BRATTLEBORO — Is there one root cause of health and human services needs like special education, corrections, generational poverty and homelessness, addiction, chronic health care needs, and early death?
The members of the Adverse Childhood Experiences legislative working group think so.
According to a report they issued in January, the unacknowledged leading cause of these challenges is childhood toxic stress and trauma.
The joint, bipartisan working group was formed in July, when Act 43, passed by the Legislature and signed by Governor Phil Scott, empowered them to meet and study how childhood trauma leads to so many issues in human services, education, and corrections.
The group consists of Sens. David Soucy, R-Rutland, and Becca Balint, D-Windham, and Reps. Michael Mrowicki D-Putney, and Anne B. Donahue, R-Northfield.
“More and more of our children, for generations now, have been subject to trauma at a level that affects their ability to function as healthy, productive citizens,” the report says.
A public health concern
Mrowicki, chair of the ACE working group, told The Commons that childhood trauma should be considered a public health concern.
“The way to address this is like what we did with smoking 50 years ago,” Mrowicki said. Whereas smoking was once prevalent, through a robust public health campaign the dangers of smoking have become well known; smoking is now banned in most public buildings, and the culture has changed.
Similarly, Mrowicki said, “we as a society can see how prevalent trauma is.”
Mrowicki pointed to a 1998 study on adverse childhood experiences, conducted by Kaiser Permanente, as a groundbreaking step in identifying this issue.
The researchers identified a connection between such experiences and chronic illness and early death.
Here in Vermont, the legislature became interested in adverse childhood experiences as a public health issue through the work of the health care and human services workers. For example, “more physicians are seeing the chronic healthcare needs that they can associate with chronic childhood traumas, and they joined the chorus,” Mrowicki said.
Mrowicki noted that in his experience with the general population, “people don't get” how trauma affects individuals. “It's not about a kid going to bed early because they didn't clean their room,” he noted.
The tiger in your house
At the working group's public hearing at the Prouty Center for Child and Family Development in September, Martha Strauss, clinical psychologist and Antioch professor, gave a presentation, “Developmental Trauma and the Brain.”
Strauss explained what trauma is, how it affects a developing brain, and stressed the point that “children need secure love to be healthy.”
She defined trauma as “not an event itself,” but “a response to stressful experiences that dramatically undermine our ability to cope.” She noted that the social isolation of traumatized children adds to their difficulties, because “it is really stressful when the person you have to go to for safety is unpredictable and unsafe.”
“I'm not blaming,” said Strauss. “These parents are stressed out.”
She talked about the effect repeated rejection, abuse, and neglect has on a young child.
“In chronic environments, cortisol in kids' brains doesn't go back down” to levels found in non-traumatized brains. Cortisol, she explained, “is a neurotoxin, and chronic exposure to cortisol causes brain damage. The developing nervous system is forever damaged.”
“Even with neuroplasticity,” the brain's ability to form new neural pathways, “it's hard to completely backfill the damage,” Strauss said.
“The take-home message,” Strauss said, is that children cannot handle danger and stress on their own. They need safe, responsive, and reliable caregivers. “These kids can't just 'suck it up,” she said, because that's developmentally impossible.
One example Strauss gave to illustrate the difference between “positive stress” and “toxic stress” comes from an earlier stage in human evolution, when we had little protection from predatory animals.
Our bodies are designed to respond to stress, so when the tiger shows up, adrenaline and cortisol help us run or hide from the tiger - we fight, flee, freeze, or flock. The threat is short-lived, and then we are safe.
But the tiger isn't supposed to live in your house.
Strauss detailed some of the long-term effects on children whose brains “bathe in” cortisol: “These kids are sick a lot.” Too much cortisol suppresses the immune function, leading to life-long chronic illness. Too many traumas, and “you're reducing your life expectancy by about 20 years,” she noted.
Kids living with trauma also have challenges with problem-solving and making friends, Strauss said, “because the things your brain is doing is what it gets refined to do. If all you're doing is 'survival,' that's all you learn to do.”
The “thinking brain” gets shut down so the “doing brain” can keep the child safe, and “they get really good at being stressed out,” she said.
For children living in rural areas, the situation is much worse, Strauss said, because of greater isolation.
“We evolved to live in communities with 30 people taking care of each other. We didn't evolve to live isolated at the end of a dirt road with a bunch of people telling us how to be better parents,” she said.
No one pill, no one bill
The report notes that the committee's work was “wonderfully collaborative and productive.”
But the working group couldn't forge one all-encompassing bill. Instead, members agreed they would draft individual bills pertinent to their topics of interest. “From there,” the report says, “we will coordinate work in each body, with the collective goal of moving this work in as comprehensive a manner as possible.”
Members of the working group have introduced several pieces of legislation, and more may come.
In January, Mrowicki sponsored H.578, which seeks to restore the state trauma coordinator and the Childhood Trauma Tri-Branch Commission. It is currently in the House Committee on Human Services.
Donahue sponsored H.579, “An act relating to trauma-informed care in health care settings,” and that bill was referred to the House Committee on Health Care.
State Rep. Kathryn Webb, D-Shelburne, sponsored H.580, which establishes trauma-informed policies in schools. It was referred to the House Committee on Education.
Sen. Virginia “Ginny” Lyons D. Chittenden sponsored S.261, “An Act Relating to Mitigating Trauma and Toxic Stress During Childhood by Strengthening Child and Family Resilience.” The Senate passed the bill and sent it over to the House Committee on Human Services.
“While there is clear evidence that addressing childhood trauma can help reduce human suffering and the money we pour into health care and social services,” there is no vaccine, pill, or singular intervention to cure cumulative toxic stresses, says the working group's report.
“It's an injury with deep roots,” said Mrowicki. “I think there's a collective denial of this.”
He compared it to the Holocaust. Until writers detailed their experiences in concentration camps, such as in Elie Wiesel's book “Night,” most people “couldn't admit it because it was so huge,” said Mrowicki. “But,” he said, “our society is going to have to take a good, hard look at trauma.”