Donald Trump’s ACEs; the mob’s ACEs

Photograph by Craig Ruttle / Redux

As I post this, the U.S. Senate is in the middle of the second trial of former President Donald Trump, after the U.S. House of Representatives impeached him for the second time.

Several people have asked me why I had not written about the events of Wednesday, January 6, 2021, sooner — a traumatizing day that will be seared in our long history of trauma in this country. Basically, I was waiting for the other shoe to drop, because this isn’t over.

I was also listening to what people in the ACEs movement were saying about the insurrection on January 6. We were all pretty much saying the same things that most people in the nation and the world were saying. First, about the violence, which was horrendous, terrifying, unreal. And then further disbelief, as well as rage, about why a mob of mostly White rioters was let loose on the U.S. Capitol, the people’s house, for six hours without consequences when just months before Black Lives Matter protestors who were practicing their First Amendment rights and were not violent, were tear-gassed, beaten, and arrested.

Below, I’m re-posting an article published last July about how former President Trump’s childhood adversity shaped his life, based on an amazing book by his niece, Mary Trump. The insurrection of January 6 demonstrated how much he has shaped ours in his run-away four-year screeching, careening metaphorical train wreck. Many people warned of this; Mary Trump could see it coming. At the root of all his actions over the last decades, and especially during his presidency, is his childhood trauma.

Adverse childhood experiences are also at the root of the behavior of people in the mob that stormed the U.S. Capitol. People who are happy and healthy, who have a promising future for themselves and their children — i.e., those that have had enough positive childhood experiences to counter the inevitable adverse childhood experiences — those people don’t storm buildings, don’t erect posts with a noose, don’t threaten the Vice-President of the United States and the U.S. Speaker of the House of Representatives with a guillotine or hanging.

But we’re stuck in a generational escalation of ACEs. Idaho just did an ACE study and found that an astonishing 23 percent of adults, who are overwhelmingly White, have an ACE score of 4 or more. The original ACE Study showed 12 percent of adults with ACEs. Too many ACEs lead to substantial violence, being a victim of violence, chronic disease and mental illness (more information in the article below). People who have an overabundance of ACEs live out their lives in a number of predictable ways: They endure lives of depression, over-achieving, extreme anger, and/or anxiety. People who use anger to cope with their ACEs will latch onto anything that satisfies the craving for hate, including racism, hate groups, misogyny, etc., just as opiates satisfy the craving for relief from depression and anxiety. Fueling their hate is the belief that the world is a dangerous place, based on the traumatic experiences seared into their tiny bodies and brains when they were babies.

On January 6, 2021, most White people had yet another awakening (after George Floyd last year). Most Blacks and Native Americans did not, because they already knew that this country was not a safe place. They have already experienced this violence, for centuries. Those of us who didn’t understand what Donald Trump represented now realize that we have a very long way to go to create a nation of communities that are self-healing.

At ACEs Connection, and in the ACEs movement, we’re in this for the long haul. We know it will take a long time for the country as a whole to heal. I hope we’ve made a strong start. I hope our efforts come in time…to ameliorate the hurt in this country, to have enough individual and community resilience to survive, and perhaps even thrive, during these next decades of climate change.

Trump’s story is a cautionary tale for all of us. For many people, the January 6 insurrection put the last four years into a different and dangerous light. Ahhh, hindsight. But the basic rule is: Hurt people hurt people, no matter how much or little money or prestige they have. Without significant intervention and healing, people who have significant childhood adversity — and little of the necessary nurturing required as babies and toddlers to grow into healthy adults — are incapable of change. That’s why Mary Trump kept saying her uncle would remain on his destructive path. I hope we put the knowledge to good use in future elections.

Lesson learned integrating ACEs science into health clinics: Staff first, THEN patients

Dr Omotoso
Dr. Omoniyi Omotoso

About two years ago, a team from LifeLong Medical Clinics jumped at the opportunity to integrate practices based on adverse childhood experiences   when it joined a two-year learning collaborative known as the Resilient Beginnings Collaborative (RBC). RBC began in 2018 and includes seven safety-net organizations in the San Francisco Bay Area. (Here’s a link to a report about the RBC.)

To join the RBC, LifeLong Clinics — which has  14 primary care clinics in Alameda, Contra Costa and Marin Counties — and the other collaborative teams had to agree to introduce all staff members to the science of childhood adversity and trauma-informed practices. LifeLong went full steam ahead with a 2.5-hour introductory training for more than 100 employees who work at its clinics that serve pediatric patients. Trauma Transformed, a program of the East Bay Agency for Children in Oakland, CA, did the training in October and November 2018.

LifeLong Clinics’ decision to move forward on integrating ACEs science and trauma-informed practices into its clinics is important particularly in California where a state policy has made childhood adversity a front and center issue. On Jan. 1, 2020, as an incentive to doctors who serve Californians in the state’s Medicaid program, the state began offering supplemental payments of $29 to doctors for screening the estimated 12 million pediatric and adult patients for adverse childhood experiences (ACEs).

