NOTE from Carey on 8.12.26 : The PACEs Connection social network was replaced by a splash page on August 10, 2026. Knowing this was happening, I urged leadership to let the most prolific content providers and donors know, and started saving blogs I’d written over my 13-years of knowing Jane Stevens, founder and publisher of PACEs Connection and the now disappeared ACESTooHigh.com. This history, written by Jane, is saved on my site now for posterity. Someday the history of how this movement came about, who led it, who funded it, how it grew, expanded, contracted, and more, will be told. Saving this and other information on my careysipp.com site is an attempt to capture as much of this information as possible. It’s here for use while the PACEs Connection site is revitalized, and here in case some of this information doesn’t make it to the new site. AGAIN, this is a limited selection of article I deemed most important, and is in no way a comprehensive or fair representation of the wide scope of PACEs Connection in its heyday, when we had about 20 staffers and were offering frequent “A Better Normal”, “Historical Trauma in America” (by region), “Connecting Communities One Book at a Time”, and other webinars and events. For more of the history, another separate site, https://www.pacesconnectioninfo.com/ is still up. I will try to add more content from it, hoping that if it is saved in several places, it will be available for the revitalized site and/or posterity.
Jane Stevens launched PACEs Connection in January 2012 with ACEsConnection.com, now PACEsConnection.com, a community-of-practice social network and ACEsTooHigh.com, a news site for the general public. The intent was to inform people, organizations, and communities about a new understanding of human behavior that had been emerging since 1980s. It was clear that this new knowledge had the potential to solve our most intractable problems. The network was designed to connect the pioneers who were integrating trauma-informed and resilience-building practices based on PACEs science across sectors. This included pediatricians, educators, business owners, judges, community activists, people participating in associations, people working in juvenile justice, social workers, people in the faith-based community, emergency medical technicians, etc.
In 2014, PACEs Connection received funding from the Robert Wood Johnson Foundation and The California Endowment and began operating as a nonprofit through a fiscal sponsorship with Prevention Institute. At that time, a small team of people began working with Stevens to grow PACEs Connection. In March 2016, PACEs Connection received another round of funding from the Robert Wood Johnson Foundation, which sunsets in 2021, and TSNE MissionWorks, which is a 501c3, became our fiscal sponsor. Subsequently, at the end of 2016, PACEs Connection received a second round of funding from The California Endowment. In 2017, the Lisa & John Pritzker Family Fund, and The George Sarlo Foundation provided two years of funding. Genentech’s Resilience Effect philanthropic initiative began providing funding, which mostly supports a reporter who covers pediatrics. In 2020, Blue Shield of California Foundation began providing funding for work in California.
PACEs Connection has become the hub for the PACEs movement. Between 2012-2021, PACEsConnection.com grew from 200 members and no community sites, to more than 52,000 people from every state in the U.S. and more than 40 countries, with more members joining daily. More than 400 communities representing PACEs initiatives have launched in nearly every state in the U.S. and in several countries, with more community sites launching weekly. The community sites can be thought of as mini-PACEsConnections that support PACEs initiatives in cities, counties, regions, states, and nations. The network also supports interest communities such as PACEs in Education, PACEs in Pediatrics, and Parenting with PACEs, and organizational groups such as California Essentials for Childhood.
On ACEsTooHigh.com, articles receive from a few hundred to more than two million page views. Since its inception, ACEsTooHigh.com has also grown: in 2012, it had 471,000 page views and 3,600 visitors; by 2021, it had nearly 10 million page views and six million visitors.
Since 2012, PACEs Connection has used Marshall Ganz’ five-pronged approach to grow the PACEs movement — relationship building, storytelling, structure, strategy, and action. Our initial strategy focused on educating people and organizations about PACEs science, telling stories about people and organizations in different sectors who developed practice-based evidence that inspired others to take action, connecting people who were doing similar work, and developing a networking structure to support all this.
In our next phase, we are focusing focus on systems and policy change. That means creating a national scaffolding using distributed networking technology that links the “mini-movements” taking place in thousands of geographic- and interest-based communities, providing them tools to support their work, and then scaling up that approach. To accomplish this, we launched the PACEs Connection Cooperative of Communities for communities that need advanced tools to measure progress, as well as more guidelines and services.
From these communities will emerge new healing-centered systems that integrate PACEs science from the start (for example, creating a healing-centered system that merges schools and healthcare…something that the State of Oregon is developing) and that can be replicated throughout the world. Our relationship-building and storytelling continues; we have seen those elements light a fire of participation, innovation and sea-change across the world.
Note – the other of the “Top Five” stories was Jane’s piece about “PACEs Science 101” It was posted here on this little site earlier. Instead of posting it twice, I am sharing another of her top posts, this one that is a personal favorite regarding how “ACEs Science can help prevent school shootings, but first people have to learn about ACEs Science.” This was posted in 2.20.18, which was actually the day Jane was diagnosed with brain cancer.
One important note – in 2019 the Positive Childhood Experiences study was published; I often wonder what would have happened had Jane revised this piece to include that. Though in reality? She overhauled what was ACEs Connection to rename it PACEs Connection in 2021, as she believed so fervently in the power of PCEs to help prevent society’s most intractable problems. And with this article, I have completed, for now, the partial transfer of what I believe to have been some of the post important pieces posted on PACEs Connection. Apologies to our dear friend Dr. Christina Bethell, who had many pieces posted. If I can, and the site stays up longer, I will include those as well. For now? Self care is a priority. Carey August 9, 2026
David Hogg, a senior at Marjory Stoneman Douglas High School, speaks at a rally calling for more gun control. Photo by Jonathan Drake / Reuters _______________________
After 17 people, mostly teens, were shot and killed by another teen last week in Parkland, FL, what seems to be a real movement is growing, propelled by kids devastated by their friends’ deaths and wanting to prevent such a massacre from ever happening again.
Their rallies and marches and lie-downs probably won’t have much effect in the short-term, as some of the Parkland teens learned as they witnessed — and some of them wept during — today’s lightning vote by state lawmakers along party lines to end debate on an assault weapons ban, which killed any further consideration of the bill in the Florida legislature’s current session.
The kids in Parkland, FL, have the advantages that we want all our children to have: a great education in an affluent community so that they are prepared for and feel confident enough to know how to communicate in social and mainstream media about what they want, and to do it in an informed and cohesive way, with their community at their back. This means support and advice from parents, teachers, mentors and other adults who have created and maintained that environment for them.
Most of the kids living on our nation’s Indian reservations, in poor African-American communities, in poor white communities that don’t have the advantage of good schools, safe neighborhoods, well-paying jobs for their parents, affordable housing, great health care, soccer fields, baseball diamonds, swimming pools and parks….these kids don’t have the support or wherewithal or access to that same megaphone. It’s not that they aren’t capable, or that their parents couldn’t be capable of providing the same support that the kids in Parkland have. But they live in conditions created by us adults and our traditional systems that prevent them from realizing their dreams. Creating those conditions of opportunity for everyone is the responsibility of the adults….all of us adults.
But ACEs science clearly shows even the advantageous environment of Parkland, FL, is not really safe, as the kids found out. Their first response — that this is a gun regulation issue — is right. There’s no reason why any kid in this country needs an assault rifle, bump stocks or anything else.
But that’s just one tiny, tiny, tiny part of the solution. This isn’t only a gun regulation issue. It’s a systems change issue. All of our systems have to change their approach to changing behavior — whether it’s criminal, unhealthy or unwanted behavior — from a blame, shame and punishment approach, to one that is based in understanding, nurturing and healing….in other words, ACEs science.
According to the article, during one year in middle school, “he racked up numerous infractions — including for a fight during the second week of school and continuing with a pattern of unruly behavior, insults and profanity.”
“His middle school and high school teachers referred him to individual and family counseling, the records show. They held parent conferences and called social workers. They sent him to in-school suspension, and they sent him off campus. For a time, they sent him to a school for emotionally disturbed youth. Finally, after he was disciplined for an assault at Marjory Stoneman Douglas High, they asked for an assessment of the threat he posed to his school, and ultimately he was expelled, about a year before he returned with a gun.”
“Teachers worked “very, very, very hard” to get Cruz to a school center that would help him address his issues, said the sixth-grade teacher, who noted that Cruz’s now-deceased (adoptive) mother also understood his problems and wanted to get him help. But that process took years, the teacher said, and required loads of paperwork to back up Cruz’s needs.”
Here’s the crux of the situation we’re in…where most of our systems are in helping troubled people:
“Instead of slipping through the cracks, it appears Cruz was the target of aggressive work to help put him on the right track. But it also appears he might have hit the limit of what could be done.”
We who know about ACEs science say: No way!
The wrap-around services could/should have started when Cruz was born, if his family was troubled, as it seems they were, from all reports. And because this is a generational issue, a wrap-around service approach that focuses on helping people heal themselves, while making sure they don’t hurt themselves or others, is important to implement in all systems that serve people along their lifespan.
Systems change begins with people who learn about ACEs science. ACEs comes from the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking research that looked at how 10 types of childhood trauma affect long-term health. They include: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused.
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 chronic disease, mental illness, violence, being a victim of violence and several other consequences. The study found that most people (64%) have at least one ACE; 12% of the population has an ACE score of 4. 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, go to ACEs Science 101. To calculate your ACE and resilience scores, go to: Got Your ACE Score?)
Other ACEs surveys include racism, witnessing violence outside the home, bullying, spanking, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, witnessing a father or other caregiver or extended family member being abused, involvement with the criminal justice system, and attending a school that enforces a zero-tolerance discipline policy.
The ACE Study is one of five parts of ACEs science, which also includes how toxic stress from ACEs damage children’s developing brains; how toxic stress from ACEs severely damages health; how it can change our genes and be passed from one generation to another in historical trauma; and resilience research, which shows the brain is plastic and the body wants to heal.
ACEs affects us all….either personally, in our family members, our friends, or people in our immediate or extended community (i.e., our nation and world). Most of our nation’s burden of chronic disease is ACE-related, as are most of our social and mental health issues. Much of the toxicity in our systems reside in the roots of our history of slavery, racial discrimination and genocide, and we are just beginning to comprehend its reach and effects.
Most people realize the effects of ACEs in their ill health outcomes; in a smaller percentage, the effects emerge as violence, or being a victim of violence. Even the people who live in the affluent community of Parkland, FL, have ACEs — the 17,000 people who participated in the original ACE Study were mostly white, college-educated, and all had jobs and great health care. Thirty-eight states and Washington, DC, have done their own ACE surveys, with similar results to the original ACE Study.
The resilience research part of ACEs science research focuses on what happens when individuals, organizations and systems integrate trauma-informed and resilience-building practices. And when they do, the results are remarkable, astounding, so mind-blowing that they finally provide some hope that we can solve our most intractable problems.
For example:
Many schools – including schools in San Francisco, CA, Spokane, WA, San Diego, CA, and Walla Walla, WA — have integrated trauma-informed practices into classrooms, playgrounds and school policies. These schools have seen 90 percent drops in suspensions after one year; after three years, the schools no longer expel students and some no longer even have the need for in-school suspensions. The grades, test scores and graduation rates increased, and the students most benefitted were those with the highest ACE scores. By the end of 2017, several hundred schools across the U.S. were integrating trauma-informed and resilience-building practices based on ACEs science.
Homeless shelters and the faith-based community are integrating practices based on ACEs research. At the heart of their approach is educating those who are homeless and people in rescue missions about ACEs science. This new understanding of their lives often changes their entire understanding of their behavior, because they realize that they weren’t born bad, that they had no control over what happened to them as children, that they coped appropriately, given what was available to them, and, most important and freeing, that they can change.
Cities and states are integrating ACE-, trauma-informed practices and resilience building practices. By the end of 2017, several hundred communities around the U.S. had launched ACEs initiatives. This report on self-healing communities describes how integrating ACEs science drastically reduced youth suicide, teen pregnancy, juvenile arrests, and high-school drop-out rates — all at the same time — in communities in Washington State that integrated practices based on ACEs science.
People who are incorporating these changes are doing so city by city, county by county, state by state across the U.S. Also people in interest-based communities, such as education and pediatrics, among many sectors, are integrating trauma-informed and resilience-building practices based on ACEs science.
These folks are educating their organizations, their communities, their families, their leaders, their legislators about this new knowledge. Several legislatures and governor’s offices have started incorporating ACEs science into laws and policies.
The important thing to note is that this ACEs science is apolitical and a-cultural. It’s being used in a communities that are Republican, Democrat, Independent, and in diverse communities around the world. It’s a new way of understanding why we humans do what we do, and how our systems can change to actually help people heal themselves, instead of further traumatizing them.
Next week, we’re debuting state profiles of all 50 states and Washington, DC, that show where remarkable progress is being made in states and communities, and where it needs a boost.
We hope that the information in the profiles will help propel this new understanding of how to actually solve our most intractable problems. Enough organizations and communities have shown that it can be done, so that, although it will take time, there’s no excuse not to do it.
This new understanding actually shows that we don’t have to put up with poverty, or the systems that keep people in poverty, whether it’s systems-induced poverty or poverty of spirit. And for every child, no matter where they live, that’s great news.
Jane Stevens Publisher, ACEsTooHigh.com Founder, PACEs Connection
Jane StevensPublisher, ACEsTooHigh; founder, PACEs Connection
Thanks, Daniel. My experience so far is that when people “get” ACEs science, it changes their whole approach, no matter what their political bent, no matter what culture or country they’re in. It’s when they don’t “get” ACEs science that they are stuck in traditional and uninformed approaches.
Hi Jane, gratitude for this report and the encouragement you give to all. However there is one statement that continues to give me pause. I know this is not a political site by any means albeit you brought it into the picture for me when you included in your statement: “…ACEs science is apolitical..”. While it may be true that ACEs science is being shared and regarded and even touted apolitically across the board, from my perspective, that is where it clearly stops in the “apolitical” sense. That is, the group(s), more specifically, the current group who holds the talking stick might speak ACEs in one direction however if it does not fit into or follow their agenda in the other direction, then that is where “apolitical” stops and it is clearly political. The effects of ACEs is a broad and deep reaching situation that requires systems and approaches that help to heal, resolve and improve wellbeing and productivity. I have to say, when it is put out there that this is an “apolitical” movement, the science of it all is not used in any what whatsoever “apolitically” over the past year and in to today. When group(s) serve to enact laws, policies and rhetoric that further marginalize people by passing tax reform laws; further increase insecurity by threatening citizenships or freedoms and assault weapons for all; further challenge systems that serve ACEs conditions by discrediting them and defunding them then there has to be some accountability here. Maybe it ought to be guilt and not blame, shame or punishment? Maybe pure guilt will get that group(s) to wake up and stop merely talking about ACEs science out of one side and start acting (and enacting) laws, policies, and funding that helps address the state of affairs on every side!
So exciting to hear the numbers of people who have read the essay you’ve written Jane. If all the people on acesconnection re post it, share on social media, share with a family member, share it at their schools, work place…..let’s see 10 x 35,000 😊
Thank you, Audrey & James. Between ACEs Connection & ACEs Too High, this essay has been viewed more than 35,000 times since last Wednesday, and seems to be getting a little momentum….which is great! The more people who become curious about ACEs, the better!
Thanks to everyone here who’s participating so deeply in this work and spreading the word.
Wonderful! I had someone in another city share the article on Facebook and tag me and a Vice-Mayor in another town who has attended our ACEs training. I recently was interviewed by phone by Minnesota Senator Amy Klobachar’s DC Counsel about ACEs, our System of Care and trauma-informed policing. I’ve shared it with them
Jane StevensPublisher, ACEsTooHigh; founder, PACEs Connection
Thank you, Audrey & James. Between ACEs Connection & ACEs Too High, this essay has been viewed more than 35,000 times since last Wednesday, and seems to be getting a little momentum….which is great! The more people who become curious about ACEs, the better!
Thanks to everyone here who’s participating so deeply in this work and spreading the word.
Go Jane!!! Thank you for so effectively articulating essential details of this current tragedy (particularly all the things that were done for/with Nicholas Cruz and still were not enough), acknowledging the importance of what happens in the intra-familial, community, structural and historical arenas both separately and together, and offering great examples of real solutions. The whole article is fantastic, and I especially appreciate these sections: The kids in Parkland, FL, have the advantages that we want all our children to have…Creating those conditions of opportunity for everyone is the responsibility of the adults….all of us adults., …approach to changing behavior — whether it’s criminal, unhealthy or unwanted behavior — from a blame, shame and punishment approach, to one that is based in understanding, nurturing and healing…. ,Other ACEs surveys include racism… and Much of the toxicity in our systems reside in the roots of our history of slavery, racial discrimination and genocide and we are just beginning to comprehend its reach and effects. As you say, we have to keep going back to a place of deeply knowing and translating the science into practice to achieve what we all want. Looking forward to sharing widely!
