• Tributes honor the life of Rep. Elijah Cummings of Baltimore

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    Image projected on a building of a younger Rep. Cummings taken on a street in his native Baltimore. From an unknown source, projected images and messages appear on the side of a building near my house in the Mt. Pleasant neighborhood of Washington, DC.

    When the news alert came across my cell phone on Thursday morning that Elijah Cummings had died, I felt overwhelming sadness for the loss of a powerful, eloquent, and soulful human who understood trauma in his bones.  An immediate second thought was he died too soon as do many other African Americans whose lifespan is shorter by years than white people’s. Then I wondered how we can honor his legacy by building on what he started dramatically in the House Oversight and Reform Committee with the first hearing of its kind on July 11 this year (Click here for a story on the hearing in ACEs Connection).

    Just the day before the news of Cummings’ death, I had read an email from Dan Press who leads the advocacy work for the Campaign for Trauma-Informed Policy and Practice (CTIPP) updating me and other members of the CTIPP Board about the latest thinking of Cummings and his staff about the advisability of moving ahead at this time with comprehensive legislation on trauma.  The strategy was fluid but it was clear that Cummings was engaged and focused on the what, when, and how of promising next steps with legislation.

    Even though Cummings was a forceful, clear-eyed, passionate progressive, he managed to have friends and allies in both parties and avoided bitter feuds that kept parties apart.  The promise of meaningful, bipartisan trauma legislation has dimmed without his leadership.

    Stories of his life were carried on the front pages of the Washington Post and the New York Times and numerous opinion pieces about how his life was an inspiration to so many were carried for days.  He will lie in state in the rotunda of the Capitol on Thursday before a funeral service in Baltimore at the New Psalmist Baptist Church where he worshipped for decades.

    Tributes came from Presidents Trump and Obama to constituents and journalists—many touched on his unlikely and amazing friendships with people who had opposite political perspectives.  Mark Shields and David Brooks on the October 18 PBS News Hour highlighted the connection he made with conservative Trey Gowdy, a member of Congress at the time, over their shared South Carolina roots (Click here for Trey Gowdy’s tribute):

    • Judy Woodruff:

    Before we go, I do want to raise the passing of Elijah Cummings, Mark, David, somebody who served a long time in the Congress, part of the House leadership, had been in the civil rights movement before then.

    I — we just learned tonight that Speaker Pelosi will have his remains lying in state at the Capitol next week.

    • Mark Shields:

    A remarkable man, a truly remarkable man, I’d say a giant, some would say a gentle giant, eloquent.

    But just a quick little anecdote about Elijah Cummings. Trey Gowdy is a white Republican from South Carolina, a fierce conservative, on the same committee. They crossed swords.

    They spent time together. And Trey Gowdy said — found out that he’d grown up in the same area of South Carolina as Cummings’ family. And he said, why did they leave? And he said, so our children, myself could get an education.

    And the conversation ended up with them both in tears.

    Now, that doesn’t happen in Washington. That doesn’t happen, where you have caricature and have cartoon cutouts of your adversaries and just sneer at them. I mean, he was that strong a man, that he could show the weakness and the gentleness of him.

    And he will be missed. He was truly the North Star.

    • David Brooks:

    Yes. And then, when Freddie Gray died in Baltimore a few years ago…

    • Mark Shields:

    Yes.

    • David Brooks:

    … he was at — spoke at the funeral, very impassioned, very righteous about the wrongs that have been done.

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  • Iowa ACEs360: Catalyzing a Movement

    Iowa ACEs Policy Coalition joins Iowa Gov. Kim Reynolds as she signs a “Resilient Iowa” proclamation in 2018. Photo courtesy of Lisa Cushatt.

    For years, advocates for a statewide children’s mental health system would stand before Iowa legislators and speak passionately about their own particular concerns.

    Psychiatrists pointed to a need for more inpatient beds for youth with severe mental illness. Pediatricians said the answer was better screening to identify mental health issues in children from birth to age five. Educators wanted more school-based mental health services, and advocates from grassroots groups like the National Alliance on Mental Illness (NAMI) asked for increased crisis services.

