Mayday at the Bottom of the World

[Personal note: People often ask what prompted me to found PACEs Connection, which began as ACEs Connection in 2012. There are two parts to this answer: the professional part—how ACEs Connection grew out of my reporting on violence epidemiology. And the personal one, which I haven’t written about in great detail until now. It appears on HiddenCompass.net, a remarkable travel site that calls itself “the antidote to clickbait”.]

Photo: Fred Olivier/Alamy

This story contains graphic content and descriptions of sexual abuse involving a minor. Reader discretion is advised.

In my beginning is my end. — T.S. Eliot

Friday, July 24, 1998 / 2:29 a.m.
Aboard The RSV AURORA AUSTRALIS
100 miles off the Antarctic coast

One long, ear-thrumming alarm jerks me from the edge of sleep. A fire drill? At this hour?

I struggle from beneath the blankets of my narrow bunk, open the cabin door, and wince at the bright light of the ship’s empty companionway.

“Is this a drill?” I ask a scientist who stumbles past. He sleepily shakes his head and shrugs.

The alarm stops. I pause in the doorway and will the silence to settle in.

detest middle-of-the-night surprises. Always have.

~~

The edge of the mattress tilts.

But it’s the breathing that sets my heart to racing.

~~

The alarm erupts again.

“Attention! Attention, please! There’s a small fire in the engine room.” The captain’s voice, tense and remote, issues from the ship’s loudspeakers. “Please muster to the heli-deck.”

My roommate, a penguin researcher, shakes herself awake and rolls out of her bunk. She steps into her “freezer” suit, designed to withstand temperatures as low as minus 4 degrees Fahrenheit (minus 20 C). I don a turtleneck sweater, pullover, jacket, long underwear, sweatpants, socks, and wool-lined boots.

I start through the doorway and — for a reason that I will never understand — dash back into the room to grab a small flashlight. I bought it in Hobart, Tasmania, the port we’d left eight days earlier, to quiet some mind-gremlins that had been shouting at me, “Don’t go! Don’t go! Go home! Go home!”

But my home was 9,000 miles away.

I’m on a seven-week expedition aboard the research icebreaker RSV Aurora Australis with several dozen scientists, technicians, and crew to explore the winter sea ice around Antarctica — a journey I’m chronicling for the Discovery Channel.

We’re exploring one of Nature’s most mysterious phenomena: Every year, starting in May, 20 square miles of sea freeze each minute in the ocean surrounding the Antarctic continent. By July, enough sea ice will form to double the size of Antarctica.

Life abounds in this ephemeral world, but for humans, it’s one of the most isolated, forbidding places on the planet.

I trudge with others single file toward the stern. As we emerge onto the helicopter deck, I smell smoke.

It’s frigid outside. Thick clouds solidify the moonless night. Floodlights punch holes of illumination onto the deck, which is covered with a thin layer of snow. Lowered lifeboats crouch in shadows along the railings.

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Mass shootings and the news media: Catching up to the science of PACEs

How do we, as a country, learn about mass shootings and gun violence? The news media. How do we learn about the best approaches to prevent mass shootings and gun violence? The answer should be “the news media”, but it’s not. Yet.

People who know about the science of positive and adverse childhood experiences (PACEs) understand that PACEs are at the root of violence. The news media is getting there. In the last couple of years of mass shootings, more articles examined the childhood of the shooter, but more could be done, as I pointed out in essays I wrote after the Buffalo, New York, and Uvalde, Texas, shootings.

After last week’s mass shooting in Highland Park, Illinois, two new threads appeared:

  1. A deep look at the shooter’s family (and this) to address the question: Are the parents to blame?
  2. And the growing number of online communities of mostly male youth or young men that glorify violence and are obsessed with nihilism. “I’ve described this as sort of like a mass shooter creation machine,” said Alex Newhouse, deputy director of the Center on Terrorism, Extremism and Counterterrorism at the Middlebury Institute of International Studies in an interview with NPR’s Odette Yousef. “A lot of these communities are designed to spin out mass shooters over time, over and over and over.”

My take on examining shooter’s families: I think it’s great to report what happened in a shooter’s family…as long as a reporter takes a trauma-informed approach. That means reporting without using words of blame, shame or punishment…so a headline that says “Are the parents to blame?” would change to “What happened in that family?”

