What is Philando Castile's daughter's ACE score?

Back in 2000, I attended a "Grand Rounds" continuing medical education presentation by an Epidemiologist, at [then Dartmouth, now] Geisel Medical School, who noted 52% of Detroit Metropolitan Area Schoolchildren met the [then] DSM-IV criteria for PTSD. I don't recall his name, where he came from, or any further research he might have subsequently done, but he noted such "items" (?ACEs?) as proximity to community violence (witnessing a classmate/schoolmate being shot, etc.), poverty, proximity to domestic violence, etc.--items which might now fit the existing World Health Organization's ACE International Questionaire, or the ACE criteria they used for their 2013 assessment of the world's healthiest children. Regretably, I don't have time to research this at the moment, but I hope it will help as we "look for leads" in this issue.

Robert Olcott posted:

I once heard a story about a 6 year old boy, who accompanied his mother-who was having a 'psychotic episode', to the Emergency room of a hospital in Iceland (Where, I'm told, they [the nation] regard their children as a 'natural resource'-to be cared for and protected). The nurse in charge advised the boy to sit [unaccompanied] in the waiting room. The boy was left unattended for at least 1 1/2 hours, and given no news about the status of his mother. It was subsequently reported that the nurse in charge ... received a 'disciplinary notice/action for not advising or comforting the boy about the status of his mother, nor arranging for someone else to advise or comfort the boy. 

We may discover that different cultures in different countries have different standards of what might be called an ACE, and perhaps the World Health Organization may help us to be able to understand the rationale for their ACE International Questionaire, and the content of its questions and categories of ACEs.

The Icelandic Nurse was, in one respect, an "Administrative Official", and most U.S. states have Civil laws covering the "Arbitrary and Capricious Abuse of Administrative Officials". (New Hampshire also provides Criminal penalties under a title called: "Official Oppression"-for administrative officials who abuse their authority in an arbitrary and capricious manner.)

The Police Officer[s] who shot the child's father, and removed the [widowed] mother from her child, may at least be subject to Civil penalties for their "Official Conduct". After-the-Fact justice, assuming a lawsuit is brought, will not restore the child to "Pre-ACE neurodevelopment". 

I am so glad you shared both pieces of info Robert- this gives me a great deal of food for thought AND action. It is so helpful to have a global comparative lens to understand more fully the possibilities of both interpersonal conduct and of official policy. I think we often can have our imaginations trapped when we only consider our local context. 

I once heard a story about a 6 year old boy, who accompanied his mother-who was having a 'psychotic episode', to the Emergency room of a hospital in Iceland (Where, I'm told, they [the nation] regard their children as a 'natural resource'-to be cared for and protected). The nurse in charge advised the boy to sit [unaccompanied] in the waiting room. The boy was left unattended for at least 1 1/2 hours, and given no news about the status of his mother. It was subsequently reported that the nurse in charge ... received a 'disciplinary notice/action for not advising or comforting the boy about the status of his mother, nor arranging for someone else to advise or comfort the boy. 

We may discover that different cultures in different countries have different standards of what might be called an ACE, and perhaps the World Health Organization may help us to be able to understand the rationale for their ACE International Questionaire, and the content of its questions and categories of ACEs.

The Icelandic Nurse was, in one respect, an "Administrative Official", and most U.S. states have Civil laws covering the "Arbitrary and Capricious Abuse of Administrative Officials". (New Hampshire also provides Criminal penalties under a title called: "Official Oppression"-for administrative officials who abuse their authority in an arbitrary and capricious manner.)

The Police Officer[s] who shot the child's father, and removed the [widowed] mother from her child, may at least be subject to Civil penalties for their "Official Conduct". After-the-Fact justice, assuming a lawsuit is brought, will not restore the child to "Pre-ACE neurodevelopment". 

