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Marta Miranda-Straub from Kentucky’s Dept. of Community-Based Services Discusses Trauma and Toxic Stress in Children

Interview with Marta Miranda-Straub, Commissioner of the Kentucky Department for Community-based Services (DCBS) discusses trauma and toxic stress in children.

Parts of this interview appeared in Healing Childhood Trauma: A KET Special Report. It has been lightly edited.

Renee Shaw: Commissioner Miranda-Straub, you’ve been so involved in this kind of work for many years.  In your new role as commissioner, what do you envision that DCBS could do in addressing trauma and toxic stress on a state policy level?

Marta Miranda-Straub

Commissioner Miranda-Straub: I believe that one of the reasons I was appointed as Commissioner is because I bring 47 years of clinical and organizational experience to this work, and an incredible commitment to the depth and breadth that it takes to actually mitigate trauma. One of the pieces that the Cabinet needs to do, and that I intend to lead, is realizing we have workers, including our administrators and myself who have experienced trauma who are still here, who haven’t committed suicide or who haven’t died of an overdose because we have resilience. So, one of the issues is to empower and create spaces for the workers who see trauma and are told the trauma stories and have to intervene in families in pain and suffering. You can’t do that over and over again without getting traumatized. Without addressing that trauma on the worker, that worker is not going to be capable of staying open and clear that this family needs support. So that’s part one. We’ve never done that in any kind of comprehensive systemic and structural way.

The other piece is that COVID-19 has really allowed us a lot of flexibility. Where we’ve had a lot of rigidity in bureaucracy before, we have been given an opportunity at the federal level and with our partners to be more flexible. We’ve been able to extend services because we didn’t want people to go through having to apply again three months later. We’ve been able to move forward on going 200% above the poverty level rates on SNAP (Supplemental Nutrition Assistance Program), as opposed to the usual 100- 130% above poverty level. We have been able to do things we needed to be doing all along. The silver lining is that we have been able to be a lot more receptive to the challenges of children and families, the challenges of poverty, the challenges of equity disparities and the importance of being able to respond in a timely manner. That means lowering the case load for our workers because now 80% of our staff is working from home, so they’re able to do more and that improves morale as a result. We have an opportunity and a short window of time with Governor (Andy) Beshear, Secretary (Eric) Friedlander and COVID-19 and the movement to really eradicate inequities in our society, for the Cabinet to join the 21st century, and to design trauma response and resilience interventions in flexible and human ways. We would have never been able to do this before.  

Renee Shaw: As you know, Kentucky ranks near the top when it comes to child abuse. When we think about those children who are already vulnerable and you add on the pandemic — talk to us about how this health pandemic really impacts child abuse in KY?

Commissioner Miranda-Straub: We are number one in child abuse in the country. That is not acceptable, and we need to correct that. With schools and day care centers closed, which are the major ways of reporting, reporting on child abuse to us went down in March and April. However, May and June are up and similar to before the pandemic. In addition, we know that when families are close together or suffering from the challenge of not being able to go to work, those things go up. Our staff has been able to reach more people and we’ve had more in person connections available because a lot of folks were working from home.  And we’ve been able to expand resources to families to mitigate some of that.

The inequities and inequalities around race have gotten really clear. The fact that many folks are in poverty without health care is really clear, and our public assistance program has really been incredible.  We’re going to have huge budget shortfalls but it doesn’t matter. This is about people’s lives and this is about people surviving. So we’ve been able to do more because of the pandemic, because we’ve had a lot more flexibility, and because we have leadership in a governor that says it’s about saving people’s lives.

Renee Shaw: How can we scale up efforts to address toxic stress and trauma with this overlay of the COVID-19 pandemic?  Even once we move beyond the pandemic, the residuals of this experience may be with us for a long time. What should we do from here, and how can we all harness resilience?

Commissioner Miranda-Straub: The builder block of self-esteem is safety, and right now we have high numbers in Kentucky. So the first request that I make of all of us is to be safe and make sure that we have enough compassion to care about everyone else – so that means wear a mask, wash your hands, practice social distancing, period.

From there on, then we really begin to work with compassion and grace about this new normal that were trying to redefine.  There are no rules because they have all been blown up. We get to design new ways that we want to parent, new ways that we want to work and new ways that we want to deal with each other now that we realize the amount of pain and suffering that a lot of us have had for a very long time. I see this as a great opportunity for us to unpack systems that have been oppressive and biases that we have had about people living in poverty and people living with substance use and certainly people of African American descent. And the great leveler is the pandemic and poverty. I think we have an opportunity to rethink how we see those issues and really become a more humane work environment, a more humane community that cares for each other and sees that we’re all responsible for each other. One of my favorite quotes is, “What happens to one of us affects all of us.” So I’m hoping that the community continues to rally, the state continues to rally and the country continues to rally around safety, protective measures and prevention of pain and trauma so that the next generation has a healthier place to be born into.

Renee Shaw: Those are pretty fine words to end on, Commissioner Marta Miranda-Straub, thank you.

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Healing Childhood Trauma: A KET Special Report was funded, in part, by a grant from the Foundation for a Healthy Kentucky.