Not long after Marcia Stanton stumbled across the original article from the CDC’s Adverse Childhood Experiences Study, she heard a conference presentation by Dr. Vincent Felitti, one of the study’s co-authors. She invited Felitti to do grand rounds with 100 pediatricians at Phoenix Children’s Hospital, where she works.
“I thought they’d be all over this,” says Stanton, a social worker in the hospital’s Injury Prevention Center, where she coordinates child abuse prevention programs and promotes primary prevention. After all, the study revealed a direct link between 10 types of childhood adversity and the adult onset of chronic disease (cancer, heart disease, diabetes, autoimmune diseases, etc.), mental illness, violence and being a victim of violence. It showed that childhood trauma was very common — two-thirds of adults have experienced at least one type. It showed that if people had experienced one, they usually experienced more. And the study showed the more types of trauma experienced, the higher the risk of chronic disease and mental illness. For example, an ACE score of 4 increased the risk of suicide by 1200 percent and alcoholism by 700 percent.
Most Iowans didn’t learn about the Centers for Disease Control’s ACE Study until early 2011. But in the three years since then, the state has completed two ACE surveys, one of them published, with a third survey underway and a fourth scheduled for 2015. Iowa has hosted three ACEs summits; two statewide summits in 2014 focus on ACEs in early childhood, and education and juvenile justice. And nearly every sector—including health care, education, social services and corrections—is busy answering the question: How do we integrate this knowledge into what we do?
“To this day, I can’t find out who knew to bring him here,” says Suzanne Mineck, president of the Mid Iowa Health Foundation, referring to physician
Robert Anda, co-principal investigator of the CDC’s Adverse Childhood Experiences Study. Anda was invited to give the keynote at the state’s annual Early Childhood Iowa Congress in 2011.
Children’s Resilience Initiative in Walla Walla, WA, draws spotlight to trauma-sensitive school — 10/7/14
In Walla Walla, Washington, the journey to implement ACEs research has been akin to a wild ride on a transformer roller coaster that arbitrarily changes its careening turns, mountainous ascents, and hair-raising plunges. And sometimes the ride just screeches to a frustrating halt.
The odyssey began in October 2007, when Teri Barila, Walla Walla County Community Network coordinator, heard Dr. Robert Anda, co-investigator of the CDC’s Adverse Childhood Experiences Study (ACE Study), speak at a Washington State Family Policy Council (FPC) event.
Without a doubt, he said, childhood trauma is the nation’s No. 1 public health problem. The ACE Study – the largest public health study you never heard of — shows that childhood trauma is very, very common. (ACE surveys in 22 states now echo the results.) And this childhood adversity causes violence, including family violence, as well as the adult onset of chronic disease and mental illness.
Simultaneously making changes at the organizational level and building alliances across sectors for larger system change, Father Jeff Putthoff, SJ, and Dr. Jeffrey Brenner realized they had to dig deeper — beyond symptoms to root causes — to understand the struggles they were witnessing in Camden, NJ. What they found were ACEs.
Putthoff, a Jesuit priest known locally as “Father Jeff,” is a fireplug of purpose under his casual uniform of cargo shorts and sweatshirt, earbuds slung around his neck, a blue bicycle his preferred mode of transport. He is voluble and passionate on the subject of his city. Since 2000, Father Jeff has directed Hopeworks N’ Camden, an organization that offers in-school and out-of-school youth GED classes and web-site design instruction—skills intended to parlay directly into jobs or college.
Brenner is equally driven—a physician/scholar/prophet in a slightly rumpled suit, with a calendar so crammed he must set a smartphone alarm to keep his days on track. He is founder and executive director of the Camden Coalition of Healthcare Providers and the recipient of a 2013 MacArthur “genius” grant. In 2011, he was profiled in The New Yorker, which chronicled his innovative plan to shrink the cost of health care by focusing on the highest-risk patients, providing them with team-based interventions to keep them out of hospitals, and by helping them manage chronic illnesses and social/emotional needs.
So, what would a trauma-informed NFL look like?
First, the NFL could recognize that childhood trauma is an epidemic, that it affects most people in the U.S. That it’s likely that the same percentage of NFL team members – and staff — have as many ACEs as the rest of the population.
