WEBVTT 00:00:07.000 --> 00:00:09.000 my background is I was in an 00:00:09.000 --> 00:00:10.000 ER nurse I am an ER nurse 00:00:10.000 --> 00:00:12.000 I did that for almost eighteen 00:00:12.000 --> 00:00:14.000 years at rush health systems 00:00:14.000 --> 00:00:18.000 in Meridian Mississippi -- in 2002 working 00:00:18.000 --> 00:00:20.000 as a staff nurse in the ER 00:00:20.000 --> 00:00:21.000 which I thought would be my 00:00:21.000 --> 00:00:23.000 end all career I would just 00:00:23.000 --> 00:00:25.000 tootle around the ER 00:00:25.000 --> 00:00:26.000 take care of trauma patients 00:00:26.000 --> 00:00:28.000 adrenaline blood and guts 00:00:28.000 --> 00:00:32.000 kind of stuff -- but in 2002 I was volun 00:00:32.000 --> 00:00:33.000 told to go to a class -- it 00:00:33.000 --> 00:00:35.000 was a sexual assault nurse 00:00:35.000 --> 00:00:37.000 examiner class or SANE course 00:00:37.000 --> 00:00:39.000 and I realized at that point 00:00:39.000 --> 00:00:41.000 actually by about Wednesday 00:00:41.000 --> 00:00:43.000 of that class as an emergency 00:00:43.000 --> 00:00:46.000 room nurse we were missing an 00:00:46.000 --> 00:00:48.000 entire population of trauma 00:00:48.000 --> 00:00:50.000 victims and we were missing 00:00:50.000 --> 00:00:52.000 healthcare issues that were 00:00:52.000 --> 00:00:55.000 related back to trauma so this 00:00:55.000 --> 00:00:58.000 is where my career -- took 00:00:58.000 --> 00:00:59.000 a bootleg turn completely 00:00:59.000 --> 00:00:61.000 derailed and the most positive 00:01:01.000 --> 00:01:04.000 way -- so we grew short 00:01:04.000 --> 00:01:06.000 story we grow a SANE program 00:01:06.000 --> 00:01:07.000 sexual assault nurse examiner 00:01:07.000 --> 00:01:09.000 program in our hospital where 00:01:09.000 --> 00:01:11.000 we went from taking care of 00:01:11.000 --> 00:01:13.000 a few adult sexual assault 00:01:13.000 --> 00:01:16.000 patients to hundreds of a 00:01:16.000 --> 00:01:17.000 sexual assault patients that 00:01:17.000 --> 00:01:20.000 were from pediatric to elderly 00:01:20.000 --> 00:01:22.000 I did that till 2013 00:01:22.000 --> 00:01:26.000 from 2010-2013 in the ER 00:01:26.000 --> 00:01:28.000 I did nothing but forensics 00:01:28.000 --> 00:01:29.000 which means that I only 00:01:29.000 --> 00:01:31.000 took care of -- interpersonal 00:01:31.000 --> 00:01:33.000 violence patients which 00:01:33.000 --> 00:01:35.000 included strangulation domestic 00:01:35.000 --> 00:01:37.000 violence child abuse sexual 00:01:37.000 --> 00:01:39.000 abuse adults and pediatrics 00:01:39.000 --> 00:01:41.000 in 2010 my full time 00:01:41.000 --> 00:01:43.000 job became the state SANE 00:01:43.000 --> 00:01:45.000 coordinator for Mississippi 00:01:45.000 --> 00:01:48.000 so now my full time job is 00:01:48.000 --> 00:01:49.000 the responsibility of doing 00:01:49.000 --> 00:01:51.000 what I'm doing here -- which 00:01:51.000 --> 00:01:53.000 is educating many different 00:01:53.000 --> 00:01:55.000 agencies on interpersonal 00:01:55.000 --> 00:01:57.000 violence as well as providing 00:01:57.000 --> 00:01:59.000 technical assistance and then 00:01:59.000 --> 00:01:61.000 I do some consulting work so 00:02:01.000 --> 00:02:02.000 I get to come out to Western 00:02:02.000 --> 00:02:04.000 Oregon University -- I get 00:02:04.000 --> 00:02:06.000 to go to -- other states and 00:02:06.000 --> 00:02:08.000 do education and partner with 00:02:08.000 --> 00:02:09.000 department of justice and other 00:02:09.000 --> 00:02:12.000 organizations but I also do 00:02:12.000 --> 00:02:13.000 a lot of work with department 00:02:13.000 --> 00:02:15.000 of defense -- doing a lot of 00:02:15.000 --> 00:02:17.000 testimony a military court 00:02:17.000 --> 00:02:19.000 marshals on interpersonal 00:02:19.000 --> 00:02:20.000 violence from pediatrics to 00:02:20.000 --> 00:02:22.000 adults strangulation and pretty 00:02:22.000 --> 00:02:24.000 much everything in between so 00:02:24.000 --> 00:02:26.000 I get my hands on a lot of 00:02:26.000 --> 00:02:28.000 different areas and the cool 00:02:28.000 --> 00:02:30.000 thing about doing that is 00:02:30.000 --> 00:02:32.000 whenever I do education I also 00:02:32.000 --> 00:02:34.000 try to learn what works and 00:02:34.000 --> 00:02:36.000 what doesn't and the places 00:02:36.000 --> 00:02:38.000 where I'm working so I've 00:02:38.000 --> 00:02:39.000 already learned some things 00:02:39.000 --> 00:02:41.000 about Western Oregon University 00:02:41.000 --> 00:02:43.000 mainly about the student 00:02:43.000 --> 00:02:44.000 advocacy program -- these are 00:02:44.000 --> 00:02:46.000 take aways that I can take 00:02:46.000 --> 00:02:48.000 back home and utilize and other 00:02:48.000 --> 00:02:50.000 areas as well so when Tina 00:02:50.000 --> 00:02:51.000 asked me to come in and speak 00:02:51.000 --> 00:02:54.000 today I said well exactly what 00:02:54.000 --> 00:02:56.000 are we looking at for this 00:02:56.000 --> 00:02:58.000 group and it's how to respond 00:02:58.000 --> 00:02:62.000 when there is a disclosure or 00:03:02.000 --> 00:03:04.000 a suspicion of a sexual assault 00:03:04.000 --> 00:03:07.000 and what that looks like and 00:03:07.000 --> 00:03:08.000 the student population 00:03:08.000 --> 00:03:11.000 well that's trauma informed care 00:03:11.000 --> 00:03:14.000 so when we start looking at what 00:03:14.000 --> 00:03:16.000 trauma informed care means it 00:03:16.000 --> 00:03:18.000 means approaching or engaging 00:03:18.000 --> 00:03:21.000 with someone based on what has 00:03:21.000 --> 00:03:23.000 happened to them as opposed 00:03:23.000 --> 00:03:26.000 to what is wrong with them and 00:03:26.000 --> 00:03:27.000 that's what we look at with 00:03:27.000 --> 00:03:29.000 interpersonal violence it's 00:03:29.000 --> 00:03:30.000 not that there's something 00:03:30.000 --> 00:03:32.000 wrong with the person that 00:03:32.000 --> 00:03:35.000 was victimized but something 00:03:35.000 --> 00:03:36.000 has happened to that person 00:03:36.000 --> 00:03:38.000 and the engagement with that 00:03:38.000 --> 00:03:40.000 person from that concept 00:03:40.000 --> 00:03:43.000 basically approaches them from 00:03:43.000 --> 00:03:45.000 there's nothing wrong with you 00:03:45.000 --> 00:03:47.000 but something has happened to 00:03:47.000 --> 00:03:49.000 you we need to know what that 00:03:49.000 --> 00:03:51.000 is in order to move forward 00:03:51.000 --> 00:03:54.000 we also want to look at that 00:03:54.000 --> 00:03:58.000 as what exactly is traumatic stress 00:03:58.000 --> 00:03:59.000 what is a trauma 00:03:59.000 --> 00:03:61.000 it can be a physical trauma 00:04:01.000 --> 00:04:04.000 it can be a psychological trauma 00:04:04.000 --> 00:04:06.000 it can be a witness to a 00:04:06.000 --> 00:04:08.000 trauma it can be an affiliation 00:04:08.000 --> 00:04:10.000 with someone or something that 00:04:10.000 --> 00:04:13.000 has experienced a trauma so 00:04:13.000 --> 00:04:15.000 it doesn't have to be that 00:04:15.000 --> 00:04:17.000 your interaction will only 00:04:17.000 --> 00:04:20.000 be victim focused it could be 00:04:20.000 --> 00:04:23.000 that you have a student or a 00:04:23.000 --> 00:04:25.000 staff member and a peer or 00:04:25.000 --> 00:04:28.000 partner experience some type 00:04:28.000 --> 00:04:29.000 of interpersonal violence 00:04:29.000 --> 00:04:31.000 and they are taking on that 00:04:31.000 --> 00:04:34.000 trauma as well when we look 00:04:34.000 --> 00:04:36.000 at sexual assault in the 00:04:36.000 --> 00:04:38.000 collegiate community and we 00:04:38.000 --> 00:04:40.000 know that this age group the 00:04:40.000 --> 00:04:42.000 sixteen to twenty four year old 00:04:42.000 --> 00:04:44.000 age group is at the 00:04:44.000 --> 00:04:48.000 highest -- group to experience 00:04:48.000 --> 00:04:51.000 a sexual assault this age group 00:04:51.000 --> 00:04:53.000 doesn't make the decisions 00:04:53.000 --> 00:04:55.000 that we think they should when 00:04:55.000 --> 00:04:56.000 they have this experience 00:04:56.000 --> 00:04:58.000 we now have science behind that 00:04:58.000 --> 00:04:60.000 that explains that but we 00:05:00.000 --> 00:05:03.000 also have to look at where 00:05:03.000 --> 00:05:05.000 this group is and there are 00:05:05.000 --> 00:05:08.000 social dynamics and the culture 00:05:08.000 --> 00:05:10.000 what they came from before 00:05:10.000 --> 00:05:11.000 we encountered them in the 00:05:11.000 --> 00:05:13.000 collegiate setting so we want 00:05:13.000 --> 00:05:16.000 to know how to help this group 00:05:16.000 --> 00:05:19.000 but they need to know how to 00:05:19.000 --> 00:05:20.000 approach us for that help 00:05:20.000 --> 00:05:24.000 are we even approachable to them 00:05:24.000 --> 00:05:25.000 so exactly what are we going to be 00:05:25.000 --> 00:05:28.000 asking those students what is 00:05:28.000 --> 00:05:30.000 the confidentiality for those student 00:05:30.000 --> 00:05:31.000 what are the students 00:05:31.000 --> 00:05:33.000 expected to disclose where is 00:05:33.000 --> 00:05:35.000 this information going to go 00:05:35.000 --> 00:05:37.000 and in this age group 00:05:37.000 --> 00:05:39.000 are you gonna tell my parents 00:05:39.000 --> 00:05:42.000 is this gonna get back to home because 00:05:42.000 --> 00:05:44.000 if that happens I'm not gonna 00:05:44.000 --> 00:05:47.000 be able to stay here at Western Oregon University 00:05:47.000 --> 00:05:49.000 that gonna change those dynamics 00:05:49.000 --> 00:05:51.000 its very interesting because I do 00:05:51.000 --> 00:05:52.000 a lot of work with a lot of 00:05:52.000 --> 00:05:55.000 different age groups this age 00:05:55.000 --> 00:05:58.000 group has a thought concept very 00:05:58.000 --> 00:05:61.000 similar to elder victims of 00:06:01.000 --> 00:06:03.000 violence if you think about 00:06:03.000 --> 00:06:06.000 it if a college age students 00:06:06.000 --> 00:06:09.000 discloses some type of an event 00:06:09.000 --> 00:06:11.000 on a college campus that would 00:06:11.000 --> 00:06:13.000 make mom or dad say no 00:06:13.000 --> 00:06:14.000 I'm gonna pluck you out of that 00:06:14.000 --> 00:06:15.000 environment bring you back 00:06:15.000 --> 00:06:17.000 home where I can keep you safe 00:06:17.000 --> 00:06:18.000 and they know this they're not 00:06:18.000 --> 00:06:19.000 going to want to come forward 00:06:19.000 --> 00:06:22.000 with that information our elder 00:06:22.000 --> 00:06:24.000 population if they disclose 00:06:24.000 --> 00:06:25.000 that there's been an episode 00:06:25.000 --> 00:06:28.000 of violence then the kids want 00:06:28.000 --> 00:06:31.000 to take mom or dad and put them 00:06:31.000 --> 00:06:33.000 in a safer place as well 00:06:33.000 --> 00:06:35.000 so it's really interesting when 00:06:35.000 --> 00:06:37.000 you look at that mindset that 00:06:37.000 --> 00:06:40.000 we're seeing through those goggles 00:06:40.000 --> 00:06:41.000 when students have 00:06:41.000 --> 00:06:43.000 an event happen obviously we 00:06:43.000 --> 00:06:45.000 want them to reach out and get 00:06:45.000 --> 00:06:46.000 help and and I apologize I did 00:06:46.000 --> 00:06:47.000 touch the mic I'll try not 00:06:47.000 --> 00:06:49.000 to muffle the mic -- but when 00:06:49.000 --> 00:06:52.000 students have an event and I 00:06:52.000 --> 00:06:54.000 I would love to say if 00:06:54.000 --> 00:06:56.000 but we all know the reality -- 00:06:56.000 --> 00:06:58.000 one in four one in five college 00:06:58.000 --> 00:06:60.000 age students are sexually 00:07:00.000 --> 00:07:01.000 assaulted when this event 00:07:01.000 --> 00:07:04.000 happens where they're gonna go 00:07:04.000 --> 00:07:06.000 hopefully to those that 00:07:06.000 --> 00:07:07.000 can help them that can help 00:07:07.000 --> 00:07:08.000 them and give them the help 00:07:08.000 --> 00:07:11.000 that they need if you are the 00:07:11.000 --> 00:07:14.000 recipient of this information 00:07:14.000 --> 00:07:15.000 what is your responsibility 00:07:15.000 --> 00:07:18.000 to that student it is to first 00:07:18.000 --> 00:07:22.000 and foremost start by believing 00:07:22.000 --> 00:07:23.000 the very first thing that a 00:07:23.000 --> 00:07:25.000 sexual assault victim 00:07:25.000 --> 00:07:27.000 and this age group or really 00:07:27.000 --> 00:07:29.000 any age group should hear is 00:07:29.000 --> 00:07:31.000 I believe you I believe you 00:07:31.000 --> 00:07:34.000 very powerful words when they 00:07:34.000 --> 00:07:36.000 did -- I think the CDC or 00:07:36.000 --> 00:07:38.000 might have been RAINN did a poll of 00:07:38.000 --> 00:07:39.000 college age students it was a 00:07:39.000 --> 00:07:42.000 random poll -- it was privacy 00:07:42.000 --> 00:07:44.000 guaranteed so there was no 00:07:44.000 --> 00:07:46.000 identifying information it was 00:07:46.000 --> 00:07:50.000 those that have experienced a sexual assault 00:07:50.000 --> 00:07:54.000 who is the person that you told 00:07:54.000 --> 00:07:57.000 most of the students didn't say I ran 00:07:57.000 --> 00:07:59.000 to a faculty member I ran to 00:07:59.000 --> 00:07:60.000 the advocacy center I ran 00:08:00.000 --> 00:08:02.000 to the health center 00:08:02.000 --> 00:08:04.000 they told a peer 00:08:04.000 --> 00:08:05.000 the next question in 00:08:05.000 --> 00:08:08.000 this survey was what was the 00:08:08.000 --> 00:08:11.000 response of the peer 00:08:11.000 --> 00:08:14.000 guess what the most common response was 00:08:14.000 --> 00:08:18.000 are you sure are you sure 00:08:18.000 --> 00:08:21.000 not I'm really sorry 00:08:21.000 --> 00:08:22.000 not are you hurt 00:08:22.000 --> 00:08:24.000 not where do we go next 00:08:24.000 --> 00:08:26.000 not I believe you but are you sure 00:08:26.000 --> 00:08:28.000 it's interesting I don't 00:08:28.000 --> 00:08:30.000 think we would say that to 00:08:30.000 --> 00:08:32.000 any other crime victim if a 00:08:32.000 --> 00:08:34.000 student came up and said hey my 00:08:34.000 --> 00:08:35.000 laptop was stolen we wouldn't 00:08:35.000 --> 00:08:37.000 go are you sure 00:08:37.000 --> 00:08:39.000 did you set it down somewhere 00:08:39.000 --> 00:08:41.000 is it under your bed 00:08:41.000 --> 00:08:42.000 we go oh my goodness where were you 00:08:42.000 --> 00:08:43.000 what happened we need to go 00:08:43.000 --> 00:08:44.000 call the police right now we 00:08:44.000 --> 00:08:45.000 need to get your laptop back 00:08:45.000 --> 00:08:46.000 oh my goodness don't let it be 00:08:46.000 --> 00:08:48.000 a cell phone that's going to 00:08:48.000 --> 00:08:51.000 stop the world right there 00:08:51.000 --> 00:08:53.000 so build that relationship open 00:08:53.000 --> 00:08:56.000 the discussion can you tell me 00:08:56.000 --> 00:08:58.000 more about that as a medical 00:08:58.000 --> 00:08:61.000 provider we're taught how to talk 00:09:01.000 --> 00:09:03.000 to people in a trauma state 00:09:03.000 --> 00:09:04.000 and the best way to talk to 00:09:04.000 --> 00:09:07.000 someone in a trauma state is open 00:09:07.000 --> 00:09:10.000 ended questions let them lead 00:09:10.000 --> 00:09:12.000 the dialogue and it's difficult 00:09:12.000 --> 00:09:13.000 for people to talk about 00:09:13.000 --> 00:09:15.000 violence is a difficult subject 00:09:15.000 --> 00:09:17.000 to talk about when you're not 00:09:17.000 --> 00:09:18.000 experiencing this but when 00:09:18.000 --> 00:09:20.000 the person is experiencing 00:09:20.000 --> 00:09:22.000 this it is obviously very 00:09:22.000 --> 00:09:24.000 difficult to talk about 00:09:24.000 --> 00:09:27.000 what information do