Parents pass on ACEs—and positive childhood experiences (PCEs), for that matter—to their children. So, if they aren’t cognizant of their own ACEs, how can they possibly understand their child’s ACEs? And where did parents get their ACEs and PCEs? From their parents and environment. How to break the cycle? Educate families, organizations and communities about PACEs science, and integrate practices and policies based on PACEs science in all organizations in every community.

My take on the online cultures of violence: At the moment, the proposed solutions are to understand the subculture and moderate the content. “It’s not hard to figure out where different violent spaces are,” Emmi Conley, an independent researcher of far-right extremist movements, digital propaganda and online subcultures told NPR. “What’s hard is what do you do once you find one, if the red flag still falls within free speech territory. Because currently we have no intervention abilities, we only have law enforcement.” I have another idea: It seems to me that these subcultures provide a perfect opportunity to reach out and help youth who are in dire need of a caring adult and counseling. That’s a project worth funding!!

Ongoing issues: There’s the ongoing issue of the news media’s obsession with mass shootings, while mostly ignoring aggregate shootings, which receive little attention. And then the dire news of too many incidents of violence that lead news organizations to not cover important stories, and in almost every community, not cover the type of violence that costs communities the most in heartbreak and dollars—family violence. This headline in the Washington Post points out that mass shootings may be going the way of family violence coverage—too little coverage to help a community figure out how to prevent the violence. There are too many mass shootings for the U.S. media to cover: News organizations must make agonizing decisions about which shootings deserve on-the-ground reporting, and for how long.

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There’s no mystery to what happened in Uvalde; there were many opportunities to prevent it .

Thousands of parents, pediatricians, social workers, educators, community advocates, kids, judges, police, district attorneys know exactly what led to Salvador Rolando Ramos running into a school and slaughtering 19 kids and two teachers in Uvalde, Texas. And what could have derailed his path, as well as the path of all other recent mass shooters.

To people educated about the consequences of too many childhood adversities and too few positive experiences, what happened in Uvalde is not a mystery.

Research has established that:

  • Adverse childhood experiences (ACEs) are the root cause of most of our economic, social, physical and mental health issues.
  • People with more than four types of ACEs and few positive childhood experiences have an extraordinarily high risk of violence as both victims and perpetrators, cancer, heart disease, mental illness, alcoholism and drug use, and dying prematurely.
  • What’s an ACE? The 10 in the original CDC-Kaiser Permanente Adverse Childhood Experiences Study include physical and emotional abuse, physical and emotional neglect, sexual abuse, a parent who is addicted to alcohol or other drugs, who is depressed or mentally ill, a mother who is abused, an incarcerated family member, divorced or separated caregivers. More than 30 other ACEs have been added since the 1998 study include bullying, racism, community violence, and homelessness.
  • People who are denied economic stability, adequate housing, education and wealth because of local, state and federal policies (a.k.a., ‘being poor’) are burdened with the highest ACEs but have fewer resources to mitigate toxic stress stemming from ACEs; in the U.S., inequities are compounded by racism affecting people of color and other minorities. But as the last three weeks of shootings show, everybody has ACEs or is affected by them.

Ramos had, at minimum, five types of childhood adversity that lasted for years. He experienced extreme bullying; an abusive relationship with his mother; his mother’s reported substance abuse; an absent father; and a disability (stuttering, lisp) for which kids taunted him mercilessly. We know little about his early childhood, where more ACEs may be lurking.

A child that experiences toxic stress from ACEs exhibits a fight, flee or freeze response. Ongoing toxic stress damages kids’ developing brains, and leads to them to exhibit coping behaviors, such as engaging in violence. Ramos coped with his distraught feelings by harming himself (he cut his face repeatedly with a knife) and violence, including fighting often with peers.

Of the seven positive experiences that research shows can ameliorate ACEs, Ramos apparently had only two: neighbors who cared about him and, until a while before the shooting, friends. As for the other ways that could have probably prevented him going on a shooting rampage—able to talk with his family about his feelings, feeling as if his family stood by him in tough times, participating in community, a sense of belonging in high school, and feeling safe and protected by an adult in the home—he clearly had none.

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PACEs champion Rebeccah Ndung’u launches trauma-informed schools in Kenya

[Ed. note: This is a continuing series of articles about people who are involved and contributing in the movement to implement practices and policies based on the science of positive and adverse childhood experiences.]

Growing up as the eldest daughter in a family of three girls and three boys in Nairobi, Kenya, Becky Ndung’u and all her siblings attended school, which is mandatory for children ages six through 14. Her parents—both farmers and her father also a lifelong government accountant—were committed to providing all their children a good education.