Laura Avellaneda-Cruz posted:

Thank you for writing this. Have you seen any publicly-available articles or the like written on this in the last few days, on the toxic stress experienced by children as a result of racist State violence? 

I hadn't, but I see that you posted one above- thanks! 

Laura Avellaneda-Cruz posted:

Christine Cissy White posted:

Donielle:

This is an excellent post. The loss of her father is one ACE, but the way she lost him and the witnessing of that brutal loss at the hands of a police officer and while her mother was powerless is surely as traumatic as witnessing domestic violence.

The fact that her mother was also held, immediately, by officers, immediately after is not exactly trauma-sensitive for anyone. I don't get why that even happened.

The ACE study and the original questions are an amazing tool but, at you note, don't capture every type of adversity that shapes the lives of children.

Cissy

 

Thank you, Donielle and Christine. This story made me think about the less violently traumatic, but still traumatic effects on my young cousins in their carseats in the back of the car when their dad or older brother have been pulled over, searched, forced to sit on the sidewalk handcuffed for NO REASON and NO crime committed. They too are wondering, "What is happening? Are my adult caregivers safe? Will they be able to care for me?" This is a constant in their lives, in the lives of Black and brown children, one brought out in stark light every time we have video evidence of another child losing a parent in front of their eyes (and there are so many more such instances that have happened without video evidence). I hurt all over thinking about this -- racist State violence is a child trauma issue and a children's rights issues. Is that enough to get the attention of the large chunk of mostly white America that is ignoring this problem, or blaming it on Black people? What is? 

Excellent point Laura, about the even more pervasive trauma (repeated trauma!) for these less physically violent but certainly emotionally and psychologically violent encounters. I've never thought about that, but I am not exaggerating when I say, now I'm not going to be able to stop thinking about it. Because I too know how frequently this occurs! That's for sharing that insight. 

Laura Avellaneda-Cruz posted:

Dr. Beverly Dexter posted:

I find it troubling that it appears this young child, who may need individual therapeutic attention, is being discussed as if she were a celebrity and we are paparazzi.  It is one thing to study and publish on people with their permission.  Quite another to capitalize on this shocking tragedy.  I respectfully recommend that this attention to this child trauma victim be redirected.

I don't think our discussion is in any way comparable to paparazzi. We are discussing this because the tragedy of injustice and loss that the child was forced to witness has forced her into a place of public awareness, and yet most of the public is not talking about the indelible effects of racism and racist violence on children, and this kind of killing as a children's rights issue -- which it is. This is an example in one child's life that shows what far too many children endure as a result of institutionalized racism and poor policing practices, and it needs to be framed as an issue of children experiencing toxic stress, loss, grief, etc. 

Yes, she needs individual therapy and other supports, and yes, all of that should be provided in a way that respects confidentiality, just as it should for any child. But that does not mean that we need to avoid the subject of what she, in this very public incident, has endured and how it might affect her. Her mother live streamed the killing on Facebook for a reason: not for fame, but to show the world exactly what happens. She knows, as a Black woman in the US, and as the mother of a Black child in the US, that personal tragedy such as this is always political and must be shared publicly if anything is going to change. 

Thanks for putting that so eloquently, Laura! In fact, the reason I ended up posting this here, was because I wanted to have this conversation but realized, no one in my real life could understand quickly what I meant. If I said, What is her ACE score, to other people who are upset right now about Castile's murder, they wouldn't know what I was talking about. I would have to explain ACEs, what a score is, why it's important, and they probably still couldn't understand right away. 

I came and posted here because I knew this community would immediately perceive the relevance and the implications, and that's exactly what has happened in this discussion. This community is so valuable, and getting the message out to our physical communities is all the more apparently urgent. 

