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.

A big surprise in the groundbreaking CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study) — besides that most of us have at least one ACE — was how “normal” and ordinary some of the types of adversity are. Seeing your parents divorce. Living with a family member who’s an alcoholic or depressed, as well as having other mental illness. Verbal abuse, which includes being screamed at every day as well as being quietly told by your mother, “I wish you’d never been born, you freak.” Then there’s the stuff that you expect will mess with your head — physical and sexual abuse. Physical neglect. Emotional neglect — hardly being acknowledged or talked to during your entire childhood. Watching your mother being hit. And having a family member in prison. Since the ACE Study was published, dozens of other ACE surveys showed similar results. Recognizing that definitely more than 10 types of ACEs exist, other surveys have included racism, bullying, witnessing violence outside the home, serious illness or accident in the family, experiencing war, losing a family member to deportation, ending up in foster care, etc.

All these experiences damage the function and structure of kids’ brains. Kids experiencing trauma act out. They can’t focus. They can’t sit still. Or they withdraw. Fight, flight or freeze – that’s a normal and expected response to trauma. Kids who are experiencing trauma live in survival mode. So, they have a really hard time shifting their attention from survival brain to learning brain. Their schools often

Continue reading

Shifting the focus from trauma to compassion

AHerz

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.

In practice, Herz describes how clinicians use a trauma-informed approach to forge closer ties with patients and at the same time discover how ACEs may lurk beneath the surface of a health condition.

“I see so many children who really struggle with obesity at a young age,” explains Herz, who is based at Kaiser Permanente in Hayward, Calif., which is testing ACEs screening of children from 12 months through 5 years old in a three-year pilot study that began in 2016. He says that he sees many patients whose weight and height are on par for a number of years and then suddenly veer off course as a child begins gaining weight. “I’ll ask ‘What happened?’, and sometimes it’s that the grandmother has moved in and is overfeeding the child,” explains Herz. But often there’s another explanation.

“I pointed to the growth curve and asked ‘What happened two and a half years ago?’ And the mom said, ‘Dad came back from jail and is living with us,’” reports Herz as he cites the case of one patient. And he didn’t stop there — he wanted to find out how the mom and the child experienced the father’s return. “And I looked at her and said, ‘So, it’s been stressful?’ And she said yes.”

“And rather than talking to her about removing the sodas, and exercising more and removing the junk food,” continues Herz, “I talked to her about the stress and how can we make things feel better, because the weight gain was in response to stress.” Herz made sure they were safe and when the mother expressed interest, helped her and the child link up with a psychologist for additional support.

Continue reading

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.

_______________________________

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.”

Continue reading

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.

Continue reading

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.

Continue reading

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.)

Continue reading

Oakland, CA, trying out model used in Baltimore to reduce trauma, increase resilience

2015.2016 1066

Baltimore BSC faculty and planning team

_________________________

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.

Continue reading

%d bloggers like this: