Over 450 diverse leaders gather in College Park, MD, to address health equity, prosperity and ACEs

abc2_TiffA young woman from North Carolina, Tiffany Shields (3rd in from the R), attended her first conference ever August 4-5 at the University of Maryland, College Park. She stood up and told the room that she was nervous about coming, didn’t expect people to be especially welcoming, and thought she’d probably be bored at least part of the time. Instead, it was clear from her beaming smile and enthusiasm that she loved the experience.

Of the hundreds of conferences I’ve planned and attended, this one—Historic Assembly on Health Equity and Prosperity— was far and away the most unusual and inspiring. There was poetry, music, theater, storytelling, and more conventionally, exercises to develop a national action plan to achieve health equity and prosperity. For a flavor of the event, scroll through a collection of photos, tweets, and drawings by Ellen Lovelidge of entre Quest. Click here for more information about the assembly and how to join the equity and prosperity movement.

Ellen Loveridge of entre Quest

Ellen Lovelidge of entry Quest creating one of many visual representations of the Assembly proceedings.

The meeting was part of the umbrella initiative, 100 Million Healthier Lives, convened by the Institute for Healthcare Improvement (IHI) with support from the Robert Wood Johnson Foundation. The vision of the initiative is “to fundamentally transform the way the world thinks and acts to improve health, well-being and equity to get to breakthrough results.” IHI grew out of the quality improvement work of Dr. Don Berwick and is best known for the development of the Triple Aim, “a framework for optimizing health system performance,” that includes population health, the experience of individuals have in the system, and costs. The Institute for Alternative Futures and 100 Million Healthier Lives convened the Health Equity and Prosperity initiative.

I’ve never been to a meeting where poems were written spontaneously and read aloud. The poem “I

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Violence is just one part of childhood trauma. So why are we focusing so much on childhood violence?

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Whac-A-Mole players (photo by Laura)

Many people and organizations focus on preventing violence with the belief that if our society can stop violence against children, then most childhood trauma will be eradicated.

However, research that has emerged over the last 20 years clearly shows that focusing primarily on violence prevention – physical and sexual abuse, in particular – doesn’t eliminate the trauma that children experience, and won’t even prevent further violence.

“Although violence can beget violence, it’s hardly the only cause of violence,” says Dr. Vincent Felitti, co-principal investigator of the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking epidemiological research that showed a direct link between 10 types of childhood trauma and the adult onset of chronic disease, mental illness, violence and being a victim of violence, among many other consequences.

“Basically there’s lots of other ways,” he says. “Humiliating people. Isolating people. Verbally provoking them. All of those have potential for producing violence in response.”

In addition, violence can provoke nonviolent behavior that can be just as damaging as violence.

In other words, childhood trauma does not equal only violence.

The many types of childhood trauma

Violence is just one among many types of childhood trauma. The ACE Study found that violence is not more – or less — damaging than divorce, living with a parent who’s an alcoholic, being yelled at nearly every day of your childhood, or emotional neglect. Just as important, it rarely happens alone. If a child is experiencing violence, there’s usually some other type of trauma happening, too.

In fact, the entire approach to preventing violence against children – by focusing on only one type of trauma, by focusing on the child and ignoring the parents or caregivers, by ignoring the toxic stress imposed on the child and family by traumatizing systems – is so outdated that pioneers in this arena compare our current approach to a never-ending game of Whac-A-Mole.

They propose a completely different approach, one that focuses on creating and growing resilient children, families, organizations, systems and communities. It’s an approach that moves from blame, shame and punishment, to understanding, nurturing and healing.

The ACE Study is part of what’s being called a “unified science” of human development that recasts our understanding of how to solve our most intractable problems, such as poverty and homelessness, as well as childhood trauma. It comprises five areas of research:

  • the epidemiology of adverse childhood experiences (ACEs),
  • the neurobiology of toxic stress (the brain),
  • the biomedical consequences of toxic stress (the body),
  • the epigenetic consequences of toxic stress (passing from parent to child),
  • and resilience research.

