The Camden story: A physician and a priest plant seeds of repair

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Simultaneously making changes at the organizational level and building alliances across sectors for larger system change, Father Jeff Putthoff, SJ, and Dr. Jeffrey Brenner realized they had to dig deeper — beyond symptoms to root causes — to understand the struggles they were witnessing in Camden, NJ. What they found were ACEs.

Putthoff, a Jesuit priest known locally as “Father Jeff,” is a fireplug of purpose under his casual uniform of cargo shorts and sweatshirt, earbuds slung around his neck, a blue bicycle his preferred mode of transport. He is voluble and passionate on the subject of his city. Since 2000, Father Jeff has directed Hopeworks N’ Camden, an organization that offers in-school and out-of-school youth GED classes and web-site design instruction—skills intended to parlay directly into jobs or college.

Brenner is equally driven—a physician/scholar/prophet in a slightly rumpled suit, with a calendar so crammed he must set a smartphone alarm to keep his days on track. He is founder and executive director of the Camden Coalition of Healthcare Providers and the recipient of a 2013 MacArthur “genius” grant. In 2011, he was profiled in The New Yorker, which chronicled his innovative plan to shrink the cost of health care by focusing on the highest-risk patients, providing them with team-based interventions to keep them out of hospitals, and by helping them manage chronic illnesses and social/emotional needs.

But it wasn’t until the last three years that each man learned of the CDC Adverse Childhood Experiences Study, whose first study was published in 1998, and began to apply its lessons to his work. That study, of  more than 17,000 Kaiser Permanente members in California, showed that early childhood adversity—including neglect, physical and sexual abuse and parental abandonment—was both widespread and corrosive to long-term physical and mental health. Trauma, the study implied, leaves tracks in the brain and lingers in the body. Stress can literally make people sick.

Putthoff saw the symptoms of that trauma every day. Camden earned the dubious title of “most violent city in America” in 2012, when there were 67 homicides among its 77,000 residents. That year, someone in Camden was shot, on average, every 33 hours. Two out of five Camden residents live below the poverty line. The streets are pocked with nearly 4,000 abandoned homes.

“I’ve been here [in Camden] 16 years,” Putthoff said. “I’ve been chasing the symptoms all those years, trying to change people’s behavior, get them jobs, get people in school. The dawning realization was that we were not dealing with the cause.”

Hopeworks N’ Camden provides training programs in a trauma-informed environment

Putthoff could see how frustration and hopelessness were wearing on the Hopeworks staff—10 full-time and four part-time employees who work to boost students’ reading skills and teach them web site design and GIS (geographic information systems, or

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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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The Philadelphia story: Education and activism converge in “ACEs epicenter”

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The women and men gathered for a training on trauma and resilience were recovery counselors and social workers, charter-school teachers and prison administrators. But to Stephen Paesani, the child and adolescent training specialist who was leading the session, every person in the room was a potential protective factor in a child’s life.

“When a child experiences adversity or trauma, he goes into the fight-or-flight stance,” Paesani explained. “That’s going to impact brain development. “But no matter what happens, all of you can be the agents for resilience.”

Paesani works for Philadelphia’s Behavioral Health Training and Education Network (BHTEN), which provides training to practitioners and community members, part of the city’s effort to infuse mental health and substance abuse services with principles of recovery, resilience and self-determination.

But BHTEN’s trainings are just one piece of the Philadelphia ACEs story. In this city of 1.5 million—a city rife with disparities of class, education and health, with pockets of multi-generational poverty and trickle-down trauma—the last decade has seen a steady effort to bring understanding of adversity, trauma and resilience to thousands of front-line workers, supervisors and administrators across the map of human services.

This work is not the result of a top-down initiative or a single funder’s vision for change. It is, instead, the gradual flowering of multiple seeds, planted by activist leaders in pediatrics, public health, behavioral health, child welfare, justice and education.

Today, Philadelphia is home to the ACE Task Force, a group of 50 practitioners intent on putting the knowledge of brain development, adversity and resilience to work in pediatric and primary care clinics, child abuse prevention networks and early childhood programs. The social network site ACEsConnection.com recently launched a Philadelphia group whose members share questions, successes and challenges.

And thanks to the Institute for Safe Families, with support from the Robert Wood Johnson Foundation, Philadelphia was the site of the first National Summit on ACEs in May 2013, attended by 160 physicians, academics, social workers and human service administrators. There, speakers called the ACEs movement “a revolution” in thinking about health and illness, human suffering and strength.

