DR. NADINE BURKE HARRIS: HEALING THE LONG-TERM EFFECTS OF CHILDHOOD ADVERSITY

good evening it's wonderful to see everyone  here today at the Commonwealth Club I'm gonna   gavel us in we're at the Commonwealth Club of  California the place where you're in the know   the club is online at Commonwealth Club org  as well as Facebook Twitter and YouTube I'm   Katie Albright I'll be your moderator this  evening I'm the executive director of safe   and sound formerly the San Francisco Child Abuse  Prevention Center and I am so thrilled to be here   with our distinguished speaker tonight dr. Nadine  Burke Harris pediatrician founder and CEO of the   Center for youth wellness and wonderful author  of this book the deepest well the healing and   long-term effects of childhood adversity which  we'll be talking about tonight dr. Burke Harris   is a pioneer in the movement to transform how  we respond to early childhood adversity and the   resulting toxic stress that dramatically impacts  our health in our longevity by exploring the   science behind childhood adversity dr. Burke  Harris is offering a new way to understand   the adverse effects that really impact us all  throughout our lifetime as the founder and CEO   of the Center for youth wellness she has brought  her scientific discoveries and her new approaches   to audiences around the country including the Mayo  Clinic the American Academy of Pediatrics Google   zeitgeist Dreamforce and now all of us here this  evening her TED talk how childhood trauma affects   the health across a lifetime has been viewed  by more than three and a half million times and   her work has been profiled in The New Yorker in  best-selling books including how children succeed   by Poul tough and hillbilly elegy by JD Vance both  incredible books and also featured on CNN Fox News   and the New York Times dr. Burke Harris has been  very acclaimed and awarded the Arnold P gold   foundation humanism in medicine award presented by  the American Academy of Pediatrics and the Heinz   award for the human condition serves also as an  expert advisor to the too small to fail initiative   a national initiative working in to improve  the outcomes for children and as well as the   national advisory board of the American Academy of  Pediatrics she details her work which we'll talk   about tonight in her new book the deepest well  and today we're really going to be discussing   her work as well as understanding past childhood  traumas and how they can result in if we address   them how to result in better and more healthy  adulthood Nadine I'm so happy to be with you   tonight it's terrific I loved reading your new  book congratulations on its success and I just   wanted to say that you and I have known each other  for many years we both were both advocates for   children advocates for the health and well-being  of children or our communities our organization   your organization the Center for youth wellness  and safe and sound we share this common goal this   common purpose to ensure the health and safety of  children in our entire community and around the   country I have to say we also share this wonderful  building in the Bayview where we provide an array   of comprehensive services to children that are  impacted by adversity to ensure that they grow up   and thrive Nadine I remember one of our very first  conversations we were with then District Attorney   Kamala Harris and now she's our US senator and  we were talking about the commonalities of our   work and really thinking about the commonalities  of poor education outcomes poor health outcomes   incarceration and understanding that the root  cause that really is addressing all these social   ills is child abuse as well as other adversities  that children experience I just want to make   sure many of us know about adverse childhood  experiences but just to ensure that we're really   all on the same page would you share with us what  are adverse childhood experiences and what is   their impact later on in life sure yes well first  of all thank you it's so wonderful to be here with   you Katie especially as we've been for so many  years on this journey advocating for children   and it's special here in San Francisco and just  to start off you know grounding a little bit with   you know what our adverse childhood experiences so  that term adverse childhood experiences actually   came from this landmark research study that  was done in partnership between the Centers for   Disease Control and Prevention the CDC and Kaiser  Permanente the healthcare Giants and in this   study what they did was they asked seventeen and a  half thousand adults about their histories of ten   categories of adversities in childhood including  physical emotional or sexual abuse physical or   emotional neglect we're growing up in a household  where a parent was mentally ill substance   dependent incarcerated where there's parental  separation or divorce or domestic violence   and what they found was absolutely striking there  were two things number one these adverse childhood   experiences were a lot more common than most  of us would presume or that we would guess by   looking right so two-thirds of their population  had at least one of these ten experiences happen   to them in childhood and one in eight individuals  had four or more adverse childhood experiences and   you know this wasn't a lot of the folks that we  might typically think about of being exposed to   stressful or traumatic events this this wasn't  you you know folks in a low-income neighborhood   this was it this was a population that was 70%  Caucasian 70% college-educated all of them had   private insurance as patients of Kaiser it was in  San Diego yes that's right this was in Kaiser San   Diego and the second really groundbreaking finding  from the adverse childhood experiences study was   that the more of these aces that a person had  the greater their risk for you know not just   behavioral problems or depression or addiction  which they certainly did find but the greater   their risk for some of the leading health problems  in the United States so for folks who had four or   more of these adverse childhood experiences their  risk for heart disease the number one killer in   the u.s. was more than double for cancer was  double for stroke was two and a half times   for chronic lung disease it was almost four times  and for the first time the medical establishment   began to understand that childhood adversity is  not just a risk factor for social ills or mental   health conditions but it's also a risk factor for  the leading causes of death in the United States   well and I want to talk about that more and that  connection between the medical and social ills and   and do it in a way because I don't I loved reading  this book and I have to say that you make the   