California’s Child Trauma Crisis, Vicarious Trauma in First Responders, the Problem with Evidence-Based Practices, and McDonnell’s ChallengesNovember 7th, 2014 by Taylor Walker
NEW EXTENSIVE REPORT SUGGESTS THAT CHILDHOOD TRAUMA IS A HEALTH CRISIS IN CALIFORNIA
The San Francisco-based Center for Youth Wellness released an unprecedented study on childhood traumas known as “adverse childhood experiences,” or ACEs, in California counties.
One in six Californians (16.7%) have four or more ACEs, according to the study, which used data from 27,745 California Behavioral Risk Factor Surveillance System surveys between 2008 and 2013. (The original 1998 ACEs study by Vincent Felitti of Kaiser Permanente and Robert Anda of the U.S. Centers for Disease Control and Prevention only sampled data from Kaiser members.)
And nearly 14% of Los Angeles residents reported four or more ACES. These ACEs include abuse and neglect, as well as things like having an incarcerated relative, divorce, and mental illness in the household. These experiences can produce toxic stress in kids, which can have lasting negative effects on kids’ health and behavior. Kids with four ACEs have a much higher likelihood of having emotional and physical health issues, and are thirteen times more likely to end up in foster care, compared to people with no ACEs.
“Toxic stress dramatically expands the risk of high risk behavior,” said Nadine Burke Harris, MD, the founder of the Center for Youth Wellness. Dr. Burke Harris also pointed to high number of childhood traumas as underlying many issues such as learning disabilities and the likelihood of incarceration. “We need to look at this as the root cause of most of our social problems.”
However childhood trauma need not be destiny, said Burke Harris. “There is an opportunity for healing throughout a lifetime.”
The report recommends increasing Californians’ access to mental health care, as well as early intervention, and regular collection of ACE data.
Here are some clips from the Center for Youth Wellness:
Nearly 62 percent of Californians have experienced at least one or more types of Adverse Childhood Experiences (ACEs)—such as abuse, neglect or household dysfunction—with one in six exposed to four or more adverse experiences, according to the new report. “A Hidden Crisis: Findings on Adverse Childhood Experiences in California” details the strong correlation between childhood exposure to adversity and trauma with poor health, behavioral and social outcomes later in life. The report also identified the prevalence of ACEs in counties across California.
“California is facing a major public health crisis that until now has gone largely unaddressed – children’s exposure to trauma and adversity,” said Dr. Nadine Burke Harris, founder and CEO of the Center for Youth Wellness. “The science is clear: early adversity dramatically affects health across a lifetime, but this public health crisis is both treatable and beatable. We have the knowledge and resources to reduce morbidity and mortality, and make a real difference in the lives of children and adults across the state.”
The report found that, compared to people with no ACEs, those reporting four or more ACEs are more likely to face greater physical and mental health, social and economic challenges. Among other outcomes, the study’s key findings indicate that they are:
• 2.4 times as likely to have chronic obstructive pulmonary disease; 1.9 times as likely to have asthma; 1.7 times as likely to have kidney disease; and 1.5 times as likely to have a stroke.
• 5.1 times as likely to suffer from depression, and 4.2 times as likely to be diagnosed with Alzheimer’s or dementia.
• 2.9 times as likely to currently smoke, 3.2 times as likely to engage in binge drinking, and 3.3 times as likely to engage in risky sexual behavior.
• Nearly 12 times as likely to be the victim of sexual violence (or forced sexual encounters) after the age of 18.
• 21 percent more likely to be below 250 percent of the Federal Poverty Level; 27 percent more likely to lack a college degree, and 39 percent more likely to be unemployed.
• 50 percent more likely to lack health insurance.
• 13 times as likely to have been removed from their home as children.
The report also details county-by-county findings, making it apparent that ACEs touch every community in California. Even in counties with the lowest prevalence of ACEs, one out of every two people has had at least one adverse experience in childhood. The highest prevalence rates of adults reporting four or more ACEs are found in Mendocino and Humboldt Counties combined (30.8 percent) and Butte County (30.3 percent), while the lowest prevalence rates of adults with four or more ACEs are found in San Francisco County (9 percent) and Santa Clara County (11 percent).