you need as 00:09:27.000 --> 00:09:29.000 staff and faculty and what 00:09:29.000 --> 00:09:30.000 I didn't add in here and I'm 00:09:30.000 --> 00:09:32.000 sure it goes without saying 00:09:32.000 --> 00:09:35.000 it is your responsibility as 00:09:35.000 --> 00:09:37.000 mandated reporters and before 00:09:37.000 --> 00:09:39.000 that dialogue even gets started 00:09:39.000 --> 00:09:41.000 what is my responsibility to 00:09:41.000 --> 00:09:43.000 this organization and based 00:09:43.000 --> 00:09:44.000 on the policies and procedures 00:09:44.000 --> 00:09:46.000 that we have in place but if 00:09:46.000 --> 00:09:48.000 that dialogue opens up and this 00:09:48.000 --> 00:09:51.000 person comes forward this is 00:09:51.000 --> 00:09:53.000 what happened to me then what 00:09:53.000 --> 00:09:55.000 can what can you tell me about 00:09:55.000 --> 00:09:57.000 that or can you tell me more 00:09:57.000 --> 00:09:58.000 about that or what would you 00:09:58.000 --> 00:09:60.000 like to share with me about 00:10:00.000 --> 00:10:03.000 that it's also very important 00:10:03.000 --> 00:10:05.000 that the language conveyed to 00:10:05.000 --> 00:10:07.000 that victim of violence is not 00:10:07.000 --> 00:10:09.000 judgmental it is not important 00:10:09.000 --> 00:10:11.000 where they were 00:10:11.000 --> 00:10:12.000 how they were dressed 00:10:12.000 --> 00:10:14.000 how much they had to drink 00:10:14.000 --> 00:10:15.000 none of that matters 00:10:15.000 --> 00:10:17.000 when we look at the dynamics 00:10:17.000 --> 00:10:19.000 of sexual assault it is not 00:10:19.000 --> 00:10:22.000 victim responsibility the 00:10:22.000 --> 00:10:25.000 responsibility and the blame of 00:10:25.000 --> 00:10:27.000 a sexual assault fall solely on 00:10:27.000 --> 00:10:29.000 the perpetrator that is the one 00:10:29.000 --> 00:10:31.000 in control of this event that 00:10:31.000 --> 00:10:32.000 is the one that facilitates 00:10:32.000 --> 00:10:35.000 that crime it doesn't matter 00:10:35.000 --> 00:10:37.000 who someone is with how much 00:10:37.000 --> 00:10:39.000 they had to drink what they 00:10:39.000 --> 00:10:41.000 were wearing - fashion does 00:10:41.000 --> 00:10:44.000 not provoke sexual violence 00:10:44.000 --> 00:10:45.000 sexual violence is strictly 00:10:45.000 --> 00:10:47.000 provoked by the perpetrator 00:10:47.000 --> 00:10:49.000 and that desire to have power 00:10:49.000 --> 00:10:51.000 and control over someone 00:10:51.000 --> 00:10:53.000 understand the patient's the 00:10:53.000 --> 00:10:55.000 victim's perspective and me being 00:10:55.000 --> 00:10:58.000 a nurse patient is my word so 00:10:58.000 --> 00:10:60.000 you will see that interspersed 00:11:00.000 --> 00:11:01.000 throughout this presentation 00:11:01.000 --> 00:11:03.000 where are you going to provide 00:11:03.000 --> 00:11:04.000 this information to be honest 00:11:04.000 --> 00:11:07.000 about that and then a closure 00:11:07.000 --> 00:11:08.000 how do you close after getting 00:11:08.000 --> 00:11:11.000 a disclosure you go well that 00:11:11.000 --> 00:11:13.000 was bad have a good day 00:11:13.000 --> 00:11:14.000 don't forget to get a term paper due 00:11:14.000 --> 00:11:16.000 nope that's not the way 00:11:16.000 --> 00:11:18.000 to handle that 00:11:18.000 --> 00:11:20.000 I am so sorry 00:11:20.000 --> 00:11:22.000 this happened to you 00:11:22.000 --> 00:11:24.000 is there anything else I can do 00:11:24.000 --> 00:11:26.000 are you safe do you feel safe now 00:11:26.000 --> 00:11:28.000 do we need to look at getting you to 00:11:28.000 --> 00:11:31.000 a safer place what about help 00:11:31.000 --> 00:11:32.000 did you go to the health care 00:11:32.000 --> 00:11:35.000 facility did you get a forensic 00:11:35.000 --> 00:11:37.000 medical exam let's talk about the 00:11:37.000 --> 00:11:39.000 available resources for that 00:11:39.000 --> 00:11:41.000 the most important thing that 00:11:41.000 --> 00:11:43.000 this client student patient 00:11:43.000 --> 00:11:46.000 victim survivor can experience 00:11:46.000 --> 00:11:49.000 at this point is advocacy 00:11:49.000 --> 00:11:51.000 and medical care medical care 00:11:51.000 --> 00:11:53.000 because we don't know what 00:11:53.000 --> 00:11:55.000 they could have been exposed to 00:11:55.000 --> 00:11:56.000 during this event of a sexual 00:11:56.000 --> 00:11:58.000 assault regardless of how 00:11:58.000 --> 00:11:60.000 long ago that was -- we have 00:12:00.000 --> 00:12:02.000 a whole lot of infections out there 00:12:02.000 --> 00:12:05.000 some are curable some are not 00:12:05.000 --> 00:12:07.000 some what we can prophylacticly 00:12:07.000 --> 00:12:09.000 or preventatively treat 00:12:09.000 --> 00:12:10.000 and hope they don't get them 00:12:10.000 --> 00:12:12.000 some we don't but a medical 00:12:12.000 --> 00:12:14.000 provider can educate that 00:12:14.000 --> 00:12:16.000 student on what's out there 00:12:16.000 --> 00:12:18.000 what's available where the 00:12:18.000 --> 00:12:20.000 testing is what the time frame 00:12:20.000 --> 00:12:22.000 is and get that student the 00:12:22.000 --> 00:12:23.000 medical advice or the medical 00:12:26.000 --> 00:12:28.000 when we start looking at the 00:12:28.000 --> 00:12:29.000 students coming in and having 00:12:29.000 --> 00:12:31.000 conversations with us about 00:12:31.000 --> 00:12:33.000 especially about this type of event 00:12:33.000 --> 00:12:36.000 think about what it 00:12:36.000 --> 00:12:39.000 looks like to get to you 00:12:39.000 --> 00:12:41.000 what does that look like from the 00:12:41.000 --> 00:12:43.000 student perspective I'm gonna 00:12:43.000 --> 00:12:45.000 pick on Tina just a little bit 00:12:45.000 --> 00:12:46.000 because I've been to her office 00:12:46.000 --> 00:12:48.000 the most so when you walk into 00:12:48.000 --> 00:12:50.000 that office were Tina is there 00:12:50.000 --> 00:12:52.000 someone sitting at the desk 00:12:52.000 --> 00:12:53.000 right there how much is that 00:12:53.000 --> 00:12:56.000 student expected to disclose 00:12:56.000 --> 00:12:58.000 before she gets to Tina and 00:12:58.000 --> 00:12:60.000 how open is that area and is 00:13:00.000 --> 00:13:03.000 there a plan in place that 00:13:03.000 --> 00:13:04.000 if a student wants to come in 00:13:04.000 --> 00:13:06.000 on and share something that's 00:13:06.000 --> 00:13:08.000 private that's confidential 00:13:08.000 --> 00:13:09.000 that this student may have 00:13:09.000 --> 00:13:12.000 difficult disclosing what does 00:13:12.000 --> 00:13:14.000 it look like environmentally 00:13:14.000 --> 00:13:16.000 is there a plan in place where 00:13:16.000 --> 00:13:17.000 they can write down something 00:13:17.000 --> 00:13:19.000 and hand it without having to 00:13:19.000 --> 00:13:21.000 say it out loud and then what 00:13:21.000 --> 00:13:23.000 does the path look like to 00:13:23.000 --> 00:13:25.000 get to Tina's office now you 00:13:25.000 --> 00:13:26.000 can count some steps get into 00:13:26.000 --> 00:13:28.000 Tina's office she's kinda down 00:13:28.000 --> 00:13:29.000 the hall and through this way 00:13:29.000 --> 00:13:31.000 and then back in the corner 00:13:31.000 --> 00:13:34.000 what if that were an open area 00:13:34.000 --> 00:13:36.000 and it's obvious who Tina is 00:13:36.000 --> 00:13:38.000 and let's say it's obvious that 00:13:38.000 --> 00:13:40.000 Tina investigates these types 00:13:40.000 --> 00:13:43.000 of allegations are there other 00:13:43.000 --> 00:13:44.000 students that are going to see 00:13:44.000 --> 00:13:46.000 the student trekking down there 00:13:46.000 --> 00:13:48.000 are is this pretty much even 00:13:48.000 --> 00:13:50.000 though with the confidentiality 00:13:50.000 --> 00:13:51.000 people are going to figure 00:13:51.000 --> 00:13:53.000 out what the student is going 00:13:53.000 --> 00:13:55.000 there to disclose so what kind 00:13:55.000 --> 00:13:58.000 of privacy is in place that 00:13:58.000 --> 00:13:60.000 will keep the student or 00:14:00.000 --> 00:14:01.000 guide the student to be able 00:14:01.000 --> 00:14:04.000 to disclose and not interfere 00:14:04.000 --> 00:14:06.000 with the student's desire to 00:14:06.000 --> 00:14:08.000 get to that point how many 00:14:08.000 --> 00:14:09.000 people does the student need 00:14:09.000 --> 00:14:12.000 to talk to before they get 00:14:12.000 --> 00:14:14.000 to the one that can help them 00:14:14.000 --> 00:14:16.000 or assist them and how much 00:14:16.000 --> 00:14:18.000 are they expected to disclose 00:14:18.000 --> 00:14:20.000 before that student when I do 00:14:20.000 --> 00:14:22.000 education with law enforcement 00:14:22.000 --> 00:14:24.000 and with hospitals and I do 00:14:24.000 --> 00:14:27.000 this part of the content 00:14:27.000 --> 00:14:28.000 it's amazing to me how many 00:14:28.000 --> 00:14:30.000 people say you know what if 00:14:30.000 --> 00:14:32.000 you walk in our hospital if you 00:14:32.000 --> 00:14:35.000 walk into our police station 00:14:35.000 --> 00:14:38.000 there's zero privacy so the 00:14:38.000 --> 00:14:40.000 two organizations that we tell 00:14:40.000 --> 00:14:43.000 victims to go to have the least 00:14:43.000 --> 00:14:46.000 amount of privacy for them to 00:14:46.000 --> 00:14:48.000 tell about this horrific crime 00:14:48.000 --> 00:14:49.000 so think about that with your 00:14:49.000 --> 00:14:52.000 office as well if you are the 00:14:52.000 --> 00:14:55.000 third or more person that this 00:14:55.000 --> 00:14:58.000 victim encounters they are less 00:14:58.000 --> 00:14:60.000 likely to give a report of this 00:15:00.000 --> 00:15:02.000 violence of the violence has 00:15:02.000 --> 00:15:04.000 happened to them when this victim 00:15:04.000 --> 00:15:06.000 is giving this disclosure 00:15:06.000 --> 00:15:10.000 be content with silence 00:15:10.000 --> 00:15:13.000 this is very difficult to talk about 00:15:13.000 --> 00:15:17.000 when victims choose to disclose 00:15:17.000 --> 00:15:20.000 no matter how comfortable or 00:15:20.000 --> 00:15:21.000 uncomfortable you are with 00:15:21.000 --> 00:15:24.000 this terminology find that 00:15:24.000 --> 00:15:26.000 place where you can receive 00:15:26.000 --> 00:15:29.000 that information without this facial expression 00:15:29.000 --> 00:15:31.000 that's not a good facial expression 00:15:31.000 --> 00:15:34.000 so figure out a way that you 00:15:34.000 --> 00:15:36.000 can listen be content with 00:15:36.000 --> 00:15:39.000 silence not interrupt and not 00:15:39.000 --> 00:15:42.000 show discomfort as a medical 00:15:42.000 --> 00:15:43.000 provider that's obviously 00:15:43.000 --> 00:15:45.000 easy for me but if I were an 00:15:45.000 --> 00:15:48.000 educator I can see where I 00:15:48.000 --> 00:15:50.000 would probably be pushed back 00:15:50.000 --> 00:15:51.000 it's kind of the way when 00:15:51.000 --> 00:15:52.000 somebody tries to talk to me 00:15:52.000 --> 00:15:54.000 about physics and I'm like well 00:15:54.000 --> 00:15:55.000 that's a little scary I don't I 00:15:55.000 --> 00:15:57.000 don't understand any of that or 00:15:57.000 --> 00:15:58.000 engineering or math or anything 00:15:58.000 --> 00:15:61.000 else pretty much in the science community 00:16:01.000 --> 00:16:03.000 if this is a group that 00:16:03.000 --> 00:16:05.000 this student is going to have to 00:16:05.000 --> 00:16:07.000 communicate with then please 00:16:07.000 --> 00:16:10.000 introduce everyone in the room 00:16:10.000 --> 00:16:12.000 or let everyone in the room 00:16:12.000 --> 00:16:14.000 introduce themselves to that 00:16:14.000 --> 00:16:16.000 student to that victim 00:16:16.000 --> 00:16:21.000 speak with words that are sensitive and non-judgmental 00:16:21.000 --> 00:16:24.000 the worst question that can be asked 00:16:24.000 --> 00:16:26.000 of a sexual assault survivor 00:16:26.000 --> 00:16:28.000 or victim depending on where 00:16:28.000 --> 00:16:30.000 they are in their path is the 00:16:30.000 --> 00:16:33.000 question why they don't know 00:16:33.000 --> 00:16:35.000 the answer to that they do not 00:16:35.000 --> 00:16:36.000 know why this happened 00:16:36.000 --> 00:16:39.000 they don't know how this happened 00:16:39.000 --> 00:16:41.000 they never saw this coming 00:16:41.000 --> 00:16:42.000 this was not something that 00:16:42.000 --> 00:16:44.000 they thought would happen 00:16:44.000 --> 00:16:48.000 I have never ever taken clothes 00:16:48.000 --> 00:16:50.000 from a victim of sexual assault 00:16:50.000 --> 00:16:51.000 in the emergency room and as 00:16:51.000 --> 00:16:53.000 I'm collecting that clothing 00:16:53.000 --> 00:16:55.000 them say to me I thought this 00:16:55.000 --> 00:16:57.000 might happen that's why I 00:16:57.000 --> 00:16:59.000 wore those torn panties just 00:16:59.000 --> 00:16:60.000 in case they ended up in a 00:17:00.000 --> 00:17:03.000 rape kit later that's not the 00:17:03.000 --> 00:17:05.000 mindset of a person that's 00:17:05.000 --> 00:17:07.000 been sexually assaulted 00:17:07.000 --> 00:17:09.000 so you want to not ask those why 00:17:09.000 --> 00:17:11.000 questions I'm absolutely sure 00:17:11.000 --> 00:17:13.000 and without knowing your policy 00:17:13.000 --> 00:17:14.000 and procedure what that looks 00:17:14.000 --> 00:17:17.000 like on this campus I know you 00:17:17.000 --> 00:17:19.000 need information but how can 00:17:19.000 --> 00:17:22.000 you gather that information 00:17:22.000 --> 00:17:24.000 in a non-judgmental and very 00:17:24.000 --> 00:17:27.000 therapeutic way refer to 00:17:27.000 --> 00:17:29.000 the victim by their preferred 00:17:29.000 --> 00:17:32.000 name by their preferred gender 00:17:32.000 --> 00:17:33.000 refer to them in a way 00:17:33.000 --> 00:17:35.000 that makes them comfortable 00:17:35.000 --> 00:17:37.000 and comfortable with 00:17:37.000 --> 00:17:40.000 disclosing this information with you 00:17:40.000 --> 00:17:42.000 what does your body language look like 00:17:42.000 --> 00:17:44.000 when you're uncomfortable 00:17:46.000 --> 00:17:48.000 uncomfortable with something my 00:17:48.000 --> 00:17:50.000 eyebrows tend to raise because 00:17:52.000 --> 00:17:54.000 no idea what you're talking about 00:17:54.000 --> 00:17:56.000 some people close off 00:17:56.000 --> 00:17:58.000 some people cross their legs 00:17:58.000 --> 00:17:60.000 it's important that if someone 00:18:00.000 --> 00:18:02.000 is disclosing this traumatic 00:18:02.000 --> 00:18:04.000 event that your body language 00:18:04.000 --> 00:18:07.000 is open it may even help if you 00:18:07.000 --> 00:18:09.000 have that open body language 00:18:09.000 --> 00:18:11.000 and lean in slightly so 00:18:11.000 --> 00:18:12.000 that you look like you're 00:18:12.000 --> 00:18:14.000 engaging with someone consider 00:18:14.000 --> 00:18:16.000 culturally what's acceptable to 00:18:16.000 --> 00:18:19.000 that victim I'm an eye contact 00:18:19.000 --> 00:18:20.000 person and the older I get 00:18:20.000 --> 00:18:22.000 and the worst my hearing gets 00:18:22.000 --> 00:18:24.000 the more eye contact I probably 00:18:24.000 --> 00:18:26.000 uncomfortably like glaring 00:18:26.000 --> 00:18:28.000 because I'm trying to hear but 00:18:28.000 --> 00:18:31.000 I'm an eye contact person what 00:18:31.000 --> 00:18:33.000 if culturally that is offensive 00:18:33.000 --> 00:18:35.000 to someone if you're making 00:18:35.000 --> 00:18:36.000 that eye contact and they're 00:18:36.000 --> 00:18:39.000 looking away then that's a 00:18:39.000 --> 00:18:41.000 big sign lay off of the eye 00:18:41.000 --> 00:18:42.000 contact but you definitely 00:18:42.000 --> 00:18:44.000 want your body language to 00:18:44.000 --> 00:18:46.000 be engaging and receptive of 00:18:46.000 --> 00:18:49.000 what they have to say 00:18:49.000 --> 00:18:51.000 explain things slowly 00:18:51.000 --> 00:18:54.000 explain things precisely 00:18:54.000 --> 00:18:58.000 explain things in a way that you would want 00:18:58.000 --> 00:18:60.000 someone to explain to you 00:19:00.000 --> 00:19:03.000 if you were anxious and we've 00:19:03.000 --> 00:19:04.000 all been there where we're kind of 00:19:04.000 --> 00:19:05.000 anxious or worried about an 00:19:05.000 --> 00:19:07.000 event or something and you 00:19:07.000 --> 00:19:10.000 want that explained in a way 00:19:10.000 --> 00:19:12.000 that is soft and comfortable 00:19:12.000 --> 00:19:15.000 and engaging with that person 00:19:15.000 --> 00:19:17.000 therapeutic communication is 00:19:17.000 --> 00:19:20.000 not what is wrong with you but 00:19:20.000 --> 00:19:22.000 tell me what happened to you 00:19:22.000 --> 00:19:25.000 and then how can we go forward 00:19:25.000 --> 00:19:28.000 and it's great to intersperse in this conversation 00:19:28.000 --> 00:19:31.000 I'm very sorry this was your experience 00:19:31.000 --> 00:19:33.000 I'm very sorry this happpened 00:19:33.000 --> 00:19:35.000 kinda another thing 00:19:35.000 --> 00:19:36.000 you want to stay away from 00:19:36.000 --> 00:19:39.000 is legal jargon -- I referred 00:19:39.000 --> 00:19:41.000 back to we had a doctor and 00:19:41.000 --> 00:19:42.000 you know us medical people 00:19:42.000 --> 00:19:45.000 we really like our million dollar words don't we 00:19:45.000 --> 00:19:47.000 we like to use those I do a lot 00:19:47.000 --> 00:19:49.000 of testimony now so for lack 00:19:49.000 --> 00:19:51.000 of a better word I'm getting 00:19:51.000 --> 00:19:53.000 good at dumbing down a lot of 00:19:53.000 --> 00:19:55.000 really big medical words on 00:19:55.000 --> 00:19:56.000 because to some of the juries 00:19:56.000 --> 00:19:58.000 the average jury intellect 00:19:58.000 --> 00:19:60.000 nationally as about eighth 00:20:00.000 --> 00:20:02.000 grade so we have to really 00:20:02.000 --> 00:20:05.000 bring down that language and 00:20:05.000 --> 00:20:07.000 in a trauma state people that may 00:20:07.000 --> 00:20:10.000 have heard these words before 00:20:10.000 --> 00:20:11.000 they've been to the lectures 00:20:11.000 --> 00:20:13.000 I know what the process is but 00:20:13.000 --> 00:20:15.000 in a trauma state that's not 00:20:15.000 --> 00:20:18.000 important bring that language 00:20:18.000 --> 00:20:21.000 down on a level that you feel 00:20:21.000 --> 00:20:24.000 like someone in junior high 00:20:24.000 --> 00:20:25.000 would be able to comprehend 00:20:25.000 --> 00:20:27.000 think of where that brain is 00:20:27.000 --> 00:20:29.000 in trauma and you want this 00:20:29.000 --> 00:20:30.000 person to be able to take this 00:20:30.000 --> 00:20:33.000 knowledge and comprehend it 00:20:33.000 --> 00:20:36.000 and - I did not mean that in a demeaning way 00:20:36.000 --> 00:20:39.000 at all I purely meant that in 00:20:39.000 --> 00:20:43.000 a simplifying kind of way you want to 00:20:43.000 --> 00:20:45.000 bring that language down -- 00:20:45.000 --> 00:20:47.000 to make it more comfortable 00:20:47.000 --> 00:20:49.000 Russell Strand is a he's 00:20:49.000 --> 00:20:51.000 former military he's former 00:20:51.000 --> 00:20:53.000 law enforcement and he's done 00:20:53.000 --> 00:20:55.000 a lot of work with victims of 00:20:55.000 --> 00:20:57.000 violence and his work with them 00:20:57.000 --> 00:20:60.000 involved how their interaction 00:21:00.000 --> 00:21:03.000 was with law enforcement he 00:21:03.000 --> 00:21:04.000 said the assault experience 00:21:04.000 --> 00:21:06.000 is remembered in fragments but 00:21:06.000 --> 00:21:08.000 infused with intense emotion 00:21:08.000 --> 00:21:10.000 and recollections of sensations 00:21:10.000 --> 00:21:13.000 such as taste smells and sounds 00:21:13.000 --> 00:21:15.000 some victims may become haunted 00:21:15.000 --> 00:21:17.000 by feelings and senses they 00:21:17.000 --> 00:21:20.000 know are related to the trauma 00:21:20.000 --> 00:21:22.000 but have difficulty identifying 00:21:22.000 --> 00:21:26.000 the source of the feeling or sensation 00:21:26.000 --> 00:21:30.000 Some of the examples of this if this victim has what 00:21:30.000 --> 00:21:32.000 we call fragmented memories 00:21:32.000 --> 00:21:34.000 they can't remember everything 00:21:34.000 --> 00:21:36.000 about this event then what 00:21:36.000 --> 00:21:39.000 can you not forget sometimes 00:21:39.000 --> 00:21:41.000 saying the word what do you or 00:21:41.000 --> 00:21:43.000 the phrase what do you remember 00:21:43.000 --> 00:21:46.000 is a lot of pressure on someone 00:21:46.000 --> 00:21:47.000 if you've ever been asked to 00:21:47.000 --> 00:21:49.000 recall an event think about the 00:21:49.000 --> 00:21:51.000 pressure involved as you were 00:21:51.000 --> 00:21:54.000 trying to give a chronological 00:21:54.000 --> 00:21:56.000 timeline of exactly what 00:21:56.000 --> 00:21:58.000 happened but if you were to 00:21:58.000 --> 00:21:59.000 somebody were to say well what 00:21:59.000 --> 00:21:61.000 can you not forget about this 00:22:01.000 --> 00:22:03.000 event then you just kinda spew 00:22:03.000 --> 00:22:06.000 out those details without that 00:22:06.000 --> 00:22:08.000 pressure to give it an order 00:22:10.000 --> 00:22:13.000 today my husband and I at lunch we 00:22:13.000 --> 00:22:15.000 went to a little restaurant 00:22:15.000 --> 00:22:17.000 there here in Monmouth on the 00:22:17.000 --> 00:22:18.000 the main highway and we sat by 00:22:18.000 --> 00:22:20.000 a window and I'm looking out 00:22:20.000 --> 00:22:21.000 I'm just kind of watching the 00:22:21.000 --> 00:22:22.000 traffic go by and you have a 00:22:22.000 --> 00:22:24.000 beautiful city so I'm just 00:22:24.000 --> 00:22:26.000 kind of vegged out engaging in 00:22:26.000 --> 00:22:29.000 that and I see these guys and 00:22:29.000 --> 00:22:30.000 they're working around this 00:22:30.000 --> 00:22:32.000 big yellow like Penske rental truck 00:22:32.000 --> 00:22:34.000 one gets out and he crosses 00:22:34.000 --> 00:22:35.000 the street and the other one is 00:22:35.000 --> 00:22:38.000 in and out of the truck and he 00:22:38.000 --> 00:22:39.000 goes to run across the street 00:22:39.000 --> 00:22:41.000 to catch up with his friend at 00:22:41.000 --> 00:22:43.000 about the time a car was coming 00:22:43.000 --> 00:22:46.000 and it rattled me because it 00:22:46.000 --> 00:22:48.000 was within inches of him not of 00:22:48.000 --> 00:22:50.000 him getting hit and he jumped back 00:22:50.000 --> 00:22:51.000 he jump back to the point that 00:22:51.000 --> 00:22:54.000 he had to move his hips and the 00:22:54.000 --> 00:22:55.000 side mirror kinda caught him and 00:22:55.000 --> 00:22:58.000 he hit the car all happened 00:22:58.000 --> 00:22:61.000 within microseconds and 00:23:01.000 --> 00:23:02.000 when this is happening I'm 00:23:02.000 --> 00:23:03.000 starting to jump a because I'm 00:23:03.000 --> 00:23:05.000 like okay here comes a trauma 00:23:05.000 --> 00:23:06.000 here comes the ER nurse and it 00:23:06.000 --> 00:23:07.000 now granted I'm a forensic 00:23:07.000 --> 00:23:08.000 nurse I'm having to remember do 00:23:08.000 --> 00:23:09.000 not go out there take his pants 00:23:09.000 --> 00:23:10.000 off and look at his genitalia 00:23:10.000 --> 00:23:13.000 go out there and take care 00:23:13.000 --> 00:23:15.000 of all the other stuff but I 00:23:15.000 --> 00:23:16.000 kind of have you know kind of 00:23:16.000 --> 00:23:20.000 halfway set up and he was okay 00:23:20.000 --> 00:23:23.000 and the car goes by and he kind 00:23:23.000 --> 00:23:25.000 of has this awkward ha ha ha 00:23:25.000 --> 00:23:26.000 look on his face and he meets 00:23:26.000 --> 00:23:27.000 his buddy and they're walking 00:23:27.000 --> 00:23:29.000 up the sidewalk his face was 00:23:29.000 --> 00:23:31.000 really red and I'm explaining 00:23:31.000 --> 00:23:33.000 what happened my husband my 00:23:33.000 --> 00:23:34.000 husband said you look really 00:23:34.000 --> 00:23:36.000 rattled are you okay and I told him 00:23:36.000 --> 00:23:37.000 that rattled me I just knew 00:23:37.000 --> 00:23:38.000 that there was about to be a 00:23:38.000 --> 00:23:41.000 trauma and I just I said oh 00:23:41.000 --> 00:23:42.000 my goodness I was drinking my 00:23:42.000 --> 00:23:43.000 water and he kept saying and 00:23:43.000 --> 00:23:45.000 are you sure you're okay are 00:23:45.000 --> 00:23:48.000 you sure you're okay now I'm 00:23:48.000 --> 00:23:50.000 able to recall that if it had 00:23:50.000 --> 00:23:53.000 been more traumatic I would 00:23:53.000 --> 00:23:54.000 probably not have been able 00:23:54.000 --> 00:23:56.000 to recall that as well I was 00:23:56.000 --> 00:23:60.000 already experiencing the this 00:24:00.000 --> 00:24:01.000 is gonna be traumatic this is 00:24:01.000 --> 00:24:03.000 gonna be bad and I could just 00:24:03.000 --> 00:24:06.000 tell afterwards as I'm processing it 00:24:06.000 --> 00:24:08.000 where my brain was going 00:24:08.000 --> 00:24:10.000 in that event and it didn't 00:24:10.000 --> 00:24:12.000 happen to me I wasn't the one 00:24:12.000 --> 00:24:14.000 that got hit I wasn't the one 00:24:14.000 --> 00:24:17.000 in the road I cannot imagine 00:24:17.000 --> 00:24:19.000 how difficult it is for victims 00:24:19.000 --> 00:24:21.000 of violence to recall this 00:24:21.000 --> 00:24:24.000 event but how we question them 00:24:24.000 --> 00:24:27.000 to give us that information 00:24:27.000 --> 00:24:29.000 if what you remember about 00:24:29.000 --> 00:24:30.000 this if you they're struggling 00:24:30.000 --> 00:24:32.000 with that you know what never 00:24:32.000 --> 00:24:35.000 mind what can you not forget 00:24:35.000 --> 00:24:38.000 about this event how much is 00:24:38.000 --> 00:24:41.000 the victim expected to disclose 00:24:41.000 --> 00:24:44.000 sexual history not an issue 00:24:44.000 --> 00:24:46.000 how many sex partners they have 00:24:46.000 --> 00:24:48.000 that's absolutely not an issue 00:24:48.000 --> 00:24:49.000 medically I'm gonna want to 00:24:49.000 --> 00:24:51.000 know their risk of exposure to 00:24:51.000 --> 00:24:53.000 sexually transmitted infections 00:24:53.000 --> 00:24:54.000 but I'm not going to ask that 00:24:54.000 --> 00:24:55.000 question with how many times 00:24:55.000 --> 00:24:57.000 have you had sex how many 00:24:57.000 --> 00:24:59.000 sex partners have you had that is 00:24:59.000 --> 00:24:60.000 none of my business I want to 00:25:00.000 --> 00:25:03.000 know what medically I need to know 00:25:03.000 --> 00:25:07.000 the victim does not defend 00:25:07.000 --> 00:25:10.000 herself himself theirself for 00:25:10.000 --> 00:25:14.000 reporting or for not reporting 00:25:14.000 --> 00:25:16.000 it's amazing anybody reports 00:25:16.000 --> 00:25:18.000 a sexual assault especially 00:25:18.000 --> 00:25:20.000 when we consider how the brain 00:25:20.000 --> 00:25:22.000 responds to this trauma how 00:25:22.000 --> 00:25:24.000 we as a society treat victims 00:25:24.000 --> 00:25:26.000 of interpersonal violence so 00:25:26.000 --> 00:25:29.000 they are not they we do not 00:25:31.000 --> 00:25:34.000 and we do not expose them if 00:25:34.000 --> 00:25:36.000 they choose not to expose 00:25:38.000 --> 00:25:41.000 need to know what are the laws 00:25:41.000 --> 00:25:42.000 what are the policies what do 00:25:42.000 --> 00:25:44.000 you need to know as a college 00:25:44.000 --> 00:25:46.000 what do you need to know as 00:25:46.000 --> 00:25:48.000 an academic institution what 00:25:48.000 --> 00:25:50.000 does the medical provider need 00:25:50.000 --> 00:25:53.000 to know what does the advocate 00:25:53.000 --> 00:25:56.000 need to know there may be parts 00:25:56.000 --> 00:25:57.000 of this event that this victim 00:25:57.000 --> 00:25:59.000 was like I do not want to tell 00:25:59.000 --> 00:25:62.000 about that one of the exercises 00:26:02.000 --> 00:26:03.000 that I do with law enforcement 00:26:03.000 --> 00:26:05.000 to teach them victim centered 00:26:05.000 --> 00:26:07.000 interviewing techniques as I 00:26:07.000 --> 00:26:09.000 do this exercise I do a lot of 00:26:09.000 --> 00:26:11.000 education with law enforcement 00:26:11.000 --> 00:26:13.000 in Mississippi and one of 00:26:13.000 --> 00:26:14.000 the things that we do as a 00:26:14.000 --> 00:26:15.000 partner with the attorney 00:26:15.000 --> 00:26:17.000 general's office and we do I 00:26:17.000 --> 00:26:19.000 set of modules so we have law 00:26:19.000 --> 00:26:20.000 enforcement come in we set 00:26:20.000 --> 00:26:22.000 up these four to five models 00:26:22.000 --> 00:26:25.000 of classes so day one is me 00:26:25.000 --> 00:26:26.000 and it's a lot of anatomy 00:26:26.000 --> 00:26:29.000 and physiology and what the rape kit looks 00:26:29.000 --> 00:26:31.000 and then we do a piece on 00:26:34.000 --> 00:26:36.000 and what perpetrators do and 00:26:36.000 --> 00:26:39.000 how to interrogate so by the 00:26:39.000 --> 00:26:41.000 third module they know me very well 00:26:41.000 --> 00:26:43.000 I'm a storyteller I tell stories 00:26:43.000 --> 00:26:45.000 about my life they 00:26:45.000 --> 00:26:46.000 feel like we're big buddies at 00:26:46.000 --> 00:26:48.000 this point I've already gotten 00:26:48.000 --> 00:26:49.000 Facebook friendships with some 00:26:49.000 --> 00:26:51.000 of the people in the class but 00:26:51.000 --> 00:26:54.000 in this third module I teach 00:26:54.000 --> 00:26:57.000 victim centered interview and I 00:26:57.000 --> 00:26:59.000 start that out with an exercise 00:26:59.000 --> 00:26:61.000 in the exercise goes like this 00:27:01.000 --> 00:27:02.000 but the law enforcement command 00:27:02.000 --> 00:27:03.000 prosecutors will do this as 00:27:03.000 --> 00:27:05.000 well and I'll say okay today 00:27:05.000 --> 00:27:08.000 before we get started here is 00:27:08.000 --> 00:27:10.000 a we call 'em a happy a fun 00:27:10.000 --> 00:27:11.000 gift in the south it's called 00:27:11.000 --> 00:27:13.000 a happy so I put the happy 00:27:13.000 --> 00:27:15.000 up on the table it may be a 00:27:15.000 --> 00:27:17.000 giant cupcake - we don't like 00:27:17.000 --> 00:27:19.000 cupcakes in the south we make 00:27:19.000 --> 00:27:21.000 cakes and call 'em cupcakes and 00:27:21.000 --> 00:27:22.000 stick them in a little box so 00:27:22.000 --> 00:27:24.000 you could feed a family of ten 00:27:24.000 --> 00:27:27.000 on the southern cut cake Gigi's 00:27:27.000 --> 00:27:28.000 cupcakes just FYI if you go 00:27:28.000 --> 00:27:30.000 down there so I'll have this 00:27:30.000 --> 00:27:33.000 giant cupcake and I'll say okay 00:27:33.000 --> 00:27:35.000 we're going to play the game 00:27:35.000 --> 00:27:36.000 and whoever chooses to come up 00:27:36.000 --> 00:27:39.000 and read your answers you get 00:27:39.000 --> 00:27:42.000 the cupcake and the exercise 00:27:42.000 --> 00:27:44.000 goes like this take out a piece 00:27:44.000 --> 00:27:46.000 of paper write the answers down 00:27:46.000 --> 00:27:48.000 to this question when was the 00:27:48.000 --> 00:27:51.000 last time you had consensual 00:27:51.000 --> 00:27:53.000 intercourse now when I do that 00:27:53.000 --> 00:27:54.000 there's a lot of snickering 00:27:54.000 --> 00:27:56.000 in the room and I keep a 00:27:56.000 --> 00:27:58.000 straight face so after a few 00:27:58.000 --> 00:27:59.000 