science so approachable you explain brain research  you explain science in a wonderful way as well as   toxic stress and adverse childhood experiences but  I have to say for those that may not have read the   book the title is a bit of a mystery hahaha  tell us what the deepest well means sure sure   and I'm so glad that you enjoyed reading the book  because I'll tell you I loved writing it it was chuckling to myself and I had so much fun  it's so much fun right again this was just   a wonderful expression oh yeah it was it was a  joyful expression of you know all of my favorite   things which is you know science and connecting  with people and storytelling and also prevention   right because that was a big part of the purpose  of writing the book and the title the deepest well   relates to a public health parable that you know  we all learn in our first day of public health   school so you know when I finished my medical  school I did my master's degree in public health   and you know it's essentially day one right you  you they teach you the parable of the well and   this relates to the outbreak of cholera in the  Soho neighborhood of London that happened in the   late 1800s and you know folks are dropping like  flies from cholera and weird and you know everyone   was trying to figure out what it could possibly  be the cause and at the time common wisdom was   that infection was spread by foul airs right  which made a lot of sense because the more raw   sewage that you throw into the water supply the  worse that would smell right and the more likely   you were to get infected and similarly for doctors  who were caring for patients if you had a patient   who had a terrible wound if you the smell test  was an important diagnostic piece of diagnostic   information the worst the wound smelled right the  more likely the patient was to die so we you know   we with our scientific rigor we believed that  you know if that infection was spread by foul   airs but there was a doctor by the name of John  Snow and I felt I almost had to write in the   book like not Game of Thrones John right but you  know what he did it was he went around canvassing   the neighborhoods this was you know early day  you know epidemiology feel it figuring out the   cause of this outbreak and what he found was that  all of the families that were affected by cholera   all the households had gotten their water from the  same water supply which was a pump on Broad Street   and he convinced the Pope and he had been studying  he was a student of Pastore pastor had just begun   putting out these ideas that you know actually  I don't think it's foul airs that are causing   infection it might be these crazy things that I'm  seeing under my microscope called microbes and   everyone thought it was crazy it was this weird  someone had this idea of germ theory of disease   right but when John snow applied that germ theory  and put it into practice and said you know what I   think there's something in this water supply and  I think it could be germs right he convinced the   public health officials to remove the pump handle  from that well and the cholera outbreaks subsided   and the reason I titled the book the deepest well  is because it's about getting to the source right   it's about getting to the root cause of so many of  what appear to be our society's most intractable   problems but the fact is that if we do not get to  the root cause then these problems will continue   to seem unsolvable but when we understand that  childhood adversity is the root cause of not   only so many of our social problems in terms of  incarceration problems with our educational system   how do we you know we talked about underperforming  schools right when we're talking about schools   that have classrooms that are full of children  who are experiencing the neurologic consequences   of childhood adversity when we get to the root and  understand that we can begin to use this science   to apply strategies that are much more likely to  be effective and you did that with Diego and you   start with this wonderful story about Diego he's  seven years old he couldn't be more than looking   like he was as tall as four he was referred to you  by a nurse who thought that maybe a school nurse   who thought maybe he had ADHD I'm remembering the  story right and you find out in your examination   that he has sexually he was sexually abused when  he was little I have to say working at safe and   sound we see so many diego's who come with their  families for help and they have this history of   severe trauma and you realize it wasn't ADHD  that was the proper diagnosis it was something   else it was toxic stress can you talk about that  examination in Diego and and really you you went   to the root and the source of what his problems  are yeah so let me back up yeah because I will   tell you that I did you know my medical school at  UC Davis I did my master my mph at Harvard did my   residency residency at Stanford I got some good  education right I did my best to get the best   education I had but I never learned in one day  of medical school that childhood adversity could   be the root of the health problems that I might  see in my patients but I you know a funny thing   which is that my dad is a biochemist he's actually  here in the audience this evening and my dad's a   biochemist and when I was when we were kids right  my dad would turn every experience every me know   me and my brother messing around with stuff  throwing paper airplanes at each other into an   opportunity to learn about physics and chemistry  and biology I mean literally I had a curry stain   on my blouse and I went to wash it out with you  know bar soap and the stain turned from a yellow   to a bright pink right and of course my dad oakar  II must be an acid-base indicator right like this he was clearly your first science inter  yeah and you must be so proud but what I   learned from my dad is that behind every natural  phenomenon there is a biological link there is a   biological mechanism you just have to look for it  and so I was when I finished my residency I came   to work for California Pacific Medical Center  and together we opened the Bayview Child Health   Center in Bayview Hunters Point with a goal of  reducing health disparities in one of our most   vulnerable neighborhoods in the city and over and  over again I was seeing all of these kids who are   being referred to me for lots of different health  problems some of them were being referred a lot   of them were being referred for ADHD right with  case is very similar to Diego but some of them   had different symptoms for example you know  a patient who was referred to me a terrible   asthma right and as I was going through asking her  mom about the asthma triggers you know is it pet   dander is that cleaning products