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

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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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