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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Opioid legislation with significant trauma provisions clears the Congress, awaits the President’s signature

Opioid legislation with significant trauma provisions clears the Congress, awaits the President’s signature

 

On October 3, the U.S. Senate voted 98-1 (only Sen. Mike Lee, R-UT voted nay) to approve The SUPPORT for Patients and Communities Act  (H.R. 6 or previously titled the Opioid Crisis Response Act), a final step before the President’s signature.  The House approved the measure on September 28. The Senate approved an earlier version of this legislation on September 17 and, as reported on ACEs Connection, it includes significant provisions taken from or aligned with the goals of the Heitkamp-Durbin Trauma-Informed Care for Children and Families Act (S. 774), including the creation of an interagency task force to identify trauma-informed best practices and grants for trauma-informed practices in schools.

As reported earlier in ACEs Connection, the trauma provisions are the result of “extensive engagement” of the offices of Senators Heitkamp (D-ND) and Durbin (D-IL) staff with Shelley Capito (R-WV), and Lisa Murkowski (R-AK). The opioid legislation represents a rare bipartisan, multiple committee achievement.

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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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Those who separate immigrant children from parents might as well be beating them with truncheons

Aimmigrants
Central American asylum seekers, including a Honduran girl, 2, and her mother, are taken into custody near the U.S.-Mexico border in June in McAllen, Texas.

They all agree. Physicians for Human Rights. American Medical Association. American Academy of Pediatrics. American Psychiatric Association. National Association of Pediatric Nurse Practitioners. 

Separating children from their parents or caregivers hurts children. Between April 19 and May 31, nearly 2,000 children were separated from their parents. As Celeste Fremon reported in WitnessLa,  that number has now passed 2,300 children (and is increasing by more than 60/day), with another 11,000 locked up in everything from large cages to a converted Walmart. 

“To pretend that separated children do not grow up with the shrapnel of this traumatic experience embedded in their minds is to disregard everything we know about child development, the brain, and trauma,” says a petition signed by more than 9,000 mental health professionals and 172 organizations.

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Middle school tackles everybody’s trauma; result is calmer, happier kids, teachers and big drop in suspensions

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John Jimno

During the 2014/2015 school year, things were looking grim at Park Middle School in Antioch, CA. At the time, staff couldn’t corral student disruptions. Teacher morale was plummeting. By the end of February 2015, 192 kids of the 997 students had been suspended — 19.2 percent of the student population.

“I was watching really good people burning out from the [teaching] profession and suspending kids over and over and nothing was changing behavior-wise, and teachers were not happy about it,” says John Jimno, who was in his second year as principal at that time.

So, Jimno and the staff took advantage of a program that Contra Costa County was integrating into its Youth Justice Initiative and, in doing so, joined a national trauma-informed school movement that has seen hundreds of schools across the country essentially replace a “What’s wrong with you?” approach to dealing with kids who are having troubles with asking kids, “What happened to you?”, and then providing them help.

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