Turning Gold into Lead: Understanding the Role of ACEs to Our Work as Judges

 

Judge Lynn Tepper and a courtroom therapy dog.
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[Editor's note: Judge Lynn Tepper, 6th Judicial Circuit, Florida, wrote this for a newsletter published by the Florida Office of the State Courts Administrator, Office of Court Improvement, and kindly agreed to cross-post it to ACEs Connection. ]

"How do we go from a newborn with its extraordinary potential to the man lying on the street whom we overlook? The answer relates directly and in unexpected ways to difficult problems of medical practice, social functioning, institutionalization, addiction, and public health. The ACE Study is about what we learned exploring the ORIGINS of those problems, and how we came to see that the perceived problem is often someone’s attempted solution to problems about which we keep ourselves unaware."

So began Dr. Vincent Felitti’s plenary presentation at the Annual Education Program of the Florida Conference of Circuit Judges: “The Repressed Role of Adverse Childhood Experiences in Addiction, Disease, and Premature Death: Turning gold into lead." (Click here  to see his presentation and his PowerPoint.) Those “problems” and “attempted solutions” fill the divisions of courts and inter-related systems. The original 1998 Adverse Childhood Experiences (ACEs) Study, of which Dr. Felitti, was co-principal investigator with Dr. Robert Anda, of the Centers for Disease Control (CDC), revealed an extraordinary, unexpected relationship between our emotional experiences as children and our physical and mental health as adults. The ACE Study revealed that humans figuratively turn the "gold” of the potential of a newborn into "lead” by converting the childhood traumatic emotional experiences into disease later in life.

During his presentation, Dr. Felitti explained, “Adverse childhood experiences are the main cause of health risk behaviors, and hence of disease, disability, premature death, and healthcare costs. People with an ACE score 6 or higher have a life expectancy almost 20 years shorter than an ACE Score 0.”

What we learned from this presentation as individuals may be revealing to us. In fact, each judge in attendance had the opportunity to complete the 10- question ACE questionnaire electronically and anonymously. As you can see in the table below, none of the responding judges had an ACE Score of 0, and in three of the categories, the judges had higher scores than the respondents from the original study.

CATEGORIES OF ADVERSE CHILDHOOD EXPERIENCES

Abuse, by Category

Original Study

Judges

    Psychological (by parents)

11%

15%

    Physical (by parents)

28%

17%

    Sexual (anyone)

22%

12%

   

Neglect, by Category

Original Study

Judges

    Emotional

15%

12%

    Physical

10%

6%

 

Household Dysfunction, by Category

Original Study

Judges

     Alcoholism or drug use in home

27%

22%

     Loss of biological parent
     <18         

23%

32%

     Depression or mental illness
     in home

17%

24%

     Mother treated violently

13%

9%

     Imprisoned household member

5%

3%


These scores and the reality that the professional lives of the judges reflect extraordinary accomplishment certainly would be “gold” and not “lead”, despite the childhood traumatic emotional experiences. Key to understanding that outcome are the responses to the two “buffering relationships” questions, which were not part of the original ACE Study, but were administered to circuit judges prior to them attending the conference. One of the insights from the ACE Study was a “primary prevention” approach. Having “buffering relationships" is one of those “primary prevention” approaches that builds resiliency so that the “extraordinary potential” of a newborn is realized, not lost. As the table below illustrates, most of the judges who responded to these questions had strong buffering relationships that mitigated the impact of their ACEs.

Question

Definitely True

Probably  True

Not Sure

Probably Not True

Definitely Not True

When I was a child I had a supportive home environment.

70% or 162

18% or 41

4% or 9

4% or 10

4% or 9

When I was a child I had stable, responsive, supportive & caring relationships with adults & caregivers.

75% or 166

18% or 41

2% or 4

2% or 5

3% or 6

 
As judges, what we learned might lead us to an understanding of what lies beneath the behaviors we see in court by litigants, and the risky behaviors that lead parties and defendants into our courts, our jails, our detention centers, and our local mental health and substance abuse facilities. Our take-away? The health risk behaviors linked to ACEs may be viewed by the public and health field as a problem, but may be viewed by a patient, defendant, delinquent, dependent party, and litigant as a solution. That view has a lot to do with why certain problems are so difficult to treat. As Dr. Felitti pointed out, “We’re not treating the problem; we’re attempting to treat someone’s solution.” This has major relevance to treating all addictions and the vast disruptive, chronic, seemingly unresponsive behaviors that cross our thresholds every day. Summarized succinctly by my colleague in the 6thcircuit, Judge Linda Babb, “We have been treating the symptoms” and not looking at the adversity in which that individual spent their childhood.

Ajudge2
(l to r) Judge Lynn Tepper, Dr. Vincent Felitti, Dr. Mimi Graham, director of the Florida State University Center for Prevention and Policy.

At the conference, Judge Scott Bernstein (11thcircuit), Chief Judge Jonathan Sjostrom (2ndcircuit), Judge Alicia Latimore (9thcircuit), and I briefly shared our experiences regarding individuals impacted by ACEs in virtually every division of the court and the benefits of being trauma-informed and developing a trauma-informed courthouse and community partners.