Thank you for sharing your talent, voice, truth Jane! – “All of our systems have to change their approach to changing behavior — whether it’s criminal, unhealthy or unwanted behavior — from a blame, shame and punishment approach, to one that is based in understanding, nurturing and healing….in other words, the science of adverse childhood experiences — ACEs.” – Amen
Thank you for this. I am a CASA to a kid the same age as Nikolas Cruz. I noticed so many places where this child was failed along the way, and where his adoptive family was failed by being under-informed about his early trauma and likely outcomes of that.
Nikolas experienced serious “developmental” Trauma. ACEs that happen to a pre-verbal child are exponentially more devastating, as they damage a mind that has not had a chance to grow or form in healthy ways yet. He was abandonned by his mother as an aware older baby. That’s the worst thing a baby can experience. As we become more sophisticated about trauma, I think ACEs need to be considered in terms of timing, too, and in terms of degree.
Nikolas likely had Reactive Attachment Disorder, though nobody seems to have diagnosed this; however it makes sense of his many symptoms and it connects to his early life trauma. I would guess he got CBT CBT CBT (one size fits all mental health services, like in my town) and no right brain focused services like Neurofeedback, EMDR, or somatic therapies. No attachment-focused therapies that would have addressed his real woundedness.
It’s heartbreaking. By un-tethering early childhood trauma from this boy’s later life problems, its easy to get confused on how to actually help.
Thank you for your post! I am a mental health professional in Houston, Texas and want to figure out a way to help spread the word on a larger scale! I educate all my clients about ACE’s and screen them during my assessment, but it’s not enough! I welcome any ideas or suggestions on how to become more active in raising awareness and educating on ACE’s. Thanks again.
Lisa, Mary, Becky, Anne and Carey: Thank you for kind words and sharing this!
I’m working with a national non-profit and the Chairman of their Board lives in Florida. She had a teenage cousin who attends Parkland and was spared injury the day of the shooting by the bravery of the football coach who directed him to run. I shared your article with her and others on the Board (who I’m helping to educate about ACEs science) and received a response…”your article was very helpful!”
Jane, I so agree. I think it would be informative for someone to research the number of ACES that the shooters have experienced. I have always thought that we can’t create a society that will be safe for our children and grandchildren until we make sure that all children are raised in a nurturing, safe way. Not every child who has experienced trauma and neglect will end up hurting others, but those that do, will often just hurt someone who is in their way and that makes all of us vulnerable to these consequences.
Jane, THANK YOU for speaking so eloquently to the core issue in this school shooting: HURT PEOPLE, HURT PEOPLE and the core solution, SYSTEMS CHANGE THAT focuses on understanding why we humans do what we do, and how our systems can change to actually help people heal themselves, instead of further traumatizing them.
This is excellent, Jane – all of it, but I especially liked this quote:
“But that’s just one tiny, tiny, tiny part of the solution. This isn’t only a gun regulation issue. It’s a systems change issue. All of our systems have to change their approach to changing behavior — whether it’s criminal, unhealthy or unwanted behavior — from a blame, shame and punishment approach, to one that is based in understanding, nurturing and healing….in other words, ACEs science.”
Thank you for this eloquent case for ACEs Science to be tied to what is happening in this incredibly challenging moment. Thanks for sharing solutions and successes so people can see what happens when we stop blaming and shaming others, and instead look at solutions, and see how we can be part of the solution.
I am sharing this far and wide in hopes that somehow it lands in the hands of the students from Marjory Stoneman Douglas High School, so they can help tell the world about the vital importance of ACEs Science. The solutions are here.
I hope young leaders from Marjory Stoneman Douglas High School can read this piece today. I believe it would give them important information and some comfort. There is comfort in knowing there are solutions. I will be Tweeting it and tagging them, and invite others to do so too. Meeting people where they are is part of the solution.
Brilliant, Jane! And so needs to be said. We have to start making the right connections to move us away from the blame and punishment scenario – at the macro level just as at the micro level. Sharing!
Jane Stevens 4/23/124:30 PMJim Sporleder, principal of Lincoln High School
THE FIRST TIME THAT principal Jim Sporleder tried the New Approach to Student Discipline at Lincoln High School in Walla Walla, WA, he was blown away. Because it worked. In fact, it worked so well that he never went back to the Old Approach to Student Discipline. This is how it went down:
A student blows up at a teacher, drops the F-bomb. The usual approach at Lincoln – and, safe to say, at most high schools in this country – is automatic suspension. Instead, Sporleder sits the kid down and says quietly:
“Wow. Are you OK? This doesn’t sound like you. What’s going on?” He gets even more specific: “You really looked stressed. On a scale of 1-10, where are you with your anger?”
The kid was ready. Ready, man! For an anger blast to his face….”How could you do that?” “What’s wrong with you?”…and for the big boot out of school. But he was NOT ready for kindness. The armor-plated defenses melt like ice under a blowtorch and the words pour out: “My dad’s an alcoholic. He’s promised me things my whole life and never keeps those promises.” The waterfall of words that go deep into his home life, which is no piece of breeze, end with this sentence: “I shouldn’t have blown up at the teacher.”
Whoa.
And then he goes back to the teacher and apologizes. Without prompting from Sporleder.
“The kid still got a consequence,” explains Sporleder – but he wasn’t sent home, a place where there wasn’t anyone who cares much about what he does or doesn’t do. He went to ISS — in-school suspension, a quiet, comforting room where he can talk about anything with the attending teacher, catch up on his homework, or just sit and think about how maybe he could do things differently next time.
Before the words “namby-pamby”, “weenie”, or “not the way they did things in my day” start flowing across your lips, take a look at these numbers:
2009-2010 (Before new approach)
798 suspensions (days students were out of school)
50 expulsions
600 written referrals
2010-2011 (After new approach)
135 suspensions (days students were out of school)
30 expulsions
320 written referrals
“It sounds simple,” says Sporleder about the new approach. “Just by asking kids what’s going on with them, they just started talking. It made a believer out of me right away.”
________________
The dark underbelly of school discipline
Take a short walk on the dark side of our public education system, and you learn some disturbing lessons about school punishment.
First. U.S. schools suspend millions of kids — 3,328,750, to be exact. Since the 1970s, says a National Education Policy Center report published in October 2011, the suspension rate’s nearly doubled for white kids, to 6%. It’s more than doubled for Hispanics to 7%, and to a stunning 15% for blacks. For Native Americans, it’s almost tripled, from 3% to 8%.
Second. If you think all these suspensions are for weapons and drugs, recalibrate. There’s been a kind of “zero-tolerance creep” since schools adopted “zero-tolerance” policies. Only 5% of all out-of-school suspensions were for weapons or drugs, said the NEPC report, citing a 2006 study. The other 95% were categorized as “disruptive behavior” and “other”, which includes cell phone use, violation of dress code, being “defiant”, display of affection, and, in at least one case, farting.
Third. These suspensions don’t work for schools. Get rid of the “bad” students, and the “good” students can learn, get high scores, live good lives. That’s the myth. The reality? It’s just the opposite. Says the NEPC report: “…research on the frequent use of school suspension has indicated that, after race and poverty are controlled for, higher rates of out-of-school suspension correlate with lower achievement scores.”
Fourth. They don’t work for the kids who get kicked out. In fact, these “throw-away” kids get shunted off a possible track to college and onto the dead-end spur of juvenile hall and prison.
“Studies show that one suspension triples the likelihood of a juvenile justice contact within that year,” California Chief Justice Tani Cantil-Sakauye told the California Legislature last month. “And that one suspension doubles the likelihood of repeating the grade.”
Fifth. All these suspensions have led many communities to create “alternative” schools, where they dump the “bad” kids who can’t make it in regular public school. Lincoln High School was set up as one of those alternative schools.
How Mr. Sporleder stumbled across an epiphany in Spokane
It’s the Spring of 2010, and Jim Sporleder’s mind more or less silently exploded.
This is the guy with 25 years experience as a principal. In Walla Walla, he’s got a rep for really connecting with kids. He preaches “discipline with dignity”.
John Medina – a developmental molecular biologist who’s an improbable cross between an old-time rip-snortin’ preacher and Jon Stewart – just drilled a hole in Sporleder’s brain and dropped this in:
Severe and chronic trauma (such as living with an alcoholic parent, or watching in terror as your mom gets beat up) causes toxic stress in kids. Toxic stress damages kid’s brains. When trauma launches kids into flight, fight or fright mode, they cannot learn. It is physiologically impossible.
Sporleder was three years into an exhausting stint as principal of the Lincoln Alternative School. He’d asked for the position after reading a report about the troubled school. The report quoted a couple of Lincoln High’s kids: “We’re the dumping ground,” one said. “Who cares about us,” another said. It wasn’t a question.
“That report riveted me,” says Sporleder. “I’m a person of faith. I felt called to come over here.”
Gangs controlled the school. It had only 50 students, but they were the toughest in the school system – the kids who’d been kicked out of other schools. Lincoln was their last chance.
“I didn’t know if I was going to make it,” recalls Sporleder. “We had some pretty rough kids. It took me quite a while to get on top of that.”
And then, at the behest of Teri Barila, co-founder of the Children’s Resilience Initiative in Walla Walla, he goes to this meeting where this guy who’s part comedian, part evangelist, part scientist (and best-selling author of Brain Rules) more or less tells him that this “discipline with dignity” stuff is, well, useless. Punishing misbehavior just doesn’t work. You’re simply adding trauma to an already traumatized kid.
“He explained it in lay terms,” says Sporleder. “I got it.”
Now, some people who are well into their careers can’t handle a paradigm shift. It’s overwhelming. That’s mostly because it’s just too much trouble to change the way you do…everything.
Spoiler alert: Sporleder isn’t one of those people.
He returned from Spokane to light a fire under his teachers. He felt compelled to figure out a way to do something different to reach his kids, but wasn’t sure exactly how. Teri Barila was in a perfect position to assist.
This is your (damaged) brain on ACEs
Really good ideas that help people solve problems often take such a long time to move from research to implementation that it can cost a community millions of dollars. Twenty years ago, Washington State created a state network — the Family Policy Counciland 42 community public health and safety networks — to share good information FAST to tackle a big, expensive problem: the high rates of child abuse and youth drug and alcohol abuse in the state. Teri Barila, a former fish biologist, leads the network in Walla Walla, a city of about 30,000 people in southeastern Washington.Teri Barila
About 10 years ago, the council caught wind of two major game-changing discoveries. One was the CDC’s Adverse Childhood Experiences Study (ACE Study). It showed a stunning link between childhood toxic stress and the chronic diseases people developed as adults. This includes heart disease, lung cancer, diabetes, some breast cancer, and many autoimmune diseases, as well as depression, violence, being a victim of violence, and suicide.
The ACE Study measured 10 common types of childhood trauma. Five were the usual suspects: emotional, sexual and physical abuse, and emotional and physical neglect. Five were family problems: a parent addicted to alcohol or other drugs, seeing a mother being abused, a family member in prison, a family member diagnosed with a mental illness, and a parent who’s disappeared through abandoning the family or divorce. (Although the word “trauma” is more commonly used to describe physical injury, in this milieu, it refers to any experience that causes toxic stress.)
The study’s researchers came up with an ACE score to explain a person’s risk for chronic disease. Think of it as a cholesterol score for childhood toxic stress. You get one point for each type of trauma. The higher your ACE score, the higher your risk of health and social problems.
A whopping 70 percent of the 17,000 people in the study had an ACE score of at least one; 87 percent of those had more than one. With an ACE score of 4 or more, things start getting serious. The likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; suicide, 1,220 percent.
The percentages climb to grim and astounding levels as the ACE score climbs – people with an ACE score of 6, for example, have a 4,600 percent increase in the risk of becoming an IV drug user. Grow up with an ACE score of 10, and you’re likely to find yourself homeless, in prison for life, or end up dead by your own hand. People with high ACE scores die, on average, 20 years earlier than those with low ACE scores.
By the way, lest you think that the ACE Study was yet another involving inner-city poor people of color, take note: The study’s participants were 17,000 mostly white, middle and upper-middle class college-educated San Diegans with good jobs and great health care – they all belonged to Kaiser Permanente, a health maintenance organization. As Dr. Robert Anda, one of the co-founders of the ACE Study says, “It’s not them. It’s us.”
The second game-changing discovery explained why childhood trauma had such tragic long-term consequences: Toxic stress physically damages a child’s developing brain. This was determined by a group of researchers, including neurobiologist Martin Teicher and pediatrician Jack Shonkoff, both at Harvard University, and neuroscientist Bruce McEwen at Rockefeller University. In a nutshell, toxic overdoses of stress hormones stunt the growth of some parts of the brain, and fry the circuits in others.
Children with toxic stress live their lives in fight, flight or fright (freeze) mode. They respond to the world as a place of constant danger. They can fall behind in school, fail to develop healthy relationships with peers, or develop problems with authority because they are unable to trust adults. With failure, despair, and frustration pecking away at their psyche, they find solace in food, alcohol, tobacco, methamphetamines, inappropriate sex, high-risk sports, and/or work. They don’t regard these coping methods as problems. They see them as solutions to escape from depression, anxiety, anger, fear and shame.
When Barila learned all this at a meeting that the Family Policy Council organized, it chilled and angered her. Determined to do something about it, she co-founded the Children’s Resilience Initiative to educate the Walla Walla community about ACEs and to build resilience to combat ACEs.
Barila brought Natalie Turner, an expert in creating trauma-free schools, to town to help Sporleder and his teachers.
Natalie Turner’s two simple rules for dealing with troubled students
It’s when your dad’s in prison AND your mom’s a meth addict AND she’s too drugged out to move in the mornings, so you’ve got to take care of your little brother, get him fed and off to school, AND you’re despairing about being evicted for the third time because she hasn’t paid the rent and the landlord’s screaming at you to do something.
Or your dad’s a raging alcoholic AND he beat the crap out of your mom again last night AND the cops came and took him away at 2 a.m. AND the EMTs took your mom to the hospital and you hardly slept a wink and you’re frantic with worry because you don’t know what’s going to happen, but you’ve got to stay cool or otherwise you’ll have a complete meltdown.
Or your fat step-dad’s sneaking into your bed in the middle of the night AND you’re too terrified to move because he says if you say anything he’ll kill you and your sister and your mom, who’s depressed AND doesn’t talk much anyway.
Teens who live with complex trauma are walking post-traumatic stress time bombs, says Turner. They teeter through their days. The smallest incident can push them into a full-blown meltdown. Some kids run away. Some explode in rage. Some just mentally check out.
“In flight, fight or freeze mode,” Turner explains, “survival trumps everything else.” So when a kid who’s got complex trauma feels threatened or overwhelmed, exploding in rage at something that most people wouldn’t even shrug over is a perfectly normal response.
That’s worth repeating: exploding in rage, getting pissed off, stomping, hitting….it’s all normal. Until a school helps kids learn how to control their emotions, they’ll just keep losing it. For some kids, erupting is a stress reflex response.
“That’s the hardest pill to swallow,” says Erik Gordon, a science teacher at Lincoln High. “Trying to figure out how much of their behavior is from a choice and how much is outside their control. It’s a drag when you believe it’s outside their control, because all of the easy disciplinary action doesn’t work.”
There are just two simple rules, says Turner.
Rule No. 1: Take nothing a raging kid says personally. Really. Act like a duck: let the words roll off your back like drops of water.
Rule No. 2: Don’t mirror the kid’s behavior. Take a deep breath. Wait for the storm to pass, and then ask something along the lines of: “Are you okay? Did something happen to you that’s bothering you? Do you want to talk about it?”
It’s not that a kid gets off the hook for bad behavior. “There have to be consequences,” explains Turner. Replace punishment, which doesn’t work, with a system to give kids tools so that they can learn how to recognize their reaction to stress and to control it. “We need to teach the kids how to do something differently if we want to see a different response.”
Kids need adults they can count on, who they know will not hurt them, and who are there to help them learn these new skills, Turner tells the Lincoln High staff. If it’s not happening at home, it had better happen at school. Otherwise that teen doesn’t have much of a chance at life.
The Lincoln High staff took Turner’s information and flipped its system of school discipline like a pancake.
The changes began in the classroom. “Teachers started becoming detectives,” says Gordon. “We began focusing our concern on what we know that’s going on that might be causing behavior in a kid,” versus what type of punishment to mete out.
When a kid erupts in class, teachers intervene quickly. “A kid that I have a really great relationship with might blow up,” says Gordon. “So, I step out of the classroom with that kid and ask: ‘What’s going on? Because that was really intense.’ I know that something is bumming this kid out, because normally, we really enjoy each other.”
Other responses include:
“Class isn’t working today, how about taking a time out with Shelly (in the ISS Room) so that you can get yourself calmed down?”
“I feel that I really blew it and I feel like I have set you off. I want to apologize and see if there is anything that I can do to help you.”
“You seem really upset, would you like to speak to someone in the Health Center?”