seconds of snickering they're 00:27:59.000 --> 00:27:61.000 like oh she means it and you 00:28:01.000 --> 00:28:03.000 can see people write down and 00:28:03.000 --> 00:28:04.000 there looking at me kind of 00:28:04.000 --> 00:28:05.000 sheepishly I say okay now 00:28:05.000 --> 00:28:07.000 we're gonna ask a lot of questions 00:28:07.000 --> 00:28:10.000 about that encounter I've got 00:28:10.000 --> 00:28:12.000 fifty questions you wouldn't 00:28:12.000 --> 00:28:14.000 believe the resource that I 00:28:14.000 --> 00:28:15.000 had to do to figure out how 00:28:15.000 --> 00:28:17.000 to ask fifty questions about 00:28:17.000 --> 00:28:19.000 a sexual encounter it was fun 00:28:19.000 --> 00:28:21.000 research I'll leave that on the floor 00:28:21.000 --> 00:28:23.000 but it's a lot a questions 00:28:23.000 --> 00:28:26.000 specific acts responses what 00:28:26.000 --> 00:28:28.000 led up to it what happened 00:28:28.000 --> 00:28:31.000 during it what was afterwards 00:28:31.000 --> 00:28:32.000 even cleaning up and questions 00:28:32.000 --> 00:28:35.000 about sex devices and toys 00:28:35.000 --> 00:28:38.000 a few questions into it I get 00:28:38.000 --> 00:28:41.000 the aha I see where she's going 00:28:41.000 --> 00:28:43.000 with this look sometimes I get 00:28:43.000 --> 00:28:46.000 some really mean looks and then 00:28:46.000 --> 00:28:48.000 there's always a couple people 00:28:48.000 --> 00:28:49.000 that really want that darn 00:28:49.000 --> 00:28:51.000 cupcake and they are writing down 00:28:51.000 --> 00:28:53.000 the answers feverishly and 00:28:53.000 --> 00:28:54.000 part of me wants to go look 00:28:54.000 --> 00:28:55.000 buddy I'll give the cupcake 00:28:55.000 --> 00:28:57.000 I do not want to hear this 00:28:57.000 --> 00:28:58.000 you know I don't and course 00:28:58.000 --> 00:28:59.000 I get the jokes well my goodness 00:28:59.000 --> 00:28:62.000 it's been so long or -- you 00:29:02.000 --> 00:29:04.000 know you did say consensual 00:29:04.000 --> 00:29:05.000 and yes cops will throw that 00:29:05.000 --> 00:29:07.000 out there every once in awhile 00:29:07.000 --> 00:29:09.000 my point of that is how 00:29:09.000 --> 00:29:12.000 uncomfortable is that and I'm 00:29:12.000 --> 00:29:15.000 asking about a consensual event 00:29:15.000 --> 00:29:18.000 we are asking someone to tell 00:29:18.000 --> 00:29:23.000 us about a crime an event that 00:29:23.000 --> 00:29:26.000 was traumatic how uncomfortable 00:29:26.000 --> 00:29:29.000 could that possibly be if you 00:29:29.000 --> 00:29:31.000 have to do this with other 00:29:31.000 --> 00:29:32.000 people if there are other 00:29:32.000 --> 00:29:33.000 members of the faculty or the 00:29:33.000 --> 00:29:34.000 university that you're doing 00:29:34.000 --> 00:29:37.000 this joint meeting with 00:29:37.000 --> 00:29:39.000 the victim ahead of time we 00:29:39.000 --> 00:29:41.000 need to talk to you and it'll 00:29:41.000 --> 00:29:43.000 be in this room and these are 00:29:43.000 --> 00:29:44.000 going to be the people that are 00:29:44.000 --> 00:29:47.000 present John Doe and this is 00:29:47.000 --> 00:29:48.000 what John's title is and this 00:29:48.000 --> 00:29:50.000 is what his responsibility is 00:29:50.000 --> 00:29:53.000 Jane Smith her title her 00:29:53.000 --> 00:29:55.000 responsibility so you want 00:29:55.000 --> 00:29:58.000 to prepare them for that 00:29:58.000 --> 00:29:60.000 what about the hospital well 00:30:00.000 --> 00:30:02.000 when I go or what about the help 00:30:02.000 --> 00:30:03.000 center when I go to the help 00:30:03.000 --> 00:30:05.000 center how much do I have to 00:30:05.000 --> 00:30:07.000 disclose at the front desk I've 00:30:07.000 --> 00:30:08.000 been in your health centers it's a 00:30:08.000 --> 00:30:10.000 beautiful building but walking 00:30:10.000 --> 00:30:12.000 up to that desk exactly how 00:30:12.000 --> 00:30:15.000 private is that is there a plan 00:30:15.000 --> 00:30:16.000 in place that they can go to 00:30:16.000 --> 00:30:18.000 the heath center and privately 00:30:18.000 --> 00:30:20.000 write I don't want to say this 00:30:20.000 --> 00:30:22.000 out loud in the emergency room 00:30:22.000 --> 00:30:23.000 of the patient's that I took 00:30:23.000 --> 00:30:25.000 care of patients didn't come 00:30:25.000 --> 00:30:27.000 in and say I was raped 00:30:27.000 --> 00:30:29.000 they would say things like I have 00:30:29.000 --> 00:30:31.000 female problems my stomach 00:30:31.000 --> 00:30:34.000 hurts I need to talk to a nurse 00:30:34.000 --> 00:30:37.000 in private I'm not sure what 00:30:37.000 --> 00:30:40.000 happened I think someone hurt 00:30:40.000 --> 00:30:42.000 me so this is the language 00:30:42.000 --> 00:30:44.000 that patient's were using in our 00:30:44.000 --> 00:30:46.000 emergency room and our emergency room 00:30:46.000 --> 00:30:48.000 was wide open if you 00:30:48.000 --> 00:30:50.000 come to our ER and you walk up 00:30:50.000 --> 00:30:51.000 to the desk there's an entire 00:30:51.000 --> 00:30:53.000 emergency room that can pretty 00:30:53.000 --> 00:30:55.000 much hear what you're there for 00:30:55.000 --> 00:30:57.000 I don't like I fussed about it 00:30:57.000 --> 00:30:59.000 it for almost eighteen years 00:30:59.000 --> 00:30:60.000 nothing ever changed in regards 00:31:00.000 --> 00:31:02.000 to it and I did let it be known 00:31:02.000 --> 00:31:03.000 that I felt that was a 00:31:03.000 --> 00:31:06.000 privacy issue so what about 00:31:06.000 --> 00:31:07.000 your victim having to go to 00:31:07.000 --> 00:31:09.000 these other agencies and what 00:31:09.000 --> 00:31:11.000 does that look like do you have 00:31:11.000 --> 00:31:13.000 a plan in place that you make 00:31:13.000 --> 00:31:14.000 and reach out to these other 00:31:14.000 --> 00:31:17.000 agencies call on behalf of that victim 00:31:17.000 --> 00:31:19.000 give them a heads-up 00:31:19.000 --> 00:31:21.000 so that they have that plan 00:31:21.000 --> 00:31:22.000 in place that you're victim is 00:31:22.000 --> 00:31:25.000 not having to expose 00:31:25.000 --> 00:31:26.000 that much of themselves 00:31:26.000 --> 00:31:28.000 there when we look at 00:31:28.000 --> 00:31:31.000 therapeutic communication you 00:31:31.000 --> 00:31:33.000 want to build rapport with that 00:31:33.000 --> 00:31:36.000 student ask them and use them 00:31:36.000 --> 00:31:39.000 their name listen actively ask 00:31:39.000 --> 00:31:43.000 questions show empathy again 00:31:43.000 --> 00:31:45.000 I'm so sorry this happened to you 00:31:45.000 --> 00:31:47.000 I'm so sorry this was your experience 00:31:47.000 --> 00:31:50.000 what else can I do for you 00:31:50.000 --> 00:31:52.000 follow the lead and 00:31:52.000 --> 00:31:55.000 be genuine one of the things 00:31:55.000 --> 00:31:56.000 that I have to remind people 00:31:56.000 --> 00:31:59.000 if you're a notetaker try to 00:31:59.000 --> 00:31:61.000 actively listen while you're 00:32:01.000 --> 00:32:02.000 taking the note if you're one 00:32:02.000 --> 00:32:03.000 of the people that you're you 00:32:03.000 --> 00:32:05.000 know writing everything down 00:32:05.000 --> 00:32:06.000 and you're really good at 00:32:06.000 --> 00:32:07.000 listening while not making eye 00:32:07.000 --> 00:32:10.000 contact that's good for you 00:32:10.000 --> 00:32:12.000 but it's bad for that rapport 00:32:12.000 --> 00:32:13.000 if you're having to put things 00:32:13.000 --> 00:32:15.000 on the computer and this is 00:32:15.000 --> 00:32:16.000 another area of medicine and 00:32:16.000 --> 00:32:18.000 then I am very frustrated about 00:32:18.000 --> 00:32:20.000 we've all gone to electronic 00:32:20.000 --> 00:32:21.000 charting if you've ever been 00:32:21.000 --> 00:32:23.000 to the doctor lately and 00:32:23.000 --> 00:32:24.000 they come into the room they 00:32:24.000 --> 00:32:26.000 come in there with that laptop 00:32:26.000 --> 00:32:29.000 questions and so there you are 00:32:29.000 --> 00:32:30.000 and here's the nurse is this 00:32:30.000 --> 00:32:32.000 going on is this going on 00:32:32.000 --> 00:32:34.000 what else is going on with you 00:32:34.000 --> 00:32:35.000 that communicates to me I'm not 00:32:35.000 --> 00:32:37.000 really interested I'm trying to 00:32:37.000 --> 00:32:39.000 check off some boxes so think 00:32:39.000 --> 00:32:41.000 about what that looks like as 00:32:41.000 --> 00:32:43.000 well even though our younger 00:32:43.000 --> 00:32:45.000 generation is very accustomed 00:32:45.000 --> 00:32:48.000 to non-verbal communication 00:32:48.000 --> 00:32:50.000 is very accustomed to texting 00:32:50.000 --> 00:32:52.000 and not talking on the phone 00:32:52.000 --> 00:32:54.000 and having that dialogue it's 00:32:54.000 --> 00:32:55.000 different with the victim 00:32:55.000 --> 00:32:58.000 for violence they need that 00:32:58.000 --> 00:32:60.000 engagement and they need that rapport 00:33:00.000 --> 00:33:02.000 but this is actually a pdf 00:33:02.000 --> 00:33:04.000 that I saw at a lecture 00:33:04.000 --> 00:33:06.000 last week and I went on the 00:33:06.000 --> 00:33:08.000 internet and you can actually 00:33:08.000 --> 00:33:11.000 pull this all for free this is 00:33:11.000 --> 00:33:13.000 a checklist for trauma informed 00:33:13.000 --> 00:33:16.000 care and it talks about the 00:33:16.000 --> 00:33:18.000 practitioner but this would 00:33:18.000 --> 00:33:21.000 work for you the interviewer 00:33:21.000 --> 00:33:23.000 about what your questions 00:33:23.000 --> 00:33:25.000 are looking like and what the 00:33:25.000 --> 00:33:27.000 patient or the victim is going 00:33:27.000 --> 00:33:29.000 to be experiencing as you're 00:33:29.000 --> 00:33:31.000 asking these questions when 00:33:31.000 --> 00:33:33.000 we start looking at what the 00:33:33.000 --> 00:33:35.000 future looks like for someone 00:33:35.000 --> 00:33:37.000 that's been sexually assaulted 00:33:37.000 --> 00:33:41.000 medically we go back to the ACE study 00:33:41.000 --> 00:33:44.000 adverse child experiences 00:33:44.000 --> 00:33:46.000 now I am fully aware that to 00:33:46.000 --> 00:33:49.000 be in college here at Western Oregon University 00:33:49.000 --> 00:33:52.000 more than likely you are at least 18 yrs old 00:33:52.000 --> 00:33:55.000 the brain and now we know this 00:33:55.000 --> 00:33:58.000 does not fully developed till about what 00:33:58.000 --> 00:33:60.000 age 25 is that what 00:34:00.000 --> 00:34:01.000 we're seeing in the literature 00:34:01.000 --> 00:34:04.000 now so even though you have 00:34:04.000 --> 00:34:07.000 the legal adult here at your 00:34:07.000 --> 00:34:09.000 college campus intellectually 00:34:09.000 --> 00:34:12.000 totally that brain is still 00:34:12.000 --> 00:34:15.000 developing so now we're looking 00:34:15.000 --> 00:34:17.000 at the literature that we know 00:34:17.000 --> 00:34:20.000 about adverse child experiences 00:34:20.000 --> 00:34:21.000 and we're taking them and 00:34:21.000 --> 00:34:23.000 then putting those experience 00:34:23.000 --> 00:34:25.000 and the adolescent and older 00:34:25.000 --> 00:34:27.000 adolescent populations such as 00:34:27.000 --> 00:34:30.000 college students and what that 00:34:30.000 --> 00:34:32.000 looks like in the health care 00:34:34.000 --> 00:34:36.000 to impact this person as they 00:34:36.000 --> 00:34:39.000 get older Dr. Nadine Burke Harris 00:34:41.000 --> 00:34:44.000 she was in San Francisco at 00:34:44.000 --> 00:34:46.000 a pediatric clinic there -- 00:34:46.000 --> 00:34:48.000 she is now the Surgeon General 00:34:48.000 --> 00:34:50.000 for California but she did a 00:34:50.000 --> 00:34:52.000 Ted Talk and I want to share 00:34:52.000 --> 00:34:53.000 that with you all for those 00:34:53.000 --> 00:34:55.000 of you that are not familiar 00:34:55.000 --> 00:34:57.000 with the Ace student or 00:34:57.000 --> 00:34:59.000 adverse child experiences she does a 00:34:59.000 --> 00:34:62.000 fantastic job of explaining 00:35:02.000 --> 00:35:05.000 that and its impact on the 00:35:05.000 --> 00:35:07.000 future health of an individual 00:35:07.000 --> 00:35:10.000 In the mid-90's the 00:35:10.000 --> 00:35:12.000 CDC and Kaiser Permanente 00:35:12.000 --> 00:35:14.000 discovered an exposure that 00:35:14.000 --> 00:35:17.000 dramatically increased the risk 00:35:17.000 --> 00:35:19.000 for seven out of ten of the 00:35:19.000 --> 00:35:21.000 leading causes of death in the 00:35:21.000 --> 00:35:24.000 United States in high doses it 00:35:24.000 --> 00:35:26.000 affects brain development the 00:35:26.000 --> 00:35:30.000 immune system hormonal systems 00:35:30.000 --> 00:35:32.000 and even the way our DNA is 00:35:32.000 --> 00:35:35.000 read and transcribed folks who 00:35:35.000 --> 00:35:38.000 are exposed in very high doses 00:35:38.000 --> 00:35:39.000 have triple the lifetime 00:35:39.000 --> 00:35:41.000 risk of heart disease and 00:35:41.000 --> 00:35:44.000 lung cancer and a twenty year 00:35:44.000 --> 00:35:47.000 difference in life expectancy 00:35:47.000 --> 00:35:49.000 and yet doctors today are not 00:35:49.000 --> 00:35:52.000 trained in routine screening 00:35:52.000 --> 00:35:54.000 or treatment yeah the exposure 00:35:54.000 --> 00:35:56.000 I'm talking about is not a 00:35:56.000 --> 00:35:59.000 pesticide or a packaging chemical 00:35:59.000 --> 00:35:63.000 it's childhood trauma okay 00:36:03.000 --> 00:36:05.000 what kind of trauma am I talking 00:36:05.000 --> 00:36:06.000 about here I'm not talking 00:36:06.000 --> 00:36:08.000 about failing a test or 00:36:08.000 --> 00:36:10.000 losing a basketball game I am 00:36:10.000 --> 00:36:11.000 talking about threats that are 00:36:11.000 --> 00:36:14.000 so severe or pervasive that 00:36:14.000 --> 00:36:16.000 they literally get under our 00:36:16.000 --> 00:36:19.000 skin and change our physiology 00:36:19.000 --> 00:36:21.000 things like abuse or neglect 00:36:21.000 --> 00:36:23.000 or growing up with a parent 00:36:23.000 --> 00:36:24.000 who struggles with mental 00:36:24.000 --> 00:36:27.000 illness or substance dependence 00:36:27.000 --> 00:36:29.000 now for a long time I viewed 00:36:29.000 --> 00:36:31.000 these things in the way I was 00:36:31.000 --> 00:36:32.000 trained to view them either 00:36:32.000 --> 00:36:34.000 as a social problem refer to 00:36:34.000 --> 00:36:37.000 social services or as a mental 00:36:37.000 --> 00:36:39.000 health problem refer to mental 00:36:39.000 --> 00:36:42.000 health services and then something 00:36:42.000 --> 00:36:45.000 happened to make me rethink 00:36:45.000 --> 00:36:48.000 my entire approach when I 00:36:48.000 --> 00:36:49.000 finished my residency I wanted 00:36:49.000 --> 00:36:51.000 to go someplace where I felt 00:36:51.000 --> 00:36:54.000 really needed some place where 00:36:54.000 --> 00:36:56.000 I could make a difference so 00:36:56.000 --> 00:36:58.000 I came to work for California 00:36:58.000 --> 00:36:59.000 Pacific Medical Center one 00:36:59.000 --> 00:36:61.000 of the best private hospitals 00:37:01.000 --> 00:37:03.000 in northern California and 00:37:03.000 --> 00:37:05.000 together we opened a clinic in 00:37:05.000 --> 00:37:08.000 Bayview-Hunters Point one of 00:37:08.000 --> 00:37:09.000 the poorest most underserved 00:37:09.000 --> 00:37:12.000 neighborhoods in San Francisco 00:37:12.000 --> 00:37:14.000 now prior to that point there 00:37:14.000 --> 00:37:16.000 had been only one pediatrician 00:37:16.000 --> 00:37:17.000 in all of the Bayview to serve 00:37:17.000 --> 00:37:19.000 more than ten thousand 00:37:19.000 --> 00:37:22.000 children so we hung a shingle 00:37:22.000 --> 