is it pollen you  know what could it be and this mom said to me you   know doctora I noticed that my daughter's asthma  acts up every time her dad punches a hole in the   wall so as I was in my practice one day um you  know typical day a mom brings in her son concerned   about possible ADHD that's what the school nurse  told her that probably he needed medications and   to take him to his doctor but when I I saw this  patient he was this beautiful beautiful child and   one of the first things I noticed about him was  that he was little he was itty bitty and it was   a I had to double check actually the date that was  in the medical chart because although he was seven   years old when I looked at him and I actually I  double I you know plotted his height and weight   again because even though he was seven years  old his height was the fiftieth percentile for   a four-year-old and as but they were there for the  ADHD so you know I asked as I you know was doing   the the history and physical there were a couple  things that I noticed in addition to the fact that   he you know his mom's concerned about behavior  he also at in fact that he was short he also had   asthma and he also had eczema which is you know  skin inflammation and as I asked my mom his mom   about when his behavioral symptoms started she  became tearful and I actually had to escort Diego   and his sister you know to wait with our medical  assistant in the waiting room and when I came back   she told me that he had experienced a sexual  assault when he was four years old and the way   that normally as doctors were trained to evaluate  these situations is like okay so we've got a kid   with behavior problems that's one category right  and I either need to you know standard of care   now for what we call for for attention deficit  hyperactivity disorder is to either the number   one treatment is is ritalin as stimulants right  and then I have this child who has asthma and   eczema and then I have this child who has growth  failure right but as I began the evaluation for   his growth failure one of the important diagnostic  pieces piece of information is something called a   bone age it's an x-ray of the less left wrist to  evaluate skeletal maturity and when I did the bone   age on this patient and I got the report back from  the radiologist it said his skeletal maturity was   mean for a four-year-old and I as I was putting  the pieces together I called the endocrinologist   and I said let me ask you something cuz in a back  of my mind you know my dad's teachings that this   is all biologically connected right there are  these mechanisms and we have a I have a kid who   has had you know had this significant trauma  when he was four and his skeletal maturity is   of a four year old I said let me ask you is it  possible that this child could have experienced   a growth arrest as a result of the trauma and the  endocrinologist that I spoke to said yes and that   was really what motivated me to go down the path  of better understanding how does this happen how   is it that what our kids experienced early in  life can have such a profound effect on their   health we've received questions from the audience  so please keep them coming and your questions just   so to me touch the fact that you have really  struck a chord with all of us I wanted to ask   why did it take so long and this is an audience  question the knowledge of aces take decades to   come out and and knowing what we know now about  aces for so many years what was what was the the   barrier to bringing this information out to the  public oh that is such a wonderful question and   it's something that my team and I at the Center  for youth wellness think about all the time which   is you know what are these barriers and to be  honest when dr. Vincent phylidia and dr. Robert   and ahooo were the principal investigators of the  study when they initially published this data the   the first reaction that they got from people was  well this can't be true because if it were true we   would already know about it right and you know so  they went back and redoubled their statistics and   you know the CDC did this very rigorous evaluation  and and then and of course everything was true and   then the other argument that they thought was okay  well this make sense that people who you you have   a rough childhood you're more likely to drink  and smoke and do all the things that are gonna   ruin your health so this is not you know okay  it's significant but ultimately isn't this just   about bad behavior and fortunately in the time  since the adverse childhood experiences study   was published a bunch of really smart researchers  decided to take that on right and they did the   regression analysis to look at the to control  for the impacts of health damaging behavior and   it turns out that only accounts for about half of  the increased risk so the good news is that if you   have adverse childhood experiences and you don't  drink or smoke or and you you exercise regularly   and do all that stuff you can reduce your risk  but it leaves a tough question right because oh   I thought this only happened to those people  because they had a bad lifestyle but you know   what this data is saying you're telling me that  I could be at risk even if I didn't do many of   those things I mean it's a common misperception  right because you think that if you had adverse   childhood experiences early that you would maybe  drink or smoke as you grew older and that would be   the way to cope and that that was leading to long  term health issues but you're saying that's not   the case that's right so what we now understand  and this was you know to go back to what is the   real source right is in the intervening two  decades we now understand much more about the   biological mechanisms that are involved which we  now understand to be what the American Academy   of Pediatrics calls toxic stress and that is  essentially the fact that when we are exposed   to scary things and especially as children right  this is particularly in childhood it activates our   body's natural fight-or-flight response and this  is the the response that's designed to save our   lives right we release hormones like adrenaline  and cortisol and they do things like you know   raise our blood pressure raise our blood sugar  they you know shut blood to all our big strong   muscles so that we can either you know fight the  whatever whatever it is fight the bear or run from   the bear and a couple of other things happen two  that I think are really important one is that if   you were to think about fighting a bear wouldn't  seem like a good idea what it and that's why the   part of our brain thankfully yes the part of our  brain that's responsible for for our fear center   right our fear center actually sends neurons  