• Dozens of Kaiser Permanente pediatricians in Northern California screening three-year-olds for ACEs

    kidsSince August 2016, more than 300 three-year-olds who visit Kaiser Permanente’s pediatric clinics in Hayward and San Leandro have been screened for adverse childhood experiences (ACEs), such as living with a family member who is an alcoholic or losing a parent to separation or divorce. But when the idea to screen toddlers and their families for ACEs was first broached at the Kaiser Permanente Hayward Medical Center, the staff were, in a word, “angsty,” says Dr. Paul Espinas, who led the effort.

    The staff was worried that if they screened for ACEs, their interactions with patients would be negative. However, an off-site weekend training for pediatricians in October 2015 changed all that.


    Dr. Paul Espinas

    One of the most significant takeaways from the training – which included an Alameda County public health expert and area experts in domestic violence, toxic stress, resilience and community health from the Kaiser system — was learning about the important connections between high ACEs scores and health outcomes, Espinas explained.

    “ACEs are the new cholesterol,” he said. “If you don’t screen for it, and you don’t look for it, you’ll never find it, but it has more health impacts than you imagine.”

    ACEs comes from the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking research that looked at how 10 types of childhood trauma affect long-term health. They include: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused.

    Subsequent ACE surveys include racism, witnessing violence outside the home, bullying, spanking, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, witnessing a father or other caregiver or extended family member being abused, involvement with the criminal justice system, attending a school that enforces a zero-tolerance discipline policy, etc.

    Thirty-eight percent of children in every state have at least one ACE, according to an analysis of the 2016 National Children’s Health Survey by the Child & Adolescent Health Measurement Initiative (CAHMI) at the Johns Hopkins Bloomberg School of Public Health.

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  • Giving “Zorgos Awards” to prevent bullying and ACEs


    Zorgos_Cowan©Richard Luibrand

    Local leaders were honored for using the power of “Zorgos.” Photo credit: Richard Luibrand

    is an imaginary superpower that prevents bullying, coined by my co-author, Dr. Louise Hart, and myself for our book, The Bullying Antidote. Zorgos is the collection of learnable skills and/or qualities that calm, interrupt, or upshift bullying dynamics.

    So much of today’s negative dynamics comes from people complaining about what’s wrong on social networks, news comments, etc. Trolls have a very degrading effect on society, and add to bullying dynamics by normalizing critical speech. We feel it is important for regular citizens to be upstanders, and highlight those who are modeling good practices.

    For a few years after we started our blog, The Zorgos Reader, we just posted cute and heartwarming examples of Zorgos power. Then our mayor proclaimed October 15th “Zorgos Day,” in recognition of our city-wide read of the book to educate the community about ACEs and teach positive parenting skills.

    On that day, we hosted the Zorgos Awards in Oakland and brought together a diverse group of local activists, artists, politicians, and professionals to highlight their work and celebrate the qualities and tools that prevent bullying. We started the evening reflecting on a child we love, and thinking about how they used their strengths. We wrote those strengths down, and we put them in a suitcase labeled Zorgos! 

    We gave awards to:

    • LaQuisha Cowan, a parent who has struggled through the stresses of inner-city parenting, and who has helped hundreds of other parents create conversations around cultural parenting dynamics through Parent Cafés;
    • Rebecka Langum, a 4th grade teacher who creates calm and uplifting dynamics among children and adults;

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  • Patient’s murder leads to soul searching, shift to ACEs science in UCSF medical clinic

    Patient’s murder leads to soul searching, shift to ACEs science in UCSF medical clinic

    It was the murder of a beloved patient that led to a seismic shift in the Women’s HIV Program at the University of California, San Francisco: a move toward a model of trauma-informed care. “She was such a soft and gentle person,” said Dr. Edward Machtinger, the medical director of the program, who recalled how utterly devastated he and the entire staff were by her untimely death.

