HIMSS Innovation & Conference Center in Cleveland recently hosted a public screening of the documentary film “Resilience: The Biology of Stress and the Science of Hope”. The film tells the story of adverse childhood experiences (ACEs) and how they change the human brain and affect health outcomes into adulthood.
The screening was followed by a panel discussion featuring local experts such as Dr. Nadine Burke Harris, a San Francisco pediatrician, founder and CEO of The Center for Youth Wellness, and California’s first-ever Surgeon General and author of “The Deepest Well: Healing the Long-Term Effects of Childhood Adversity.” Resilience features her innovative treatment of young patients with toxic stress and her leadership in promoting national awareness of ACEs and their impact on health.
Story behind the ACE study
"Resilience: The Biology of Stress and the Science of Hope" centers around groundbreaking research findings from the 1998 Adverse Childhood Experiences Study (ACE Study) conducted by Kaiser Permanente and the Centers for Disease Control and Prevention. Tracking long-term follow up on health outcomes, the study revealed an association between health and social problems and a patient’s number of ACEs found in these categories:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Emotional neglect
- Exposure to domestic violence
- Household substance abuse
- Household mental illness
- Parental separation or divorce
- Incarcerated household member
The study revealed a key correlation: the higher a person’s ACE score, the higher their risk for poor health outcomes over their lifespan. The one-hour film tells the story behind the study conducted between 1995 and 1997, originally intended to uncover reasons behind a 50 percent non-compliance rate in a Kaiser Permanente obesity clinic. The data on 17,000 adults showed much broader findings. Researchers were shocked to discover how many of the overweight patients had been sexually abused as children. They began to understand the connections between weight gain, childhood abuse and depression, anxiety and fear. That led to further exploration of how traumatic or toxic stress early in life can be associated with serious health issues.
Researchers Vincent Felitti and Robert Anda began to see the value in changing the way they viewed patients, from asking, “What’s wrong with you?” to instead asking “What happened to you?” Their findings became pivotal public health data and created a movement that’s engaging pediatricians, therapists, educators and communities.
“The child may not remember, but the body remembers.”
The film explores the science of adverse childhood experiences and new approaches to treat and prevent toxic stress and the biological consequences – from heart disease and cancer, to substance abuse and depression. The film discusses how stressful experiences can alter brain development and have lifelong effects on health and behavior.
Interviewees in the film talk about evidence-based solutions that help break the cycles of adversity and disease, such as:
- universal screening for ACEs at well-child physicals.
- taking steps to identify and reduce a child’s exposure to adversity through home visits.
- parenting skills training and support groups.
- therapies for children in schools and clinics including mindfulness and meditation exercises for regaining personal control.
- education around nutrition, exercise, and sleep.
Dr. Nadine Burke Harris became interested in ACEs and the science behind them when she began to see effects of toxic stress among her young patients. “I was seeing severe and significant adversities and behavioral issues. They were occurring most often in kids whose parents had drug addiction, mental illness, or were witnessing domestic violence at home,” says Dr Burke Harris. Beyond behaviors, she saw health problems triggered by adverse experiences, including asthma, diabetes and other health issues. The connections became clear and “hit me like a bolt of lightning,” she recalls. Dr. Burke Harris delved into research on ACEs and has become a leading advocate for understanding and treating what the film describes as “our single largest unaddressed health problem.”
Prior to the event at the HIMSS Innovation & Conference Center, Dr. Burke Harris spoke at a public forum hosted by the City Club of Cleveland. When asked how health systems can improve their understanding and treatment of ACEs, Dr. Burke Harris said, “We need to create seamless coordination of care. Invest in data systems that allow us to share across health systems so that the folks already doing excellent work can coordinate efforts and get better outcomes. There are models of thoughtful and innovative work out there. Make sure we are aligning resources and sharing metrics to do evaluations.”
Addressing ACEs at local and state levels
Dr. Burke Harris is excited to see efforts across the country to address toxic stress in childhood. She cites data showing the pervasiveness of the issue -- with two-thirds of Americans experiencing at least one significant adverse childhood experience and one in eight listing four or more ACEs.
At the HIMSS Innovation & Conference Center, Dr Burke Harris was joined by a local panel to discuss what is being done in Greater Cleveland to diagnose and treat the physical, mental and emotional effects of toxic stress. The panel included Dr. Heidi Gullett, Medical Director of the Cuyahoga County Board of Health; Dr Edward Barksdale, Pediatric Surgeon at University Hospitals; Daniel Cohn, Vice President of Strategy at Mt. Sinai Health Care Foundation; Holli Ritzenthaler, Assistant Vice President at OhioGuidestone; and Margaret Mitchell, President and CEO, YWCA of Greater Cleveland.
While encouraging local awareness and activism to address ACEs, Dr. Burke Harris cautioned that no single program or intervention will prevent or heal toxic stress in childhood. She suggested looking at California’s approach, with legislation slated for 2020 that will implement requirements for routine ACE screening for all Medicaid recipients. She pointed to the effectiveness of integrating primary care and behavioral health treatment through a team-based care approach. “It will take all of us working together with a shared goal.”