00:37:23.000 and we were able to provide 00:37:23.000 --> 00:37:26.000 top quality care regardless 00:37:26.000 --> 00:37:28.000 of ability to pay it was so 00:37:28.000 --> 00:37:30.000 cool we targeted the typical 00:37:30.000 --> 00:37:32.000 health disparities access to 00:37:32.000 --> 00:37:34.000 care immunization rates asthma 00:37:34.000 --> 00:37:36.000 hospitalization rates and 00:37:36.000 --> 00:37:38.000 we had all of our numbers we 00:37:38.000 --> 00:37:41.000 felt very proud of ourselves 00:37:41.000 --> 00:37:42.000 but then I started noticing 00:37:42.000 --> 00:37:45.000 a disturbing trend a lot of 00:37:45.000 --> 00:37:46.000 kids were being referred to me 00:37:46.000 --> 00:37:49.000 for ADHD or attention deficit 00:37:49.000 --> 00:37:52.000 hyperactivity disorder but when I 00:37:52.000 --> 00:37:55.000 actually did a thorough history 00:37:55.000 --> 00:37:57.000 and physical what I found was 00:37:57.000 --> 00:37:59.000 that for most of my patients 00:37:59.000 --> 00:37:61.000 I couldn't make a diagnosis 00:38:01.000 --> 00:38:04.000 of ADHD most of the kids I was 00:38:04.000 --> 00:38:06.000 seeing had experienced such 00:38:06.000 --> 00:38:10.000 severe trauma that it felt like 00:38:10.000 --> 00:38:12.000 something else was going on 00:38:12.000 --> 00:38:15.000 somehow I was missing something 00:38:15.000 --> 00:38:18.000 important now before I do my 00:38:18.000 --> 00:38:20.000 residency I did a master's 00:38:20.000 --> 00:38:21.000 degree in public health and one 00:38:21.000 --> 00:38:23.000 of the things that they teach 00:38:23.000 --> 00:38:24.000 you in public health school is 00:38:24.000 --> 00:38:26.000 that if you're a doctor and you 00:38:26.000 --> 00:38:28.000 see a hundred kids that all drink 00:38:28.000 --> 00:38:31.000 from the same well and 98 00:38:31.000 --> 00:38:33.000 of them develop diarrhea 00:38:33.000 --> 00:38:35.000 you can go ahead and write that 00:38:35.000 --> 00:38:37.000 prescription for dose after 00:38:37.000 --> 00:38:40.000 dose after dose of antibiotics 00:38:40.000 --> 00:38:42.000 or you can walk over and say 00:38:42.000 --> 00:38:45.000 what hell is in this well 00:38:45.000 --> 00:38:48.000 so I began reading everything 00:38:48.000 --> 00:38:49.000 that I could get my hands on 00:38:49.000 --> 00:38:52.000 about how exposure to adversity 00:38:52.000 --> 00:38:54.000 affects the developing brains 00:38:54.000 --> 00:38:56.000 and bodies of children and then 00:38:56.000 --> 00:38:58.000 one day my colleague walked 00:38:58.000 --> 00:38:61.000 into my office and he said 00:39:01.000 --> 00:39:04.000 Dr. Burke have you seen this 00:39:04.000 --> 00:39:08.000 in his hand was a copy of a research 00:39:08.000 --> 00:39:12.000 study called the adverse childhood experiences study 00:39:12.000 --> 00:39:15.000 that day changed my clinical 00:39:15.000 --> 00:39:20.000 practice and ultimately my career 00:39:20.000 --> 00:39:23.000 the adverse childhood experiences study is something 00:39:23.000 --> 00:39:25.000 that everybody needs to know 00:39:25.000 --> 00:39:26.000 about it was done by 00:39:26.000 --> 00:39:28.000 Dr. Vince Felitti at Kaiser 00:39:28.000 --> 00:39:30.000 and Dr. Bob Anda 00:39:30.000 --> 00:39:32.000 the CDC and together they 00:39:32.000 --> 00:39:35.000 asked seventeen and a half 00:39:35.000 --> 00:39:37.000 thousand adults about their 00:39:37.000 --> 00:39:39.000 history of exposure to what 00:39:39.000 --> 00:39:41.000 they called adverse childhood 00:39:41.000 --> 00:39:45.000 experiences or ACEs those 00:39:45.000 --> 00:39:47.000 include physical emotional 00:39:47.000 --> 00:39:49.000 or sexual abuse physical or 00:39:49.000 --> 00:39:51.000 emotional neglect parental 00:39:51.000 --> 00:39:53.000 mental illness substance 00:39:53.000 --> 00:39:56.000 dependence incarceration 00:39:56.000 --> 00:39:58.000 parental separation or divorce 00:39:58.000 --> 00:39:61.000 or domestic violence for every 00:40:01.000 --> 00:40:04.000 yes you would get a point on 00:40:04.000 --> 00:40:06.000 your ACE score and then what 00:40:06.000 --> 00:40:08.000 they did was they correlated 00:40:08.000 --> 00:40:11.000 these ACE scores against health 00:40:11.000 --> 00:40:14.000 outcomes what they found was 00:40:14.000 --> 00:40:17.000 striking two things number 00:40:17.000 --> 00:40:21.000 one ACEs are incredibly common 00:40:21.000 --> 00:40:24.000 sixty seven percent of the 00:40:24.000 --> 00:40:28.000 population had at least one ACE 00:40:28.000 --> 00:40:30.000 and twelve point six percent 00:40:30.000 --> 00:40:34.000 one in eight had four or more ACEs 00:40:34.000 --> 00:40:36.000 the second thing that they found 00:40:36.000 --> 00:40:38.000 was that there was a dose 00:40:38.000 --> 00:40:41.000 response relationship between 00:40:41.000 --> 00:40:45.000 ACEs and health outcomes 00:40:45.000 --> 00:40:47.000 the higher your ACE the 00:40:47.000 --> 00:40:49.000 worse your health outcomes for 00:40:49.000 --> 00:40:51.000 a person with an ACE score of four 00:40:51.000 --> 00:40:53.000 or more their relative risk of 00:40:53.000 --> 00:40:55.000 chronic obstructive pulmonary 00:40:55.000 --> 00:40:57.000 disease was two and a half 00:40:57.000 --> 00:40:59.000 times that of someone with an 00:40:59.000 --> 00:40:62.000 ACE score of zero for hepatitis it 00:41:02.000 --> 00:41:04.000 was also two and a half times 00:41:04.000 --> 00:41:06.000 for depression it was four and 00:41:06.000 --> 00:41:09.000 a half times for suicidality 00:41:09.000 --> 00:41:12.000 it was twelve times a person 00:41:12.000 --> 00:41:15.000 with an ACE score of seven or more 00:41:15.000 --> 00:41:17.000 had triple the lifetime risk 00:41:17.000 --> 00:41:19.000 of lung cancer and three and a 00:41:19.000 --> 00:41:22.000 half times the risk of ischemic 00:41:22.000 --> 00:41:23.000 heart disease the number one 00:41:23.000 --> 00:41:25.000 killer in the United States 00:41:25.000 --> 00:41:29.000 of America well of course this 00:41:29.000 --> 00:41:31.000 makes sense you know some 00:41:31.000 --> 00:41:32.000 people look at this data and 00:41:32.000 --> 00:41:35.000 they said come on you know 00:41:35.000 --> 00:41:37.000 you have a rough childhood you're 00:41:37.000 --> 00:41:40.000 more likely to drink and smoke 00:41:40.000 --> 00:41:41.000 and do all the things that are 00:41:41.000 --> 00:41:42.000 going to ruin your health this 00:41:42.000 --> 00:41:47.000 isn't science this is just bad behavior 00:41:47.000 --> 00:41:49.000 it turns out this is exactly 00:41:49.000 --> 00:41:52.000 where the science comes in we 00:41:52.000 --> 00:41:54.000 now understand better than we 00:41:54.000 --> 00:41:58.000 ever have before how exposure 00:41:58.000 --> 00:41:60.000 to early adversity affects the 00:42:00.000 --> 00:42:01.000 developing brains and bodies 00:42:01.000 --> 00:42:03.000 of children it affects areas 00:42:03.000 --> 00:42:05.000 like the nucleus accumben the 00:42:05.000 --> 00:42:07.000 pleasure and reward center of 00:42:07.000 --> 00:42:09.000 the brain that is implicated 00:42:09.000 --> 00:42:11.000 in substance dependence 00:42:11.000 --> 00:42:12.000 it inhibits the prefrontal 00:42:12.000 --> 00:42:15.000 cortex which is necessary for 00:42:15.000 --> 00:42:16.000 impulse control and executive 00:42:16.000 --> 00:42:18.000 function a critical area for 00:42:18.000 --> 00:42:21.000 learning and on MRI scans we 00:42:21.000 --> 00:42:24.000 see measurable differences in 00:42:24.000 --> 00:42:26.000 the amygdala the brain's fear 00:42:26.000 --> 00:42:29.000 response center so there are 00:42:29.000 --> 00:42:32.000 real neurologic reasons why 00:42:32.000 --> 00:42:34.000 folks exposed to high doses of 00:42:34.000 --> 00:42:36.000 adversity are more likely to 00:42:36.000 --> 00:42:38.000 engage in high risk behavior 00:42:38.000 --> 00:42:40.000 and that's important to know 00:42:40.000 --> 00:42:42.000 but it turns out that even if 00:42:42.000 --> 00:42:45.000 you don't engage in any high 00:42:45.000 --> 00:42:46.000 risk behavior you're still 00:42:46.000 --> 00:42:49.000 more likely to develop heart 00:42:49.000 --> 00:42:53.000 disease or cancer the reason 00:42:53.000 --> 00:42:55.000 for this has to do with the 00:42:55.000 --> 00:42:57.000 hypothalamic pituitary adrenal axis 00:42:57.000 --> 00:42:61.000 the brain's and body's stress response 00:43:01.000 --> 00:43:03.000 system that governs our fight 00:43:03.000 --> 00:43:06.000 or flight response how does 00:43:06.000 --> 00:43:08.000 it work well imagine you're 00:43:08.000 --> 00:43:10.000 walking in the forest and you 00:43:10.000 --> 00:43:12.000 see a bear immediately your 00:43:12.000 --> 00:43:14.000 hypothalamus sends a signal 00:43:14.000 --> 00:43:16.000 to your pituitary which sends a 00:43:16.000 --> 00:43:17.000 signal to your adrenal gland 00:43:17.000 --> 00:43:19.000 that says release stress 00:43:19.000 --> 00:43:22.000 hormones adrenaline cortisol 00:43:22.000 --> 00:43:23.000 and so your heart starts to 00:43:23.000 --> 00:43:25.000 pound your pupils dilate your 00:43:25.000 --> 00:43:27.000 airways open up and you are 00:43:27.000 --> 00:43:29.000 ready to either fight that 00:43:29.000 --> 00:43:33.000 bear or run from the bear and 00:43:33.000 --> 00:43:35.000 that is wonderful if you're 00:43:35.000 --> 00:43:41.000 in a forest and there's a bear 00:43:41.000 --> 00:43:43.000 but the problem is what 00:43:43.000 --> 00:43:44.000 happens when the bear comes 00:43:44.000 --> 00:43:46.000 home every night and the 00:43:46.000 --> 00:43:49.000 system is activated over and 00:43:49.000 --> 00:43:52.000 over and over again and it 00:43:52.000 --> 00:43:55.000 goes from being adaptive or 00:43:55.000 --> 00:43:58.000 life-saving to maladaptive or 00:43:58.000 --> 00:43:61.000 health damaging children are 00:44:01.000 --> 00:44:04.000 especially sensitive to this 00:44:04.000 --> 00:44:06.000 repeated stress activation 00:44:06.000 --> 00:44:07.000 because their brains and 00:44:07.000 --> 00:44:10.000 bodies are just developing 00:44:10.000 --> 00:44:12.000 high doses of adversity not 00:44:12.000 --> 00:44:14.000 only affect brain structure 00:44:14.000 --> 00:44:17.000 and function the affect the 00:44:17.000 --> 00:44:19.000 developing immune system 00:44:19.000 --> 00:44:22.000 developing hormonal systems 00:44:22.000 --> 00:44:25.000 and even the way our DNA is 00:44:25.000 --> 00:44:30.000 read and transcribed so for me 00:44:30.000 --> 00:44:31.000 this information through my 00:44:31.000 --> 00:44:33.000 old training out the window 00:44:33.000 --> 00:44:34.000 because when we understand 00:44:34.000 --> 00:44:37.000 the mechanism of a disease 00:44:37.000 --> 00:44:38.000 when we know not only which 00:44:38.000 --> 00:44:40.000 pathways are disrupted 00:44:40.000 --> 00:44:44.000 but how then as doctors it 00:44:44.000 --> 00:44:47.000 is our job to use the science 00:44:47.000 --> 00:44:49.000 for prevention and treatment 00:44:49.000 --> 00:44:51.000 that's what we do so in 00:44:51.000 --> 00:44:53.000 San Francisco we created The Center 00:44:53.000 --> 00:44:56.000 for Youth Wellness to prevent 00:44:56.000 --> 00:44:58.000 screen and heal the impact 00:44:58.000 --> 00:44:61.000 of ACEs and toxic stress we 00:45:01.000 --> 00:45:03.000 started simply with routine 00:45:03.000 --> 00:45:04.000 screening of every one of our 00:45:04.000 --> 00:45:06.000 kids at their regular physical 00:45:06.000 --> 00:45:09.000 because I know that when my patient 00:45:09.000 --> 00:45:11.000 has an ACE score of four she's 00:45:11.000 --> 00:45:13.000 two and a half times as likely 00:45:13.000 --> 00:45:16.000 to develop hepatitis or COPD 00:45:16.000 --> 00:45:17.000 she's four and a half times as 00:45:17.000 --> 00:45:19.000 likely to become depressed and 00:45:19.000 --> 00:45:20.000 she's twelve times as likely 00:45:20.000 --> 00:45:22.000 to attempt to take her own 00:45:22.000 --> 00:45:25.000 life as my patient with zero ACEs 00:45:25.000 --> 00:45:26.000 I know that when she's 00:45:26.000 --> 00:45:29.000 in my exam room for our patients who do 00:45:29.000 --> 00:45:32.000 screen positive we have a multi 00:45:32.000 --> 00:45:33.000 disciplinary treatment team 00:45:33.000 --> 00:45:35.000 that works to reduce the dose 00:45:35.000 --> 00:45:38.000 of adversity and treat symptoms 00:45:38.000 --> 00:45:40.000 using best practices including 00:45:40.000 --> 00:45:43.000 home visits care coordination mental 00:45:43.000 --> 00:45:46.000 health care nutrition holistic 00:45:46.000 --> 00:45:49.000 interventions and yes 00:45:49.000 --> 00:45:51.000 medication when necessary but 00:45:51.000 --> 00:45:53.000 we also educate parents about 00:45:53.000 --> 00:45:55.000 the impact of ACEs in toxic 00:45:55.000 --> 00:45:57.000 stressful the same way you 00:45:57.000 --> 00:45:59.000 would for covering electrical 00:45:59.000 --> 00:45:61.000 outlets or lead poisoning 00:46:01.000 --> 00:46:03.000 and we tailor the care of our 00:46:03.000 --> 00:46:05.000 asthmatics and our diabetics 00:46:05.000 --> 00:46:07.000 in a way that recognizes that 00:46:07.000 --> 00:46:09.000 they may need more aggressive 00:46:09.000 --> 00:46:11.000 treatment given the changes 00:46:11.000 --> 00:46:12.000 to their hormonal and immune 00:46:12.000 --> 00:46:15.000 systems so the other thing that 00:46:15.000 --> 00:46:17.000 happens when you understand 00:46:17.000 --> 00:46:19.000 the science is that you want 00:46:19.000 --> 00:46:21.000 to shout it from the rooftops 00:46:21.000 --> 00:46:22.000 because this isn't just an 00:46:22.000 --> 00:46:25.000 issue for kids in Bayview 00:46:25.000 --> 00:46:27.000 I figured the minute the 00:46:27.000 --> 00:46:29.000 everybody else heard about this 00:46:29.000 --> 00:46:30.000 it would be routine screening 00:46:30.000 --> 00:46:31.000 your multi disciplinary 00:46:31.000 --> 00:46:33.000 treatment teams and it would 00:46:33.000 --> 00:46:35.000 be a race to the most effective 00:46:35.000 --> 00:46:38.000 clinical treatment protocols 00:46:38.000 --> 00:46:41.000 yeah that did not happen 00:46:41.000 --> 00:46:44.000 00:46:44.000 --> 00:46:45.000 would I have thought of as 00:46:45.000 --> 00:46:49.000 simply best clinical practice I 00:46:49.000 --> 00:46:53.000 now understand to be a movement 00:46:53.000 --> 00:46:55.000 in the words of Dr. Robert Block 00:46:55.000 --> 00:46:57.000 the former president of the 00:46:57.000 --> 00:46:60.000 American Academy of Pediatrics 00:47:00.000 --> 00:47:02.000 adverse childhood experiences 00:47:02.000 --> 00:47:05.000 are the single greatest 00:47:05.000 --> 00:47:06.000 unaddressed public health 00:47:06.000 --> 00:47:10.000 threat facing our nation today 00:47:10.000 --> 00:47:12.000 and for a lot of people that's 00:47:12.000 --> 00:47:14.000 a terrifying prospect the 00:47:14.000 --> 00:47:16.000 scope and scale of the problem 00:47:16.000 --> 00:47:18.000 seems so large that it 00:47:18.000 --> 00:47:20.000 feels overwhelming to think 00:47:20.000 --> 00:47:22.000 about how we might approach it 00:47:22.000 --> 00:47:25.000 but for me that's actually where 00:47:25.000 --> 00:47:28.000 the hope lies because when we have 00:47:28.000 --> 00:47:31.000 the right framework when we 00:47:31.000 --> 00:47:33.000 recognize this to be a public 00:47:33.000 --> 00:47:36.000 health crisis then we can begin 00:47:36.000 --> 00:47:38.000 to use the right tool kit to 00:47:38.000 --> 00:47:40.000 come up with solutions from 00:47:40.000 --> 00:47:42.000 tobacco to lead poisoning to 00:47:42.000 --> 00:47:45.000 HIV Aids the United States 00:47:45.000 --> 00:47:47.000 actually has quite a strong 00:47:47.000 --> 00:47:50.000 track record with addressing 00:47:50.000 --> 00:47:52.000 public health problems but 00:47:52.000 --> 00:47:55.000 reprocating those successes 00:47:55.000 --> 00:47:58.000 with ACEs and toxic stress is 00:47:58.000 --> 00:47:60.000 going to take determination 00:48:00.000 --> 00:48:02.000 and commitment and when I look 00:48:02.000 --> 00:48:04.000 at what our nation's response 00:48:04.000 --> 00:48:08.000 has been so far I wonder 00:48:08.000 --> 00:48:10.000 why haven't we taking this more seriously 00:48:10.000 --> 00:48:12.000 you know at first 00:48:12.000 --> 00:48:15.000 I thought that we marginalized 00:48:15.000 --> 00:48:16.000 the issue because it doesn't 00:48:16.000 --> 00:48:18.000 apply to us right that's an 00:48:18.000 --> 00:48:19.000 issue for those kids in those 00:48:19.000 --> 00:48:22.000 neighborhoods which is weird 00:48:22.000 --> 00:48:23.000 because the data doesn't bare 00:48:23.000 --> 00:48:26.000 that out the original ACEs study 00:48:26.000 --> 00:48:29.000 was done in a population 00:48:29.000 --> 00:48:30.000 that was seventy percent 00:48:30.000 --> 00:48:32.000 caucasian seventy percent 00:48:32.000 --> 00:48:36.000 college educated but then 00:48:36.000 --> 00:48:39.000 the more I talk to folks I'm 00:48:39.000 --> 00:48:40.000 beginning to think that maybe I 00:48:40.000 --> 00:48:44.000 had it completely backwards if 00:48:44.000 --> 00:48:46.000 I were to ask how many people 00:48:46.000 --> 00:48:49.000 in this room grew up with a 00:48:49.000 --> 00:48:51.000 family member who suffered 00:48:51.000 --> 00:48:54.000 from mental illness I bet 00:48:54.000 --> 00:48:57.000 if you hands would go up and 00:48:57.000 --> 00:48:58.000 then if I were to ask how many 00:48:58.000 --> 00:48:61.000 folks had a parent who maybe 00:49:01.000 --> 00:49:03.000 drank too much or who really 00:49:03.000 --> 00:49:04.000 believed that if you spare 00:49:04.000 --> 00:49:08.000 the rod you spoil the child 00:49:08.000 --> 00:49:10.000 I bet a few more hands would go up 00:49:10.000 --> 00:49:13.000 even in this room 00:49:13.000 --> 00:49:14.000 this is an issue that touches 00:49:14.000 --> 00:49:16.000 many of us and I'm beginning 00:49:16.000 --> 00:49:18.000 to believe that we marginalize 00:49:18.000 --> 00:49:21.000 the issue because it does apply 00:49:21.000 --> 00:49:23.000 to us maybe it's easier to see 00:49:23.000 --> 00:49:25.000 in others zipcodes because we 00:49:25.000 --> 00:49:27.000 don't want to look at it 00:49:27.000 --> 00:49:32.000 we'd rather be sick fortunately 00:49:32.000 --> 00:49:35.000 scientific advances and frankly 00:49:35.000 --> 00:49:38.000 economic realities make that 00:49:38.000 --> 00:49:42.000 option less viable every day 00:49:42.000 --> 00:49:44.000 the science is clear 00:49:44.000 --> 00:49:47.000 early adversity dramatically affects 00:49:47.000 --> 00:49:50.000 health across the lifetime 00:49:50.000 --> 00:49:52.000 today we are beginning to 00:49:52.000 --> 00:49:54.000 understand how to interrupt 00:49:54.000 --> 00:49:56.000 the progression from early 00:49:56.000 --> 00:49:58.000 adversity to disease and early 00:49:58.000 --> 00:49:61.000 death and thirty years from 00:50:01.000 --> 00:50:03.000 now the child who has a high 00:50:03.000 --> 00:50:05.000 ACE score and whose behavioral 00:50:05.000 --> 00:50:08.000 symptoms go unrecognized 00:50:08.000 --> 00:50:09.000 whose asthma management is not 00:50:09.000 --> 00:50:11.000 connected and who goes on to 00:50:11.000 --> 00:50:14.000 develop high blood pressure an 00:50:14.000 --> 00:50:16.000 early heart disease or cancer 00:50:16.000 --> 00:50:18.000 we'll be just as anomalous 00:50:18.000 --> 00:50:20.000 as a six month mortality from 00:50:20.000 --> 00:50:22.000 HIV Aids people will look at 00:50:22.000 --> 00:50:24.000 that situation and say what 00:50:24.000 --> 00:50:27.000 the heck happened there this 00:50:27.000 --> 00:50:32.000 is treatable this is beatable 00:50:32.000 --> 00:50:33.000 the single most important 00:50:33.000 --> 00:50:36.000 thing that we need today is the 00:50:36.000 --> 00:50:38.000 courage to look this problem in 00:50:38.000 --> 00:50:41.000 the face and say this is real 00:50:41.000 --> 00:50:47.000 and this is all of us I believe 00:50:47.000 --> 00:50:51.000 that we are the movement thank you 00:50:51.000 --> 00:50:53.000 this is not preschool this 00:50:53.000 --> 00:50:55.000 is not elementary school why 00:50:55.000 --> 00:50:57.000 did you show us that video 00:50:57.000 --> 00:50:59.000 because you don't know what 00:50:59.000 --> 00:50:62.000 the ACE score is of the 00:51:02.000 --> 00:51:03.000 students that are attending 00:51:03.000 --> 00:51:06.000 this university you don't know 00:51:06.000 --> 00:51:08.000 if the bear came home every 00:51:08.000 --> 00:51:10.000 night you don't know what 00:51:10.000 --> 00:51:12.000 the substance abuse looked like 00:51:12.000 --> 00:51:13.000 you don't know what the 00:51:13.000 --> 00:51:14.000 mental health of the people 00:51:14.000 --> 00:51:17.000 in that household were before 00:51:17.000 --> 00:51:19.000 that student made it to this 00:51:19.000 --> 00:51:22.000 university students that have 00:51:22.000 --> 00:51:24.000 a history of interpersonal 00:51:24.000 --> 00:51:26.000 violence adolescents and adults 00:51:26.000 --> 00:51:27.000 that have a history of sexual 00:51:27.000 --> 00:51:31.000 assault are at more risk to be 00:51:31.000 --> 00:51:34.000 sexually assaulted again that 00:51:34.000 --> 00:51:36.000 crime is not a one and done 00:51:36.000 --> 00:51:37.000 it's not like okay well I can 00:51:37.000 --> 00:51:39.000 check that all thank goodness 00:51:39.000 --> 00:51:40.000 I got I got that over with at 00:51:40.000 --> 00:51:41.000 the age of fourteen and I won't 00:51:41.000 --> 00:51:43.000 have to worry about that when 00:51:43.000 --> 00:51:46.000 I get to college that still 00:51:46.000 --> 00:51:49.000 contributes to their ACE score 00:51:49.000 --> 00:51:51.000 what do we know about people 00:51:51.000 --> 00:51:53.000 that are sexually assaulted 00:51:53.000 --> 00:51:55.000 they do not deal well with it 00:51:55.000 --> 00:51:58.000 after the event they are at 00:51:58.000 --> 00:51:61.000 risk for physical trauma they 00:52:01.000 --> 00:52:03.000 are at risk for psychological 00:52:03.000 --> 00:52:07.000 trauma there is a possibility 00:52:07.000 --> 00:52:09.000 of death that can result after 00:52:09.000 --> 00:52:12.000 a sexual assault what we see 00:52:12.000 --> 00:52:14.000 and victims of sexual assault 00:52:14.000 --> 00:52:17.000 you heard Dr. Harris speak to 'em 00:52:17.000 --> 00:52:21.000 that we see in children 00:52:21.000 --> 00:52:22.000 it is imperative that we look 00:52:22.000 --> 00:52:24.000 at this as how this is going 00:52:24.000 --> 00:52:27.000 to impact the student for the 00:52:27.000 --> 00:52:29.000 rest of their health life and 00:52:29.000 --> 00:52:31.000 also when Dr. Harris made 00:52:31.000 --> 00:52:33.000 the reference of the bear 00:52:33.000 --> 00:52:36.000 what if they see the bear on 00:52:36.000 --> 00:52:38.000 the college campus they're 00:52:38.000 --> 00:52:40.000 crossing the campus there's 00:52:40.000 --> 00:52:42.000 the bear they're in the class 00:52:42.000 --> 00:52:44.000 there's the bear they go to a 00:52:44.000 --> 00:52:46.000 social event and there's the 00:52:46.000 --> 00:52:49.000 bear what does that impact 00:52:49.000 --> 00:52:51.000 look like for that student as well 00:52:51.000 --> 00:52:53.000 when we start looking at 00:52:53.000 --> 00:52:55.000 behavioral impact we know that 00:52:55.000 --> 00:52:57.000 students are adolescents that 00:52:57.000 --> 00:52:58.000 are sexually assaulted they 00:52:58.000 --> 00:52:61.000 deal with it in unhealthy ways 00:53:01.000 --> 00:53:02.000 they deal with it with 00:53:02.000 --> 00:53:04.000 substance abuse they deal with 00:53:04.000 --> 00:53:06.000 it with multiple sex partners 00:53:06.000 --> 00:53:08.000 they deal with it and some sort 00:53:08.000 --> 00:53:11.000 of coping mechanism that many 00:53:11.000 --> 00:53:14.000 times is not healthy there is 00:53:14.000 --> 00:53:17.000 a possibility of fatal outcome 00:53:17.000 --> 00:53:19.000 as a result of a sexual assault 00:53:19.000 --> 00:53:21.000 as I told you earlier we do 00:53:21.000 --> 00:53:23.000 have some sexually transmitted 00:53:23.000 --> 00:53:25.000 infections that we can't cure 00:53:25.000 --> 00:53:28.000 HIV and full blown Aids is 00:53:28.000 --> 00:53:30.000 starting to rear its ugly head 00:53:30.000 --> 00:53:33.000 again and the state that I work 00:53:33.000 --> 00:53:35.000 in Jackson Mississippi 00:53:35.000 --> 00:53:37.000 Jackson Mississippi is #4 00:53:37.000 --> 00:53:40.000 in the country for new 00:53:40.000 --> 00:53:43.000 HIV diagnoses the population 00:53:43.000 --> 00:53:46.000 most at risk with the most new 00:53:46.000 --> 00:53:51.000 diagnoses is 13 to 22 yr old African American females 00:53:51.000 --> 00:53:53.000 that age group does not 00:53:53.000 --> 00:53:56.000 take medicines well they are 00:53:56.000 --> 00:53:58.000 non compliant with healthcare 00:53:58.000 --> 00:53:61.000 historically I feel like -- in 00:54:01.000 --> 00:54:03.000 my career lifetime my daughter 00:54:03.000 --> 00:54:05.000 is a registered nurse I'm sure 00:54:05.000 --> 00:54:08.000 in her career lifetime we're 00:54:08.000 --> 00:54:10.000 going to see a full blown Aids 00:54:10.000 --> 00:54:13.000 rear its ugly head again 00:54:13.000 --> 00:54:16.000 it is not going away there are 00:54:16.000 --> 00:54:18.000 other issues that this person 00:54:18.000 --> 00:54:20.000 can experience medically that 00:54:20.000 --> 00:54:22.000 can be -- that can be fatal 00:54:22.000 --> 00:54:25.000 as well the brain does not 00:54:25.000 --> 00:54:28.000 process a sexual assault as 00:54:28.000 --> 00:54:30.000 in they can move forward and 00:54:30.000 --> 00:54:32.000 get past it for those of you 00:54:32.000 --> 00:54:34.000 that don't know the research 00:54:34.000 --> 00:54:36.000 on the neurobiology of trauma 00:54:36.000 --> 00:54:39.000 Dr. Rebecca Campbell is a neuro psychologist at 00:54:39.000 --> 00:54:41.000 Michigan State University 00:54:41.000 --> 00:54:42.000 and she and her group of 00:54:42.000 --> 00:54:44.000 researchers were tasked with 00:54:44.000 --> 00:54:46.000 trying to figure out why law 00:54:46.000 --> 00:54:48.000 enforcement and prosecutor's 00:54:48.000 --> 00:54:50.000 were not prosecuting sexual 00:54:50.000 --> 00:54:53.000 assault crimes so what they did 00:54:53.000 --> 00:54:54.000 is they went and I talked to 00:54:54.000 --> 00:54:58.000 those that see these victims first hand 00:54:58.000 --> 00:54:60.000 law enforcement and medical providers 00:55:00.000 --> 00:55:03.000 this is an actual statement from 00:55:03.000 --> 00:55:05.000 a sex crimes detective with 00:55:05.000 --> 00:55:07.000 fifteen years of experience 00:55:07.000 --> 00:55:08.000 he's basically blowing this 00:55:08.000 --> 00:55:10.000 person off because they didn't 00:55:10.000 --> 00:55:13.000 make any sense but Dr. Campbell 00:55:13.000 --> 00:55:15.000 said that statement 00:55:15.000 --> 00:55:17.000 does it make any sense make 00:55:17.000 --> 00:55:19.000 complete sense to her because 00:55:19.000 --> 00:55:22.000 her hypothesis was the brain 00:55:22.000 --> 00:55:24.000 is looking at sexual assault 00:55:24.000 --> 00:55:26.000 like it does any other trauma 00:55:26.000 --> 00:55:28.000 so they did their research 00:55:28.000 --> 00:55:30.000 by going into emergency rooms 00:55:30.000 --> 00:55:31.000 and waiting for trauma victims 00:55:31.000 --> 00:55:34.000 to come in this included a 00:55:34.000 --> 00:55:35.000 lot of people that were shot 00:55:35.000 --> 00:55:38.000 beat up in a car wreck victim 00:55:38.000 --> 00:55:40.000 of domestic violence victim 00:55:40.000 --> 00:55:41.000 of interpersonal violence 00:55:41.000 --> 00:55:44.000 strangulation sexual assault 00:55:44.000 --> 00:55:45.000 and officers involved in 00:55:45.000 --> 00:55:47.000 the shooting and once these 00:55:47.000 --> 00:55:49.000 patients were medically cleared 00:55:49.000 --> 00:55:51.000 Dr. Campbell and her team 00:55:51.000 --> 00:55:53.000 of researchers went in and did 00:55:53.000 --> 00:55:54.000 some blood studies to see where 00:55:54.000 --> 00:55:56.000 the hormone levels were and 00:55:56.000 --> 00:55:58.000 reference to how their brain 00:55:58.000 --> 00:55:60.000 processed the trauma when we have 00:56:00.000 --> 00:56:02.000 to understand this research 00:56:02.000 --> 00:56:04.000 we have to know how the brain 00:56:04.000 --> 00:56:07.000 works in a non traumatic state 00:56:07.000 --> 00:56:08.000 rational decisions are made 00:56:08.000 --> 00:56:10.000 in the frontal lobe memories 00:56:10.000 --> 00:56:13.000 are systematically categorized 00:56:13.000 --> 00:56:15.000 and stored and people are 00:56:15.000 --> 00:56:17.000 processing things in a normal 00:56:17.000 --> 00:56:19.000 way but in a trauma and you 00:56:19.000 --> 00:56:22.000 heard Dr. Harris reference this 00:56:22.000 --> 00:56:23.000 the amygdala which is 00:56:23.000 --> 00:56:25.000 scanning the environment for 00:56:25.000 --> 00:56:27.000 things that might kill you is 00:56:27.000 --> 00:56:29.000 on high alert if that amygdala 00:56:29.000 --> 00:56:32.000 detects a threat it notifies 00:56:32.000 --> 00:56:34.000 the hypothalamus which is 00:56:34.000 --> 00:56:35.000 like information switching 00:56:35.000 --> 00:56:37.000 station for the brain 00:56:37.000 --> 00:56:39.000 like Twitter of the brain and it 00:56:39.000 --> 00:56:42.000 notifies the hippocampus 00:56:42.000 --> 00:56:44.000 the hippocampus is trying to 00:56:44.000 --> 00:56:45.000 storm memories that notifies 00:56:45.000 --> 00:56:47.000 the pituitary gland let the 00:56:47.000 --> 00:56:49.000 adrenals know there's been a 00:56:49.000 --> 00:56:52.000 trauma release the cortisol 00:56:52.000 --> 00:56:54.000 release the catecholamine 00:56:54.000 --> 00:56:56.000 release the hormones that 00:56:56.000 --> 00:56:58.000 are going to put this person 00:56:58.000 --> 00:56:60.000 in a position of fight or 00:57:00.000 --> 00:57:02.000 flight and the hippocampus 00:57:02.000 --> 00:57:03.000 while all of this is going 00:57:03.000 --> 00:57:05.000 on that can systematically 00:57:05.000 --> 00:57:06.000 store memories in that frontal 00:57:06.000 --> 00:57:08.000 lobe and categorize on takes 00:57:08.000 --> 00:57:10.000 those memories and scatters 00:57:10.000 --> 00:57:12.000 them throughout the brain what 00:57:12.000 --> 00:57:14.000 the adrenals do is they dump 00:57:14.000 --> 00:57:17.000 hormones there's not like okay 00:57:17.000 --> 00:57:19.000 we let this level come out and 00:57:19.000 --> 00:57:20.000 then we cut it off and let this 00:57:20.000 --> 00:57:22.000 level come out it dumps the 00:57:22.000 --> 00:57:24.000 hormones that catecholamines 00:57:24.000 --> 00:57:26.000 which is the adrenaline dump 00:57:26.000 --> 00:57:28.000 the cortisol which is 00:57:28.000 --> 00:57:30.000 the available energy that the 00:57:30.000 --> 00:57:33.000 person has opioids because any 00:57:33.000 --> 00:57:35.000 pain physical or psychological 00:57:35.000 --> 00:57:37.000 that the person experience 00:57:37.000 --> 00:57:39.000 has to be addressed and then 00:57:39.000 --> 00:57:40.000 oxytocin which is in the 00:57:40.000 --> 00:57:43.000 endorphin family to counter 00:57:43.000 --> 00:57:45.000 balance the