The Center for Youth Wellness is working in partnership with the San Francisco Police Department to develop a program, scheduled to launch in early 2015, to help officers better understand the effects of trauma in the communities they patrol. “The training, which is still a work in progress, will be designed, “to provide officers with the tools to recognize trauma when they see it,” said CYW policy analyst, Cecila Chen. But while CYW may be providing the data and research for the program, the SFPD will weigh in substantially on how the training is designed. Otherwise, said Chen, it won’t work. “We’re not going to try to tell police officers how to do their jobs. We just want to give them information that they can use to do their jobs better.”
Chen and others at CYW also expressed the hope that the training will help officers to cope with their own on-the-job trauma, that too often goes unacknowledged.
WHILE WE’RE ON THE SUBJECT: SECONDARY TRAUMA AND COUNSELING SERVICES FOR COPS AND OTHER FIRST RESPONDERS
Police officers, fire fighters, and other first responders (as well as social workers, attorneys, and judges) experience high rates of “vicarious trauma,” when they witness or become involved in others’ traumatic experiences. Secondary trauma can produce symptoms akin to those of Post Traumatic Stress Disorder (PTSD), yet departments and agencies often have inadequate support and resources to manage the trauma experienced by cops and other responders.
Thus far, very little research has emerged on what services and programs work to address vicarious trauma. However, the Justice Department’s Office for Victims of Crime is funding the creation of a toolkit by Northeastern University researchers, which is expected to be piloted at four sites next year.
The Crime Report’s Cara Tabachnick has more on the issue. Here are some clips:
“[Most] people work as hard as they can to move away from trauma, but we spend our whole lives running towards trauma,” said Gina Scaramella, Executive Director of the Boston Area Rape Crisis Center (BARCC).
As a young social worker, Scaramella once found herself working with a client who was gang-raped shortly after being forced to watch as her three-year old child was killed. At the time, Scaramella also had a young child.
“I remember I couldn’t stop thinking about it—it was hard to stop,” she said. “You become more guarded, more cautious.”
BARCC offers numerous techniques for their workers and volunteers to guard against vicarious trauma. After an incident call in which a rape or trauma is reported, the volunteer that takes the call checks in with a back-up coordinator, where they can decompress. After medical visits, the staff whom accompanies and counsels the victim, also reports to a back-up coordinator. Additionally, the clinical director at BARCC is always available for private sessions with staff.
Although there are programs and resources that address first responders needs, including the Johns Hopkins University’s Preparedness and Emergency Response Research Center and the First Responders Addiction Treatment Program run by the Livengrin Foundation.
But for the broad spectrum of organizations there are few resources available; nor are there sufficient or policy guidelines for dealing with their experiences. And there is no real standardized information about what works. That led researchers from the Institute on Urban Health Research and Practice at Northeastern University in Boston to develop a national toolkit for vicarious trauma aimed at professionals working in the fields of victim assistance, law enforcement, emergency medical services, and similar jobs.
Funding for the toolkit came through a grant from, the Department of Justice’s Office for Victims of Crime (OVC).
Although the Justice Department released “Vision 21,” a seminal report on the needs of crime victims two years ago, researchers realized there was almost no effort to address the needs of professionals exposed to traumatizing criminal incidents.
Research findings consistently reported that between 40% and 80% of helping professionals experienced “compassion fatigue” and/or high rates of secondary trauma, according to the institute.
The two-year grant paid for an initial survey of professionals about their experiences, which garnered 8,000 responses. Based on the findings, researchers will develop the toolkits for use in four pilot sites—not yet named—by November 2015.
While organizations or institutions can establish their own safeguards against vicarious trauma, including on site clinical mental health, encouraging a strong support network for staff and a work-life balance, the survey results should guide researchers to develop a more standardized approach using practitioners needs and techniques that have worked in other organizations. If this approach proves successful, it could make a big difference to the emotional health of law enforcement professionals.
WHEN EVIDENCE-BASED PRACTICES GET IN THE WAY OF FRESH AND IMPROVED PRACTICES
For the last 15 years, evidence-based practices—certain community alternatives to locking kids up—have been lauded as the solutions to the over-incarceration of kids. Programs like Multi-Systemic Therapy (MST) and Functional Family Therapy (FFT) have done a lot of good to steer kids away from out-of-home placements, but they are certainly not a cure-all.
