When students show up for an appointment at the Elsie Allen Health Center, which is located on the Elsie Allen High School campus in Santa Rosa, CA, one of the first things they do is answer questions about the trauma they’ve experienced during their lives.
That’s because research has shown a direct link between adverse childhood experiences — ACEs – and the adult onset of chronic disease, mental illness, violence and being a victim of violence. The CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study) — which has been replicated by 29 states — also show that ACEs create mental and physical health risks that continue to crop up over a person’s lifetime if not adequately addressed.
These can include developmental delays early in life, mental health and academic achievement issues in childhood, involvement in the juvenile justice system, and alcohol and drug abuse as a youth and adult.
The original ACE Study measured 10 types of childhood trauma, those that occurred before the age of 18. They are physical, verbal and sexual abuse; physical and emotional neglect; a household member with mental illness, or who has been incarcerated or is abusing alcohol or other drugs; witnessing a mother being abused; losing a parent to divorce or separation. (Got Your ACE Score?)
The researchers found that the higher a person’s ACE score, the greater the risk of health and social issues. For example, compared with someone who has an ACE score of zero, a person with four ACEs is 12 times more likely to attempt suicide, seven times more likely to become an alcoholic, and twice as likely to have heart disease, according to the data.
At Elsie Allen Health Center, the students answer 16 questions instead of the original ACE Study 10-question survey.
That’s because the questionnaire was designed by the clinic staff to address the kinds of experiences – such as homelessness and pregnancy – that are common in their students.
Seventy percent of the students at Elsie Allen High School are Latino, and most of their parents work in low-income jobs. Most of the school’s 1,100 students are covered by insurance and Medical, and there is a sliding scale for older teens. The clinic is part of Santa Rosa Community Health Centers.
Erin Moilanen, a family nurse practitioner, is one of the core staff, which also includes two therapists, a pediatrician, and a physician assistant. They began taking students’ ACEs histories a year and a half ago when Kaiser Permanente Northern California Region awarded the clinic a $50,000 grant to do trauma-informed care.
“We started with a six-question questionnaire called the Childhood Traumatic Events Scale, but we realized it didn’t cover a lot of traumatic experiences, and it didn’t ask specific questions. The kids are very concrete, and some didn’t even understand what trauma meant,” says Moilanen.
The result was that in the second year of the program – which was funded again with $50,000 from Kaiser – the staff modified the questionnaire to include 16 questions relevant to the experiences of the students they had seen the first year. (Here are the ACESquestions they ask.)
Moilanen says that 20 students come into the clinic each day, but typically only between one and three of the students are new. They are asked their ACEs history on their first appointment, and then yearly. A therapist explains the ACEs form to them and why it is important: “Difficult things that happen to us can affect our choices and our health in the future.”
The kids get it, she says. Responses include “a lot of head nodding in agreement, looks of dawning understanding, and some ‘yeahs.’”
Moilanen says this is how she explains ACEs to the teens: “So I say something like, ‘We, the medical community, now know that when difficult things happen to us when we’re young, it can actually affect our health in the future, so we’re trying to ask kids when they’re younger to try to prevent some of the bad things from happening and help them have healthier lives.”
She adds, “I feel that the kids answer honestly. We all like to talk about ourselves, and a lot of these kids don’t have people who are listening to them.” Asking kids about their ACEs has had a greater impact on her work than any other information they ask the students for, such as asking about STDs or dental health, she says, because it helps develop better relationships with the students.
Because of construction issues that kept the clinic closed for a few months last year, only 200 students were asked about their ACEs history. This year, Moilanen says, they’ve had far more new patients since they were open during the summer. They have neither the time nor the money to analyze the data, which they have turned over to Kaiser.
As a result of asking students about their childhood adversity, however, the entire staff is “a bit more understanding about some of the behaviors of the kids. And I think we encourage counseling a lot more than we ever did before,” says Moilanen. The staff has also done their own ACE scores and talked about handling vicarious trauma. Information for staff counseling is posted throughout the clinic as a result.
“There’s a different level of honesty and connection with the kids,” adds Moilanen, who trained, along with the other grantee staff, at Kaiser workshops on trauma-informed care. “It feels like it’s going to make a bigger impact. Thinking back to my own experiences as a teen, it’s far more important to talk about these experiences earlier and prevent negative results from happening in the future.”
The clinic is just starting to get the school itself involved by getting permission to speak to the teachers about ACEs. Additionally, the clinic is turning a large room into a lounge area for the 100 or so students who visit the clinic each day so they’ll have a place to talk, get a free condom, or piece of fruit, and to share their experiences.
I recently viewed Lady Gaga’s new video, “Till It Happens to You”. I have stifled my rage for a number of years now, because it wasn’t my trauma and the healing process is about meeting someone where they are. But, I am a mother. It is my trauma. It is my rage. It is my guilt.
According to the White House’s web site, 1 is 2 Many: “Over 11% of high school girls report having been physically forced to have sexual intercourse.” Much focus has been on college students, and rightfully so. However, the epidemic of sexual assault is not confined to college campuses. The epidemic is in middle school, high school, college, and beyond.
