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

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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.

Iowa ACEs360: Catalyzing a Movement

Iowa ACEs Policy Coalition joins Iowa Gov. Kim Reynolds as she signs a “Resilient Iowa” proclamation in 2018. Photo courtesy of Lisa Cushatt.

For years, advocates for a statewide children’s mental health system would stand before Iowa legislators and speak passionately about their own particular concerns.

Psychiatrists pointed to a need for more inpatient beds for youth with severe mental illness. Pediatricians said the answer was better screening to identify mental health issues in children from birth to age five. Educators wanted more school-based mental health services, and advocates from grassroots groups like the National Alliance on Mental Illness (NAMI) asked for increased crisis services.

“We were all saying, ‘Throw money at this issue,’” says Chaney Yeast, co-chair of the policy coalition of Central Iowa ACEs 360, a multi-sector network formed in 2012. “That confused legislators; they felt it was this black hole, and they didn’t act.”

This year—thanks in part to connections forged by Iowa ACEs 360—advocates for a comprehensive child behavioral health system told a single story: Children whose mental health needs are met will be more likely to graduate, be employed and become productive members of the community. Current mental health services for children are fragmented and inconsistent. We know what it would take to fix that.

Group after group that testified before Iowa legislative committee members—officials from the sheriff’s department, mental health providers, community advocates, child welfare workers—drummed home talking points that the ACEs policy coalition had developed with a public policy messaging and research firm.

“That common messaging hit home. We were all on the same page,” says Yeast. The bill—which requires Iowa counties to implement a coordinated array of preventive, diagnostic and treatment services for children, and calls for parents of children with mental health issues to have a voice in designing those services—passed the legislature in April and was signed by the state’s governor in May.

“That was a huge win in terms of collaboration,” says Yeast. It was also a clear example of the power that cross-sector networks can wield when members move beyond their own silos to support a shared goal. Such work is not easy—“It takes a lot of time and effort to continually nurture those relationships and connections,” says Yeast—but it is essential to making long-term, systemic change.

That’s been the ambition of Iowa ACEs 360 since its start, when a small group of stakeholders—in public health, mental health, family support and community advocacy—gathered, with the support of the Mid-Iowa Health Foundation (MIHF), to discuss the original CDC-Kaiser Permanente ACE Study and how their work needed to change in response.

That group decided on two priorities: collect Iowa ACE data and spread awareness of the ACE Study, so others could be galvanized by its findings on the lifelong, corrosive effects of early childhood adversity.

After Rob Anda, the co-investigator of the 1998 ACE Study, did a presentation about the ACE Study to a small group of key stakeholders, an early step was to include the ACE module in Iowa’s Behavioral Risk Factor Surveillance System (BRFSS). Following an invitation-only summit in 2011 that featured a follow-up with Anda, he and Laura Porter, a nationally known expert on ACEs and population health, spoke to 800 people at the 2012 Iowa ACE Summit.

Suzanne Mineck, president of MIHF and one of the original committee members who launched ACEs 360, says “water cooler conversations” in the weeks following Anda’s visits that gave the work momentum. “We all had the privilege of learning about compelling research, but it was the lingering impact, both on those in decision-making places and those on the front lines, that was as much of an ‘aha.’”

As the coalition grew, hosting quarterly learning circles, developing work groups and, in 2014, acquiring a part-time program manager, it became a place where people from various sectors—juvenile justice, child welfare, health care and education—could learn together.

“It created a culture where there wasn’t a singular response…a culture of transparency, humility, honoring and supporting risk-taking,” says Mineck. “Many felt they were learning things for the first time together.”

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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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CA announces robust perinatal depression prevention for Medi-Cal recipients

Melinda Coates experienced a tumultuous pregnancy. “I was really mentally upset literally from day one (of the pregnancy),” she says. (Melinda Coates is a pseudonym. To protect her and her children’s privacy and safety, we are not using her real name.)

Coates had hoped to get counseling last October, when she was seven months pregnant. That’s when she enrolled in the state’s Medi-Cal program, shortly after she and her abusive husband moved to California, “but nobody was able to get me in that quickly,” she says. “If I had gotten the help that I needed with my mental state, I may not have stayed in my abusive marriage as long,” she says.

Six weeks after her son’s birth she had one session with a counselor who prescribed an antidepressant. “I was supposed to go back, and I needed to reschedule, but I never heard from her again,” says Coates, who has been living in a domestic violence shelter since the end of June with her eight-month-old son and three-year-old daughter. She is currently separated and filing for a divorce from her husband.

A new policy in California that went into effect in July now makes it possible for pregnant women like Coates to get the counseling they need, according to a recently-released MediCal bulletin.

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