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September 12, 2012

Addressing Trauma in School Districts

Lincoln Alternative High School, in Walla Walla, Washington, and Brockton Public Schools in Brockton, MA has innovated in bringing a new discipline process forward that deals with children on a different level. Their process now accounts for children living with trauma. The process does not do away with accountability or responsibility. Instead, it accounts for trauma as a mediator for the negative behavior (notice now I didn’t call it bad behavior?) Washington State has identified an average of 13 students in every classroom of 30 kids who are impacted by 3 or more Adverse Childhood Experiences. At Lincoln, suspensions have dropped by 85%. Teachers and administrators are being trained in a different method of responding to problems with students. Instead of asking why are you bad, they ask what is happening to you. You can read the story here. Here is Washington State’s graphic on the prevalence of ACE’s among their student population.

As a sharing individual with significant contacts, I offered this same information to the President of the Anchorage School District and the Superintendent. I get the same political response I always seem to get. The President acknowledged the receipt of the information, but was too busy to read it yet. The Superintendent assigned the information to their head nurse. I also shared it with the President of the School Board association. No response at all, but I don’t know her so I understand. She probably thinks I am a crackpot who doesn’t know what he’s talking about.

I did have success with the Juneau Douglas School District. I have a friend who works there and understands my Adverse Childhood Experience mission. They are looking at the information and wanting to learn more about this discipline process.

By the way, here is an outstanding addition to any teaching library, and it is free. It’s called Helping Traumatized Children Learn by Massachusetts Advocates for Children: Trauma and Learning Policy Initiative.

Toxic Stress

August 22, 2012

I will be blogging somewhat more frequently about Chugachmiut’s Restoration to Health (RtH) initiative now as we move to implement the board’s strategy. It is important that the knowledge behind the strategy is disseminated more widely. This first blog is about the impact of Toxic Stress on the human brain. I want to share the documents that helped us develop our RtH initiative.

The Adverse Childhood Experience (ACE) Study provides valuable knowledge about the link between what happens to a child who grows up with trauma as they are raised and both their adoption of coping behaviors to deal with the stress accompanying the trauma and their health outcomes later in life. A summary of the ACE Study is available at: http://www.cdc.gov/ncipc/pub-res/pdf/childhood_stress.pdf.

The American Academy of Pediatrics issued a policy statement about the impact of “Toxic Stress” on the developing brain, which can be found at: http://pediatrics.aappublications.org/content/129/1/e224.full.pdf. The Policy statement was accompanied by a technical report supporting the policy statement, and that can be found at: http://pediatrics.aappublications.org/content/early/2011/12/21/peds.2011-2662. The documents combined describe the science effectively.

Finally, here are three videos that describe the developing brain from the Center on the Developing Child at Harvard University. Dr. Jack Shonkoff, an author of both the AAP Policy statement and technical paper is director of the Center. http://developingchild.harvard.edu/index.php?cID=428

I will be building off of this knowledge in future blogs.

Childhood Trauma Cycles Rapidly Among Alaska Natives

October 2, 2011

Nicholas Kokotovich III was sentenced to 20 years in jail (5 years suspended) for a vicious assault on a 2 year old girl, according to an article in the Juneau Empire on September 15, 2011. The victim was the child of his girlfriend at the time. I am not an apologist for his actions or the sentence. The type of crime he committed is altogether too common among Alaska Native people. Close to 38% of Alaska’s considerable prison population is Alaska Native.

It is obvious from the article that the victim’s life will never be the same. She will endure a lifetime of medical and psychological trauma. It is likely that, without significant behavioral health intervention, she may grow into an adult with behavioral issues herself. The tragedy is that, once she becomes an adult, we will stop caring about her. Her behavioral abnormalities, even if linked to the vicious assault on her, will not be tolerated and her attempts to find solutions may lead her to the same behaviors as the man who assaulted her. Why do I say this?