Jane Stevens posted:

I think that addressing the trauma that this child endured helps people widen their frame of the impact of trauma and how to help those who witness it. When police understand how they may cause further harm by removing a child from a mother when they're not arresting her, but just questioning her, then I believe they would make sure a child remains with the mother, and that the mother is questioned in a trauma-informed manner. It may also change people's understanding so that they would would no longer say that a child or even an adult is "OK" after experiencing a traumatic event if there's been no physical harm. We know differently -- there has been harm and people who witness trauma need help. I see us as people who care deeply and who are willing to talk about these effects instead of pretending they don't exist.

Jane I love how you were immediately able to carve out the practical alternative response in that specific situation- I can see what you just very specifically outlined above about the questioning process, making its way into policing training. Once again this demonstrates how relevant ACEs is to every domain, it is not just the domain of clinicians. 

Andres F Sciolla, MD posted:

Dear Donielle, thank you for your post commenting this atrocious incident from a trauma-informed perspective. This perspective can and should shed light not only on the traumatic grief of Mr Castile's family and friends, but also on the historical trauma experienced by communities of color, law-enforcement officers (including the frantic, unhinged police officer who shot Mr Castile), first respondents, media professionals and the wider community.

With a heavy heart, I sincerely hope that this trauma-informed perspective and its twin, a resilience-informed perspective, can engage and energize political, spiritual, organized community action and other approaches to bring justice, healing, reconciliation and the end of violence and abuse of power in our communities.

Thanks Andres for your words and insights. I see so many connections between the trauma framework and systemic abuses. Your insight that the resilience-informed perspective also points to solutions is golden. 

http://www.thedailybeast.com/a...back-of-the-car.html

I agree with Laura and Jane. Until we realize that institutional racism and violence is a national problem, all of our problem, we won't find a solution. This young girls tragedy is her personal problem, and all of our problem-- and we should bear witness and collectively offer support and ask for justice for her. May all kids, and their parents, be safe and calm, and get all the help and support, and love that they need. 

Dr. Beverly Dexter posted:

I find it troubling that it appears this young child, who may need individual therapeutic attention, is being discussed as if she were a celebrity and we are paparazzi.  It is one thing to study and publish on people with their permission.  Quite another to capitalize on this shocking tragedy.  I respectfully recommend that this attention to this child trauma victim be redirected.

I don't think our discussion is in any way comparable to paparazzi. We are discussing this because the tragedy of injustice and loss that the child was forced to witness has forced her into a place of public awareness, and yet most of the public is not talking about the indelible effects of racism and racist violence on children, and this kind of killing as a children's rights issue -- which it is. This is an example in one child's life that shows what far too many children endure as a result of institutionalized racism and poor policing practices, and it needs to be framed as an issue of children experiencing toxic stress, loss, grief, etc. 

Yes, she needs individual therapy and other supports, and yes, all of that should be provided in a way that respects confidentiality, just as it should for any child. But that does not mean that we need to avoid the subject of what she, in this very public incident, has endured and how it might affect her. Her mother live streamed the killing on Facebook for a reason: not for fame, but to show the world exactly what happens. She knows, as a Black woman in the US, and as the mother of a Black child in the US, that personal tragedy such as this is always political and must be shared publicly if anything is going to change. 

I think that addressing the trauma that this child endured helps people widen their frame of the impact of trauma and how to help those who witness it. When police understand how they may cause further harm by removing a child from a mother when they're not arresting her, but just questioning her, then I believe they would make sure a child remains with the mother, and that the mother is questioned in a trauma-informed manner. It may also change people's understanding so that they would would no longer say that a child or even an adult is "OK" after experiencing a traumatic event if there's been no physical harm. We know differently -- there has been harm and people who witness trauma need help. I see us as people who care deeply and who are willing to talk about these effects instead of pretending they don't exist.

Christine Cissy White posted:

Donielle:

This is an excellent post. The loss of her father is one ACE, but the way she lost him and the witnessing of that brutal loss at the hands of a police officer and while her mother was powerless is surely as traumatic as witnessing domestic violence.

The fact that her mother was also held, immediately, by officers, immediately after is not exactly trauma-sensitive for anyone. I don't get why that even happened.