And then, the NFL could implement approaches similar to other organizations that are trauma-informed:
- Educate players and staff about the science of childhood adversity and resilience. This includes learning about how common trauma is, how the toxic stress of childhood trauma harms kids’ brains and gets embedded in their bodies so that chronic disease appears decades later, how it can be passed from one generation to the next, and what the research shows about how to heal the damage.
The women and men gathered for a training on trauma and resilience were recovery counselors and social workers, charter-school teachers and prison administrators. But to Stephen Paesani, the child and adolescent training specialist who was leading the session, every person in the room was a potential protective factor in a child’s life.
“When a child experiences adversity or trauma, he goes into the fight-or-flight stance,” Paesani explained. “That’s going to impact brain development. “But no matter what happens, all of you can be the agents for resilience.”
Paesani works for Philadelphia’s Behavioral Health Training and Education Network(BHTEN), which provides training to practitioners and community members, part of the city’s effort to infuse mental health and substance abuse services with principles of recovery, resilience and self-determination.
But BHTEN’s trainings are just one piece of the Philadelphia ACEs story. In this city of 1.5 million—a city rife with disparities of class, education and health, with pockets of multi-generational poverty and trickle-down trauma—the last decade has seen a steady effort to bring understanding of adversity, trauma and resilience to thousands of front-line workers, supervisors and administrators across the map of human services.
Trauma-informed judges take gentler approach, administer problem-solving justice to stop cycle of ACEs — 9/24/14
Three years ago, Judge Lynn Tepper of Florida’s Sixth Judicial Circuit Court in Dade City, FL, learned about the CDC-Kaiser Adverse Childhood Experiences (ACE) Study The ground-breaking research links childhood abuse and neglect with adult onset of chronic disease, mental illness, violence and being a victim of violence.
It was like flipping a switch.
“I suddenly had this trauma-informed lens, as we call it. I see it everywhere,” she says, giving an example of someone in front of her on child abuse charges for whom she might recommend counseling and/or anger management. “I have discovered the reality is that when I start asking a few questions, that parent or partner has experienced ACEs,” she says.
Tarpon Springs, Florida, once known as the nation’s sponge-fishing capital, today boasts a new designation: the first city in the country to declare itself a trauma-informedcommunity.
It isn’t that the 24,000 residents of the scenic Gulf Coast town know more than the rest of us about emergency room techniques, spend their time crunching spreadsheets of violence data or watch more episodes of “America’s Most Wanted.”
Being a trauma-informed community means that Tarpon Spring has made a commitment to engage people from all sectors—education, juvenile justice, faith, housing, health care and business—in common goals. The first is to understand how personal adversity affects the community’s well being. The second is to institute resilience-building practices so that people, organizations and systems no longer traumatize already traumatized people and instead contribute to building a healthy community.
To prevent childhood trauma, pediatricians screen children and their parents…and sometimes, just parents…for childhood trauma — 7/29/14
When parents bring their four-month-olds to a well-baby checkup at the Children’s Clinic in Portland, OR, Drs. Teri Petersen, R.J. Gillespie and their 15 other partners ask the parents about their adverse childhood experiences (ACEs).
When parents bring a child who’s bouncing off the walls and having nightmares to the Bayview Child Health Center in San Francisco, Dr. Nadine Burke Harris doesn’t ask: “What’s wrong with this child?” Instead, she asks, “What happened to this child?” and calculates the child’s ACE score.
In rural northern Michigan, a teacher tells a parent that her “problem” child has ADHD and needs drugs. The parent brings the child to see Dr. Tina Marie Hahn, who experienced more childhood trauma than most people. Instead of writing a prescription, Hahn has a heart-to-heart conversation with the parent and the child about what’s happening in their lives that might be leading to the behavior, and figures out the child’s ACE score.
What’s an ACE score? Think of it as a cholesterol score for childhood trauma.
San Francisco’s El Dorado Elementary uses trauma-informed & restorative practices; suspensions drop 89% — 1/28/14
For one young student – let’s call him Martin — the 2012-2013 school year at El Dorado Elementary in the Visitacion Valley neighborhood of San Francisco was a tough one, recalls Joyce Dorado, director of UCSF HEARTS — Healthy Environments and Response to Trauma in Schools.
“He was hurting himself in the classroom, kicking the teacher, just blowing out of class many times a week.” There was good reason. The five-year-old was exposed to chronic violence and suffered traumatic losses. His explosions were normal reactions to events that overwhelmed him.
