Category Archives: Community prevention programs

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

June 7, 2022 By in ACE Study, Adverse childhood experiences, Child trauma, Community prevention programs, Opinion (Oped), Positive & adverse childhood experiences, Solutions 13 Comments

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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To prevent mass shootings, don’t bother with motive; do a forensic ACEs investigation

May 18, 2022 By in Adverse childhood experiences, Child trauma, Chronic disease, Community prevention programs, Positive & adverse childhood experiences, Solutions 15 Comments

Because 18-year-old Payton Gendron provided in his 180-page diatribe a motive for shooting 10 people in Buffalo, NY, on Saturday night, police didn’t need to search for one, as they often have other in mass shootings. But using motive to prevent mass shootings will just get you a useless answer to the wrong question.

The right question is: What happened to this person? What happened to a beautiful baby boy to turn him into an 18-year-old killer spouting racist screed?

Steve Breen, San Diego Union Tribune

In those questions—and looking at the answers through the lens of positive and adverse childhood experiences—lie our solutions.

In a 2019 Los Angeles Times article, “We have studied every mass shooting since 1966. Here’s what we’ve learned about the shooters”, Jillian Peterson and James Delaney wrote: “First, the vast majority of mass shooters in our study experienced early childhood trauma and exposure to violence at a young age. The nature of their exposure included parental suicide, physical or sexual abuse, neglect, domestic violence, and/or severe bullying.”

Research clearly shows that the road that leads from a precious infant becoming an abused or neglected child who grows up to become a distressed murderer is predictable. That was revealed in the CDC-Kaiser Permanente Adverse Childhood Experiences Study.

The ACE Study showed a remarkable link between 10 types of childhood trauma and being violent or a victim of violence, as well as experiencing the adult onset of chronic disease and mental illness. The ten types of childhood trauma include experiencing physical and emotional abuse, neglect, living with a family member who is addicted to alcohol or who is mentally ill, and witnessing domestic violence. (For more information, see PACEs Science 101 and What ACEs/PCEs Do You Have?) Subsequent ACE surveys include experiencing bullying, racism, the foster care system, living in a dangerous community, losing a family member to deportation and being a war refugee, among other traumatic experiences.

The point is — and the science is irrefutable now — just as a bullet rips through flesh and bone, a child experiencing ongoing encounters that cause toxic stress, without positive intervention to help the child, will suffer damage to the structure and function of their brain.

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

April 6, 2022 By in ACE Study, Adverse childhood experiences, Community prevention programs, Education, Positive & adverse childhood experiences 4 Comments

[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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Gun violence expert says tackling underlying inequities key to prevention

October 13, 2021 By in Community prevention programs, Uncategorized 3 Comments
Gun violence expert says tackling underlying inequities key to prevention

Through the news media, Americans are served an almost-daily dose of violence caused by guns. This year to date, more than 33,929 people in the United States have been killed and another 30,000+ have been injured by guns. The U.S. homicide rate for firearms is 22 times greater than that of the European Union, even though the European population is 35% larger.

But to Dr. Garen Wintemute, the statistics on injuries and deaths are only one part of the story. To reverse those appalling numbers, he says, the larger focus must be on changing the conditions that foster gun violence. These include the underlying inequities that are baked into the essence of American life.

“Violence has social determinants, such as disparities based on race/ethnicity, gender or sexual orientation, place of origin and other characteristics,” says Wintemute, director of the Violence Prevention Research Program at the University of California at Davis School of Medicine. He is an expert in the public health crisis of gun violence and a pioneer in injury epidemiology and prevention of firearm violence.

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Think you know something about historical trauma? PACEs Connection’s ‘Historical Trauma in America’ series promises to be an eye-opener

July 14, 2021 By in Community prevention programs, Positive & adverse childhood experiences, Trauma 15 Comments

The murder of George Floyd in May 2020 unleashed hundreds of articles, books, podcasts, film and online documentaries. It’s not that the roots of racism and inequity in historical trauma hadn’t been known about or written about previous to his death (Frederick Douglas, James Baldwin, anyone?), but the pressures of hundreds of years of injustice began a near explosive untangling from the massive twisted and angry knot they’d formed over generations. It’s been like cutting through a gargantuan ball of rubber bands stretched to their limit: layers upon layers of hurt, unfairness, frustration, lives lost, lives constricted into rigid and narrow boundaries, all because of the human bent toward “othering”. (That’s something that PACEs science clearly demonstrates: There is no us and them. Just us.)