In an op-ed for the Juvenile Justice Information Exchange, Amanda Petteruti, Senior Research Associate at the Justice Policy Institute, says that evidence-based practices are not flexible enough to fit the needs of all kids, and should not stand in the way of some more appropriate customizable cost-effective systems that make kids feel like “assets” instead of “damaged goods.”
“Insisting on using only ‘evidence-based practices’ can lock you into what was known 20 years ago,” said Dr. Vincent Felitti at a conference this past Thursday on children and trauma. (Felitti is co-author of the original ACEs study.) “It can be a way of avoiding change. It can keep you from finding newer, better methods.”
Here’s a clip from Petteruti’s op-ed:
Over the last 15 years, juvenile justice advocates fought hard to convince policymakers and government officials that the best way to help youth succeed and improve public safety is to keep them out of secure confinement. To keep youth out of confinement, we argued, we should place youth in the community and enroll them in evidence-based practices (EBPs) close to home…
Policymakers and government officials seem to have bought what we were selling: As a former staffer at a juvenile justice agency, I had to help a council member understand why every youth couldn’t and shouldn’t be in an MST program. These policymakers wanted the “gold standard” EBPs, but not every young person qualified to participate in MST.
What’s more, MST and other evidence-based programs couldn’t meet the needs of every young person in the system. Perhaps it’s our own doing that we now hear policymakers, government officials and an array of stakeholders beating the drum to implement evidence-based practices, even at the expense of other promising and innovative services, interventions and programs.
Although they can well serve youth with specific needs, evidence-based practices and programs aren’t perfect, and they aren’t the only programs that can meet a young person’s needs. They can also be very costly to implement and evaluate, demand strict fidelity to the original model and only work for the type of youth for which they were designed.
In other words, they are not meant to be tinkered with to meet the unique needs of a young person, their family, their community or the agency implementing them. This can leave out a lot of young people, perhaps the same young people who still end up in secure confinement or who have been transferred to the adult system.
The problem isn’t simply that EBPs can’t and don’t serve all youth — the problem is, in part, that we think they should.
Petteruti goes on to explain what practices have more of an individualized focus for kids who don’t fit into the evidence-based practice mold. Here’s an example:
Positive Youth Justice (PYJ) is an approach that draws from positive youth development principles to meet the unique needs of justice-involved youth. PYJ includes six domains: education, work, relationships, creativity, community and health. These domains are not meant to be used in isolation, but rather as a system of supports and services that can include EBPs.
CHALLENGES FOR OUR NEW LA COUNTY SHERIFF, JIM MCDONNELL
KPCC’s Frank Stoltze takes a look at four significant hurdles newly-elected Jim McDonnell must face as he steps in as head of the LA County Sheriff’s Department on December 1.
Here are two of the challenges Stoltze lists (go read the rest):
The need for change goes far beyond the jails, says longtime sheriff’s watchdog Merrick Bobb.
“The key issue facing the new sheriff is restoring a culture of accountability that got lost very significantly,” Bobb told KPCC.
The citizen’s panel found a failed discipline system and apparent favoritism in promotions. A federal grand jury has indicted 21 current and former sheriffs officials on civil rights and corruption charges. Seven have been convicted.
Bobb says McDonnell will have to replace some of the command staff. “I think it’s very important for him to bring in fresh people, fresh air.”
Interim Sheriff John Scott says he’s replaced some people, “but more work needs to be done.”
Activists argue outside oversight must accompany any changes in the command staff, because there are no term limits for the sheriff.
“This sheriff will probably be with us for decades,” Patrice Cullors of Dignity and Power Now told a recent rally outside Twin Towers.
McDonnell will have an overseer of sorts: newly appointed inspector general Max Huntsman. He wants McDonnell to ignore concerns from the deputies union and give him access to personnel records so he can identify problem cops.
“If you exclude personnel records from the vision of the inspector general’s office, suddenly you’ve got a huge blind spot,” Huntsman says.