Her education began in a public school, followed by a private high school. Our conversation was conducted in English, but Ndung’u is also fluent in her native languages, Kikuyu and Kiswahili.

After graduating from high school, the young scientist earned a “higher diploma”—equivalent to a bachelor’s degree—in analytical chemistry in 2000 at what is now the Technical University of Kenya and then went on to earn a higher diploma in soil science in 2003 at what is now the Jomo Kenyatta University of Agriculture and Technology.

Not able to find a job in her field, she opted to work in schools as a science lab assistant, organizing and teaching lessons in biology, chemistry, and physics. She also prepared students for the exams they needed to matriculate from secondary schools.

She recounted that during this time, she was often asked to teach biology and chemistry when the teacher was absent. As a result, she says, “I learned a lot about how school systems work, their challenges in terms of teachers being overworked, discipline in learners, poor academic performances, and the struggles of parents to pay school fees.”

From Science Assistant to Educational Psychologist

But she had no desire to become a teacher herself. “I wanted to help the schools but not as a teacher,” she explains. “My focus was helping learners improve their academic performance and acquiring the discipline to avoid dropping out of the school. But in Kenya, there is no provision for educational psychologists in the education system.”

After earning a diploma online in educational psychology and emotional intelligence at the University of Ireland in 2020, she started working on her own as an educational psychologist. She acquired students by word of mouth from parents. “Amazingly,” she said, “I was able to help kids with behavior problems, learning difficulties, poor academic performances, and learners with special needs.”

Before learning about the science of adverse childhood experiences (ACEs), Ndung’u’s knowledge about emotional intelligence (EQ) opened her eyes as to why children acted out and misbehaved in the classroom.

She recalls having to remove two sisters, ages six and eight, with severe dyslexia from the classroom because they couldn’t read at their grade levels. She used her EQ skills to get the sisters to open up and talk about their issues. She also involved their parents so that they could understand what their children were experiencing and to explain what needed to be done. She secured the students a special needs teacher, who home-schooled them for eight months. Later, they were both successfully integrated back into the schoolroom.

Learning About ACEs

While working with children, the trauma educator heard a talk by Dr. Angie Yonda-Maina, director of Green String Network, a nonprofit dedicated to peacebuilding through practices related to trauma, justice, spirituality, and security. Ndung’u was struck by a poster presented in the doctor’s talk that included a reference to ACEs.

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Research shows only a tiny percentage of physicians integrating PACEs science

Three relatively recent studies from different parts of the U.S. show that only a tiny percentage of physicians, medical school faculty and other healthcare providers are integrating practices and policies based on the science of positive and adverse childhood experiences (PACEs).

Why it matters: For people in the PACEs community, the following is news that’s 20 years old: Adverse childhood experiences are common, preventable and linked to six out of the top ten leading causes of death in the United States.

As one of the studies noted: “Positive and negative experiences in childhood shape our trajectory of health or illness for our entire lives, and this impact can be attributed to the brain-body physiology that results from our experiences during childhood.”

The science is well established. Thousands of research papers have been published about the long- and short-term health effects. Every U.S. state has done an ACE survey, many more than one. Legislation addressing childhood trauma and PACEs science has been passed in 39 states. Dozens of books have been written about the topic, including two bestsellers; one of those—Bessel van der Kolk’s The Body Keeps the Score—has been on the New York Times paperback bestseller list for 178 weeks. Physicians who have been early adopters for more than a decade say they would never go back to not integrating it into their practices.

In 2016, only eight out of 192 medical schools included content about childhood trauma, and that could be just a single lecture. Early adopters in the medical community know that if PACEs science isn’t integrated into medical schools, benefits of its knowledge will never get to patients. And people WANT their doctors to know about this. Donna Jackson Nakazawa, author of Childhood Disrupted: How Your Biography Becomes Your Biology and How You Can Heal, posted this article on ACEsTooHigh.com: Childhood trauma leads to lifelong chronic illness—so why isn’t the medical community helping patients? It’s had more than two million page views and hundreds of comments.

