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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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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Patrick Kennedy builds connections among diverse sectors to change healthcare

(l to r) Patrick Kennedy, Bill Emmet, Kennedy Forum executive director, and Mike Thompson

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Former U.S. Congressman Patrick Kennedy is building a “Community of Mental Health,” by making connections that are needed for mental health to be fully integrated into our understanding of overall health. To achieve this goal, the son of U.S. Senator Edward M. Kennedy has created the Kennedy Forum—so named to evoke the memory of President John F. Kennedy and employ the family name to inspire, motivate, and unite advocates and policymakers around a shared vision of what healthcare should be. The Kennedy Forum is focused on the development, implementation, and dissemination of mental health and addiction policy and standards—with the first order of business being the implementation of the new mental health and addiction parity law.

The Kennedy Forum is providing this leadership by convening people with diverse interests and perspectives in a variety of formats including one-on-one meetings, national summits, locally focused seminars and forums being held venues as diverse as Chicago and Cape Cod. The goal of the Forum is to help shape the service delivery and payment system of the future—one that encourages prevention, early intervention, and coordinated care for all who need it.

Patrick Kennedy (center) addresses gathering at the Kennedy compound in Hyannis Port, MA

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The premier meeting of the Kennedy Forum was held at the Kennedy Library in Boston in the fall of 2013 (the second such meeting will be held in June 2015). Earlier this summer, a series of small gatherings took place at the Kennedy compound in Hyannis Port, on Cape Cod in Massachusetts. A meeting is scheduled for November 13 in Chicago to address local issues. Part of that meeting will address prevention and early intervention in mental health, including the traumatic impact of community violence on the city’s children.

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Arthur Evans at Philadelphia “I Will Listen” event

The gatherings at the the family home on Cape Cod brought together leaders from a variety of fields to share experiences and expertise and learn from each other, often for the first time. Here are several examples of participants who illustrate different perspectives on improving health in the broadest sense of the word:

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Massachusetts “Safe and Supportive Schools” provisions signed into law, boosts trauma-informed school movement

Massachusetts Gov. Deval Patrick

Massachusetts Gov. Deval Patrick

Massachusetts Governor Deval Patrick today signed into law provisions to create conditions for “safe and supportive schools” intended to improve education outcomes for children statewide, and giving momentum to the state’s trauma-informed schools movement. They were included in The Reduction of Gun Violence bill (No. 4376). This groundbreaking advance was achieved when advocates seized the opportunity to add behavioral health in the schools to the options under consideration as state officials searched for ways to strengthen one of the nation’s more restrictive gun laws in the aftermath of the tragic shooting of schoolchildren in Newtown, CT.

House Speaker Robert DeLeo saw the connection between reducing gun violence and school achievement and was instrumental in the bill’s passage. When the original sponsor of a Safe and Support Schools Act, Katherine Clark, left the state legislature for the U.S. House of Representatives, some advocates were concerned the void would not be filled. Their fears were assuaged when Rep. Ruth Balser of Newton and Sen. Sal DiDomenico of Boston became lead sponsors.

The schools act supporters were jubilant that the legislation they labored on for years was incorporated in the gun violence bill now signed into law, and expressed deep relief and excitement about the achievement. They also said the hard work of statewide implementation now begins.

The law requires the state education department to develop a framework for safe and supportive schools, first developed by a task force established by the legislature in 2008, that provides a foundation to help schools create a learning environment in which all students can flourish. The framework is based on a public health approach that includes fostering the emotional wellbeing of all students, preventive services and supports, and intensive services for those with significant needs.

Within the framework, schools are encouraged, but not mandated, to develop action plans that will be incorporated into the already required School Improvement Plans. The law also provides a self-assessment tool to help in the creation of the plans.

Under the leadership of the Trauma and Learning Policy Initiative (TLPI), a coalition of the Massachusetts Advocates for Children and Harvard Law School, the “Safe and Supportive Schools Coalition” was formed to move the legislation

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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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