The Adverse Childhood Experience study, conducted between 1992-1994, looked at adverse experiences during the childhood of approximately 17,400 adult patients of Kaiser Permanente in San Diego, CA. The results were astounding. Individuals who grew up with 4 or more ACE’s had strong graded relationship between the number of ACE’s in their childhood and the adoption of numerous negative behaviors. The young victim has obvious ACE’s in her life. She was subjected to physical and emotional abuse. The perpetrator was a drug abuser and possibly perpetrated domestic violence on the victim’s mother. She apparently has an absent biological parent. She has 5 ACE’s if my assessment is accurate, and may have more by the time she is an adult. She will be at risk for adopting negative behavioral choices to help her deal with her traumas.

A sad part of this story is that the perpetrator was once a child, and from what I read in the story, was also a victim of ACE’s. His father makes a regular appearance on the Alaska Court records, including Domestic Violence petitions and a DWI charge. His attorney tried to tell the court, Judge Phillip Pallenberg, about that abuse and the impact it had on his client. He is right. I talk to Alaska Natives frequently, and when they are willing to share the number of adverse childhood experiences they have suffered, it is high. I talk regularly to people who have all ten. The stories they tell me about the behaviors they have experienced are startling: alcohol and drug abuse; domestic violence (perpetrator and victim); sexual abuse; homelessness; attempts at suicide; promiscuity (50 or more lifetime partners); and crime (perpetration and victimization) leading to incarceration.

The perpetrator was once a child, and apparently a child victimized by ACE’s. His negative behavioral choices probably started early in his life, and nobody noticed enough to realize that he needed help. And the help wasn’t available. We live in a society that is critical of negative behaviors, and attributes the behaviors to personal choice. Pull yourself up by your bootstraps. Be a man (for men). You can change if you only want to. The problem is that the neurobiological changes in your brain from the infliction of ACE’s causes substantial resistance to change. The negative behaviors adopted help adults deal with the neurobiological consequence’s of ACE’s. As Dr. Vincent Felitti has said, “It’s hard to get enough of something that almost works.” For someone suffering from the negative consequences of unresolved childhood trauma, relief is necessary. Negative behaviors provide some of the relief the brain desires. But it doesn’t stop the need. It only resolves it for a short time.

We can heal our current generation of children by stopping their exposure to ACE’s. To do this, we will need to heal our parent and grandparent generations. This is a dialogue we, as Alaska Native leaders, need to start immediately.

Mr. Kokotovich’s childhood trauma led him to behaviors that have caused trauma for the child of his former girlfriend. Lives have been damaged because trauma cycles rapidly through our generations.

Another Short Alaska Native Life

October 2, 2011

Lena “Terri” Joseph passed away while living on the streets in Anchorage. I didn’t know her, but she had friends who loved her and discussed her on Facebook. One of her friends shared a picture of a very beautiful young Terri. It was said of her, “She experienced a lot (sic) tragedy in her life,.…” She was Alaska Native and died too young.

Hannah6, a hater blogger on Anchorage Daily News, stated a viewpoint common among readers of a tragic story like this. Responding to a compassionate comment berating another writer, Hannah6 said “You condone people who are so irresponsible they won’t even take proper care of themselves,…”

My friend John Franklin, former Anchorage Commissioner of Public Safety who has since passed on, shared a more compassionate view with me. John would sit at Peratrovich Park in downtown Anchorage in the early 1980’s and greet street people by name. Because of his own challenges in life, John knew the challenges they faced and respected them as people enough to know them.

After a lifetime of working to find solutions to the problems of homelessness, alcohol abuse, domestic violence and other social and behavioral problems, I believe the solution has been identified. Dr. Vincent Felitti, a hero of mine just like John is, cared so much about his morbidly obese patients that he asked one question of a patient that changed his life—“What happened to you?” The answer surprised him and set him on a path that resulted in the Adverse Childhood Experience Study (ACES). The results of the study identified the considerable impact of ACE’s on the adoption of negative behaviors later in life. The neurodevelopment of adolescents is affected when they grow up with ACE’s. Having an alcoholic parent, depressed parent, absent biological parent, witnessing domestic violence in the home and 6 other adverse experiences has an impact on you as an adult. 15% of adults with 4 ACE’s become alcoholic, and 25% have severe problems with alcohol. With no ACE’s, the impact is about 5%.