catecholamines 00:57:45.000 --> 00:57:47.000 this is a dump and nobody can 00:57:47.000 --> 00:57:49.000 control it the brain and the 00:57:49.000 --> 00:57:50.000 pituitary gland are the ones 00:57:50.000 --> 00:57:53.000 responsible for it so what they 00:57:53.000 --> 00:57:55.000 found out is that people that 00:57:55.000 --> 00:57:57.000 are sexually assaulted their 00:57:57.000 --> 00:57:60.000 brain dumps these hormones just 00:58:00.000 --> 00:58:03.000 like if it were any other kind 00:58:03.000 --> 00:58:05.000 of trauma catecholamines impair 00:58:05.000 --> 00:58:08.000 rational thought the rational 00:58:08.000 --> 00:58:10.000 thought during a sexual assault 00:58:10.000 --> 00:58:12.000 is you fight you kick you 00:58:12.000 --> 00:58:15.000 scream you run you do anything 00:58:15.000 --> 00:58:17.000 you can to defend and protect 00:58:17.000 --> 00:58:20.000 yourself catecholamines impair that 00:58:20.000 --> 00:58:22.000 the opioids cause a flat 00:58:22.000 --> 00:58:24.000 affect that's the way that our 00:58:24.000 --> 00:58:26.000 body handles the pain if you've 00:58:26.000 --> 00:58:28.000 ever seen someone that maybe 00:58:28.000 --> 00:58:30.000 after surgery was on morphine 00:58:30.000 --> 00:58:32.000 they're just kind of not there 00:58:32.000 --> 00:58:36.000 oxytocin gives them a euphoria 00:58:36.000 --> 00:58:38.000 have you ever seen the nervous giggler 00:58:38.000 --> 00:58:40.000 they've had bad news or they're experiencing 00:58:40.000 --> 00:58:42.000 something but they just got this 00:58:42.000 --> 00:58:44.000 really awkward giggle we've 00:58:44.000 --> 00:58:46.000 all seen that that's because 00:58:46.000 --> 00:58:48.000 in that trauma state the oxytocin 00:58:48.000 --> 00:58:50.000 is higher corticosteroids 00:58:50.000 --> 00:58:52.000 decrease and the person doesn't 00:58:52.000 --> 00:58:54.000 have the energy available to 00:58:54.000 --> 00:58:56.000 fight or flight when all of 00:58:56.000 --> 00:58:58.000 this happens the victim can 00:58:58.000 --> 00:58:60.000 experience tonic immobility 00:59:00.000 --> 00:59:03.000 where they shut down in my 00:59:03.000 --> 00:59:04.000 years as an ER nurse and taking 00:59:04.000 --> 00:59:06.000 care sexual assault patients 00:59:06.000 --> 00:59:08.000 I saw over two thousand 00:59:08.000 --> 00:59:10.000 sexual assault patients the 00:59:10.000 --> 00:59:11.000 most common response that 00:59:11.000 --> 00:59:13.000 I got when I question the 00:59:13.000 --> 00:59:15.000 patient can you tell me what 00:59:15.000 --> 00:59:17.000 you did during this event the 00:59:17.000 --> 00:59:19.000 most common response was 00:59:19.000 --> 00:59:22.000 I laid there I just laid there 00:59:22.000 --> 00:59:23.000 I don't know why I don't know 00:59:23.000 --> 00:59:25.000 why I didn't do all the things 00:59:25.000 --> 00:59:26.000 I've been taught to do if I'm 00:59:26.000 --> 00:59:29.000 ever attacked but I did not 00:59:29.000 --> 00:59:31.000 later on when we learned this 00:59:31.000 --> 00:59:32.000 information we were able to 00:59:32.000 --> 00:59:34.000 communicate to the patient 00:59:34.000 --> 00:59:36.000 exactly how the brain processed that 00:59:36.000 --> 00:59:38.000 let's add another chemical in there 00:59:38.000 --> 00:59:40.000 alcohol and what does 00:59:40.000 --> 00:59:43.000 alcohol due to the brain as 00:59:43.000 --> 00:59:45.000 well and then on top of all 00:59:45.000 --> 00:59:46.000 these other chemicals that 00:59:46.000 --> 00:59:48.000 are being released 00:59:48.000 --> 00:59:51.000 while this is happening the hippocampus 00:59:51.000 --> 00:59:52.000 which is scattering those 00:59:52.000 --> 00:59:54.000 memories is throwing in the 00:59:54.000 --> 00:59:55.000 part of the brain that don't 00:59:55.000 --> 00:59:58.000 usually store memories so the 00:59:58.000 --> 00:59:61.000 victim cannot physiologically 01:00:01.000 --> 01:00:03.000 recall the event because they 01:00:03.000 --> 01:00:05.000 cannot find the memories -- 01:00:05.000 --> 01:00:08.000 the illustration that Dr. Campbell uses is if you try 01:00:08.000 --> 01:00:11.000 to take notes on post it notes 01:00:11.000 --> 01:00:13.000 for a lecture and then you 01:00:13.000 --> 01:00:14.000 take these post it notes and 01:00:14.000 --> 01:00:15.000 scattered them all over your 01:00:15.000 --> 01:00:17.000 office in places that you would 01:00:17.000 --> 01:00:19.000 never put notes from a lecture 01:00:19.000 --> 01:00:20.000 and somebody comes back and 01:00:20.000 --> 01:00:22.000 says get your notes together 01:00:22.000 --> 01:00:24.000 assemble them in order and read 01:00:24.000 --> 01:00:25.000 back to me what you learned 01:00:25.000 --> 01:00:28.000 how confusing would that be 01:00:28.000 --> 01:00:29.000 and that's the illustration of 01:00:29.000 --> 01:00:32.000 how the brain processes this 01:00:32.000 --> 01:00:34.000 traumatic event but we expect 01:00:34.000 --> 01:00:36.000 victims of violence to make 01:00:36.000 --> 01:00:38.000 rational decisions to go to the 01:00:38.000 --> 01:00:40.000 law enforcement to go to the 01:00:40.000 --> 01:00:42.000 medical provider to come and tell 01:00:42.000 --> 01:00:44.000 the college this thing happened 01:00:44.000 --> 01:00:46.000 to me and they physically can't 01:00:46.000 --> 01:00:47.000 do it because of the way that 01:00:47.000 --> 01:00:50.000 the brain processes that 01:00:50.000 --> 01:00:53.000 this is an interview of a victim 01:00:53.000 --> 01:00:58.000 of sexual assault that Dr. Campbell did and this victim 01:00:58.000 --> 01:00:59.000 is explaining that there was 01:00:59.000 --> 01:00:62.000 a bad cop that was asking her 01:01:02.000 --> 01:01:04.000 rapid questions but then this 01:01:04.000 --> 01:01:06.000 other cop came in and sat down 01:01:06.000 --> 01:01:08.000 offered her a cup of coffee 01:01:08.000 --> 01:01:11.000 took her history and she said 01:01:11.000 --> 01:01:12.000 you know I don't know why he 01:01:12.000 --> 01:01:13.000 offered me the coffee but he 01:01:13.000 --> 01:01:15.000 just gave me the opportunity 01:01:15.000 --> 01:01:18.000 to talk it out and walk it through 01:01:18.000 --> 01:01:19.000 so then Dr. Campbell 01:01:19.000 --> 01:01:21.000 went and she interviewed that 01:01:21.000 --> 01:01:23.000 detective this detective had 01:01:23.000 --> 01:01:24.000 never heard of the neurobiology 01:01:24.000 --> 01:01:25.000 of trauma he didn't know 01:01:25.000 --> 01:01:27.000 anything about this information 01:01:27.000 --> 01:01:29.000 but what he did know is it's 01:01:29.000 --> 01:01:31.000 difficult for people to talk 01:01:31.000 --> 01:01:34.000 about and if you just give them time 01:01:34.000 --> 01:01:36.000 they are able to process it 01:01:36.000 --> 01:01:37.000 she went ahead and asked 01:01:37.000 --> 01:01:39.000 because this is a hot button 01:01:39.000 --> 01:01:41.000 topic in our communities 01:01:41.000 --> 01:01:43.000 ya think maybe she was making it up 01:01:43.000 --> 01:01:45.000 and I love what this cop 01:01:45.000 --> 01:01:48.000 says no I think it's hard 01:01:48.000 --> 01:01:50.000 for people to talk about 01:01:50.000 --> 01:01:52.000 are sexual assaults fabricated 01:01:52.000 --> 01:01:55.000 occasionally but the literature 01:01:55.000 --> 01:01:57.000 tells us the science is pretty 01:01:57.000 --> 01:01:59.000 clear only about two to eight 01:01:59.000 --> 01:01:61.000 percent of reported sexual 01:02:01.000 --> 01:02:03.000 assaults to law enforcement 01:02:03.000 --> 01:02:05.000 are fabricated it is a very 01:02:05.000 --> 01:02:09.000 small number well what about 01:02:09.000 --> 01:02:11.000 in the college setting 01:02:11.000 --> 01:02:14.000 So in society you put all these 01:02:14.000 --> 01:02:16.000 sort of labels on sexual assault 01:02:16.000 --> 01:02:19.000 real rape not real rape gray rape 01:02:19.000 --> 01:02:21.000 pink rape what the hell is gray rape 01:02:21.000 --> 01:02:24.000 blue rape green rape no -- 01:02:24.000 --> 01:02:27.000 real rape not rape stranger rape non stranger rape 01:02:29.000 --> 01:02:31.000 rape not quite legally defined 01:02:31.000 --> 01:02:33.000 as rape I'm a bad experience 01:02:33.000 --> 01:02:35.000 such that she regrets we put 01:02:35.000 --> 01:02:38.000 all of these labels on it but 01:02:38.000 --> 01:02:42.000 neuro-biologically that's not how we process it 01:02:42.000 --> 01:02:45.000 it's all rape it's all that 01:02:45.000 --> 01:02:47.000 it's all something that the brain 01:02:47.000 --> 01:02:48.000 interprets that this might 01:02:48.000 --> 01:02:51.000 kill me okay so early research 01:02:51.000 --> 01:02:53.000 on the neurobiology of sexual 01:02:53.000 --> 01:02:56.000 assault we we're expecting that 01:02:56.000 --> 01:02:57.000 when we looked at the blood 01:02:57.000 --> 01:02:61.000 of a victim of stranger rape for example 01:03:01.000 --> 01:03:02.000 someone who'd been abducted dragged into a 01:03:02.000 --> 01:03:04.000 building sexually assaulted a knifepoint 01:03:04.000 --> 01:03:06.000 we're like oh yea this is absolutely going to 01:03:06.000 --> 01:03:07.000 be an amygdala controlled 01:03:07.000 --> 01:03:09.000 response we're definitely going to see 01:03:09.000 --> 01:03:10.000 the hormone pattern consistent 01:03:10.000 --> 01:03:12.000 with the amygdala firing off and 01:03:12.000 --> 01:03:15.000 we did okay - 2 drunk kids in 01:03:15.000 --> 01:03:17.000 a college dorm room anyone 01:03:17.000 --> 01:03:20.000 want to take that one want to take that bet 01:03:20.000 --> 01:03:21.000 well in the scientific community we're all 01:03:21.000 --> 01:03:23.000 kinda holding our breathe 01:03:23.000 --> 01:03:25.000 were like I don't know I don't know 01:03:25.000 --> 01:03:27.000 society tells us that this 01:03:27.000 --> 01:03:28.000 isn't the same type of rape 01:03:28.000 --> 01:03:30.000 guess what their blood chemistry 01:03:30.000 --> 01:03:32.000 looks almost identical it is 01:03:32.000 --> 01:03:35.000 statistically indistinguishable 01:03:35.000 --> 01:03:36.000 if you put a whole bunch of 01:03:36.000 --> 01:03:37.000 led profiles in front of me 01:03:37.000 --> 01:03:39.000 tonight and said sort these 01:03:39.000 --> 01:03:41.000 into stranger and non stranger 01:03:41.000 --> 01:03:43.000 date rape I couldn't do it 01:03:43.000 --> 01:03:46.000 because you can't it's all rape 01:03:46.000 --> 01:03:48.000 it's all bad the amygdala 01:03:48.000 --> 01:03:50.000 fires off it's an incredibly 01:03:50.000 --> 01:03:52.000 invasive crime to the body 01:03:52.000 --> 01:03:54.000 hence the amygdala this is 01:03:54.000 --> 01:03:58.000 going to kill us potentially fire off okay 01:03:58.000 --> 01:03:62.000 so what happens after a sexual assault 01:04:02.000 --> 01:04:05.000 what do I look for in this student 01:04:05.000 --> 01:04:07.000 maladaptive coping 01:04:07.000 --> 01:04:09.000 they're not functioning well 01:04:09.000 --> 01:04:12.000 they're not functioning well in society 01:04:12.000 --> 01:04:14.000 how do we know it they're gonna do good 01:04:14.000 --> 01:04:17.000 or or move forward or not 01:04:17.000 --> 01:04:18.000 be able to move forward many 01:04:18.000 --> 01:04:20.000 factors play into that 01:04:20.000 --> 01:04:22.000 what does their peer network look like 01:04:22.000 --> 01:04:24.000 what is the support of 01:04:24.000 --> 01:04:25.000 their peer network what about 01:04:25.000 --> 01:04:27.000 their family history what was 01:04:27.000 --> 01:04:29.000 their previous experience in 01:04:29.000 --> 01:04:31.000 coping with trauma we have two 01:04:31.000 --> 01:04:33.000 responses to sexual assault 01:04:33.000 --> 01:04:35.000 we have rape trauma syndrome 01:04:35.000 --> 01:04:37.000 and if that isn't addressed then 01:04:37.000 --> 01:04:38.000 we look at this person 01:04:38.000 --> 01:04:41.000 developing PTSD rape trauma 01:04:41.000 --> 01:04:43.000 syndrome we see symptoms that 01:04:43.000 --> 01:04:45.000 last a month or less they are 01:04:45.000 --> 01:04:47.000 acute symptoms this is where 01:04:47.000 --> 01:04:50.000 the victim is not being able 01:04:50.000 --> 01:04:52.000 to function well after this 01:04:52.000 --> 01:04:54.000 assault and this maladaptive 01:04:54.000 --> 01:04:56.000 cycle they are having trouble 01:04:56.000 --> 01:04:58.000 processing the emotions of 01:04:58.000 --> 01:04:60.000 this they have a wide range 01:05:00.000 --> 01:05:02.000 of emotions they may block the 01:05:02.000 --> 01:05:04.000 incident and not remember it 01:05:04.000 --> 01:05:06.000 or not remember parts of it and 01:05:06.000 --> 01:05:07.000 I may never be able to recall 01:05:07.000 --> 01:05:09.000 that they may withdraw from 01:05:09.000 --> 01:05:11.000 school they may withdraw from 01:05:11.000 --> 01:05:13.000 activities you are going to 01:05:13.000 --> 01:05:15.000 recognize this in your students 01:05:15.000 --> 01:05:16.000 because the grades are going to 01:05:16.000 --> 01:05:18.000 plummet you're gonna see their 01:05:18.000 --> 01:05:20.000 appearance change you're gonna 01:05:20.000 --> 01:05:22.000 see their attitude change this 01:05:22.000 --> 01:05:24.000 is a student that was coming 01:05:24.000 --> 01:05:26.000 in and dressed one way and 01:05:26.000 --> 01:05:27.000 suddenly they may be disheveled 01:05:27.000 --> 01:05:30.000 one person told me that they 01:05:30.000 --> 01:05:32.000 started wearing pajamas and I said 01:05:32.000 --> 01:05:33.000 well you do know that that's 01:05:33.000 --> 01:05:34.000 a thing in colleges people 01:05:34.000 --> 01:05:36.000 just light wear pajama pants 01:05:36.000 --> 01:05:38.000 to class and I go no no no this 01:05:38.000 --> 01:05:40.000 was different this was a very 01:05:40.000 --> 01:05:42.000 drastic change -- they quit 01:05:42.000 --> 01:05:44.000 taking care of themselves their 01:05:44.000 --> 01:05:46.000 physical appearance changes 01:05:46.000 --> 01:05:47.000 they may gain a lot of weight 01:05:47.000 --> 01:05:49.000 or lose a lot of weight -- we used 01:05:49.000 --> 01:05:50.000 to hear about the freshman 01:05:50.000 --> 01:05:52.000 fifteen and now that it's taken 01:05:52.000 --> 01:05:54.000 on a whole new meaning because 01:05:54.000 --> 01:05:56.000 we're seeing that -- people 01:05:56.000 --> 01:05:58.000 that are sexually assaulted 01:05:58.000 --> 01:05:60.000 they will try to cope by eating 01:06:00.000 --> 01:06:01.000 eating a lot or not eating 01:06:01.000 --> 01:06:03.000 very much so I look at that 01:06:03.000 --> 01:06:06.000 as well they may express fear 01:06:06.000 --> 01:06:08.000 and anger they might act out 01:06:08.000 --> 01:06:10.000 male victims of sexual assault 01:06:10.000 --> 01:06:12.000 tend to act out in physical 01:06:12.000 --> 01:06:15.000 violent behavior fights heavy 01:06:15.000 --> 01:06:17.000 drinking and reactionary -- to 01:06:17.000 --> 01:06:20.000 violence in very simple type of 01:06:20.000 --> 01:06:22.000 anxiety type moments physical 01:06:22.000 --> 01:06:24.000 responses they may start 01:06:24.000 --> 01:06:26.000 having what we call somatic 01:06:26.000 --> 01:06:28.000 complaints this is they have 01:06:28.000 --> 01:06:31.000 physical pain but we can't find 01:06:31.000 --> 01:06:33.000 a medical reason for that pain 01:06:33.000 --> 01:06:35.000 suddenly having what we call a 01:06:35.000 --> 01:06:37.000 typical migraine headaches or 01:06:37.000 --> 01:06:39.000 stomach aches or back aches we 01:06:39.000 --> 01:06:41.000 tell help center staff to keep 01:06:41.000 --> 01:06:43.000 an eye on this as well wanting 01:06:43.000 --> 01:06:45.000 to have prescriptions for 01:06:45.000 --> 01:06:47.000 