State data fuels the ACEs conversation in Iowa

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Most Iowans didn’t learn about the Centers for Disease Control’s ACE Study until early 2011. But in the three years since then, the state has completed two ACE surveys, one of them published, with a third survey underway and a fourth scheduled for 2015. Iowa has hosted three ACEs summits; two statewide summits in 2014 focus on ACEs in early childhood, and education and juvenile justice. And nearly every sector—including health care, education, social services and corrections—is busy answering the question: How do we integrate this knowledge into what we do?

“To this day, I can’t find out who knew to bring him here,” says Suzanne Mineck, president of the Mid Iowa Health Foundation, referring to physician Robert Anda, co-principal investigator of the CDC’s Adverse Childhood Experiences Study. Anda was invited to give the keynote at the state’s annual Early Childhood Iowa Congress in 2011.

“The ballroom was packed—maybe 300 people,” Mineck recalls. “After his presentation, a group of us walked out and looked at each other. We decided that what we’d heard was really important, and we needed to do something with it.”

Over the next few months, the ACE Study kept coming up in “water-cooler” conversations among people in Iowa’s health and child welfare communities. So the health foundation decided to bring two questions to a small group of state and community leaders: “Is this relevant to the work in our state? If the answer is ‘yes,’ what are we going to do about it?”

Fielding those questions were Sonni Vierling, state coordinator for the 1st Five Healthy Mental Development, a project of the Iowa Department of Public Health, and representatives from the Polk County Health Department, Orchard Place Child Guidance Center, United Way of Central Iowa, and Prevent Child Abuse Iowa.

“Data is what led the conversation from the beginning,” says Mineck. The CDC’s data plugged real science into what many on the front lines of health and social services already knew, but the numbers also begged the question: Does Iowa have the same incidence of childhood adversity?

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Iowa’s Department of Public Health was willing to include the ACE survey in the Behavioral Risk Factor Surveillance System (BRFSS) that all states use to measure rates of obesity, smoking, cancer, teen pregnancy and other health issues. But it would cost $24,000 to do the survey.

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Children’s Resilience Initiative in Walla Walla, WA, draws spotlight to trauma-sensitive school

RRocksbannerIn Walla Walla, Washington, the journey to implement ACEs research has been akin to a wild ride on a transformer roller coaster that arbitrarily changes its careening turns, mountainous ascents, and hair-raising plunges. And sometimes the ride just screeches to a frustrating halt.

The odyssey began in October 2007, when Teri Barila, Walla Walla County Community Network coordinator, heard Dr. Robert Anda, co-investigator of the CDC’s Adverse Childhood Experiences Study (ACE Study), speak at a Washington State Family Policy Council (FPC) event.

Without a doubt, he said, childhood trauma is the nation’s No. 1 public health problem. The ACE Study – the largest public health study you never heard of — shows that childhood trauma is very, very common. (ACE surveys in 22 states now echo the results.) And this childhood adversity causes violence, including family violence, as well as the adult onset of chronic disease and mental illness.

The Family Policy Council was the umbrella organization for 42 community networks across the state that were addressing local issues such as youth substance abuse, school drop-out rates and teen pregnancy. Anda implored the coordinators to “get something started” in their own communities because he was getting little traction on a national level.

Barila returned to Walla Walla fired up. The city, with a population of 32,000, has three colleges, a robust agricultural community, including a newly flourishing wine industry, and a revitalized downtown. But one out of four of its children live in poverty, 65% of its residents have not attended college, and gangs and drugs are common. Barila was determined to educate the community about the dire and costly consequences of ACEs and the “clear impact of stress on the developing brain of a child.” She organized a community meeting in early 2008 and brought Anda in for a two-and-a-half-hour seminar; 165 people showed up.

At the end of Anda’s presentation, a parent named Annett Ridenour walked to the front of the room, and, with tears streaming down her face, took the microphone out of Anda’s hand. “I have 10 ACEs,” she said, “and now I understand my life.”

“This made me believe in the liberating effects of ACEs,” writes Barila in the “Getting Started” chapter of the the Resilience Trumps ACEs Manual. It was also the unofficial start of the Children’s Resilience Initiative.

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How the NFL can stop abuse AND keep its players on the field

A young fan wears an Adrian Peterson jersey.  [Photo: Ann Heisenfelt/AP]

A young fan wears an Adrian Peterson jersey. [Photo: Ann Heisenfelt/AP]

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Many people are happy that the Vikings kicked Adrian Peterson off the team and that Ray Rice can no longer play for the Ravens. Their off-field violence has cascaded into harm and loss for everyone involved – spouses, children, team, league and fans — all because of the consequences of their childhood trauma. And the only way the NFL can stop further abuse, harm and loss is…well…to deal with its players’ childhood trauma.

The severe and toxic stresses in Peterson’s past – or what we in the trauma-informed community count on a scale from one to 10 as adverse childhood experiences or ACEs – aren’t minor. As a child, he lost his father to prison, suffered through his parents’ divorce, saw his brother killed by a drunk driver, and was beaten by his stepfather. Repeating the pattern, he whipped his own four-year-old son with a switch so harshly that he raised welts on the child’s body. And if Peterson is convicted and goes to prison, his son can add another ACE to his trauma-filled life.