In 2012, while living in Miami, FL, my oldest daughter — 15 years old at the time (her last name is different than mine, which I will not share) — went to spend the night at a friend’s house. I did not know she had other plans. She was invited to a party, which she attended instead. At the party she was given alcohol spiked with drugs. Apparently it was a gang initiation, and her blonde hair and blue eyes had made her a target. She was gang-raped and tattooed. Those words haunt me. I choke on them. I’ve been a practicing pacifist for a long time, but this rage made me question my core.
I didn’t learn about what had happened until I received a phone call from her high school counselor two weeks after the attack. A student who had witnessed it had come forward and was worried about my daughter harming herself. The school police officer told me there was nothing he could do, because it occurred off campus. Some of the boys apparently were in her school, but I was told I was not allowed to know who they were. No accommodations were offered my daughter. I was told by the school counselor my daughter was seen flirting with one of the boys before it happened, so she thought it was possible the first attack wasn’t an attack. Apparently, the friend who had come forward had cell phone video of the attack, which the counselor and school officer watched. I was told I wasn’t allowed to talk to the friend or see the video.
A diverse group of school staff, mental health professionals, justice advocates, and city employees recently crowded the Moot Court Room at the University of the District of Columbia David E. Clark Law School to begin dismantling the school to prison pipeline.
The event included justice-involved youth and recently incarcerated people who described their struggles to overcome adversity; they spoke from the heart in unsparing detail. The audience and the other presenters—including David Grosso, at-large DC City Council member and the chair of the Education Committee—were riveted by the stories and the poetry, and lingered in animated conversation long after the program ended. The Trauma-Informed DC Initiative and ACEs Connection Network organized the event, which took place last month.
Grosso described how the city council took a first, small step by passing a ban on pre-K suspensions and expulsions of three- and four-year olds, overcoming pushback from those who believed a ban, even for children this young, would undermine discipline and learning. The legislation also requires every local education agency to submit information—organized by campus, grade, sex, and race—to the Office of State Superintendent of Education on suspensions and expulsions. The first report is due in October.
By Amanda Kay, JD, and Ryan L. Gonda, JD
Children and adult victims of violence and abuse are routinely called upon by police, attorneys, advocates, and judges to be witnesses and to tell their stories. But many victims lie or recant their testimonies.
Often victims’ stories change over time; they might recant their original testimony. And when a victim who initially described abuse later withdraws the allegations, minimizes them, or expresses confusion about what happened, police, attorney and judges often conclude that the victim lied.
Truth, however, is very rarely the issue. In child abuse cases, it been reported that nearly 75% of sexual abuse victims initially deny abuse and that nearly 25% eventually recant their allegations. Many reasons have been identified for the relatively high percentage of adult victims who fail to press charges, refuse to cooperate with prosecution, or do not pursue protection orders.
Distrust of the system
Adult victims may choose to forgo the courts because they think the justice system is ineffective, which is supported by confusing procedures, lack of information provided to the victims about their cases, lack of support in meeting the demands of the system (e.g., transportation, time off work, and child care), frustration at the slow progress of the proceedings, concern about losing custody of any children, and fear that the abuser still has access to the victim while
Minnesota has the potential to become a trauma-informed state if the hard work is done to raise awareness of ACEs and the impact of toxic stress on brain development, says third-term state representative Rena Moran (D-St. Paul). Moran led the effort to have a resolution—similar to ones passed in Wisconsin and California—read in the legislature in March to educate lawmakers and the public about ACEs and related research. Democrats and Republicans took turns reading the resolution.
According to Moran, there was insufficient bi-partisan support to hold a hearing and take a specific vote on legislation. Several of the legislators who opposed a full hearing on the issue of childhood trauma revealed privately to Moran their own experiences of childhood abuse.
After the “whereas” section of the resolution addressing the impact of toxic stress on brains and the prevalence of ACEs among state residents, the final statement reads that the House of Representatives of the State of Minnesota resolves “that the principles of brain development, the connection between mental and physical health, the concepts of toxic stress, adverse childhood experiences, buffering relationships, in the roles of early intervention and investment in children are important strategies for the well-being of all Minnesota children.”
Moran believes that punitive policies that negatively impact children, especially those in communities of color, must be eliminated. The policies that are ripe for change are those that relate to school discipline and result in inappropriate placements in special education and feed the school-to-prison pipeline.
Vic Compher, director and co-producer of “Portraits of Professional Caregivers: Their Passion. Their Pain,” didn’t start out as a filmmaker. This documentary — his fourth — was inspired by his 20 years working in child protective services, and another 10 years working in hospice and clinical social work with older adults.
During that decade, he learned that many professional caregivers who work with traumatized people experience secondary trauma — also known as compassion fatigue or vicarious trauma. This includes firefighters, emergency medical crews, ER nurses, doctors, police, and others.
The first part of the documentary — which was co-produced by Rodney Whittenberg, who teaches filmmaking, and who also composed the music for this film — focuses on secondary trauma, or what caregivers experience when they respond to and care for people experiencing trauma.
“Secondary trauma, or compassion fatigue, is one more layer of the trauma experience,” says Compher, “a parallel process for many professional caregivers with symptoms that at times can somewhat resemble what their clients may be experiencing.