Dispatches from the field: In conversation with Dr. Barbara Prempeh

“How will you deal with grief and loss, given the high number of students you’ll have in classrooms that lost a parent, a grandparent, an aunt, or a community member to this COVID pandemic? What about the classrooms where teachers aren’t there because they passed away from COVID-19? How are we addressing that? I really want to see schools emphasize their emotional support for students. I get it that some schools just don’t have the capacity, or don’t want to add anything else to the school day, but we have to become creative in how we’re supporting students” – Dr. Barbara Prempeh

Interview with Dr. Barbara Prempeh

Please share with us a typical day for you.

An average Monday for me would include coming to the hospital and doing a psychological evaluation of a child who has experienced abuse. Before seeing the child, I’d already have spoken to the child protection agency about the referral and concerns they have. I’d also have spoken to the nonoffending parent to learn about what happened and discuss any noticeable behavioral or emotional changes they’ve seen in the child because of the alleged abuse, and any changes in family dynamics. In addition, I’d get a history of the family and the child.

Interwoven into this process is asking culturally-competent questions about the family’s practices or any immigration issues. Knowing this allows us to take a look at the full picture and the impact of the abuse, not just on the child but also on the family. After the evaluation, I provide recommendations to the family and to the child protection agency worker. Beyond doing evaluations myself, I supervise doctoral-level students in conducting psychological evaluations and engaging in trauma-informed treatment of children who have been abused.

In doing this work, I recognize that specifically with child trauma — whether it’s physical abuse, sexual abuse, or neglect — that the child didn’t go through that experience alone. A parent has now been impacted by the knowledge of their child being abused. How will that affect the parent? We need to understand that how the parent deals with it impacts how the kid progresses through that traumatic experience as well. For that reason, I really would like to see more programs that are not just for kids, but also have parent components because we have to be able to address and provide support for both. I’m always checking with the parent to ask, “how have you been coping with this?” Sometimes in my evaluations kids will share that “since I said something it’s been very hard for my parent.” Kids notice how their parents are coping. I just hope we’re considering the well-being of parents to be just as important when doing this work.

You also teach college students who are studying psychology.

Yes, after that day is done at the hospital, I go on to teach. I’m a professor in Montclair State University’s school psychology program. This is a new role for me and this semester I’m teaching a class titled, “Behavioral Assessment.” I feel this is very important work, in particular training future school psychologists to be aware of the impact of ACEs within the school environment and how they can be advocates for services for children who’ve had adverse experiences.

Over the past academic year, you were a consulting counselor at a Pre-K through Grade 12 school in New York State. What did you learn about the challenges facing students, particularly students of color, and what should schools think about as they navigate another year affected by the pandemic?

Over the past year and a half, while we’ve been in this pandemic, there’s been a lot of talk about the need to understand that this is a challenging time for students emotionally, and also understand the prevalence of social injustice and how we all got a first-hand view. We had no distractions while we were in the pandemic and had no choice but to see what was happening on our screens and social media sites. Students saw it with their own eyes as well, and we saw students protesting and marching alongside their parents. There’s been a lot of talk about it, but I want to see action now that the schools are opening. Where is the action? My concern is that we can do a great deal of talking and acknowledging but then we stop there. It’s great to acknowledge. I’m glad that a lot of places have acknowledged the racial trauma and the collective trauma that we’re experiencing with the pandemic, but what’s the action behind it? I really want to see schools emphasize their emotional support for students.

How will you deal with grief and loss, given the high number of students you’ll have in classrooms that lost a parent, a grandparent, an aunt, or a community member to this COVID pandemic? What about the classrooms where teachers aren’t there because they passed away from COVID-19? How are we addressing that? This is in addition to the increased anxiety that students have experienced, maybe the lack of motivation, because during that year and a half things just weren’t the same, they weren’t able to interact with their friends as much, or they missed out on junior prom. What about kids that were in eighth grade when the pandemic started, entered a new high school last year, and now they’re sophomores? Not only are they adjusting to being in a new building, they’re also adjusting to this new group of students. Are schools running emotional support groups? Are they providing some type of psychoeducation to parents to inform them on how to support their children at home? I get it that some schools just don’t have the capacity, or don’t want to add anything else to the school day, but we have to become creative in how we’re supporting students.

Lastly, how will schools acknowledge their awareness of racial trauma even within the school setting? Are they doing some type of analysis or assessment about their school climate as it relates to race and differential treatment of certain students? Are they evaluating disciplinary actions to see if there’s any implicit bias? And, if so, what are they going to do to address that? We know racial trauma is experienced in the school system, similar to everywhere else.

