Investigate Populations that May Be at Increased Risk of Experiencing Trauma

Consider the two journal articles attached. Then, put together a 2 to 3-page reflection that discuss characteristics that might increase the risk of experiencing trauma. For example, consider how different populations may be at greater risk for experiencing trauma or how trauma might occur in on-campus, online, after-school, or community settings. Think about how trauma risk might be elevated for students and educators.

2-page reflection

Include three scholarly sources in addition to the attachment.

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

Chronic Poverty: The Implications of Bullying,

Trauma, and the Education of the Poverty-Stricken

Population

Kevin Johnson, M.Ed.
Liberty University, United States

Doi: 10.19044/ejes.s.v6a6 URL:http://dx.doi.org/10.19044/ejes.s.v6a6

Abstract

Chronic poverty is a worldwide epidemic, and communities must take

a proactive approach to assist the poor by extending a hand to lift them up and

not hold them down. Tribulations are part of life, but are some afflictions self-

imposed, escalated, or reinforced by living in deprived contextual

environments. Poverty-stricken people experience more trauma throughout

their lifetime; they are less educated than their counterpart, causing them to

become targets in school, increasing their chances of being bullied and

demoralized. Bullying is not a rite of passage, and it has lifelong effects that

reveal itself in adulthood by strengthening generational curses, oppressing

families and communities, expanding the educational gap, and reinforcing the

cycle of chronic

poverty.

The research depicted in this article explores the

correlation between poverty, human development, trauma, pedagogical

implications, and bullying, characterizing the detrimental ramifications in

adulthood. The paper analyzes bully symptomology, the etiology of traumatic

experiences, and how the consequences of chronic poverty affect human

development that expands the educational gap between minorities and white

students. Trauma-focused cognitive behavioral therapy is an effective

empirically-based treatment modality to combat the symptoms of

posttraumatic stress. School systems must do a better job of educating

traumatized children living in poverty. The research ventures to explain

chronic poverty’s role in human development, traumatology, and education,

taking an inclusive approach to providing solutions to create a cultural shift

that will change the contextual environment and propel people to become self-

sufficient, more educated, and equipped to break the generational curse of

chronic poverty.

Keywords: Chronic poverty, trauma, bullying, CPTSD, education.

http://dx.doi.org/10.19044/ejes.s.v6a6

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

Introduction:

President Thomas Jefferson wrote, “We hold these truths to be self-

evident, that all men are created equal, that they are endowed by their Creator

with certain unalienable Rights, that among these are life, liberty and the

pursuit of happiness.” In the eyes of their Creator, all men are created equal –

in the image of God, but throughout history, a man divided equality and justice

for all during slavery, Jim Crow, and the Civil Rights Movement. Many people

are miseducated and do not comprehend that the Civil Rights Movement was

not just for the Black race but all people, nationalities, ethnicities, gender, and

the disabled; the fight was for fairness for every color and creed. During this

period, the mentally challenged and disabled had struggles and battles of their

own. Fortunate enough, there were advocate groups and parents who were

willing to stand up and fight for the equal rights of those who could not stand

and fight for themselves. The mentally challenged and disabled have been

marginalized from society and the classrooms for years. Is it possible for

people who are reared in chronic poverty to beat the odds and succeed when

all odds are stacked against them? How is it possible to provide quality

education and security when children living in poverty normally stand out

from the crowd due to hunger, lack of resources, and poor hygiene, not

adequately having clothing, shelter, and other basic needs?

In President John F. Kennedy’s inaugural address, he proclaimed, “And

so, my fellow Americans: ask not what your country can do for you—ask what

you can do for your country.” What happens when the country placed certain

people at a significant disadvantage by being born the wrong color? How can

those who live a life of chronic poverty and generational curses of destitute do

anything for their country when they lack education and financial resources?

Chronic poverty orchestrates a life of injustice, discrimination, prejudice, and

unequal opportunities, regardless of the misconception that people are created

equal. Chronic poverty puts people at higher risk of poor mental and physical

health, risky behaviors, substance use disorders, complex posttraumatic stress,

and live a traumatic and detrimental lifestyle that stifles education, religious

beliefs, maturity, and personal growth, which has the propensity to bind

individuals mentally, spiritually, and emotionally. Lifetime adversities and

trauma correlate with low self-esteem, mental illness, lower socioeconomic

status, and small educational achievement, especially in the Black and Latino

populations who happen to be underrepresented to most studies. Myers,

Wyatt, Ullman, Loeb, Chin, Prause, Zhang, Williams, Slavich, and Liu (2015)

asserted that minorities experience unique stressors that impact their health –

including stressors such as neglect by society, discrimination, and multiple

traumatic experiences. Hardships in life devitalize people, resulting in pain,

suffering, and stress, while others who perceived the same traumatization rally

up the power to not only survive but thrive.

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

Generational poverty poses a distinct predisposition to the etiology of

the essence of traumatization because poverty can be a “little leaven” that

levels an entire generation. As the root cause of many traumatic events,

poverty has the proclivity to construct a unique dynamic that makes trauma

challenging to isolate and identify as a tragedy because families are described

as dysfunctional. Lowdermilk and Brunache (2013) professed that many

children reared in poverty mirrors the same behaviors as parents and their

community. They reflect those individuals growing up in demanding

environments, reporting negative/absent parent, parents with multiple sexual

partners or engaged in prostitution, substance use disorder, violence in the

home and community, verbal/physical abuse, unsanitary conditions, lack of

finances and resources, and parents demonstrate very low educational

expectations for their children, and all of this happens within the children’s

nuclear family. With the dismantling of the family structure, is it possible to

close the achievement gap and break the generational curse of the chronicity

of poverty?

Chronic Poverty and Human Development

Researchers examine the psychological and emotional development of

children living in poverty based on parental guidance and the methods parents

use to rear their children. Evans and Kim (2012) reported that “in the last two

decades, many scholars have investigated the underlying psychological

processes that explain why childhood poverty has such pervasive ill effects on

human development” (p. 43). Evidence substantiates that poverty causes

chronic stress, which deteriorates human functioning in every faculty of the

body, especially memory, brain development, and emotional regulation.

Children in poverty face unusual stressors that children living in middle-class

do not know about because they live in a contextual environment perceived as

safe and nurturing. Amatea and West (2007) declared that children living in

poverty are considerably more likely than children from the middle-class to

report increased levels of anxiety and depression, exhibiting a higher

frequency of behavioral and academic difficulties, and a lower level of

positive academic interaction and engagement in the school system. Collins,

Connors, Donohue, Gardner, Goldblatt, Hayward, Kiser, Strieder, and

Thompson (2010) reported that children who grow up in urban poverty display

symptoms of complex posttraumatic stress disorder; “complex trauma is a

varied and multifaceted phenomenon, frequently embedded in a matrix of

other psychosocial problems (e.g., neglect, marital discord, and domestic

violence that carry ongoing threat)” (p. 12). As reported by Gabrielli, Gill,

Koester, and Borntrager (2013), it takes a thorough understanding of the

ramifications of trauma and the unfolding developmental processes of

childhood as it is experienced in a particular culture, without neglecting to

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

understand the nature of historical trauma, as aggregated spiritual, physical,

emotional, and psychological wounding over the lifespan and across

generations.

Studies show that the ability to sense touch occurs around eight weeks

of gestation, and fetal development of the other sensory organs begin around

five weeks of conception and continue to refine through birth and early

childhood (Uhernik, 2017). While in utero, the fetus can hear and respond to

sounds and noises outside of the womb. Many parents play music, read books,

and talk to their fetuses throughout the pregnancy, interacting by touching

certain spots of the mother’s belly by poking or grabbing a hand or foot when

it is visible. At birth, the newborn can only see eight to ten inches, and research

denotes this short distance is “precisely the range required for gazing into the

caregiver’s eyes when held and for beginning the visual and interactive dance

of attachment and bonding” (Uhernik, 2017, p. 54). Establishing a bond and

attachment between the mother and the baby is the first step in psychosocial

development, which is vital for successful progression throughout life. As

reported by Kim, Fonagy, Allen, and Strathearn (2014),

Maternal sensitivity to infant distress and non-distress as predictors of

infant-mother attachment security. Maternal attachment trauma, particularly

when unresolved, presents to the mother’s attunement to and management of

her infant’s distress. Although this has not yet been the subject of direct

empirical scrutiny, attachment researchers have long speculated that infants’

distress signals may activate unresolved traumatic memories in their

respective mothers, thereby initiating a cascade of compromised maternal

responses. (p. 354)

The maternal reactions manifest traumatic memories for the mother

and can affect memory and cognitive abilities for the newborn.

Erik Erikson was a renowned psychologist and anthropologist who

identified eight stages of psychosocial stages of development, from birth to

old age. Everyone must discover her sense of regulation as she interacts with

the environment and the biological, emotional, and psychological

idiosyncrasies in life. Infants must establish trust so that they feel safe in

knowing that their needs will be met, and they will not be neglected. Stability

and a sense of security allow infants to see the world as secure and a

dependable place, encouraging optimism about the future and having

confidence in themselves and other people. Mounting research postulates that

fetuses can learn and have short term memory, which is believed to help the

fetus bond with his or her mother. When researchers used vibroacoustic

stimulation, Gonzalez-Gonzalez, Suarez, Perez-Pinero, Armas, Domenech,

and Bartha (2006) asserted that newborns in utero recognized the stimulus.

Newborns habituated sooner than babies who were not stimulated before birth.

This evidence suggests that babies encouraged during fetal life were able to

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

learn, recall, and memorize. Fetuses demonstrate advancement in cognitive

abilities throughout the fetal development period because the brain is this

amazing organ that has the potential for plasticity, neurogenesis, and the

creation of new neural pathways. Researchers like Otto Rank and Wilfred

Bion hypothesized that being born is a traumatizing experience because the

brain becomes bombarded by outside stimuli, causing the infant to experience

chaos and traumatization.

The hypothesis is not too far-fetched, considering that research

postulated that learning and memory formation occur in utero. Memory and

cognitive abilities learned inside the womb clash with the new environment

when the infant is removed from the womb. The baby takes in an array of

sounds, light, and different touches and smells that were limited in utero. If

the trauma of being born is significant, it is the caregiver’s responsibility to

ensure that a secure attachment is formed, because this lessens the “traumatic

experience” by providing a contextual environment where the infant can

establish trust instead of mistrust. The strength of the mother’s attachment,

mentally and physically, predicates the extensiveness of the trauma or

determines if the traumatic birthing experience will be lessened and managed

by providing love and trust instead of neglect and mistrust. Aside from the

possible functions of recognition and attachment to the mother, the

significance of fetal memory and cognition are necessary for the promotion of

breastfeeding and language acquisition (James, 2010).

Lipina, Colombo, and Jorge (2010) postulated that SES levels are

associated with a degree of hemispheric specialization and gray/white matter

volumes, concluding that reduced language skills were associated with lower

SES and related to less underlying neuronal specialization. According to

James (2010), “A large amount of evidence from habituation, classical

conditioning and exposure learning in humans substantiate that the fetus can

learn; however, there is no sound evidence showing that extra auditory

stimulation is of benefit to child development” (p. 52). Chronic poverty adds

a different variable to how newborns learn; the implications poverty has on

babies as they develop through the various stages of life impact their

education, increase stress levels, exposure to violence, and put them at a higher

risk of being traumatized.

Mounting studies show the detrimental impact of poverty on brain

development in children and adolescents, revealing how and why there is an

achievement gap in education between Blacks, Latinos, and their white

counterpart. Cortisol is the stress hormone needed when there is distress and

the fight and flight response catapults into high gear when the body senses

imminent danger or significant stress. High levels of cortisol affect the

amygdala that regulates emotions, and it can cause coronary heart disease,

hypertension, and high cholesterol levels. Children living in poverty have

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

higher levels of cortisol and other stress markers that have disadvantageous

effects on emotional intelligence, regulation, academics, and executive

functioning. According to Blair and Raver (2016),

Executive function is essential for self-regulation and school readiness

and is a fundamental building block of early cognitive and social competence.

Available evidence indicates that the effects of socioeconomic and early

psychosocial disadvantage on cortisol and brain structure partially mediate

effects of poverty on the development of executive function in childhood.

Impact of poverty on brain development and executive function are likely one

critical pathway, along with reduced stimulation for learning, through which

poverty is associated with gaps in school readiness and achievement and

positive life outcomes. (p. 4)

Taylor and Barrett (2018) professed that “the impact of developmental

trauma in the early years can have a disproportionate effect on the growth,

day-to-day functioning and life chances of a young person” (p.73).

Other studies have shown how nonhumans’ neural pathways evolve,

creating new and advanced channels when placed in environments where they

were stimulated and challenged to interact with devices and manipulatives that

promoted higher levels of cognitive functioning. According to Lipina and

Colombo (2009), elements of executive function, memory, and self-

monitoring tend to be lower in children who live in poverty. The researchers

used basic tasks to “assess skills related to dorsolateral prefrontal (working

memory), anterior cingulate (cognitive control), and ventromedial (reward

processing) prefrontal systems, the results showed a consistent disparity

between children from lower and middle SES groups” (p. 583). As various

studies report, poverty-stricken children are placed at a disadvantage from

birth throughout the different stages of life. If preventive measures,

interventions, and programs are not tailored to meet this demographic, the

cycle of generational poverty will continue, creating a new environmental

DNA passed down to its offspring. How do society and educational systems

close the divide in education, learning, and development? According to Ladd

(2012), “Addressing the educational challenges faced by children from

disadvantaged families will require a broader and bolder approach to

education policy than the recent efforts to reform schools” (p. 204).

