Category Archives: Solutions

Mass shootings and the news media: Catching up to the science of PACEs

July 13, 2022 By in ACE Study, Adverse childhood experiences, Opinion (Oped), Positive & adverse childhood experiences, Solutions 8 Comments

How do we, as a country, learn about mass shootings and gun violence? The news media. How do we learn about the best approaches to prevent mass shootings and gun violence? The answer should be “the news media”, but it’s not. Yet.

People who know about the science of positive and adverse childhood experiences (PACEs) understand that PACEs are at the root of violence. The news media is getting there. In the last couple of years of mass shootings, more articles examined the childhood of the shooter, but more could be done, as I pointed out in essays I wrote after the Buffalo, New York, and Uvalde, Texas, shootings.

After last week’s mass shooting in Highland Park, Illinois, two new threads appeared:

  1. A deep look at the shooter’s family (and this) to address the question: Are the parents to blame?
  2. And the growing number of online communities of mostly male youth or young men that glorify violence and are obsessed with nihilism. “I’ve described this as sort of like a mass shooter creation machine,” said Alex Newhouse, deputy director of the Center on Terrorism, Extremism and Counterterrorism at the Middlebury Institute of International Studies in an interview with NPR’s Odette Yousef. “A lot of these communities are designed to spin out mass shooters over time, over and over and over.”

My take on examining shooter’s families: I think it’s great to report what happened in a shooter’s family…as long as a reporter takes a trauma-informed approach. That means reporting without using words of blame, shame or punishment…so a headline that says “Are the parents to blame?” would change to “What happened in that family?”

Parents pass on ACEs—and positive childhood experiences (PCEs), for that matter—to their children. So, if they aren’t cognizant of their own ACEs, how can they possibly understand their child’s ACEs? And where did parents get their ACEs and PCEs? From their parents and environment. How to break the cycle? Educate families, organizations and communities about PACEs science, and integrate practices and policies based on PACEs science in all organizations in every community.

My take on the online cultures of violence: At the moment, the proposed solutions are to understand the subculture and moderate the content. “It’s not hard to figure out where different violent spaces are,” Emmi Conley, an independent researcher of far-right extremist movements, digital propaganda and online subcultures told NPR. “What’s hard is what do you do once you find one, if the red flag still falls within free speech territory. Because currently we have no intervention abilities, we only have law enforcement.” I have another idea: It seems to me that these subcultures provide a perfect opportunity to reach out and help youth who are in dire need of a caring adult and counseling. That’s a project worth funding!!

Ongoing issues: There’s the ongoing issue of the news media’s obsession with mass shootings, while mostly ignoring aggregate shootings, which receive little attention. And then the dire news of too many incidents of violence that lead news organizations to not cover important stories, and in almost every community, not cover the type of violence that costs communities the most in heartbreak and dollars—family violence. This headline in the Washington Post points out that mass shootings may be going the way of family violence coverage—too little coverage to help a community figure out how to prevent the violence. There are too many mass shootings for the U.S. media to cover: News organizations must make agonizing decisions about which shootings deserve on-the-ground reporting, and for how long.

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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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The myth of survivor solidarity: Why it’s so hard for us to all just get along

April 22, 2022 By in Opinion (Oped), Resilience, Solutions, Trauma 6 Comments

As a Weinstein survivor, I’ve noticed that journalists love to explore the presumed solidarity among “sister survivors” – in our case, the over 100 women who came forward about Weinstein’s sexual predation. But what journalists don’t write about are the challenges in preventing any group of trauma survivors from imploding. Only when we survivors understand the impact of trauma can we overcome the underlying forces that threaten to pull us apart and stand together against injustice and abuse.
 
Journalists often look for a “feel good” element to a story, particularly when reporting on distressing subjects. It makes sense. Why not try for a little positivity when there is enough bad news nowadays to sink us into overwhelming despair? As a Weinstein survivor, I’ve noticed that one positive spin journalists love to explore is a presumed solidarity among “sister survivors” – in our case, over 100 women who came forward publicly to recount our personal experience of Weinstein’s long reign of sexual predation.

Trauma, anger
Trauma, anger. Photo @Melanie Wasser for Unsplash.

