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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How childhood trauma could be mistaken for ADHD

 

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[Photo credit: woodleywonderworks, Flickr]

Dr. Nicole Brown’s quest to understand her misbehaving pediatric patients began with a hunch.

Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD).

These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus.

When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive.

“Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control,” she said of treating her patients according to guidelines for ADHD. “I began hypothesizing that perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience.”

Considered a heritable brain disorder, one in nine U.S. children—or 6.4 million youth—currently have a diagnosis of ADHD. In recent years, parents and experts have questioned whether the growing prevalence of ADHD has to do with hasty medical evaluations, a flood of advertising for ADHD drugs, and increased pressure on teachers to cultivate high-performing students. Now Brown and other researchers are drawing attention to a compelling possibility: Inattentive, hyperactive, and impulsive behavior may in fact mirror the effects of adversity, and many pediatricians, psychiatrists, and psychologists don’t know how—or don’t have the time—to tell the difference.

Though ADHD has been aggressively studied, few researchers have explored the overlap between its symptoms and the effects of chronic stress or experiencing trauma like maltreatment, abuse and violence. To test her hypothesis beyond Baltimore, Brown analyzed the results of a national survey about the health and well-being of more than 65,000 children.

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California Assembly Health Committee OKs ACEs resolution 16-0

ImageThe California Assembly Health Committee today approved, by a vote of 16-0, a resolution to encourage statewide policies to reduce children’s exposure to adverse childhood experiences. California took a page from Wisconsin’s playbook with the introduction of legislation (California Assembly Concurrent Resolution (ACR) No. 155) on May 28. It drew upon ideas from Wisconsin’s legislation (Senate Joint Resolution 59), approved by the legislature this early this year. Both the Wisconsin resolution and the California proposal encourage state policy decision-making to consider the impact of early childhood adversity on the long-term health and well being of its citizens.

Before the vote was taken on June 17, the lead sponsor of the California bill, Assemblymember Raul

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Vermont first state to propose bill to screen for ACEs in health care

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Dr. George Till, Vermont state legislator and physician

When Vermont State Legislator and physician Dr. George Till heard Dr. Vincent Felitti present the findings of the CDC’s Adverse Childhood Experiences Study at a conference in Vermont last October, he had an epiphany that resulted in a seismic shift in how he saw the world. The result: H. 762, The Adverse Childhood Experience Questionnaire, the first bill in any state in the nation that calls for integrating screening for adverse childhood experiences in health services, and for integrating the science of adverse childhood experiences into medical and health school curricula and continuing education.

That Vermont would be the first in the nation to address adverse childhood experiences so specifically in health care at a legislative level isn’t unusual. More than most states, Vermont is a “laboratory of change” for health care. It has embraced universal health care coverage for all Vermonters, and it passed the nation’s first comprehensive mental health and substance abuse parity law. (Washington State passed a law in 2011 to identify and promote innovate strategies, and develop a public-private partnership to support effective strategies, but it was not funded as anticipated. The Washington State ACEs Public-Private Initiative is currently evaluating five communities’ ACE activities.)

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Arresting our way out of drug crisis is yesterday’s theory, says VT Gov. Shumlin; urges public health approach

AshumlinState of the state addresses—like the State of the Union—tend to cover a wide range of topics from the economy to health care to education.  Vermont Governor Peter Shumlin broke the mold when he devoted his entire 2014 State of the State address to the state’s drug addiction crisis.  The rising tide of drug addiction and drug-related crime spreading across Vermont is “more complicated, controversial, and difficult to talk about” than any other crisis the state confronts, he said.

“We have lost the war on drugs,” he said. ” The notion that we can arrest our way out of this problem is yesterday’s theory.”  Even though Vermont is the second smallest state in the union (pop. 626,600), more than $2 million of heroin and other opiates are being trafficked into the state every week. Shumlin expressed alarm over the increase in the deaths from heroin overdose that doubled in 2013 from the year before and the 770 percent increase in treatment for opiates.

Shumlin told emotional stories of young Vermonters becoming addicted to prescription opiates and heroin — one recovered, one died from an overdose. While stories of young and promising individuals dying from heroin overdoses may grab headlines, data from the Centers for Disease Control and Prevention (CDC) show that deaths from prescription opioid pain relievers — such as codeine, methadone, and oxycodone — between 1999-2008 now exceed deaths involving heroin and cocaine combined.

CDC reports that in 2008, 36,450 deaths were attributed to drug overdoses in the U.S.  Opioid pain relievers were involved in 14,800 deaths (73.8%) of the 20,044 prescription overdose deaths.  The drug overdose death rate of 11.9 per 100,000 (Vermont’s rate was 10.9 per 100,000) was roughly three times the rate in 1991. Prescription drugs accounted for most the increase.  An April 12, 2012 statement from the Office of National Drug Control Policy reported that death from unintentional drug overdoses is greater than car accidents, the leading cause of injury in the U.S.

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Violence Against Women Act flounders, sinks in 112th Congress…

VAWA…and Sen. Patty Murray intends to reintroduce it. Here’s a great analysis of what happened to the legislation — passed in 1994, with the leadership of then-Sen. Joe Biden — and reauthorized without problems until Oct. 2011, “after conservative lawmakers balked at the addition of expanded protections for undocumented immigrant, Native American, and LGBT victims of sexual assault.” As author Tara Culp-Ressler, an editorial assistant at ThinkProgress, noted on Atlantic.com:

As the legislation hung in the balance this past year, Rep. Gwen Moore went to the House floor to recount the story of her own sexual assault to explain why this country needs VAWA. Moore said that as she watched Republican men begin to stall the reauthorization of the bill, “it brought up some terrible memories for me” of both the

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Pediatrics academy tells baby docs: your new job is to reduce toxic stress

According to research over the last 15 years, there’s no doubt now that child trauma causes toxic stress on the brains of babies and children, which causes short-term harm and long-term health consequences. So, it’s not a big surprise that the American Academy of Pediatrics issued a policy statement about the issue. What’s significant is the advice to pediatricians: Radically change how you do your job and take new approaches to protect those fragile developing brains.

The report advised pediatricians to:

  • Integrate a psychosocial approach into doing medicine. “Psychosocial problems and the new morbidities should no longer be viewed as categorically different from the causes and consequences of other biologically based health impairments.”
  • Incorporate into medical school and continuing education classes the knowledge of how childhood toxic stress affects “disruptions of the developing nervous, cardiovascular, immune, and metabolic systems, and the evidence that these disruptions can lead to lifelong impairments in learning, behavior, and both physical and mental health.” A technical report, in press, will provide more details about this.
  • Take an active leadership role in educating everyone — public, policy makers, educators, etc. — about the long-term consequences of childhood toxic stress.
  • Advocate for “new, evidence-based interventions (regardless of the provider or venue) that reduce sources of toxic stress and/or mitigate their adverse effects on young children.”