Eraka Bath, MD, & Paula Powe, MD, Current Research in Trauma-Informed Psychiatry

Two recent presentations offered audiences from the Department of Psychiatry and beyond a nuanced look at health disparities and trauma in psychiatry.

Eraka Bath, MD (Associate Professor of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California / Los Angeles) delivered a Department of Psychiatry Distinguished Scientist Lecture, “Addressing Reproductive Inequities in Youth with Histories of Commercial Sexual Exploitation.” She began her talk by urging the audience to consider a “framework of intersectionalism” (how multiple social identities intersect to marginalize individuals).

Dr. Bath is a child, adolescent, and forensic psychiatrist with particular interest in structural racism’s impact on the underserved populations of foster care and juvenile justice-involved youth. Currently, Dr. Bath focuses on addressing the substantial sexual health needs of young survivors of commercial sexual exploitation in the justice, foster care, and child welfare systems. “The racial disparities are really stark. There are huge gaps in ability to access services, and these gaps are disproportionate to need.”

She noted a key moment in the development of this project, the realization “as a child forensic psychiatrist, that we need to center reproductive health, sexual health education, and access for this population. We have to empower them with education.” Using a community-based participatory research model, Dr. Bath and her colleagues developed the My Body My Choice sexual health workshop. This education program uses a variety of methods to engage young people, including partnership with individuals with commercial sexual exploitation lived experience. 

Paula Powe, MD (Assistant Professor of Psychiatry, University of Pittsburgh) is medical director of the Matilda H. Theiss Child Development Center, which serves children at risk for behavioral and emotional issues, and their families. At the UPMC Western Psychiatric Hospital Trauma-Informed Approach to Racial Healing: A Summit for Collaborative Approaches, Dr. Powe spoke on the long-term impact of childhood trauma. 

Dr. Powe discussed how toxic stress can affect brain development in childhood—particularly during the critical, formative ages of 0-3 years old—which can lead to executive function deficits, impulse control disorders, emotion dysregulation, substance use disorders, and disruptive behavior. Much toxic stress is caused by social determinants including housing insecurity/homelessness, living in an unsafe neighborhood, community violence, foster care placement, school resources, discrimination, and job insecurity. “Thinking about race, how many of these social determinants were determined for us? I have trauma in my own DNA because of things my ancestors experienced,” said Dr. Powe.

Moreover, in adulthood there are clinical manifestations of early adversity. These serious health problems include increased risk for heart disease, cancer, depression, and early death, among numerous other issues. She characterizes the progress of historical trauma, through experienced adversity, to health problems and risk for early death as a pathway to pathology.

Dr. Powe’s work focuses on prevention by fostering resilience through relationships. Currently, she leads a qualitative research study with Black fathers in Allegheny County to assess their knowledge and attitudes about the neurodevelopmental effects of toxic stress and resilience factors. At the Theiss Center she works with children who are at risk for behavioral and emotional issues and their families. The Center provides evidence-based therapies including child-parent psychotherapy, trauma-focused cognitive behavioral therapy, and integrative treatment of complex trauma.