Talking ACEs and building resilience in prison

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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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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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I Was a Witness to Serial Silence

I felt the foot as it thrust between my legs and rammed over and over and over again into my crotch. I was lying on my back in the dirt. Strands of my long hair pulled from their roots under the weight of my body as my torso was forced forward. My head was tethered. My neck bent back nearly to its limit.

I felt the shoe. No one had touched me there before.

Shoes.

There wasn’t just one. They took turns. Chuck Taylors, Hush Puppies, Wallabies. The Waffle Stompers were the worst. They hurt.

It all hurt. Did no one hear me screaming? Was that even possible? There was a parade of people walking by. There were people all around.

I cried for help. My voice was my only defense as they held my arms and penetrated my dignity. Their grubby hands were on my breasts. They squeezed, and grabbed, and pinched, and wrung the newly mounded flesh.

They tore the pink bow off the center of my first bra. A metaphoric deflowering.

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

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

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

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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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Why early experience matters: Videos of scientists teach you

Scholars know so much about the importance of early experience–you should too!

A 2010 symposium brought together anthropologists, clinical, developmental and neuro-scientists to discuss early experience in light of evolution and human development. This is necessarily an interdisciplinary area of study because we have to know our history as social mammals, what optimizes our development in our sensitive early years and what undermines the development of a cooperative human nature. The talks are available for free online. Here is a sampling of the speakers with links.

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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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“Government-Sanctioned Child Abuse”: Separating Kids, Parents at Border

Government officials are doing irreparable harm to families seeking asylum. They are separating children from their families, no matter the age of the child.

The American Academy of Pediatrics (AAP) and over 200 other child welfare organizations, which have become increasingly sensitized to early life stress, have condemned the practice of child-parent separations. The head of the AAP, Colleen Kraft, has written an op-ed against it.

She says: “Officials at the Department of Homeland Security claim they act solely “to protect the best interests of minor children.””

Hardly. Is it ignorance or malice? We don’t know, but the justifications sound both ignorant and malicious.

What ignorance are they displaying? Here is a short description:

Human children are not like other animals. They are born so immature they look like fetuses of other animals till about 18 months of age. In the first years of life, children co-construct their biological and social capacities, organizing their basic features around the experiences they have.  The norms for our species is the evolved nest. One specific need that separation denies is physical affection from known caregivers. This need among social mammals like us was well documented by Harry Harlow’s monkey experiments. Young monkeys deprived of their mother’s touch developed into aggressive and autistic (socially awkward) individuals, never to recover.

Extensive distress shifts development, undermining what otherwise develops in a loving supportive environment –biologically healthy systems and social engagement. Instead extensive distress enhances primitive survival mechanisms in ways that grow to harm self and others—e.g., the stress response becomes hyperreactive. Because the first years of life are so sensitive to experience, the individual may never recover to reach their full potential (although they may recover enough to survive—i.e., what is often called “resilience”).

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