Peterson and Rice are two of millions of child and spouse abusers who love their families and can learn from their mistakes, if provided with help early enough. The average child abuser or spouse abuser isn’t dirty, disheveled, reeking of alcohol or stoned on meth. Child and spouse abusers are corporate CEOs, ministers, priests, actors, business owners, teachers, truck drivers, physicians, nurses, basketball heroes, journalists, computer programmers, and your next-door neighbors.

They’re dads and moms who have a hard time controlling their emotions when they’re under stress because they themselves were abused. Nobody helped them when they were kids and nobody’s helping them as adults.

Plain and simple, childhood trauma is the nation’s No. 1 public health problem. The CDC’s Adverse Childhood Experiences Study (ACE Study) – the largest public health study you never heard of — shows that childhood trauma is very, very common. (ACE surveys in 22 states echo the results.) And this childhood adversity causes violence, including family violence, as well as the adult onset of chronic disease and mental illness.

By learning about the science of childhood adversity, and following the lead of many other organizations that are becoming trauma-informed, the NFL could have players whose families are happier and healthier, it could have better players (more focused, less stressed), and it might never have to deal with a Ray Rice or Adrian Peterson situation again.

The NFL has 1,696 players. Of those 1,696 players, probably two-thirds – 1,119 young men – have experienced one type of serious childhood trauma. And it’s likely that 22 percent – about 370 players –

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Tarpon Springs, FL, first trauma-informed city, embraces messy path toward peace

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Tarpon Springs, Florida, once known as the nation’s sponge-fishing capital, today boasts a new designation: the first city in the country to declare itself a trauma-informed community.

It isn’t that the 24,000 residents of the scenic Gulf Coast town know more than the rest of us about emergency room techniques, spend their time crunching spreadsheets of violence data or watch more episodes of “America’s Most Wanted.”

Being a trauma-informed community means that Tarpon Spring has made a commitment to engage people from all sectors—education, juvenile justice, faith, housing, health care and business—in common goals. The first is to understand how personal adversity affects the community’s well being. The second is to institute resilience-building practices so that people, organizations and systems no longer traumatize already traumatized people and instead contribute to building a healthy community.

Beginnings: a goal to stop violence

The journey officially began in February 2011, when the Tarpon Springs City Council signed a memorandum of understanding to marshal the community to address and prevent childhood and adult trauma.

The results have been profound. Trauma-informed practices have been implemented in small and large ways in a variety of organizations, including an elementary school, an ex-offender re-entry program and the local housing authority. The Pinellas County Department of Health recently decided to incorporate in its Community Health Improvement Plan a goal of providing trauma-informed information in all of its county health facilities.

“Once you bring the community into it, you just don’t know how it’s going to grow,” says local artist Robin Saenger.

But the unofficial journey began in the middle of 2010. Saenger, who was Tarpon Springs’ commissioner and vice-mayor from 2005 to 2011, wanted to figure out a way to reduce the increasing levels of violence in her community. She talked with a friend, Andrea Blanch, a senior consultant at the National Center for Trauma-Informed Care, about her goal.

“She listened,” says Saenger, “and then said: ‘You’re talking about a trauma-informed community.’” Blanch explained how many of the issues facing Tarpon Springs—homelessness, domestic violence and substance abuse—stemmed from childhood adversity. And the Peace4Tarpon Trauma-Informed Community Initiative was born.

“My belief is that trauma is universal,” says Saenger. “Everyone’s experienced trauma in one form or another, and usually does on a regular basis throughout the course of a lifetime,” whether that stems from being in a car accident, witnessing domestic violence or having a loved one with substance abuse problems. And everyone is affected

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Mindfulness protects adults from physical, mental health consequences of childhood abuse, neglect

Aeye2Fact #1: People who were abused and neglected when they were kids have poorer physical and mental health. The more types of ACEs (adverse childhood experiences) – physical abuse, an alcoholic father, an abused mother, etc. – the higher the risk of heart disease, depression, diabetes, obesity, being violent or experiencing violence. Got an ACE score of 4 or more? Your risk of heart disease increases 200%. Your risk of suicide increases 1200%.

Fact #2: Mindfulness practices improve people’s physical and mental health.

Now, says Dr. Robert Whitaker, a pediatrician and professor of pediatrics and public health at Temple University, there’s one more important fact: People who are mindful are physically and mentally healthier, no matter what their ACE scores are.

This study, to be published in the October issue of Preventive Medicine, is the first to look at the relationship between ACEs, mindfulness and health. And it has implications for anyone, and especially those who take care of children– teachers, parents, coaches, healthcare and childcare workers.

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Dr. Robert Whitaker

Many people think of mindfulness as sitting around and saying “Ommmm.” There’s actually more to it, and it’s worth explaining. People who aren’t mindful don’t regulate their own emotions very well. Situations that trigger traumatic memories may cause people who aren’t mindful to lose focus on what’s happening currently, and lead them to make snap judgments and have knee-jerk reactions of anger, frustration, or fear, which can further the spread stress and trauma. They also ruminate on situations they can’t control, and can’t let go. And they may not even be conscious that they’re doing any of this. They just think it’s part of their personality.

Here’s what it’s like not to be mindful:

  • “My co-worker’s angry today. I must have done something wrong. She’s JUST like my mother: moody, angry, a screamer. Well, I’d better get my defenses up and give her a piece of my mind before she attacks me.”

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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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