This year, Martin’s doing better. That’s because he spent months working with a HEARTS therapist, and that therapist worked with his teachers and other school staff to create a more safe and supportive learning environment. Still, on days when he feels extremely anxious, Martin sometimes asks to visit the school’s Wellness Center, a small, bright room stocked with comforting places to sit, headphones to listen to music, and soft and squishy toys.
Iowa’s 2012 ACE survey found that 55 percent of Iowans have at least one adverse childhood experience, while one in five of the state’s residents have an ACE score of 3 or higher.
In the Iowa study, there was more emotional abuse than physical and sexual abuse, while adult substance abuse was higher than other household dysfunctions.
This survey echoed the original CDC ACE Study in that as the number of types of adverse childhood experiences increase, the risk of chronic health problems — such as diabetes, depression, heart disease and cancer — increases. So does violence, becoming a victim of violence, and missing work days.
Among the many interesting graphics in the report was one that showed how 5 out of every 30 students in an Iowa classroom live with a parent who has an ACE score of 4 or more. Children who live with parents who have high ACE scores may be living in situations of toxic stress; the kids’ behavior — acting out, withdrawing, etc. — may indicate their own normal response to toxic stress.
A teen starts a fistfight with a fellow student. Another brings alcohol to school. Another urinates on a fellow student’s locker, and a fight ensues.
Three years ago at Le Grand High School, in Le Grand, CA, these students would have been immediately expelled or suspended. This year, they weren’t. They didn’t miss any classes. They made amends. They learned from their mistakes.
In 2010-2011, Principal Javier Martinez suspended 49 students and expelled six. Last year, he suspended 15 and expelled only one.
This school year, with the help of the Restorative Justice League, he’s going for double zeros.
Cornerstone Theater’s “Tangle” weaves childhood trauma into changing harsh school discipline — 9/25/13
If you’re in or near Long Beach, CA, the afternoon of Oct. 5, you might want to reserve a seat (it’s free) for a dramatic reading of the play, Tangle, and a conversation about its content and what it means for the punitive approach to school discipline.
Although I haven’t seen the play, I’ve read the script. It tells the story of how a student’s — and a teacher’s — adverse childhood experiences affect their school lives. This is the first I’ve heard of a play overtly incorporating ACEs as a principle “character”.
The approach that playwright Sigrid Gilmer used to visualize ACEs as the student and teacher interact
with one another is terrific…and that’s as much as I’ll explain. No spoilers!
There’s no such thing as a bad kid in these Spokane, WA, trauma-informed elementary schools — 8/20/13
What’s a trauma-informed school? It’s a place where this happens:
There’s this third-grade kid. Let’s call him Sam. He’s got ODD (oppositional defiant disorder…a misnomer for normal behavior a child exhibits when he’s living with chronic trauma).
Nine-year-old Sam (not his real name) is very smart. But sometimes he balked, dug his heels in deep,
refused to work in class. So his teacher sent him to see the principal. Often.
The teacher and the principal knew something about his home life. At night, Sam sleeps on a couch. Dad sleeps on the other couch. The TV’s on all day, all night. When Dad’s awake, he always has a computer in his lap. Mom drifts in and out of the home. His parents have little to do with their son. They rarely touch him.
Q-and-A with Suzanne Savall, principal of trauma-informed elementary school in Spokane, WA — 8/20/13
Suzanne Savall, principal of Otis Orchards Elementary School in Spokane’s East Valley School District, says she didn’t really know what she was signing up for, but the words “complex trauma”
resonated with her in 2008, when she heard about a workshop that was being offered by the Washington State Area Health Education Center (AHEC).
From the moment 54 teachers and support staff, including custodians and cooks, finished the six-hour workshop in 2008, they never looked back. After five years — the last two during which Natalie Turner, AHEC assistant director, and AHEC project associate Bonnie Wagner did monthly training workshops with the school’s teachers and staff, and weekly on-site consulting — Otis Orchards can call itself a trauma-informed school. What’s the difference between then and now?
Here’s a conversation that Suzanne Savall and I had about how Otis Orchards changed to a trauma-informed school, and what the effects have been.
What does ANY of the following POSSIBLY have to do with school discipline?
- Every day at 7:40 a.m., all of the school’s 570 children start their day by eating a free breakfast. In their classrooms. With their classmates.