Others call this “the theory of everything” in human development or NEAR science (neurobiology, epigenetics, ACEs, resilience). I just call it ACEs science.

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The single best medical appointment of my life was when a nurse practitioner asked about my adverse childhood experiences (ACEs)

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Heidi Aylward spent much of 2015 going to doctor’s appointments for back and joint pain, dizziness, swelling of the legs and feet, high blood pressure, elevated platelets, heart palpitations and extreme fatigue.

2016 isn’t looking much better. She’s worn a heart monitor, had a bone marrow biopsy and continues to have blood work. She holds down a job as a full-time project manager, tends to her daughters, home and pets.

But she feels like her body is falling apart.

“I’m not going to make it to 60,” she said, “Why do I even contribute to my retirement savings account?”

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Time and again: This time, Orlando, and again more pertinent questions must be asked

Mourners in Orlando. Photo credit: Sam Hodgson for The New York Times

Mourners in Orlando. Photo: Sam Hodgson for The New York Times

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For those of us who know that childhood adversity can lead to chronic disease, mental illness, and violence, among other consequences, the questions about Omar Mateen, the man who killed 49 people and wounded 53 others in an Orlando night club early Sunday morning, aren’t answered yet. In fact, most of the questions that would address the roots of his violent actions — and our successful efforts to prevent other mass shootings — haven’t even been asked.

There are a couple of hints. According to this New York Times article, “Mr. Mateen had a chilling history that included talking about killing people, beating his former wife and voicing hatred of minorities, gays and Jews…”

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At Science of Trauma briefing on Capitol Hill, U.S. Sen. Heitkamp urges panelists to “keep preaching”

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When U.S. Sen. Heidi Heitkamp (D-ND) arrived mid-way through a congressional briefing on the Science of Trauma last week, she delivered her remarks with passion, humor, and most of all, a sense of urgency to the room full of Capitol Hill staff and a smattering of advocates. Her message was macro as well as micro—change national policy to incorporate what the ACEs science tells us about trauma, and see and respond to the needs of those you encounter in everyday life. (Her remarks start at 27:48 and continue through 41:45.)

ACEs science refers to adverse childhood experiences. This includes the epidemiology of ACEs (the CDC-Kaiser Permanente Adverse Childhood Experiences Study and several dozen ACE surveys in U.S. states and organizations), the neurobiology of toxic stress, the effects of toxic stress on our bodies, how toxic stress is passed from one generation to the next (epigenetic consequences), and resilience research, which shows our brains are plastic and our bodies want to heal.

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A working ranch integrates ACEs and animals into treatment for teens

HorseCU Although it’s too soon to tell if integrating trauma-informed and resilience-building practices based on adverse childhood experiences (ACEs) sciences is making a difference for the teens living at Home on the Range, a residential treatment center in Sentinel Butte, ND, it’s made a huge difference for the people who work there. They now understand that kids aren’t born bad.

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Oregon psychiatrist testifies before Senate Finance Committee on the impact of childhood adversity and toxic stress on adult health

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Appearing before the powerful Senate Finance Committee  in Washington, DC, recently, Dr. Maggie Bennington-Davis, psychiatrist and chief medical officer of Health Share Oregon, devoted a significant portion of her testimony to  the role of adversity and toxic stress during childhood on adult health, both physical and emotional. She explained how Health Share Oregon—that state’s largest Medicaid coordinated care organization—examined the people with the costliest health bills and found them to have experienced high levels of childhood adversity. She told the senators that the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), first published in 1998 by Drs. Vincent Felliti and Robert Anda, found exactly this correlation.

At the April 28 hearing titled “Mental Health in America: Where are we now?,”* Bennington-Davis addressed the need to look to people’s experiences in childhoods to improve health, knowing that mental illness and substance use disorders, along with other

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