After three days of inspiring presentations, panel discussions and breakout sessions at the National ACEs Conference, the crowd of 850 people was eager to hear from two of the ACEs movement’s pioneers: Dr. Vincent Felitti and Dr. Nadine Burke-Harris.
During a luncheon plenary on the last day of the conference, which was held Oct. 15-17 in San Francisco, Felitti related a story about what happened when he first broached the subject with colleagues of asking patients to fill out a questionnaire that included questions about their childhood trauma. They thought he was crazy, he said.
“They thought [the patients] would decompensate,” he told a packed ballroom.
His story was an example of how paradigm shifts in science go hand-in-hand with the push-pull of deep resistance to change. What accelerates acceptance is when convincing and persistent champions have gathered clear and convincing evidence, share it, and it lays the stepping stones for a national movement. For the ACEs movement, Felitti and Dr. Robert Anda, his co-principal investigator in the groundbreaking CDC-Kaiser Permanente Adverse Childhood Experiences Study, are two of those people.
Felitti told conference attendees about the moment that led to a tipping point in his thinking. It was an exchange with a patient in Kaiser San Diego’s weight clinic, he explains, as giant photos of the particular patient were projected behind him on the wall. The clinic had had enormous success, leading more than 1,500 patients through a weight reduction program that helped many lose hundreds of pounds within a year. But disturbingly, recounted Felitti, many left the program only to rapidly gain back the weight they shed, including the woman whose before and after photos were projected on the wall behind him.
Felitti developed a number of questions to try and understand why patients were putting on weight. He recalls accidentally asking a patient, “How much did you weigh when you first became sexually active?” when he meant to ask, “How old were you when you first became sexually active?”
“Forty pounds,” she responded, and then blurted out, “It was with my father,” and she started sobbing, Felitti said. He explained how he thought to himself that it was only the second case of incest he had heard about in 24 years.
That would change over the course of the next few weeks, he said, when every other person queried by him and his colleagues divulged histories of child sexual abuse or other types of childhood trauma.
That was the game-changer that led to the development of the ACE Study. Felitti told conference attendees that after the first publications of the ACE Study, he integrated the original 200-question survey into the Health Appraisal Center at Kaiser Permanente in San Diego, which he ran. After 440,000 patients had answered the questions as part of their bio-social-physical health assessment, he and his colleagues learned that the protocol around asking people about their childhood trauma had cut down emergency room visits by 11 percent. He noted that patients filled out ACEs questionnaires in the comfort of their homes, followed up by an appointment with their doctors who asked, “’Could you tell me how these things have impacted you later in life?’ And we listened, period.”
That interest made a difference: ”Patients told us that they had told the darkest secret of their life to the doctor and the doctor was still nice to them, and wanted to see them again,” he said.
The act of listening and acceptance, said Felitti, “turns out to be a previously unrecognized, remarkably powerful tool.” And, while ACEs science and education has been used widely across sectors, he said, there’s still resistance in medical settings to using the ACE survey. He suggested that recording and widely disseminating videos showing how physicians interact with patients around the ACE survey is one way of overcoming that resistance.
And, with the work of ACEs champions around the country, Felitti concluded: “What you are doing is of major importance for the country and for the world.”
One of those notable champions, a woman who has been a pioneer in spreading the word about ACEs science in the pediatric and public policy arena, is Dr. Nadine Burke Harris, founder of the Center for Youth Wellness and author of The Deepest Well.She learned about the ACE Study in 2009, and it changed her whole approach to her work as a pediatrician.
“This work is happening in clinics, in classrooms, in communities, in courtrooms, and it is larger than all of us!” Burke Harris told the crowd at the end of the conference.
To show how the ACEs movement has spread geographically and across sectors, Burke Harris ticked off examples of encounters with attendees at the National ACEs Conference, including the person from New Jersey rolling out ACEs screening, a person in Florida who talked about integrating practices based on ACEs science in child welfare, a San Diego attendee working with foster youth and the woman from Brazil who talked about her work in Latin America.
Burke Harris also noted how awareness of ACEs has reached the highest levels in government. “In June of this year,” she said, “One of the proudest moments of my career was to travel to Washington and testify before Congress about the separation of children from their caregivers.”
But even better, she said, was the language used in the district court ruling to stop that policy. “On page 19…it said, ‘There is ample evidence that separating caregivers from their children leads to serious consequences for the children’s health and development. And, in addition, traumatic separation of children from parents creates toxic stress (emphasis added) in children and adolescents.’”
That, she said, “is awareness to action!”, the theme of the last ACEs conference in 2018.
In summing up, Burke Harris said: “If we each take on our individual roles and we do this in a coordinated system of care, this is how we weave a fabric of trauma-informed care across our communities that disrupts the multigenerational transmission of ACEs and changes the outcomes for millions of children across our country.”
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Felitti spoke on the 20-year anniversary of the first publication of the ACE Study. To honor and commemorate his work, hundreds of conference attendees wrote messages in two books about what the ACE Study meant to them.
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