Who did the studies and why? In Muskegon County, MI, Resilience Muskegon, a community organization created by mental health agency HealthWest, did a survey of county residents that showed a huge disconnect between the healthcare system, which is highly rated, and the health of people in the county. A local ACE survey showed that 31.4 percent of adults have experienced 4 or more ACEs, nearly three times the number in the original CDC-Kaiser Permanente Adverse Childhood Experiences Study, which showed 12.5 percent had an ACE score of 4 or higher. This prompted researchers to recruit 226 physicians from Mercy Health, a hospital and healthcare system that serves 85% of the county, to participate. They asked if they knew about ACEs science, if they used it in their practice, and if they had a personal history of ACEs.

In Texas, researchers from the University of Texas and the University at Albany, NY, recruited 85 healthcare providers from Central Texas that included physicians, nurses, social workers and other staff who were at least 18 years old and providing care in a medical setting to women or children in Central Texas. Going into the study they thought that most healthcare workers would know about ACEs. They thought that most screened for traditional ACEs such as substance use or mental health issues, more often than ACEs such as bullying or community violence, and they thought that most patients would self-disclose common ACEs. They also thought that healthcare providers familiar with ACEs would implement ACE-informed strategies for patients, such as providing resources for patients or creating an ACE-informed culture in their practice. They were remarkably off target.

In Illinois, a team comprising three medical students and four medical school faculty noticed that “very, very few of our colleagues knew anything about childhood trauma,” says Dr. Audrey Stillerman, one of the authors who is clinical assistant professor in the Department of Family and Community Medicine at the University of Illinois at Chicago. They were also interested in why this science that has existed for decades hasn’t been integrated into medical education so that it could become a part of clinical practice. What’s the rub? they wondered. Why isn’t medical education just different now? The team developed a survey to explore these questions; 81 faculty members from the University of Illinois College of Medicine and Rush Medical College in Illinois responded.

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How Vladimir Putin’s childhood is affecting us all

Examine Vladimir Putin’s childhood and you will see an eerie parallel to the atrocities playing out in Ukraine today. His life is a stark example of how childhood adversity is the root cause of most social, economic and mental health issues, as well as violence and chronic disease, as the science of positive and adverse childhood experiences demonstrates.

And while we can’t change the Russian president, we can encourage and educate people not to create more Putins by recognizing how childhood adversity impacts us throughout our lives and by integrating solutions into our healthcare, education, justice and economic systems.

Born in 1952 Leningrad, Putin was a street kid in a city devastated by a horrific, three-year siege by the Nazis during WWII, a genocide described as the world’s most destructive siege of a city. Most of the population of three million people died, one million starving to death. Putin’s father was badly injured in the war, his mother nearly died of starvation. Living in a rat-infested apartment with two other families, the family had no hot water, no bathtub, a broken-down toilet, little or no heat. His father worked in a factory; his mother did odd jobs she could find. A small child, whose two older siblings are believed to have been lost to war and disease, Putin was left to fend for himself, severely bullied by other children.

From his parents he inherited their wartime trauma personified by Nazi forces threatening their existence, ravaging their city and killing their friends and family. With his parents struggling to survive, they were absent or too traumatized to be attentive to their son. There’s no mention of other family members: no grandparents, aunts, uncles, cousins. Kindness and affection didn’t seem to have been part of the child Putin’s world.

While the experiences of childhood adversity piled up, two positive experiences changed his trajectory: After years of being labeled a troublemaker in school, a sixth-grade teacher helped him realize his potential. He excelled in high school, learned judo to defend himself, got a law degree and was selected to join the KGB. But the damage that led to his current behavior was done. It produced a machismo man, distrustful and unpredictable, and who cultivates disinformation to advance his own agenda at any cost. 

In her essay, The Ignorance or How We Produce the Evil,” psychologist Alice Miller wrote: “Children who are given love, respect, understanding, kindness and warmth will naturally develop different characteristics from those who experience neglect, contempt, violence or abuse and never have anyone they can turn to for kindness and affection. Such absence of trust and love is a common denominator….All the childhood histories of serial killers and dictators I have examined showed them without exception to have been the victims of extreme cruelty, although they themselves steadfastly denied this.”

Research shows that early abuse and neglect damages an infant’s developing brain. If a child suffers abuse and neglect for years without intervention, the consequences can be dire. As Dr. Bruce Perry, co-author with Oprah Winfrey of What Happened to You? Conversations on Trauma, Resilience and Healing, says, the more healthy relationships a child has, the more likely they will be to recover from trauma and thrive. Relationships are the agents of change and the most powerful therapy is human love.” 