    “We were all saying, ‘Throw money at this issue,’” says Chaney Yeast, co-chair of the policy coalition of Central Iowa ACEs 360, a multi-sector network formed in 2012. “That confused legislators; they felt it was this black hole, and they didn’t act.”

    This year—thanks in part to connections forged by Iowa ACEs 360—advocates for a comprehensive child behavioral health system told a single story: Children whose mental health needs are met will be more likely to graduate, be employed and become productive members of the community. Current mental health services for children are fragmented and inconsistent. We know what it would take to fix that.

    Group after group that testified before Iowa legislative committee members—officials from the sheriff’s department, mental health providers, community advocates, child welfare workers—drummed home talking points that the ACEs policy coalition had developed with a public policy messaging and research firm.

    “That common messaging hit home. We were all on the same page,” says Yeast. The bill—which requires Iowa counties to implement a coordinated array of preventive, diagnostic and treatment services for children, and calls for parents of children with mental health issues to have a voice in designing those services—passed the legislature in April and was signed by the state’s governor in May.

    “That was a huge win in terms of collaboration,” says Yeast. It was also a clear example of the power that cross-sector networks can wield when members move beyond their own silos to support a shared goal. Such work is not easy—“It takes a lot of time and effort to continually nurture those relationships and connections,” says Yeast—but it is essential to making long-term, systemic change.

    That’s been the ambition of Iowa ACEs 360 since its start, when a small group of stakeholders—in public health, mental health, family support and community advocacy—gathered, with the support of the Mid-Iowa Health Foundation (MIHF), to discuss the original CDC-Kaiser Permanente ACE Study and how their work needed to change in response.

    That group decided on two priorities: collect Iowa ACE data and spread awareness of the ACE Study, so others could be galvanized by its findings on the lifelong, corrosive effects of early childhood adversity.

    After Rob Anda, the co-investigator of the 1998 ACE Study, did a presentation about the ACE Study to a small group of key stakeholders, an early step was to include the ACE module in Iowa’s Behavioral Risk Factor Surveillance System (BRFSS). Following an invitation-only summit in 2011 that featured a follow-up with Anda, he and Laura Porter, a nationally known expert on ACEs and population health, spoke to 800 people at the 2012 Iowa ACE Summit.

    Suzanne Mineck, president of MIHF and one of the original committee members who launched ACEs 360, says “water cooler conversations” in the weeks following Anda’s visits that gave the work momentum. “We all had the privilege of learning about compelling research, but it was the lingering impact, both on those in decision-making places and those on the front lines, that was as much of an ‘aha.’”

    As the coalition grew, hosting quarterly learning circles, developing work groups and, in 2014, acquiring a part-time program manager, it became a place where people from various sectors—juvenile justice, child welfare, health care and education—could learn together.

    “It created a culture where there wasn’t a singular response…a culture of transparency, humility, honoring and supporting risk-taking,” says Mineck. “Many felt they were learning things for the first time together.”

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  • Florida State launches professional certification in trauma and resilience

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    Florida State University has launched a new online curriculum for a professional certification in trauma and resilience.

    The curriculum was developed by the Clearinghouse on Trauma and Resilience within the Institute for Family Violence Studies at the FSU College of Social Work in conjunction with the FSU Center for Academic and Professional Development.

    “This training addresses a gap in the knowledge base of human services professionals,” said Clearinghouse Director Karen Oehme. “Many professionals do not receive training on the impact of how to provide services to someone who is experiencing the harmful effects of trauma.”

    The course enables professionals to develop the knowledge and skills they need to understand the impact of adult and childhood trauma, along with the keys to resilience. Participants will learn crucial information to improve service delivery to clients, students, human services recipients, patients and other members of the public.

    The self-paced curriculum includes 20 hours of course content and 10 chapters of research-based readings, case scenarios, multimedia materials, assignments and quizzes.

    The multidisciplinary course has been approved for continuing education credits for a diverse range of professionals including licensed counselors, social workers, nurses, dentists and lawyers. Participants outside of Florida can submit their certification to their own licensing board to determine credit awarded.

