The quest to find biomarkers for toxic stress, resilience in children — A Q-and-A with Jack Shonkoff

The JPB Research Network on Toxic Stress, led by Dr. Jack Shonkoff, is working on developing biological and behavioral markers for adverse childhood experiences (ACEs) and resilience that they believe will be able to measure to what extent a child is experiencing toxic stress, and what effect that stress may be having on the child’s brain and development.

The JPB Research Network on Toxic Stress is comprised of scientists, pediatricians and community leaders, and is a project of the Center on the Developing Child at Harvard University.

Jack P. Shonkoff, M.D. is the Julius B. Richmond FAMRI Professor of Child Health and Development at the Harvard T.H. Chan School of Public Health and Harvard Graduate School of Education; Professor of Pediatrics at Harvard Medical School and Boston Children’s Hospital; and Director of the Center on the Developing Child at Harvard University. He currently chairs the National Scientific Council on the Developing Child, whose mission is to bring credible science to bear on public policy affecting children and families, and The JPB Research Network on Toxic Stress. In 2011, he launched Frontiers of Innovation, a multi-sector R&D platform committed to achieving breakthrough outcomes at scale for young children facing adversity.

Dr. Shonkoff was interviewed by filmmaker Roger Weisberg about the innovations in research around developing ways of measuring toxic stress in Weisberg’s documentary Broken Placeswhich will be previewed at the National ACEs Conference. That interview was the impetus for the following conversation.

Laurie Udesky: In your interview with the filmmaker Roger Weisberg for the documentary Broken Places you said:

“We will have a measure to be able to differentiate between children who seem to be more sensitive to adversity and therefore need more attention. And at the same time this will be a measure of resilience because there are a lot of children living in very tough environments who are doing well and whose parents are doing a magnificent job. That’s the big breakthrough. It’s being able to measure this at an individual level.”

Laurie Udesky: Where is the science now in our ability to measure and differentiate children with ACEs who are more sensitive to adversity from those who are less so? 

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Dr. Jack Shonkoff

Dr. Jack Shonkoff: It’s very close; the measurement battery we’re working on is no more than a couple of years away from being ready to start being used widely in pediatric settings.

Basically what we’re talking about is the JPB Research Network on Toxic Stress, and I direct that group standing on the shoulders of a dream team of scientists, and a dream team of practicing pediatricians, and a dream team of community leaders, primarily community leaders of color, who have collectively been working together three and a half years now as coequal partners on this. And the reason that’s important is because there’s obviously a scientific dimension to this, which

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Kaiser family medicine clinic launches 4-question ACE survey pilot for adults

In July, medical residents in family medicine at Kaiser Permanente in San Jose, CA, began screening adult patients for adverse childhood experiences (ACEs). But it’s an ACE survey with a twist: it’s shorter, not the  10-question survey of the original CDC-Kaiser Permanente ACE Study, according to Dr. Kathryn Ridout who is leading the pilot along with Dr. Francis Chu and Dr. Alec Uy.

Why a shorter ACE survey?

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“When we were doing our initial discussions with stakeholders in the clinical setting, one of the barriers was the perception of the amount of time it takes to do a screening,” says Ridout. So, she and her colleagues developed a shorter ACE survey of four questions. The questions were adapted from the original ACEs screen of 10 questions as well as expanded ACE surveys that include statements about experiencing bullying or racism, living in a war zone, or in a violent neighborhood. (Since the four-question survey is currently being piloted, it’s not yet available for public release, according to Ridout.)

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Oakland, CA, trying out model used in Baltimore to reduce trauma, increase resilience

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Baltimore BSC faculty and planning team

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When a group of community organizations in Baltimore came together in 2015, they already knew trauma figured large in many lives. There was violence in the community, in schools, and in community members’ homes. Police brutality occurred. Many suffered the loss of loved ones to incarceration or death. There were house fires and homelessness. Much of the dysfunction was systemic and rooted in racism, according to a report on a collaborative effort to restructure city organizations and agencies. The goal was to build community resilience.

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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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Study unearths patterns in ACE scores in San Jose, CA, homeless population

It was around 2010 that Dr. Angela Bymaster was seeing a disturbing pattern in the histories of her adult patients. She already knew that patients who saw her at the Valley Homeless Health Care Program in San Jose, CA, where she worked at the time, were homeless or recently homeless. What was most troubling to Bymaster was knowing that their current precarious existence could have been prevented.

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Dr. Angela Bymaster

“Over and over and over again I was hearing the same stories of abuse in childhood and neglect, incarceration, moving around a lot, a lot of trauma for them as children,” said Bymaster, who as a family physician always took her adult patients’ in depth pediatric histories. She now works for the Washington Neighborhood Health Clinic, a school health clinic in San Jose that’s part of a non-profit School Health Clinics of Santa Clara County.

Bymaster became aware of the landmark CDC/Kaiser Permanente Adverse Childhood Experiences Study in 2007. The study showed a link between 10 types of childhood trauma and adult onset of chronic disease, violence and being a victim of violence, among other outcomes.

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Middle school tackles everybody’s trauma; result is calmer, happier kids, teachers and big drop in suspensions

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John Jimno

During the 2014/2015 school year, things were looking grim at Park Middle School in Antioch, CA. At the time, staff couldn’t corral student disruptions. Teacher morale was plummeting. By the end of February 2015, 192 kids of the 997 students had been suspended — 19.2 percent of the student population.

“I was watching really good people burning out from the [teaching] profession and suspending kids over and over and nothing was changing behavior-wise, and teachers were not happy about it,” says John Jimno, who was in his second year as principal at that time.

So, Jimno and the staff took advantage of a program that Contra Costa County was integrating into its Youth Justice Initiative and, in doing so, joined a national trauma-informed school movement that has seen hundreds of schools across the country essentially replace a “What’s wrong with you?” approach to dealing with kids who are having troubles with asking kids, “What happened to you?”, and then providing them help.

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Early childhood educators learn new ways to spot trauma triggers, build resiliency in preschoolers

Julie Kurtz, co-director, trauma-informed practices in early childhood education, WestEd Center for Child & Family Studies/photo by Laurie Udesky

A hug may be comforting to many children, but for a child who has experienced trauma, it may not feel safe.

That’s an example used by Julie Kurtz, co-director of trauma-informed practices in early childhood education at the WestEd Center for Child & Family Studies (CCFS), as she begins a trauma training session. Her audience, preschool teachers and staff of the San Francisco, CA-based Wu Yee Children’s Services at San Francisco’s Women’s Building, listen attentively.

Kurtz leads them into a description of how a child’s young brain functions, how young children – regardless of whether they have experienced trauma or not — live in their reptile brain.

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