To prevent childhood trauma, pediatricians screen children and their parents…and sometimes, just parents…for childhood trauma

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Tabitha Lawson and her two happy children

When parents bring their four-month-olds to a well-baby checkup at the Children’s Clinic in Portland, OR, Drs. Teri Petersen, R.J. Gillespie and their 15 other partners ask the parents about their adverse childhood experiences (ACEs).

When parents bring a child who’s bouncing off the walls and having nightmares to the Bayview Child Health Center in San Francisco, Dr. Nadine Burke Harris doesn’t ask: “What’s wrong with this child?” Instead, she asks, “What happened to this child?” and calculates the child’s ACE score.

In rural northern Michigan, a teacher tells a parent that her “problem” child has ADHD and needs drugs. The parent brings the child to see Dr. Tina Marie Hahn, who experienced more childhood trauma than most people. Instead of writing a prescription, Hahn has a heart-to-heart conversation with the parent and the child about what’s happening in their lives that might be leading to the behavior, and figures out the child’s ACE score.

What’s an ACE score? Think of it as a cholesterol score for childhood trauma.

Why is it important? Because childhood trauma can cause the adult onset of chronic disease (including cancer, heart disease and diabetes), mental illness, violence, becoming a victim of violence, divorce, broken bones, obesity, teen and unwanted pregnancies, and work absences.

The CDC’s Adverse Childhood Experiences Study (ACE Study) measured 10 types of childhood adversity: sexual, physical and verbal abuse, and

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Q-and-A: Pediatrician screens parents, kids for trauma because her ACE score is 9

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Dr. Tina Marie Hahn

Dr. Tina Marie Hahn is a pediatrician in Alpena, Michigan. She agreed to answer these more personal questions as part of an interview about how she and other pediatricians are screening children — and parents — for adverse childhood experiences.

Q. What personal or professional moment or event in your life inspired you to work on adverse childhood experiences (ACEs)?

A. When I was four-and-a-half years old, I saw my father murder my grandmother.

My father was quite a demanding man — he felt as if everyone owed him. But he was also lazy. He didn’t work my entire childhood. He supported himself from state welfare checks intended to provide for his three children. My father wanted Grandma Hahn to give him money for cigarettes, but she refused. She told him he needed to go work at the hardware store and do something productive before she would give him more money. He became VERY angry and he pushed her down her basement steps.

After pushing her, he screamed angrily: “I don’t care if she dies. When she dies, I’m going to piss on her grave.” It terrified me. It seemed as if Satan possessed him. Even though I was frightened, I stayed at grandma’s side for a day and a half, trying to give her water from a bathroom Dixie cup because she kept saying that she was thirsty. My screaming father and my mother, ignoring the whole thing, left Grandma trapped at the bottom of those steps for almost two days until her cries ceased.

Diane, my mother, did nothing, not because she was afraid of my father, but because she followed him around

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Trying to make LA schools less toxic is hit-and-miss; relatively few students receive care they need

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The Peacemakers of Harmony Elementary School in Los Angeles, CA.

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For millions of troubled children across the country, schools have been toxic places. That’s not just because many schools don’t control bullying by students or teachers, but because they enforce arbitrary and discriminatory zero tolerance school discipline policies, such as suspensions for “willful defiance”. Many also ignore the kids who sit in the back of the room and don’t engage – the ones called “lazy” or “unmotivated” – and who are likely to drop out of school.

In the Los Angeles Unified School District (LAUSD), which banned suspensions for willful defiance last May, the CBITS program (pronounced SEE-bits), aims to find and help troubled students before their reactions to their own trauma trigger a punitive response from their school environment, including a teacher or principal.

Gabriella Garcia’s son attended Harmony Elementary School during the 2012-2013 school year. The school has 730 children in kindergarten through fifth grade. She says without CBITS, she would have lost custody of him and her other two children. “But for some reason,” she says, “I let him (her son) take that test.”

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Top U.S. health philanthropy – Robert Wood Johnson Foundation – awards ACEs Connection Network $384,000

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As part of its commitment to improving the health of the nation’s most vulnerable people and building a culture of health, the nation’s largest health-focused philanthropy, the Robert Wood Johnson Foundation, recently awarded a $384,000, two-year grant to the ACEs Connection Network.

Jane Stevens, a long-time health, science and technology journalist, launched the network two years ago. It comprises ACEsConnection.com, a community of practice social network, and its accompanying news site, ACEsTooHigh.com.

ACEsTooHigh publishes news, features, essays and analysis for the general public about the short- and long-term consequences of adverse childhood experiences (ACEs). The site has received more than one million page views over the last two years. Its stories are also distributed to other media sites, including The Huffington Post and SocialJusticeSolutions.com. With the additional resources provided by the grant, the site will feature more stories about how people and communities are implementing practices based on ACEs research and concepts, and distribute these stories more widely.

The grant will also help grow ACEsConnection, ACEsTooHigh’s companion community of practice social network, from its current 2,000 members to 8,000 participants and more than 100 groups. ACEsConnection links people – online and face-to-face — who are implementing trauma-informed and resilience-building practices based on adverse childhood experiences research. ACEsConnection participants include physicians, judges, social workers, nurses, academics, educators, legislators, advocates, philanthropists, peer support specialists, probation and parole officers, therapists, researchers, members of the faith-based community, writers, documentary producers, business owners, artists, and community officials.

