The myth of motive in mass shootings

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Photo: Vernon Bryant, Dallas Morning News

Almost the first thing you hear out of the mouths of police after a mass shooting is: “We’re looking for a motive.”

In Gilroy, CA, the FBI is investigating the shooting at the Gilroy Garlic Festival as domestic terrorism. In El Paso, TX, police are describing the shooting as a possible hate crime and act of domestic terrorism, and focusing on the manifesto written by the shooter. Police in Dayton, OH, are still looking for a motive for why 24-year-old Connor Betts murdered nine people in 30 seconds.

But if we want to prevent shootings, asking about motive will just get you a useless answer to the wrong question. Police might feel as if they have an explanation for why 19-year-old Santino William Legan murdered three people, and why 21-year-old Patrick Crusius murdered 22 people. But motives don’t explain the roots of why those three young men, or any other mass shooters or bombers, foreign or domestic, start their journey as innocent babies and end up on a road to killing people. And in those roots, are our solutions.

If you use the lens of the science of adverse childhood experiences, the answer reveals itself, and usually pretty quickly.

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Medical students’ ACE scores mirror general population, study finds

national survey published in 2014 revealed a disturbing finding. Compared to college graduates pursuing other professions, medical students, residents and early career physicians experienced a higher degree of burnout.

Citing that article, a group of researchers at University of California at Davis School of Medicine wondered whether medical students’ childhood adversity and resilience played a role in their burnout, said Dr. Andres Sciolla, an associate professor of psychiatry and behavioral sciences at the University of California at Davis Medical School. Sciolla is the lead author of a recent study in the journal Academic Psychiatry that investigated those questions.

Their query was based on the landmark CDC-Kaiser Permanente Adverse Childhood Experiences Studythat showed a remarkable link between 10 types of childhood trauma — such as witnessing a mother being hit, living with a family member who is addicted to alcohol or who is mentally ill, living with a parent who is emotionally abusive, experiencing divorce — and the adult onset of chronic disease, mental illness, being violent or a victim of violence, among many other consequences. The study found that two-thirds of the more than 17,000 participants had an ACE score of at least one, and 12 percent had an ACE score of four or more. (For more information, see ACEs Science 101.)

The ACE Study and subsequent research shows that people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic than someone with an ACE score of 0. Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1200 percent. An ACE score of 6 or higher is associated with a 20-year shorter lifespan than someone with an ACE score of 0. However, subsequent research has shown that social buffers, such as having just one caring adult in a child’s life, can mitigate the impact of ACEs.

For the UC Davis study, 86 third-year medical students completed an ACE survey. Of those, 49% had an ACE score of 0, 40 % had ACE scores between 1-3, and 12 % had ACE scores of 4 or more.

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Personal stories from witnesses, U.S. representatives provided an emotional wallop to House Oversight and Reform Committee hearing on childhood trauma

William Kellibrew's grandmother receives standing ovation

Room erupts in applause for the grandmother of witness William Kellibrew during July 11 House Oversight and Reform Committee hearing.

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The power of personal stories from witnesses and committee members fueled the July 11 hearing on childhood trauma in the House Oversight and Reform Committee* throughout the nearly four hours of often emotional and searing testimony and member questions and statements (Click here for 3:47 hour video). The hearing was organized into a two panels—testimony from survivors followed by statements from experts—but personal experiences relayed by witnesses (including the experts) and the members of Congress blurred the lines of traditional roles.

Chairman Cummings
Chairman Elijah Cummings
Ranking Committee member Jim Jordan (R-OH)
Ranking member Jim Jordon (OH)

Chairman Elijah Cummings (D-MD) set the tone early in the hearing by recalling his childhood experience of being in special education from kindergarten to sixth grade, and being told he would “never be able to read or write.”  Still, he “ended up a Phi Beta Kappa and a lawyer.”

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Talking ACEs and building resilience in prison

WA-Penitentiary_Exterior

They’re the forgotten, the 2.3 million people in US prisons. The overwhelming majority of them have experienced significant childhood trauma. Before you click out of here, this isn’t another boo-hoo story, as some of you might describe it, about the dismal state of our corrections system, for inmates and guards alike. (Oh, yes, it is profoundly dismal.) This is a story about how one tiny part of it isn’t so dismal, and actually addresses head-on the fact that most (91 percent) of the approximately 2.3 million prisoners will finish their sentences and go home. To your neighborhood. So….wouldn’t you want the prisons to help these guys and gals so that they, and by definition, we, come out happier and more well-adjusted than when they went in?