Chronic Poverty and Trauma

The majority of psychological research on the consequences of trauma,

poverty, and education has been conducted at the level of the individual,

typically studying the persons’ trauma histories, and trauma exposures with

their symptoms, demographics, and contextual environment (Klest, 2012). As

reported by Collins et al. (2010), there is critical evidence suggesting that

children, adolescents, and families growing up in poverty are more likely to

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

experience multiple traumas, significant adverse life events, and develop

convoluted symptoms of traumatic distress at disproportionate rates. The

research presented in this literature explores trauma from a specific group that

it impacts and consists of a subset or region of individuals, instead of looking

at trauma as a single catastrophe but a subset of issues or deficiencies that

culminate into traumatic experiences from living a life of generational curses

and chronic poverty. It is no secret that Blacks, Latinos, and other minorities

constitute most of this vulnerable and underserved group. As reported by

Collins et al. (2010), “Efforts to explain the severity and chronicity of reactions

to repeated traumas traditionally focus on the cumulative effects of multiple

traumatic episodes” (p. 11). Trauma can be experienced or witnessed

vicariously, and second-hand trauma can be worse for the person who is

helping the survivor or the one who saw the event from a different perspective.

After the 911 attack in New York, people suffered from posttraumatic stress

as far as Texas and Oklahoma; it is understood as a profoundly disrupting

experience that can threaten the well‐being and safety of those involved

(Gabrielli, Gill, Koester, & Borntrager, 2013).

Many psychologists and researchers describe trauma differently,

characterizing a common thread that ties the theories together, but a definitive

definition of trauma is difficult to establish because tragedy can be subjective.

A clinician and client can disagree about an episode being traumatic or not,

because of the client’s apperception, resiliency, and personal growth. Scott and

Briere (2015) discussed the ambiguous description of trauma that is

characterized by the Diagnostic and Statistical Manual of Disorders, 5th

edition (DSM-5), which provides a broad definition with limitations, causing

conflicting information in determining if an event satisfies statistical

definitions of trauma. Scott and Briere (2015) denoted their interpretation and

professed that “an event is traumatic if it is extremely upsetting, at least

temporarily overwhelms the individual’s internal resources, and produces

lasting psychological symptoms” (p. 10). If the definition defined by the DSM-

5 is adhered to strictly, many clients would not be classified as a trauma

survivor.

There is a fallacy that a traumatic event must be a devastating isolated

experience that keeps resurfacing in a person’s life. Trauma does not have to

be a single catastrophe but a culmination of small, insignificant issues that

converge together until all the pieces of life’s problems connect like the perfect

jigsaw puzzle. The mental symptomology of traumatic experiences can

debilitate people from being able to access coping skills to keep intrusive

thoughts at bay, and they lack the cognitive abilities to manage and process

the traumatic experience and the possible manifestation of psychological

disorders. It takes a thorough understanding of the ramifications of trauma and

the unfolding developmental processes of childhood as it is experienced in a

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

particular culture to understand the nature of historical trauma, as aggregated

spiritual, physical, emotional, and psychological wounding over the lifespan

and across generations (Gabrielli, Gill, Koester, & Borntrager, 2013). Trauma

that affects poverty-stricken cultures covers a broad range of atrocities that

destroys the sense of safety within the individuals’ community, including

neighborhoods, schools, churches, towns, and other places where people

conjugate together but separately (“Center for Substance Abuse,” 2014).

Studies have identified the problem and determined that increased

trauma is associated with poverty and deprivation. The consistent restriction

and limited opportunities that characterize poverty can lead to daily hassles

and unexpected traumatic events like the lack of food or disconnection from

water, electricity, and other supplies (Shamai, 2017). It is normal to experience

trauma across the lifespan; for most people, individuals and communities

usually respond to tragedy with resilience, because many influences shape the

effects of trauma among individuals and families. Due to other factors and

circumstances, it is not just the traumatic episode that predicts the outcome,

but also the episode’s context and the interactions between family support, first

responders, counselors, psychological first aid providers, and community

leaders (“Center for Substance Abuse,” 2014). Severe childhood adversity, in

the form of traumas such as physical and sexual abuse, alters young people’s

transition into adulthood due to social and behavioral reasons, but also due to

the physiologic and neurobiological changes that occur due to chronic

stressors. Considering the impact and effects of poverty and trauma, Myers et

al. (2015) proclaimed that numerous studies refute the results expected

because both African Americans and Latinos(as) appeared to be rather

resilient, despite their higher than normal stressors and burdens of adversities

and traumatizing experiences. It is safe to infer that people who have lived a

life of trauma and lack resources all of their lives have become conditioned to

become content in whatever state they find themselves in their contextual

world. They do not know the hidden rules of the middle-class, so what appears

to be poverty and trauma for the middle-class is healthy everyday living for

people residing in poverty.

Research substantiates that fifty percent of people will experience

trauma in their lifetime. This traumatic experience for only fifty percent of the

population is up for debate if we believe in the work of Otto Rank who

proclaimed that being born is a traumatic experience, beginning when the

infant inhaled his or her first breath. Stewart (2014) purported that Arthur

Schopenhauer and Otto Rank discussed suffering because of birth itself,

referring to being born as a traumatic experience. Aside from birth, people in

poverty are exposed to the daily hassles that cause stress. Klest (2012) reported

that models of trauma and coping include the erosion of family processes and

dynamics (structure, relations, coping) in the context of community violence

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

and poverty, explaining the higher likelihood of family violence in the

contextual environment of poverty. The traumatic experience by one family

member can create a traumatic stress reaction in other family members through

association and proximity to the danger or the catastrophe (Kiser & Black,

2005).

The Domino Effect: Chronic Poverty, Trauma, and Bullying

Today, school violence is nothing new, and it continues to become

more frequent and deadly in the school systems. Across the globe, educational

institutions have active-shooter drills protocols and prepare students, faculty,

administrators, and staff what to do when this vicious act of violence occurs.

No matter the amount of preparation, no one is ever prepared for the time a

school shooting happens in their contextual framework. This type of school

violence is evident, reported by newspapers, talk shows, television, social

media, and other mediums, repeatedly. As published by Levers (2012), it took

the U.S. Department of Education and the U.S. Secret Service to define the

parameters of school violence, but one of the most critical findings was

“defining school violence as consisting of two sorts: lethal and nonlethal.”

This research focuses on the nonlethal violence that does not get the attention

warranted, and protocols are not protecting the children and ensuring their

safety sufficiently. Nonlethal school violence consists of all forms of bullying

threats, intimidation, harassment, assault, and sexual assault, constituting

physical, verbal, social, and cyberbullying (Levers, 2012). According to

Skaine (2015), “bullying is an unwanted, aggressive behavior that involves a

real or perceived power imbalance that is repeated, or has the potential to be

repeated, over time” (p. 40). Bullied children and adolescents have PTSD, and

they need to be treated for the symptoms because traumatized children grow

up to become traumatized, broken adults. Herman (2001) reported the

significance of abuse in childhood, and how later in life, childhood abuse can

contribute to increased risk for cancer, heart disease, stroke, and obesity –

increasing the risk of alcoholism, depression, suicide attempts, self-harm, and

absenteeism from work in adulthood. Bullying is a form of complex

posttraumatic stress disorder (CPTSD). Herman (2012) reported that “CPTSD

was specifically associated with early-onset and long duration of trauma; it

was very rarely found in survivors of natural disasters, and very commonly

found in survivors of childhood abuse” (p. 25).

The reoccurrence of the same traumatic experience is what

distinguishes CPTSD from PTSD. An individual might have PTSD after a

horrific car accident, an isolated sexual assault, or natural disaster, but CPTSD

is characterized as having the same traumatic experience repeated on several

occasions. Research substantiates that CPTSD symptoms account for the

functional impairment of trauma survivors who endured prolonged and

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

repeated tragic episodes exceeding the damage attributed to PTSD alone

(Herman, 2012). Bullying falls under the category of complex trauma, and it

attributes to the psychological effects in adulthood. Children living in poverty

can stand out from the crowd because of dirty clothes, holes in shoes, unkempt

hair, and poor personal hygiene. Bilic (2015) reported that almost all

socioeconomic variables that suggest that a family is poor correlate

significantly with victimization, and the results from the same study denoted

that 34.8% of those living in poverty responded violently toward peers because

of their more inferior financial status, and 45.7% were bullied and victimized

for being poor. Some bullied children might retaliate by taking extreme violent

means of retaliation. In the 1990s, 12 of the 15 school shooting cases that

occurred, the shooters had a history of being bullied (Skaine, 2015).

Trauma is an occurrence when an intense experience stuns a child like

a bolt out of the blue, overwhelming the child, leaving him or her altered and

disconnected from body, mind, and spirit (Steele & Malchiodi, 2012).

Bullying is not harmless; bullying is not child’s play; bullying is not a rite of

passage. A rite of passage insinuates that bullying is part of life and the school

experience, so children should expect to be bullied. Children go to school to

learn about history, science, arithmetic, spelling, and using correct grammar,

so being bullied is one of the soft skills or indirect learning experiences

embedded in the school curriculum. In the academic subjects, students receive

a letter grade of pass or fail as they matriculate through school. What grade do

students get for enduring four, six, eight, or twelve years of bullying? How do

teachers indicate if their students passed or failed? If the student never

attempts suicide, is that a passing score?

If the student only has low self-esteem and depression and anxiety, is

that considered acceptable to be promoted to another year of punishment? If

the individual only has non-suicidal injuries – such as cutting or burning – is

that enough for promotion? However, when the person dies by suicide, it is

safe to say that he or she failed the rite of passage. Many children believe that

when they get older, they will grow up and out of the bullying environment,

but the psychological effects and ramifications follow them into adulthood.

Tariq (2011) purported that the problem of most significant concern is

the stifling effects produced by the survivor of bullying. Staggering numbers

of investigators have asked whether victims of peer aggression experience

psychosocial maladjustments, such as depression, anxiety, and low self-

esteem, and “it is clearly important to know the answer to this question, so that

children’s distress does not go unrecognized” (p. 23). Suicide rates have

increased tremendously over time in schools, contributing to the fact that those

who are being bullied and lack evidence of physical scars, but they suffer away

in silence until victimization becomes overbearing, losing hope, and deciding

that the only solution for them is to die by suicide (Hendricks & Tanga, 2019).

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

Bullying is not a rite of passage – even though children are steadfast in

believing that their trials and tribulations will be over when they become

adults. Unfortunately, the research does not predict a happily ever after but a

possible lifetime of physical and psychological problems – leaving mental,

spiritual, emotional, and physical wounds. Parents and educators must

recognize the signs and symptoms of bullying. Often, the physical signs are

evident – like unexplained injuries, bruises, broken bones, and the black eye.

Bullied children tend to isolate themselves from family and friends, become

depressed, and become overly anxious. Vanderbilt and Augustyn (2010)

identified several red flags that an individual is being bullied. Some of the

more common indications are stomachaches, headaches, insomnia, social

problems, lack of friends, and academic failure. It is critical that bullying is

considered on an extensive list of differential diagnoses because bullying may

overlap with other conditions such as medical illness, learning problems, and

psychological disorders (Vanderbilt & Augustyn, 2010).

Adults who were bullied as a child or adolescent may have a lower

socioeconomic status (poverty), engage in risky behaviors, suffer from anxiety

and depression, and experience psychosis and have suicidal ideations or

attempts. Blad (2016) stated that children should be assessed from birth to

understand the extent of bullying on psychosis later in their adult life – with

some groups to be nearly five times more likely to suffer from episodes of

psychosis by the age of 18. In adulthood, bullied children have higher rates of

suicidal thoughts and plans than children who had not been bullied (Wagner,

2016). There is no escape when bullied children grow up to be high school

dropouts and experience long-term effects (depression, relationship problems,

psychosis, substance use disorder, risky behaviors, and suicide). When the

psychological effects of bullying accompany children into adolescent and

adulthood, not only did the children fail the rite of passage, but parents failed;

educators failed; church leaders failed; the school system failed; society failed

these children.

Why is it critical that bullying is discussed trauma and the chronicity

of poverty? It is the psychological effects of bullying that warrants the nation’s

attention if the educational gap is going to be closed. Being bullied as a child

or experiencing bullying behaviors have the propensity to continue the cycle

of chronic poverty, so the generational curse continues with no end if a cultural

shift does not happen soon.

• Children who live in poverty experience higher rates of trauma and

bullying.

• Children who are bullied are more likely to drop out of school,

continuing to expand the educational divide and the continuation of chronic

poverty.

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

• They have a lower social, economic status, suffer from mental

disorders, engage in risky behaviors, experience psychosis, and have a higher

risk of having a substance use disorder.

• Bullied children have a difficult time keeping a job at the age of 24 to

26, and men who were bullied in high school had a significant chance of being

unemployed at the age of 50 (Brimblecombe, Evans-Lacko, Knapp, King,

Takizawa, Maughan, & Arsenault, 2008).

