Dr. Linda Chamberlain lives in Alaska, where suicide rates are “typically double the national rate”, she says in this blog post on the web site of the Scattergood Foundation. She’s the Thomas Scattergood Scholar on Child Behavioral Health this year. As founder of the Alaska Family Violence Prevention Project, she’s concerned about domestic violence and child abuse, which the CDC’s Adverse Childhood Experiences Study found are risk factors for suicide. She points out how ACEs increase the risk of suicide:
Early adverse childhood experiences [ACEs] dramatically increase the risk of suicidal behaviors. ACEs have a strong, graded relationship to suicide attempts during childhood/adolescent and adulthood. An ACE score of 7 or more increased the risk of suicide attempts 51-fold among children/adolescents and 30-fold among adults (Dube et al, 2001). In fact, Dube and colleagues commented that their estimates of population attributable fractions for ACEs and suicide are “of an order of magnitude that is rarely observed in epidemiology and public health data.” Nearly two-thirds (64%) of suicide attempts among adults were attributable to ACEs and 80% of suicide attempts during childhood/adolescence were attributed to ACEs. Further, while system responses to family violence continue to place greater emphasis on physical forms of abuse, the strongest predictor of future suicide attempts in ACE research was emotional abuse.
Holy Toledo. These numbers are nothing but scary. And tragic.
One of the ways that communities can begin to prevent suicide is to understand adverse childhood
experiences — what they are and how to prevent them, she says. (The 10 types of adversity that were measured in the ACE Study are physical, verbal and sexual abuse; physical and emotional neglect; a parent who’s addicted or diagnosed with a mental illness such as depression; a family member who’s in prison; witnessing a mother being abused; and loss of a parent through divorce or abandonment. There are, of course, others that can cause a child severe and chronic trauma, such as homelessness or living in a violent neighborhood.) Chamberlain thinks suicide is everybody’s business, not just the purview of the mental health health community.
Others are leaning in that direction, too. In some communities, the silos of schools, the medical community, public health, law enforcement, juvenile justice, mental health, social services and business are developing a common language to work together to prevent child maltreatment. Their approach involves helping out troubled families and changing systems and institutions so that they don’t further traumatize already traumatized children, teens and adults.
Several cities are moving apace to become trauma-informed: Among them are Tarpon Springs, FL; Albany, NY; Philadelphia, PA; San Diego, CA; San Francisco, CA; Memphis, TN; Walla Walla, WA; Port Townsend, WA. As part of the Philadelphia ACEs Task Force, the Institute for Safe Families is starting a project to map all the communities where ACE- and trauma-informed practices are being implemented.
Despite the yawner of a title for this report — Complex Trauma in the Spokane Area: Key Informant Perspectives (ComplexTraumaReport) — it is riveting. Well, a clarification. It’s riveting if you’re into figuring how to do away with child maltreatment forever, help troubled families become healthy, and build healthy communities.
It asks the question: How ready is Spokane to move ahead on ACEs? Here’s a chart that shows where various parts of the Spokane community are on understanding childhood adversity.
Spokane’s got some work to do. So said the report, which was done by Clegg & Associates for the Empire Health Foundation and released last November. But that’s just a tiny, tiny part of this report, which is brilliant in that it maps out precisely where Spokane is on this journey, and provides a strong path for how the entire community can become ACE- and trauma-informed.
Included in the report is a list of the organizations that do trauma prevention now — for the community, families and children. There’s also a list of what’s missing.
I thought the best part were the dozens of very chunky ideas to change or improve policy and systems, as well as ideas to transform organizations, ideas for training and ideas for research. Here’s a tiny sampling:
- Encourage schools to adopt a more positive and consistent response in how they handle challenging children. They should not suspend these kids, but keep them connected to services and education and reach out to engage the families in addressing the issues behind challenging behaviors.
- Take advantage of health care reform efforts to transform providers’ practice to include screening for complex trauma and ACEs, reporting child abuse, integrating behavioral health services, and implementing approaches that embed ACEs-related prevention activities into the healthcare system. This would support the reduction of high cost care required under healthcare reform.
- Assess the need for training of ACE- and trauma-informed practices in schools, health centers, juvenile justice, child welfare and social service systems; develop a training plan.
- Determine the prevalence of ACEs in high schools.
- Increase the amount of work across silos.