• Talking ACEs and building resilience in prison

    WA-Penitentiary_Exterior

    They’re the forgotten, the 2.3 million people in US prisons. The overwhelming majority of them have experienced significant childhood trauma. Before you click out of here, this isn’t another boo-hoo story, as some of you might describe it, about the dismal state of our corrections system, for inmates and guards alike. (Oh, yes, it is profoundly dismal.) This is a story about how one tiny part of it isn’t so dismal, and actually addresses head-on the fact that most (91 percent) of the approximately 2.3 million prisoners will finish their sentences and go home. To your neighborhood. So….wouldn’t you want the prisons to help these guys and gals so that they, and by definition, we, come out happier and more well-adjusted than when they went in?

    Well, yea-uh.

    Ok. Just in case you glossed over it, let’s go back to that sentence about childhood trauma. It is precisely why the 2,300 inmates at Washington State Penitentiary in Walla Walla, Wash., ended up there. Over the last 20 years some profound, intense research revealed that people who have a lot of childhood adversity have seven times the risk of becoming an alcoholic, 12 times the risk of attempted suicide, twice the risk of cancer and heart attacks. They’re more violent, more likely to be victims of violence, have more broken bones, more marriages, and use prescription drugs more often than people who have no childhood adversity. And those are just the few drops in the bucket of how childhood trauma affects people’s lives.

    A big surprise in the groundbreaking CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study) — besides that most of us have at least one ACE — was how “normal” and ordinary some of the types of adversity are. Seeing your parents divorce. Living with a family member who’s an alcoholic or depressed, as well as having other mental illness. Verbal abuse, which includes being screamed at every day as well as being quietly told by your mother, “I wish you’d never been born, you freak.” Then there’s the stuff that you expect will mess with your head — physical and sexual abuse. Physical neglect. Emotional neglect — hardly being acknowledged or talked to during your entire childhood. Watching your mother being hit. And having a family member in prison. Since the ACE Study was published, dozens of other ACE surveys showed similar results. Recognizing that definitely more than 10 types of ACEs exist, other surveys have included racism, bullying, witnessing violence outside the home, serious illness or accident in the family, experiencing war, losing a family member to deportation, ending up in foster care, etc.

    All these experiences damage the function and structure of kids’ brains. Kids experiencing trauma act out. They can’t focus. They can’t sit still. Or they withdraw. Fight, flight or freeze – that’s a normal and expected response to trauma. Kids who are experiencing trauma live in survival mode. So, they have a really hard time shifting their attention from survival brain to learning brain. Their schools often

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  • Shifting the focus from trauma to compassion

    AHerz

    Dr. Arnd Herz

    Dr. Arnd Herz, a self-described champion for ACEs science, would like nothing more than to witness a greater appreciation of how widespread adverse childhood experiences are. Herz, a pediatrician and director of Medi-Cal Strategy for the Greater Southern Alameda Area for Kaiser Permanente Northern California, would also like to encourage more people in health care to engage in a trauma-informed care approach, a change in practice that he says not only benefits patients, but also health care providers and their staff.

    “It makes so much sense,” say Herz. “This is why I went into medicine. I don’t want to just click off diagnoses, but create relationships and help people by understanding them better, and trauma-informed care is just a way to bring compassion back into the care that we do.”

    For the uninitiated, a trauma-informed approach includes an awareness that adverse childhood experiences (ACEs) are common, knowing how to recognize the signs and symptoms of trauma, creating a safe environment where the focus is on “What happened to you?” rather than “What’s wrong with you?”, engaging trauma survivors as equal decision-makers in their care, and offering patients referrals to supportive services as needed, according to a report by the Substance Abuse and Mental Health Services Administration and a primer by the Center for Health Care Strategies.

    In practice, Herz describes how clinicians use a trauma-informed approach to forge closer ties with patients and at the same time discover how ACEs may lurk beneath the surface of a health condition.

    “I see so many children who really struggle with obesity at a young age,” explains Herz, who is based at Kaiser Permanente in Hayward, Calif., which is testing ACEs screening of children from 12 months through 5 years old in a three-year pilot study that began in 2016. He says that he sees many patients whose weight and height are on par for a number of years and then suddenly veer off course as a child begins gaining weight. “I’ll ask ‘What happened?’, and sometimes it’s that the grandmother has moved in and is overfeeding the child,” explains Herz. But often there’s another explanation.

    “I pointed to the growth curve and asked ‘What happened two and a half years ago?’ And the mom said, ‘Dad came back from jail and is living with us,’” reports Herz as he cites the case of one patient. And he didn’t stop there — he wanted to find out how the mom and the child experienced the father’s return. “And I looked at her and said, ‘So, it’s been stressful?’ And she said yes.”

    “And rather than talking to her about removing the sodas, and exercising more and removing the junk food,” continues Herz, “I talked to her about the stress and how can we make things feel better, because the weight gain was in response to stress.” Herz made sure they were safe and when the mother expressed interest, helped her and the child link up with a psychologist for additional support.

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