• Medical students’ ACE scores mirror general population, study finds

    national survey published in 2014 revealed a disturbing finding. Compared to college graduates pursuing other professions, medical students, residents and early career physicians experienced a higher degree of burnout.

    Citing that article, a group of researchers at University of California at Davis School of Medicine wondered whether medical students’ childhood adversity and resilience played a role in their burnout, said Dr. Andres Sciolla, an associate professor of psychiatry and behavioral sciences at the University of California at Davis Medical School. Sciolla is the lead author of a recent study in the journal Academic Psychiatry that investigated those questions.

    Their query was based on the landmark CDC-Kaiser Permanente Adverse Childhood Experiences Studythat showed a remarkable link between 10 types of childhood trauma — such as witnessing a mother being hit, living with a family member who is addicted to alcohol or who is mentally ill, living with a parent who is emotionally abusive, experiencing divorce — and the adult onset of chronic disease, mental illness, being violent or a victim of violence, among many other consequences. The study found that two-thirds of the more than 17,000 participants had an ACE score of at least one, and 12 percent had an ACE score of four or more. (For more information, see ACEs Science 101.)

    The ACE Study and subsequent research shows that people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic than someone with an ACE score of 0. Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1200 percent. An ACE score of 6 or higher is associated with a 20-year shorter lifespan than someone with an ACE score of 0. However, subsequent research has shown that social buffers, such as having just one caring adult in a child’s life, can mitigate the impact of ACEs.

    For the UC Davis study, 86 third-year medical students completed an ACE survey. Of those, 49% had an ACE score of 0, 40 % had ACE scores between 1-3, and 12 % had ACE scores of 4 or more.

    “Contrary to our expectations, the prevalence of ACEs in a class of third-year medical students was comparable to rates in the general population,” wrote the authors.

    Sciolla 11_cropped
    Dr. Andres Sciolla

    “You can assume that because physicians, in general, and medical students, come from more affluent backgrounds than the general population that those medical students would have a lower prevalence of ACEs than the general population and that was not the case,” explained Sciolla.

    Also significant, said Sciolla, is that all of the students who had ACE scores of 4 or more were women. “When we’re talking about interpersonal violence — physical abuse, sexual abuse, emotional abuse — women are more likely than men to be victims,” he said. “The medical workforce is becoming increasingly female. And we know that female physicians are at a high risk for suicide and burning out, we can speculate that female physicians may be at increased risk for negative health and professional outcomes, so it needs to be looked at further.”

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  • Personal stories from witnesses, U.S. representatives provided an emotional wallop to House Oversight and Reform Committee hearing on childhood trauma

    William Kellibrew's grandmother receives standing ovation

    Room erupts in applause for the grandmother of witness William Kellibrew during July 11 House Oversight and Reform Committee hearing.

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    The power of personal stories from witnesses and committee members fueled the July 11 hearing on childhood trauma in the House Oversight and Reform Committee* throughout the nearly four hours of often emotional and searing testimony and member questions and statements (Click here for 3:47 hour video). The hearing was organized into a two panels—testimony from survivors followed by statements from experts—but personal experiences relayed by witnesses (including the experts) and the members of Congress blurred the lines of traditional roles.

    Chairman Cummings
    Chairman Elijah Cummings
    Ranking Committee member Jim Jordan (R-OH)
    Ranking member Jim Jordon (OH)

    Chairman Elijah Cummings (D-IL) set the tone early in the hearing by recalling his childhood experience of being in special education from kindergarten to sixth grade, and being told he would “never be able to read or write.”  Still, he “ended up a Phi Beta Kappa and a lawyer.”

    Near the end of the hearing, Rep. Mark DeSaulnier (D-CA) spoke about the “personal and private,” multi-generational experience of addiction and abuse in his family, including the death of his father by suicide.  (Click here for video of Rep. DeSaulnier’s statement). He said he often recalls the metaphor he heard years ago about children drowning downstream before someone finally said “let’s go upstream to see why.”

    In lauding fellow committee member Rep. Sarbanes (D-MD) for his leadership on school-based health centers, Rep. Ayanna Pressley (D-MA) said, “There but for the grace of God, go I. I can say with certainty that it was a school nurse who recognized, who saw the signs of trauma and abuse in my own life, and it is so important that the school community is trained in these indicators because there are children who act out, but there are many more that shut down. I was one of those children. “ (Click here for video of Rep. Pressley’s remarks).

    William Kellibrew, the first witness, described how he finally got help from a skilled and caring therapist after he became suicidal years after his brother and mother were killed—and his life threatened— by her partner. He asked to yield the reminder of his time to have his grandmother in the room stand and be acknowledged. The room erupted in applause as it did at the end of the survivor’s panel with a rare standing ovation by the representatives and everyone else in the room. Dan Press, legal advisor to the Campaign for Trauma-Informed Policy and Practice, said he had never seen a standing ovation in a hearing in his 45 years of working with Congress.

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  • 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.

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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.

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  • I Was a Witness to Serial Silence

    I felt the foot as it thrust between my legs and rammed over and over and over again into my crotch. I was lying on my back in the dirt. Strands of my long hair pulled from their roots under the weight of my body as my torso was forced forward. My head was tethered. My neck bent back nearly to its limit.

    I felt the shoe. No one had touched me there before.

    Shoes.

    There wasn’t just one. They took turns. Chuck Taylors, Hush Puppies, Wallabies. The Waffle Stompers were the worst. They hurt.

    It all hurt. Did no one hear me screaming? Was that even possible? There was a parade of people walking by. There were people all around.

    I cried for help. My voice was my only defense as they held my arms and penetrated my dignity. Their grubby hands were on my breasts. They squeezed, and grabbed, and pinched, and wrung the newly mounded flesh.

    They tore the pink bow off the center of my first bra. A metaphoric deflowering.

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