Solidarity among survivors is a value I happily embraced, the idea of us coming together to support each other as more and more victims of high-profile abusers courageously stepped forward to join the ranks of those who cried, “Me too!” For my part, I have spent the last four years talking with survivors and connecting individuals to create a network of mutual support. It felt like an act of sedition in the face of powerful men and an at-times indifferent establishment. Still, I should have known that this camaraderie would develop stress points and, in some cases, fall apart. Interpersonal trauma in particular often results in a distrust of other people and a host of other protective responses that work against cohesiveness. In the refreshingly honest words of one interviewee in an article about community trauma: “…traumatized people interacting with other traumatized people – a community can really run the risk of imploding” (1).

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The Intolerable Cure

April 6, 2022 By in Adverse childhood experiences, Positive & adverse childhood experiences, Resilience, Solutions 12 Comments

As a survivor of interpersonal trauma, commitment and intimacy have never been easy, which is why I never did remarry after my first marriage fell apart. That is until last October, when my boyfriend who had been living at a comfortable distance (measured in thousands of miles) suggested I pack up my apartment and ride out the pandemic with him in Hawaii. Thus began an adventure that had me breathing into paper bags and him warranting a nomination for the Nobel Peace Prize.

I get bent out of shape easily. On days when I haven’t had enough sleep, I’m particularly vulnerable to being disgruntled and snappy, finding everything about my partner annoying, right down to his very existence. I usually seek refuge in elaborate plans of escape. (No doubt on those days my husband is similarly engaged.) I dream of a light-bathed studio giving onto a beach or a small cabin perched by a lake and surrounded by pines. The scene changes, the head count doesn’t. I am on my own.

For many trauma survivors, “avoidance”—a symptom of post-traumatic stress and driver of my escape fantasies—is the only way to make our lives feel manageable.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders describes avoidance as “efforts to avoid distressing memories, thoughts, or feelings” and “external reminders (people, places, conversations, activities, objects, situations)” associated with traumatic events. But what if the source and reminder of the trauma is other people? And what does that mean for our relationships?

The essential dilemma for survivors of interpersonal trauma is that, as Judith Herman has written, “recovery can take place only within the context of relationships; it cannot occur in isolation.” It makes sense that for those of us who have suffered abusive relationships, safe, stable relationships would be the cure, in the same way someone who has been poisoned might flush out toxins with pure water. However, as survivors of interpersonal trauma, getting close to people also feels inherently unsafe. In many cases, our trauma stems from the fact that the people who were supposed to love and protect us instead hurt us. We learned—sometimes at a young age—to distrust and fear the very thing we need as humans to survive. In The Boy Who Was Raised as a Dog, Bruce Perry writes:

“Being harmed by the people who are supposed to love you, being abandoned by them, being robbed of the one-on-one relationships that allow you to feel safe and valued and to become humane—these are profoundly destructive experiences. Because humans are inescapably social beings, the worst catastrophes that can befall us inevitably involve relational loss.”

Even more worrying, the inability to tolerate close relationships not only impedes trauma recovery but may even shorten our lifespan. A 2015 Brigham Young study reported that isolation is as bad as smoking 15 cigarettes a day in terms of the impact on our mental and physical health—and ultimately our longevity. The daily pain of social isolation is very real; it actually registers in the same region of the brain as physical pain. For some trauma survivors, isolation can be “iatrogenic”—meaning, the remedy is worse than the disease.

Some people get around the need for emotional connection with other humans by befriending other large mammals: dogs or horses are regularly used in trauma therapy. For those of us who dare to dip a toe into the potentially tumultuous waters of relationships with other humans, the experience is probably best approached as a kind of exposure therapy, where you face the thing you most dread in small increments until your brain is rewired and you no longer sense a threat. The problem is that marriage—to go back to my own situation—does not work like that. You can’t be married for say, one day a week, until you build up a tolerance. And, quite apart from your own ability to tolerate this unaccustomed state of being close to another person, unless your partner understands trauma well—and, like my husband (thus far), has enduring patience—there is a serious risk that the relationship will end up imploding.

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Dear Gannett: Great start! Now go the distance.

August 18, 2021 By in Opinion (Oped), Positive & adverse childhood experiences, Solutions 10 Comments

“Gannett launches a network-wide push to rework its crime coverage.” It’s about damn time. We advocated this more than 20 years ago, and we go a LOT further in our suggestions to make crime reporting more relevant, less racist and more useful to communities.

Berkeley Media Studies Group, a public health research organization, launched the Reporting on Violence project throughout California in 1997 and expanded it to interested newsrooms across the U.S. in 2001. The second edition of “The Reporting on Violence: A Handbook for Journalists” came out in 2001. The first, which came out in 1997, was distributed to more than 950 journalists and 100 newsrooms. I wrote the handbooks. Dr. Lori Dorfman, BMSG’s director, edited them. Together, we led the project, which was funded by the W. K. Kellogg Foundation and The California Wellness Foundation.