ACEs comes from the groundbreaking Adverse Childhood Experience Study (ACE Study), first published in 1998 and comprising more than 70 research papers published over the following 15 years. The research is based on a survey of more than 17,000 adults and was led by Drs. Robert Anda and Vincent Felitti. The study linked 10 types of childhood adversity — such as living with a parent who is mentally ill, has abused alcohol or is emotionally abusive — to the adult onset of chronic disease, mental illness, violence and being a victim of violence. Many other types of ACEs — including racism, bullying, a father being abused, and community violence — have been added to subsequent ACE surveys. (ACEs Science 101Got Your ACE/Resilience Score?)

The ACE surveys — the epidemiology of childhood adversity — is one of five parts of ACEs science, which also includes how toxic stress from ACEs affects children’s brains, the short- and long-term health effects of toxic stress, the epigenetics of toxic stress (how it’s passed on from generation to generation), and research on resilience, which includes how individuals, organizations, systems and communities can integrate ACEs science to solve our most intractable problems.

After it trained employees in 2018, brainstorming around workflow was provided for staff at the LifeLong Howard Daniel Health Center in Oakland, CA, in February 2019, where LifeLong plans to pilot ACEs screening in newborns to five-year-olds, said Dr. Omoniyi Omotoso, the pediatric lead at LifeLong Clinics, who led the brainstorming about workflow and additional training.

Four months into that training, in June, Omotoso showed staff the ACEs questionnaire and asked them how they thought patients would feel about it.

And that’s when Omotoso realized that they had to put on the brakes. “A lot of the staff were uncomfortable because they themselves had similar instances that they personally were triggered by as they read the [ACE] questions themselves,” said Omotoso, who splits his clinical time between LifeLong Howard Daniel Health Center and LifeLong William Jenkins Health Center. He said that LifeLong will be using the de-identified PEARLS ACE screener for its pediatric population, which asks those surveyed to write on the form the number of ACEs that apply to them. (Here’s a link to ACEs Aware, where you’ll find out more information about PEARLS, the only pediatric ACEs screener for which California providers can be reimbursed.)

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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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Study shows most pregnant women and their docs like ACEs screening

Would pregnant women participate in surveys from their doctors asking them about whether they had experienced trauma in their childhood? In surveying moms-to-be at two Northern California Kaiser sites, clinicians discovered that the women were receptive to filling out an adverse childhood experiences (ACE) survey, according to a study that was published earlier this year in the Journal of Women’s Health.

In fact, researchers found out that the vast majority of pregnant women — 91 percent of the 375 women— were “very or somewhat comfortable,” filling out the ACE survey. Even more, 93 percent, said that they were comfortable talking about the results with their doctors. The women were surveyed from March through June 2016 at Kaiser Permanente clinics in Antioch and Richmond, CA.

ACE refers to the groundbreaking CDC/Kaiser Permanente Adverse Childhood Experiences Study that tied 10 types of childhood trauma, including living with an alcoholic family member or experiencing verbal abuse from a parent, to a host of health consequences. (Got Your ACE Score?)

The higher the number of ACEs that people have, researchers learned, markedly increases their risk for poor health outcomes, as well as social and economic consequences. Having four ACEs, for example, nearly doubles a person’s risk for heart disease and cancer, raises the risk of attempted suicides by 1200 percent and alcoholism by 700 percent.

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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.

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

Afloridashooting

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.

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Peer mentor uses her own ACEs story to teach med residents how to help traumatized patients

O’Nesha Cochran, OHSU peer mentor

When O’Nesha Cochran teaches medical residents about adverse childhood experiences in patients, she doesn’t use a textbook.

Instead, the Oregon Health & Science University peer mentor walks in the room, dressed in what she describes as the “nerdiest-looking outfit” she can find.

And then she tells them her story.

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We can’t stop sex harassment by firing or incarcerating our way out; we can stop it by using ACEs science

AMeToo

So, Harvey Weinstein has gone to ground, along with Charlie Rose, Matt Lauer, and Kevin Spacey, to name a few, and they’re likely never to work in their chosen fields again. This week, federal Appeals Court Judge Alex Kosinski retired after 15 women, including former clerks, accused him of sexual misconduct. Do a search for “sexual harassment” and stories about dozens of men across a variety of professions appears.

Sexual harassment is everywhere – all professions, including higher education, and all walks of life (see the NYTimes article about women who work in Ford’s Chicago plants). The U.S. Equal Employment Opportunity Commission says that 60% of women report having experienced sexual harassment. That’s 45 million women. Forty-five million. And a much smaller, but still in the millions, number of men have also been sexually harassed by their male or female bosses.

The solutions so far — Fire them! Jail them! Destroy them! — might garner some headlines and short-term satisfaction. The solutions certainly fit our traditional approach of using blame, shame and punishment to attempt to change human behavior.

But we can’t fire or imprison our way out of this — it’s too big and too complex. Here’s why:

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Dozens of Kaiser Permanente pediatricians in Northern California screening three-year-olds for ACEs

kidsSince August 2016, more than 300 three-year-olds who visit Kaiser Permanente’s pediatric clinics in Hayward and San Leandro have been screened for adverse childhood experiences (ACEs), such as living with a family member who is an alcoholic or losing a parent to separation or divorce. But when the idea to screen toddlers and their families for ACEs was first broached at the Kaiser Permanente Hayward Medical Center, the staff were, in a word, “angsty,” says Dr. Paul Espinas, who led the effort.

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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.

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