• ACEs science can prevent school shootings, but first people have to learn about ACEs science

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    David Hogg, a senior at Marjory Stoneman Douglas High School, speaks at a rally calling for more gun control. Photo by Jonathan Drake / Reuters

    After 17 people, mostly teens, were shot and killed by another teen last week in Parkland, FL, what seems to be a real movement is growing, propelled by kids devastated by their friends’ deaths and wanting to prevent such a massacre from ever happening again.

    Their rallies and marches and lie-downs probably won’t have much effect in the short-term, as some of the Parkland teens learned as they witnessed — and some of them wept during — today’s lightning vote by state lawmakers along party lines to end debate on an assault weapons ban, which killed any further consideration of the bill in the Florida legislature’s current session.

    But their persistence can make a difference in the long run, especially if they — and we — widen this to include the dozens of kids shot on the streets of Chicago or Camden or in other communities every week. We can even broaden the approach to include the 200 people, including many children, who died in Syrian air strikes in the last two days, because the roots and solutions are the same.

    The kids in Parkland, FL, have the advantages that we want all our children to have: a great education in an affluent community so that they are prepared for and feel confident enough to know how to communicate in social and mainstream media about what they want, and to do it in an informed and cohesive way, with their community at their back. This means support and advice from parents, teachers, mentors and other adults who have created and maintained that environment for them.

    Most of the kids living on our nation’s Indian reservations, in poor African-American communities, in poor white communities that don’t have the advantage of good schools, safe neighborhoods, well-paying jobs for their parents, affordable housing, great health care, soccer fields, baseball diamonds, swimming pools and parks….these kids don’t have the support or wherewithal or access to that same megaphone. It’s not that they aren’t capable, or that their parents couldn’t be capable of providing the same support that the kids in Parkland have. But they live in conditions created by us adults and our traditional systems that prevent them from realizing their dreams. Creating those conditions of opportunity for everyone is the responsibility of the adults….all of us adults.

    But ACEs science clearly shows even the advantageous environment of Parkland, FL, is not really safe, as the kids found out. Their first response — that this is a gun regulation issue — is right. There’s no reason why any kid in this country needs an assault rifle, bump stocks or anything else.

    But that’s just one tiny, tiny, tiny part of the solution. This isn’t only a gun regulation issue. It’s a systems change issue. All of our systems have to change their approach to changing behavior — whether it’s criminal, unhealthy or unwanted behavior — from a blame, shame and punishment approach, to one that is based in understanding, nurturing and healing….in other words, the science of adverse childhood experiences — ACEs. The great news is that many organizations and communities already have, and are achieving results that many people thought were not possible.

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  • Book review: “The Deepest Well: Healing the Long-Term Effects of Childhood Adversity” by Dr. Nadine Burke Harris

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    Dr. Nadine Burke Harris debuted her book, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, at the Philadelphia Free Library this evening in a talk and book signing.

    This first stop in an ambitious book tour that crisscrosses the country reflects a mission that Burke Harris has pursued for nearly a decade: to spread the knowledge about the science of adverse childhood experiences, and about how people can use this knowledge to help solve our most intractable problems. (Her TED Talk has nearly 3.5 million page views.)

    The story that the pioneering pediatrician and CEO of the Center for Youth Wellnessrelates is hers. It begins when, as a young pediatrician, Burke Harris struggles to define what was happening to her young patients at the Bayview Child Health Center in the Bayview Hunters Point community in San Francisco, CA.

    I believed, ever since we’d opened the clinic in 2007, that something medical was happening with my patients that I couldn’t quite understand. It started with the glut of ADHD cases that were referred to me.…most of my patients’ ADHD symptoms didn’t just come out of the blue. They seemed to occur at the highest rates in patients who were struggling with some type of life disruption or trauma….what if there was a more nuanced answer? What if the cause of these symptoms — the poor impulse control, inability to focus difficulty sitting still — was not a mental disorder, exactly, but a biological process that worked on the brain to disrupt normal functioning?

    And thus begins something akin to a gripping medical detective saga. Burke Harris began her career as any other pediatrician, trained as pediatricians have been trained in medical schools for decades: to treat the symptoms in front of her. She paid little attention to the story behind the story, but those background stories would pop up time and again, practically yelling at her: “Pay attention! There’s something going on here!!”

