WHEN CHILDHOOD BECOMES TOXIC
In 2008, a colleague handed pediatrician Nadine Burke Harris an article that had appeared, with little fanfare, in a medical journal six years before.
At the time, Burke Harris was running a pediatric clinic located in Bayview-Hunters Point, a largely African American neighborhood that is arguably San Francisco’s poorest and most violent.
While Burke is, herself, African American, her upbringing is very different from that of most of her patients. The doted on daughter of Jamaican immigrant parents, both of whom are highly educated professionals, she got her medical degree from the University of California at Davis, her master’s in public health from Harvard, and did her pediatric residency at Stanford. After the stint at Stanford, she went to work for a private hospital group called the California Pacific Medical Center. Burke Harris talked California Pacific into letting her open the Bayview-Hunters Point clinic in 2007, which included allowing her take all pediatric patients who came through the door, regardless of their ability to pay.
In short order, the clinic was seeing 1000 patients a year. But, although Burke Harris loved the work, she was bothered by her sense that many of the ailments she was treating in the kids who came to her—things like asthma, ADHD, obesity and chronic bronchitis—were in some way related to the emotionally traumatizing things that were going on in the children’s lives—violence in the household, gang violence in their neighborhoods, homelessness, sexual abuse, incarcerated family members, extreme poverty, and more.
She wasn’t yet sure how to define the relationship between emotionally debilitating life events, and the physical conditions and illnesses she was treating. Still she felt sure there was a tangible link.
It was in this context that Burke Harris read the medical article titled The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead.” It was written by a researcher named Dr. Vincent Felitti, the Chief of the Department of Preventive Medicine for Kaiser Permanente who, together with Dr. Robert Anda from the Center for Disease Control (CDC), had conducted a study from 1995 to 1997 where they asked more than 17,421 Kaiser patients about ten categories of childhood trauma, which Felitti and Anda termed adverse childhood experiences or ACEs. After analyzing the data that resulted, in 1998 Felitti and Anda published findings that showed an irrefutable relationship between their subjects’ ACE scores and their physical and emotional health later in life.
Burke was utterly gobsmacked at what Felitti was saying. The article—and the study to which it referred—explained a phenomenon she’d been witnessing daily yet had been unable to adequately interpret.
FIRST EVER ACES SUMMIT
“It’s like the clouds parted and the angels sang,” Burke Harris said last week when she told the story to a ballroom full of 200 health professionals, policy makers and advocates who had gathered in San Francisco for a first-of-its-kind summit to talk about the widespread and profound health and behavioral effects produced by adverse childhood experiences.
Burke Harris explained that four or more ACEs, or what she and others now called toxic stress, could produce long term changes in a kid’s brain structure. High ACE scores compromised the immune system, and dramatically expanded the likelihood of high risk behavior, of depression, of suicidality, of later incarceration.
Moreover, the original Kaiser study—which was conducted on mostly white and mostly college education subjects-–showed that these ACEs were extremely common: Two out of three—or 67 percent—of the 17,000 people studied at Kaiser had at least one ACE, and 12.5 percent had four or more ACEs.
In addition, there was a dose-response relationship between the number of ACEs a child experienced, and his or her risk of developing certain illnesses later in life. The same was true for emotional conditions and behaviors such as depression, violent behavior, or being a victim of violence.
But ACEs don’t have to be destiny, Burke Harris told the crowd. “There is an opportunity for healing throughout a lifetime.”
When Burke Harris had her 2008 epiphany, the medical effects of childhood trauma and toxic stress that she recognized as obvious were still being studiously ignored by most of the medical establishment and those who make public policy—nevermind the fact that Felitti and Anda’s research had been out for a decade.
Yet, by the time she was the featured speaker at last week’s summit, the volume of parallel research into the issue had become increasingly difficult to disregard. Now in pockets all over the country, progressive health professionals are advocating for pediatric ACEs screening, and a growing group of forward-looking lawmakers are starting to talk about trauma-informed policy.
(This newly-ignited interest in California was demonstrated at the summit itself when state senator Mark Leno, state Secretary of Health and Human Services, Diana Dooley, and Chief Justice of the California Supreme Court, Tani G. Cantil-Sakauye, were among the officials who cheerfully agreed to be on one of the event’s panels.)
Meanwhile, Burke Harris is deservedly becoming one of the superstars of the ACEs movement.
At the beginning of this month, Google gave a $3 million grant to Burke Harris’s Center for Youth Wellness—the health organization she founded to operate with her clinic in order to respond to the expanded needs she recognized in her patients. The pediatrician said the Google grant will allow her team to develop a clinical protocol to test for toxic stress.
Last week (as WLA reported) the Center for Youth Wellness released a new California-based study called “A Hidden Crisis: Findings on Adverse Childhood Experiences in California.” Using data from 27,745 California Behavioral Risk Factor Surveillance System surveys between 2008 and 2013, the study found that one in six Californians (16.7%) have four or more ACEs making them:
• 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…
Burke and others estimate these numbers to be on the low side. A newer study likely to come out later this year is expected to have findings that are even more dramatic.
INTRODUCING…..THE TRAUMA FILES
We’re going to be looking at the issue of toxic stress and related topics, on a regular basis in an ongoing series called The Trauma Files.
In the series, we’ll be reporting on trauma in the world of juvenile justice, trauma and its affect on law enforcement, and lots more.
So stay tuned.