Matthews, Jennings, Lee, & Pardini (2017) discussed research

showing that bullied children had a low SES, and they are less likely to have

a high school diploma or GED. Throughout their lifetime, they have lower

adult family income and lack adequate resources with lower social status in

their community. Brimblecombe et al. (2008) reported that “four decades after

the bullying occurred, both men and women who were bullied in childhood

were less likely to be in employment and accumulated less wealth in the form

of home-ownership or savings than participants who were not bullied” (p.

138). Research depicting those results can only strengthen chronic poverty

with a new generation of people who will continue to reinforce and ensure

generational poverty advances for the foreseeable future.

TF-CBT

The best method for treating bullying is prevention and having a zero-

tolerance in school and at home. McAdams and Schmidt (2007) purported that

teachers have indicated feeling underprepared to recognize and manage bullies

and bullying behaviors in their classroom. Their lack of knowledge causes

them to ignore serious aggressive behaviors, or they identify bullying but feel

inadequate or too afraid to intervene and address the problem. Parents and

guardians are not equipped to train their children and convey the dangers of

bullying, model a bully-proof home, and they lack the knowledge of teaching

their children how to become resilient. Bullying that happens in the home is

often overlooked by everyone involved because it is family-oriented. Bowes,

Wolke, Joinson, Lereya, and Lewis (2014) proclaimed that sibling bullying is

a specific type of aggressive behavior that is repeated over time (complex

trauma) – intending to cause harm and dominate the weaker sibling. Studies

show a strong correlation between sibling bullying and increased internalizing

symptoms – resulting in the emergence of depression and self-harm in

children, adolescent, and adulthood. It is essential to protect children in the

two most important places where they spend a significant amount of time–

home and school.

Children must become emotionally intelligent, develop coping skills,

and use assertive communication (verbal and non-verbal) to deescalate and

disengage from bullying behaviors and bullies. If a child is not safe within

one’s mind, he is not safe anywhere. The renewing of their mind must

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

transform children by becoming bully-proof. Bullying survivors may have

PTSD, and they do whatever it takes to escape the intrusive thoughts, shame,

and humiliation of being demoralized. Steele and Malchiodi (2012) professed

that “PTSD is more common in children than most physicians believe;

therefore, the diagnosis can often be missed. Children being treated for

behavioral problems may be suffering from PTSD” (p. 15). Black,

Woodworth, Tremblay, and Carpenter (2012) proclaimed that “TF-CBT is a

component-based model and can be summarized using the acronym

“PRACTICE” (p. 196). Cognitive behavioral therapy (CBT) is an empirically

supported approach to treating PTSD and CPTSD. According to Levers

(2012), through the method, clients learn how to reduce negative emotional

and behavioral responses that follow a traumatic event, because “the treatment

is based, fundamentally, on learning and cognitive theories that address

distorted beliefs and attributions related to the traumatic events experienced

by an individual” (p. 496). As reported by Black et al. (2012),

In relation to treating trauma-related symptoms, there are a number of

CBT-like treatments that involve most aspects of the therapy but do not

actually present themselves specifically as CBT, such as multimodal trauma

treatment (MMTT), as well as different variations of CBT, such as trauma-

focused cognitive behavioural therapy (TF-CBT). (p. 194)

TF-CBT is the treatment modality discussed in this paper as an

efficient approach to treating bullying survivors suffering from symptoms of

CPTSD. Johnson (2012) reported that trauma-focused care is done

professionally and thoughtfully. It is informed of the overall construct

showing great concern not only for the survivor’s emotional safety but it is

focused on the reassessment and restructuring of the treatment system to

evaluate how the traumatic experience may affect the survivor’s role and

interaction with certain aspects of the entire systematic approach for treatment.

One of the many benefits of TF-CBT is that multimodalities can be applied to

reach the desired goals of hope, recovery, and resiliency, and the approach is

substantiated by years of empirical and evidence-based research and

advancing theories to wellness. As explained by Black et al. (2012),

During treatment, the traumatized child is provided with

psychoeducation, taught relaxation skills, affective expression and

modulation, and cognitive coping skills. In addition, they are encouraged to

use trauma narration and cognitively process the trauma, use in vivo exposure

to master trauma reminders, have conjoint parent-child sessions, and enhance

safety and the trajectory of development. (p. 196)

Johnson (2012) stated that TF-CBT is the most studied of all the

treatments for trauma-related symptoms among children and adolescents, even

though many professionals do not recognize the advantages. Black et al.

(2012) asserted that regardless of the specific treatment protocol that is

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

adhered to, it is crucial to keep in mind that psychoeducation, coping skills,

trauma narratives, cognitive restructuring, and creating an action plan for after

the cessation of therapy are all typically integral practices of the trauma-

informed treatment programs. By implementing some or all of these critical

practices, it should be possible to reduce trauma-related symptoms among

trauma survivors. Even resilient children show distress following trauma

exposure, and their reactions cause them to increase monitoring of their

environment for potential dangers, experiencing anxiety when they are

separated from trusted adults, or heightened need for affection, support, and

reassurance because trauma re-enactments may resurface again in their lives

(Kiser & Black, 2005). Therefore, treating the psychological effects of

bullying is critical to living a life free of chronic poverty. It is estimated that

160,000 school-aged children miss school because of bullies or bullying

behaviors (Skaine, 2017). If children are too afraid or too humiliated to go to

school, how will they ever learn the hidden rules of the middle-class and

become educated, productive members of society?

Chronic Poverty and the Educational Divide

Individuals who live in poverty present a profound challenge in school

systems, homes, and communities. Brito and Noble (2014) asserted that

socioeconomically disadvantaged children tend to experience less linguistic,

social, and cognitive stimulation from their caregivers and home environments

than children from higher Socioeconomic Status (SES) homes” (p. 2). Hair,

Hanson, Wolfe, and Pollak (2015) proclaimed that there is strong evidence

that poverty influences language (temporal lobe) and executive functioning

(frontal lobe). Deficits in the executive functioning of individuals in poverty

have been found during the life course in studies conducted during infancy as

well as in childhood, adolescence, and adulthood (p. 823). Mending the issues

associated with chronic poverty and breaking generational curses is a massive

undertaking, but several educational programs are intervening at an early age

in the child’s psychological and psychosocial development, but those

initiatives alone do not alleviate the problems or lessen the psychological

effects of poverty and trauma. Hair, Hanson, Wolfe, and Pollak (2015)

reported that “children living in poverty have lower scores on standardized

tests of academic achievement, more mediocre grades in school, and lower

educational attainment (p. 823).

Parents must be taught and trained to become self-sufficient, improve

self-esteem and self-compassion and learn to have high self-efficacy and the

will and desire to change. Before tackling the trauma that is interwoven in

poverty that causes a reoccurring cycle, society has to take an aggressive

approach to improve the physical conditions, educate and train parents, and

combat hunger and other lack of resources. Ruby Payne wrote a book entitle,

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A Framework for Understanding Poverty. According to Payne (1996), if

people around a person has similar circumstances, and the problems attached

to poverty, the notion of poverty and wealth is vague. Individuals bring the

hidden rules of their environment, placing poverty-stricken communities at a

disadvantage because schools and society operate from the middle-class

norms and use the arcane rules of the middle class. The two most important

conditions to help people move out of poverty are education and relationships

(Payne, 1996).

How is it possible for parents to teach their children the hidden rules

of common cultural patterns when all they know is the exposed rules of

poverty? There must be a cultural shift to train parents to become

knowledgeable and educated because education is the vehicle that will drive

them away from poverty. The effects of generational poverty cannot be

obliterated in an instance. It takes significant time to unravel generations of

neural pathways that have been programmed to accept poverty. Society and

educators must be willing to be patient, teach, and reprogram a culture of

people by transforming their mental faculties. Amatea and West (2007) stated

that rather than viewing poverty from society’s perspective, inclusive of

systemic influences and class privilege, many of these educators believe that

poor people are intrinsically inferior because of their innate flaws such as lack

of motivation or poor decision making. Parents and children living in poverty

cannot be held accountable for their intrinsic defects. Until the generational

narrative of poverty has been retold psychologically, spiritually, and

emotionally, the problem will remain in today’s societies. Poor people will

always exist in the world; however, educators and society must be willing to

lead, follow, or get out of the way, because if they are not ready to be part of

the solution, their patronizing demeanor is part of the problem.

The educational gap between Blacks and Latinos and Whites has

nothing to do with the intellectual abilities of the poverty-stricken minority

population. In many minority families, getting a good education is not

emphasized because survival is more important than learning. Children living

in poverty do not receive support or challenges that are necessary to be

successful in high school, college, and life. Since education is not essential to

their parents, why should they make it vital for themselves? Some minority

students overcome the odds and become successful; however, for the majority,

these neglected students fall between the cracks.

There is a need to train parents on how to educate and instill the value

of education in their children. van der Veen and Preece (2005) asserted that

“the trend in adult education policies (where they exist at all) has been to focus

on literacy or basic education. Research has shown that basic literacy skills

are not in themselves sufficient to make a significant impact on poverty

reduction, though they do help” (p. 381). Therefore, it would be beneficial to

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

provide workshops, seminars, and hands-on training for parents of minorities

living in poverty, but more is required in areas where a tremendous impact can

be made to improve living conditions. van der Veen and Preece (2005) stated

that targeting the real needs of the poor will take a collaborative approach

between all stakeholders, employers, businesses, and employees. Poverty is an

eyesore, and it does not benefit society, families, education, and the economy.

Many parents do an excellent job rearing respectful citizens; however, they

fail to train them to be self-sufficient, self-motivated, and educationally

prepared to attend school, college, and productive members of society. When

children are prepared at home, they come to school at an advantage, and they

are eager to learn. A healthy family with solid values is the foundation for

academic and personal success. Through adult education, what better way to

model the importance of learning and to work to improve living conditions.

The evidence on adult education in the public economic domain leads to the

hypothesis that a “more extended and more targeted system for basic

education, agricultural extension, and vocational training is urgently needed

to help people to generate income” (van der Veen & Preece, 2005, 390). If the

root (family) is not nurtured and watered, the possibility for success and

motivation will wither and die.

Teacher’s Perception and Stereotype Threats

According to Dye (2014), research from previous studies revealed that

teachers often doubt that education is vital for low-income students of color,

and they have feelings of inadequacy when teaching minorities who live in

poverty. The confident educator influences students’ lives in ways

unimaginable until many years later, when the former students share their

experiences about that one instructor who made a difference. Many influential

people contribute their success to a memorable teacher who encouraged them

to be the best they could be in the classroom and beyond. Research has

provided enough evidence to support that minorities do not learn the same way

as their counterpart, and the same criterion does not motivate them. Educators

must create culturally diverse environments, have belief in their pedagogical

skills and abilities to connect and teach all students. Studies reported that

educators could feel unequipped to teach culturally diverse students, reporting

lower self-efficacy. Tucker, Porter, Reinke, Herman, Ivery, Mack, and

Jackson (2005) postulated that a lack of efficacy could explain the educational

divide between minorities living in poverty and the middle-class; however,

school administrators must increase efforts to improve teacher efficacy

because it is paramount to decrease the disproportionate high school dropout

rates and underperforming children in the classroom.

When children are neglected, abused, and experience trauma, teachers

are usually on the frontline, being a friend, mother-figure, and voice of reason.

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

Teachers need to know their students’ culture. According to Aldermann

(2004), cultural competence helps educators to become astute to verbal and

nonverbal cues from minorities, creating a classroom climate that encourages

students to express themselves and feel accepted without losing their identity.

School personnel, administrators, staff, and educators must see that there is a

need to improvise and devise a plan to address the educational needs of

culturally diverse students living in poverty. Cultural sensitivity is a process

that will prevent stereotype threats in the classroom that decrease bias,

prejudice, and demoralization that stifles the learning process.

Neuburger, Jansen, Heil, and Quaiser-Pohl (2012) purported that

“stereotype threat is the event of a negative stereotype about a group to which

one belongs becoming self-relevant and to being at risk of confirming, as self-

characteristic, a negative stereotype about one’s group” (p. 62). Stereotype

threat can disrupt educational performance, causing low self-efficacy, low

self-esteem, and a significant decrease in academic motivation. Studies show

that the threat of stereotype causes minorities to not only struggle

academically, but it asphyxiates personal growth and social development.

Stereotype threat is indoctrinated in the belief that anyone in a stereotypical

group can feel pressure to avoid fulfilling negative expectations. The pressure

of becoming a self-fulfilling prophecy bolsters underperformance, which is

the most detrimental barrier to achievement. There is no doubt that minorities

have equal potential to perform as well as their counterpart; however, when

minority students know that they are being compared, they tend to perform

discouragingly.

