“Children are compelled to give meaning to what is happening to them. When there is no clear explanation , they make one up; the intersection of trauma and the developmentally appropriate egocentrism of childhood often leads a little kid to think, I made it happen.”
― Dr. Nadine Burke Harris
“We would crowd together on the back porch every afternoon around 4:00 p.m.,” shared longtime inland area resident Ellen P.
“I was just six-years-old, and my sisters were four and three. We’d sit facing the driveway, peeking down the block, watching for his car.”
When their dad pulled into his parking spot they would jump up and down gleefully, she recalled. Looking back through her adult eyes Ellen explained she now knows he was probably very tired after a long day working on the production line at the Chevrolet plant, but he never let it show.
After setting his lunch pail on the porch, he would pick up his daughters one by one beginning with the youngest, and give them each a big hug and kiss, she said, and he would say with a grin, “I left a little something for you girls to share.”
It was the same ritual every day. He always left a treat from his lunch, cookies, an orange, a half sandwich. “We looked forward to it,” Ellen remembered, “we were happy to share whatever it was.”
“I never looked at the clock,” she explained. “I don’t think I even knew how to tell time yet, but somehow we knew when it was near time for him to come home and we would squeeze together on that back step. “He arrived the same time every day,” she explained. “We looked forward to it. We counted on it. . . until the day—he didn’t. And our lives were changed, forever.”
Ellen said because they were so young, when they were told he was dead, it was a mystery. They had no idea about heaven and all the words adults used to describe his disappearance. It was not until they were older and asked why he died, that they were told he committed suicide.
“Years later when we reminisced about his loss, we all somehow felt responsible for his death. I know that doesn’t make sense because we were so young when he died, but we did.”
The sisters never received any counselling and later, when their mother remarried, the emotional damage caused by the sudden loss of their father and the reason he died was further exacerbated by a stepfather with a violent temper who abused their mom and made the rest of their childhood, a living hell.
The story of Ellen and her sisters is just one example of the kinds of adverse childhood experiences or ACEs—traumatic events that can occur in childhood (between the ages of 0 and 17 years)—and can impact one for a lifetime.
In 2019, California set a bold goal of reducing ACEs by 50% in one generation, guided by the principles of prevention, equity, and scientific rigor.
Earlier this month, California’s first Surgeon General Dr. Nadine Burke Harris, a nationally celebrated expert on ACE’s, began to deliver on that promise when she released a report, Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health, which provides a rigorous scientific framework designed to offer shared language and a shared understanding and to serve as the clinical foundation for that work.
The report is designed to serve as a blueprint for how communities, states, and nations can recognize and address adverse childhood experiences (ACEs) and toxic stress effectively as a root cause to some of the most harmful, persistent, and expensive societal and health challenges confronting many Americans, particularly people of color and those in low-income communities.
Like Ellen and her sisters, experiencing trauma and various levels of toxic stress in childhood carries over into one’s adult life and manifests in various ways from dysfunctional relationships, obesity, and a myriad of negative physical and emotional health outcomes.
The report includes an executive summary and briefs that pull out some of the key themes and highlight what can be done by sector as well as a specific focus on how ACEs and toxic stress are interacting with the current COVID-19 emergency.
According to the Surgeon General’s office, “[The report] brings together global experts across sectors, specialties, regions, and disciplines to drive science-based approaches to primary, secondary, and tertiary prevention strategies for ACEs and toxic stress.” In addition, it offers a clear and equitable response, solutions, models, and best practices to be replicated or tailored to serve community needs.
“This report and this work is rooted in our core values of prevention, equity and rigor, and throughout the report what we understand is that Adverse Childhood Experiences and toxic stress represent a public health crisis,” said Burke Harris.
The term Adverse Childhood Experiences refers to 10 categories of experiences that were investigated by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente in the landmark Adverse Childhood Experiences study. And those include physical, emotional, and sexual abuse, physical and emotional neglect, the loss of a parent in childhood or growing up in a household where a parent was mentally ill, substance dependent, incarcerated, where there was parental separation or divorce, or intimate partner violence.