The immediate response was great—we did workshops in all the major newsrooms in California. But things didn’t change the way I’d hoped. A few news organizations included a few contextual questions in their reporting from time to time, but none changed their crime reporting. The data we gathered inspired the San Jose Mercury News (more info below) to do a series on domestic violence, but despite reporters asking to develop a domestic violence beat, the editors said no.

Remarkably, the basics of crime reporting haven’t changed much since the late 1890s (essentially, the man-bites-dog approach). Why is it taking so long for this change to happen? The irony is that although change is journalism’s bread and butter, getting the journalism community to modernize is like moving a mountain with a spoon and a bucket.

I am a longtime health, science and technology journalist. When I wrote the Reporting on Violence handbook, I’d been covering the epidemiology of violence off and on for several years, after the CDC began taking the same approach to violence and violence prevention as they had with smoking and smoking prevention, and motor vehicle accidents and their prevention. I realized that my profession was part of the problem in how the general public understood violence, and I wanted to do something about it.  

Now Gannett is beginning to make some rudimentary changes. After two years of experimenting in its news organizations in Rochester, NY, and Phoenix, AZ, Gannett is rolling out these revisions across its 250 newsrooms.

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Childcare providers use two-generational approach to help preschoolers from being expelled

May 23, 2021 By in ACE Study, Positive & adverse childhood experiences, Solutions 4 Comments

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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Youth Detention Facility finds culture of kindness more effective than punishment

March 30, 2021 By in Child trauma, Solutions 6 Comments
A corner of the Multi-Sensory-De-escalation Room. All photos of the MSDR courtesy of Valerie Clark

When a young person enters the de-escalation room in the Sacramento County Youth Detention Facility, they’ll find dimmed lights, bottles of lavender, orange and other essential oils, an audio menu featuring the rush of ocean waves and other calming sounds, along with squeeze balls, TheraPutty, jigsaw puzzles, and an exercise ball to bounce on.

DSC_0663
TheraPutty, squeeze balls and more

Sometimes, with a teen’s permission, “We’ll put a weighted blanket on them, just to give them that hug that feels good, since we can’t give them [real] hugs in our facility,” says Valerie Clark, the probation officer who oversees the room. Giving hugs violates the protocol requiring that staff maintain healthy boundaries with their young charges. But “especially if someone is highly upset and just really crying,” Clark explains, the blanket can be a comforting substitute.

Since it first opened to youth in November 2016, the de-escalation room has been a refuge for kids feeling overwhelming anger, grief, sadness, and anxiety, who are either referred by staff or can request a visit. They stay in it anywhere from 30 minutes up to two hours.

The room is one example of how the Sacramento County Probation Department is shifting its culture to be responsive to adolescent trauma. In 2016, the department sponsored a countywide summit on trauma and the adolescent brain. This February and March, 330 employees from the Youth Detention Facility, and 155 from Juvenile Field, Placement and Court divisions, were trained in the roots of trauma and how to respond to it. And five members of the probation leadership were certified as trainers in trauma-informed practices. The training includes learning about how trauma in childhood can trigger the brain into fight, flight and freeze; can cause depression and lead to disruptive behaviors, and how they can build strength and resilience in the youth they serve.

Prior to having the de-escalation room, says Clark, youth would be sent to their individual rooms when they were disruptive or upset. “This way they have the opportunity to regain control of their emotions and behavior so they can go back to their programs instead of [having to stay] in their room alone with their thoughts,” she explains.

An impetus for the room, known as the Multi-Sensory De-escalation Room, was legislation that was signed into law in California in 2016, says Shaunda Cruz, the deputy chief of field services at the Sacramento County Probation Department and one of the department’s trauma-informed champions.

“The legislation recognizes the impact that trauma, and obviously the impact of coming into a facility, has on young people,” she says. The law, which was sponsored by former California State Senator Mark Leno, limits the use of solitary confinement for minors in detention facilities to four hours, and allows it only when juveniles’ behavior is considered a safety threat and less restrictive options have been exhausted.

Around the same time that the legislation was being developed, members of the county probation department and juvenile court staff were working on a capstone project through a justice reform collaborative out of Georgetown University’s Center for Juvenile Justice Reform. That’s where the idea for an MSDR emerged, says Ruby Jones, assistant chief deputy of the Sacramento County Youth Detention Facility.

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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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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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