As reported by Neuburger et al. (2012), stereotype threat debilitates

performance because it initiates three different mechanisms that reduce the

capacity of working memory (physiological stress, monitoring processes, and

emotion-suppressing efforts). The mechanisms evoke a cognitive imbalance

between the person’s concept of self, ability domain, and group. Stereotype

threat accentuates minorities perception of being inferior; therefore, they take

on an inferiority complex of their own, contributing to their lack of confidence

in their abilities, accepting the façade that white students are smarter than they

and educators view them as inept. The research does not support that

stereotype threats occur in white teachers only but any educator who feels a

particular population, such as those living in poverty, is beneath them and they

hold poverty-stricken people responsible for a life of deprivation. Amatea and

West (2007) proclaimed that Many educators view poor people as morally and

culturally deficient. Believing that poor families have attitudes, values, and

behaviors that sustain their position at the bottom of the economic ladder, these

educators often blame parents for passing on these traits to their children

instead of transmitting the middle-class cultural patterns they believe are

necessary to succeed in school and in life. (p. 83)

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Research supports that students who can identify with their academics

and self-esteem have a better chance of being successful. Minority students

try to accomplish goals and achieve a sound education as everyone else, but

chronic poverty and teacher’s perception cause them to struggle and fall

behind. To succeed, minorities living in poverty are trying too hard because

they are dealing with the threat of stereotype and disidentification. It could be

assumed that hard work, dedication, and commitment to educational

endeavors would close the gap and help minorities excel; however, trying

harder adds an extra burden, causing more problems such as higher levels of

stress, anxiety, and depression. What options are left for minority children

living in poverty?

Implications and Conclusion

Living a life of chronic poverty that increases the risk of trauma,

victimization, bullying and its psychological effects, becoming a high school

dropout, and being educated by a system that was not designed for people

living in deprivation is not a situation that anyone would choose. Trauma plays

a significant role in the lives of people living in poverty. Traumatic

experiences are subjective, but the concept of trauma suggests that the

wounded is confronted by an enormous life-changing event, such as divorce,

death of a loved one, unemployment or terminated, diagnosis of illness or

disease, or culture shock; however, trauma is generally referred to a severe or

psychological injury sustained as a result of a life-threatening or horrific

experience (Stebnicki, 2017). Bullying is a significant problem for children,

and the epidemic warrants the attention of policymakers, educators, parents,

church leaders, and community stakeholders. Society is doing a poor job of

protecting and educating children. Vanderbilt and Augustyn (2010) discussed

the significance of people being more vigilant and aggressive by not tolerating

bullying and modeling that it is not welcomed in the home, community, and

school. Particular focus must be placed on children or adolescents who have

chronic medical illnesses like acne, being medically obsessed, severe eczema,

physical deformities like cleft lip and palate, or some who suffer from

neuropsychological disorders like learning disabilities, down syndrome, and

autism spectrum disorder, making them potential targets for bullying and

demoralization. School bullying is a widespread phenomenon not only in the

United States of America but in many countries around the world, signifying

that bullying should be considered a significant international public health

problem (Collier, 2013).

Research proclaims that today’s school counselors can bring unique

skills to help educators working with students in high-poverty schools who

experience bullying and the psychological effects. Working with this

population provides a significant opportunity for school counselors to broaden

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

their role with educators, staff, office personnel, and administrators beyond

only delivering services to individual students but taking a collaborative

approach (Amatea & West, 2007). Poverty-stricken minorities can accomplish

great things academically when teachers and others in the learning

environment create an atmosphere that makes them feel confident. Children

can learn and achieve at very high levels, once they gain confidence in their

abilities and accept that their thinking and efforts can help them do well. It

takes a cumulative effort to make a substantial change in the classroom, and

everyone must accept his or her role. Amatea and West (2007) declared that

These roles are (a) serving as a cultural bridge between teachers and

students and blocking the blaming that often derails efforts to work with poor

students and their families, (b) functioning as a pedagogical partner with

teachers by connecting the curriculum more directly to students’ lives, and (c)

teaming with teachers to create a more welcoming, family-centric school

climate. (p. 82)

School systems and administrators must make the cultural

transformation a priority and not an afterthought or placed at the bottom of the

school’s agenda. Neuburger et al. (2012) declared that stereotype threat and

self-fulfilling prophecies play an instrumental role in socialization and are part

of the hidden curriculum in schools. Adding the hidden curriculum to the

hidden rules of the middle-class, minorities living in poverty do not have a

fighting chance and will remain hidden in the classroom to continue the cycle

of generational poverty. Head Start, 2 Gen Programs, Babies “Can’t” Wait,

and other programs have been established to address the disparity in the

vulnerable population; however, a tremendous amount of work must be put

into action along with robust educational reforms.

No Child Left Behind (NCLB) was designed to ensure that all schools

meet the same academic standards and achievement levels, regardless of the

school system was in an area where poverty is high or not. Research proves

that the NCLB has been nothing but an ultimate failure because state and

federal standards cannot establish guidelines on the hidden rules of education

that was designed for the middle-class. Ladd (2012) reported that under

NCLB, “each school must meet the same standard, regardless of whether it

serves low‐ or high‐SES students and must do so for all relevant subgroups

within the school defined by income, minority status, and Limited English

Proficient status” (p. 213). Poverty-stricken children will always be a general

population of people in the middle-class classroom, skewing achievement

expectations and standards. What must happen for educators to improve their

low self-efficacy and lack of confidence to teach children from lower SES?

Teachers must become culturally competent, demonstrating relevant

pedagogy techniques that encourage educators to understand local students,

cultures, demographics, and the hidden rules of poverty. It is equally crucial

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

for middle-class teachers to understand children and parents living in

deprivation as it is for people living in poverty to learn the hidden rules of the

middle-class. Matsko and Hammerness (2014) suggested that multicultural

education create dialogue and relevancy to bridge the gap between educators,

students, state and federal standards, and the school’s curriculum. The faculty

must understand the significance of the teacher-student relationship, their

respective cultures, and how the dynamics of education are interwoven in the

classroom. Teachers do not have to go to an elite college or university to reach,

teach, and empower children living in poverty. They must be willing to accept

the fact that these children will always be their classrooms, become flexible

and willing to change to become the best educator for all students and take

those teachable moments to learn more about those students who come from

a different geographical area. Mattsko and Hammerness (2014) cited that

educators must demonstrate how “context extends well beyond one’s

immediate physical surroundings, and in doing so, we illustrate how a simple

understanding of context can be expanded to include state and federal policy,

the neighborhood, the district, and urban public school classroom” (p. 137).

This burden of educating the underserved does not fall solely on the

educational system, but the parents must take a proactive approach to improve

their education and the education of their children. Education starts at home

with family and community. Families must provide stability, the foundation

for education, and relay the importance of learning to their children. When a

family gives their children support, challenges, and stimulate their children,

minorities are more likely to choose harder subjects in high school, get better

grades, end up in better colleges, and have higher self-esteem in college and

beyond. Challenges empower minority children by giving them a vision,

direction, focus, and perseverance to succeed. A new approach called 2 Gen

helps families break the cycle of poverty by simultaneously addressing the

needs of parents and children to improve significant outcomes for the entire

family (“Two-Generation Approaches,” 2018). Familial support provides the

solace that allows freedom and closes the door on stress, worries, and fears.

Parents living in poverty must become educated and learn to be their children’s

first teacher. According to “Two-Generation Approaches” (2018), “Two-

generation strategies can be used in many policy areas, including human

services, education, labor and workforce, and health. They can be used to

address a myriad of policy issues, including poverty, literacy, school

readiness, and family economic stability” (p. 3).

The research presented here does not touch the surface of what it will

take to disassociate poverty from bullying, the disproportionate rate of

traumatic experiences, and the complicated process of closing the educational

divide by educating all students regardless of low socioeconomic status,

demographics, cultures, races, and ethnicities of the underserved, vulnerable

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

population. Payne (1996) purported that “support systems need to include the

teaching of procedural self-talk, positive self-talk, planning, goal-setting,

coping strategies, appropriate relationships, options during problem-solving,

access to information and know-how, and connections to additional resources”

(p. 75). To make changes and see significant differences, society must be

willing to challenge the status quo and change the culture by breaking the cycle

of generational poverty – equipping people living below the poverty level to

use education as the catalyst to move from poverty to middle-class – where the

hidden rules to function in society are available for everyone.

The United States is an individualistic society, and too many people

are only concerned about their small microcosm. It is going to take a

collectivist approach to stomp out the harmful effects of bullying and its

detrimental ramifications later in life. Bullying is not a rite of passage, and if

not treated, they will carry the trauma and hidden scars into their adult life.

Society must stop considering bullying as a school ritual but recognize it as a

public health crisis. Skaine (2015) reported that 19 percent of U.S. elementary

students are bullied, and more than 160,000 kids stay home from school

because they are afraid as published by Vanderbilt and Augustyn (2010),

bullying, whether as bullies, victims and bully-victims, is correlated with

poorer outcomes in the classroom and society. Bullying involvement is

significant because it can lead to poor psychosocial adjustment, greater health

problems, poverty, and deficient emotional and social adjustment (p. 316).

Bullying behaviors and their lasting effects have the propensity to continue

the cycle of chronic poverty, so the generational curse continues with no end

if a cultural shift does not happen soon. People who live in poverty experience

higher rates of trauma and bullying. Children who are bullied are more likely

to drop out of school, have a lower social, economic status, suffer from mental

disorders, engage in risky behaviors, and substance use disorders. According

to Matthews, Jennings, Lee, & Pardini (2017), research showed that bullied

children had a low SES, and they are less likely to have a high school diploma

or GED. Throughout their lifetime, they have lower adult family income and

lack adequate resources with lower social status in their community. Studies

depicting those results strengthen chronic poverty with a new generation of

people contributing to the poverty-stricken life cycle.

Taylor and Barrett (2018) professed that raising awareness of early

trauma is a critical first step to reduce its impact, but most of the contemporary

literature focuses on the actual incidence of trauma. As denoted, trauma is not

necessarily an isolated incident but the culmination of traumatic events and

episodes in the contextual environment. Society must construct a plan that

addresses the mental, physical, psychological, and cognitive faculties of all

individuals living in poverty. 2 Gen is very promising because it focuses on

educating the parents, children, and community by working from the inside

European Journal of Educational Sciences, Special Edition, October 2019, ISSN: 1857- 6036

out. According to Taylor and Barrett (2018), educators cannot prevent

traumatic experiences from occurring; however, they can seek to mitigate their

impact by implementing a range of approaches and interventions such as

R4L,” Readiness for Learning (R4L), a ‘Brain-based, Attachment-Led,

Trauma-Informed Community intervention’ (BALTIC) approach to

supporting learners to be settled and ready to learn” (p. 65). Collected data

indicates that R4L has made significant progress in the classroom with a

proven increase in students concerning self-regulation and executive

functioning (Taylor & Barret, 2018). In summation, Ladd (2012) reported that

policymakers must assure that children attending schools that educate large

proportions of disadvantaged children must provide them access to high-

quality teachers, principals, supports for students, and other resources, holding

school systems accountable for the quality of education provided and their

internal processes and practices.

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Stressful Life Events and Associations With Child and Family
Emotional and Behavioral Well-Being in Diverse Immigrant and

Refugee Populations

Jerica M. Berge, PhD, MPH, LMFT, Samaria Mountain, BS, Susan Telke, MS,
Amanda Trofholz, MPH, RD, Katie Lingras, PhD, LP, Roli Dwivedi, MD,

and Lisa Zak-Hunter, PhD, LMFT
University of Minnesota Medical School, Minneapolis, Minnesota

Objective: Although stressful life events (SLEs) have been suggested to be associated with
child well-being, few studies have examined SLEs with child and family behavioral and
emotional well-being, especially within diverse populations. The current study examined
the associations between SLEs and child behavioral and emotional outcomes, in addition to
family-level measures of well-being. Method: Children 5–7 years old and their families
(n � 150) from 6 racial and ethnic groups (n � 25 each for African American, Hispanic,
Hmong, Native American, Somali, White families) participated in this mixed-methods
study. Participants were recruited through primary care clinics. Results: Results showed
that all racially and ethnically diverse immigrant and refugee families were experiencing
SLEs. The majority of diverse children were experiencing emotional and behavioral
problems (i.e., hyperactivity, emotional) in the face of SLEs (i.e., combined SLE score,
health-related events), with Somali children being at highest risk. Additionally, the majority
of diverse families did not experience lower family functioning in response the SLEs,
except regarding certain SLEs (i.e., health-related, legal). However, specific families (i.e.,
Somali) experienced lower family functioning in the face of multiple SLEs. Discussion:
Health care practitioners should consider screening and providing extra resources for
reducing stress in children, given all children in the study had some emotional and
behavioral problems in the face of SLEs. Additionally, it would be important for practi-
tioners to know which families are at greatest risk for experiencing SLEs (i.e., African
American, Native American, Somali families) to ensure they are provided with the re-
sources necessary to mitigate the impact of SLEs.

Public Significance Statement
This study investigated Stressful Life Events (SLEs) in racially/ethnically diverse popula-
tions. SLEs were prevalent and were associated with lower levels of emotional and
behavioral well-being in some children. Many families experienced high levels of family
functioning, despite having SLEs, which may provide potential intervention targets.

This article was published Online First August 27, 2020.
X Jerica M. Berge, PhD, MPH, LMFT, Samaria Mountain,

BS, X Susan Telke, MS, and X Amanda Trofholz, MPH, RD,
Department of Family Medicine and Community Health, Uni-
versity of Minnesota Medical School, Minneapolis, Minnesota;
Katie Lingras, PhD, LP, Department of Psychiatry, University of
Minnesota Medical School, Minneapolis, Minnesota; Roli
Dwivedi, MD and X Lisa Zak-Hunter, PhD, LMFT, Depart-
ment of Family Medicine and Community Health, University of
Minnesota Medical School, Minneapolis, Minnesota.