- Every other week, the San Diego Food Bank drops off 4,000 pounds of fruits or vegetables for families of students, and another 12,000 pounds every month for the community. Nothing goes to waste.
- Once a year, all 570 children have their eyes tested, their teeth checked and a physical. Eyeglasses are free. They and their families have access to free counseling services.
- Every Friday, 100 backpacks loaded with healthy snacks go home with 100 kids (with their parents’ permission). Teachers select the kids who always seem hungry, who ask for seconds at breakfast and lunch.
- Parents are everywhere. Joking with the school office staff. Assisting teachers in classrooms. Monitoring kids on the playground. Chatting with each other in the parents’ room. Attending English classes. Computer classes. Parenting skills classes. Health and safety classes. Zumba classes.
- In the auditorium after school, fourth- and fifth-graders work with students from nearby high schools and the university; student teachers; parents; and local community members on a leadership training exercise. The program is so popular that the kids who participated last year refuse to stay away.
So what DOES any of this have to do with school discipline?
At Cherokee Point Elementary School in the City Heights district of San Diego….everything.
….but they don’t call it trauma-informed. They call it Community Mobilization.
This is a must-read about a police department in the small Canadian town of Prince Albert, Saskatchewan, pop. 35,000, that was dealing with 35,000 calls a year, which was double the number in 2001. The calls were on track to double again in eight years, until the department instituted what they call Community Mobilization, a concept they borrowed from police in Glasgow, Scotland.
Here’s an excerpt from the excellent story by Winnipeg Free Press reporter Randy Turner.
‘Starve the beast,’ say these cities, but don’t cut people off; reduce the need for services instead — 7/30/12
In a plain brick building on a tree-lined street in Albany, NY, a 67-year-old man brought to his knees from a lifetime struggle with alcohol addiction fills out a survey. Across town, on the bucolic campus of a residential treatment center for troubled teenage boys, a counselor asks a 13-year-old the same questions.
- Did a parent often swear at you, insult you, put you down or humiliate you?
- Did you see your mother being hit, pushed, slapped or kicked?
- Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
What’s the point of dredging up bad memories with these and seven other questions? Believe it or not, there’s a long-term payoff for the man, the boy and the city and county of Albany.
Strangely enough, it has to do with the short-term, beneficial effects of the drugs they’re using. Nicotine reduces anger, increases focus and relieves depression. Alcohol relieves stress.
Last week, nearly 800 adults — human services professionals, educators, judges, business leaders, philanthropists, and policy makers — sitting in a room in Des Moines, Iowa, imagined they were 12 years old. At the request of the speaker, half stood up. These kids are regular smokers, the speaker, Dr. Robert Anda, told the audience. All of those of you who are seated do not smoke, he explained. The half that are standing also have high ACE scores (ACE = adverse childhood experiences). That means that they have experienced or are living with four or more of the following:
- sexual, physical or verbal abuse;
- physical or emotional neglect;
- a parent who is diagnosed mentally ill or who is addicted to alcohol or another drug;
- a mother who is regularly beaten or verbally abused;
- a family member who is in prison;
- the loss of a parent through abandonment or divorce.
So, at the very least, these kids, the smokers, are dealing with the effects of those adverse childhood experiences — anxiety, depression, and difficulty concentrating, he explained. Nicotine makes those effects disappear….for a little while. And when they come back, what makes them go away again? Another cigarette.
Anda asked the people who were sitting to give those who were standing a round of applause for “figuring out a biochemical coping strategy”.
SINCE AT LEAST 2005, A FEW DOZEN INDIVIDUAL schools across the U.S. have adopted some type of trauma-sensitive approach. But the centers of gravity for the action are in Massachusetts and Washington. These two states lead the way in taking a district-wide approach to integrating trauma-informed practices, with an eye to state-wide adoption.
With a school-wide strategy, trauma-sensitive approaches are woven into the school’s daily activities: the classroom, the cafeteria, the halls, buses, the playground. “This enables children to feel academically, socially, emotionally and physically safe wherever they go in the school. And when children feel safe, they can calm down and learn,” says Susan Cole, director of the Trauma Learning Policy Initiative, a joint project of Harvard Law School and Massachusetts Advocates for Children. “The district needs to support the individual school to do this work. With the district on board, principals can have the latitude to put this issue on the front burner, where it belongs.”
