Last week, I was fortunate to be a part of a small group of professionals in San Diego to attend the Academy on Violence and Abuse preconference session for the 30th Annual San Diego International Conference on Child and Family Maltreatment. The conference draws over 1,800 professionals in the maltreatment field from around the world each year. The session, titled: Building Trauma Informed, Resilience, and Healthy Communities: Regional, National, and Global Perspectives, had an ambitious agenda with an all-star cast of experts in the field.
Dr. Vincent Felitti kicked things off with an overview of the Adverse Childhood Experiences (ACEs) Study, but in order to do that, he had to tell the story of how the ACE study came to be. Hearing about his early experiences with patients in the weight loss clinic was a first for me, and gave me a deeper understanding of the relevance of his work. Dr. Felitti shared videos of patients he worked with in the obesity clinic, which really brought to life the stories his patients had to tell. One woman, with a history of sexual abuse, and who weighed over 400 pounds, spoke of her weight being her “protective wall.” She used food to protect herself from a world she didn’t trust. With the help of Dr. Felitti and his clinic, the woman began to lose weight, and she subsequently became suicidal. She was not ready for the world to see her without her protective wall. Sadly, we also learn that this woman died at the age of 42 of a heart condition. Seeing her face, and hearing the pain in her voice as she talks about these things is not something one can easily forget. Her story was not unusual; however, as we heard other patients talk about gaining weight back after successfully losing hundreds of pounds as a means of protecting themselves. After digging deeper with these patients and beginning to ask some questions, Dr. Felitti and his staff learn of the high prevalence of childhood trauma in these patients’ lives, which led to the ACE study we are familiar with today. Dr. Felitti goes on to describe the 10 categories selected for the ACE study, based on their prevalence in the weight loss clinic. He explains he was compelled to know “does this exist in the general population, and how does it play out.”
When describing the results of the ACE study, surveying over 17,000 Kaiser Permanente patients throughout San Diego County, he admits “even I had difficulty accepting these results as valid.” He is referring to the high prevalence of ACEs within this group (see title image). He goes on to add, if 1 ACE is present, there is an 87% chance of at least one more, and a 50% chance of 3 or more ACEs. Additionally, women are 50% more likely than men to have an ACE score of 5 or more.
Dr. Felitti poses the question, “what can we do?” He suggests healthcare, social service, and other providers must routinely screen for ACEs. And then we must LISTEN. We must ask, “how has this impacted you later in life?” He suggests that what presents as the problem may really be an attempted solution, which is really the basis of trauma-informed care. He adds, there is “huge power in asking, listening, implicitly accepting.”
Dr. Susan Kelley spoke about the importance of leadership and emotional intelligence and its role in advancing this work. As leaders, the most dangerous weakness we have is the one we think we don’t. The session also featured a presentation on the biology of trauma, as well as how to build trauma-informed communities. Dr. Tasneem Ismailji referred to the principles of trauma-informed care; realizing, recognizing, and responding (see attached photo - Principles of TI care).
The session also included examples of cutting edge work happening around the country, with stories shared from both St. Louis and Salt Lake City. Dr. David Schneider spoke of poverty and community violence in St. Louis, most recently known for the death of Michael Brown in Ferguson, and the riots in the city that followed his death. He spoke of a peaceful protest on the campus of St. Louis University and other initiatives as a result of the events in Ferguson, including Alive and Well St. Louis and the Ferguson Commission, to name a few.
Dr. Susie Weit spoke about The Salt Lake City Health and Resilience Symposium and the development of a community wide Trauma-Resiliency Collaborative. They have implemented a screening tool called the Health Resilience Stress Questionnaire that they are piloting in her medical center and are currently collecting data. Dr. Weit also spoke of a trauma-informed curriculum currently being developed for dissemination across the Salt Lake City school district.
AVA President Dr. Randy Alexander described how ACEs can play out in the workplace. The higher an individual’s ACE score, the more likely the individual is to experience difficulty with job performance, financial problems, and absenteeism (see attached photo - ACEs at work). He also talked about the financial burden of child maltreatment on our society as a whole (see attached photo - Economics of child maltreatment).
Overall, the message is clear: Trauma-informed care and resilient communities are the answer to addressing the long-term impacts of ACEs. We must also begin to focus on prevention, as I learned this week, what is predictable is also preventable.
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