Haters like Hannah6 attribute problems experienced by people like Terri to be personal moral failings. Science tells us that Terri experienced multiple ACE’s in her life, and never got the help she needed to escape the neurobiological pull of those same negative behaviors in her life. They are in many ways a biological imperative, or solution, for ACE victims wanting to find a normal life. The problem is the solutions don’t work. They become problems instead.

ACE’s can impact children in all homes. Mommy Dearest is a book about Joan Crawford, a white wealthy mother who perpetrated ACE’s on her daughters. While we may not feel sympathy towards Joan, the chances that she experienced multiple ACE’s in her life is reported to be high and undoubtedly affected her behaviors, and the behaviors of her children.

My Alaska Native people experience a lot of ACE’s in their lives. Historical trauma drove our ancestors to behaviors that now pass trauma intergenerationally from grandparent to parent to child. I have been advocating for an ACE’s study to be conducted among Alaska Natives and American Indians so we can understand the impact of ACE’s in our lives. I have been advocating for a reformation of our Health Care System to integrate behavioral health services into our primary care offerings. And I am asking that we have a dialogue on the impact of ACE’s in the lives of our people.

My hope is that the knowledge that our behaviors are not always the result of personal moral failing, but from neurological adaptations to childhood trauma, will start us on a path to healing. Terri’s life ended tragically, decades before it should have. A girl who should have developed into a woman full of life and love ended up on the streets because of issues in her childhood beyond her control.

Paul O’Neill

July 21, 2011

One of my lean heroes is Paul O’Neill. I came across his name early and often while I was learning. Mark Graban has a podcast of an interview with Mr. O’Neill and I highly recommend listening to it through the link (on word podcast). He is talking about patient safety.

The Real Cost of Obesity

January 20, 2011

Inspiration to this blog comes from the McKinsey Quarterly which has the same title. The essence of the article is that the United States spends about $160 billion on obesity, but that sum is just a fraction of the total cost of obesity—estimated at $450 billion. The following chart is contained in the article.

Dr. Vincent Felitti’s original motivation for proposing the Adverse Childhood Experience Study was to study why patients who were successfully losing weight would just quit. Anecdotal evidence pointed to the lack of safety and security when you are slender and in shape. In some patients, remaining obese means remaining safe—from jealous husbands and boyfriends, from sexual predators and from a perception of lack of food availability and security. We are afraid of being slender and our brain kicks in to protect us by putting our weight back on.

What is a solution? Chugachmiut is proposing awareness of the impact of childhood trauma on body weight, and interventions to help resolve the trauma. Rewiring our way of thinking may lead us to a more comfortable relationship with our body, and a lower body weight will probably follow.

A Glimmer of Hope

January 18, 2011

People will amaze you with their resilience. They can adapt to most changes given time. However, pain is one area where adaptation is sometimes difficult, and fraught with potential for difficulties. Yet people continue to hold out hope that they can deal with their pain without resort to drugs. Drugs have other consequences, including the potential for addiction, so they seek out sources of relief through alternate therapies. This post is inspired by an article from Brandan Van Valkenburgh, who practices MFTP therapy and massage at Avante Medical Center in Anchorage, Alaska. In Alaska Wellness (Vol. 16, #1, January/February 2011), he talks about a patient confronting pain. He writes that: “Simply by learning about the source of his pain, he was already beginning to feel empowered and in control.” Mr. Van Valkenburgh then described how a majority of the patient’s pain was eventually eliminated.

Mental pain is no less fraught with potential for difficulty. And I believe the same principle described in the quote applies for mental pain-knowing the source of your mental empowers you. In talking to therapists, I have learned that a common question from clients is “Why do I feel the way I do” or “Why do I do the things I do.” It is a search for answers to the mental pain they feel on a daily basis.

This is why our Restoration to Health Strategy is examining very closely the whole concept of a regional dialogue on Adverse Childhood Experiences and the potential it may have for causing some immediate distress. When we had our employees view a video distributed by Cavalcade Productions about “The ACE Study,” we warned them about the potential for feeling distress, and to contact a therapist if it did. The reason is simple, but complex. We don’t really know about the impact our family of origin had on us. The patients interviewed in the ACES talked about the pain they experienced for decades, and the destructive behaviors they followed. But one point well made in the video’s (there are 2 of them) was that knowing the source of pain (Adverse Childhood Experiences) had an immediate and positive impact on those interviewed. They began to realize that they felt and acted the way they did for a reason.