projections to the part of our brain that's   responsible for executive functioning judgment  impulse control which is the prefrontal cortex   and turns it way down right so that we don't  have to have judgment getting in the way of   survival right and the other thing that happens  is that when we activate our stress response it   also activates our immune response right because  if you're walking in a forest and there's a bear   you want your immune system to be primed to bring  inflammation to stabilize the wound so that you   can live long enough to either beat the bear  or get away right so this is brilliant it was   in evolved over millennia to save our lives from a  mortal threat but the problem is what happens when   that bear comes home every night right and this  biological process is activated over and over   and over and over again and it goes from being  adaptive or life-saving to maladaptive or health   damaging and this biological process is something  that we now understand to begin in childhood and   can actually continue throughout the lifetime and  that is what leads to the increased risk of heart   disease cancer stroke diabetes Alzheimer's asthma  keep going you talk about toxic stress and and   and the outcomes the long-term negative health  outcomes but some stress is good right at the   moment my palms are sweating stress is good talk  about what is normal stress what's toxic stress   what's that difference yes the American Academy  of Pediatrics does a great job in describing you   know the three types of and we actually talked  about not so much as the stressor but actually   our body's biological stress response right so  we have what is known as the positive stress   response the tolerable stress response and the  toxic stress response positive stress response   is you know what you and I experienced backstage  before we walked up here a little bit of you know   these brief increases in stress hormones that  little surge of adrenaline that helps us to   be able to you know get out here and speak and do  our best listen if we didn't have a little bit of   that biological response you know we we wouldn't  prepare we wouldn't you know pay attention all   of that kind of stuff so that's the the positive  stress response and a typical example of something   that would induce that positive stress response  it's like you know a tough test at school or you   know a big sports meet or something like that then  there's the tolerable stress response where the   stressor is more severe right and that can lead to  a more prolonged change in our biology and so for   children in particular that can be something like  a natural disaster right or the death of a loved   one where there may be some time where that child  experiences for example developmental regression   maybe they're back to bedwetting something  like that but with the buffering presence of   safe stable and nurturing relationships the body  actually comes back to homeostasis it actually   comes back into balance and these hormones and  biological processes don't persist and we go back   to normal but with toxic stress the difference the  difference is that when children are exposed to   severe or prolonged stressors and they don't have  adequate buffering from safe stable and nurturing   relationships that leads to long term long term  changes in our biological systems and that is   what is known as the toxic stress response and  that's what leads to long term health problems   so you also talk about some of the remedies yeah  and that there are six really important key pieces   I want to focus on just one healthy relationships  talk about all six but it's safe and sound we are   so supportive of families really trying to be  as used to talk about that buffer that parental   buffer and the importance of that yeah so talk  about the the six components of the remedy the   anecdote to toxic stress and why from a science  perspective they work and particularly why it's   so important to have that parental buffer  yeah well let me tell you the remedies are   my favorite part right because you know folks  it's particularly who here about you know this   research in this field of work they're like oh  my goodness childhood adversity isn't that so   stressful it's gloom and doom and I'm just like  oh no this for me is fundamentally hopeful work   because again when we understand the mechanism  right that's what we get to have fun mess around   and figure out like how do we disrupt these  mechanisms and in the in the deepest well I   talked about you know six things that as we as  our team scour the literature and I will say you   know the reason that I founded the Center for  youth wellness is that as a pediatrician trying   to care for my patients right I didn't have any  clinical protocols I didn't have any prescribed   treatments or anything like that all I knew all  I learned in in residency was you know you can   either refer them to a mental health provider you  can refer them to a social worker but you know if   kids are experiencing experiencing adversity is  kind of you know hashtag not my job right and   and so the reason I created the Center for youth  wellness is because I feel like I'm probably not   the only pediatrician who doesn't feel like they  have adequate information and training about how   to address this issue so our research team at  the Center for youth wellness literally scoured   the literature we looked at more than 16,000  journal articles that's how much we loved this   science and what we found is that the science  the the things that make the biggest difference   in the toxic stress response are sleep exercise  nutrition mindfulness mental health and healthy   relationships and I want to I'll just pick the  healthy relationships to unpack a little bit   from a scientific standpoint because the fun part  is talking about all of the the biological basis   for these but you know so when it comes to healthy  relationships right there's a couple things that   happen number one so we know as as both of us  are moms right we know that when we're getting   ready to have our babies right there's this a  there's a hormone called oxytocin and it's a   really important hormone for its induce it it's  naturally released during childbirth if you need   to augment your labor you know the doctors will  give you extra oxytocin and the funny thing about   oxytocin and part of the the biological mechanism  is that it's a powerful bonding hormone right so   when your baby comes out right you're looking  at your like I would take a bullet for you   incredible bonding and the funny thing about  oxytocin right is that we now understand that   yeah it is released during you know in healthy  relationships with with hugs and snuggles and   all kinds of you know we release oxytocin to each  other my