Within the schools’ assessments there are three different tiers they need to think about. Will they do a tier-one approach where it’s just general information for everyone? Are they considering second tier, where they assess who’s been impacted more and connect them to services? Finally, third tier, what are they doing to ensure they maintain the support that’s being provided? I really hope they take that tiered approach to addressing both pandemics that we’re experiencing right now.

As a psychologist, can you speak about the barriers that prevent people from seeking or getting mental health services? What can be done to reduce those barriers?

Given the typical barriers or challenges related to accessing mental health services, many people were happy when we transitioned to teletherapy. It was seen as a plus; we thought, “it’s going to help us see more people than before.” But access to teletherapy also becomes an equity issue. I’m making an assumption that my patient has the actual equipment, whether a smartphone or tablet device through which they can do teletherapy, and also assuming the patient literally has the bandwidth to do that. Do they have Wi-Fi and, if they do, is it a dependably sustainable bandwidth so they can do teletherapy service? We know that some schools were proactive in providing students computers, but were therapists able to do that?

For some people, another issue in accessing therapy services is transportation. Think about it: If a family has to take two buses and then walk 15 minutes, it becomes a hassle.

And for communities of color, there’s the acknowledgment that there aren’t enough therapists and psychologists of color because there’s a privilege in having a therapist that looks like you. We have to acknowledge that communities of color don’t have that privilege all the time. That’s something they have to consider: “Yes, I want to go to therapy, but how long do I have to wait to find to find a therapist of color who has an opening, who takes my insurance, and whose office I can get to easily?”

There is also the stigma of seeking mental health services within communities of color. People think: “I’m not crazy,” or “things are not that bad for me to go to therapy,” and it’s important to break down that stigma by saying, “you don’t have to be at a breaking point to go to therapy — you should go way before that.” There’s also the acknowledgment that most approaches to therapy are Eurocentric. People of color might believe that therapists won’t understand their family’s dynamics, or how certain cultures are more collective.

Part of your career has been focused on juvenile justice and you’ve spoken out about how most children in the juvenile justice system have a history of trauma. Can you talk about this intersection?

This is where my passion has been. I began my educational journey focused on juvenile justice and did my doctorate internship at a juvenile detention and probation center. I saw firsthand that statistic regarding the history of abuse with a lot of the kids for whom I did assessments. This shifted my focus and made me want to help kids in the juvenile justice system. I understood that to better help them I had to better understand the impact of trauma.

That intersection is very important because it helps us recognize the things that could be done earlier in children’s lives to actually decrease the likelihood of someone ending up in the juvenile justice system. The work around ACEs makes the connection from these adverse childhood experiences to long- term medical impact, but there has to also be this second piece of connection relating to incarceration. Maybe there are variables, where a certain number of adverse childhood experiences increases the likelihood of incarceration. That’s where we’re seeing the two worlds come together. When you think back to the school-to-prison pipeline, you have to question if there are resources that kids with ACEs are getting or not getting? Are their certain disciplinary actions taken against kids with a history of ACEs? And do these things increase the likelihood of kids ending up in the juvenile justice system?

The shift in thinking needs to be that instead of handing out excessive suspensions and expulsions, what therapeutic resources are you putting in to stop that trajectory toward the juvenile justice system? Instead of a suspension because the kid is fighting, why not have them meet with a counselor or put them in some type of therapeutic program? This is what I’m hoping will happen as people become more trauma informed. They’ll look beyond the observable behaviors to understand you’re not just seeing a present moment, but you may be seeing a history of things being presented to you.

It feels like there’s some momentum, with a growing number of states focusing on ACEs and developing programs that seek to prevent and/or respond to childhood trauma. Are you optimistic that more states will follow?

Programs like these really can be a support in helping put families back on the pathway to healing after experiencing traumatic events. With more states recognizing the importance of programs to help address childhood trauma, the future looks bright. And there is a role for the federal government as well because, at the end of the day, it’s about the funding needed to support these programs. We also need to redirect funds to provide more community-based support. For example, we know there are certain calls that police shouldn’t be responding to, where mental health professions and crisis counselors should respond instead. The federal government can promote the policies and provide the funding to support critical community-based programs that, in collaboration with law enforcement, can result in safer communities for police officers and community members.

What’s one way we can get people to become more comfortable with the idea of seeking therapy?

It would help if we spoke about it as a wellness check. Just like you go to the medical doctor for a wellness check yearly, insurance companies should also cover going to see a psychologist as a wellness service once a year. I think that would break down a lot of stigmas as well by incorporate mental health into the wellness model — not separating the two. There are people that don’t have diagnoses but could benefit from seeing a therapist to reaffirm them as they go through daily life challenges. Having people be more open to the idea of therapy is quite important and it’s something we will have to work hard to address in all communities, but especially in communities of color.