If it escalates to principal level, Jim Sporleder uses his infamous zone system: red, yellow and green. Here’s how that works:
Three boys don’t respond to their teacher, who asks them politely, but firmly to leave class and talk with the principal. Although three fuming teens sit down in front of Sporleder, he sees three brains under extreme stress, unable to take in anything useful or to solve a problem.
“You’re in the red zone,” he tells them succinctly. He doesn’t yell. He doesn’t roll his eyes. There’s no body language that says “I can’t stand you kids,” because he actually thinks the world of them.
“Let’s meet tomorrow morning. You’re going to take the rest of the day and night to process this.” (Sometimes Sporleder has found himself in the red zone, and tells the kids: “I’m in the red. I don’t want to make any decisions that could come from my own anger or stress. Let’s take a break and meet later.”)
The next morning, Sporleder says, all three approach him and say they’ve talked over the problem with the teacher, have apologized and figured out a solution. “We’ve got it all worked out,” they explain.
“That’s more common than not these days,” says Sporleder.
But if they had refused to apologize to the teacher and refused to solve the problem, or their infraction was more serious, they would have gone to ISS – in-school suspension.
“I don’t have kids arguing about the consequences,” says Sporleder.
Well…mostly he doesn’t. Sometimes he still gets kids asking to be suspended to home instead of in school, which tells him that ISS may be more uncomfortable, but it’s more effective. In that quiet room, they can’t distract themselves with TV, video games or drugs. A staff member offers conversation – about how the teen is dealing with the incident, or other issues in her or his life. Other teachers stop by to make sure the teen is caught up on homework.
“At home, there’s no accountability,” he explains. During in-school suspension, the teens can’t escape their issues. It’s not fun to have to give up old beliefs and habits. But they all get lots of support to get into the green zone.
“We tell our kids we love them,” says Sporleder. “They’re important to us.”
The third big change occurs in the school’s monthly staff meetings. Instead of talking about disciplining problem kids, they focus on why that teen’s having problems, develop a plan to help the teen, and make sure to follow up.
In the last two years, the Lincoln High staff has noticed that the kids’ ability to regulate their own emotions has dramatically improved. “There’s not near the number of huge emotional explosions that there used to be,” says Gordon. “Even the way the kids interact with each other is more subdued.”
They way the kids see it is that the teachers have chilled out.
What else do the kids say?
At Lincoln High, the kids not only live ACEs, but they talk them.
As senior Heidi Schoessler, 18, explains it: Students have ACEs (adverse childhood experiences). Those are the bad things going on in their lives. Resilience factors – such as asking for help, helping a friend, experiencing success, having hope — trumps those ACEs. They’re beginning to learn about those resilience factors in school and in the school’s health clinic.
When Schoessler showed up at Lincoln, she couldn’t be in a classroom with more than two or three people at a time, says Sporleder. She’d been bullied and harassed so much in elementary and middle school, that being around too many students caused a stress response that made her sick. Sixteen-year-old Aron Wulf was so withdrawn, he hardly talked. Jordan Massey, 17, had anger issues. Brendon Gilman, 15, who was removed from a family of meth addicts and has lived in several foster homes, says in this video about The Health Center at Lincoln High he was so angry with life that he didn’t care about the future because he was so mad about the present.
Today, all four chat easily about the school and its changes. Gilman went from failing grades to A’s. Schoessler’s taking college classes. Wulf is active in the production of the school play. All four do presentations for the community about the changes in the school.
“I got here, and my whole high school experience flat-out changed,” says Massey, a junior who transferred in halfway through his freshman year. “People came up to me and greeted me. It felt like I had real friends here. I loved it. I call it my home away from home. It really feels like a family here. The teachers are amazing. That’s how a high school should be.”
Here’s how Wulf describes the changes in his life: Shortly after he was born, his parents divorced. He’s been living with his mother. When he was younger, he spent every other weekend with his father.
“My dad’s verbally abusive. He has a really bad temper,” Wulf says quietly. “My mom has always been sick in bed pretty much. The people who should have been around were never around, basically. She has problems with depression and what not. She might commit suicide. There are financial issues.”
When he talks about Lincoln, his voice gets strong, and hopeful. “Lincoln’s the first school I’ve been to that I actually loved,” he explains. “It was the first time I ever felt that somebody actually cared to hear my story to know how I was feeling. My own teachers understand me better than my mom does.”
Wulf is an example of the type of quiet, isolated student that Dr. Vincent Felitti, co-founder of the CDC’s ACE Study, advises educators to “make sure you always connect with,” says Sporleder. The quiet students – the ones who respond to toxic stress with “fright” or “flight” – sit quietly in the back of the room with their heads down. They’re often labeled as “lazy” or “unmotivated”. They might not be as loud or belligerent as those who drop into “fight” mode, but they’re hurting just as much.
“I’m always looking for kids who are isolated,” says Sporleder.
“What is happening at Lincoln is completely different,” says Schoessler. “There’s so much more of a caring atmosphere. Students will come to the teachers when they need help. It’s something I have never seen in any other school.”
Even in-school suspension is useful, says Gilman, who spent time in ISS for getting in a dust-up with his ex-girlfriend at school. “I couldn’t handle being around her,” he says. “It kind of helped, even for just the day, to be away from everyone and everything, including her. It helped me reflect why I was there and why I had acted the way I did — without someone telling me how I’m wrong for what I did. It helped me look at the situation and what I can do to prevent it from happening again.”
School’s ACE survey helps kids, teachers understand each other
“It is so invasive,” says Sporleder, barely suppressing a shudder. “If an outsider developed it, it would never have been used.”
Since the original research in San Diego, 18 states have done ACE surveys, including Washington. If not the first high school in the U.S., Lincoln is certainly among the first in the U.S. to do its own ACE survey.
The survey’s anonymous, and students can skip questions if they want to. Some examples:
“Has there ever been an adult in your household that has hit you so hard that you had marks or were injured?” One-quarter of the kids said yes.
“How many sexual partners have you had? Ten percent said 4 to 6.
“Have you ever been forced to do something sexual that you didn’t want to do?” Almost 20 percent said yes.
The results show that these kids are grappling with way more than any kid – or adult, for that matter — should:
25% of the students are homeless.
84% have lost a loved one.
66% feel abandoned by their parents.
65% have an immediate family member in jail.
80% have suffered serious depression
50% live with someone who abuses alcohol or other drugs.
The survey’s useful, says Gilman, because “it gives you this feeling that ‘I’m not the only person who’s gone through that’. It’s easier to interact with people and to understand the way some people act.
The staff uses the survey to help understand the level and intensity of the teens’ stress. They also use it to teach the students that they cannot control and are not accountable for the trauma they have endured.
“When students understand they’re not responsible for the family they were born into, but they are responsible for who they will become as adults, and when they can see the power in that, it’s just amazing what happens,” Barila says in the Health Center video.
The grim reality is that the average ACE score for the teens at Lincoln High is 4.5. These kids are at high risk for developing chronic diseases when they’re older, becoming violent or being a victim of violence, suffering from depression or committing suicide.
ACE Study co-founder Dr. Robert Anda says that the study exposed “a chronic public health disaster”. So if a teen’s bad behavior or isolation or lack of motivation is a normal response to complex trauma, then that behavior is also a health issue. That’s what pediatrician Alison Kirby says.
The Health Clinic at Lincoln High
Four years ago, says Sporleder, “we needed a doctor to provide physicals for our first boys basketball team. Dr. Alison Kirby, a local pediatrician, volunteered to do all the exams for free.
“When’s the last time you had a physical?” she blithely asked the first boy. Ten years ago, he answered, before he started first grade. Her eyebrows shot up. She asked another. Never, he said.Dr. Alison Kirby
Kirby was appalled. She didn’t realize that there were children in Walla Walla who hadn’t seen a doctor in 10 years.
“In my regular clinic, I see with kids with insurance,” says Kirby. “The students at Lincoln are a different group of kids. They are invisible. It doesn’t really connect with most people in this community that these kids are the future of our small town. Once you do see it, it’s unethical to look away.”
In all communities, kids are the future – a costly future or a beneficial future. They grow up to live out their lives in healthy or unhealthy ways, in ways that contribute to the growth and health of their community or to the economic and emotional afflictions. And how they live their childhood determines their future. If a large number have high ACE scores, then the community ends up spending more money for cops, courts, prisons, welfare, social services, medical and mental health than for schools, playgrounds, community pools, and libraries. People working in education, prisons, child welfare agencies and juvenile justice have known this intuitively for a long time. Now the research proves it.
Kirby didn’t look away. She cajoled, rounded up, lobbied, wheedled, coaxed, prevailed upon, inveigled and persuaded the community to step up, fund and volunteer at a health clinic that’s right next to the school. Open 10 a.m. to 2 p.m., five days a week, it’s the only school health center in eastern Washington.
Kirby expected 90 percent of the clinic work to be “treating asthma, infections, stitches.” It turns out that 90 percent of the work focuses on the kids’ mental health.
“What we were finding is that there are not enough psychologists and counselors to go around,” she says. Given the toxic stresses that the kids are dealing with, she says, it’s no surprise.
“If your brain isn’t healthy and you’re not doing well, your body physically isn’t going to do well, either,” says Katherine Boehm, clinic coordinator in the health center video. “If you are struggling with depression or anxiety, you’re going to have a much harder time concentrating in school and being able to complete your work.”
The staff at the health center uses the student ACE survey to develop programs and services that help the kids learn skills to build resilience, specifically to:
create social connectedness
provide concrete support in times of need
teach social and emotional competence
Last year, 175 of the school’s 200 students made 1,500 visits to the clinic. Still, nearly 20 percent of the students “still don’t trust us,” says Kirby. “They’re so beat up emotionally that they have huge vulnerability issues. They’ll come in with a friend for 6 months to a year before they come on their own.”
Part of that reticence comes from their treatment at other clinics. They have homemade tattoos and shaved eyebrows. They might smell bad because they’re homeless and haven’t been able to take a shower for three days. “At a big clinic, if they’re judged on appearance or smell,” says Kirby, “they get treated badly and the kids won’t go back. We accept them for who they are. Their future is more important than their past.”
Some have lived in dysfunctional families for so long that they don’t know what healthy is, so they’re vulnerable to abusive relationships, says Kirby. One 15-year-old girl, desperate for interaction with a loving adult, went online and found a “foster-daddy”.
“She got a ride 50 miles to a bigger city, where he was,” says Kirby. “She had severe depression, was “cutting”. His solution was to beat her.” The clinic treated her festering wounds and talked with her about healthy relationships.
“Many of these kids don’t have a parent who says ‘I love you’ and means it,” says Kirby. “Instead it’s ‘I love you, so now go score some dope for me’.
Kirby and the staff want to provide the support for the students to heal and to develop enough self-confidence to live healthy lives. For some, that means living different lives than their families are living. Many education experts say that kids wouldn’t have problems if their parents would just get involved. But the parents of most of the students at Lincoln HIgh are themselves are struggling with the effects of their own childhood trauma, and many are passing the trauma on to their children.
As Kirby puts it: “Their family is in a plane that’s going to crash. We tell them: ‘You’re going to parachute out. You’re going to college.’ Their family is likely to say to them: ‘Hey you in the parachute — get back in this plane. We need you to go to work and support us.’ The people in the plane give lots of pushback: ‘What? You’re too good to be with our family now?’ Sometimes kids change back. Sometimes kids get healthy and say: ‘I don’t want to live like that anymore.’”
Lincoln High’s metamorphosis is just beginning
Natalie Turner says that of all the schools she and her co-workers at the Area Health Education Center work with, “Lincoln’s at the top of the list.”
One of the keys has been a staff that embraces two basic concepts: toxic stress prevents kids from learning, and moving from a punitive approach to a supportive, educational approach changes behavior. Gordon says it’s also the unconditional love that the teachers at Lincoln High show the kids on a regular basis.Lincoln High School, Walla Walla, WA
“Watching Jim Sporleder’s paradigm shift over the last five years has been just awesome,” says Gordon. “I’ve seen that guy cry talking about our kids. Lincoln is just a collection of staff that unconditionally love these kids. The rest is just mental hoo-ha.”
The mental hoo-ha has allowed and encouraged that kind of overt love, caring and support that’s characteristic of Lincoln and that inspires many people to go into the teaching profession. Turner has worked with educators who just won’t budge from clinging to a system that clearly shows no progress in helping the “troublemakers” and “unmotivated” students.
“If the staff aren’t ready, there’s no point in going in and trying to move a system,” she says. “There have been a couple of schools where they’ve had a very resistant staff, and we’ve decided to leave and try again another time.”
Although it’s made significant changes, Lincoln’s not finished, says Sporleder. “Part of what we’ve done is the relationship piece,” he explains. “That’s the powerful piece – we’ve built strong relationships with our kids. Now I want to move forward to help kids understand how resilience trumps ACEs.
Since he’s found no guidelines for this part, he’s trying this approach: He’s put together a chart that hangs on a wall in his office. It shows ACEs and, on red cards, the qualities of resilience that can overcome those ACEs.
He’s asked some students to read the ten ACEs and tell him how many they have, says Sporleder. “I never ask them which ones. And then we start talking about resilience. I share with them qualities that I have seen them demonstrate that build that resilience.”
One student told him: “I get it — the more red cards you have the greater the chance it trumps your ACEs.” Sporleder emphasizes how important it is for them to connect with positive caring adults to help them to continue to build their character and to build their resilience.
The changes at Lincoln have not eliminated expulsions. And the school hasn’t done the analysis to know for certain if the changes have resulted in better grades and attendance.
Nevertheless, Lincoln’s results are showing the community that change is possible. If suspensions can be reduced by 85 percent among teens whom most of the community had given up on, if they can blossom into happy kids who suddenly see themselves as having a future, perhaps the same changes can occur in other settings.
“We intentionally focused on Lincoln as a pilot of sorts,” says Barila, “with the full support of the assistant superintendent, so we could learn what strategies work and how, so we could then ‘pass it on’ throughout the school district.”
The next chapter, she says, is to see if the rest of the schools in the district can accomplish similar results. That includes Walla Walla High School, with its 2,000 students and larger class sizes, as well as six elementary schools, two middle schools, a Catholic school system and a Seventh Day Adventist school.
There’s little doubt that many of the 6,000 other kids in Walla Walla’s school district have adverse childhood experiences, too. Perhaps they don’t have ACE scores as high as Lincoln students, but ACE scores are more common than not. According to Washington State’s 2009 ACE survey, 62 percent of the state’s population has at least one ACE, and 27 percent have an ACE score of 3 or more.
But Lincoln alone can’t make enough changes to help every child, says Barila. “That social-emotional competency has to be built in soooo much sooner than Lincoln,” she notes. The goal of the Children’s Resilience Initiative is to educate the entire community about adverse childhood experiences, the effect of toxic stress on kids’ brains, and to encourage all organizations, agencies, clinics and youth groups to build and increase resilience factors. That’s why she named the organization the Children’s Resilience Initiative and not the ACEs Education Initiative, she says.
Still, if other schools adopt this approach, it won’t be easy, says Sporleder. He knows that his peers discipline “like I used to discipline. I think our educational system reacts to the action. We need to respond to what is causing the action.
“This is such a paradigm shift, you have to believe in it to make change happen,” Sporleder says. “The administration has to show support. That’s what I’ve seen. You’ve just gotta believe in it. You’ve gotta know that it’s true.”
Jane Stevens Publisher, ACEsTooHigh.com Founder, PACEs Connection
This was a tremendously impressive place to visit. It deserves a documentary TV show to illustrate what’s being done about problems that generally are comfortably not acknowledged or understood.
Jane StevensPublisher, ACEsTooHigh; founder, PACEs Connection
He says: Addiction shouldn’t be called “addiction”. It should be called “ritualized compulsive comfort-seeking”.
He says: Ritualized compulsive comfort-seeking (what traditionalists call addiction) is a normal response to the adversity experienced in childhood, just like bleeding is a normal response to being stabbed.
He says: The solution to changing the illegal or unhealthy ritualized compulsive comfort-seeking behavior of opioid addiction is to address a person’s adverse childhood experiences (ACEs) individually and in group therapy; treat people with respect; provide medication assistance in the form of buprenorphine, an opioid used to treat opioid addiction; and help them find a ritualized compulsive comfort-seeking behavior that won’t kill them or put them in jail.
This “he” isn’t some hippy-dippy new age dreamer. He is Dr. Daniel Sumrok, director of the Center for Addiction Sciences at the University of Tennessee Health Science Center’s College of Medicine. The center is the first to receive the Center of Excellence designation from the Addiction Medicine Foundation, a national organization that accredits physician training in addiction medicine. Sumrok is also one of the first 106 physicians in the U.S. to become board-certified in addiction medicine by the American Board of Medical Specialties.
