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.

“My mom sold me to her tricks and her pimps from the age of three to the age of six,” she begins. “I could remember these grown men molesting me and my sisters. I have three sisters and we all went through this,” she says.

When she was 13, some adults enticed her to start smoking crack cocaine. “They knew if they got me strung out on drugs, they could sell me easily from person to person and that is what they did,” she says matter-of-factly. For the next 20 years, she tells them, she stole things, beat up a lot of people, and was homeless and in and out of the penitentiary.

“I tell this story very plainly and you can see their mouths drop open,” Cochran says. It’s exactly the effect she’s aiming for – that her story doesn’t match the wonky-looking teacher standing in front of them. It’s partly a lesson, she says, about making snap judgments based on appearances.

And that lets Cochran offer a deeper lesson: “Nobody is born thinking ‘I want to be a dope fiend. I want to be a criminal.’”

Cochran asks the medical residents to consider that under the circumstances she was thrust into as a 13-year-old, using crack actually helped her survive her trauma. “It made me feel beautiful. It made me feel invincible, like nothing can hurt me!”

At that point she says, she can see a light bulb go on in the students. “They think, ‘Wow, this is a little girl at 13 making a bad decision, but with the best information she had available to her at that time.”

This is how Cochran opens the door to the CDC-Kaiser Permanente Adverse Childhood Experiences Study, the groundbreaking research by the CDC and Kaiser Permanente that looked at 10 types of childhood trauma. This includes: physical, emotional and sexual abuse, physical and emotional neglect, living with a family member who’s addicted to alcohol or other substances, or who has mental illness. It also includes experiencing parental divorce or separation, having a family member who’s incarcerated, and witnessing neighborhood or family violence, such as a mother being abused.

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Montefiore Medical in Bronx screens 12,000+ kids for adverse childhood experiences

Image courtesy of Creative Commons/Flickr/ Family drawing-Meggy

Since 2016, more than 12,000 children have been screened for adverse childhood experiences (ACEs) at Montefiore Medical Center in Bronx, New York, according to Miguelina German, the director of Quality & Research in the Pediatric Behavioral Health Integration Program and project director of Trauma Informed Care at the center.

Parents of infants are asked to fill out ACE scores for themselves and their infants.

“They’re told words to the effect: ‘We know that when a parent has a rough go of it growing up, it can make parenting more challenging and more difficult. We ask these questions because we want to support children and families coming to this clinic in whatever way they might need,'” explains German. Pediatricians also explain that higher ACE scores are tied to long-term impact on their child’s health.

If parents or their infants have ACE scores of 4 or higher, they’re automatically offered a referral to the onsite HealthySteps program, which the center says is designed “to ensure that parents and babies are started on the right track.” For children one year and older, a parent is asked to complete an ACE screen on their child,but not for themselves, and if the child’s score is 4 or higher, they’re also referred to HealthySteps. Children over the age of five are referred to the onsite Child and Adolescent Psychology/Psychiatry (CAPP). Both are part of Montefiore’s Pediatric Behavioral Health Integration program. Pediatricians may also elect to refer children to either program if they have any other concerns, regardless of the child’s ACE score, says German.

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Miguelina German

HealthySteps offers a wealth of support services, including a hotline for infant and toddler care questions, optional home visits, parents’ discussion groups, and onsite treatment for parents with depression, anxiety and other mental health issues.

ACEs refer to the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking research that looked at how 10 types of childhood trauma affect long-term health. They include: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused.

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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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Custody in crisis: How family courts put children in danger

acourts

Six years ago, in 2010, an appellate court in Tennessee affirmed a family court ruling that had awarded Darryl Sawyer* primary custody of his six-and-a-half-year-old son, Daniel.

The court ruled in favor of Sawyer despite evidence presented by his ex-wife that alleged he had sexually abused their child.

Three years earlier, Daniel returned from a visit with his father with suspicious bruises on his bottom. His mother, Karen Gill, immediately took the three-year-old boy to his pediatrician.

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