husband is my regular source of oxytocin oxytocin biologically buffers the  fight-or-flight response is actually   called the hypothalamic-pituitary-adrenal axis  and the hormones that activate the fight-or-flight   response are blocked by the release of oxytocin  right so we literally have the ability to   counteract the toxic stress response in each other  biologically through healthy relationships and one   of the studies that our our team just looked at  in fact we're getting ready to to publish a paper   that includes this research there was a paper  there was some researchers who looked at who   did a randomized control trial and they looked at  kids who were exposed to maltreatment right these   were institutionalized kids and they randomized  them to high-quality nurturing relationships or   care as usual and this high these high-quality  nurturing relationships what they did was they   did MRIs on these kids to see what was the  difference in their brain development and   when these kids were randomized at age two by  age eight the children who had been receiving   high-quality nurturing relationships literally had  changes in their brain structure measurable on MRI   when we're talking about healing relationships as  an antidote to toxic stress I'm not just talking   about it makes you feel better I am talking  about it literally leads to changes in brain   structure and function which is so incredible  and we see that every day and so when we see the   assessments but understanding the brain structure  of understanding the components that are happening   with hormones and the science behind it makes  so much sense so I wanted to ask and and and   we may all nee this is heavy stuff so we may all  need to take a collective breath and and really   consider our own stress response system even  just hearing this so I invite everyone just to   take a breath but let me read another one of the  audience's questions and this may speak to so   many of us here but how should adults who were  emotionally neglected as children overcome the   voice in their head that says these people don't  know my story and I don't trust them enough to   share it basically this feeling of an inability to  engage mm how do we talk how do we help people who   as children mm-hmm were experiencing significant  adverse childhood experiences yeah so there are   a couple things and one of the pieces about  the adverse childhood experiences study that   I think was really important was that the first  thing I mentioned about two-thirds of folks had   experienced at least one adverse childhood  experience right and I think that was really   powerful for a lot of people because what it  highlighted was probably for every single one   of those 17,000 people they felt like they were  the only one right they felt like so much of   childhood adversity happens in secrecy and shame  and is hidden and one of the things that we are   learning now is simply speaking that truth is  such an important part of healing and in fact   I was talking with a researcher recently and he  said they were looking at mortality rates in the   early phases of in the hiv/aids epidemic and even  after they developed antiretroviral drugs what   they found was that when they were looking among  gay men the gay men who were out had much higher   survival rates than the gay men who were positive  right and as the researchers looked at that they   they were looking at the impact of secrecy and  shame on our health outcomes because what we   now know is that it's all part of our system  right it's all part of our biological system   so it is really powerfully important for us to  be able to speak that truth that is part of the   healing process right speaking truth I want to  talk about what we're reading in the paper all   the time so you've talked about nine traditional  adverse childhood experiences but in the paper we   read about bullying and violence in schools  shootings in schools we read about families   that are exposed to significant trauma and stress  around immigration and deportation discrimination   how how do those community adversities impact  a child in terms of the adverse childhood   experiences I've know you've done some research  in that can you share about that yeah so this   is something that I talk about in the deepest  well and the you I actually gave an example in   the book about you know when my family was on  vacation in Lake Tahoe and you know I was off   to the restroom and my husband was there with our  boys and you know our three boys were playing on   the bench and up came these two men who with you  know shaved head steel-toe boots write this it's   it's they you know dark grey tattoos sneaking up  their necks and they were glowering at our three   black boys playing on the bench and as I looked  up I saw my husband I saw that his fight-or-flight   response was activated I mean literally his it  looked like he was ready to brawl right and the   thing that I talk about in the book is that  although our three boys three at the time now   for although our three boys are black my husband  is Caucasian in fact my husband is the the has is   a successful CEO but when people are faced with  threat it activates a human biological response   and what I saw on that bench in Lake Tahoe is  that when you are black in America you have far   more experiences that will activate your natural  biological response right and when you are you   know living in a situation where you know there  are ice raids going on right and so the reason so   but the thing that I think is really important  here right because folks can look at this and   say you know I talked to one Republican state  senator from Mississippi and he said you know I   you know I thought all of this was just some you  know mumbo jumbo so that you know liberals could   get more entitlements but when I actually read the  science you know it was I recognize that there's   real science behind it and that is the point  when we look at how we make our policies right   if we know for example the difference between  tolerable stress and toxic stress is a safe   stable and nurturing caregiver then we really  need to examine policies that are designed to   separate children from their caregivers right that  is just that is something that that is something   that as as science advances right we as society  as a civil society we understand that there are   certain kind basic ethical considerations that  we have to make around the risks that we are   putting our population you know in front  of and this is a place where I hope that   any administration would take into account the  science of aces and toxic stress and understand   that we need to be investing in prevention we  need to be investing in making sure that our   policies are not exacerbating toxic stress but  