medications that they haven't 01:06:47.000 --> 01:06:49.000 previously asked for they may 01:06:49.000 --> 01:06:51.000 have a wide range of emotions 01:06:51.000 --> 01:06:53.000 I want to get away leave the 01:06:53.000 --> 01:06:55.000 school drop out of school drop 01:06:55.000 --> 01:06:57.000 out of life not do their job 01:06:57.000 --> 01:06:59.000 and not do their work 01:06:59.000 --> 01:06:61.000 PTSD duration of symptoms 01:07:01.000 --> 01:07:03.000 is greater than a month and 01:07:03.000 --> 01:07:04.000 were not present before the 01:07:04.000 --> 01:07:07.000 person experienced the trauma 01:07:07.000 --> 01:07:10.000 PTSD can be lifelong but 01:07:10.000 --> 01:07:12.000 it can also we can give them 01:07:12.000 --> 01:07:14.000 some coping skills to deal 01:07:14.000 --> 01:07:15.000 with that as these symptoms 01:07:15.000 --> 01:07:18.000 reoccur it is estimated 01:07:18.000 --> 01:07:20.000 that seventy percent of adults 01:07:20.000 --> 01:07:22.000 have experienced a traumatic 01:07:22.000 --> 01:07:25.000 event and that PTSD can develop 01:07:25.000 --> 01:07:27.000 any time post traumatic -- 01:07:27.000 --> 01:07:30.000 post traumatic experience 01:07:30.000 --> 01:07:31.000 victims of physical and sexual 01:07:31.000 --> 01:07:34.000 assault are at the highest 01:07:34.000 --> 01:07:36.000 to develop PTSD more than 01:07:36.000 --> 01:07:39.000 any other type of trauma and 01:07:39.000 --> 01:07:41.000 this is based from the Sidran Institute 01:07:41.000 --> 01:07:43.000 PTSD is involuntary 01:07:43.000 --> 01:07:45.000 were you have involuntary 01:07:45.000 --> 01:07:47.000 intrusive thoughts flashbacks 01:07:47.000 --> 01:07:49.000 episodes that interferes with 01:07:49.000 --> 01:07:51.000 a person's life and it interferes 01:07:51.000 --> 01:07:53.000 with their ability to cope 01:07:53.000 --> 01:07:55.000 and function and life and 01:07:55.000 --> 01:07:58.000 situations they want to avoid 01:07:58.000 --> 01:07:60.000 thoughts feeling they don't want 01:08:00.000 --> 01:08:01.000 to talk about the trauma 01:08:01.000 --> 01:08:03.000 they have an inability to recall 01:08:03.000 --> 01:08:05.000 the trauma they decrease 01:08:05.000 --> 01:08:06.000 interest or participation in 01:08:06.000 --> 01:08:09.000 their activities they have a 01:08:09.000 --> 01:08:11.000 a foreshortened future meaning 01:08:11.000 --> 01:08:12.000 they think they are going to 01:08:12.000 --> 01:08:14.000 have a shortened life they 01:08:14.000 --> 01:08:17.000 are very at risk for suicide 01:08:17.000 --> 01:08:19.000 attempts or completed suicides 01:08:19.000 --> 01:08:22.000 as well they can be hyper 01:08:22.000 --> 01:08:24.000 vigilant irritable outbursts of 01:08:24.000 --> 01:08:26.000 anger difficulty concentrating 01:08:26.000 --> 01:08:28.000 we can see now how you're 01:08:28.000 --> 01:08:29.000 going to see this with the 01:08:29.000 --> 01:08:31.000 student whose grades are going 01:08:31.000 --> 01:08:34.000 to change as well this can cause 01:08:34.000 --> 01:08:36.000 significant clinical distress 01:08:36.000 --> 01:08:38.000 and impairment in all areas 01:08:38.000 --> 01:08:41.000 of their life and this is -- 01:08:41.000 --> 01:08:43.000 Sidran Institute that shows us 01:08:43.000 --> 01:08:45.000 that sexual assault is at 01:08:45.000 --> 01:08:49.000 the highest -- to develop PTSD 01:08:49.000 --> 01:08:51.000 additional symptoms and signs 01:08:51.000 --> 01:08:54.000 of rape trauma syndrome and PTSD 01:08:54.000 --> 01:08:57.000 SRS and silent rape syndrome when 01:08:57.000 --> 01:08:58.000 you have someone that doesn't 01:08:58.000 --> 01:08:60.000 disclose a sexual assault 01:09:00.000 --> 01:09:02.000 and you can see all of those 01:09:02.000 --> 01:09:04.000 symptoms there as well there 01:09:04.000 --> 01:09:06.000 is no cookie cutter response to 01:09:06.000 --> 01:09:09.000 sexual assault the victim may 01:09:09.000 --> 01:09:10.000 or may not have all of these 01:09:10.000 --> 01:09:12.000 experiences and they may not 01:09:12.000 --> 01:09:14.000 have them immediately after the 01:09:14.000 --> 01:09:17.000 assault we have seen situations 01:09:17.000 --> 01:09:19.000 where victims didn't process this 01:09:19.000 --> 01:09:21.000 til months or years down 01:09:21.000 --> 01:09:24.000 the road and now are having 01:09:24.000 --> 01:09:25.000 these symptoms and they can't 01:09:25.000 --> 01:09:26.000 really understand what's going 01:09:26.000 --> 01:09:28.000 on and they don't relate it 01:09:28.000 --> 01:09:31.000 back to -- the sexual assault 01:09:31.000 --> 01:09:33.000 emotional reactions to sexual 01:09:33.000 --> 01:09:35.000 assault are treatable the most 01:09:35.000 --> 01:09:37.000 difficult step is getting this 01:09:37.000 --> 01:09:40.000 person to recognize this and 01:09:40.000 --> 01:09:42.000 getting them to the counseling 01:09:42.000 --> 01:09:44.000 and the advocacy that they need 01:09:44.000 --> 01:09:46.000 why is it hard for people to 01:09:46.000 --> 01:09:48.000 get treatment they don't have 01:09:48.000 --> 01:09:50.000 a support system they don't 01:09:50.000 --> 01:09:52.000 understand that this experience 01:09:52.000 --> 01:09:55.000 that they have now this pain 01:09:55.000 --> 01:09:57.000 the psychological dysfunction 01:09:57.000 --> 01:09:59.000 is related back to the sexual 01:09:59.000 --> 01:09:61.000 assault they may not connect 01:10:01.000 --> 01:10:03.000 that and they don't know where 01:10:03.000 --> 01:10:05.000 help is and how to get it 01:10:05.000 --> 01:10:06.000 they don't know how to move 01:10:06.000 --> 01:10:09.000 forward in that direction 01:10:09.000 --> 01:10:11.000 treatment options psychotherapy 01:10:11.000 --> 01:10:13.000 medication combination of 01:10:13.000 --> 01:10:15.000 psychotherapy and medication 01:10:15.000 --> 01:10:18.000 but on-going counseling is the 01:10:18.000 --> 01:10:20.000 best treatment option you're 01:10:20.000 --> 01:10:22.000 very fortunate to have Abby's 01:10:22.000 --> 01:10:24.000 House here on campus and have 01:10:24.000 --> 01:10:25.000 so many counselors that are 01:10:25.000 --> 01:10:27.000 available to address this 01:10:27.000 --> 01:10:28.000 in students not only that 01:10:28.000 --> 01:10:30.000 have an acute experience here 01:10:30.000 --> 01:10:32.000 on this campus but may have 01:10:32.000 --> 01:10:34.000 had that experience prior to 01:10:34.000 --> 01:10:36.000 getting to this campus as well 01:10:36.000 --> 01:10:39.000 behaviors that facilitate recovery 01:10:39.000 --> 01:10:41.000 keeping busy 01:10:41.000 --> 01:10:43.000 staying involved 01:10:43.000 --> 01:10:44.000 staying in school 01:10:44.000 --> 01:10:45.000 keeping their job 01:10:45.000 --> 01:10:49.000 moving forward moving forward moving forward 01:10:49.000 --> 01:10:50.000 getting them the help 01:10:50.000 --> 01:10:52.000 that they need and helping 01:10:52.000 --> 01:10:53.000 them to move forward 01:10:53.000 --> 01:10:57.000 behaviors that can hinder this recovery 01:10:57.000 --> 01:10:58.000 dropping out 01:10:58.000 --> 01:10:60.000 not having a good support system 01:11:00.000 --> 01:11:02.000 having a negative experience with the 01:11:02.000 --> 01:11:04.000 university and this can include 01:11:04.000 --> 01:11:07.000 peers faculty staff and taking 01:11:07.000 --> 01:11:10.000 on the blame that this assault is their fault 01:11:10.000 --> 01:11:13.000 and receiving that as well 01:11:13.000 --> 01:11:16.000 what can family friends and peers do 01:11:16.000 --> 01:11:18.000 be patient 01:11:18.000 --> 01:11:20.000 encourage the person to get 01:11:20.000 --> 01:11:21.000 the help that is available to 01:11:21.000 --> 01:11:23.000 them reach out to the advocacy 01:11:23.000 --> 01:11:26.000 center listen to those that 01:11:26.000 --> 01:11:28.000 are trying to help them and 01:11:28.000 --> 01:11:30.000 being patient with themselves 01:11:30.000 --> 01:11:33.000 as the try to progress as well 01:11:33.000 --> 01:11:35.000 the other thing that we 01:11:35.000 --> 01:11:38.000 can do is put responsibility 01:11:38.000 --> 01:11:41.000 on the perpetrator and it 01:11:41.000 --> 01:11:44.000 may be that this assault doesn't 01:11:44.000 --> 01:11:46.000 meet the jurisdictional 01:11:46.000 --> 01:11:48.000 jurisdictional requirements 01:11:48.000 --> 01:11:49.000 to be adjudicated in either 01:11:49.000 --> 01:11:52.000 college judical system or 01:11:52.000 --> 01:11:54.000 in the criminal justice system 01:11:54.000 --> 01:11:56.000 but it is still important that 01:11:56.000 --> 01:11:58.000 that victim reach out and 01:11:58.000 --> 01:11:60.000 get that advocacy get that 01:12:00.000 --> 01:12:02.000 care and understand that it's the 01:12:02.000 --> 01:12:04.000 perpetrator that is responsible 01:12:04.000 --> 01:12:07.000 for the assault and not the victim 01:12:07.000 --> 01:12:08.000 and here the resources 01:12:08.000 --> 01:12:10.000 and I've sent this -- powerpoint 01:12:10.000 --> 01:12:12.000 to Tina any questions 01:12:12.000 --> 01:12:14.000 for me regarding anything 01:12:14.000 --> 01:12:16.000 that we've talked about so far 01:12:16.000 --> 01:12:18.000 so the question was how 01:12:18.000 --> 01:12:22.000 do you get to that point of 01:12:22.000 --> 01:12:24.000 not showing discomfort even 01:12:24.000 --> 01:12:25.000 though you are uncomfortable 01:12:25.000 --> 01:12:27.000 how do you get to that point 01:12:27.000 --> 01:12:28.000 of not being uncomfortable 01:12:28.000 --> 01:12:30.000 with this disclosure 01:12:30.000 --> 01:12:32.000 first of all I don't think you're ever 01:12:32.000 --> 01:12:34.000 not -- I don't think you're 01:12:34.000 --> 01:12:36.000 ever comfortable with this 01:12:36.000 --> 01:12:38.000 disclosure -- the trick is to 01:12:38.000 --> 01:12:43.000 portray that you are open and 01:12:43.000 --> 01:12:44.000 you're comfortable with the 01:12:44.000 --> 01:12:46.000 disclosure but internally it's 01:12:46.000 --> 01:12:48.000 absolutely and I still do it 01:12:48.000 --> 01:12:50.000 where -- completely repulsed 01:12:50.000 --> 01:12:52.000 and a lot of times what I'm 01:12:52.000 --> 01:12:53.000 hearing not repulsed at the 01:12:53.000 --> 01:12:55.000 victim but just that acts 01:12:55.000 --> 01:12:57.000 that another human being that 01:12:57.000 --> 01:12:58.000 a human being did to another 01:12:58.000 --> 01:12:61.000 human being for me personally 01:13:01.000 --> 01:13:04.000 what I do is and I did this 01:13:04.000 --> 01:13:06.000 early in my career I would 01:13:06.000 --> 01:13:08.000 look in the mirror and I would 01:13:08.000 --> 01:13:10.000 practice a facial expression 01:13:10.000 --> 01:13:12.000 that I felt was inviting 01:13:12.000 --> 01:13:13.000 and for me it's raising the 01:13:13.000 --> 01:13:15.000 eyebrows it is it's almost like 01:13:15.000 --> 01:13:17.000 I open my eyes a little bit 01:13:17.000 --> 01:13:20.000 wider and then I kinda tilt 01:13:20.000 --> 01:13:22.000 my head to the side it's almost 01:13:22.000 --> 01:13:23.000 like an advocate social worker 01:13:23.000 --> 01:13:25.000 kind of a head tilt thing -- 01:13:25.000 --> 01:13:27.000 and I just try to listen and 01:13:27.000 --> 01:13:31.000 nod and just be aware of 01:13:31.000 --> 01:13:33.000 you know do not frown I'm 01:13:33.000 --> 01:13:36.000 saying that almost to myself -- 01:13:36.000 --> 01:13:37.000 I've never ever gotten to the 01:13:37.000 --> 01:13:39.000 point where I heard something 01:13:39.000 --> 01:13:41.000 from a victim and thought well that 01:13:41.000 --> 01:13:42.000 that that didn't sound so bad 01:13:42.000 --> 01:13:44.000 it all sounds bad it all 01:13:44.000 --> 01:13:46.000 sounds horrible but it's just 01:13:46.000 --> 01:13:48.000 that practice of watching the 01:13:48.000 --> 01:13:50.000 facial expression -- and then 01:13:50.000 --> 01:13:51.000 there are times when I've had 01:13:51.000 --> 01:13:53.000 to leave and go find a peer 01:13:53.000 --> 01:13:56.000 our colleague and say I need 01:13:56.000 --> 01:13:57.000 a break I need to get this 01:13:57.000 --> 01:13:59.000 off my chest that was horrible 01:13:59.000 --> 01:13:61.000 that was really rough you know 01:14:01.000 --> 01:14:02.000 having someone that I can kind 01:14:02.000 --> 01:14:05.000 of regurgitate that to 01:14:07.000 --> 01:14:09.000 cleansing for me to do that 01:14:09.000 --> 01:14:10.000 did that answer your question 01:14:10.000 --> 01:14:13.000 okay and and it I guess nurses 01:14:13.000 --> 01:14:14.000 you know because it would be 01:14:14.000 --> 01:14:16.000 medical account that we kind 01:14:16.000 --> 01:14:18.000 of go there with our career -- 01:14:18.000 --> 01:14:19.000 and I understand it is a lot 01:14:19.000 --> 01:14:21.000 different for lay people that 01:14:21.000 --> 01:14:22.000 are that are not in the medical 01:14:22.000 --> 01:14:25.000 profession -- but just however 01:14:25.000 --> 01:14:29.000 you can control those facial expressions 01:14:29.000 --> 01:14:30.000 so I want to make 01:14:30.000 --> 01:14:31.000 sure I get the question right 01:14:31.000 --> 01:14:33.000 you notice something and 01:14:33.000 --> 01:14:34.000 you want to be inviting for a 01:14:34.000 --> 01:14:36.000 student to have that dialogue 01:14:36.000 --> 01:14:38.000 with you but communicate that 01:14:38.000 --> 01:14:41.000 you are mandated reporter 01:14:41.000 --> 01:14:43.000 I think in that situation if 01:14:43.000 --> 01:14:45.000 they if there's like well I 01:14:45.000 --> 01:14:46.000 want to say up but I I know 01:14:46.000 --> 01:14:48.000 that you're mandated reporter 01:14:48.000 --> 01:14:49.000 I think it would be point them 01:14:49.000 --> 01:14:51.000 to Abby's House you know what 01:14:51.000 --> 01:14:52.000 there's a counseling center 01:14:52.000 --> 01:14:54.000 on campus I can understand 01:14:54.000 --> 01:14:56.000 your apprehension for telling 01:14:56.000 --> 01:14:59.000 this to me but what's most 01:14:59.000 --> 01:14:60.000 important is your health and 01:15:00.000 --> 01:15:02.000 well being the most important 01:15:02.000 --> 01:15:04.000 thing is not you telling me 01:15:04.000 --> 01:15:06.000 the most important thing is 01:15:06.000 --> 01:15:09.000 your health and well being and 01:15:09.000 --> 01:15:10.000 I highly recommend that you go 01:15:10.000 --> 01:15:12.000 to Abby's House and meet with 01:15:12.000 --> 01:15:15.000 a counselor and they can I know 01:15:15.000 --> 01:15:17.000 there are more -- privacy and 01:15:17.000 --> 01:15:19.000 confidentiality -- resources 01:15:19.000 --> 01:15:22.000 in place there and just 01:15:22.000 --> 01:15:23.000 I would go that path and I've had 01:15:23.000 --> 01:15:25.000 to do that with people before 01:15:25.000 --> 01:15:26.000 as well especially like in 01:15:26.000 --> 01:15:27.000 the medical community I don't 01:15:27.000 --> 01:15:29.000 want to go to the hospital 01:15:29.000 --> 01:15:30.000 but what do I need to do you 01:15:30.000 --> 01:15:31.000 know what you need to talk to 01:15:31.000 --> 01:15:33.000 somebody -- and I think after 01:15:33.000 --> 01:15:36.000 that just may be periodically 01:15:36.000 --> 01:15:39.000 checking in hey how you doing 01:15:39.000 --> 01:15:40.000 I just want to check in on you 01:15:40.000 --> 01:15:42.000 are you doing okay all right 01:15:42.000 --> 01:15:43.000 did you find Abby's House 01:15:43.000 --> 01:15:44.000 do know where that is 01:15:44.000 --> 01:15:46.000 just want to check in on you 01:15:46.000 --> 01:15:48.000 I think that would be the best way 01:15:48.000 --> 01:15:49.000 to handle that 01:15:49.000 --> 01:15:52.000 oh you're welcome thank you for asking