The ACE study and the original questions are an amazing tool but, at you note, don't capture every type of adversity that shapes the lives of children.

Cissy

 

Thank you, Donielle and Christine. This story made me think about the less violently traumatic, but still traumatic effects on my young cousins in their carseats in the back of the car when their dad or older brother have been pulled over, searched, forced to sit on the sidewalk handcuffed for NO REASON and NO crime committed. They too are wondering, "What is happening? Are my adult caregivers safe? Will they be able to care for me?" This is a constant in their lives, in the lives of Black and brown children, one brought out in stark light every time we have video evidence of another child losing a parent in front of their eyes (and there are so many more such instances that have happened without video evidence). I hurt all over thinking about this -- racist State violence is a child trauma issue and a children's rights issues. Is that enough to get the attention of the large chunk of mostly white America that is ignoring this problem, or blaming it on Black people? What is? 

Thank you for writing this. Have you seen any publicly-available articles or the like written on this in the last few days, on the toxic stress experienced by children as a result of racist State violence? 

I, too, immediately thought of the child that was reported to be in the back seat when this occurred, and I was doubly horrified by the fact that they took her mother (for no apparent legitimate reason) after the fact.  What support will be provided for this child? For her mother?  They should be provided the best in trauma aftercare...I sincerely hope that someone who works in MN will respond and let us know that all measures possible are being taken to provide the best support for this family free of charge.  My heart is broken......again....

thanks so much for this. Im feeling so much sorrow-- and welcome this opportunity to bear witness to this pain and injustice with you. Makes Jesse Williams words  (see link here) even more poignant -- not that any more evidence were needed....

Dear Donielle, thank you for your post commenting this atrocious incident from a trauma-informed perspective. This perspective can and should shed light not only on the traumatic grief of Mr Castile's family and friends, but also on the historical trauma experienced by communities of color, law-enforcement officers (including the frantic, unhinged police officer who shot Mr Castile), first respondents, media professionals and the wider community.

With a heavy heart, I sincerely hope that this trauma-informed perspective and its twin, a resilience-informed perspective, can engage and energize political, spiritual, organized community action and other approaches to bring justice, healing, reconciliation and the end of violence and abuse of power in our communities.

Donielle:

This is an excellent post. The loss of her father is one ACE, but the way she lost him and the witnessing of that brutal loss at the hands of a police officer and while her mother was powerless is surely as traumatic as witnessing domestic violence.

The fact that her mother was also held, immediately, by officers, immediately after is not exactly trauma-sensitive for anyone. I don't get why that even happened.

The ACE study and the original questions are an amazing tool but, at you note, don't capture every type of adversity that shapes the lives of children.

Cissy

Parental depression actually was included as an adverse childhood experience in the original study. In addition to a family member's incarceration, I often see people refer to parental separation or divorce, and even sometimes death, as an ACE, though this is inconsistent across sources. What I do think is really important to keep in mind during these conversations is the fact that ACEs are just one piece of the puzzle, or one lens through which to look at the issue of childhood trauma. In order to get the attention of the people with power (legislators, funders, etc.), information like the ACEs study and data are used to tell a compelling story. But the fact of the matter is that there are many factors that are traumatic for children (and we're talking "big T" traumas) that were not included in this study but can have serious repercussions on the child's physical and mental health (e.g., bullying, community violence such as what is described above, discrimination, poverty). I believe it is important for ACEs to be a starting point for a larger conversation rather than being viewed as the final word. A child's ACEs score matters less, in my opinion, than their perception of experiences and the protective factors that enable them to be resilient in the face of these experiences. I get the sense that you're trying to make this point as well. Fortunately, a lot of valuable work is occurring to help children and their families develop these protective factors! Unfortunately, we still need to do far too much work to help children heal from trauma since we aren't successfully preventing those traumas from occurring in the first place...