The first five members of the ACEs Connection Network team are:

  • Valerie Krist, graphic designer for ACEsConnection and ACEsTooHigh. She also provides design assistance for group pages on ACEsConnection, and creates infographics for selected articles.
  • Sylvia Paull, a well-known network marketing strategist, develops marketing materials, strategic partnerships, outreach strategies, and new distribution channels for content.
  • Jasmine Pettis, a Masters of Public Health student at San Jose State University, is ACEsConnection’s information specialist.
  • Elizabeth Prewitt, ACEsConnection community manager, also does policy analysis for both sites. Formerly, she was director of public policy for the National Association of State Mental Health Program Directors and director of government affairs and public policy for the American College of Physicians.
  • Joanna Weill, ACEs Connection Network intern. She is working on her doctorate in social psychology at the University of California, Santa Cruz. Her research focuses on the experiences and relationships that put people at risk for criminal behavior and recidivism.

Dr. Jeffrey Brenner: “I believe ACE scores should become a vital sign, as important as height, weight, and blood pressure.”

This video looks at the relationship between ACEs and hospital emergency rooms.

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Dr. Jeffrey Brenner is founder and executive director of the Camden Coalition of Healthcare Providers, and a 2013 MacArthur Foundation genius award winner. He did groundbreaking work in Camden, N.J., by using data to identify people who were hospital emergency room “frequent fliers”. He found that between their trips to the ER, little or nothing was done to help them improve their health. So, he began putting basic services in place to help these people. His work was written up in a New Yorker article — The Hot Spotters, by Dr. Atul Gawande — in  2011.

That article sent a shock of electricity through me — not only because it was so well written, but because Brenner was on to a solution for markedly reducing health care costs. However, it seemed to me that there was a piece missing —  if Brenner knew about the CDC’s Adverse Childhood Experiences Study, he (and other physicians) might be able to identify the people who suffer most in our society more quickly.

Today, an essay Brenner wrote about how the medical community has neglected the ACE Study, even though its findings were published in 1998, appeared on Philly.com’s The Field Clinic blog. It’s well worth a read. Here’s part of it:  

For nearly 15 years we’ve had the secret to delivering better care at lower cost in America.  The information has sat, hidden away in the medical literature, and barely mentioned among physicians.  It’s a remarkable story of bias. The neglect of this information by the medical community tells you a lot about our failings as a profession and the poor training we receive.  It’s also a powerful commentary on the values of our society and the biases built into our society’s view of health and healthcare.

In the 1990’s, a physician at Kaiser Permanente in California, Dr. Vincent Felitti, conducted a mail survey with 17,000 middle class patients.  He asked them questions about traumatic events that might have happened to them as children.  Incredibly, over 70% of people receiving the survey responded, and they gave permission to connect their survey answers to their medical records.

….In the work that I do in the City of Camden building interventions for high-cost complex

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San Francisco’s El Dorado Elementary uses trauma-informed & restorative practices; suspensions drop 89%

El Dorado Elementary School Principal Silvia Cordero announces one of the winners of the weekly student-of-the-week award.

El Dorado Elementary School Principal Silvia Cordero announces one of the winners of the weekly student-of-the-week award.

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For one young student – let’s call him Martin — the 2012-2013 school year at El Dorado Elementary in the Visitacion Valley neighborhood of San Francisco was a tough one, recalls Joyce Dorado, director of UCSF HEARTS — Healthy Environments and Response to Trauma in Schools.

“He was hurting himself in the classroom, kicking the teacher, just blowing out of class many times a week.” There was good reason. The five-year-old was exposed to chronic violence and suffered traumatic losses. His explosions were normal reactions to events that overwhelmed him.

This year, Martin’s doing better. That’s because he spent months working with a HEARTS therapist, and that therapist worked with his teachers and other school staff to create a more safe and supportive learning environment. Still, on days when he feels extremely anxious, Martin sometimes asks to visit the school’s Wellness Center, a small, bright room stocked with comforting places to sit, headphones to listen to music, and soft and squishy toys.

“If a student starts to lose it, the teacher can give the kid a pass to go to the Wellness Center,” says Dorado. “The kid signs in, circles emotions on a ‘feelings’ chart (to help the person who staffs the center understand how to help the child). The staff member starts a timer. The kid gets five to 10 minutes. The kid can sit on the couch with a blanket, listen to music, squeeze rubber balls to relieve tension and anger, or talk to the staff member. Kids who use the room calm down so that they can go back to class. It’s not a punishment room. It’s not a time-out room. It’s not an in-school suspension room. It’s a room where you feel better going out than when you went in.”

One day this year, as school staff members are meeting in the Wellness Center, Martin bursts in. “I need to borrow something,” he tells them. “Somebody needs my help.”

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At Reedley (CA) High School, suspensions drop 40%, expulsions 80% in two years with PBIS, restorative justice; but going the distance might require more tools

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In 2009, when the Kings Canyon Unified School District in California’s rural Central Valley offered its 19 schools the opportunity to adopt a system that would reduce school suspensions and expulsions, Reedley High School jumped at the chance.

Today, Reedley is in its fourth year of changing a zero-tolerance policy that has failed this school and community miserably, just as every zero-tolerance policy across the country has. The school, which has 1,900 students, is feeling its way out of those draconian days by integrating PBIS — Positive Behavioral Interventions and Support — and entering into a unique partnership with the West Coast Mennonite Central Committee and the local police department to implement a successful restorative justice program.

This approach is already having remarkable effect. The school saw a 40% drop in suspensions from the 2010-2011 to the 2012-2013 school year — from 401 to 249 suspensions involving 198 and 80 students, respectively. Expulsions went from 94 in 2010-2011 to 20 last year. But this year’s trends indicate that impressive decline may have stalled out.

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