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What I learned about ACEs on my Star Trek-like Sabbatical in Seattle

 

My Star Trek-like existence has ended. I returned recently to my home base of Santa Fe after a fascinating year sabbatical in Seattle. I was introduced to a very wealthy and wired city where most residents truly believe that there’s an app for everything. Not only could one beam in food, clothes and uber-like transport, but personal trainers/home chefs, massage therapists/house cleaners, existential therapists, counselors with specialties in seasonal affective disorder and socially-engaged start-up experts.

Of course, if one leaves tech-infused Seattle, you can find yourself in a county where a third of the households have incomes near the federal poverty level. It’s really another world in rural Washington, that exists only a few miles from the Space Needle.  

Whether urban or rural, a quarter of Washington's population have endured (or will endure) three or more adverse childhood experiences (ACEs), which means living in households where adults misuse substances, are threatening or violent, have untreated mental health challenges, are abusive and neglectful, are dissolving marriages or are incarcerated. The vast majority of ACEs fly under the radar of child welfare yet they carry high emotional costs, diminishing a person's ability to learn, work and establish healthy relationships.

One would think that a state with such a tech-empowered city (the home of thousands of philanthropists from the software industry), would be focusing their data-driven expertise and resources on eradicating childhood trauma the way they did landlines.

As I bask in the sun of Santa Fe, allow me to pause and offer an excerpt from our book, Anna, Age Eight, Chapter Eight: There's an app for that (maybe): Healthy kids and the promises and perils of technology.

We shouldn’t hold our breath that technology will solve our epidemic of childhood trauma and maltreatment for the simple reason that there is not currently a well-functioning system to digitize and make faster. All our cities have huge gaps in services, including trauma-informed behavioral health care. This means that a quarter of the population may live with untreated emotional trauma due to various forms of childhood neglect and abuse.

There’s no app for that problem yet.

The prescription instead calls for systematic change – things like getting home visiting nurses into the homes of all newborn babies, universal preschool, and a big brother or big sister for all kids who need one. It calls for all politicians to take time to understand the emotional and financial costs of trauma (and give a damn), where they might not have before, and for their constituents to make them give a damn and mobilize. And it calls for several government departments to act as though the enlightenment happened and they’re on board with it. It means city government leaders agree to collaborate with county government leaders to ensure services like safe housing, transport, health clinics and job training.

These are not things that can be packaged into an app, even if there was some obvious profit motive to be found. Present someone with the option to do something easier and cheaper from the comfort of home and without making any phone calls, and they’ll do it, which is why Craigslist is a hit.

But preventing and treating adverse childhood experiences, trauma and maltreatment will take money we’d rather not spend, time we’d rather not devote, and a campaign to change minds that would rather not change. It’s like the difference between being offered a delicious dessert and being asked to cook an elaborate four-course meal from scratch. There is not as of yet a good app to make sure every baby gets a good start in life. That will take political pressure, a willingness to get out there and change hearts and minds in a saturated media landscape, and the ability to say yes to being a youth mentor.

So, by all means, use every piece of cool technology at your disposal. It may well make your life and work a little easier, but it won’t negate the need for elbow grease. The tech companies make everything look so smooth and efficient, but that’s because next to preventing and treating childhood trauma, their job is easy.

 

About a community conversation on Child Welfare 2.0: The authors of Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment, Katherine Ortega Courtney, PhD and Dominic Cappello, discuss their book focused on how we must and can fix child welfare—a monumental challenge that requires the engagement of all of us. Thursday, July 26, 2018 10:00 AM - 12:00 PM, Santa Fe Community Foundation. Fees: FREE. For more information and to reserve a seat: https://www.santafecf.org/what...mp;cdt=7%2f26%2f2018

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Hi, Dominic: Actually, Washington State was, for a time, a leader in integrating practices based on ACEs science. From 1994 to 2012, Washington State supported use of the Self-Healing Community Model in 42 communities.

Communities using the SHCM for eight or more years reduced the rates of seven major social problems: child abuse and neglect, family violence, youth violence, youth substance abuse, dropping out of school, teen pregnancy and youth suicide. Communities with consistently high index scores improved five or more separate problem rates concurrently. Per-year avoided caseload costs in child welfare, juvenile justice and public medical costs associated with births to teen mothers were calculated to be over $601 million, an average of $120 million per year, for a public investment of $3.4 million per year.

Over 10 to 15 years in Cowlitz Co., Wash.:

Births to teen mothers went down 62% and infant mortality went down 43%;

Youth suicide and suicide attempts went down 98%;

Youth arrests for violent crime dropped 53%;

High school dropout rates decreased by 47%;  

Similar results were seen in other counties.

The self-healing community model is one of a handful around the U.S. that are integrating ACEs knowledge. Common to all is the understanding that no one sector can do this alone. It has to be all of us, educating our organizations so that they can integrate trauma-informed and resilience-building practices, as well as our communities.

Our best guess is that between 200 and 500 communities are or have launched some type of ACEs initiative. 

We think that between 1200 and 1500 pediatricians have or are starting to integrate ACEs science in their clinics. 

HUNDREDS OF U.S. SCHOOLS are integrating trauma-informed, resilience-building practices based on ACEs science. 

Probably several hundred physicians in the U.S are integrating ACEs science

Attached are an overview of the SHCM model, and a longer examination.

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