^{Lynnan Svensson wearing a fake sheriff badge as a joke, because some people consider her the "sheriff" for the county enforcing Covid compliance, which she oversees}

Lynnan Svensson is a nursing program manager for El Dorado County Public Health. She oversees several grant programs ranging from maternal, child and adolescent health to senior services. Six months ago, she also took on the county’s COVID response as deputy incident commander, a responsibility she shares with her health officer. The county extends from its headquarters in Placerville in the Sierra foothills, to the southern high Sierra and plunges down to South Lake Tahoe. It’s no wonder the public health advocate and her small staff work long hours each day to ensure the health of its 192,843 residents now exacerbated by a global pandemic, fires, extreme heat, power outages and widespread unemployment.

Svensson is no stranger to trauma. She attributes her ACE score of 2 to when her parents, living in Bakersfield, adopted an older, trouble-ridden sixth-grade boy and he lived with them for five years, starting when she was in first grade.

Before then, “I had the most wholesome, wonderful childhood,” she said. The adopted boy would try to fight his stepsister and then tried to make up. He also used drugs and stole from everyone in the family. He later entered juvenile detention and the family eventually lost touch with him.

“It really impacted me,” Svensson says, “because it broke that innocence I had.”

As a result, she acted out in high school. “I wanted to be different from my family, which was Christian and conservative,” she says. “I always went to church with them throughout my childhood. I was trying to find my own identity and was also hurt from what had happened during those years. I didn’t go to high school much."

Her parents didn’t know the extent of the physical, verbal, and mental abuse their daughter had suffered. She only told them eight years ago…after she had learned about ACEs science.

But before then, Svensson entered community college, where she met her husband of 30 years. “He made me get my act together,” she says, and she became a straight-A student.

Svensson earned a bachelor’s in nursing from Cal State University in Bakersfield and worked as a neonatal nurse after graduation, which entails highly intensive work with micro preemies, babies born weighing under 1 pound, 12 ounces, or before 26 weeks gestation. Motivated by a desire “to prevent illness and disease, not just treat it,” she went into public health and eventually became a public health nurse and health program coordinator for Sacramento County Public Health from 1997 to 2011. She then moved up to El Dorado County Public Health to help her "slow down a bit". A self-described striver, who “wanted to open up other avenues for my career,” Svensson then earned a master’s of science in nursing degree in 2018 from Cal State, Sacramento.

Only half jokingly, the public health advocate claims that because of her 23 years of experience in the field, albeit without the formal degree, “I have a doctorate in public health.”

Six years ago, at a conference for maternal child and adolescent health directors, she heard Dr. Vincent Felitti talk about the seminal CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study).

“I came back to my county and I was just on fire,” she recalls. “We had high domestic violence, mental health, and substance abuse rates. It just came together for me: My county is struggling with ACEs and we need to do something.”

ACEs is a term that comes from the landmark study that showed how widespread childhood adversity is. The ACE Study of more than 17,000 adults, which was first published in 1998, linked 10 types of childhood adversity — such as living with a parent who is mentally ill, has abused alcohol or is emotionally abusive — to the adult onset of chronic disease, mental illness, violence and being a victim of violence. Many other types of ACEs — including racism, bullying, a father being abused, and community violence — have been added to subsequent ACE surveys.

The ACE Study found that the higher someone’s ACE score — the more types of childhood adversity a person experienced — the higher their risk of social, economic, health and civic consequences. The study found that most people (64%) have at least one ACE; 12% of the population has an ACE score of 4 or higher. Having an ACE score of 4 nearly doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and the risk of attempted suicide by 1200 percent. (For more information about how this works and about the full complement of ACEs science, go to ACEs Science 101. To calculate your ACE and resilience scores, go to: Got Your ACE Score?)

Empowered with knowledge of ACEs science, Svensson reached out to Judy Knapp at Prevention Works, a local non-profit agency, and together in 2015, they founded the El Dorado ACEs Collaborative. She still facilitates but says it’s run by the community, and now includes more than 200 members. Using ACEsConnection.com as a resource, the collaborative uses the ACEs science and resiliency frameworks in a way to fit their community members, which include the Latinx population in the county.

Since 2018, El Dorado County Public Health integrates ACEs science with all its staff. “We also trained every person in our health and human services agency on ACEs, resiliency, and self-care,” explains Svensson. The training took 2.5 hours, and many said it really opened their eyes to what is happening in society; many also wanted to be part of the ACE movement. they use the standard 10 ACEs for patient screening. Staff Svensson's in maternal and child adolescent health programs receive additional training in conducting interviews and using words that use supportive language that helps patients feel safe.

The department does not screen every patient for ACEs because for some with obviously high ACEs, the screen itself might be too triggering. However, armed with ACEs knowledge, nurses are able to informally score the patients to determine their level of risk.

The result of integrating ACEs training, says Svensson, “has helped a lot during COVID. For patients who test positive for the virus, we approach them in a trauma-informed way. With the Latinx population, we tell them we don’t care if they have documentation or not. And if they need food support, we will help arrange that with our community partners.”

With those in the county who are reluctant or refuse to wear masks and socially distance themselves, Svensson says they take a trauma-informed approach. “Our wording is very positive," she explains. "Personal responsibility versus punitive or chastising.”

And it’s working, she says. With support from her board of supervisors, the approach is to educate people first and then work with them, relying on enforcement tactics last.

Although Svensson works more than an 8-to-5 job during the week, after work and on weekends, she and her husband — who was furloughed from his job as a mechanical engineer in March — have plenty to do on their five-acre ranch in Placerville. She calls the idyllic setting “God’s country”. They built a barn and a horse arena where Svensson rides her horse and tends to a large vegetable garden as well as fruit trees. Their 24-year-old daughter is now living at home while completing her nursing degree, and Svensson is about to bring her octogenarian parents, whose health is declining, up from Bakersfield so she can take care of them on her farm for the rest of their days.

"I want to give them the end of life that they deserve," says Svensson.