The power of personal stories from witnesses and committee members fueled the July 11 hearing on childhood trauma in the House Oversight and Reform Committee* throughout the nearly four hours of often emotional and searing testimony and member questions and statements (Click here for 3:47 hour video). The hearing was organized into a two panels—testimony from survivors followed by statements from experts—but personal experiences relayed by witnesses (including the experts) and the members of Congress blurred the lines of traditional roles.
Chairman Elijah Cummings (D-MD) set the tone early in the hearing by recalling his childhood experience of being in special education from kindergarten to sixth grade, and being told he would “never be able to read or write.” Still, he “ended up a Phi Beta Kappa and a lawyer.”
Near the end of the hearing, Rep. Mark DeSaulnier (D-CA) spoke about the “personal and private,” multi-generational experience of addiction and abuse in his family, including the death of his father by suicide. (Click here for video of Rep. DeSaulnier’s statement). He said he often recalls the metaphor he heard years ago about children drowning downstream before someone finally said “let’s go upstream to see why.”
In lauding fellow committee member Rep. Sarbanes (D-MD) for his leadership on school-based health centers, Rep. Ayanna Pressley (D-MA) said, “There but for the grace of God, go I. I can say with certainty that it was a school nurse who recognized, who saw the signs of trauma and abuse in my own life, and it is so important that the school community is trained in these indicators because there are children who act out, but there are many more that shut down. I was one of those children. “ (Click here for video of Rep. Pressley’s remarks).
William Kellibrew, the first witness, described how he finally got help from a skilled and caring therapist after he became suicidal years after his brother and mother were killed—and his life threatened— by her partner. He asked to yield the reminder of his time to have his grandmother in the room stand and be acknowledged. The room erupted in applause as it did at the end of the survivor’s panel with a rare standing ovation by the representatives and everyone else in the room. Dan Press, legal advisor to the Campaign for Trauma-Informed Policy and Practice, said he had never seen a standing ovation in a hearing in his 45 years of working with Congress.
Expert witnesses Dr. Debra Houry and Dr. Christina Bethell shared some of their life experiences. Dr. Houry told about a time as an emergency room physician when she discovered evidence of injury from child abuse when a child was brought to the ER for other problems. Bethell said the evidence of her own high-ACE childhood began at her birth with multiple hospitalizations that resulted from child abuse and later injuries as a result of neglect.
Cummings’ opening statement focused on both the scope of the problem of childhood trauma and the “good news.” He noted that the warnings from a wide spectrum of researchers, medical professionals, and others that childhood trauma is “one of the most consequential and costly public health issues facing our nation today. The science is powerful.” He also noted that damage can be healed, and children can become thriving and productive adults. He called for a robust approach to address the problem, signaling his intention to draft comprehensive legislation.
Members of the committee held up the courage of the witnesses who told their stories of childhood trauma. “I am so sorry you have to weaponize your pain in order for this and the survivor tribe to be seen and heard, but it is so critical for this work to be survivor-led,“ said Pressely. (Click here for the video of her statement). DeSaulneir told the witnesses: “You are so powerful and what you did today made you…the most powerful people in Washington, DC, and it’s transformative.”
Several committee members acknowledged Pressley’s leadership in partnering with Cummings to schedule this unprecedented hearing. She mentioned her work on the Boston City Council where she served for eight years and organized seven hearings on trauma. DeSaulneir referenced his time in Boston as a juvenile court officer and spoke about recent reforms in juvenile justice in California that have resulted in more children staying in the community rather than going to residential settings, a reform that improved lives and saved money.
Strategies to prevent and address trauma
Wide-ranging approaches to prevent and address childhood trauma were offered during the hearing. These include workforce enhancements, economic support for families, and education and support for families.
—Houry emphasized the critical role of prevention and held up Child Parent Centers and the Nurse Family Partnership model as well as the economic supports recommended in the CDC technical package, Preventing Child Abuse & Neglect: A Technical Package for Policy, Norm, and Programmatic Activities.
—Bethell recommended support for the use of the best, evidence-based practices and a requirement for every National Institutes of Health RFP (Request for Proposal) to consider trauma science. Specific policy recommendations are included in her testimony and in the oral version (attached).
—James Henry, former deputy governor and chief of staff for the State of Tennessee, said states and localities have to be committed and find solutions that work locally. He emphasized the importance of convening the key decision makers (e.g., the governor and first lady in Tennessee) and providing recurring (not one-time dollars) to support trauma-informed programs.
—DeSaulnier and Bethell spoke of building an infrastructure to support the reduction of childhood trauma. “We are losing people to early death because we don’t have the infrastructure to match the neuroscience and known evidence-based practices,” DeSaulnier said. “Our kids and their kids will look back on this time as both barbaric and transformative if we do what we need to do.”