Research is supported by National Heart, Lung, and
Blood Institute Grant R01HL126171 (principal investiga-

tor: Jerica M. Berge, PhD, MPH, LMFT). The content is
solely the responsibility of the authors and does not nec-
essarily represent the official views of the National Heart,
Lung and Blood Institute or the National Institutes of
Health. Authors have no financial disclosures or conflicts
of interest to report.

Correspondence concerning this article should be ad-
dressed to Jerica M. Berge, PhD, MPH, LMFT, Depart-
ment of Family Medicine and Community Health, Univer-
sity of Minnesota Medical School, 717 Delaware Street
Southeast, Room 425, Minneapolis, MN 55414. E-mail:
jberge@umn.edu

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Families, Systems, & Health
© 2020 American Psychological Association 2020, Vol. 38, No. 4, 380–395
ISSN: 1091-7527 http://dx.doi.org/10.1037/fsh0000524

380

https://orcid.org/0000-0003-3371-351X

https://orcid.org/0000-0003-0238-7248

https://orcid.org/0000-0002-2759-8220

https://orcid.org/0000-0002-0065-5168

mailto:jberge@umn.edu

http://dx.doi.org/10.1037/fsh0000524

Keywords: stressful life events, emotional well-being, behavioral problems, diverse
families, immigrants/refugees

Stressful life events (SLEs) are discrete,
acute stressors that disrupt an individual’s usual
activities and typically result in substantial
change and readjustment (Cronholm et al.,
2015; Manyema, Norris, & Richter, 2018;
Neece, Green, & Baker, 2012; Thoits, 2010).
Some examples of SLEs include death, financial
problems (e.g., job loss), interpersonal relation-
ship problems (e.g., divorce, separation), health
problems (e.g., diagnosis of a disease, exacer-
bation of a disease, mental health condition),
trauma (e.g., violence, sexual), and legal prob-
lems (e.g., prison, jail time, problems with the
police). SLEs and adverse childhood events
(ACEs) are similar in that the event provoking
the stress may be the same (e.g., divorce of a
parent, sexual trauma); however, ACEs, by defi-
nition, occur in childhood (�18 years), whereas
SLEs may occur across the life span (Allen,
Rapee, & Sandberg, 2008; Cronholm et al., 2015;
Felitti, 1993; Felitti, 2019; Felitti et al., 2019; Ge,
Natsuaki, & Conger, 2006; Manyema et al., 2018;
Thoits, 2010).

Prior research has shown that SLEs are asso-
ciated with negative health and well-being out-
comes at the individual level, especially with
children. For example, several cross-sectional
studies have shown that SLEs (i.e., death, di-
vorce, legal, health, financial) are associated
with emotional and behavioral problems in chil-
dren and adolescents including, depression,
anxiety, disordered eating behaviors, child ad-
justment problems, and reduced coping skills in
response to stress (Allen et al., 2008; Berge,
Loth, Hanson, Croll-Lampert, & Neumark-
Sztainer, 2012; Ge et al., 2006; Harland, Reij-
neveld, Brugman, Verloove-Vanhorick, & Ver-
hulst, 2002; Loth, van den Berg, Eisenberg, &
Neumark-Sztainer, 2008; Siegel et al., 1992). In
addition, longitudinal studies have found that
parental divorce was associated with more prob-
lematic child behavior (e.g., conduct disorder)
and lower emotional well-being (e.g., depres-
sive symptoms, anxiety) into adolescence and
adulthood (Conger et al., 2002; Ge et al., 2006;
Thoits, 2010). Combined, these studies have
suggested that SLEs can have immediate nega-
tive influences on child health and wellness and

long-term impacts because they track into ado-
lescence and adulthood. Researchers have also
shown that SLEs (i.e., divorce, financial, legal)
are associated with negative outcomes at the
family level, such as lower family functioning,
increased family conflict and interpersonal prob-
lems, and reduced familial well-being (Allen et
al., 2008; Conger et al., 2002; Kaczmarek &
Trambacz-Oleszak, 2017; Manyema et al., 2018;
Neece et al., 2012; Thoits, 2010). Whereas most
of the prior research on SLEs has focused primar-
ily on either the individual (e.g., child) or the
family (e.g., family functioning) level, the current
study investigated the influence of SLEs both at
the individual child level and the family level.

In addition, few studies examining SLEs
have been conducted with families across di-
verse backgrounds (Cronholm et al., 2015).
This may be particularly important because
families from diverse backgrounds may be at
higher risk of experiencing SLEs. For example,
some studies have shown African American and
Hispanic families report higher levels of ACEs,
discrimination, and harassment, which have
been shown to be associated with mental health
problems (e.g., depression, disordered eating
behaviors, low self-esteem, substance abuse;
Ellis, MacDonald, Lincoln, & Cabral, 2008;
Lee & Chang, 2012; Neumark-Sztainer et al.,
2002; Ortega, Rosenheck, Alegría, & Desai,
2000; van den Berg, Mond, Eisenberg, Ackard,
& Neumark-Sztainer, 2010) and chronic disease
(e.g., diabetes, obesity, hypertension, cardiovas-
cular disease; Arcan et al., 2014; Cooper et al.,
2000; Krieger, Kosheleva, Waterman, Chen, &
Koenen, 2011; Mensah, Mokdad, Ford, Green-
lund, & Croft, 2005). In addition, immigration
and citizenship have also been shown to be asso-
ciated with health disparities (Escobar, Hoyos
Nervi, & Gara, 2000; Gee, Ryan, Laflamme, &
Holt, 2006; Grant et al., 2004). Furthermore, the
sociopolitical climate in the United States has
evolved from a climate of relative acceptance of
racially and ethnically diverse immigrant and ref-
ugee populations to one of nonacceptance
(Abraído-Lanza, Armbrister, Flórez, & Aguirre,
2006; Guo, 2016; Siddiqui, 2016). These sociopo-
litical shifts may also increase SLEs experiences

381STRESSFUL LIFE EVENTS IN DIVERSE FAMILIES

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by racially and ethnically diverse families (Hoyt,
Zeiders, Chaku, Toomey & Nair, 2018; Williams
& Medlock, 2017). Therefore, the current study
investigated the prevalence of SLEs and their as-
sociation with emotional and behavioral well-
being outcomes in racially and ethnically diverse
immigrant and refugee populations.

Family systems theory (FST; Whitchurch &
Constantine, 1993; White, Klein, & Martin,
2015) supports the prior research findings de-
scribed above showing that SLEs are influential
at both the individual and family levels. Specif-
ically, one tenet of FST is that events or behav-
iors experienced in one family member influ-
ence other family members, for worse or for
better. For example, if a parent gets divorced
and then experiences depression, it is highly
likely that the child will be affected by the
parent’s symptoms of depression either through
less parental attention or care or by experienc-
ing symptoms of depression themselves. In ad-
dition, FST asserts that it is important to take
into account cultural aspects of one’s family
system when trying to understand how SLEs are
experienced and ultimately impact individual
well-being and family functioning. For exam-
ple, if divorce or death occurs, some cultures
may have traditions or rituals that help them
adjust to such changes in ways that are healthy
versus unhealthy, and these responses may be
driven by cultural values or beliefs.

Thus, using FST as a framework, the main
research questions addressed in the current
study include (a) What is the prevalence of
SLEs in White, African American, Latino, Na-
tive American, Hmong, and Somali families?
(b) What types of child emotional and behav-
ioral problems and levels of family functioning
are described in White, African American, La-
tino, Native American, Hmong, and Somali
families? (c) What is the association between
SLEs and child emotional and behavioral well-
being? and (d) What is the association between
SLEs and family functioning? Results from this
study will provide information about the influ-
ence of SLEs at the individual and family lev-
els, in addition to how SLEs are experienced
across different racial and ethnic immigrant and
refugee groups. Findings may be useful for
practitioners who work with families (e.g., men-
tal health workers, physicians) in addition to
future intervention research.

Method

Data for the current study are from Phase 1 of
Family Matters (Berge et al., 2017), a National
Institutes of Health–funded observational study
designed to identify novel risk and protective
factors for childhood obesity in the home envi-
ronments of racially and ethnically diverse and
primarily low-income children (n � 150). Phase
1 of the Family Matters study included an in-
depth observational study of diverse families
using a variety of methods (in-home observa-
tions, 24-hr dietary recalls, individual inter-
views, surveys), with the goal of using these
observations to inform the development of a
culturally appropriate survey to be conducted
within a larger sample of families (n � 1,200)
during Phase 2, as well as subsequent interven-
tions geared toward families of elementary
school-age children. In-depth details about both
study phases are published elsewhere (Berge et
al., 2017). The University of Minnesota’s Insti-
tutional Review Board Human Subjects Com-
mittee approved all protocols used in the Family
Matters study; all adult participants provided
written informed consent and parental consent
for their children, and all children assented to
the study.

Participants

The study recruited children and their fami-
lies attending family medicine clinics in the
Minneapolis–Saint Paul, Minnesota, area be-
tween 2015 and 2016 via a letter sent to them by
their family physician. Children were eligible to
participate in the study if they were between 5
and 7 years old, lived with their parent or pri-
mary guardian more than 50% of the time, and
were from one of six racial and ethnic groups
(non-Hispanic White, non-Hispanic Black, La-
tino, Native American, Hmong, or Somali).
This highly diverse sample was intentionally
recruited because children from racially and
ethnically diverse households experience obe-
sity and health disparities at a much higher rate
than do their nondiverse counterparts, and it is
important to identify modifiable factors to mit-
igate obesity risk in childhood. The study im-
plemented a stratified sampling strategy; within
each of the six racial and ethnic groups (n � 25
families from each racial or ethnic group), half
(n � 75) of the sample children recruited had a

382 BERGE ET AL.

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body mass index (BMI) �85 percentile,
whereas the other half had a BMI between 5
percentile and 85 percentile. In-depth details
regarding recruitment and study design are pub-
lished elsewhere (Berge et al., 2017).

Parents and guardians were mostly mothers
(91%) and were approximately 34.5 years old
(SD � 7.1). Over half of the primary guardians
(58%) were born in the United States. The educa-
tional status was as follows: 40% of parents fin-
ished high school or obtained a general equiva-
lency diploma but had not attended college. About
half (42%) of parents were working full time, and
the majority (70%) of participants reported that
their annual income was �$35,000. The majority
of participants (66%) were receiving public assis-
tance.

Procedures and Data Collection

Eligible families participated in two in-home
visits that were 10 days apart. The current study
uses data from the first home visit, which in-
cluded a parent online survey. Researchers con-
ducted in-home visits in the family’s preferred
language (English, Somali, Spanish, or
Hmong). Participants were paired with a re-
search staff who was both bilingual and bicul-
tural to ensure participant comfort as well as
data collection accuracy.

Measures

Table 1 describes the measures used in the
current study (e.g., parent report of SLEs, child
emotional and behavioral problems, family
functioning).

Statistical Analysis

Descriptive analyses were performed to char-
acterize the sample of 149 families (one family
was dropped from analyses because it did not
complete the survey) with means and standard
deviations across race for number of SLEs,
child behaviors (Strengths and Difficulties
Questionnaire subscales; Goodman, 2001), and
family functioning and to evaluate modeling
assumptions. Linear regression with Huber–
White robust standard errors (to protect against
possible misspecification of the error structure)
were used to estimate means with 95% confi-
dence intervals and p values. Adjusted models
controlled for child gender, parent gender, edu-

cation, mental health (depression, anxiety),
household income, number of children in the
household, and time in the United States. Mod-
els were fitted separately for each scale or sub-
scale measure of child behavior, family func-
tioning, and the occurrence of SLEs. All
analyses were performed in Stata 15.1 SE
(www.statacorp.com).

Results

Results of the current study are presented
below by research question.

Research Question 1: What is the preva-
lence of SLEs in White, African American,
Latino, Native American, Hmong, and So-
mali families?

Overall, families reported experiencing be-
tween one and two SLEs in the prior 6 months.
In addition, there were significant differences in
the prevalence of SLEs by race or ethnicity (see
Table 2; p � .007). African American and Na-
tive American families reported the highest
prevalence of SLEs overall. When examined
across the four specific categories of SLEs (i.e.,
health-related, financial, interpersonal, and le-
gal), Native American and African American
families reported the most health-related SLEs,
African American families reported the most
interpersonal SLEs, and Hmong families re-
ported the most financial and legal SLEs.

Research Question 2: What types of child
emotional and behavioral problems and
levels of family functioning are described
in White, African American, Latino, Na-
tive American, Hmong, and Somali
families?