But without that love in their childhoods, abused people in power can do serious damage. Hitler, Stalin and Mao Zedung all suffered years of merciless beatings and other unconscionable abuse in childhood and went on to be responsible for the deaths of millions of people. In Mao’s case, 35 million people. Of course, dictators can’t become dictators absent an environment that supports their ability to accumulate power. In The Real War, Richard Nixon pointed out that the “Darwinian forces of the Soviet system produce not only ruthless leaders, but clever ones.” Stalin killed nearly a million people each year he was in power; in 1938 he sent Khrushchev to Ukraine where he proved his ruthless ways by eliminating 163 out of 166 members of that country’s Central Committee. Of course, not everyone who has an abusive childhood grows up to abuse others; but it’s safe to say that all abusive dictators and autocrats had a childhood filled with abuse and/or neglect, and not enough love. 

So, Putin’s statements on and after Feb. 23, are chilling and revealing: “The purpose of this operation is to protect people who, for eight years now, have been facing humiliation and genocide perpetrated by

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Childcare providers use two-generational approach to help preschoolers from being expelled

It’s shocking: Preschoolers are three times more likely to be expelled than children in elementary, middle and high school, according to figures from the U.S. Department of Health & Human Services. Boys are four times more likely than girls to be kicked out, and African American children are twice as likely as Latinx and White children.

One organization with childcare centers and mental health providers in Kentucky and Ohio began a long journey 15 years ago, when they began hearing about young kids getting expelled. By integrating a whole family approach and the science of adverse childhood experiences, the Consortium for Resilient Young Children (CRYC) took a radically different approach to help little kids stay in school.

Carolyn
Carolyn Brinkmann

“We came together 15 years ago to start addressing the growing need for social emotional supports for young children,” says Carolyn Brinkmann. “Our organizations were getting phone calls from their own programs about younger children being expelled from preschool and childcare, and we tried to figure out how to start responding to that.”

Brinkmann is the director for the Resilient Children and Families Program (RCFP), a coaching and training arm of the CRYC. The CRYC comprises five childcare or educational agencies and three mental health provider agencies in southwest Ohio and northern Kentucky. The RCFP provides coaching and training to around 50 community-based programs that serve around 1,541 children.

Brinkmann and her colleagues began by looking for programs that address stressors and promote resilience in the whole family.

“We’re not working with little ones in a vacuum,” says Whitney Cundiff, the team leader of early childhood services for Northkey Community Care in Covington, Kentucky, part of the consortium. Along with Brinkmann, Cundiff led the research and training for the Consortium and they decided to use something commonly known as a two-generational approach—little kids and their parents or caregivers.

Whitney
Whitney Cundiff

In 2008, Brinkmann trained childcare providers in the Strengthening Families Protective Factors approach, a framework developed by the Center for the Study of Social Policy. It includes building resilience in parents, strengthening families’ social connections in their communities, educating parents about child development, and helping parents link up with organizations that can help them when they’re struggling to feed and house their families or provide other basic needs. It does not, however, train people in PACEs science.

Then, in 2016, the RCFP joined a Cincinnati-based collaborative called Joining Forces for Children, a cross-sector collaborative that focuses on building resilience and preventing adversity in children and families. Among its founding members was Cincinnati Children’s Hospital pediatrician, Dr. Robert Shapiro, who was interested in their two-generational focus.

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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.

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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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Tributes honor the life of Rep. Elijah Cummings of Baltimore

IMG_1791

Image projected on a building of a younger Rep. Cummings taken on a street in his native Baltimore. From an unknown source, projected images and messages appear on the side of a building near my house in the Mt. Pleasant neighborhood of Washington, DC.

When the news alert came across my cell phone on Thursday morning that Elijah Cummings had died, I felt overwhelming sadness for the loss of a powerful, eloquent, and soulful human who understood trauma in his bones.  An immediate second thought was he died too soon as do many other African Americans whose lifespan is shorter by years than white people’s. Then I wondered how we can honor his legacy by building on what he started dramatically in the House Oversight and Reform Committee with the first hearing of its kind on July 11 this year (Click here for a story on the hearing in ACEs Connection).

Just the day before the news of Cummings’ death, I had read an email from Dan Press who leads the advocacy work for the Campaign for Trauma-Informed Policy and Practice (CTIPP) updating me and other members of the CTIPP Board about the latest thinking of Cummings and his staff about the advisability of moving ahead at this time with comprehensive legislation on trauma.  The strategy was fluid but it was clear that Cummings was engaged and focused on the what, when, and how of promising next steps with legislation.

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