Building a National Movement to Prevent Trauma and Foster Resilience-Mount Sinai Adolescent Health Center

Geographic Origins of Mount Sinai �Adolescent Health Center Patients

Childhood abuse and neglect in a cohort of adolescent and young adult females from an HPV surveillance study

• A cohort of adolescent women participating in a HPV vaccine surveillance study between 2012 and 2017 

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• 882 inner-city African-American and Hispanic young women 12-20 years of age

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• Used the Child Trauma Questionnaire (CTQ)

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• Cross-sectional study involving self-report surveys

Disclosure of childhood abuse and neglect in a cohort of adolescent and young adult females from an HPV surveillance study

• 60% experienced childhood abuse or neglect (of any type).

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• 37% experienced childhood physical and/or sexual abuse.

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Diaz, et al Effect of child abuse and neglect on risk behaviors in inner-city minority female adolescents and young adult. Child Abuse & Neglect 101 (2020)

Disclosure of physical and sexual abuse

• 54.1% of participants disclosed childhood physical and/or sexual abuse

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• 44% disclosed physical abuse
• 29.6% disclosed physical abuse only
• 14.5% disclosed physical and sexual abuse

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• 24.5% disclosed sexual abuse
• 10% disclosed sexual abuse only
• 14.5% disclosed sexual abuse and physical abuse

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• Among participants reporting sexual abuse, the majority (59.6%) also reported a history of childhood physical abuse

Diaz, A., Peake, K., Nucci-Sack, A., Shankar, V. Comparison of Modes of Administration of Screens to Identify a History of Childhood Physical Abuse in an Adolescent and Young Adult Population. Annals of Global Health special issue on Adolescent Health and Medicine, 2017 Sep-Dec; 83(5-6): 726-734.

Child sexual abuse

• 22.7% of my patients disclosed a history of sexual abuse when asked directly during a routine medical screening.
• 85% abused by family member
• 66% abused by blood related family members (consistent with incest)

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• 81% of these patients accepted referrals to counseling as a result of this disclosure.

Mount Sinai Adolescent Health Center Sexual Abuse Study: Age at Onset of Sexual Abuse

70% of child sexual abuse began pre-pubertal

• For 51% of females, abuse started and ended before menstruation
• For 19% of females, abuse started before menstruation and ended after

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30% of abuse began after menstruation

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Profile of sexual victimization

*Mean age at first episode was 8.8 years

Age of Victim at First Episode*

Profile of sexual victimization

Age of Perpetrator at First Episode*

*Mean age of perpetrator was 32 years

Profile of sexual victimization

Who Were the Perpetrators?

Profile of sexual victimization

Total Number of Perpetrators

Profile of sexual victimization

Duration of Abuse by First Perpetrator

Profile of sexual victimization

Frequency of Abuse by First Perpetrator

Percent of youth with a history of running away

Victims

Controls

Comparison of Coopersmith Self-Esteem Scores

Comparison of perceived relationship with mother

Comparison of depressive symptoms

Comparison of suicidality

Methods used during suicide attempts

Victimization

How I Ask about Sexual Abuse: Using Language that Young People Understand

• Has anyone ever asked you to touch them or do something sexual you did not want to do?
• Has anyone ever touched your body in a way that made you feel uncomfortable or when you did not want them to? Has anyone ever forced you to perform any sexual act on your body or on theirs?
• Has anyone ever touched your breast? Vagina? Penis? Buttocks? Anus? Or any other part of your body when you did not want them to?
• If yes:
• Who did this? Was it … your father? Stepfather? Mother’s boyfriend? Mother? Stepmother? Father’s girlfriend? Uncle? Aunt? Brother? Sister? Grandparent? Teacher? Neighbor? Babysitter? Friend? Friend of the family? Stranger?
• How often has this happened?
• When was the last time?

How I Ask about Human Trafficking: Using Language that Young People Understand

• Have you ever been pressured to have sex from someone who gave you food, a place to sleep, money or drugs?
• Have you ever had to exchange sex for food, shelter, drugs or money?
• Have you ever been in “the life”?
• Are you working?
• What type of work do you do?
• Where?
• What is your salary?
• Are you working for these people or this company to pay a debt to them? To pay a debt to someone else? For what?
• Are you in control of your salary?
• Are you in control of all your documents?

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Human Trafficking: Profile of Victims

• 237 total youth who have been trafficked
• 94% live in NYC
• 41% of men have had sex with men
• 37% have ever had an STI
• 32% of women have had sex with women
• 20% have ever been in foster care
• 19% (of young women) have given birth
• 16% were born outside the USA
• 8% identify as transgender
• 4% are HIV positive

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Sex

Race/Ethnicity

Trauma-informed & healing-centered care

• Be aware of trauma and its impact
• Adopt a safe, patient-centered treatment approach
• Provide trauma-responsive and healing-centered care
• Ensure that all staff maintain appropriate interpersonal boundaries
• Provide a supportive, holistic, integrated, non-judgmental approach
• Empower the victim/survivor
• Provide clear and consistent messages about what will happen during each visit, giving patients choice and control
• Ensure patient’s rights to information, privacy, bodily integrity and participation in decision making

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Resilience: Three Critical Conditions

Growing up in distressing life conditions and demanding societal conditions that are considered significant threats or severe adversities

G. Windle, “What is resilience? A review and concept analysis,” Reviews in Clinical Gerontology, vol. 21, no. 2, pp. 152–169, 2011

1)

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2)

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3)

The achievement of positive adaptation despite experiences of significant adversity

The availability of protective factors, including internal assets and external resources that may be associated with counteracting the effects of risk factors

Protective factors

Taxonomies of protective factors share common elements:

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• Bonding or close relationships with a mature and supportive adult and with a parent who maintains a positive family environment

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• Competence and self-efficacy, including good cognitive abilities, good self regulation, positive self-perception, talents valued by society, social competence, and faith or a sense of meaning in life

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• Supportive environment: an organized home, structured and warm parenting, socio-economic advantage, effective schools, safe neighborhoods with good public health, and access to health care

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Lee, Cheung, and Kwong, Resilience as a Positive Youth Development Construct: A Conceptual Review, The Scientific World Journal Volume 2012

The Mount Sinai Adolescent Health Center is a youth friendly program highlighted in the “The Promise of Adolescence: Realizing Opportunity for All Youth (2019) Report.”��The program is designed with the principles of positive youth development, �racial, social, economic and sexual and reproductive justice, and with the goal of achieving equity for young people.

Contact Information

Angela Diaz, MD, PhD

Director

Mount Sinai Adolescent Health Center

Angela.Diaz@mountsinai.org

212-423-2900

www.teenhealthcare.org