Despite all the stories that have been loosened from the grip of our remarkable ability to ignore what’s in front of us, White people are just beginning to learn—to our ongoing dismay, shame and horror—that racism and inequity are baked into everything we do, into all our systems, in every community in the U.S., even though most of us don’t know or want that. Fortunately, we are now in a time of reckoning, and have the potential to make real change. If you haven’t already put together your reading list to educate yourself, the 27 books here range from Ibram X. Kendi’s “How to Be an Antiracist”, to Cathy Park Hong’s “Minor Feelings”, to Toni Jensen’s “Carry: A Memoir of Survival on Stolen Land.”

Despite our individual ACEs, the White people among us have been incredibly fortunate to be born into a power structure from which most of us didn’t even realize we benefited. We’ve been swimming in a sea that we didn’t even know was wet. Thus I think it’s our obligation, from the moment we grok the enormity of how our history granted us immeasurable advantages, to spend the rest of our lives educating ourselves and educating as many people as we can to change our systems. That’s a major goal of our work at PACEs Connection, the social network that accompanies ACEs Too High.

Over the last two years, PACEs Connection team members Ingrid Cockhren and Donielle Prince have been leading efforts to educate our organization about racism, inequity, White privilege, and how PACEs science figures into that. Ingrid’s been leading a series of in-depth webinars for our team that have truly challenged our understanding of where we are and how we got here. It’s been sobering, but one thing that being in this PACEs community offers is that we help each other face not only our individual truths, but our society’s truths, because that’s one of our values. (If you aren’t a member of PACEs Connection, please join by going to PACEsConnection.com.)

“I came up with the idea for the series in response to the controversy concerning Critical Race Theory in schools,” says Cockhren, who is PACEs Connection’s director of communities, “or basically the reluctance to discuss America’s true history.” When she suggested that we host a series of webinars on historical trauma in six different regions of the country, the team jumped into action.

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Lesson learned integrating ACEs science into health clinics: Staff first, THEN patients

February 16, 2020 By in ACE Study, Adverse childhood experiences, Community prevention programs, Solutions 3 Comments
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 101; Got 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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San Mateo (CA) launches county initiative to tackle ACEs and build resilience

February 6, 2020 By in Adverse childhood experiences, Community prevention programs 2 Comments
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Group ice-breaker exercise

When you’re working with people who’ve had a lot of childhood and adult adversity, it’s hard for you to believe that anyone else can have a bad day, says Laura van Dernoot Lipsky. “Your neighbor or your best friend says: ‘I’ve had a bad day.’ And you think, ‘Oh, I’m sorry you had a bad day; were you sex trafficked today? No, you were not!’”

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Laura van Dernoot Lipsky

Van Dernoot Lipsky, the author of Trauma Stewardship: An Everyday Guide to Caring for Yourself While Caring for Others, was driving home one of several points of how working in a job that serves severely traumatized people can harm people who help them, too.

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Screening for Childhood Trauma

January 13, 2020 By in Adverse childhood experiences, Community prevention programs, Solutions, Trauma 9 Comments

Dr. Ken Epstein has been in the social services sector for nearly four decades and has witnessed firsthand the long-term effects of trauma. As both the son and father of fellow social workers, the work runs in his blood. He has been frontline staff at a residential facility for youth with severe mental and emotional challenges, a therapist, a family and couples therapy professor and director of the Child, Youth and Family System of Care for the City of San Francisco’s Department of Public Health. Now, he’s helping Bay Area health clinics screen for and address childhood trauma through the Resilient Beginnings Collaborative (RBC), led by Center for Care Innovations (CCI) and made possible by Genentech.

Trauma is pervasive. Studies show that one in seven children in California experience trauma by age five (Children Now, 2018), and research links adverse childhood experiences (ACEs) – incidences of abuse or neglect, household dysfunction, and community violence – to an increased likelihood of negative health outcomes. In youth, trauma can cause behavioral issues, asthma, and infections; as adults, those same individuals are at greater risk of heart, lung, and autoimmune disease, obesity, mood disorders, and substance use disorders. This is magnified when you include income disparities and the impact of systemic and structural inequities.

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Tributes honor the life of Rep. Elijah Cummings of Baltimore

October 21, 2019 By in ACE Study, Adverse childhood experiences, Community prevention programs, Legislation, Solutions 1 Comment
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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.

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Iowa ACEs360: Catalyzing a Movement

August 28, 2019 By in ACE Study, Adverse childhood experiences, Community prevention programs, Resilience, Solutions 3 Comments

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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