Bethell said just as the US highway system connects the country, a social infrastructure will pave the way so that the evidence base of trauma combined with the knowledge of the impact of lived experiences of trauma are finally meeting with policy, creating impactful programs and policies that will save money (through prevention and healing, reducing the costs of childhood trauma and ACEs) and increase well-being in the country.
—Pressley inquired about the Self-Healing Communities model used in Washington state. Bethell briefly described the model and offered to send information on the results being achieved in the SHCM locations.
—Dr. Denese Shervington, clinical professor of psychiatry, Tulane University School of Medicine, addressed the impact of extreme natural disasters such as Katrina on communities where there is already a high level trauma as a result of violence, racism, and poverty. Strategies to address trauma should recognize the compounding impact of natural disasters that are increasing across the country, Shervington said.
The 2017 tax bill and provisions of the Affordable Care Act (ACA) were also addressed. Republican members Jody Hice of Georgia and Bob Gibbs of Ohio asked witnesses if the increase in the child tax credit in the tax law would help reduce trauma by easing poverty. Democrat Jim Copper (TN) raised the question of “the elephant in the room” that he said is the impact of states not taking the option under the ACA to expand Medicaid. (Click here for video of Cooper’s remarks—question regarding Medicaid expansion begins 1:47). Witness responses were uniform—Medicaid coverage is essential in providing support to children and their families to prevent and reduce trauma.
While committee members expressed differences in policy, the overall tone of the hearing was bipartisan and respectful. Press said that even though the politics of members on the committee range from the very liberal to the very conservative, “the questions were focused on learning more about the issue and not scoring partisan points. This offers the possibility that the committee will be able to reach bipartisan agreement on at least the broad elements of legislation to address the problems identified during the hearing. While the devil is always in the details, it is rare these days to have such a nonpartisan tone in any hearing room, much less in the Committee on Oversight and Reform.”
While the hearing brought issues into focus for the development of new legislation to address childhood trauma, a trauma bill (S. 1770, H.R. 3180, the RISE from Trauma Act) was introduced in June by Illinois lawmakers Sen. Dick Durbin and Rep. Davis. On the day of the oversight hearing, Press and other CTIPP members made Hill visits to raise awareness of the RISE bill and demonstrate local and statewide support for the legislation. While there are separate tracks for the RISE from Trauma Act and other bills, the congressional offices involved are proceeding in a complementary manner. For background on the Durbin-Davis legislation, click here.
As advocates undertake education and awareness efforts with their members of Congress, the state-specific fact sheets mentioned in Bethell’s testimony (a copy of her oral statement also is attached) should be useful in making the case for a policy response informed by data on local prevalence. Here’s another ACEs Connection article that describes the resource.
With the August recess coming up (the Senate recess runs from August 3 to Sept. 9; the House is in recess July 27 to September 8), advocates will be seeking opportunities to raise awareness and recommend policy approaches to their members of Congress. These include town hall meetings, office hours, and other events such as round tables on ACEs science and trauma-informed approaches. Round tables may be sponsored by a member of Congress but are largely organized by stakeholder organizations to bring awareness to an issue and examine policy solutions. With elected officials in attendance, activists can showcase the trauma-informed initiatives that are taking place in the congressional district or the state. For more information on how to host a round table, contact Dan Press at the Campaign for Trauma Informed Policy and Practice (email@example.com) or discuss holding a forum on ACEs science and trauma-informed practices with your local partners or affiliated national organizations.
Two specific developments to engage on with U.S. representatives and senators are the RISE from Trauma Act and other potential legislation coming out the groundwork laid by the oversight hearing. Members of the Senate Health, Education, Labor & Pensions (HELP) Committee may be interested in this topic, and therefore offer an opportunity to be educated. Allies for comprehensive legislation could include members of the House Oversight and Reform Committee.
*This link includes the written testimony of the nine witnesses plus a description of the purpose of hearing and the video of the entire hearing.
Charles Patterson HHRG-116-GO00-Wstate-PattersonC-20190711Creena Rygg HHRG-116-GO00-Wstate-RyggC-20190711Dr. Christina Bethell HHRG-116-GO00-Wstate-BethellC-20190711Dr. Christina Bethell House Committee Oral Testimony 7.11.19-2Dr. Debra Houry HHRG-116-GO00-Wstate-HouryD-20190711Dr. Denese Shervington HHRG-116-GO00-Wstate-ShervingtonD-20190711Heather Martin HHRG-116-GO00-Wstate-MartinH-20190711James Henry HHRG-116-GO00-Wstate-HenryJ-20190711Justin Miller HHRG-116-GO00-Wstate-MillerJ-20190711William Kellibrew HHRG-116-GO00-Wstate-KellibrewW-20190711