• A Kaiser pediatrician, wise to ACEs science for years, finally gets to use it

    Dr. Suzanne Frank has known about the impact of childhood adversity on young lives for decades. She’s seen the fallout in the faces of young people huddled in beds at a children’s shelter where she worked years ago.

    She’s seen it as the regional child abuse services and champion for the Permanente Medical Group.

    And she’s seen it in hospital examination rooms where, as a member of the Santa Clara County’s Sexual Assault Response Team, she’s been called in to examine shell-shocked children and teens.

    Since January 2017, Frank, a pediatrician at Kaiser Permanente’s San Jose campus, has been screening her patients for adverse childhood experiences, along with fellow pediatricians. In doing so, the campus joined Kaiser Hayward and Kaiser San Leandro in a regional rollout of ACEs screening of pediatric patients. It began first at Kaiser Hayward in January 2016, which designed the protocol and is analyzing the results.

    For those unfamiliar with such screenings, ACEs comes from the CDC-Kaiser PermanenteAdverse 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.

    The ACE Study found that the higher someone’s ACE score – the more types of childhood adversity a person experienced – the higher their risk of chronic disease, mental illness, violence, being a victim of violence and several other consequences. The study found that most people (64%) have at least one ACE; 12% of the population has an ACE score of 4. Having an ACE score of 4 nearly doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and the risk of attempted suicide by 1200 percent. (For more information, go to ACEs Science 101. To calculate your ACE and resilience scores, go to: Got Your ACE Score?)

    Other ACEs 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, and attending a school that enforces a zero-tolerance discipline policy.

    Following the lead of Kaiser Hayward, pediatricians in the San Jose clinic began screening 3-year-olds by having their parents fill out ACEs surveys.

    The 10-question ACEs survey, adapted from one designed by the Center for Youth Wellness (see attached) asks parents to read a list of statements and write down a total number of ACEs at the top of statements that apply to their child. For example, in the CYW form, parents are asked if, “At any point since your child was born: Your child’s parents’ or guardians were separated or divorced.” Or, “Your child lived with a household member who served time in jail or prison.”CYW ACE-Q CHILD

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


    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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