Well, yea-uh.

Ok. Just in case you glossed over it, let’s go back to that sentence about childhood trauma. It is precisely why the 2,300 inmates at Washington State Penitentiary in Walla Walla, Wash., ended up there. Over the last 20 years some profound, intense research revealed that people who have a lot of childhood adversity have seven times the risk of becoming an alcoholic, 12 times the risk of attempted suicide, twice the risk of cancer and heart attacks. They’re more violent, more likely to be victims of violence, have more broken bones, more marriages, and use prescription drugs more often than people who have no childhood adversity. And those are just the few drops in the bucket of how childhood trauma affects people’s lives.

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Shifting the focus from trauma to compassion

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Dr. Arnd Herz

Dr. Arnd Herz, a self-described champion for ACEs science, would like nothing more than to witness a greater appreciation of how widespread adverse childhood experiences are. Herz, a pediatrician and director of Medi-Cal Strategy for the Greater Southern Alameda Area for Kaiser Permanente Northern California, would also like to encourage more people in health care to engage in a trauma-informed care approach, a change in practice that he says not only benefits patients, but also health care providers and their staff.

“It makes so much sense,” say Herz. “This is why I went into medicine. I don’t want to just click off diagnoses, but create relationships and help people by understanding them better, and trauma-informed care is just a way to bring compassion back into the care that we do.”

For the uninitiated, a trauma-informed approach includes an awareness that adverse childhood experiences (ACEs) are common, knowing how to recognize the signs and symptoms of trauma, creating a safe environment where the focus is on “What happened to you?” rather than “What’s wrong with you?”, engaging trauma survivors as equal decision-makers in their care, and offering patients referrals to supportive services as needed, according to a report by the Substance Abuse and Mental Health Services Administration and a primer by the Center for Health Care Strategies.

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Investing in cross-sector networks to build a trauma-informed region

Participants at a Pottstown Trauma Informed Community Connection community meeting, which typically draw between 75 and 130 people. Courtesy of Valerie Jackson/PTICC.

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When Suzanne O’Connor first joined the Philadelphia ACE Task Force (PATF)—a group then composed mostly of pediatricians who wanted to put ACE science into practice—she did more listening than talking.

“I wasn’t a doctor, I wasn’t a clinician, but a teacher trying to integrate trauma-informed care into early childhood education,” she says. “What struck me the most was what educators didn’t know about social services, mental health and even physical health. We didn’t have language for what we were seeing with kids who were particularly challenging.”

ACEs gave O’Connor that language. She became a passionate advocate for trauma training for early childhood and K-12 teachers. Now, as director of education for United Way of Greater Philadelphia and Southern New Jersey, O’Connor is helping trauma-informed practice to ripple across the region.

United Way, which recently honed its mission to focus on ending intergenerational poverty, funds and supports cross-sector networks in Philadelphia, surrounding counties and the borough of Pottstown, all part of United Way’s effort to “build a trauma-informed region.”

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Radical Inquiry: Research Practices for Healing and Liberation

Radical Inquiry

RYSE Center in Richmond, CA, was born of out of young people of color (YPOC) organizing to shift the conditions of violence, distress, and dehumanization in which they suffer, survive, succeed, dream, and die.  We center the lived experiences of YPOC, we lead with love and sacred rage to cultivate healing and build movement, and we take risks as an essential part of transformation and justice, of liberation. We do this in a physical space that feels safe, welcoming, and affirming; that is vibrant with aesthetics created by and for YPOC, and in which members feel ownership, agency, and responsibility.  We do this through cultivating a staff team and organizational culture that is reflective of and responsive to our members, and which engages in ongoing learning, healing, and movement-building.

A third of our current staff started at RYSE as members, half of our staff are under the age 27, and over 90% are people of color. RYSE runs programs across areas of community health; education and justice; youth organizing and leadership; and media, arts, and culture. All programs serve as platforms to cultivate connection, healing, love, and resistance.

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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?

KRidout headshot2

“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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