Sumrok, a family physician and former U.S. Army Green Beret who’s served the rural area around McKenzie, TN, for the last 28 years, combines the latest science of addiction and applies it to his patients, most of whom are addicted to opioids — but also to alcohol, food, sex, gambling, etc. He sees them in the center’s two outpatient clinics: his clinic, which the Center for Addiction Science has taken over as its rural clinic, and another that opened recently in downtown Memphis.
Since he first sat down in the early 1980s to write a research paper (“Public Health Legacy of the Vietnam War: Post-Traumatic Stress Disorder and Implications for Appalachians”) to describe the symptoms of the newly named post-traumatic stress disorder in Vietnam veterans – “problems with the law, having trouble sleeping, anxiety, divorce, sleep troubles, substance use disorders, depression, anxiety, cognitive and chronic pain issues” — Sumrok has pieced together the ingredients for a revolutionary approach to addiction. It’s an approach that’s advocated by many of the leading thinkers in addiction and trauma, including Drs. Gabor Maté, Lance Dodes and Bessel van der Kolk. Surprisingly, it’s a fairly simple formula: Treat people with respect instead of blaming or shaming them. Listen intently to what they have to say. Integrate the healing traditions of the culture in which they live. Use prescription drugs, if necessary. And integrate adverse childhood experiences science: ACEs.
“My patients seem to respond really well to this,” he says.
ACEs understanding changes practice
Learning about ACEs more than two years ago was a big turning point for his understanding of addictions, explains Sumrok. “I was working in an eating disorders clinic and someone told me ‘90 percent of these folks have sexual trauma’. I remember thinking: That can’t be right. But that was exactly right. Since I’ve learned about ACEs, I talk about it every day.”
He also practices it every day, by integrating ACEs assessments for all patients in his clinics. He currently has about 200 patients who are addicted, most to opioids (heroin and prescription pain relievers, including oxycodone, hydrocodone, codeine, morphine, and fentanyl). “I’ve seen about 1,200 patients who are addicted,” he says. “Of those, more than 1,100 have an ACE score of 3 or more.”
ACEs comes from the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking research that looked at how 10 types of childhood trauma affect long-term health. They include: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused. Subsequent ACE surveys include racism, witnessing violence outside the home, bullying, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, witnessing a father or other caregiver or extended family member being abused, involvement with the criminal justice system, attending a school that enforces a zero-tolerance discipline policy, etc.
The ACE Study is one of five parts of ACEs science, which also includes how toxic stress from ACEs damage children’s developing brains; how toxic stress from ACEs affects health; and how it can affect our genes and be passed from one generation to another (epigenetics); and resilience research, which shows the brain is plastic and the body wants to heal. Resilience research focuses on what happens when individuals, organizations and systems integrate trauma-informed and resilience-building practices, for example in education and in the family court system.
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 chronic disease, mental illness, violence, being a victim of violence and a bunch of other consequences. The study found that most people (64%) have at least one ACE; 12% of the population has an ACE score of 4. 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, go to ACEs Science 101. To calculate your ACE and resilience scores, go to: Got Your ACE Score?)
High ACE scores also relate to addiction: Compared with people who have zero ACEs, people with ACE scores are two to four times more likely to use alcohol or other drugs and to start using drugs at an earlier age. People with an ACE score of 5 or higher are seven to 10 times more likely to use illegal drugs, to report addiction and to inject illegal drugs.
The ACE Study also found that it didn’t matter what the types of ACEs were. An ACE score of 4 that includes divorce, physical abuse, an incarcerated family member and a depressed family member has the same statistical health consequences as an ACE score of 4 that includes living with an alcoholic, verbal abuse, emotional neglect and physical neglect.
Subsequent research on the link between childhood adversity and addiction corroborates the findings from the ACE Study, including studies that have found that people who’ve experienced childhood trauma have more chronic pain and use more prescription drugs; people who experienced five or more traumatic events are three times more likely to misuse prescription pain medications.
Dr. Dan Sumrok with group therapy members at McKenzie, TN, clinic (Photo: Yalonda James, The Commercial Appeal)
“ACEs just doesn’t predict substance abuse disorders,” says Sumrok. “All of our major chronic diseases link to substance abuse, so this is too big to ignore.”
Whether you’re talking about obesity, addiction to cigarettes, alcohol or opioids, the cause is the same, he says: “It’s the trauma of childhood that causes neurobiological changes.” And the symptoms he saw 40 years ago in soldiers returning from Vietnam are the same in the people he sees today who are addicted to opioids or other substances or behaviors that help them cope with the anxiety, depression, hopelessness, fear, anger, and/or frustration that continues to be generated from the trauma they experienced as children.
Learning about ACEs helped him understand that the original definition of PTSD, which many people still cling to, is not accurate. In the 1980s, PTSD was defined as a result of trauma that was outside the realm of normal experience.
“That was just wrong,” says Sumrok. “Divorce, living with depressed or addicted family members are very common events for kids. My efforts are around helping people to see the connections, and that their experiences are predictable and normal. And the longer the experiences last, the bigger the effect.”
He also says, “Drop the ‘D’, because PTSD is not a disorder.” It’s what he learned from van der Kolk, who wrote The Body Keeps the Score. “Bessel says we’ve named this thing wrong. Post-traumatic stress is a brain adaptation. It’s not an imagined fear. If one of your feet was bitten off by a lion, you’re going to be on guard for lions,” explains Sumrok. “Hypervigilance is not an imagined fear, if you’ve had one foot bitten off by a lion. It’s a real fear, and you’re going to be on the lookout for that lion. I tell my patients that they’ve had real trauma that’s not imagined. They’re not crazy.”
Patients learn about their ACEs, understand their lives better
This is what happens when a person sees Sumrok for the first time: They fill out the 10-question ACE survey (Got Your ACE Score?) in the waiting room. “Then when I see them, I go through each question and ask them again,” says Sumrok, who also does a normal physical exam. “Frequently, there’s a difference between the two. For example, this morning, I saw a woman and she reported an ACE score of 1 on the survey. Then, when I asked her the questions, she reported nine out of 10.”
That’s just how I grew up, she told Sumrok. She didn’t think being beaten, humiliated or seeing her mother smoking crack every day was harmful or unusual, especially since most kids she knew were experiencing the same thing.
Sumrok normalizes their addiction, which he explains is the coping behavior they adopted because they weren’t provided with a healthy alternative when they were young. He explains the science of adverse childhood experiences to them, and how their addictions are a normal – and a predictable – result of their childhood trauma. He explains what happens in the brain when they experience toxic stress, how their amygdala is their emotional fuse box. How the thinking part of their brain didn’t develop the way it should have. How it goes offline at the first sign of danger, even if they’re not connecting the trigger with the experience. Drugs like Zoloft don’t really help much, he tells them. Zoloft and other anti-depressants don’t remove the memory triggered by the odor of after shave that was worn by your uncle who sexually abused you when you were eight, or the memory triggered by a voice that sounds just like your mother who used to beat you with a belt, or by a face of a man who looks like your father who used to scream at you about how worthless you were…the examples are infinite. That’s why van der Kolk says, “’The body keeps the score’,” Sumrok says.
“After I explain all this to them, many of them stare at me and say: ‘You mean I’m not crazy?’” says Sumrok. “I tell them, ‘No, you’re not crazy’.” Sometimes he yells out the door to his nurse: ‘Patsy! Where’s my not-crazy stamp? I need to stamp this person’s chart.”
For people who are addicted to opioids, he prescribes buprenorphine (one of the brand names: Suboxone), which helps them to withdraw from opioids and to keep their job, or return to work. For most people, the drug is less addictive than other opioids. Sometimes if people are young, healthy and haven’t been addicted long, they can withdraw from opioids without buprenorphine.
“There’s no buzz associated with buprenorphine,” says Sumrok. “They can concentrate and think. Once they’re free of the continuous distraction of the acquisition and use of substances, they become pretty valuable employees.”
For people who are addicted to alcohol, he prescribes naltrexone (one of the brand names: Revia), because alcoholics have a high risk of death if they aren’t provided medication. And in this current national attention on opioids, Sumrok is careful to point out that although 33,000 people died from opioid overdose in 2015, 88,000 people die annually from alcohol-related causes, and 480,000 from cigarette smoking. The complicating factor — and why policies don’t work when they chase the eradication of one drug, only to focus on eradicating the next popular drug of choice for “ritualized compulsive comfort-seeking” — is that many people use opioids and alcohol and cigarettes. And if they receive no help to get at why they’re using legal or illegal substances, they will move on to another, more easily accessible drug when the current drug they’re using becomes more difficult to find.
All patients sign a contract agreeing that they won’t drink alcohol or take other drugs. “We don’t mess around with that,” says Sumrok. “We can’t deal with them being deceptive, because if they drink or do other drugs, it can kill them. If their drug screens aren’t consistent, we ask them to find another doctor.” Just about everybody stays, he says.
They also participate in group therapy. For physicians who prescribe buprenorphine, it’s now required, but Sumrok had seen the research about the effectiveness of group therapy, and had started 12-step groups for his patients about 10 years ago. Talking with others who have the same experiences helps each person normalize their own experiences. Sumrok and the others in the group help each other find “ritualized compulsive comfort-seeking behaviors” that won’t kill them or put them in jail, such as coaching their kid’s soccer team or volunteering at a food bank. (Sumrok often quotes Forest Gump: “Helping helps the helper.”). He also encourages them to integrate other rituals into their lives, such as walking 30 minutes a day or other exercise, joining a 12-step group or finding a path to encourage a spiritual awakening.
“Six months into this,” says Sumrok, “they start saying things like, ‘My wife and I are back together’, they’re hanging out with their kids. It’s pretty cool to see how people get their lives back. My favorite word is ‘normal’. When they tell me they feel normal, I know they’re doing okay.”
So, how long does it take before they’re cured? “How long should you take insulin if you have diabetes?” responds Sumrok, making the point that this is a chronic disease, that people should be in treatment for as long as it is necessary, and that some may relapse. His goal is for them to not have to use buprenorphine, but he knows that because of the number and duration of their ACEs, and the paucity of resilience factors provided to them when they were children, many will need continual support. He helps them learn how to integrate that support into their lives.
“When a diabetes patient comes in with a blood sugar level of 300, we don’t say: ‘Give me back that insulin.’ We intensify the treatment to get them back in balance,” explains Sumrok. “Only in addictions do we shame people. We tell them they can’t be part of this recovery anymore. We create a teeny hoop that’s called abstinence, and not too many people can jump through that hoop. If every time we saw a diabetic, we told them that their kidneys were going to fail, they would be blind and we would amputate their extremities, there wouldn’t be many diabetics who got help. I have patients who drop out, and then return a couple of months later, and say, ‘Doc, Christmas came, I saw some of my buddies, and I started using again.’ I tell them, ‘Come on in. Let’s work with you.’ And I remind myself that I’m not saving souls, I’m saving their asses. It’s about getting them so they can function at work, at home, at play. It’s not about making them perfect human beings.
“It has been abundantly clear to me and reinforced over a 40-year career,” continues Sumrok, “that patients desire, and respond better to, sensitive and informed care. From the Navajo Nation to Appalachia to Memphis and from the mountains of Honduras to the jungles of Amazonia, people regard respect as the sine qua non of quality care.”
Stories AND data drive solutions
Although Sumrok thinks his approach benefits his patients, he knows he needs data to prove it. When he saw a recent study that said 43% of people on buprenorphine were using other opioids, he did his own analysis of a sample of his patients, and found that only 8% were using other opioids. After tracking down those who were, most had good reasons, such as a man whose arm and shoulder were in a new cast after surgery repairing an injury, and he was taking a narcotic. Only one did not, and when shown his drug test, he said, “You know what? I slipped.” He talked about it in group, says Sumrok, and everyone in his group hovered around him to make sure he’d continue the program.
Dr. Karen Derefinko
Because Sumrok has kept fastidious records of the patients who have done their ACE scores, Dr. Karen Derefinko, a clinical psychologist and assistant professor in the Department of Preventive Medicine at the University of Tennessee Health Science Center, is starting a research project to examine all 1,200 records in Sumrok’s clinic in McKenzie to look at the relationship between people’s ACE scores and their adherence to treatment and their relapses.
“We think that people with high ACE scores are likely to have more relapses,” she says. “And that may be because people with higher scores have fewer resources and more difficulty associated with adhering to their treatment plans.”
She and her research assistant will de-identify the records, so that all information is anonymous, and then collect the data. Once that data is analyzed — probably within two months — Derefinko and her assistant will conduct focus groups of some of Sumrok’s patients. She’s already been sitting in some of the groups.
“Dan encourages this participatory nature of his groups,” she says. “People are very willing to talk. After the group sessions, they’re often not done talking about why they came to Sumrok and why other programs didn’t work for them.”
Through the records and the focus groups, Derefinko hopes to identify barriers to care, which include basics such as how people can find good care easily (most of Sumrok’s patients find out about him through word of mouth), being wary of the treatment because it isn’t explained to them, or — what Sumrok hears a lot — being judged or talked down to instead of given understanding and respect.
“In Shelby County, people complain about barriers to care, which many people think is because of economics,” she says. “But it may not be just economics that is keeping people from accessing treatment; it may be more about being judged, and not knowing what the treatment looks like.”
Being treated with respect builds trust, trust builds health
One of Sumrok’s patients – I’ll call him John, which is not his real name – has been driving 140 miles from Southeast Missouri to see Sumrok for the last five years. He began using drugs off and on during his 20s. When he was in his 30s, he injured his back, was sent to a worker’s comp physician, who prescribed stronger doses of pain killers until his back stopped hurting.
“I was taking pain pills like candy,” says the 46-year-old, who is married and has a son. “All of a sudden, the pills are gone, and you’re very sick, and I start looking for them everywhere – on the street, taking them from family members without asking – just to keep me from getting sick. I thought I had to have them to function. If I didn’t have six or seven pain pills, I wasn’t going to be able to get out of bed. If I didn’t get them, I’d be sick, puking….I’d do about anything to have those pills.”
After he spent his and his wife’s life savings, and the money they’d put away to buy a home, and his retirement fund from a previous job; after he saw friends die from overdosing; and after he realized that he was risking losing his wife and son, he told his wife he needed help, and they found Sumrok.
“It’s been a miracle, for sure,” says John. As the Suboxone took effect, “after two or three weeks, I began to feel normal again.”
About two years ago, Sumrok asked him to fill out the ACE survey. “It really did make a difference,” says John. He had never connected experiences in his childhood with using drugs as an adult.
“When I was just a baby,” recalls John, “my grandpa took me from my mother, and told my parents: ‘When you guys are stable, I’ll let you have him back.’ Up until I was 10 or 11, I called them ‘Mom’ and ‘Dad’.’” His older sisters were sent to live with his other set of grandparents. He didn’t live with his parents again until he was 15 years old. His sisters were adults and out on their own by then.
Until he did the ACE survey and talked with Sumrok about his childhood, it didn’t dawn on him that losing his mother, father and his sisters at a young age could have affected him in ways he didn’t realize. “I knew I was loved by my grandfather and grandmother, but being a young kid and seeing other kids going out with their parents was frustrating,” he says. “I lived with old people who never left the house, while my parents were out running around. I maybe thought my mom and dad didn’t care about me enough to change. I might have always felt like I wasn’t important enough to my mom and dad for them to change the way they were living and acting.”
But now he has a better understanding of what it was like to be a 19-year-old in the late 1960s and involved in the drug and party scene then, as his parents were. He understands them better, and why they weren’t able to care for him. He and his family members have “had our discussions,” says John. “My family life is a whole lot better. I didn’t have relationships with my parents or sisters. We only live seven miles apart, and I barely saw them twice a year, if that. But now I have my wife back. I’ve got my son back. And I see my parents and sisters all the time. We’re a tight-knit family.” He’s also able to hold a job, and is a reliable employee.
John sees Sumrok once a month now. He participates in group therapy, where they can safely talk about their ACE scores without having to get into specifics. He checks in with Sumrok, who renews his prescription.
“I like group therapy with Dr. Sumrok,” says John. “He talks to us with respect. We feel very comfortable with him. Dr. Sumrok never lies. I trust him fully. And he trusts me. It took five or six months to build that trust. The more I met with him, the more I realized that he was really concerned about me. He wants to help people. Let him train more doctors in the procedures he uses. You can’t treat people like they’re nobodies.”
A 29-year-old patient, who chose to be called “Mr. Big” since I’m not using his real name, has been seeing Sumrok for the last six months. He had been in a methadone treatment program, and found Sumrok after he couldn’t pay for treatment any longer. Sumrok was the only physician who would take his insurance. Mr. Big filled out the ACE survey in the waiting room, but reported his score as a two. Then Sumrok went through the survey with him, and Mr. Big’s score climbed to an 8.