In Philadelphia, that revolution began even before the groundbreaking Centers for Disease Control Adverse Childhood Experiences Study (ACE Study) demonstrated the lifelong impact of early adversity.

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Trauma-informed judges take gentler approach, administer problem-solving justice to stop cycle of ACEs

Judge Lynn Tepper hugs Taylor, 11, at his final adoption hearing. Before finding his permanent home, he'd been returned by three families since being removed from his biological mother when he was three years old.

Judge Lynn Tepper hugs Taylor, 11, at his final adoption hearing. Before finding his permanent home, he’d been returned by three families. [Photo: Edmund D. Fountain, Tampa Bay Times]

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Three years ago, Judge Lynn Tepper of Florida’s Sixth Judicial Circuit Court in Dade City, FL, learned about the CDC-Kaiser Adverse Childhood Experiences (ACE) Study The ground-breaking research links childhood abuse and neglect with adult onset of chronic disease, mental illness, violence and being a victim of violence.

It was like flipping a switch.

“I suddenly had this trauma-informed lens, as we call it. I see it everywhere,” she says, giving an example of someone in front of her on child abuse charges for whom she might recommend counseling and/or anger management. “I have discovered the reality is that when I start asking a few questions, that parent or partner has experienced ACEs,” she says.

The 10 types of childhood trauma measured in the ACE Study are: physical, verbal and sexual abuse, and physical and emotional neglect; a family member who abused alcohol or other drugs, who was depressed or mentally ill, or was in prison; witnessing a mother being abused, and loss of a parent through separation or divorce.

Tepper, a veteran of 37 years on the bench, realized that childhood trauma experienced by the people who ended up in her courtroom was much worse than their paperwork showed. “When you dig down deeper, you wonder how these people get up in the morning,” she says. “I remember thinking at one point, ‘Oh boy, did we blow it all these years on these delinquents.’ ”

Most judges in the United States are unfamiliar with the ACE Study and the research on the neurobiology of toxic stress that has emerged over the last 15 years. But that’s beginning to change in courtrooms across the U.S., due to a number of educational programs aimed at producing trauma-informed judges—and courts. As a result, trauma-informed judges have made three big changes:

  • They’ve modified their courts to be safer and less threatening to defendants with histories of childhood trauma and who are often already traumatized.
  • They recognize that trauma is passed from one generation to another, and take a two- or three-generational approach in child abuse and neglect cases.
  • Because, they say, the traditional approach in criminal justice continues the traumatization of children, youth and families, they’re taking a solution-oriented approach.

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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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CA Senate unanimously approves ACEs reduction resolution

California Dome & Senate SealOn August 18, the California Senate unanimously approved Concurrent Resolution (ACR) No. 155 to encourage statewide policies to reduce children’s exposure to adverse childhood experiences. As reported on ACEs Too High, the resolution is modeled after a Wisconsin resolution that encourages state policy decision-making to consider the impact of early childhood adversity on the long-term health and well being of its citizens. Since the resolution does not require California Gov. Jerry Brown’s signature, the Senate’s approval is the final step in the process.

The resolution echoes the language of a Wisconsin bill passed earlier this year—the state’s policies should “consider the principles of brain development, the intimate connection between mental and physical health, the concepts of toxic stress, adverse childhood experiences, buffering relationships, and the roles of early intervention and investment in children…”

New programs or mandates are not included in the resolutions, but both provide an important framework for state level decision-making that is informed by the findings of the CDC’s Adverse Childhood Experiences (ACE) Study. The two state resolutions are natural extensions of already robust ACEs-related and trauma-informed programs and policies in those states.

The principal sponsor of the California resolution was Assembly Member Raul Bocanegra (D-Pacoima) who spoke on behalf of the resolution on the Assembly floor and was joined by Rob Bonta (D-Oakland) and Reginald B. Jones-Sawyer, Sr. (D-Los Angeles). Bonta said that “sadly and tragically” almost every youth in the City of Oakland has been touched by violence and that life expectancy is negatively impacted by conditions in vulnerable communities. Jones-Sawyer said that conditions that result in urban PTSD are “unnoticed and unaddressed.”  To see these short speeches, click here http://calchannel.granicus.com…d=7&clip_id=2332 and scroll down to ACR 155. The video also shows the adding of 68 members as coauthors.

During the weeks after the Assembly passage and before the Senate action, advocates led by the Center for Youth Wellness built support for the resolution.  Senator Holly Mitchell (D-Los Angeles), chair of the California Legislative Black Caucus, was the floor

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