    “The course is designed for professionals in a wide variety of fields because individuals in all different environments have exposure to trauma,” Oehme said. “We wanted to provide an economical, evidence-based resource to the public for those who want to enhance their professional knowledge, skills and career potential.”

    The curriculum is based on developing an understanding of adverse childhood experiences and the associated long-term negative effects. The training offers a powerful new perspective on trauma-informed approaches to effective service delivery.

    “Florida State University recognizes that professionals from all backgrounds have the ability to help individuals build resilience,” said Jim Clark, dean of the College of Social Work. “But first they have to learn about why resilience is so crucial in treating the negative impacts of trauma.” Clark said that FSU realized the need for such a course as it was developing the Student Resilience Proect.

    “Our community partners have told us time and time again that they need research-informed resources,” Clark said. “It was a natural next step for the Clearinghouse on Trauma and Resilience to develop such a course.”

    Faculty from across Florida State’s campus participated in the review of the new course.

    Mimi Graham at the Center for Prevention & Early Intervention Policy, a leader in trauma-informed education, served as a reviewer, along with 10 other faculty members.

    “FSU is a leader in trauma and resilience education for the public,” Graham said. “This course ensures that crucial information is available to our community leaders, so they can make trauma-informed decisions.”

    Joedrecka Brown Speights at the College of Medicine said, “It’s important for human services professionals to keep up with the new research on brain development so they remember there is always hope for healing after trauma.”

    Chapters in the certification cover the mental and physical effects of trauma, cultural considerations in trauma research, skills for addressing trauma and an interdisciplinary approach to building resilience.

    Professionals are required to review all of the course material and pass the chapter quizzes and final exam. When professionals complete the training, they will receive their professional certification from the Center for Academic and Professional Development.

    Discounts for the 20-hour course are offered for FSU alumni and veterans. For questions about fees and enrollment, contact the FSU Center for Academic & Professional Development at resilience@capd.fsu.edu or (850) 644-7545.

  • Bad news-good news: Each additional ACE increases opioid relapse rate by 17%; each ACE-informed treatment visit reduces it by 2%

    Aopioids2Photo by Ian Sheddan via Flickr Creative Commons
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    It’s no surprise that serious childhood trauma can lead people to use opioids. In the absence of healthy alternatives and an understanding of how experiences — such as living with a parent who’s alcoholic or depressed, divorce, and being constantly yelled at when you’re a kid — can make your adult life miserable, opioids help many people cope with chronic depression, extreme anxiety and hopelessness.

    But a new study has shown the significance of ACEs and ACEs-science-informed treatment: Each additional type of adverse childhood experience increases a person’s risk of relapse during medication-assisted opioid treatment by a whopping 17 percent. And each visit to a clinic that integrates trauma-informed practices based on ACEs science reduced the relapse rate by two percent, which can carry a person perhaps not to zero, but to a minimal risk of relapse.

    “This research clearly shows the lasting impact that ACEs (adverse childhood experiences) can have,” says Dr. Karen Derefinko, lead author and assistant professor in the Department of Preventive Medicine at the University of Tennessee Health Science Center, and director of the National Center for Research of the Addiction Medicine Foundation. “I think it’s the first research to connect ACEs to relapse.”

    Researchers from the University of Tennessee Health Science Center and the University of Memphis also found that more than half (54%) of people in a rural Tennessee opioid clinic relapsed, and the highest relapse rate was on the first visit. Almost half of the 87 people who participated in the study had an ACE score of four or higher — the average was 3.5, which is remarkably high. The study, “Adverse childhood experiences predict opioid relapse during treatment among rural adults”, appears in the September 2019 issue of the journal, Addictive Behaviors, and was published online last week.

    Derefinko
    Dr. Karen Derefinko

    “This study will help practitioners understand the importance of providing trauma-informed treatment,” says Derefinko. “Because of the stigma associated with drug use, it’s hindered health care workers’ understanding of why people use drugs and has led to an assumption that they’re bad people. This shows that trauma-informed care and providing resources does impact how well people can do. It’s also validating for patients and gives them a lot of hope.”

     

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  • 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.

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