As many studies show, we are remarkable in the way we structure our lives around positive thoughts and accomplishments. We try not to look at the negative. And we fight to be normal. An adult with ACES, while likely normal, still has issues that can’t be explained with the normal everyday knowledge circulating around us. As an adult with 6 ACE’s, and as a pretty decent researcher, I didn’t know why I did some of the things I did or felt the way I did.

The question I have to ask myself constantly is whether opening up these old wounds, ones that affect our behaviors throughout our lives, is worth the results that are possible-considerable healing. I have to answer yes, and Mr. Van Valekburgh’s statement about his patient helps confirm my thinking. A glimmer of hope can help us become empowered to undertake the sometimes long and difficult path to a different, and happier more fulfilled, life.

 

Supporting a Healthy Brain

January 14, 2011

As I have written about many times, unresolved Adverse Childhood Experiences can lead to adoption of negative behaviors like smoking, drinking, drug use, depression, poor diet and hydration and many others. Many of our choices start to negatively influence our brain starting with our childhood and continuing to adulthood. Drinking caffeinated beverages such as alcohol, coffee, heavily sugared fruit type drinks and soda dehydrate our brain, which consists of 80% water. In contrast, our bodies are about 60% water. Here are some of the effects of dehydration:

-“…slight dehydration can produce a small but critical shrinkage of the brain, impairing neuromuscular coordination, concentration and thinking.”

-“ A deficiency of water can alter the concentration of electrolytes such as sodium, potassium and chloride which has a negative effect on the function of the brain.”

-“ Dehydration reduces blood volume, creating thicker, more concentrated blood which stresses the heart.  This also decreases the ability to transport oxygen and nutrients to the muscles and other living cells.”

Many children find temporary relief from their stresses and anxiety through sniffing substances and “huffing,” with have great potential for brain damange.

Alcohol use causes many more problems, as discussed on the National Institute on Alcohol and Drug Abuse web site (ALCOHOL’S DAMAGING EFFECTS ON THE BRAIN).

Restoring our Health requires taking better care of our brain. We can start to do that by very simply replacing a majority of the liquids we drink with filtered water. Eliminating as many toxins as we can from the water we drink is a great goal. Some people add a couple of teaspoons of apple cider vinegar to their water daily, although the medical community claims that more study needs to be done to prove whether there is benefit. (Apple Cider Vinegar). Many more add about a quarter teaspoon of salt to each quart of water. I am not talking about common table salt here, but about high quality sea salt. Most high quality salts have significant amounts of minerals. Processed table salts are typically said to be very hard on the body. Here is an article that discusses the use of sea salt in your water. (Health Benefit of Sea Salt).

Some physicians also recommend supplements for improved brain health, although diet is the preferred source of vitamins. Among the recommendations are Fish Oil (Omega 3 Fatty Acids);Vitamin D; Folic Acid (and other B vitamins); Vitamins C & E; CoEnzyme Q10; and Alpha Lipoic Acid. Your own Doctor or a nutritionist should help you select what you need for optimal brain health. Dr. Daniel Amen, a Psychiatrist, has a good discussion of supplementation in Chapter 20 (pp. 192-216) of his book titled “Making A Good Brain Great.”

Exercise is also great support for your brain. Proper hydration facilitates good blood flow for oxygen and nutrients when combined with exercise that sustains your optimal heart rate for a period of time consistent with your overall fitness. (That means don’t overdo exercise, but do enough to benefit your body). And according to Dr. John Ratey, author of “Spark: The Revolutionary New Science of Exercise and the Brain,”

“ Exercise produces large quantities of brain-derived neurotrophic factor (BDNF), a protein that helps neurons survive and encourages the growth of new ones. ‘I call it Miracle-Gro for the brain,’ says John Ratey, MD, a clinical associate professor of psychiatry at Harvard Medical School and author of the upcoming Spark: The Revolutionary New Science of Exercise and the Brain. “It helps the cells grow and makes them better and more resilient to future stresses.” Brains with more BDNF have a greater capacity for knowledge. To boost BDNF levels, Ratey recommends moderate- to high-intensity aerobic exercise, incorporating interval training. Other research shows that just walking brings substantial benefits. Best bet: Include a 10-minute speedwalk in your daily stroll.” (The Body Beautiful)

Challenging your brain is also highly recommended. Learning new skills and languages are beneficial because they help you “exercise” your brain. Reading new and challenging material, play cards or board games, socialize and work hard at remembering names and faces, and memorize something significant every day. Keep a journal to record what has happened in your day and write it down at the end of the day.