Across races, there were significant differ-
ences in average child emotional and behavioral
problems as measured by the Strengths and
Difficulties Questionnaire subscales, including
emotional problems (p � .01) and peer prob-
lems (see Table 2; p � .001). Specifically,
White families reported the lowest scores and
Native Americans reported the highest scores
for both emotional problems and peer problems.
There were also significant differences in aver-
age prosocial (e.g., helping others) scores across
race and ethnicity (p � .004), with higher
prosocial scores for White and lower scores for

383STRESSFUL LIFE EVENTS IN DIVERSE FAMILIES

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is
no

t
to

be
di

ss
em

in
at

ed
br

oa
dl

https://www.statacorp.com

T
ab

le
1

M
ea

su
re

s
U

se
d

in
th

e
C

ur
re

nt
A

na
ly

si
s

F
ro

m
th

e
F

am
il

y
M

at
te

rs
st

ud
y

C
on

st
ru

ct
Q

ue
st

io
n

R
es

po
ns

e
op

tio
ns

O
pe

ra
tio

na
liz

ed
va

ri
ab

St
re

ss
fu

l
lif

e
ev

en
ts

St
re

ss
fu

l
lif

e
ev

en
ts

(B
ru

gh
a

&
C

ra
gg

,
19

90
)

“H
av

e
an

y
of

th
e

fo
llo

w
in

g
lif

e
ev

en
ts

or
pr

ob
le

m
s

ha
pp

en
ed

to
yo

u
du

ri
ng

th
e

la
st

6
m

on
th

s?
”

1.
Y

es
,

an
d

I
st

il
l

th
in

k
ab

ou
t

it
a

lo
t

2.
Y

es
,

an
d

I
st

il
l

th
in

k
ab

ou
t

it
a

li
tt

le
3.

Y
es

,
bu

t
I

do
no

t
th

in
k

ab
ou

t
it

4.
N

If
a

pa
rt

ic
ip

an
t

se
le

ct
ed

Y
es

(O
pt

io
ns

1,
2,

or
3)

,
th

e
ev

en
t

w
as

co
de

d
as

ha
vi

ng
oc

cu
rr

ed
.

If
N

o
(O

pt
io

n
4)

w
as

se
le

ct
ed

,
th

e
ev

en
t

w
as

co
de

d
as

no
t

ha
vi

ng
oc

cu
rr

ed
.

H
ea

lth
ev

en
ts

“Y
ou

yo
ur

se
lf

su
ff

er
ed

a
se

ri
ou

s
ill

ne
ss

,
in

ju
ry

,
or

an
as

sa
ul

t”
“A

se
ri

ou
s

ill
ne

ss
,

in
ju

ry
,

or
as

sa
ul

t
ha

pp
en

ed
to

a
cl

os
e

re
la

tiv
e”

“Y
ou

r
pa

re
nt

,
ch

ild
or

sp
ou

se
di

ed
”

“A
cl

os
e

fa
m

ily
fr

ie
nd

or
an

ot
he

r
re

la
tiv

e
(a

un
t,

co
us

in
,

gr
an

dp
ar

en
t)

di
ed

”
Fi

na
nc

ia
l

st
re

ss
or

s
“Y

ou
be

ca
m

e
un

em
pl

oy
ed

or
w

er
e

se
ek

in
g

w
or

k
un

su
cc

es
sf

ul
ly

fo
r

m
or

e
th

an
a

m
on

th
”

“Y
ou

w
er

e
fir

ed
or

la
id

of
f

fr
om

yo
ur

jo
b”

“Y
ou

ha
d

a
m

aj
or

fin
an

ci
al

cr
is

is
”

In
te

rp
er

so
na

l
st

re
ss

or
s

“Y
ou

ha
d

a
se

pa
ra

tio
n

du
e

to
m

ar
ita

l
di

ffi
cu

lti
es

”
“Y

ou
br

ok
e

of
f

a
st

ea
dy

re
la

tio
ns

hi
p”

“Y
ou

ha
d

a
se

ri
ou

s
pr

ob
le

m
w

ith
a

cl
os

e
fr

ie
nd

,
ne

ig
hb

or
,

or
re

la
tiv

e”
L

eg
al

ev
en

ts
“Y

ou
ha

d
pr

ob
le

m
s

w
ith

th
e

po
lic

e
an

d
a

co
ur

t
ap

pe
ar

an
ce

”
“S

om
et

hi
ng

yo
u

va
lu

ed
w

as
lo

st
or

st
ol

en
”

384 BERGE ET AL.

T
hi

s
do

cu
m

en
t

is
co

py
ri

gh
te

d
by

th
e

A
m

er
ic

an
Ps

yc
ho

lo
gi

ca
l

A
ss

oc
ia

tio
n

or
on

e
of

its
al

lie
d

pu
bl

is
he

rs
.

T
hi

s
ar

tic
le

is
in

te
nd

ed
so

le
ly

fo
r

th
e

pe
rs

on
al

us
e

of
th

e
in

di
vi

du
al

us
er

an
d

is
no

t
to

be
di

ss
em

in
at

ed
br

oa
dl

T
ab

le
1

(c
on

ti
nu

ed
)

C
on

st
ru

ct
Q

ue
st

io
n

R
es

po
ns

e
op

tio
ns

O
pe

ra
tio

na
liz

ed
va

ri
ab

Fa
m

ily
fu

nc
tio

ni
ng

Fa
m

ily
fu

nc
tio

ni
ng

(B
yl

es
et

al
.,

19
88

)
“H

ow
st

ro
ng

ly
do

yo
u

ag
re

e
w

ith
th

e
fo

llo
w

in
g

st
at

em
en

ts
ab

ou
t

yo
ur

cu
rr

en
t

ho
m

e?
”

“F
am

ily
m

em
be

rs
ar

e
ac

ce
pt

ed
fo

r
w

ho
th

ey
ar

e”
“W

e
av

oi
d

di
sc

us
si

ng
ou

r
fe

ar
s

an
d

co
nc

er
ns

”
“M

ak
in

g
de

ci
si

on
s

is
a

pr
ob

le
m

fo
r

th
e

fa
m

ily
”

“W
e

do
n’

t
ge

t
al

on
g

w
el

l
to

ge
th

er
”

“W
e

ca
n

ex
pr

es
s

fe
el

in
gs

to
ea

ch
ot

he
r”

“P
la

nn
in

g
fa

m
ily

ac
tiv

iti
es

is
di

ffi
cu

lt
be

ca
us

e
w

e
m

is
un

de
rs

ta
nd

ea
ch

ot
he

r”
“I

n
tim

es
of

cr
is

is
w

e
ca

n
tu

rn
to

ea
ch

ot
he

r
fo

r
su

pp
or

t”
“W

e
ca

nn
ot

ta
lk

to
ea

ch
ot

he
r

ab
ou

t
th

e
sa

dn
es

s
w

e
fe

el
”

“T
he

re
ar

e
lo

ts
of

ba
d

fe
el

in
gs

in
th

e
fa

m
ily

”
“W

e
ar

e
ab

le
to

m
ak

e
de

ci
si

on
s

ab
ou

t
ho

w
to

so
lv

e
pr

ob
le

m
s”

“W
e

co
nfi

de
in

ea
ch

ot
he

r
(b

y
“c

on
fid

e”
w

e
m

ea
n

to
tr

us
t

yo
ur

fa
m

ily
m

em
be

rs
en

ou
gh

to
te

ll
th

em
so

m
et

hi
ng

th
at

is
im

po
rt

an
t

to
yo

u)
”

1.
St

ro
ng

ly
di

sa
gr

ee
2.

So
m

ew
ha

t
di

sa
gr

ee
3.

So
m

ew
ha

t
ag

re
e

4.
St

ro
ng

ly
ag

re
e

Su
m

sc
or

e
of

L
ik

er
t

sc
al

e
w

ith
re

ve
rs

e
co

di
ng

fo
r

•
W

e
av

oi
d

di
sc

us
si

ng
ou

r
fe

ar
s

an
d

co
nc

er
ns

•
M

ak
in

g
de

ci
si

on
s

is
a

pr
ob

le
m

fo
r

th
e

fa
m

ily
•

W
e

do
n’

t
ge

t
al

on
g

w
el

l
to

ge
th

er
•

Pl
an

ni
ng

fa
m

ily
ac

tiv
iti

es
is

di
ffi

cu
lt

be
ca

us
e

w
e

m
is

un
de

rs
ta

nd
ea

ch
ot

he
r

•
W

e
ca

nn
ot

ta
lk

to
ea

ch
ot

he
r

ab
ou

t
th

e
sa

dn
es

s
w

e
fe

el
•

T
he

re
ar

e
lo

ts
of

ba
d

fe
el

in
gs

in
th

e
fa

m
ily

H
ig

he
r

sc
or

es
in

di
ca

te
hi

gh
er

fa
m

ily
fu

nc
tio

ni
ng

C
hi

ld
be

ha
vi

or
St

re
ng

th
s

an
d

D
if

fic
ul

tie
s

Q
ue

st
io

nn
ai

re
su

bs
ca

le
s

(G
oo

dm
an

,
20

01
)

“B
as

ed
on

[c
hi

ld
’s

na
m

e]
’s

be
ha

vi
or

ov
er

th
e

la
st

SI
X

M
O

N
T

H
S,

pl
ea

se
re

sp
on

d
to

th
e

fo
llo

w
in

g
qu

es
tio

ns
.”

1.
N

ot
tr

ue
2.

So
m

ew
ha

t
tr

ue
3.

C
er

ta
in

ly
tr

C
on

du
ct

Pr
ob

le
m

s
“[

C
hi

ld
’s

na
m

e]
of

te
n

lo
se

s
hi

s/
he

r
te

m
pe

r”
“[

C
hi

ld
’s

na
m

e]
of

te
n

fig
ht

s
w

ith
ot

he
r

ch
ild

re
n

or
bu

lli
es

th
em

”
“[

C
hi

ld
’s

na
m

e]
is

of
te

n
ar

gu
m

en
ta

tiv
e

w
ith

ad
ul

ts
”

“[
C

hi
ld

’s
na

m
e]

is
ge

ne
ra

lly
w

el
l-

be
ha

ve
d,

us
ua

lly
do

es
w

ha
t

ad
ul

ts
re

qu
es

t”
“[

C
hi

ld
’s

na
m

e]
ca

n
be

sp
ite

fu
l

to
ot

he
rs

A
ve

ra
ge

sc
or

e
w

ith
re

ve
rs

e
co

di
ng

fo
r

[c
hi

ld
’s

na
m

e]
is

ge
ne

ra
lly

w
el

l-
be

ha
ve

d,
us

ua
lly

do
es

w
ha

t
ad

ul
ts

re
qu

es
t”

H
ig

he
r

sc
or

es
in

di
ca

te
hi

gh
er

co
nd

uc
t

pr
ob

le
m

s.
(t

ab
le

co
nt

in
ue

385STRESSFUL LIFE EVENTS IN DIVERSE FAMILIES

T
hi

s
do

cu
m

en
t

is
co

py
ri

gh
te

d
by

th
e

A
m

er
ic

an
Ps

yc
ho

lo
gi

ca
l

A
ss

oc
ia

tio
n

or
on

e
of

its
al

lie
d

pu
bl

is
he

rs
.

T
hi

s
ar

tic
le

is
in

te
nd

ed
so

le
ly

fo
r

th
e

pe
rs

on
al

us
e

of
th

e
in

di
vi

du
al

us
er

an
d

is
no

t
to

be
di

ss
em

in
at

ed
br

oa
dl

T
ab

le
1

(c
on

ti
nu

ed
)

C
on

st
ru

ct
Q

ue
st

io
n

R
es

po
ns

e
op

tio
ns

O
pe

ra
tio

na
liz

ed
va

ri
ab

E
m

ot
io

na
l

Pr
ob

le
m

s
“[

C
hi

ld
’s

na
m

e]
of

te
n

co
m

pl
ai

ns
of

he
ad

ac
he

s,
st

om
ac

h-
ac

he
s,

or
si

ck
ne

ss
”

“[
C

hi
ld

’s
na

m
e]

ha
s

m
an

y
w

or
ri

es
or

of
te

n
se

em
s

w
or

ri
ed

”
“[

C
hi

ld
’s

na
m

e]
is

of
te

n
un

ha
pp

y,
de

pr
es

se
d,

or
te

ar
fu

l”
“[

C
hi

ld
’s

na
m

e]
is

ne
rv

ou
s

or
cl

in
gy

in
ne

w
si

tu
at

io
ns

,
ea

si
ly

lo
se

s
co

nfi
de

nc
e”

“[
C

hi
ld

’s
na

m
e]

ha
s

m
an

y
fe

ar
s,

ea
si

ly
sc

ar
ed

”

A
ve

ra
ge

sc
or

e.
H

ig
he

r
sc

or
es

in
di

ca
te

hi
gh

er
em

ot
io

na
l

pr
ob

le
m

H
yp

er
ac

tiv
ity

“[
C

hi
ld

’s
na

m
e]

is
re

st
le

ss
,

ov
er

ac
tiv

e,
ca

nn
ot

st
ay

st
ill

fo
r

lo
ng

”
“[

C
hi

ld
’s

na
m

e]
is

co
ns

ta
nt

ly
fid

ge
tin

g
or

sq
ui

rm
in

g”
“[

C
hi

ld
’s

na
m

e]
is

ea
si

ly
di

st
ra

ct
ed

,
co

nc
en

tr
at

io
n

w
an

de
rs

”
“[

C
hi

ld
’s

na
m

e]
ca

n
st

op
an

d
th

in
k

th
in

gs
ou

t
be

fo
re

ac
tin

g”
“[

C
hi

ld
’s

na
m

e]
ha

s
a

go
od

at
te

nt
io

n
sp

an
,

se
es

w
or

k
th

ro
ug

h
to

th
e

en
d”

A
ve

ra
ge

sc
or

e
w

ith
re

ve
rs

e
co

di
ng

fo
r

•
“[

C
hi

ld
’s

na
m

e]
ca

n
st

op
an

d
th

in
k

th
in

gs
ou

t
be

fo
re

ac
tin

g”
•

“[
C

hi
ld

’s
na

m
e]

ha
s

a
go

od
at

te
nt

io
n

sp
an

,
se

es
w

or
k

th
ro

ug
h

to
th

e
en

d”
H

ig
he

r
sc

or
es

in
di

ca
te

hi
gh

er
hy

pe
ra

ct
iv

ity
.