Over 75% of the judges who responded to the post-test that was administered believed they may have missed telltale signs of ACEs or trauma in the past; 75% think they might handle “disruptive” parties more effectively moving forward; and 77% think there are things they can change in their courthouse or courtroom as a result of what they learned from Dr. Felitti’s presentation. Ideally, our judicial response will include:

  • how we handle and respond to litigants, defendants, and all who appear before us;
  • what sentences and dispositions we may impose;
  • what types of assessments we may order;
  • which bench guides and tools we may utilize to determine “What happened to this person?” instead of “What did this person do wrong?”; and
  • embracing the “Big Ten” found within the Family Court Tool Kit: Trauma and Child Development and the constantly updated array of resources and interactive materials on the Florida Courts website.

Dr. Felitti studied the connection between ACEs and health. Unexpectedly, he uncovered for the courts and our community partners a path past our litigants’ “past.” By applying science to what we do every day and responding appropriately to ACEs, we have a chance to change the trajectory of each life we touch. We have an opportunity to change the world if we see it through a trauma lens.

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Thank you, Judge Tepper,

I'm so excited to see this, I'm at a loss for words, but my heart is for action. I left Law Enforcement 5 years before retirement to train the Justice System. I train the Trauma Response for the Justice System, Trauma Informed Victim Interview (TIVI) and how to investigate Domestic Violence and Sexual Assault through the trauma lens. I have just recently begun to tie in the ACE's into my training. Trying to build empathy into the officers. 

I have made mistakes in my career. I have booked the victims of a DV into jail. I didn't know what I didn't know. The guilt sucks. Thank goodness for EMDR and great therapists. I am not one. I'm a cop. Sometimes you need a cop to train cops. Our MDT recently conducted a small study on the TIVI in adult sex crime prosecutions. We went from a 6% prosecution rate to 24%!! With 97% of our survivors giving positive feedback. 

Now to tie ACE's into the work. 

If anybody wants to chat about this please let me know. 

Peace!!

Justin

 

Thank you Judge Tepper.

It is wonderful to know there is a trauma champion among judges in the Florida criminal justice system.  Are there ways to more widely share your powerful post with judges and others who work in your system and beyond? My plan is to share it locally with officers of the court I know, some lawyers, as well as staff who work in the behavioral health system as I do. 

There are so many adolescents and young adults currently incarcerated or on probation because of what they managed to do (as you point out) to survive abuse and household dysfunction as well as other difficult factors in their childhoods and then what they did to manage the lifelong impact of these adverse experiences. So many of these young people are in fact constantly re-traumatized by their incarceration or probation/parole experiences. Not only are they unable to have help with their healing and recovery, they are exiting the system (if they can) with worsening and more intense trauma issues than when they entered.

As we now know, the costs to the community is in the many billions of dollars and the impact on the young people as well as the community is incalculable.

 

 

Judge Tepper -

This is so brilliant. So human and real. I have often wondered how the heck judges can do what it is they do; how they can, in a second, change someone's life so drastically. The sad thing is that so often the drastic change is for the worse, because in most places, there is no drastic change for the better. BUT Florida has its bright, bright spots! Not treating a child in the sex trade as a perpetrator when she is soliciting to keep herself and her child alive, but seeing her as a victim; working to help keep families together by providing supports families need instead of punishing and separating those truly delicate of human structures: new families born with all manner of pressures and fears; unknowns and "knowns-that-didn't-work-then-but-are-all-we-know." I love that you wanted to see where the judges were coming from, and compare their respective and collective childhoods to what's experienced by the general population as shown in the study. That kind of applied curiosity, coupled with the emphasis on the fact that what people do that gets them into trouble is what they view as their solution (the "relief" from the strains of life  that one physician calls "ritualized comfort seeking" is what most of us call addiction; many of us saying it with disdain.) 

Thank you for your thoughtfulness, thinking outside the (judges') box, and willingness to write and share this evocative piece. I will be sharing it with a law professor or two as well as a couple of judges, one who is a longtime friend.

This ability to "seek first to understand" might really slow down the judicial process. With caseloads and demands for swift justice on you and your colleagues, taking a look at cases through a trauma informed lens probably does not clear the docket more quickly. But it does get to the heart of what we as humans are called to do, the old "judge not lest you be judged" and to condemn someone without having walked a mile in his or her moccasins.  I am also called to remember another big personal aspiration, which is to ever avoid 
"contempt prior to investigation." Though I believe that line could be re-written to just avoid contempt altogether, yes? Isn't it likely that most folks who come before a judge are already chock-full of self-contempt, and again, their "solution" to deal with those overwhelming feelings of self-loathing is what society sees as the "problem." For the little kid who is out of the loop with parents who are part of the court system, it must be so traumatizing. How wonderful to go into your courtroom where there are dogs for comfort. Where there is comfort and not straight-up condemnation. 

Thank you to you, Mimi Graham, your colleagues who participated in the surveys. There is so much great work going on in Florida. You all are leading the way and it is a joy to witness it. I can only imagine the difference in outcomes a generation from now, when the babies who could have been the men lying in the streets are in fact in helping professions, passing on what's been shared to prevent trauma, heal trauma, build resilience. THIS is a cycle that breaks the almost inevitable cycle of addiction and abuse. 

Thank you for sharing the wisdom and insights from Dr Felitti’s presentation. His work started a revolution that changes how we view individuals and difficult behaviors. Using a ”trauma-informed” lens within the judicial system has the potential to really prevent and heal childhood traumas. Thank you, Judge Tepper for being a leader in this area! Karen 

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