“It does help me understand my addiction better,” says Mr. Big, who is a single father of two children, five and six years old. “For one, my trauma in my childhood was very dramatic. I thought everyone’s parents did what they were doing. I could see why I related to narcotics and stuff. It was the only place I had to turn. I started taking opiates when I was 11 or 12 years old. I was playing football, and broke my ankle. They gave me painkillers that made me feel like Superman. I couldn’t get enough, because I wasn’t feeling like Superman without it.”
The Suboxone helps him feel “normal — probably the way everybody else feels,” says Mr. Big. “Nothing I took ever gave me that feeling before. I’m a better person, father, and a better brother” to his sister, whom he convinced to also get help from Sumrok.
The first time he went for help, to a methadone clinic, he didn’t like it for two reasons: Methadone made him nod off or feel high, and the people at the clinic treated him as if he was a number, or just there for the drugs. “That’s just unprofessional, in my opinion,” he says. “Sumrok actually sits down and talks to you like a human being.”
Mr. Big wants to work with Sumrok to develop a “game plan so that I can live without my medicine,” he says. He just wants to live a normal life. What does a normal life mean?
“It means that I’m home overnight with my children,” he says. “I don’t have to rob, lie, steal, or cheat to find drugs. I can fit in with society and not be high off my mind. I can wake up every day and do stuff. My children — they know Daddy’s not in bed sick any more. It’s wonderful. I’m wore out. I never knew that first grade and kindergarten had homework that was so complicated.”
With addictions and deaths on upswing, how to increase addiction docs?
Prescription and illicit opioids are the “main driver of drug overdose deaths,” according to the CDC, with 33,091 deaths in 2015. That’s four times more than 1999. And between 2014 and 2015, Tennessee saw a 13.8 percent increase in opioid deaths. More than 1,000 people died from opioid overdoses in 2014, and tens of thousands of people lead desperate lives, most of them unknowingly fueled by their childhood experiences. Only 10% of these are getting the help they need, says Sumrok.
Dan Sumrok is just one doctor, in one part of the country. How can what he does be scaled up to thousands of physicians who can treat addiction successfully in all parts of the U.S.? By doing what Dr. David Stern, Robert Kaplan executive dean and vice-chancellor for clinical affairs for the University of Tennessee’s College of Medicine and the University of Tennessee Health Sciences Center, did: launch the Center for Addiction Science.
“This really starts with Dr. Altha Stewart, who’s the director of the Center for Health in Justice-Involved Youth,” says Stern. “She’s the one who showed me that kids with high ACE scores end up in trouble. When I developed the Center for Addiction Science, it had to be like a cancer center, it had to be multi-disciplinary. In the old days, we thought people who had addictions were weak in the moral department. You really needed someone to straighten you out, because your mother didn’t do a good enough job.”
Dr. David Stern
But that approach doesn’t work. Neither does criminalizing addictions. Stigma drives problems underground, says Stern, instead of driving them to a solution. The center is taking an integrated approach to using research and education to help people in all possible ways, from physiology to genetics to counseling.
Stern believes that every physician should know about ACEs science, which is one of the reasons he chose Sumrok to lead the center, along with his willingness to be creative and seek solutions across disciplines. “Two of the most prevalent things in acute care are depression and addiction,” says Stern. “I think it’s important to be able to understand what ACEs mean to patients, what addiction is all about, how to recognize it, how to treat it.” He’s in the process of finding an associate dean for medical education, and is looking for someone who will integrate ACEs and other social determinants of health into the school’s curriculum.
“I think a medical school should provide for the community it serves,” says Stern. “This medical school should be the medical school for Memphis. We should develop solutions that are scalable.”
Dr. Altha Stewart, associate professor of psychiatry in the University of Tennessee College of Medicine, learned about ACEs in 2009 when a group in Shelby County began educating people about ACEs science. They brought Dr. Vincent Felitti, co-founder of the ACE Study, and Robin Karr Morse, who wrote Ghosts from the Nursery: Tracing the Roots of Violence, which was published in 2007, to give a presentation. (Karr-Morse later wrote Scared Sick: The Role of Childhood Trauma in Adult Disease with Meredith S. Wiley; it was published in 2012.)
Dr. Altha Stewart
“It’s become a core part of what I do now in my professional work,” says Stewart, who was recently named president-elect of the American Psychiatric Association. She’s working with the Shelby County community and the local criminal justice system to integrate trauma-informed and resilience-building practices to find ways to help youth who enter the justice system — all of whom have likely experienced ACEs — instead of shaming, blaming or punishing them.
The things that have happened to kids — as well as to many people who come into the health care system — are out of their control, says Stewart. “When you’re a child, you don’t control the people who abuse and assault you, who create hostile environments, who don’t provide you with clean clothes,” she says. “If a child can’t control their environment, because of these things they grow up thinking they’re bad, different, horrible people. This new approach (integrating trauma-informed and resilient-building practices based on ACEs science) helps them feel like they’re not drowning anymore. When they can pop their head out of the water and get a breath, and see outstretched hands, a life preserver, a life boat, that changes their entire perspective.”
When Sumrok began integrating ACEs into addiction treatment, that was innovative, says Stewart. “If you don’t ask these questions, people tend not to tell you,” she says. Sumrok’s approach is part of a shift in patient engagement and involvement. “The trend in health care is that patients are partners in their treatment.”
This new knowledge about why and how humans behave the way they do also speaks to how “we have trained the medical profession,” says Stewart. The traditional approach is that physicians “know everything. The people whom we treat know nothing. We tell them what to do, and if they don’t get better or do what we say, it’s their own fault.
“That’s simply not true,” she emphasizes. “Some of us have come to understand that there’s more expertise in the community and our patients than we’ve understood. That takes a bit of humility on the part of a physician, and an understanding that we are partners in helping a person heal.”
Sumrok’s experience with the young fellows at the Center for Addiction Science is giving him some real hope that the medical profession can change. When he’s explained to them how important it is to ask patients about ACEs and other aspects of their lives — such as food availability, safe housing, transportation, jobs (in the medical profession vernacular: social determinants of health) — “they say ‘isn’t that just taking a patient history?’”
He and others at the University of Tennessee Health Sciences Center have an opportunity to educate young physicians outside the state, too. Derefinko is also director of the newly created National Center for Research of the Addiction Medicine Foundation. The foundation oversees the 130 addiction medicine fellowships at 46 medical schools across the country.
“We want metrics to understand the impact they’re having” when they go out in the world, says Derefinko: where they go, whom they’re treating, how they’re practicing, whether they’re integrating ACEs science. In addition, the foundation will be developing some accreditation guidelines so that all fellows receive the latest and best education in addiction medicine.
One of those elements, says Sumrok, has to be empathy, which physicians can practice by listening, acknowledging and understanding how the experiences in a person’s childhood and adulthood have shaped their lives and health.
“Can you teach empathy?” he asks. “Can people learn to be empathetic providers? I think you can. I think so.”
all that being said, I think a significant contribution of articles like Dr Sumrok’s is that it might help release people from the mental straightjackets in which they struggle, so to consider a bigger range of factors involved in more complex relationships. Such multifactorial studies can be very expensive and difficult to undertake. Look again at the recent discussion of Culverhouse’ “collaborative” meta-analysis of the role, or lack thereof, of the serotonin gene variant in influencing the role of early life stress in the development later problems — not all researchers agreed to have their data included in the meta-analysis. Whether or not current research methodologies, and inter-institutional schemes of arrangement, are up to the task remains a big question — meta-analysis itself is a relatively new methodology. Such questions won’t be answered in my lifetime but need to remain center-stage if we are to bring more humanity into the hard task of living human lives,
Jane StevensPublisher, ACEsTooHigh; founder, PACEs Connection
just became aware of this from the Australian peer support workers Facebook page
Jane, exhaustive / exhausting coverage of this! — people would be well acquainted with my own postings re this on this site — but also don’t forget that this is yet another re-visiting of the “self-medication hypothesis” — and for comments on this from multi-disciplinary perspectives see http://onlinelibrary.wiley.com…012.04001.x/abstract
Darke’s article must be purchased to be read — he didn’t respond to my request to a copy when I asked closer to its original publication — but the comments letters are free.
“for every complex problem, there is a simple solution, and it’s simply wrong” — in practice, it’s a bit more complicated, but one cannot ignore the VERY high incidence of adverse childhood events in the AOD population, so “not true for everybody, but …..”
Jane StevensPublisher, ACEsTooHigh; founder, PACEs Connection
Thanks, Emily! That’s a good point about the artificial bifurcation in trauma and addiction. The people who’ve worked at the Substance Abuse and Mental Health Services Administration (SAMHSA) have told me that it wasn’t all that long ago that people thought substance abuse and mental health weren’t related. And I think there are quite a few people who think that substance abuse and mental health and physical health aren’t related. ACEs science definitely shows otherwise!
Thanks for all that great work you’re doing at ConVal!
FMFormer Member
Fantastic article, Jane! It is so edifying in the work I have led for the ConVal School District. More importantly, it may help open eyes to those facilities and practitioners who have long made an artificial bifurcation in trauma and addiction (e.g. “you can’t be in treatment if you haven’t dealt with your trauma” or vice versa). We need to further embrace a trauma informed approach across the continuum of care spectrum. Again, great work!
Jane StevensPublisher, ACEsTooHigh; founder, PACEs Connection
Thanks, Jen! That was my reaction, too, when I first heard the idea. It makes total sense!
Great article, Jane. I am particularly struck by this notion of dropping the “D” in PTSD. It makes sense. Calling it a disorder is further pathologizing what is really a normal or expected response to traumatic stress. I had never even considered this idea. We throw PTSD around so much to describe a variety of symptoms and reactions. This is definitely something to consider.
Jane StevensPublisher, ACEsTooHigh; founder, PACEs Connection
Cissy, thanks for sharing this. Quite a few people have seen this today. I hope it’s helpful!
Jondi, thanks for your kind words!
Lisa, thanks for all the great work you’re doing; and for sharing that work on this network.
Rick, I’m very glad you’re part of this community.
And, Mary — I agree. There are so many people who are integrating this ACEs science in creative ways that show the promise that this new knowledge has for solving our most intractable problems!
You hit a home run with me on this article. Great job. I really am so happy to be a part of this informed community and men and women who are on the front lines of this Social epidemic.
Thank you for writing this, Jane – it is so thorough and so needed. I have been working in the substance use disorders (or as Dr. Sumrok calls it, the “ritualized compulsive comfort-seeking”) field for many years, now, and once I learned about the ACEs Study – it was “ah – ha” – that explains how a person develops the disorder and it explains why they relapse because the root causes were not treated. Most importantly, it helps the person understand – they didn’t choose it or as Dr. Sumrok quoted his patients often saying, “You mean I’m not crazy?”
Christine Cissy WhiteIt’s not trauma-informed unless it’s informed by trauma survivors.
Jane:
I’m sharing the heck out of this. What a fantastic profile and example of how thinking and lives and practices change, for the better, from an understanding of ACEs. To be on the receiving end of this type of care and approach (I love the “not crazy” stamps) is life-changing to life-saving. And it changes the entire framework for lots of us in ways that allow us to make more effective changes – as helpers and people being helped sometimes.
And with that, many of share this sentiment.
“Since I’ve learned about ACEs, I talk about it every day.”
Two years ago, instead of retiring as planned, Dave Ellis decided to apply for the new position of “executive on loan” to create and lead the New Jersey Office of Resilience (OoR) in the Department of Children and Families (DCF). It is the first state-level office to integrate policies and practices based on the science of positive and adverse childhood experiences. His appointment electrified the national PACEs movement, not only because he was a pioneer in the movement, but because the state was willing to make some bold moves.
On Friday, DCF announced that Ellis is leaving May 31, at the end of his two-year contract. Although he may be leaving New Jersey, his commitment to integrating policies and practices based on PACEs science, especially in communities, hasn’t waned. He’s already received inquiries from other states and is adding to his busy consulting schedule.
In reaction to the announcement, a chorus of “oh nooooo’s” began echoing throughout New Jersey as well as other states. Yesterday, Ellis and I had a Zoom call to talk about his tenure and departure.
“I refuse to be upset,” says Ellis, a plain-speaking, truth-talking, advocate with an insatiable curiosity, “mainly because I knew from the very beginning that this was a two-year opportunity. It’s always been two years. I kept telling folks, it’s a two-year grant position.”
His intention for the two years was simple: “To come to New Jersey, to recognize the great work already happening, to move the state into a position of national recognition and to give the community the ability to actually implement things that it believes will work. I also wanted to give local communities a voice. With the $3-million micro-grant process that we’ve launched, the amazing ideas that communities have come up with, and the upcoming People’s Gathering in September, the state is poised to truly exhibit what it looks like to partner with communities most impacted by adversity.”
How NJ laid the groundwork
Three foundations and DCF created a sound foundation for Ellis arrival so that he could hit the ground running. In 2018, The Nicholson Foundation, the Burke Foundation and the Turrell Fund worked with DCF to begin the process of launching the Office of Resilience. Ellis was chosen to lead the office; he is not a state employee—his salary is paid by the foundations. His five team members are paid by the state.
In two short years, the Office of Resilience developed the NJ ACEs Statewide Action Plan; a statewide awareness campaign, Actions4ACEs, that targets educators and law enforcement; a healing-centered education pilot in 75 school districts; and has provided in-depth training for around 4,000 people through ACE Interface.
When they began their work in 2020, “DCF had little contact with the Native American community,” says Ellis. “Not until Dwana Young on my staff went out there and kept beating on doors. Now we’re connected to all three tribes and the New Jersey Commission on American Indian Affairs. That’s important because the Indigenous populations across the country are No. 1 in being disproportionally impacted by ACEs.”
Great accomplishments, and more work to do
“We’ve done so much, and yet there’s so much left to do,” says Ellis.
Ellis worked with DCF’s grant and contract units to use $3 million in federal funding to design a system of awarding microgrants. “We awarded $3 million to three nonprofits to distribute through a process that will allow small agencies and individuals to submit their ideas for consideration,” says Ellis. “A selection committee made up of Office of Resilience staff, DCF staff, the three awarded agencies and community members will select the ideas to be funded.”
The reporting process will be unlike most grants, notes Ellis. “I told them it’s quite simple,” he says. “I’m interested in what we are learning. Whether you fail or succeed, that’s the wrong question. It’s not about how many you served. If you’re succeeding, I’m more interested in what are you learning? If you’re failing, what are you learning? And how do we share all of that with community so that we all learn, and we can all move forward together?”
All people who participate in the grants— funders, organizations and individuals alike—have been or will be trained in PACEs science, so that it becomes part of the DNA of the work, he says. Unless people who administer the funds and carry out the projects do the difficult work of understanding their own childhood trauma, they can’t be as successful as they could be. Training will continue to expand: With the support of two small grants from foundations, a cohort of trainers is being coached to train all 6,700 DCF staff in PACEs science.
Long-term goals for a long-term effort
Ellis’ main concerns are ensuring sustainability of the work over the next couple of decades and making sure the work is centered in communities. “How do I put this office in a position so that 10 years from now, 20 years from now this is still relevant work? That’s why I wanted things grounded in community so that whatever we did, the community then had the ability to do it themselves.”
The state, foundations, communities need to invest in integrating PACEs science in communities and state agencies for the next 10 to 20 years, he says: “You have to invest for the long haul. We tend to invest for the short term rather than looking at the long game which, in this work, is required to actually prevent ACEs and increased PCEs (positive childhood experiences.” Only in this way can the state solve its most intractable problems.
“There’s a request into the governor for a $10-million allotment over three years of the federal American Rescue Plan Act funds to stabilize this office outside of DCF,” says Elllis. “Because if this effort stays only in one state agency as a statewide initiative, it becomes associated just with that agency. The design, from my perspective has always been, that the OoR in DCF would continue, but that there would be a statewide, much larger umbrella that would be outside of DCF.” The working name of the organization is the Healing NJ Together Technical Assistance Center. Suggestions for its location include being housed at a university, creating it as a standalone nonprofit, or as part of the state extension office. That will be determined after Ellis’ departure.
He would like to see more involvement from the legislature. “There is no state appropriation at this time,” he explains. And yet, this is a statewide initiative. It began as a governor’s initiative. A lot of the work going forward will require state support specifically to support the office.”
And, above all, communities need to continue to be at the center and foundation of the work. “You know who I mean by community,” he points out. “Those people who are most directly impacted need to be involved in all decisions about them. That’s not what the traditional model is, but I believe that unless until we engage with them, this change isn’t going to happen.
“What I really want to see us figure out is how to move from a place where we’re doing harm and to think about how we prevent it,” he continues. “How do we not just heal from childhood adversities and their effects, but how do we prevent them from occurring? That is the ultimate goal. It’s the one thing that I won’t stop fighting for. We can’t focus on only healing because that means that we’re allowing all of these things to continue.”
As we talk, in the background Ellis’ wife is busy packing boxes. “Somebody asked me the other day: Are you okay?” Ellis muses. “I’m better than okay. I feel good that when I leave here, and there’s somebody younger who comes in, I will certainly work to help them transition and give them whatever I can. But I’m not going to tell them how to do this job. I want them to do it their way.”