Pe
er

Pr
ob

le
m

s
“[

C
hi

ld
’s

na
m

e]
ha

s
at

le
as

t
on

e
go

od
fr

ie
nd

”
“[

C
hi

ld
’s

na
m

e]
is

ge
ne

ra
lly

lik
ed

by
ot

he
r

ch
ild

re
n”

“[
C

hi
ld

’s
na

m
e]

is
pi

ck
ed

on
or

bu
lli

ed
by

ot
he

r
ch

ild
re

n”
“[

C
hi

ld
’s

na
m

e]
ge

ts
al

on
g

be
tte

r
w

ith
ad

ul
ts

th
an

w
ith

ot
he

r
ch

ild
re

n”

A
ve

ra
ge

sc
or

e
w

ith
re

ve
rs

e
co

di
ng

fo
r

•
“[

C
hi

ld
’s

na
m

e]
ha

s
at

le
as

t
on

e
go

od
fr

ie
nd

”
•

“[
C

hi
ld

’s
na

m
e]

is
ge

ne
ra

lly
lik

ed
by

ot
he

r
ch

ild
re

n”
H

ig
he

r
sc

or
es

in
di

ca
te

hi
gh

er
pe

er
pr

ob
le

m
s.

Pr
os

oc
ia

l
“[

C
hi

ld
’s

na
m

e]
is

co
ns

id
er

at
e

of
ot

he
r

pe
op

le
’s

fe
el

in
gs

”
“[

C
hi

ld
’s

na
m

e]
sh

ar
es

re
ad

ily
w

ith
ot

he
r

ch
ild

re
n,

fo
r

ex
am

pl
e

to
ys

,
tr

ea
ts

,
pe

nc
ils

”
“[

C
hi

ld
’s

na
m

e]
is

he
lp

fu
l

if
so

m
eo

ne
is

hu
rt

,
up

se
t

or
fe

el
in

g
ill

”
“[

C
hi

ld
’s

na
m

e]
is

ki
nd

to
yo

un
ge

r
ch

ild
re

n”
“[

C
hi

ld
’s

na
m

e]
of

te
n

of
fe

rs
to

he
lp

ot
he

rs
(p

ar
en

ts
,

te
ac

he
rs

,
ot

he
r

ch
ild

re
n)

”

A
ve

ra
ge

sc
or

e.
H

ig
he

r
sc

or
es

in
di

ca
te

hi
gh

er
pr

os
oc

ia
l

be
ha

vi
or

386 BERGE ET AL.

T
hi

s
do

cu
m

en
t

is
co

py
ri

gh
te

d
by

th
e

A
m

er
ic

an
Ps

yc
ho

lo
gi

ca
l

A
ss

oc
ia

tio
n

or
on

e
of

its
al

lie
d

pu
bl

is
he

rs
.

T
hi

s
ar

tic
le

is
in

te
nd

ed
so

le
ly

fo
r

th
e

pe
rs

on
al

us
e

of
th

e
in

di
vi

du
al

us
er

an
d

is
no

t
to

be
di

ss
em

in
at

ed
br

oa
dl

T
ab

le
1

(c
on

ti
nu

ed
)

C
on

st
ru

ct
Q

ue
st

io
n

R
es

po
ns

e
op

tio
ns

O
pe

ra
tio

na
liz

ed
va

ri
ab

C
on

tr
ol

va
ri

ab
le

s
Pa

re
nt

ed
uc

at
io

n
“W

ha
t

is
th

e
hi

gh
es

t
gr

ad
e

or
ye

ar
of

sc
ho

ol
th

at
Y

O
U

ha
ve

co
m

pl
et

ed
?”

1.
M

id
dl

e
sc

ho
ol

or
ju

ni
or

hi
gh

2.
So

m
e

hi
gh

sc
ho

ol
3.

H
ig

h
sc

ho
ol

or
G

E
D

4.
V

oc
at

io
na

l,
te

ch
ni

ca
l,

tr
ad

e
or

ot
he

r
ce

rt
ifi

ca
ti

on
pr

og
ra

m
5.

A
ss

oc
ia

te
de

gr
ee

6.
B

ac
he

lo
r

de
gr

ee
7.

G
ra

du
at

e
or

pr
of

es
si

on
al

de
gr

ee
(M

S,
M

B
A

,
M

D
,

P
hD

,
et

c.
)

8.
O

th
er

Fa
ct

or
sc

or
e

H
ou

se
ho

ld
in

co
m

e
“W

ha
t

is
yo

ur
ye

ar
ly

T
O

T
A

L
H

O
U

SE
H

O
L

D
in

co
m

e?
(i

.e
.,

in
co

m
e

fr
om

A
L

L
fa

m
ily

m
em

be
rs

w
ho

se
jo

b
he

lp
s

su
pp

or
t

th
e

fa
m

ily
)”

“T
hi

s
in

cl
ud

es
w

ag
es

,
ca

sh
as

si
st

an
ce

,
So

ci
al

Se
cu

ri
ty

,
ch

ild
su

pp
or

t,
et

c.
”

1.
L

es
s

th
an

$2
0,

00
0

2.
$2

0,
00

0–
$3

4,
99

9
3.

$3
5,

00
0–

$4
9,

99
9

4.
$5

0,
00

0–
$7

4,
99

9
5.

$7
5,

00
0–

$9
9,

99
9

6.
$1

00
,0

00
or

m
or

Fa
ct

or
sc

or
e

H
ou

se
ho

ld
ra

ce
“W

hi
ch

ra
ci

al
/e

th
ni

c
gr

ou
p

be
st

de
sc

ri
be

s
yo

ur
fa

m
ily

?”
W

hi
te

A
fr

ic
an

A
m

er
ic

an
H

m
on

g
So

m
al

i
N

at
iv

e
A

m
er

ic
an

L
at

in
o

Pa
rt

ic
ip

an
ts

se
lf

-i
de

nt
ifi

ed
w

hi
ch

ra
ci

al
/e

th
ni

c
gr

ou
p

be
st

de
sc

ri
be

d
th

ei
r

ho
us

eh
ol

N
o.

of
ch

ild
re

n
in

th
e

ho
us

eh
ol

d
“H

ow
m

an
y

ch
ild

re
n

(y
ou

ng
er

th
an

18
ye

ar
s

ol
d)

ar
e

liv
in

g
in

th
e

ho
m

e?
”

1,
2,

3,
4,

5,
6,

7,
8,

9,
10

�
1,

2,
3,

4�

T
im

e
in

th
e

U
ni

te
d

St
at

es
“H

ow
m

an
y

ye
ar

s
ha

ve
yo

u
liv

ed
in

th
e

U
ni

te
d

St
at

es
?”

�
1

ye
ar

1–
5

ye
ar

s
5–

10
ye

ar
s

10
–2

0
ye

ar
s

20
–3

0
ye

ar
s

30
�

ye
ar

Fa
ct

or
sc

or
e

Pa
re

nt
an

xi
et

y
an

d
pa

re
nt

de
pr

es
si

on
“O

ve
r

th
e

pa
st

2
w

ee
ks

,
ho

w
of

te
n

ha
ve

yo
u

be
en

bo
th

er
ed

by
th

e
fo

llo
w

in
g

pr
ob

le
m

s?
”

“N
ot

be
in

g
ab

le
to

st
op

or
co

nt
ro

l
w

or
ry

in
g”

1.
N

ot
at

al
l

2.
Se

ve
ra

l
da

ys
3.

M
or

e
da

ys
th

an
no

t
4.

N
ea

rl
y

ev
er

y
da

Fa
ct

or
sc

or
e

“F
ee

lin
g

do
w

n,
de

pr
es

se
d,

or
ho

pe
le

ss
”

Fa
ct

or
sc

or
e

387STRESSFUL LIFE EVENTS IN DIVERSE FAMILIES

T
hi

s
do

cu
m

en
t

is
co

py
ri

gh
te

d
by

th
e

A
m

er
ic

an
Ps

yc
ho

lo
gi

ca
l

A
ss

oc
ia

tio
n

or
on

e
of

its
al

lie
d

pu
bl

is
he

rs
.

T
hi

s
ar

tic
le

is
in

te
nd

ed
so

le
ly

fo
r

th
e

pe
rs

on
al

us
e

of
th

e
in

di
vi

du
al

us
er

an
d

is
no

t
to

be
di

ss
em

in
at

ed
br

oa
dl

Latino families. In addition, across racial and
ethnic groups, there were significant differences
in overall family functioning, with White fam-
ilies reporting higher overall (i.e., 40.36 partic-
ipants [pts]) family functioning and Latino fam-
ilies reporting lower family functioning (i.e.,
35.28 pts; see Table 2; p � .001).

Research Question 3: What is the associ-
ation between SLEs and child emotional
and behavioral problems in White, African
American, Latino, Native American,
Hmong, and Somali families?

There were many significant results in the full
sample (i.e., all races combined) when examin-
ing the associations between SLEs and child
emotional and behavioral problems (see Table
3). For example, there was an average increase
of 0.14 (95% confidence interval [CI: 0.00,
0.27]; effect size � 0.34) in emotional problems
when considering the occurrence of any SLE.
For health-related SLEs, there was an average
increase of 0.15 ([0.02, 0.29]; effect size �
0.36) in conduct problems. The occurrence of a
legal-related SLE resulted in an average in-
crease of 0.24 ([0.04, 0.44]; effect size � 0.57)
in conduct problems and of 0.14 ([0.01, 0.26];
effect size � 0.41) in peer problems.

Overall, Somali children had higher levels of
emotional and behavioral problems scores for
health-related, financial, interpersonal, and legal
SLEs compared to all other races and ethnici-
ties. Specifically, SLEs were positively associ-
ated with conduct problems, emotional prob-
lems, hyperactivity, and peer problems and
negatively associated with prosocial behaviors
for Somali children.

Research Question 4: What is the associ-
ation between SLEs and family function-
ing in White, African American, Latino,
Native American, Hmong, and Somali
families?

Overall, family functioning change scores
were significantly different across racial and
ethnic groups regarding the occurrence of any
SLE (p � .05). For example, Somali families
experiencing any SLE had an average decrease
of 5.18 (95% CI [�8.76, �1.60]; effect size �
�1.00) in family functioning. Regarding spe-
cific SLEs, a health-related SLE resulted in an
average decrease of 4.80 ([�8.40, �1.20]; ef-T

ab
le

2
U

na
dj

us
te

d
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ea
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or

es
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d
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an
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rd
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ev
ia

ti
on

s
of

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re

ss
fu

l
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if
e

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ve

nt
s,

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hi

ld
B

eh
av

io
rs

,
an

d
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am
il

y
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un
ct

io
ni

ng
A

cr
os

s
R

ac
e/

E
th

ni
ci

Pr
ev

al
en

ce
s

of
SL

E
s,

em
ot

io
na

l
an

d
be

ha
vi

or
al

pr
ob

le
m

s,
an

d
fa

m
ily

fu
nc

tio
ni

H
ou

se
ho

ld
ra

pa
A

fr
ic

an
A

m
er

ic
an

W
hi

te
H

m
on

g
L

at
in

o
N

at
iv

e
A

m
er

ic
an

So
m

al
i

St
re

ss
fu

l
lif

e
ev

en
ts

A
ny

(r
an

ge
�

0–
12

)
2.

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(1

.9
9)

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01

a
Fo

r
bi

va
ri

at
e

te
st

ac
ro

ss
di

ff
er

en
ce

s
am

on
g

ra
ce

s
fo

r
sc

or
es

388 BERGE ET AL.

T
hi

s
do

cu
m

en
t

is
co

py
ri

gh
te

d
by

th
e

A
m

er
ic

an
Ps

yc
ho

lo
gi

ca
l

A
ss

oc
ia

tio
n

or
on

e
of

its
al

lie
d

pu
bl

is
he

rs
.