    “This murder woke us up,” he said. ”It just made us take a deeper look at what was actually happening in the lives of our patients.” The Women’s HIVprogram, explained Machtinger, was well regarded as a model of care for treating HIV patients – reducing the viral load of HIV in the majority of its patients to undetectable levels.

    But the staff was clearly missing something. A closer look at the lives of their patients revealed that 40 percent were using hard drugs – including heroin, methamphetamine and crack cocaine, according to Machtinger. Half of them suffered clinical depression, the majority had isolated themselves due to deep shame associated with having HIV, and many experienced violence.

    “And way too many of our patients were dying,” he said. “When we did an analysis of why they died, the vast majority of deaths were related to trauma – either directly through murders or indirectly through substance abuse, overdose, depression and suicide.”

    His patients were not dying from HIV, he said, “but from a lifetime history of trauma.”

    This led the clinic to integrate into its practice the science of adverse childhood experiences, known as ACEs science, which explores the lifetime toll on physical, emotional, social and economic health linked to childhood experiences of everything from physical or sexual abuse to living with an alcoholic parent or witnessing violence outside the home.

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  • My encounter with Harvey Weinstein and what it tells us about trauma


    Harvey Weinstein, 2014/ Photo by Georges Biard


    I have been watching the scandal about Harvey Weinstein emerge with great interest – in the early ‘90s, I too was one of the young women he preyed upon.

    The details of what I have learned was not unique to me are out there now – the office tour that became an occasion to trap me in an empty meeting room, the begging for a massage, his hands on my shoulders as I attempted to beat a retreat… all while not wanting to alienate the most powerful man in Hollywood.

    This morning I learned he was fired. His misdeeds are now common knowledge and I don’t see much mileage in adding my name to the list of women he abused, especially since those who were brave enough to come forward in the New York Times article are the ones who had to ride out the inevitable attempts to shame and discredit them in the face of Harvey’s denials, only to emerge vindicated. I salute these women. I would be a footnote to their courage. Thanks to them, this genie will not go back into the bottle.

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  • Wisconsin aims to be first trauma-informed state; seven state agencies lead the way

    Here in California, many people think that it’s only liberal Democrats who have a corner on championing the science of adverse childhood experiences (ACEs) and putting it into practice. That might be because people who use ACEs science don’t expel or suspend students, even if they’re throwing chairs and hurling expletives at the teacher. They ask “What happened to you?” rather than “What’s wrong with you?” as a frame when they create juvenile detention centers where kids don’t fight, reduce visits to emergency departments and shrink teen pregnancy rates….among many other things.

    Because they do all this and more by abandoning the notion of trying to change people’s behavior by punishing, blaming or shaming them, and instead using understanding, nurturing and healing, some people might think this approach belongs to the purview of one political party.

    Mmmmmm….Not so fast.

    To paraphrase Tonette Walker, the First Lady of Wisconsin, married to Republican Governor Scott Walker, who was a GOP presidential candidate in 2016:

    That’s ridiculous.

    Her exact words were: “It’s ridiculous that people say this is a Democratic or Republican issue. We all care about issues concerning families and children. We all care about the outcome of people’s lives, no matter who you are.”

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  • Zorgos: A superpower we can teach kids

    Zorgos: A superpower we can teach kids

    This article contains two excerpts from the beginning and end of The Bullying Antidote: Superpower Your Kids for Life, by Dr. Louise Hart and Kristen Caven. The book explores how ACEs are created by stress, change, beliefs, and tradition, and provides a guide to positive parenting so that parents can prevent them in their children and communities.


    The Bullying Antidote: Zorgos

    Bullying is a power dynamic where one person exerts control over another physically, emotionally, or socially. Bullying can be persistent—a focused and repeated pattern—or it can be a single, traumatic event. In the bullying dynamic, one person always loses.

    There is no pill, no quick fix for the enormous problem of bullying. But there are thousands of solutions…and we’d like you to have access to them all.

    There is a superpower with which we’d like to endow your child, and all children. This power enables them to repel bullies and transform their relationships; it allows them to get what they need without resorting to bullying.

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