    I lived in that state of not-quite-getting-it for years because I was doing my job the way I had been trained to do it. I knew that my gut feeling about this biological connection between adversity and health was just a hunch. As a scientist, I couldn’t accept these kinds of associations without some serious evidence.

    Pieces of evidence appeared as she pursued understanding the effects of stress hormones on kids’ development. But the turning point came when a co-worker handed her an article that had been published in 1998 in the American Journal of Preventative Medicine: “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: the Adverse Childhood Experiences Study,” by Dr. Vincent Felitti, Dr. Robert Anda, and six of their colleagues.

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  • Peer mentor uses her own ACEs story to teach med residents how to help traumatized patients

    O’Nesha Cochran, OHSU peer mentor

    When O’Nesha Cochran teaches medical residents about adverse childhood experiences in patients, she doesn’t use a textbook.

    Instead, the Oregon Health & Science University peer mentor walks in the room, dressed in what she describes as the “nerdiest-looking outfit” she can find.

    And then she tells them her story.

    “My mom sold me to her tricks and her pimps from the age of three to the age of six,” she begins. “I could remember these grown men molesting me and my sisters. I have three sisters and we all went through this,” she says.

    When she was 13, some adults enticed her to start smoking crack cocaine. “They knew if they got me strung out on drugs, they could sell me easily from person to person and that is what they did,” she says matter-of-factly. For the next 20 years, she tells them, she stole things, beat up a lot of people, and was homeless and in and out of the penitentiary.

    “I tell this story very plainly and you can see their mouths drop open,” Cochran says. It’s exactly the effect she’s aiming for – that her story doesn’t match the wonky-looking teacher standing in front of them. It’s partly a lesson, she says, about making snap judgments based on appearances.

    And that lets Cochran offer a deeper lesson: “Nobody is born thinking ‘I want to be a dope fiend. I want to be a criminal.’”

    Cochran asks the medical residents to consider that under the circumstances she was thrust into as a 13-year-old, using crack actually helped her survive her trauma. “It made me feel beautiful. It made me feel invincible, like nothing can hurt me!”

    At that point she says, she can see a light bulb go on in the students. “They think, ‘Wow, this is a little girl at 13 making a bad decision, but with the best information she had available to her at that time.”

    This is how Cochran opens the door to the CDC-Kaiser Permanente Adverse Childhood Experiences Study, the groundbreaking research by the CDC and Kaiser Permanente that looked at 10 types of childhood trauma. This includes: physical, emotional and sexual abuse, physical and emotional neglect, living with a family member who’s addicted to alcohol or other substances, or who has mental illness. It also includes experiencing parental divorce or separation, having a family member who’s incarcerated, and witnessing neighborhood or family violence, such as a mother being abused.

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  • Montefiore Medical in Bronx screens 12,000+ kids for adverse childhood experiences

    Image courtesy of Creative Commons/Flickr/ Family drawing-Meggy

    Since 2016, more than 12,000 children have been screened for adverse childhood experiences (ACEs) at Montefiore Medical Center in Bronx, New York, according to Miguelina German, the director of Quality & Research in the Pediatric Behavioral Health Integration Program and project director of Trauma Informed Care at the center.

    Parents of infants are asked to fill out ACE scores for themselves and their infants.

    “They’re told words to the effect: ‘We know that when a parent has a rough go of it growing up, it can make parenting more challenging and more difficult. We ask these questions because we want to support children and families coming to this clinic in whatever way they might need,'” explains German. Pediatricians also explain that higher ACE scores are tied to long-term impact on their child’s health.

    If parents or their infants have ACE scores of 4 or higher, they’re automatically offered a referral to the onsite HealthySteps program, which the center says is designed “to ensure that parents and babies are started on the right track.” For children one year and older, a parent is asked to complete an ACE screen on their child,but not for themselves, and if the child’s score is 4 or higher, they’re also referred to HealthySteps. Children over the age of five are referred to the onsite Child and Adolescent Psychology/Psychiatry (CAPP). Both are part of Montefiore’s Pediatric Behavioral Health Integration program. Pediatricians may also elect to refer children to either program if they have any other concerns, regardless of the child’s ACE score, says German.

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    Miguelina German

    HealthySteps offers a wealth of support services, including a hotline for infant and toddler care questions, optional home visits, parents’ discussion groups, and onsite treatment for parents with depression, anxiety and other mental health issues.

    ACEs refer to 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.

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