Over a relative short time, he, his team, the state departments he’s worked with and the communities he’s inspired have made huge strides in New Jersey. At the end of this month, he and his wife will move to Arizona where they’re building a house. And after a two-week vacation in Portugal, he’ll return to figure out his next challenge.
Jane Stevens Publisher, ACEsTooHigh.com Founder, PACEs Connection
Thank you Jane for the report. Dave has done amazing work, leaving a legacy. Exchanged brief messages a couple of days ago. Met him at my conference in February here Arizona, and he is coming here… interestingly small world and the movement advances wherever he goes!
TraumaInformedJobs.com is a new job board for the trauma and resilience communities. PACEs Connection members can save 10% on posting with code PACES10
Note – This is another post by Jane. It is about a fellow staffer whom we adored. We also lost Elizabeth Prewitt to cancer in 2025, and then Jane herself, also in 2025. This was following the death of Dan Press, founder of the Campaign on Trauma Informed Policy and Practice, a “sister organization”, in, I believe, 2022. Their obituaries are all posted on this careysipp.com site, as I wanted to save them, to remember these amazing people. With help from some of Jane’s friends and fellow PACEs staffers, I crafted Jane’s obituary, which I will try to link here once I fiture out more about wordpress. Also in the mix is the obituary of my dear friend and partner in Neuro Nuturing, Deborah McNelis, who also died of cancer in 2025. I did not post, unfortunately, the obituary of another dear friend of PACEs Connections, Robin Cogan, author of “The Relentless School Nurse.” I regret not posting about her untimely life and death in a fitting post on PACEs. Her death was stunning and grieved by literally thousands of nurses across the country. Too many wonderful people in this field die early and of cancer. I wonder about the connection. Knowing the stories of some of these people well, I could say their “numbers” told the tale. AND knowing some of these people so very well, I would say that were I to say this, that their ACEs spelled their death sentences, I know they would be PISSED. Because all of these people also believed in the power of positive childhood experiences (PCEs) and found and lifted up the positive as a part of their healing. It was remarkable and wonderful to witness; to be a part of their work to help prevent children from having their lives altered by toxic childhood stress. Again, not everyone I’ve mentioned here had a high ACE score. Their own writings reveal those facts and are their stories shared. Bottom line? I am grateful to have known each of the people mentioned, and Cissy, who was the first among the group to pass away, lived fully and was grieved mightily.
Our beloved friend and former PACEs Connection staff member, Cissy White, died peacefully in Weymouth, MA, on Sunday morning, surrounded by family and friends.
This the obituary the family wrote that appeared here.
So many people are holding this angel of grace, strength, beauty, intellect, humor, and compassion in their hearts right now, remembering Cissy’s deep kindness and generous, brave heart. She taught us all how to live.
Cissy leaves daughter Kai Schildmeier, mother Nancy Atwood and her husband Chip (Cissy’s stepfather), sister Karyn Doherty and her husband John, brother Joseph Atwood and his wife Mindy, stepbrother Dan Coxall, nieces Rachel and Catrin Doherty, nephews Zane and Kindred Atwood, beloved aunt and uncle Mary and Jimmy Moy, aunt Diane Shaughnessy, uncle Eddie Moy, cousins Jeffrey, Michael, Stephen, Danny, Jennifer, Jamie, Andrea, Chris, Corey, Teddy, Ryan, and Katie. She also leaves her co-parent, her former husband David Schildmeier, as well as many devoted friends, including caregivers Beth O’Malley, Heidi Aylward, Kathy MacDonald, and Lynn Tryba. Cissy’s biological father was the late Frank White of Boston.
Although she left us much too early, Cissy never viewed her diagnosis of ovarian cancer in 2019 as a tragedy. In her own words: “If I die soon, it will be too soon but it will also not be tragic because I got peace and a sense of closeness and acceptance of myself. I still feel triumphant and joyful about this life and I do not feel diminished.”
Cissy’s life was a triumph. Her only regrets were that she couldn’t be here longer for her daughter and that, as an activist, she didn’t always prioritize having fun. In recent years, Cissy made a practice of “joy stalking,” a phrase she coined to describe fiercely appreciating “the small and delicious delights” of everyday life. [Here is her post “Professional Joy Stalker”, and here is a link to all of Cissy’s posts on PACEsConnection.com.]
Before getting into Cissy’s many accomplishments, we want to take a moment to remember her one-of-a-kind laugh (her brother-in-law John describes it as a cross between Marilyn Monroe and Arnold Horschack); the warmth, safety, and acceptance she offered; the long conversations over glasses of iced coffee; the way she could be so open and verbally appreciative of others’ gifts and talents; the way she built connections among her many and assorted friends; the creative moments, gathering sea glass and making art; the way she spoiled her pets unapologetically; the way her daughter, Kai was always her number one priority.
Cissy was an outspoken and passionate advocate for trauma survivors, most recently working at ACEs Connection (now PACEs Connection), a social network that recognizes the impact of adverse childhood experiences (ACEs) in shaping physical and emotional health. Her roles included Northeast Region Community Facilitator as well as Community Manager, Parenting with ACEs.
“It’s not trauma-informed if it’s not informed by trauma survivors” was her motto; she always said that healing tools should be affordable, accessible, and appealing to survivors and that patient-centered care should center patients’ voices, experiences, and collaboration, otherwise it was hypocritical and silencing. Cis would not stand for anyone being silenced. Her survivor-led advocacy work earned her the Touching Trauma at its Heart Award from the Attachment and Trauma Network, the VOICE for Traumatized Children.
Her work was written about in the Atlantic Monthly, the Boston Globe, and other outlets. She appeared in the December 2020 PBS News Hour series “Invisible Scars: America’s Childhood Trauma Crisis,” in an episode about how treating trauma early can help kids cope down the line.
She was a guest on podcasts such as Cancer Connections by the Clarity Foundation and Trauma Therapist Podcast with Guy McPherson. She was a sought-after speaker on issues related to PTSD and childhood trauma. Herself a childhood trauma survivor, Cissy knew first hand the power of writing to heal. She began sharing her journey on her blog healwritenow.com in 2013. In 2014, she collaborated with artist, writer, and professor Margaret Bellafiore to create Body Language: An Interactive Installation Exploring the Impact of Trauma, which was shown in Cambridge, MA. The installation gave visitors the chance to viscerally experience the changes that occur in the body as a result of surviving trauma.
Cissy realized a longtime dream in 2015 when she opened the Heal Write Now Center in Weymouth. That experience was a powerful way for her to step out into the world, saying she believed in the healing power of words, community, truth-telling, and safe and affordable spaces for people to create and share. Cissy’s journalism and essays were published in Ms. Magazine online, Elephant Journal, the Boston Globe, Spirituality Camp; Health, PTSD Journal, PsychCentral, To Write Love on Her Arms, ACEs Connection, PACEs Connection and ACEs Too High, among others.
After being diagnosed with ovarian cancer in 2019, Cissy became involved in patient advocacy work, volunteering for the Ovarian Cancer Research Alliance (OCRA) as part of the Survivors Teaching Students program. Her hope was that future medical professionals better understand the early symptoms of ovarian cancer in order to prevent misdiagnosis, delayed diagnosis, and a poorer prognosis, as there’s currently no way to screen for ovarian cancer.
After Cissy was herself misdiagnosed, she was dismayed to learn that ovarian cancer survival rates were no better than they were decades ago when she had been a caretaker for her beloved maternal grandmother, Edna “Nan” Shaughnessy, who died of ovarian cancer in 1990. Cissy’s first-person account of what it was like to be involved in cancer drug trials, “The Clinical Trial Treatment Train,” was published in the New England Journal of Medicine on August 23, 2022. Throughout her rigorous and often disheartening treatment, Cis felt seen and supported by the team at MGH, and especially by her oncologist, Dr. Richard Penson, who knew her as a writer, not only as a cancer patient. It was their discussions that led to her essay in the NEJM.
Though Cis was proud of her published writing, equally important to her was the expressive creative writing she did right up until the last week of her life in her weekly writing circle. As she did her entire life, she leaned into the healing power of writing to hold her in joy and sorrow. She considered this practice, and the love of her family and friends, her medicine after treatments failed her.
From 2000 to 2003, Cissy worked in the Communications Camp; Events Planning department for Wide Horizons for Children, an adoption agency in Waltham, MA, that works with orphaned children worldwide. In 2003, she and her then-husband David Schildmeier traveled to China to adopt Kai, the love and light of Cissy’s life. In her own words: “My daughter brought the world to me. My daughter is a beam of sunlight brought to my soul.”
Cissy was an amazing parent who devoted her life to ensuring Kai had everything she needed to become the smart, caring, kind, and impressive young woman she is today, taking an active role as a parent advisor and member of the board of trustees for the South Shore Charter Public School, and later through her years as a devoted and proud dance mom at the respective dance academies for which Kai was an avid dance team competitor. This culminated in Cissy’s great pride in Kai’s admission to Boston University, where she is a STEM student hoping to become a physician.
Cissy graduated from Bromfield High School in Harvard, MA, in 1985 and earned a BA from Hampshire College in Amherst, MA, in 1991. Her focus at Hampshire was social psychology and creative and critical writing. Cis appreciated and supported the work of Beth O’Malley’s Adoption Lifebook’s for children and teens who were either adopted or live in foster care; when she discovered O’Malley and her work, she made a lifelong friend.
She found inspiration in the work of psychotherapist Serben Fisher; guided imagery pioneer Belleruth Krepon Naparstek; science journalist Donna Jackson Nakazawa; and writer Nancy Slonim Aronie. Cis always said Nancy’s writing workshops were where she found her voice.
Relatives and friends are respectfully invited to attend a visitation for Cissy on Saturday April 15, 2023, from 11-1pm in the CC Shepherd Funeral Home located at 134 Pleasant St (Columbian Sq.) Weymouth. A service for Cissy will take place immediately after the visitation in the funeral home. Cissy asked that family and friends wear bright colors if they choose. Hot pink was her favorite, but all colors are encouraged. In lieu of flowers, memorial donations may be made to the Ovarian Cancer Research Alliance.
Please visit Cissy’s tribute page at https://give.ocrahope.org/cissy. Checks may be mailed to Ovarian Cancer Research Alliance, PO Box 32141, New York, NY 10087-2141.
Jane Stevens Publisher, ACEsTooHigh.com Founder, PACEs Connection
Note – With PACEs Connection switching over to a splash page on August 10, 2026, I wanted to save some of the most important posts written by Jane Stevens, a couple of other staff people, and myself. I didn’t save even a 10th of what I would like to have, but I am assured that a “data dump” of all posts and the entire social networking site exists and that we will be able to access what’s needed when the need arises. AND… just in case, I am posting this and a couple of others Jane wrote — which in no way does justice to the volumes of materials she created to help people begin to grok the connection between adverse childhood experiences (ACEs) and our most intractable social ills, or how Jane said PACEs science could help us prevent perpetuating those ills with the flip side of adverse childhood experiences — positive childhood experiences — and policies supporting PCEs and more. Please know I apologize in advance for not uploading more pieces here. Jane’s beloved “ACEsTooHigh.com” site went down earlier in 2026 and I was stunned that that decade plus of work just disappeared. My hope is that the archives of the PACEs Connection social networking site will live on and we can someday create a history of this movement, as I, too, believe the answers to all of our most intractable problems are in this science. How to prevent multi-generational ACEs, how to foster “Neuro-Nurturing” to create the early relational health that is foundational to a lifetime of better health and better choices; how to leverage finding and norming the positive to create ever-widening circles of healthy communities, families, people. Thank you, Carey Sipp
A baby is born into a family where he’s ignored by his father. When he does receive his father’s attention, his father constantly yells at, criticizes or punishes him. For the first two years of his life, this child’s mother is perfunctorily attentive, but not loving, and then abandons him for a year. From the time he was born until he is an adult, he witnesses his father abuse his older brother by terrorizing him verbally. This leads to his older brother becoming an alcoholic and dying at the age of 42. He sees his parents engaged in an emotionally neglectful, if not emotionally abusive, marriage.
This is the story of the early years of President Donald J. Trump, according to the captivating book, “Too Much and Never Enough: How My Family Created the World’s Most Dangerous Man.” The book was written by the president’s niece, Mary L. Trump, the daughter of Donald Trump’s older brother. It bursts open the doors to understanding why Donald Trump behaves the way he does. It is also is a cautionary tale for how we decide who becomes a leader, whether that leader is a president, CEO, judge or school superintendent.
In Mary Trump’s words: “Child abuse is, in some sense, the experience of ‘too much’ or ‘not enough.’ Donald directly experienced the ‘not enough’ in the loss of connection to his mother at a crucial developmental stage, which was deeply traumatic. Without warning, his needs weren’t being met, and his fears and longings went unsoothed. Having been abandoned by his mother for at least a year, and having his father fail not only to meet his needs but to make him feel safe or loved, valued or mirrored, Donald suffered deprivations that would scar him for life.”
Anyone who knows about the science of adverse childhood experiences has suspected all along thatcritical aspects of the president’s formative years contributed to his behavior today.
Mary describes Fred Trump, Donald Trump’s father, as a “high-functioning sociopath.”
“In order to cope,” writes Mary, “Donald began to develop powerful but primitive defenses, marked by an increasing hostility to others and a seeming indifference to his mother’s absence and father’s neglect….In place of [his emotional needs] grew a kind of grievance and behaviors—including bullying, disrespect, and aggressiveness—that served their purpose in the moment but became more problematic over time. With appropriate care and attention, they might have been overcome.”
But Donald Trump had practically no positive childhood experiences that could buffer the abuse he endured. “Unfortunately, for Donald and everybody else on this planet,” writes Mary Trump, who has a Ph.D. in psychology, “those behaviors hardened into personality traits…”
Donald Trump didn’t have a chance. The only thing that kept him from ending up as a small-time crook with a prison record is money, and lots of it.
Most people think of child abuse as sexual abuse or the physical abuse of being beaten. But the science of adverse childhood experiences found that other types of childhood abuse—experiencing emotional abuse, emotional neglect, living with a parent who’s addicted to alcohol or other drugs or is mentally ill, having a relative who’s incarcerated or witnessing a mother being abused, witnessing a sibling being abused, bullying, racism and other traumatic experiences—can do just as much damage. That’s because the brain itself can’t distinguish between types of trauma. It’s all just trauma that a child’s brain has to adapt to in order to survive. For example, when a father’s only interactions with a child are to suddenly rage without warning, the stress hormones in the child’s brain trigger a kid to flee for his life, fight or freeze in fear. And if that kid has to protect himself from that father every day, eventually that kid’s brain is altered.
Science is very clear that babies need two important types of positive experiences to lay a solid foundation for a healthy life, notes Mary Trump. One is physical and emotional closeness: “Being held and comforted, having our feelings acknowledged and our upsets soothed are all critical for the healthy development of young children.”
The second is mirroring, “the process through which an attuned parent reflects, processes, and then gives back to the baby the baby’s own feelings,” she writes. “Without mirroring, children are denied crucial information both about how their minds work and about how to understand the world. Just as a secure attachment to a primary caregiver can lead to higher levels of emotional intelligence, mirroring is the root of empathy.”
Although the CDC-Kaiser Permanente Adverse Childhood Experiences Study still isn’t widely known, even though it’s been around for 20 years, it and the other parts of ACEs science are providing a profound shift in our understanding about why we humans behave the way we do. ACEs science also shows that to change behavior that is unhealthy, criminal or unwanted requires a very counterintuitive approach. Instead of using practices based on blaming, shaming and punishing, as we have for centuries, incorporating policies and practices on understanding, nurturing and healing have seen remarkable results in every sector in tens of thousands of organizations (but there are millions of organizations). Schools that integrate practices based on ACEs science, sometimes called trauma-informed schools, are able to eliminate suspensions and expulsions. Hospital emergency rooms see a 30% drop in visits. Suicide attempts by youth drop 98%. Recidivism rates by graduates of batterer intervention courses drop from 60% to 1%. A year after families participate in Safe Babies Courts, 99% of children suffer no further abuse.
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 adverse 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. It increases obesity, violence, and mental illness. Forty-three U.S. states, many countries and countless organizations have done their own ACE surveys, and the results are remarkably similar. (To calculate your ACE and resilience scores, go to: Got Your ACE/Resilience Score?)
Subsequent research links ACEs to Alzheimer’s, dementia, maternal ACEs and infant development, obesity in youth, gynecology patients with chronic pelvic pain….you name the disease or condition, and it’s likely to be exacerbated by ACEs.
By applying this rough, but insightful, way to assess the risk of childhood adversity, and based on the information in Mary Trump’s book, Donald Trump’s ACE score is a 6.
Trump’s father emotionally neglected his son when he was a baby and a toddler.
When Donald Trump was older, his father was emotionally abusive.