Because we are going to be helping our patients overcome their unresolved childhood traumas, which have been programmed into their brain by Adverse Childhood Experiences, we need healthy brains to support this effort. Our patients will need to put in the long hard work necessary to change their dark thinking and negative actions to sunny thinking and positive actions. A healthy brain makes it more likely that the patient will be successful.

The Alaska Native Men’s Dialogue

January 13, 2011

Chugachmiut sponsored a dialogue for Alaska Native men on January 12, 2011. Cook Inlet Tribal Council co sponsored the event through their donation of the Rasmusen Conference Center located in their building. First Alaskan’s Institute Provided assistance with facilitation and analysis. Approximately 40 Native men attended, with a wide variety of experiences and interests.

I first had this idea of a Dialogue a number of years ago. While attending a conference in Florida, I read about a school district that partnered with a group titled “100 Black Men,” with a goal of mentoring at risk black youth. Being curious, I wanted to know more about this organization and researched it’s history. It has been around since 1964 and does great things in communities with significant black populations. I asked why we couldn’t do the same as Alaska Native men for our communities.

As I spoke to other men about the concept, I found acceptance. Finally, in late 2010, I started talking to some prominent Native women about the concept, and found almost universal acceptance for the concept. Gloria O’Neill, President of CITC, not only encouraged me but contributed the meeting space. Diane Benson, then a candidate for Alaska’s Lt. Gov., did as well. I then asked Liz Medicine Crow for counsel and advice in holding a dialogue, based upon her experience with the First Alaskan’s Institute.

We talked about a wide variety of topics, using a couple of dialogue techniques. We started with an introduction session. Following was an “Open Dialogue” with 6 topic groups that men could move around to depending on interest. We had a World Café session as well.

At the end of the day, we knew each other more intimately, understood more of our shared and different concerns, and felt pretty good about the potential for Alaska Native men to coalesce in a way to enhance our participation in the growth and development of our community.

Don’t Worry, Be Happy

January 7, 2011

Some of our older readers will recognize this phrase as the principal lyrics for the song written and recorded by Bobby McFerrin in 1988. I used this phrase in discussion our Restoration to Health Strategy with a staff member recently. In context, we were talking about mindfulness, cognitive behavioral therapy and reprogramming our minds through the concept of neuroplasticity. Mindfulness is described at Wikipedia as follows: “…a psychological tool capable of stress reduction and the elevation of several positive emotions or traits.” Neuroplasticity is the ability of our mind to change negative neural pathways through training. I described the change as in part, “Don’t Worry, Be Happy.”

I was talking to a therapist some time ago about a common discussion point with clients. They will ask, “why do I feel this way.” They worry constantly and can’t seem to be happy. This 13 minute YouTube clip of an interview of Dr. Gabor Mate shares his thinking about neural circuits being set during childhood.

 

I agree. The reason we are talking about mindfulness, CBT and neuroplasticity around Chugachmiut is because of the emerging research about the impact our childhood traumas have on our adult behaviors. Of the severely addicted patients Dr. Mate serves, less than 5% recover. He talks about the societal blame and shame, punishment and war on drug addicts. His role is to “reduce the harm” suffered by this population. That is the aim of his treatment.

Changing negative coping behaviors is tough work. It’s easier to prevent the trauma, if we can. However, since parental behaviors impact the child, we do need to work extensively with the parent generation to help them try to resolve their childhood trauma so they are less likely to inflict trauma on their children.

That’s why we are talking about neuroplasticity, “Don’t Worry, Be Happy,” “mindfulness” and cognitive behavioral therapy. If we help patients focus on the reasons for their unhappiness, or “why they feel this way,” maybe we can help them be happy.