rather that they are mitigating and supporting   families to be safe and stable and by the way  that that ultimately pays we are ultimately paid   back in dividends because listen the reason  that our team is so focused on the leading   causes of death in the United States of America  is because guess what heart disease is expensive   right chronic obstructive pulmonary is expensive  cancer is expensive and the United States right   now we spend almost three trillion dollars  per year right that's 3,000 billion dollars   per year on health care and most of it is for the  treatment of chronic disease and if you have an   ace score of four or more you have a dramatically  increased risk of seven out of ten of the leading   causes of death in the United States of America  so when we are talking about these policies and   policies that exacerbate toxic stress we need to  be thinking if you don't care about civil rights   if you don't care about individual freedoms if  you don't care you care about economic viability   and we have to use every every lever that we can  use to get our society to do right our kids and   and folks with your questions I think folks all  of us the audience are moving and the questions   are showing this really to thinking about what  is that future what is that community response   you have called for Universal screening and early  intervention of adverse childhood experiences can   you explain that and can you also explain what has  been the reaction of the medical community because   I'm sure that call has created a great deal of  impact in the medical community yeah so so the   good news when we're talking about aces and toxic  stress is that we're not talking about solving   poverty or world peace or some of these things  that people really feel like are you know it's   overwhelming there is a very direct mechanism by  which we can dramatically mitigate the impact of   adverse childhood experiences in toxic stress and  that is all of the data all of the science tells   us that early intervention improves outcomes and  for the most part what we see is that most often   adverse childhood experiences are handed down  from generation to generation we have a powerful   ability to break that intergenerational cycle and  what and and the way that we can do that is listen   every kid's got to see their doctor anyways right  typically a kid's got to see their doctor for   you know the first visit is that a week of life  right now as a pediatrician I know there's a lot   of things we got to do we got to check height  we got weight blood pressure all these things   but we know that adverse childhood experiences  directly correlate to health risk and now we know   the biological mechanism right so what we need is  to have every pediatrician in America screening   for adverse childhood experiences as part of the  routine physical exam that we do for kids because   when we do early detection we can begin the  early intervention and there are evidence-based   interventions that we know can improve outcomes  for kids so how do we do this when I talk to my   colleagues about every pediatrician in America  screening they is there's naturally believe it   or not people ask like oh do you get pushback from  parents we don't get any pushback from parents I'm   gonna be honest parents we get the least much  back from where we get pushback from is other   doctors right doctors say well what do you mean  there's another thing that I have to screen for   I don't have time I was never trained to do this  and by the way I'm not being reimbursed right and   so at the Center for youth wellness we've really  thought about some thoughtful strategies to be   able to address this and that's why we've actually  created the National pediatric practice community   on adverse childhood experiences screening  and this is a digital platform it's an online   platform any pediatrician in America can go to  npp see aces org they can sign up to be part   of the practice community and they'll get the  latest research on adverse childhood experiences   and toxic stress they will get information on  different types of screening tools that you can   use to screen they'll get advice on how to respond  to a patient who has aces in your practice what do   you do differently in your clinical practice and  even practical stuff like which billing codes can   you use to at least get reimbursed for a little  bit of your time right or how do you practically   you know put this into into your electronic  health record and so we launched that in 2017 we believe that we have a viable path and  over the next five years our goal is to triple   the number of pediatricians in America screening  so even though this research thank you even though   this research was published now two decades ago  right right now only four percent of pediatricians   in America are screening for adverse childhood  experiences and that has to change so where does   and you talked about billing where insurance  companies fit with all this and what about Big   Pharma how are the pharmaceutical companies are  addressing this well let me tell you so it to be   honest I haven't heard very much from Big Pharma I  don't think we're even you know big enough to get   on their radar so far but but it's it's really the  question of Big Pharma I think is really relevant   because if we all think that it's just the science  and this you know we once we get the science once   we get the data it's so compelling that people  are just gonna change practice right sadly that   is naive once people hear this they're gonna just  you know change all the systems pediatricians are   gonna screen universally and you know we're gonna  we're gonna beat this not the case because when   we look at well when we what we have to do when  we look at any change in healthcare right or in   society it's not just the science you don't  need to just have the data you also need to   have the advocacy and when you pair the science  with the advocacy that's when you begin to to   motivate change right but right now who are the  biggest health care advocates in the u.s. pharma   companies right we didn't nobody even knew they  needed viagra until they were told by the so so   we don't we don't have big pharma bankrolling  this initiative right and that's why we need   every single person in this room and for folks  listen on the radio we need all of you because   the advocacy is going to come from us right we  need to whatever it is if you are a parent you   there are you can join the movement you can rate  talk about talk to your pediatrician right talk to   your pediatrician about hey do you guys queen  four aces or or you know do you know have you   learned about the a science and if you don't know  about it would you be willing to learn right talk   to talk with whatever