T
hi

s
ar

tic
le

is
in

te
nd

ed
so

le
ly

fo
r

th
e

pe
rs

on
al

us
e

of
th

e
in

di
vi

du
al

us
er

an
d

is
no

t
to

be
di

ss
em

in
at

ed
br

oa
dl

T
ab

le
3

A
dj

us
te

d
P

re
di

ct
ed

M
ea

n
Sc

or
e

C
ha

ng
e

an
d

95
%

C
Is

fo
r

F
am

il
y

F
un

ct
io

ni
ng

an
d

C
hi

ld
B

eh
av

io
rs

by
SL

E
O

cc
ur

re
nc

e
A

cr
os

s
an

d
W

it
hi

n
R

ac
e

SL
E

an
d

SD
Q

su
bs

ca
le

H
ou

se
ho

ld
ra

pb
A

ll
ra

ce
s

co
m

bi
ne

d
A

fr
ic

an
A

m
er

ic
an

W
hi

te
H

m
on

g
L

at
in

o
N

at
iv

e
A

m
er

ic
an

So
m

al
i

A
ny

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E

C
hi

ld
be

ha
vi

or
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on
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ct
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ob
le

m
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(t
ab

le
co

nt
in

ue
s)

389STRESSFUL LIFE EVENTS IN DIVERSE FAMILIES

T
hi

s
do

cu
m

en
t

is
co

py
ri

gh
te

d
by

th
e

A
m

er
ic

an
Ps

yc
ho

lo
gi

ca
l

A
ss

oc
ia

tio
n

or
on

e
of

its
al

lie
d

pu
bl

is
he

rs
.

T
hi

s
ar

tic
le

is
in

te
nd

ed
so

le
ly

fo
r

th
e

pe
rs

on
al

us
e

of
th

e
in

di
vi

du
al

us
er

an
d

is
no

t
to

be
di

ss
em

in
at

ed
br

oa
dl

T
ab

le
3

(c
on

ti
nu

ed
)

SL
E

an
d

SD
Q

su
bs

ca
le

H
ou

se
ho

ld
ra

pb
A

ll
ra

ce
s

co
m

bi
ne

d
A

fr
ic

an
A

m
er

ic
an

W
hi

te
H

m
on

g
L

at
in

o
N

at
iv

e
A

m
er

ic
an

So
m

al
i

In
te

rp
er

so
na

l
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C

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on

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N
ot

e.
Sc

or
es

w
er

e
ad

ju
st

ed
fo

r
ch

ild
ge

nd
er

,
pa

re
nt

ge
nd

er
,

ed
uc

at
io

n,
m

en
ta

l
he

al
th

(d
ep

re
ss

io
n,

an
xi

et
y)

,
ho

us
eh

ol
d

in
co

m
e,

nu
m

be
r

of
ch

ild
re

n
in

th
e

ho
us

eh
ol

d,
an

d
tim

e
in

th
e

U
ni

te
d

St
at

es
.

V
al

ue
s

in
bo

ld
ha

ve
p

�
.0

5
(n

ot
ad

ju
st

ed
fo

r
m

ul
tip

le
co

m
pa

ri
so

ns
).

C
I

�
co

nfi
de

nc
e

in
te

rv
al

;
SL

E
�

st
re

ss
fu

l
lif

e
ev

en
t;

SD
Q

�
St

re
ng

th
s

an
d

D
if

fic
ul

tie
s

Q
ue

st
io

nn
ai

re
.

a
Fo

r
ea

ch
su

bs
ca

le
,

ra
ng

e
�

0
–2

.
b

V
al

ue
fo

r
bi

va
ri

at
e

te
st

ac
ro

ss
sc

or
e

di
ff

er
en

ce
s

am
on

g
ra

ce
s.

390 BERGE ET AL.

T
hi

s
do

cu
m

en
t

is
co

py
ri

gh
te

d
by

th
e

A
m

er
ic

an
Ps

yc
ho

lo
gi

ca
l

A
ss

oc
ia

tio
n

or
on

e
of

its
al

lie
d

pu
bl

is
he

rs
.

T
hi

s
ar

tic
le

is
in

te
nd

ed
so

le
ly

fo
r

th
e

pe
rs

on
al

us
e

of
th

e
in

di
vi

du
al

us
er

an
d

is
no

t
to

be
di

ss
em

in
at

ed
br

oa
dl

fect size � �1.48) and legal SLEs resulted in
an average decrease of 7.61 ([�10.39, �4.83];
effect size � �0.93) in family functioning
score for Somali families.

Discussion

Results of the current study support and ex-
tend prior research by being one of the first
studies to examine SLEs in diverse immigrant
and refugee families and to examine the asso-
ciation between SLEs at the individual child and
family levels (Thoits, 2010).

Descriptive results showed that the preva-
lence of SLEs was between one and two in
White, Hmong, Somali, African American, La-
tino, and Native American families, with Afri-
can American and Native American families
experiencing the highest prevalence of SLEs
(i.e., two or more). Although one or two SLEs
may seem like a low number, prior research on
ACEs has shown that even one or two ACEs
increased one’s risk of numerous health, behav-
ioral, and social problems throughout the life
span (Felitti, 1993, 2019; Felitti et al., 2019).
Additionally, ACEs and SLEs tend to be cumu-
lative, and the accumulation of ACEs or SLEs
has a strong graded relationship with health risk
(cardiovascular, mental health, weight-related)
and mortality (Felitti, 1993, 2019; Felitti et al.,
2019). Taken together, these findings suggest
that White and non-White groups experience
SLEs and may need resources to reduce their
potential impact, but especially African Amer-
ican, Native American, and Somali groups may
need them.

In addition, descriptive results showed that
child emotional and behavioral problems were
experienced at low to moderate levels, with the
highest occurrence of problems being hyperac-
tivity, conduct disorder, behavioral problems,
and emotional problems occurring among non-
White children. Also, children from non-White
backgrounds experienced higher prevalence of
emotional and behavioral problems; thus, fam-
ilies may also benefit from resources to help
reduce the potential negative impact of these
child emotional and behavioral problems. Fur-
thermore, descriptive results showed that most
families reported relatively high family func-
tioning. Ultimately, this strength may be helpful
for mitigating the potential negative impact of
SLEs. For example, health care providers who

work with families or interventionists who carry
out family-based interventions could leverage
family support as a potential protective factor
when SLEs occur. FST supports these findings,
in that strong family relationships are expected
to be protective during challenging times, ac-
cording to FST.

Results also indicated significant associations
between SLEs and child emotional and behav-
ioral well-being and family functioning overall,
as well as differences by race and ethnicity.
Regarding child emotional and behavioral prob-
lems, the occurrence of any SLE was associated
with higher levels of emotional problems in all
children. This finding supports prior studies
showing SLEs have immediate and long-term
influences on child emotional and behavioral
well-being (Allen et al., 2008; Ge et al., 2006;
Harland et al., 2002; Siegel et al., 1992). In
addition, this result supports prior work related
to ACEs and cumulative risk, in that the more
SLEs a person and/or family experiences, the
higher likelihood they have of experiencing
negative health and well-being outcomes (Fe-
litti, 1993, 2019; Felitti et al., 2019).

Additionally, results showed that health-
related SLEs were associated with higher levels
of emotional and behavioral problems in all
children. Thus, it may be the case that certain
SLEs can have a stronger influence on chil-
dren’s emotional and behavioral well-being
than other SLEs. Furthermore, when examined
by race and ethnicity, Somali children had the
highest levels of all behavioral and emotional
problems across all SLEs. Overall, these results
suggest that children are experiencing higher
levels of emotional and behavioral problems in
the face of SLEs and that Somali children may
be at highest risk. It is important for future
research to both further examine this relation-
ship to identify potential protective factors for
prevention as well as to identify resources to
help with treatment for children. Regarding So-
mali children, it may be important for qualita-
tive research to be conducted to better under-
stand how Somali families experience SLEs and
how they perceive their family functioning, in
addition to their child’s emotional and behav-
ioral well-being, in the face of SLEs.

Regarding family functioning, there was no
significant association between total SLEs and
overall family functioning; however, when cer-
tain SLEs occurred (e.g., health-related, legal),

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they were associated with lower family func-
tioning within racially/ethnically diverse sub-
populations. This supports prior studies show-
ing SLEs are associated with lower family
functioning and extends prior research by show-
ing there may be differences by race or ethnicity
(Thoits, 2010). Thus, it may be the case that
specific SLEs are harder to cope with than oth-
ers for particular populations. For example, So-
mali families reported lower family functioning
in the face of health-related and legal SLEs.
There may also be differential implications for
certain types of SLEs for different racial or
ethnic groups (e.g., legal issues may have dif-
ferent implications or be of a different type on
average for Latino families vs. Somali fami-
lies).

Overall, findings from the current study un-
derscore the importance of applying critical race
theory to the understanding of physical, emo-
tional, and behavioral health concerns in chil-
dren and families and for discussing race and
immigrant and refugee status in the context of
assessing SLEs (Cunningham, 2014; Cunning-
ham & Scarlato, 2018). Many important factors,
such as discrimination or harassment, structural
racism, citizenship experience, reason or story
for leaving country of origin, and trauma or
torture, may influence study findings. It is im-
portant for future research, especially qualita-
tive, to further investigate these findings to in-
form interventions and implications for
practitioners.

Strengths and Limitations

This study had both strengths and weak-
nesses. A marked strength of the study is the
diversity of the sample population, which in-
cluded racially and ethnically diverse, immi-
grant and refugee, and low-income families.
Examining both individual child-level emo-
tional and behavioral well-being and familial
well-being was another strength of the study. In
addition, the ability to control for multiple po-
tential confounders (i.e., parent gender, weight,
education, income, mental health (depression,
anxiety), number of children in the household,
and time in the United States) is a further
strength. One limitation of this study is that
other confounding variables related to child and
family functioning that can vary between
groups by citizenship experience or immigra-

tion status, such as voluntarily leaving one’s
country of origin versus fleeing for safety and
access to community services or resources,
were not assessed and may change the findings
in this study; these variables should be studied
in future research. Another limitation of the
study is the overall small sample size (n � 150)
and even smaller sample size when examining
associations by each racial and ethnic group
(n � 25 per group). However, given SLEs and
mental health outcomes have not been studied
in such diverse populations before, including
immigrant and refugee households, this study
provides an initial important examination of
these factors that future larger studies can use as
a starting point to verify results and expand
findings. In addition, the cross-sectional nature
of the study limited our ability to understand
temporality of the associations. Furthermore,
this study relied on parent report of SLEs and
child emotional and behavioral problems, which
may have introduced some social desirability
bias. The measure of SLEs was also limited to
the prior 6 months, and it may be important to
assess a longer time period of exposure to SLEs,
such as 12 months. The SLE measure, Strengths
and Difficulties Questionnaire, and family func-
tioning measure are also limited by being vali-
dated on only some of the populations we stud-
ied. It may also be possible that families who
are immigrants or refugees have difficulty
understanding the way survey questions are
asked or there may not be words for survey
items that are easily translatable into their
language; however, all survey materials were
translated into Spanish, Hmong, and Somali
by individuals from their own local commu-
nities. Additionally, immigrant or refugee
families come from a variety of contexts, and
it may be the case that families from war-torn
countries may report and/or experience SLEs
differently from families from other countries
and backgrounds.

Conclusion

Results of the current study showed that all
families in this racially and ethnically diverse
and immigrant and refugee sample were expe-
riencing SLEs. In addition, the majority of di-
verse children were experiencing emotional and
behavioral problems (i.e., hyperactivity, emo-
tional problems) in the face of SLEs (i.e., com-

392 BERGE ET AL.

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bined SLE score, health-related events), with
Somali children being at highest risk. Addition-
ally, the majority of diverse families did not
experience lower family functioning in re-
sponse the SLEs, except regarding certain SLEs
(i.e., health-related, legal). However, specific
families (i.e., Somali) experienced lower family
functioning in the face of the majority of SLEs.
These results suggest implications for practitio-
ners (mental health and health care providers)
working with diverse families regarding SLEs.
For example, it would be important for practi-
tioners to know that the majority of families
experience one or two SLEs and that given the
cumulative nature of SLEs it would be impor-
tant to provide families with resources to min-
imize the stress produced by these events. In
addition, practitioners should potentially con-
sider screening for SLEs and providing extra
resources for children, given all children in the
study had some emotional and behavioral prob-
lems in the face of SLEs and the impact of
cumulative risk with SLEs (Felitti, 1993, 2019;
Felitti et al., 2019). Additionally, it would be
important for practitioners to know which fam-
ilies are at greatest risk for experiencing SLEs
(i.e., African American, Native American, So-
mali families) to ensure they are provided with
the resources necessary to mitigate the impact
of SLEs. Practitioners may also want to utilize
family-level resources, given results of this
study showed most diverse families had high
family functioning in the face of SLEs. Further-
more, practitioners working with Somali fami-
lies may want to provide resources for both
family functioning and child emotional and be-
havioral problems when SLEs are experienced.

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Received January 16, 2020
Revision received April 28, 2020

Accepted July 5, 2020 �

395STRESSFUL LIFE EVENTS IN DIVERSE FAMILIES

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http://dx.doi.org/10.1016/S0022-3999%2802%2900486-5

http://dx.doi.org/10.1097/00005053-200011000-00002

https://www.theguardian.com/us-news/2017/jan/27/donald-trump-muslim-refugee-ban-executive-action

http://dx.doi.org/10.1097/00004583-199203000-00022

http://dx.doi.org/10.1177/0022146510383499

http://dx.doi.org/10.1007/978-0-387-85764-0_14

http://dx.doi.org/10.1056/NEJMms1702111

Stressful Life Events and Associations With Child and Family Emotional and Behavioral Well-Being …

Method

Participants

Procedures and Data Collection

Measures

Statistical Analysis

Results

Discussion

Strengths and Limitations

Conclusion

References

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