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By Thomas Goldsmith
Young people who are aging out of foster care at the Hope Center in Raleigh often present themselves very well, said a social worker for the agency. That’s because they’re used to concealing the devastating life experiences many have endured.
“They’ve learned it; it’s a skill,” said Meredith Yuckman, program director at the Hope Center at Pullen last week. “That’s where relationships are important, building trust with our staff so that they can get beneath that mask.”
Toxic experiences young people may hide are key to one of the most compelling medical realizations of recent decades: that adverse experiences in childhood, even those that aren’t remembered or expressed, can have a strong negative effect on physical and mental health.
Twenty years after the publication of a pioneering study on the topic, practitioners and communities across North Carolina continue to find their own ways to deal with these adverse childhood experiences, or ACEs. These experiences include divorce, child sexual abuse, parental substance abuse and hope-extinguishing isolation.
At the Hope Center last Tuesday, nearly 100 people gathered to watch “Resilience,” a film that details the genesis and growth of using the knowledge about ACEs in approaching kids who’ve experienced trauma. After the screening, Hope Center staff and others discussed how this knowledge is being used in Raleigh and across the country.
“It’s sort of permeating everything we’re doing,” said Mellonee Kennedy, an attorney advocate at the Wake County guardian ad litem.
Changing the approach to care
The guardian-ad-litem program, in which volunteers advocate for abused and neglected children, has lately been receiving ACEs-based assessments of children who have entered the court system.
“Sometimes the recommendations will be for the child to be removed from the home, to stop the abuse,” Kennedy said.
Cristin Deronja, executive director of the Raleigh-based independent agency SAFEchild, said the ACEs principles inform staffers in their assessments of children’s lives and future.
“Part of what we do is an evaluation of a child’s adverse childhood experiences, and how that has impacted that child’s life,” Deronja said in a separate interview.
Elements of a person’s ACEs score include trauma encountered before age 18, including physical abuse, sexual abuse, parental substance abuse, divorce in the family, and time in prison for a family member.
According to a foundational 1998 article by Drs. Vincent Felitti and Robert Anda, originators of the ACEs approach, a person who has had four such experiences, or an ACEs score of four, had a:
- much greater risk for alcoholism, drug abuse, depression and suicide attempt;
- were as much as four times more likely to smoke, have more sexual intercourse partners, acquire sexually transmitted diseases, and rate their own health as “poor”;
- were at least two times more likely to suffer heart attacks and strokes and were even more likely to be diagnosed with cancer and diabetes.
The realization that childhood stress can dramatically increase a person’s chance of having a range of life-threatening diseases, as well as behavioral problems, arrived like a lightning bolt in the 1990s for researchers Anda and Felitti, who appear in the “Resilience” film.
Additional physicians who have made a national reputation by boosting the ACEs approach include Nadine Burke Harris, a San Francisco neighborhood pediatrician, and Jack Shonkoff, a pediatrics professor at Harvard Medical School and Boston Children’s Hospital and founding director of the Center on the Developing Child at Harvard.
“Everyone likes to talk about resilience. It’s not something you’re born with; it’s something you build up over time,” Shonkoff says in the film.
“We don’t say to people who have cancer, ‘Why don’t you suck it up and be like the person who didn’t get cancer?’”
Approach spreads around N.C.
The growing knowledge of ACEs-based medicine showed up in a project started this year by the Public School Forum in three low-income schools, Stocks Elementary and Pattillo Middle in Edgecombe county and Koontz Elementary in Salisbury.
As previously reported in NC Health News, the goal is for schools to encourage professionals in the schools to ask “What happened to you?” instead of seeing a negative behavior and jumping to “What is wrong with you?” Through the program, students are asked to be open with their feelings and fears, a process that has led to more learning and fewer suspensions in places where the technique has been used.
And in January 2017, psychologist Betty Rintoul talked about the way ACEs cause more susceptibility to disease before 400 people gathered at the UNC-Chapel Hill Friday Center for the 39th annual Legislative Breakfast on Mental Health.
As much as 80 percent of health care costs arise from diseases that are preventable, Rintoul explained that day.
People with disabilities are even more prey to problems associated with having four or more adverse childhood experiences in their backgrounds. That’s according to a 2014 study prepared for the State Center for Health Statistics based on state health data that included ACEs responses and some shocking findings.
“A key finding is that an estimated one-in-four North Carolina adults with a disability and high ACE exposure reported being forced to have sex with an adult before age 18,” authors Harry W.B. Herrick and Anna E. Austin wrote. “Secondly, both the prevalence (38.2%) and the relative risk (adjusted for gender, age and education) of current smoking were significantly higher for those with a disability compared to those without a disability.”
The North Carolina study said that people with disabilities and ACEs score of four or greater are 3.7 times as likely to develop chronic obstructive pulmonary disease (COPD). Across a range of health problems, this group was at least 2.4 times more at risk.
“ACEs, particularly childhood sexual abuse, among North Carolina adults with a disability are an important public health issue,” the authors concluded. “Strategies are needed to help improve both the physical and mental well-being of persons with disability who have been exposed to multiple types of childhood abuse and trauma.”
At Pullen Memorial Baptist Church, where “Resilience” was shown, even people who had seen the film before were moved to tears by its story of children harmed for a lifetime by forces beyond their control. That seemed especially true of people associated with the Pullen-backed Hope Center, where lawyer and former state Rep. Jennifer Weiss is executive director.
The nonprofit center will help 140 young people this year who are aging out of foster care at age 18. Those who might have had several ACEs in childhood underwent another trauma when child protective services workers removed them — by necessity — from a home that was at least familiar.
“Toxic stress occurs in the absence of protective relationships,” said Kennedy, the attorney advocate. “In Wake County, we have 500 to 700 kids in foster care. Every single one of them, by definition, has experienced toxic stress.”
Medical science is still working to effect workable solutions to the effects of severe stress — likened to being confronted by a charging tractor-trailer truck — although some efforts to change parents’ behavior has shown promise.
Looking toward the children’s future, digging through layers of past bad experiences becomes the job of people at agencies such as the Hope Center and SAFEchild, along with the volunteers who are crucial to this effort. Recently, SAFEchild parenting coordinator Jadie Baldwin-Hamm has worked on locating adult volunteers who can be paired with young people at the Hope Center — clients who are themselves parents.
“Their children are also seeing that there are caring adults in their lives that are protective of their parents,” Baldwin-Hamm told the crowd. “We are trying to defer what happened to these young adults from happening to their children.”
Advocates for Health in Action, or AHA, is offering a series of screenings at Marbles Kids Museum in downtown Raleigh.
There’s another showing of “Resilience” at April 19 at Pullen Memorial Baptist Church.