if you're in your faith  group your church or synagogue whatever it is   begin having these conversations about aces  there's a there's a face group called ace   over comers where they are addressing and talking  about aces in this face based organizations if you   are an advocate or a parent at your kids school  and you're talking about the PTA hey how do we   make sure that our educational institutions have  trauma-informed and trauma responsive curricula   we're not talking about teachers having to now  go and screen for aces right like we as the dot   we can only have one strategy right now no but  but we can leave that to doctors right because   whoever does the screening has to follow up on  all the results right and we already have within   the medical establishment right a system that  affords legal protection over the privacy of   the information that comes out right as well as  an obligation both ethical and legal to act on   these findings right so if you are a doctor you  there we do have the right infrastructure to get   kids the help that they need right but we need  advocates and we need to hold our policymakers   responsible we need to ask our policymakers what  are you doing about aces you want to get my vote   tell me what you're doing about adverse childhood  experiences and toxic stress to ensure the health   and well-being of the next generation I'm gonna  vote for unity peace that I want to say and I'm   always really so there's one other piece that  I want to say which is that we don't have big   pharma dollars bankrolling this work so we also  need to invest in this work as individuals right   there are so many organizations that are doing  excellent work on adverse childhood experiences   in toxic stress and you know at the Center  for youth wellness we literally we don't get   any government dollars right we because so the  government isn't investing in this work it's   an investing in these broad scale prevention  strategies and if we want to see advancements   in the treatment and the care of kids who are  experiencing adverse childhood experiences we   need to invest in the folks who are doing this  work and advancing the field sustainability is   so so critical and so important in this field  you've talked about the medical system and this   is all about systems and how we're going to  create this change I want to talk about the   education system and an audience member question  is how can we bring this information down to the   early childhood education community I would say  the entire k12 you know up to higher education I'm   aware that folks are focusing on trauma-informed  practice and you talked about that a little bit   but I'm not convinced that there's a connection to  ASIS in this dialogue so can you talk about what   are the changes that are gonna have to be made in  the education system or do you see changes that   are gonna have to be made in the education system  to really understand that the youth that we are   educating may have significant adverse childhood  experiences sure I so there is a very very very   powerful connection between aces and educational  outcomes right and I talked a little bit about   underperforming schools my own introduction to  this work where it's all the all the parents   who were bringing their kids to me saying you  know I've been told that my child has ADHD and   I'm looking for a prescription for Ritalin right  and the the piece that is so important here and   I have spoken to some very very very frustrated  teachers who are trying to educate children who   are experienced high doses of adversity and in  our own Center actually in my clinical practice   one of the first things when I I did when  I learned this research is we did a chart   review of our own patients and we actually did a  scientific study and looked at the percentage of   our kids who had experienced aces and and what the  effects were on their health and the two outcomes   this was researched with dr. Victor carrion best  Stanford with Stanford that's right and the two   outcomes that we looked at were their risk of  being overweight or obese overweight or obese   and having learning and behavior problems and  what we found was yes two-thirds of our patients   had experienced aces twelve percent of them had  four more aces but these weren't adults reporting   retrospectively what had experienced what they had  experienced by the time they were 18 the mean age   in our study was eight years old right so these  kids have a waist to go but what we found was   that our kids with four or more aces were twice  as likely to be overweight or obese and their   risk of having learning or behavior problems  in school thirty two point six times as likely   to have learning and behavior problems in school  then our kids then our kids who were also living   in bayview-hunters point right you know it's same  neighborhood same population right black and brown   kids right but if they had four more aces they  were thirty two point six times to have learning   and behavior problems in school and I talked to  a lot of frustrated teachers who are saying I'm   trying to educate this kid but he's having all  of these problems and I said to a teacher in   Philadelphia one of the biggest challenges that  you're having right is that ya ask teachers are   it's an expected part of their job that they  are supposed to deal with behavior problems   right that's a normal thing but what we're asking  teachers to do and the reason so many of them are   so frustrated is because these teachers are  dealing with a health problem but they don't   know it and they don't have the resources that  we apply to dealing with health problems right yeah if you had a teacher in front of a class  right and 20 out of the 30 kids had epilepsy   right and if they were in their seat no one would  be like so how are you star test scores right like   it would just be totally unfair and that is why  imagine imagine the difference in our society   and particularly in our vulnerable communities  and our underperforming schools if every if this   is my idea so you guys feel free to take it at  implement it right if you know that form that   you need to have signed in order for your kid  to get into kindergartens got to be signed by a   doctor says the kids got immunizations they've  had their TB test if that form said this child   has been screened for Asus you don't have to put  their a score on there we maintain patient privacy   all of that stuff just that a doctor has done an  A screen on this child and if there's any abnormal   findings it's our job to deal with it right it's  not on the teachers to try and fix this Bob it's   our job to deal with them imagine if that was  required on the kindergarten entry form and every   child by age 4 no later than their then had been  