Trump’s mother emotionally neglected her son when he was a toddler, at a formative time for his brain development. In other words, he didn’t receive the positive experiences necessary for healthy development.
Trump watched his older brother be abused by his father for years.
Trump’s mother had mental health problems that seem to have gone undiagnosed and untreated for several years.
Trump’s parents were in a relationship that was emotionally neglectful.
Mary Trump chronicles the lives of three generations of Trumps in her book, and shows how trauma is passed from generation to generation. The Trump family considered their lives to be normal. They probably never gave a thought to how their behavior was shaped by what they experienced as children. When people—a few hundred thousand by now—with similar backgrounds have learned about ACEs science, a constant refrain is: “I didn’t know that what I experienced was abuse. I thought it was normal. This explains my life. Why did it take so long for me to hear about this?”
The participants in the ACE Study were 17,000 mostly white, middle- and upper-middle class, college-educated people with jobs and great health care. Looking at Donald Trump’s ACEs is a potent reminder that ACEs apply to people of all economic classes, something to which the ACEs movement and research hasn’t paid much attention lately because people of color and low economics bear the burden of ACEs.
We know that the phrase “hurt people hurt people” emerged from the understanding that most people who’ve committed violent crimes have high ACE scores.
However, hurt people hurt people on many levels, including enacting policies and laws that are just as harmful as interpersonal violence, and often more harmful because they affect hundreds or thousands or millions of people.
People with high ACE scores go in one of two general directions: They see the world as a place of suffering that needs healing, encourage people to work together to solve problems, and believe that the world works better without conflict than with it. Generally speaking, their positive childhood experiences have mitigated the adversity they experienced.
Or they see the world as a dark and dangerous place where carnage is rampant, problems are everywhere and are best solved by identifying and defeating enemies, building walls, and cutting off communication from people identified as “other.” And if enemies do not present themselves, they who see the world as a dangerous place will create enemies and make them larger than they really are, so that their “defeat” empowers them to find more enemies to conquer. Generally speaking, people in this group haven’t had enough protective factors in their lives, and thus favor punitive approaches to changing behavior, such as harsh prison sentences or zero-tolerance schools, even with ample evidence that they don’t work.
People who have high ACE scores and experienced few protective factors in their childhood can heal and change—ACEs aren’t destiny—but it often requires years of effort and constant reinforcement to at least ameliorate what’s been hard-wired into a baby’s brain. Mary Trump believes that her uncle Donald is very likely never to heal. She writes:
“Donald continues to exist in the dark space between the fear of indifference and the fear of failure that led to his brother’s [Fred’s] destruction. It took forty-two years for the destruction to be completed, but the foundations were laid early and played out before Donald’s eyes as he was experiencing his own trauma. The combination of those two things—what he witnessed and what he experienced—both isolated him and terrified him. The role that fear played in his childhood and the role it plays now can’t be overstated. And the fact that fear continues to be an overriding emotion for him speaks to the hell that must have existed inside the House [the Trump family home] six decades ago.
“Every time you hear Donald talking about how something is the greatest, the best, the biggest, the most tremendous (the implication being that he made them so), you have to remember that the man speaking is still, in essential ways, the same little boy who is desperately worried that he, like his older brother, is inadequate and that he, too, will be destroyed for his inadequacy.”
I don’t hate Donald Trump. I’m very sad for the things he experienced—no child should go through what happened to him. However, I hate many of the things he’s done. Authorizing ripping children out of the arms of their parents and separating them for months, years or forever, for example, sets me to writhing in helpless fury, and I wonder: Did the experience of having his mother ripped from his life so suddenly and for so long cause him such pain that it snuffed out the light of his empathy? Mary Trump thinks so.
For those of you who don’t like him, I’m not saying you have to feel sorry for him. I’m saying: You must understand him. You must understand him so that we don’t create more Donald Trumps in this world.
Jane Stevens Publisher, ACEsTooHigh.com Founder, PACEs Connection
I am a special educator for emotional/ behavior disorders. I do a lot of research on poverty and the ACE’s. I spend my time making connections and sometimes the only one believing in my students. I passionately continue my education and influence my colleagues on the importance of recognizing trauma. I am so disappointed this article was published in a forum I value and respect. President Trump has a resilience story. The poor choice to publish a politically charged article is a decision that is costing you members.
I read the book also. I was very happy to read someone who witnessed much of the abuse and dysfunction illustrating how $ can be used to paint what ever picture the possessor wishes. No matter How much $ a “family” has it can be used to make GMO people out of their children. I’ve known, felt and been saying this for decades. Most “families” just want their children to make $. It’s a very rare Family who actually raises their child to be Authentic. To be who they’re naturally meant to be THEN make $ being That. Is how I’ve been trying to live for decades with Not much luck. I never expected this country to be a SICK as it’s proven to be.
I felt it by the early 80s as I was getting older and had to “get a job”, after living with psych torture for nearly 2 decades, that my health was going One way and $ the other. I needed to focus on my health, recovery. Since I fought my abuser back for over 5 years at least,, I wasn’t like Donald, Freddy or the others,, but, I was criminalized for it and Everyone around Guilted me and made excuses For the Abuser ever since. But, I still had that part of me that was able to fight back, speak truth to “power” to hold onto that a lot of people don’t seem to have, they were indoctrinated like D.T.
I figured that if $ was real I should be able to follow the Health and the $ would follow. NOPE! I turned to Fitness because I KNEW that for anything to be Legit it needed to be aligned With Natural Law, physics, like an athlete scores a goal. It’s Clearly been the other way around even for people WITH a lot of money as it is for those “families” who don’t.
I will NEVER understand WHY so many people follow $ when it’s Clearly Illegitimate and the exact OPPOSITE of supporting health. Maybe if people realized that Health is More than just physical,, Emotional/Spiritual/Relationships,, we Might just get somewhere
I will never understand either and I guess I tend to think of things I don’t understand and spiritual questions. Why do people choose to follow a path of making the most money possible, instead of, say, becoming the most loving person they can be? That’s what you’re asking, right? I think that our work at ACEs Connection shows that childhood can be a sort of brainwashing, and that because Trump learned from his father, “your only value is as a real estate investor,” that’s what he spent his life pursuing, even though, as his numerous bankruptcies show, it’s not something that he had any sort of special talent in.
After reading Snowball, a biography about Warren Buffett, it seemed to me that pursuing money doesn’t always have evil intentions. As a kid, finding interesting ways to make money was a hobby of Buffett’s. The companies he would choose to invest in always had to make sense on paper for the long run–he was never interested in show or quick money. I don’t think billionaires need to exist in our society but he has shown to be someone who values investing in people and using his money to make the world a better place.
But back to the spiritual question…there seem to be ego callings that are false and its our work to sort them out as we grow.
I read the book also. I was very happy to read someone who witnessed much of the abuse and dysfunction illustrating how $ can be used to paint what ever picture the possessor wishes. No matter How much $ a “family” has it can be used to make GMO people out of their children. I’ve known, felt and been saying this for decades. Most “families” just want their children to make $. It’s a very rare Family who actually raises their child to be Authentic. To be who they’re naturally meant to be THEN make $ being That. Is how I’ve been trying to live for decades with Not much luck. I never expected this country to be a SICK as it’s proven to be.
I felt it by the early 80s as I was getting older and had to “get a job”, after living with psych torture for nearly 2 decades, that my health was going One way and $ the other. I needed to focus on my health, recovery. Since I fought my abuser back for over 5 years at least,, I wasn’t like Donald, Freddy or the others,, but, I was criminalized for it and Everyone around Guilted me and made excuses For the Abuser ever since. But, I still had that part of me that was able to fight back, speak truth to “power” to hold onto that a lot of people don’t seem to have, they were indoctrinated like D.T.
I figured that if $ was real I should be able to follow the Health and the $ would follow. NOPE! I turned to Fitness because I KNEW that for anything to be Legit it needed to be aligned With Natural Law, physics, like an athlete scores a goal. It’s Clearly been the other way around even for people WITH a lot of money as it is for those “families” who don’t.
I will NEVER understand WHY so many people follow $ when it’s Clearly Illegitimate and the exact OPPOSITE of supporting health. Maybe if people realized that Health is More than just physical,, Emotional/Spiritual/Relationships,, we Might just get somewhere
I think that the rules for discussing a private citizen and a powerful public figure who makes decisions that profoundly affect people’s lives is more than warranted. It is the responsibility to do so in any democracy. It is necessary to shine light on the powerful — regardless of their political party or beliefs — to better understand them, and when applicable to hold them accountable.
Jane StevensPublisher, ACEsTooHigh; founder, PACEs Connection
Thank you for your comment, Amy. And I’m sorry to see you go. The door is always open here.
FMFormer Member
Jane, you are using ACES Connection as a political platform. First I saw this article that had nothing to do with preventing ACES, healing trauma and building resilience: https://www.pacesconnection.com…s-washingtonpost-com. Now this article based on a book that was not written by the POTUS himself. Wouldn’t that be breaking a very important rule of trauma informed care? Not giving the person impacted by trauma some control, a voice for their own story? I imagine we will be seeing many, many more articles about the POTUS from you putting him in the light you choose as we are approaching 11/3/20. I will be unsubscribing.
Thanks for compiling this synopsis Jane. The more we realize the extent of pain experienced by the powerful and privileged who are making and implementing destructive policies, the faster we will reprioritize our societies. This is the focus of my work regarding ACEs. It’s not them, it’s us. And financial security or wealth, whiteness, education, or an intact family doesn’t protect most of us. That is the salient point of the original ACE Study that stands out most to me. Donald Trump is a symptom, of the pervasive problem of unresolved childhood trauma plaguing humanity from the echelons of power around the world. The blatant example we see every day of a pained human dissociated from his self, others, nature, and reality is my source of hope for our long awaited awakening to who we are as humans and our need to reset our priorities to meet our children’s needs to prevent creating any more broken men.
This is a slide from today’s ACEs Aware webinar. As you can see, interrupting intergenerational transmission is one the goals of screening for ACEs in medical practice. It’s not really about blaming, it’s about freeing people from passing these physical and mental health risks to future generations, none of whom deserve to be born into these ongoing processes. I’d like to acknowledge some other posts that have added the very important dimension of marginalized populations’ stressors, present, and historical, into the calculus. ACEs Aware was founded and supported by the California Surgeon General, Dr Burke Harris, who deserves effusive praise for her work on ACEs. Included in the today’s presentation was the epigenetic factors of trauma and how they affect every body system of those exposed.
Well written, thank you. Like a few others, I’m somewhat concerned by what I perceived as some “blame” directed toward Mr. Trump’s parents. In my view ACEs are an expression of “the biology of Karma”, and without detailed knowledge his parent’s early environments, and their parents, etc. it might be more useful to regret what he was exposed to and focus on “now what?”
I am placing my comments based on the years I spent as a PO addressing heinous crimes and tragically raised individuals who had little opportunity to address their lives and move toward developing positive change. The social part of the pre-sentence report addresses the upbringing and traumas of the criminal as well as those of their family. Regardless of their history, they received consequences that were often severe at times. The bottom line was that they faced consequences, irrespective of their ACES. Poverty and race were rarely seen as extenuating circumstances.
In all the years I worked, I can not tell you how rare it was to have a wealthy spoiled deviant person in front of me. They had the benefit of the expensive defense team against the State. I’ve read Mary Trump’s book and her warning is that Donald Trump was raised with the ability and skill to avoid consequences and surround himself with enablers. It was a warning as to how pervasive the depravity of the family and their enablers are/were. ACES is about identifying the issues where we as a society, can assist in programs and policies to facilitate positive change and understanding.
There is a fairly broad consensus that President Trump is suffering from mental health problems. I’m an a Green Party member, so I’m not trying to sway anyone’s towards VP Biden, who I serious reservations about also in the mental health area. This is one more example of a source concerning President Trump’s mental health.
“The Dangerous Case of Donald Trump is a 2017 book edited by Bandy X. Lee, a forensic psychiatrist, containing essays from 27 psychiatrists, psychologists, and other mental health professionals describing the “clear and present danger” that US President Donald Trump’s mental health poses to the “nation and individual well being.”
Although, the results of such upbringing can cause the end results, I do not think it is fair to use ACES Connection to target Donald Trump. What is Mary Trump getting out of this? ($$$$) Not comfortable with this article and seems to be more of a political platform. I will unsubscribe today.
Brilliant Jane. If only there were some professional gate keeping within professions (outside of mental health) that would allow us to intervene when a person’s personal trauma was causing them to become a danger to themselves and/or others. Cops, politicians, lawyers, cashiers, landscapers, servers…I mean really, we all need each other to help us see what we can’t see. I guess that’s why we need the trauma-informed revolution.
Excellent article! I have been both fascinated and repulsed by the idea of reading Mary Trump’s book. Reading this synopsis through a trauma-informed, ACEs lens, was powerful, informative and important. Thank you, Jane!
Hmmm…something does not sit well with me about this article. Many, myself included, have long felt that mainstream ACEs movement does not sufficiently address the intersections of race, class, geography and other socio-environmental factors. This article seems like an apologist stance for bad behavior, without taking into account the extreme privilege that paved the way for Trump to maintain class privilege and be elected president. The ACEs he experienced, while I’m sure traumatizing, should not be extricated from the race and class privilege he also experienced. This argument seems to parallel the narrative that gets played out in the media that white people who commit crimes (the Dylan Roof’s of the world) have mental health issues, when Black, Indigenous People of Color (BIPOC) folks get labeled as thugs. It glaringly leaves out the institutional and systemic racism that overwhelmingly bars BIPOC people from gaining wealth or political power and has no impact on white cisgender men who still hold disproportionate and harmful amounts of power. Honestly, it is further proof of our society’s horrifyingly entrenched white supremacy and I highly encourage you to re-think posting this article in its current form.
I agree with you completely, Molly. This essay strives to explain so that we can understand and change our systems, with the understanding that we are our systems. It’s definitely not an apology.
Jane, thank you for your fascinating article. A challenge I frequently come across in my practice as a primary care physician for adults, is how to effectively and respectfully get a person, who has certain maladaptive coping mechanisms, to see that their ways of coping are destructive. I wouldn’t expect Mr. Trump to hear Mary Trump’s assessment and respond by thanking her and asking how he can work on changing himself. Patient’s usually don’t come to me because they’ve identified their maladaptive coping as a problem, but instead focus on their headaches, insomnia, or other symptoms. When ACEs are a contributing cause to such symptoms, and we discuss ACEs science, some people have “a ha!” moments, and start on a path towards healing. However, a lot don’t see the connection, even when I’ve (gently) brought up the topic again.
I also want to comment that I appreciate the concern Anna expressed earlier, about all of us associated with ACEs Connection needing to not allow this forum to devolve into political bickering (my description, not Anna’s). However, I feel it’s appropriate to discuss Mr. Trump’s case here, as long as our goal is to advance the awareness and understanding of ACEs, as opposed to people expressing their negative feelings toward him. Many precedents have been set, in this forum, to discuss the childhood experiences of still living people (Darrell Hammond being a recent example). I realize that in most previous cases, it’s people sharing their own stories, while in this case, Mr. Trump is not doing the sharing. I believe we therefore, in a trauma-informed way, should be sensitive to the possibility the person who didn’t share their own story might have a different story to tell.
Hmmm…something does not sit well with me about this article. Many, myself included, have long felt that mainstream ACEs movement does not sufficiently address the intersections of race, class, geography and other socio-environmental factors. This article seems like an apologist stance for bad behavior, without taking into account the extreme privilege that paved the way for Trump to maintain class privilege and be elected president. The ACEs he experienced, while I’m sure traumatizing, should not be extricated from the race and class privilege he also experienced. This argument seems to parallel the narrative that gets played out in the media that white people who commit crimes (the Dylan Roof’s of the world) have mental health issues, when Black, Indigenous People of Color (BIPOC) folks get labeled as thugs. It glaringly leaves out the institutional and systemic racism that overwhelmingly bars BIPOC people from gaining wealth or political power and has no impact on white cisgender men who still hold disproportionate and harmful amounts of power. Honestly, it is further proof of our society’s horrifyingly entrenched white supremacy and I highly encourage you to re-think posting this article in its current form.
Counting ACEs = essentially a rough sorting-hat for being raised in a dysfunctional family/ by dysfunctional adults. Functional healthy families have fewer ACE-level events (though something like the death of a parent can strike even a very wholesome home).
Donald had a huge multitude of “baby ACEs” or “shadow ACEs” as I call them. You can be rich, fed, never hit, ‘privileged’ — but if your own parents do not *connect* with you, it is much worse than an isolated horrible event like a divorce. Being neglected profoundly is orders of magnitude worse than your attentive, loving parents getting a divorce. For you have no resources to deal with anything bad that happens.
