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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One-way mirrors, monitors and a whole lot of training — how Parent-Child Interaction Therapy works

A typical setup for a PICT training, in which a counselor monitors interaction between parent and child.

A typical setup for a PICT training, in which a counselor monitors interaction between parent and child.

By Christie Renick

Carla Francis’ training session is fast-paced.

Francis, a therapist, sits in an observation room with two monitors in front of her; one displays her clients – a grandmotherly woman and a toddler (their names have been changed to protect their identity) — in the playroom next door, and through the other she sees her virtual trainer, psychologist Dawn Blacker, who observes from her office hundreds of miles north at the University of California, Davis.

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Los Angeles bets big on Parent-Child Interaction Therapy to reduce adverse childhood experiences

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By Christie Renick

In June 2014, the Los Angeles County Board of Supervisors began implementing the recommendations made by the Blue Ribbon Commission on Child Protection, which calls for augmented child maltreatment prevention efforts.

While implementation of the commission’s many recommendations is a long-term venture, leaders are hoping that the rollout of a maltreatment prevention initiative may improve child safety in the short-term.

First 5 LA, a taxpayer-supported initiative that provides a variety of services to families with young

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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

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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.

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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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