with your uber driver.

When I first got there I didn’t like expressing myself. Hearing everyone’s experiences helped me open up. To really meet each other and open up and build a brotherhood based on sharing and expressing yourself has helped me to stay poised throughout the day.

Decentered Authority & Locus of Change • Sharing personal narratives in supportive environment • Norms of attunement, authenticity, openness, acceptance • Shared identity enhanced student experience • No evidence that facilitator identity affected core outcomes

Before I never looked forward to coming to class but this one I did. This class was a major help to get me out of my comfort zone and move to another. In the past I was hard on myself, I could never notice my rights. You guys taught me that positivity is key to progression.

UMass Resilience Team • Mary O’Connor, LMHC, Holyoke Community College • Derek Doughty, Ph. D Candidate, Dept of Anthropology & Case Manager for Athletics, Dean of Students Office • Nellie Lewis, Ph. D Student, College of Nursing • Adrial Lobelo, RN, Ph. D Student, College of Nursing • Maddie Vale, Undergraduate Student, College of Nursing • Samantha Allen, Undergraduate Student, College of Nursing & NCAA Division I Athlete