Nobody TOOK PLEASURE in baby Donald. Nobody interpenetrated with him. Nobody was his safe place, his place of refuge. Nobody modeled a safe and interested, caring “other.” All the experiences by which human beings learn to attach and self-regulate were robbed from him.
When you never receive secure attachment as a baby, that’s the worst ACE that can exist. A securely attached human being can withstand something like a parental divorce in a VERY different way than a person without that ballast of relational security. A securely attached person has internalized their own worth.
I see the child separation at the border as a kind of sick theatre of DJT’s past. Being ripped away from his mother (the mom as ‘criminal’) as a kind of large scale re-enactment.
Ever since 2016 I have observed and wondered about Trump and ACEs, and have occasionally shared my view with others. My ACEs perspective is one of understanding behavior, not as an excuse for behavior.
Dearest Jane, You are a stunningly powerful and gifted writer. Thank you for continuing to use your gifts in such a profound way. I continue to be thunderously grateful.
I’m reading this book now. As an infant mental health therapist I continue to wonder: what happened to Fred Trump in his early childhood? Or Mary? How did they become the parents they were to the Trump children? How far back do we go?
Yes Karen, as a psychologist with an interest in transgenerational transmission of symptoms, I’ve wondered about our president’s family history and reflect on the concept of “undifferentiated ego mass.”
I have Mary’s book and have to admit, I haven’t read it yet. I know about the existence of the Goldwater rule concerning not diagnosing those we have not interviewed or tested. That being said, his niece does have insider, collateral information and is a professional herself. I don’t think you need years of training as a clinician to spot something is very wrong with our president at a time in which we need leadership the most. His lack of empathy and self-referented style is apparent. Thank you posting this. He is definitely a tragic man (from Kohut) and even more tragic, is imbued with power that affects us all.
Excellent article. Thank you for sharing. I have wondered many times what Trump’s childhood must have been like to produce what we see today. I also think the media played a lot into what he is today. The adoration by them in the early 90s gave him the attention he so desperately craved and fueled his narcissism that had taken root in childhood as a defense mechanism.
I’m reading this book now. As an infant mental health therapist I continue to wonder: what happened to Fred Trump in his early childhood? Or Mary? How did they become the parents they were to the Trump children? How far back do we go?
Im going to say it: I’m really uncomfortable with this, that this movement and this platform have become so political that it’s now OK to pathologize the private details of a living person’s childhood — details they did not themselves choose to disclose and in fact fought to stop (and that may not even be true).
An adult’s public actions may be fair game, but it is most definitely NOT fair to use a person’s childhood in order to diagnose them, read their mind, or make damning claims that because of trauma, they can “never heal,” they can’t feel empathy, they are destined to be a “small time crook in Jail” (unless wealthy) or that people like them should not be “created.” These kinds of statements are uncomfortably familiar from other times when “science” was used to label and marginalize others.
I hope ACEs Connection will be extra careful never to “weaponize” ACEs science against anyone, whether you like their policies or not.
This is why parenting education must be a part of the solution. Not conventional parenting education, but a new kind…one that reaches everyone, everywhere, all the time.
The Centers for Disease Control, the American Academy of Pediatrics, the National Alliance on Mental Illness, and the National Institute of Mental Health should be working furiously on this new kind of parenting education. Perhaps parenting education campaigns akin to the smoking and seat belts campaigns of the past. Perhaps multi-media messaging that teaches parenting behaviors and practices generally recognized as supporting the healthy development of children.
Visit www.advancingparenting.org. Use a computer…our website is not optimized for phones. We are all about finding interesting and perhaps more effective ways of teaching everyone about parenting.
After more than two years of a deadly pandemic, a racial reckoning laying bare gross inequities, historic environmental catastrophes, and record-breaking gun violence and mental health challenges, could the first known national study of “What Happened to You?,” by Bruce D. Perry and Oprah Winfrey, help us heal our collective trauma, one relationship and community at a time?
That’s the question Carey Sipp, PACEs Connection director of strategic partnerships, hopes will be answered with a resounding “yes” in the months and years following the July 13 launch of our Connecting Communities One Book at a Time reading initiative.
“I believe ‘What Happened to You?,’ a New York Times bestseller, is one of the most important works ever written on our collective public health crisis of trauma,” Sipp said. “This book is a readable and relatable way to learn about trauma, its enormous impact in human suffering, loss of life and promise, economic costs and more. Whether you read it or listen to Perry and Oprah have the conversations, which I recommend, this book makes the science easy to understand. It is full of stunning insights, remarkable stories, and applicable solutions.
“Our hope is that asking ‘What happened?’ in community will lead to truth, empathy, compassion, connection. We hope that reading and studying the book together can help people process current and generational experiences, and learn about the science of PACEs – positive and adverse childhood experiences – and that this will lead to family and community efforts to prevent future trauma, and heal from past trauma,” she said.
Sipp said the PACEs Connection initiative was inspired by the Georgia Reads “What Happened to You?” program, in which over 40 community book clubs, including the Georgia Parent Advisory Council group, met to discuss the book in 2021.
“I learned about the success of the Georgia program, started by Deborah Chosewood and Jennifer Lee Stein, in a LinkedIn post from Deborah, who is also a community manager for Georgia PACEs Connection. She explained that the PAC book club used a multi-session guide for parents developed by the Children’s Trust Fund Alliance and now promoted by Perry, while the Georgia Reads book clubs used a one- or two-session discussion guide developed by Georgia Essentials for Childhood. Both guides will be highlighted and shared – at no cost – in our July 13 webinar, when we officially launch the book study and begin registering book study leaders,” Sipp said.
As a part of her work at PACEs Connection, Sipp leads the launch of the Connecting Communities One Book at a Time initiative with me, Natalie Audage, the PACEs Connection family and community resources lead. Our partners for this project include Teresa Rafael, Chloe Corrion, Kara Georgi, and Maureen Hollacker of the Children’s Trust Fund Alliance, and Deborah Chosewood and Jennifer Lee Stein of Georgia Essentials for Childhood.
“Our partners have been incredible in offering their time, the guides they created, and their experience to help lay out a series of events, including two support sessions for book study leaders and a follow-up session on protective factors, that we believe will help make this entire effort have a lasting impact in communities,” Sipp said. “We are hoping new PACEs Connection communities will form as the result of the study, and study leaders and participants will connect and become involved with some of our more than 400 geographic and 40 interest-based communities.”
Perry’s reflections on the national book study
Perry said he finds the national book study a very exciting opportunity. “I don’t think that there has been anything like the scale and scope of what you have planned,” he said.
“Certainly, the impact of stress, distress and trauma has been all over the news recently, and, over the last two years of the COVID-19 pandemic, people have experienced the dysregulating impact of unpredictability, relational disconnection, chronic vigilance, decision fatigue and, for some, serious traumatic loss,” Perry said. “So in some ways, the time is right to better understand and address these issues.
“In reality, however, all of human history has been characterized – and shaped – by traumatic events of all sorts, natural disasters, war, misogyny, racism, and so much more. But, as Maya Angelou said, ’I did then what I knew how to do. Now that I know better, I do better.’ So let’s help people know better so we can all do better.”
He added that he hopes the book study ”helps stimulate a bit more curiosity and kindness, which will lead to more conversation and connection.”
Our partners hope their groups will join in
Chloe Corrion came up with the idea of creating a detailed chapter-by-chapter study guide of the book. “As Dr. Perry, says, ‘Healing happens in community’,” she said. “I’m so excited for this work to continue spreading so that more individuals and communities can begin or continue their healing journeys.”
“This book club is about building relationships while learning, growing and healing with others as we celebrate the effect protective factors can have on our lives,” said Kara Georgi, Corrion’s partner on the guide and co-facilitator of the Georgia Parent Advisory Committee book study. “It’s not about a single journey or solution. It is about us all being able to approach a great piece of science and personal narrative where we are at. We can then decide what intention we will take as we move forward in our lives and communities in strength-based ways.”
Join us!
Register now to attend the upcoming “What Happened to You?” events. Please see the attached flier for more information about each event.
Meet the Author: a discussion of historical trauma in America with Bruce Perry, PACEs Connection CEO Ingrid Cockhren, and director of communities Mathew Portell on Tuesday, June 28, 1:30-3 p.m. ET
We hope you will join us on this journey, and we look forward to seeing you at the upcoming events!
In the meantime, stay tuned for future blog posts from PACEs Connection about our Historical Trauma in America series, and from our partners about the impact of Georgia Reads, the compelling story behind the Children’s Trust Fund Alliance guide, and more.
PACEs Connection is thrilled to share that our first-ever Connecting Communities One Book at a Time initiative involved thousands of people; scores of book studies! The PACEs Connection’s Connecting Communities One Book at a Time initiative helps people bring their community together around books that help us have critical conversations about trauma, racism, inequity, protective factors, positive childhood experiences, and the role community plays in preventing and healing trauma and creating resiliency.
Our first book was What Happened to You? by Bruce D. Perry, MD PhD, and Oprah Winfrey. We’re excited to report that a total of 4,454 people registered for at least one of the six What Happened to You? book study events, and 136 people signed up to lead book studies in their communities.
Together with our partners, we hosted six book study events:
Meet the Author: a discussion of historical trauma in America with Bruce Perry, PACEs Connection CEO Ingrid Cockhren, and director of communities Mathew Portell on June 28
Lead Your Own What Happened to You? Book Study on July 13
Book Study Leader Training by Children’s Trust Fund Alliance on July 27
Book Study Leader Check-In with Children’s Trust Fund Alliance on Aug. 10
Moving Families from Surviving to Thriving: Strengthening Families Protective Factors Framework Overview by Children’s Trust Fund Alliance on Aug. 30
Book Study Leader Check-In with Children’s Trust Fund Alliance on Sept. 20
As we wrap up our efforts, we want to share some next steps:
2. It’s not too late to host a What Happened to You? book study in your community! You can still learn from all of the recordings and resources below and register to lead your own book study!
PastWhat Happened to You?events
Meet the Author event recording: On June 28, PACEs Connection CEO Ingrid Cockhren, director of communities Mathew Portell, and Dr. Bruce Perry, co-author of What Happened to You?, met to discuss historical trauma and What Happened to You?
If you are already involved in our book study initiative, we look forward to seeing you at our next event on October 12! If you are not, we invite you to join us as we work to Connect Communities One Book at a Time!
The book, published on September 13, 2022, was the focus of a conversation between the author, Donna Jackson Nakazawa, and Carey Sipp, PACEs Connection director of strategic partnerships, on October 12, 2022.
As Nakazawa writes in the introduction of her book, “Depression has long been more prevalent in girls than in boys, but rates of depression in girls have now reached epidemic proportions. One in four adolescent girls reports suffering from symptoms of major depression compared with fewer than one in ten boys. Girls and young women are twice as likely as boys to suffer from anxiety. In 2021, the Centers for Disease Control and Prevention reported that suicide attempts had recently increased 51 percent among girls compared with 4 percent among boys. These statistics cannot be explained by higher rates of awareness or diagnosis. They are real, and they are scary to every parent of every daughter and to anyone who cares about young women.”
She writes further, “In many ways I wrote this book because I felt a moral imperative to close the gap between what experts have learned about growing strong girls in an increasingly threat-laden ear and what parents need to know.”
“PACE’s Connection’s Connecting Communities One Book at a Time initiative was created to bring communities together around books that help us have critical conversations about trauma, racism, inequity, positive and adverse childhood experiences, and the role community plays in preventing and healing trauma and creating resiliency,” said Sipp. “The mental health of our young people is a concern in every community in the world right now. We believed this book could bring communities together to address a particularly frightening trend involving the increase in depression and anxiety in girls,” she added.
The conversation between Nakazawa and Sipp covered myriad topics, including the effects of unmitigated stress on the female brain, epigenetics, the complex interactions between estrogen and the female brain during adolescent development, sexism, the evolutionary mismatch between girls’ sensitivity to social cues and today’s social media culture, and the finding that the stress response can be decreased by talking to one trusted caregiver.
Nakazawa was clear that while she sees much to worry about girls’ mental health today, she also has hope. She offers 15 antidotes or “strategies for raising emotionally healthy girls” in the book and spoke about a few of them in the webinar.
Antidotes fall into three categories and include three on “the building blocks of good parent-child connection, and the importance of family connection,” six antidotes for “making her home a safe space,” and six antidotes to “bring in what the wider community can provide.” The interview honed in on at least one antidote from each of the three categories, including making it a good experience when your daughter turns to you, the importance of “wonder”, and encouraging a sense of mastery.
“We need to spread Nakazawa’s research and her message of hope. There is so much we can do to improve the mental health of the girls in our lives” said one participant. Another attendee wrote: “Thank you Donna! You’ve changed my life for the better—and I’ve shared your message with many, MANY others…”
“PACEs Connection encourages our members to come together in their communities of friends, colleagues, family members, and fellow parents to start a book study of Girls on the Brink,” said Sipp.”Book studies are terrific ways for communities to address challenges while building the relationships that can help reinforce solutions. We’d love to see many, many communities come together to share Donna’s work and help girls thrive, and have created tools to make this easy for our members to invite their friends, family members, others in their resiliency initiatives, parents of their daughters’ schoolmates, or other groups, to start a book club.”
Here are some resources to help members start their own book studies:
“Please join us as we work to Connect Communities One Book at a Time. By reading the book with a group of friends in your book study of Girls on the Brink, you can be part of the solution. All of us can play a part in supporting girls’ mental health,” said Sipp.
“We are thrilled to deliver study guides, support, and a connecting place for our members to come together, learn from the authors, share and learn from each other. We’ve even created an invitation leaders can use to invite members of the community to join their book study, to make it as easy as possible for them to get started,” said Sipp.
“We’d love to see this grow and bring unique books and opportunities to our more than 430 geographic and 40 interest-based communities, and hope they’ll use the book studies as ways to grow their communities, too!” she added.
Sipp encourages book study leaders to please register their book study with PACEs Connection, and to answer a few questions to help in planning for the next study. “Also, as we, learn about new resources that could become available in the “Girls on the Brink” book study, having this information helps us share news with book study leaders,” said Sipp.
There remains platitudinous lip-service by society in genera, including police services, when it comes to proactive mental illness prevention as well as treatment. Various mainstream news and social media will state the obvious, that society must open up its collective minds and common dialogue when it comes to far more progressively addressing the challenge of more fruitfully treating and preventing such illness in general.
But they will typically fail to address the problem of ill men, or even boys, refusing to open up and/or ask for help due to their fear of being perceived by peers, etcetera, as weak/non-masculine. The social ramifications exist all around us; indeed, it is endured, however silently, by males of/with whom we are aware/familiar or to whom so many of us are closely related.
Even today, there remains a mentality, albeit perhaps a subconscious one: Men can take care of themselves, and boys often are basically little men.
Even Ms. Jackson Nakazawa’s own book, Childhood Disrupted, was only able to include one man among its six interviewed adult subjects, there presumably being such a small pool of ACE-traumatized men willing to formally tell his own story of childhood abuse.
One must ask: Is it yet more (in a societal pile of) evidence of a continuing subtle societal take-it-like-a-man mindset, one in which so many men will choose to abstain from ‘complaining’ about their torturous youth, as that is what ‘real men’ do?
One also sees some of that mentality reflected in, for example, a New York Times feature story (“She Was a Big Hit on TikTok. Then a Fan Showed Up With a Gun”, February 19, 2022). Written by Times reporter Elizabeth Williamson, the piece at one point states that “Instagram, owned by Meta, formerly known as Facebook, has … been accused of causing mental and emotional health problems among teenage female users.”
The fact is, mental and emotional — along with physical — health problems are being suffered by teenage boys directly due to social media use. Revelatory of the latter is the increasing incidence of social-media-focused obsession among boys with gaining significant muscle mass, a.k.a. “bigorexia”.
The author of The Highly Sensitive Man (2019, Tom Falkenstein, Ch.1) writes that There are “numerous psychological studies over the last forty years that tell us that, despite huge social change, the stereotypical image of the ‘strong man’ is still firmly with us at all ages, in all ethnic groups, and among all socio-economic backgrounds. In the face of problems, men tend not to seek out emotional or professional help from other people. They use, more often than women, alcohol or drugs to numb unpleasant feelings and, in crises, tend to try to deal with things on their own, instead of searching out closeness or help from others.
“While it is true that a higher percentage of women than men will be diagnosed with an anxiety disorder or a depressive episode, the suicide rate among men is much higher. In the United States, the suicide rate is notably higher in men than in women. According to data from the Centers for Disease Control and Prevention, men account for 77 percent of the forty-five thousand people who kill themselves every year in the United States.
“In fact, men commit suicide more than women everywhere in the world. Men are more likely to suffer from addiction, and when men discuss depressive symptoms with their doctor, they are less likely than women to be diagnosed with depression and consequently don’t receive adequate therapeutic and pharmacological treatment.”
While it’s important that the notable needs of girls’ mental health get properly addressed, society also needs to do more for its males.
Carey Sipp 