screened for aces that is a policy strategy to   ensure that can you imagine the difference if  those kids were then getting being recognized   early getting early intervention that was more  likely to be effective so that there we would   you know these these white matter changes that we  see in brain structure and function that teachers   are no longer teaching against the neurotoxic  effects of toxic stress but instead they're kids   were getting early multidisciplinary interventions  and had the opportunity to show up in a classroom   ready to learn thank you so much for that call  to action we have a call to action and you talked   about early on that when you were going through  Medical School no one was talking about Asus and   I'll read a member of the audience's questions  60 minutes just did a segment right Oprah with you she did this wonderful segment she  discussed trauma-informed care and the experience   that we need can you talk about the progress  that's been made why now are we beginning to see   in mainstream media Oprah on 60 minutes in The New  Yorker why are we beginning to see a conversation   about Asus OMG well I will tell you that this  height this increased national awareness is one   of the most important things that can be happening  around this issue because if there's one thing   that we learn also in the public health playbook  is that you can figure out really sophisticated   and expensive treatments for things right but if  you want to change the population level burden   of disease the number one most important thing is  raising awareness for the purposes of prevention   right so we all remember those days back in  the day there's not a few younger folks here   right where people the mom would be driving in  the car where the four kids in the back of the   car none of them wearing seatbelts she's puffing  on the cigarette right and then we learned like   Oh secondhand smoke kills right and then we had  policies like click it or ticket right and we had   this public health infrastructure for making sure  that every person knew what they were supposed to   do right every person knew how they could prevent  it in their own little ecosystem and I my husband   will tell you cuz I was in bed watching  60 minutes like screaming like oh everyone and this is so powerful when we armed individuals  with this information of how to not to prevent but   also how to you know Oprah I don't know if you saw  the after 60 minutes yes it was when Oprah said   this she's done a lot of stories in her life this  is the single most impactful story she has ever   done it changes the way that she does everything  it turned to changes the way she sees her staff   the way she interacts with people all of these  pieces right and that is wet when we know better   we can do better knowledge is power and that is  why raising national awareness is one of the most   important things we can do that's why I wrote the  deepest well that's why our Center the Center for   youth wellness is launching a national public  education campaign called stress health we're   sending out these messages to parents and families  we've launched a website hey if you have aces if   your parenting with aces here are some resources  for you if you think your child has toxic stress   here are some of the things to look out for and  here are the things that you can do it's stress   test - health.org anyone can go to the website  this is and why are we having it now because of   the incredible hard work of advocates that have  been working tirelessly over the past decades   right to raise awareness about this issue and  the good news is y'all it is working so every   single person that's in the audience right now go  home get on your Twitter get on your Facebook if   you're still using MySpace that's okay good right  but we need to shout it from the rooftops because   when we raise awareness we can change the way our  society responds to this issue thank you so much we've really we've reached the end of our program  we have just time for a few closing words and you   you you probably just said it but maybe say  it again clearly people are passionate we have   amazing questions and we have a sold-out theater  people are watching Oprah they're jumping up and   down on the bed with you but before we go tell  us how we individually and as a community as   a San Francisco a Bay Area community what can  we do to advance this work and protect kids so   there are a couple of really important things that  every single one of us can do right number one is   spreading the word and be part of the solution by  raising awareness number two as I mentioned it's   really important that we invest in this work right  regardless of whatever capacity if it's even you   know you know five cents or whatever it is making  sure that we are enabling this transformative work   to happen but I'm gonna tell you all that this is  long work right and when we're talking about aces   we're not just talking about those people we're  talking about us right so I encourage the folks   who are in this room to do a little pulse check  maybe check your own a score we know that the   most important thing that we can do to counteract  the effects of toxic stress is safe stable and   nurturing relationships and environments and  in order for us to be able to do that we need   to make sure that our own stress response is  in check right and one of the most important   ways that we can do that is with self-care right  we got to take care of ourselves we have to make   sure that as we are going into this work in order  for us to be available to be doing this work over   the long haul right that we are practicing  self-care we're taking care of ourselves and   each other I want to thank you oh and get the  book right thank you so much for your attention our thanks goes to dr. Nadine Burke Harris CEO and  founder of the Center for youth wellness in this   amazing book the deepest well thank you so much I  thank everyone in the audience and on radio and on   Internet go hug your oxytocin partner I want to  remind everyone that dr. Burke Harris's book is   on sale in the in the lobby area right immediately  outside of this outside of our program I'm Katie   Albright it's been a pleasure to be with you  tonight we're signing off on this meeting of the   Commonwealth Club of California the place where  you're in the know the meeting is now adjourned

Channel: Commonwealth Club of California

Views: 57,409

Rating: 4.9252338 out of 5

Keywords: Nadine Burke Harris, M.D., Center for Youth Wellness;, Author, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, Katie Albright, Executive Director, Safe & Sound, Health and Medicine, Commonwealth Club of California, San Francisco

Id: MDTW89Ycxw0

Length: 67min 22sec (4042 seconds)

Published: Wed Mar 28 2018