“ACEs and toxic stress are the root cause of some of the most harmful, persistent, and expensive societal and health challenges facing our world today,” said Burke Harris. “And that has never been more poignant than what we’ve experienced during this year, 2020. Our multiple, simultaneous public health emergencies, the COVID-19 pandemic, the impacts of climate change felt here in California [with the] record-setting wildfires, and our sharper focus on the deep-rooted systemic racism in our society only highlights how important it is for us to have trauma-informed systems to be able to buffer the long-term harms of these stressors because we recognize that our vulnerable and systematically overlooked communities bear the brunt of each new crisis.”
Across the United States, almost two-thirds of Americans have experienced at least one Adverse Childhood Experience and almost 16% have experienced four or more. “Here in California,” Burke Harris advised, “the numbers are very similar, though slightly higher. 62.3% of Californians experience at least one ACE and 16.3% experiencing four or more.”
She continued, “ACEs occur in all communities, in all income levels, in all geographies, in every latitude and longitude, we also recognize that certain groups are more impacted. And so, the latest national data shows us that our Black and Brown communities as well as our LGBTQ communities experience greater levels of ACEs.”
One of the key findings of the report is that ACEs are causally associated with the toxic stress response and although there previously existed an understanding of the relationship, the study brought together the body of science to put that understanding through the scientific rigors. “Just as a previous U.S. Surgeon General’s report established the causal relationship between smoking and lung cancer, similarly in this report, the researchers and scientists that contributed to this report really highlighted that ACEs are causal of toxic stress,” Burke Harris revealed.
Defining toxic stress, she defined it as the prolonged activation of the stress response system that can disrupt brain development, development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment well into adult years. “And we recognize that in addition to ACEs, other risk factors for toxic stress include poverty, exposure to discrimination and exposure to the atrocities of war.”
The report lays out the evidence that ACEs undergird toxic stress, which is the prolonged activation of the biological response which ultimately leads to an increased risk of stress-related diseases and disorders.
ACEs dramatically increase the risk for nine out of 10 of the leading causes of death in the United States, including heart disease, cancer, accidents, chronic respiratory disease, stroke, Alzheimer’s, kidney disease and suicide attempts.
The evidence also confirms toxic stress has biological implications that can genetically influence the next generation, increasing the risk for child physical and mental health outcomes as well as child behaviors. The hopeful news, according to Burke Harris, is advances in science provides the ability to interrupt the toxic stress response more precisely, to break that intergenerational cycle of ACEs and toxic stress and promote an intergenerational cycle of health.
“We know from the data that early intervention can improve brain immune, hormonal and genetic regulatory control of development. And we recognize that treatment of toxic stress in adults can prevent transmission of toxic stress to the next generation. The report, details and highlights the science of how to interrupt that toxic stress response.”
The annual cost to ACEs to the state of California alone is $112.5 billion, simply due to the health care costs and the loss productivity from these eight ACE-associated health conditions. There is also another $19.3 billion of costs due to child abuse and neglect on the impact of other sectors, such as education, welfare, criminal justice and looking at lifetime productivity.
“And so, when we think about Adverse Childhood Experiences and toxic stress as a public health crisis, what we mean is that many, many people are affected, two-thirds of Americans,” she explained.
Consider the impact of ACEs in the inland region. According to kidsdata.org between 2011 and 2017 in Riverside County among households with children 48% experienced between one to three ACEs and 20% experienced four or more. In San Bernardino County the data was similar. Among households with children, 47% experienced one to three ACEs and at least 18% experienced four ACEs or more.
The Roadmap for Resilience report lays out a plan for how California moves forward in a coordinated cross-sector fashion by diving into the science, scope and impacts of ACEs and toxic stress; outlines a public health approach for cutting ACEs and toxic stress in half in a generation; offers a detailed what, why and how of California’s response to ACEs and toxic stress; and highlights what lies ahead.
Follow this link to the Surgeon General’s report, Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health.
S.E. Williams is executive editor of the IE Voice and Black Voice News.
Header Photo: Dr. Nadine Burke Harris (Source: PBS NewsHour)