Last month, an article titled “The Tragedy of Baltimore” in the New York Times Magazine described the upsurge in violence in a city long known for its “blight, suburban flight, segregation, drugs, racial inequality, [and] concentrated poverty.” At the center of the storm are transition-age youth, who too often face long odds and challenging futures in the communities where they live.

I recently had the opportunity to talk with Patricia Cobb-Richardson, MS. For the past 20 years, she has worked in New York City, Delaware, and now Baltimore developing and leading programs that aim to leverage the protective factors and resilience of young adults in communities challenged by chronic toxic stress and trauma borne of gun violence, substance use, poverty, structural racism, and mass incarceration. In our recent interview, Patricia shared her work and perspective on trauma-informed care. What follows is a transcript of our conversation, which has been edited for length and clarity.

RJE: Most of your work is with “transition-age youth.” Who are they and what’s important to know about them? 

PCR: Generally, we consider transition-age youth to be young adults who are between 18 and 25 years old. I began working with young adults because I saw so many young people with behavioral health problems who had aged out of the foster care system and ended up homeless. Those kids made me look more closely at the problems in the system that failed them. They appeared to lack the skills to succeed as adults in the community. They weren’t finding jobs and frequently became part of the criminal justice system. 

What I realized over time was that the early adverse childhood experiences (ACEs) that we now understand in terms of toxic stress were the primary cause of their lack of skills. They struggled with interpersonal relationships, sustaining employment, securing housing, and achieving academic goals. All of these are important components of adult life and these young people were often blamed for failing to achieve them. What was needed was a public health understanding of the ways in which systems, policies, and structural factors combine to prevent youth from achieving their goals. The expression “It’s not what’s wrong with you but rather what happened to you” reflects this public health perspective. 

These youth are in a system that wasn’t designed for them. They aren’t children but they’re not yet fully adults either. It’s not surprising that three out of four who are referred for behavioral health treatment do not access that treatment. Of particular concern to me is the fact that many of these young men and women are dealing with multiple factors impacting their development. They’ve experienced childhood trauma, community violence, and poverty, and for some a disconnection from family, community, and culture.  

Again, we’re talking about individuals who’ve been exposed to multiple adverse experiences in childhood, and we know this has both physical and emotional consequences. These young people have difficulty regulating their emotions and engaging in effective problem-solving. They tell us that just showing up to work on time is extremely difficult and sometimes they have inexplicable conflicts at work. Sometimes they adapt to these stressors by using substances to manage their anxiety and feelings of sadness. The challenges they’re facing may seem on the surface so easy to others, but it’s not so for them. 

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