Lincoln High School in Walla Walla, WA, tries new approach to school discipline, suspensions drop 85% — 4/23/2012
THE FIRST TIME THAT principal Jim Sporleder tried the New Approach to Student Discipline at Lincoln High School in Walla Walla, WA, he was blown away. Because it worked. In fact, it worked so well that he never went back to the Old Approach to Student Discipline. This is how it went down:
A student blows up at a teacher, drops the F-bomb. The usual approach at Lincoln – and, safe to say, at most high schools in this country – is automatic suspension. Instead, Sporleder sits the kid down and says quietly:
“Wow. Are you OK? This doesn’t sound like you. What’s going on?” He gets even more specific: “You really looked stressed. On a scale of 1-10, where are you with your anger?”
Last week, I posted a story about how a family services clinic in Port Townsend, WA, includes childhood trauma in regular health screenings for pregnant women and families. They’re doing this because the research is very clear: Toxic stress from adverse childhood experiences (ACEs) causes adult onset of chronic diseases, such as heart disease and diabetes. It causes suicide and depression. It also leads to committing violence or becoming victim of violence.
The purpose is to reduce toxic stress in children, so that they grow up to be healthier and happier.
As far as the staff at Jefferson County Public Health knows, they are the first in the country to figure out a way to integrate into their daily work the research about the consequences of adverse childhood experiences. If there are other clinics doing this, please let me know – this ACEsTooHigh community wants to hear about you.
What IS certain is that, of all the community systems in Jefferson County that support, intervene or interact with children and families, Quen Zorrah and the staff at the Family Services clinic were the first to jump in the pool. The pool, of course, is the metaphor for the place where everybody’s talking ACEs and integrating ACEs research into their everyday activities.
The big question that Jefferson County is grappling with now is: How do you get everyone else to jump into the pool?
When a pregnant woman visits the Jefferson County Public Health clinic in Port Townsend, WA, a town of about 9,000 people on the northeast tip of the Olympic Peninsula, she’s asked the typical questions about tobacco, alcohol and other drug use. She’s also screened for something that most public heath departments, ob-gyns or primary care providers don’t even consider asking: her childhood trauma.
That’s because the public health nurses at Family Health Services know that a childhood full of toxic stress causes a lifetime of health problems, and, if not addressed, is usually passed on from parent to child.
But setting up a system to screen for child trauma, which seems so logical in hindsight, wasn’t an easy thing to do, says Quen Zorrah, a public health nurse who led the effort. Even after years of talking, reading research and preparation, the staff was still reluctant. But in the end, she and her co-workers concluded: If we can teach a client to put on a condom, we can ask a client about ACEs.
It wasn’t a light-bulb moment that prompted Denise Hughes-Conlon to institute a few changes at the Pinellas Ex-offender Re-entry Coalition. It more like a nudge. Specifically, a nudge from Robin Saenger, then vice-mayor of Tarpon Springs, FL, who asked, “What small piece can you bring to Peace for Tarpon?
Hughes-Conlon’s piece? Have her clients – “not always the nicest, kindest people” she says — fill out the short 10-question version of the 200-question ACE survey.
How can answering a few questions on a survey possibly help ex-offenders or the people who help them?
PROMPTED BY RESULTS from a large study of Spokane, WA, schoolchildren that showed how childhood trauma is taking more of a toll than many imagined, an innovative project is underway that will test three types of intervention in 900 families that participate in Spokane’s Head Start program. The study of 2,100 children was done in ten elementary schools in Spokane, WA, in late 2010. The study found not only that trauma is common in kids’ lives – trauma includes divorce, homelessness, witnessing family violence, involvement with child protective services, a family member abusing alcohol or other drugs, neglect, or mental illness in a family – but it’s also the main reason that children missed school or got into trouble. It’s the second-highest predictor of academic failure, after a child being in special education classes.
TARPON SPRINGS, FL, ONCE KNOWN for harboring the nation’s largest sponge-harvesting industry, today boasts a new designation: it may be the first city in the country to declare itself a trauma-informed community. It isn’t that the 24,000 residents of the scenic Gulf Coast community know more than the rest of us about emergency room techniques, spend their time crunching spreadsheets of violence data, or watch more episodes of “America’s Most Wanted”. It means that the community has made a commitment to engage people in all walks of life – education, juvenile justice, welfare, housing, medical practices, businesses, etc. — in a common goal of less trauma…large and small, immediate and generational.