Nadine Burke Harris, MD with Kristin Leong: Healing the Long-Term Effects of Childhood Adversity

a part of the conversation in the city we hope you will consider joining our membership dr. Nadine Burke Harris is the founder and CEO of the Center for youth wellness in San Francisco's Bayview Hunters Point in 2005 she joined the California Pacific Medical Center staff tasked with the goal of developing programs to end health disparities in San Francisco and in 2007 with support from CPMC she became the founding physician of the baby u child health center and the medical director of that new clinic which became the crucible for her understanding of childhood wellness and in particular the effects of toxic stress on children and their families dr. Burke Harris has been the subject of a New Yorker profile was featured in a book by another town hall guest Paul tuff his book is called how children succeed she received a prestigious Heinz award in 2016 among many honors and her TED talk how childhood trauma affects health across a lifetime has been viewed over three and a half million times Kristen young is town halls Community Programs curator she's one of 30 international ted-ed innovative educators of 2017 and the curator of hashtag education so white which is turning a town hall into a multi-year investigation scheduled this year for March 15th she's also leading the work with our artists and scholars in community that will be a huge part of the inside out experience later this spring Kristen will join dr. Burke Harris in just a moment to discuss her latest book the deepest well healing the long-term effect of childhood adversity please join me in offering a warm Town Hall welcome to crystal young and dr. Nadine Burke Harris thank you welcome dr. Burke Harris welcome to all of you here today to begin I would love to see who is in our audience today please raise your hand if you are a doctor any pediatricians in that group excellent welcome raise your hand if you are a social worker thank you raise your hand if you work in if you are mental health professional yes thank you raise your hand if you are a teacher [Music] raise your hand if you work with children raise your hand if you think you might know somebody that has at least one ace in their life well welcome we are we're thrilled to have all of you here today with us I wanted to begin the event by going through dr. Burke Harris's adverse childhood experiences questionnaire and for this please you don't have to raise your hand and in fact you should not but go ahead and you can think for yourself if this counts as a one for you or you can think of a child that you love if it counts for a one for them but go ahead and keep a running score in your mind and and that will be your your ace score number one your child's parents or guardians were separated or divorced number two your child lived with a household member who served time in jail or prison number three your child lived with a household member who was depressed mentally ill or attempted suicide you saw your child or heard household members hurt or threatened to hurt each other a household member swore at insulted humiliated or put down your child in a way that scared your child or a household member acted in a way that made your child afraid that he or she may be physically hurt someone touched your child's private parts are asked to your child to touch their private parts in a sexual way more than once your child went without food clothing a place to live or had no one to protect him or her someone pushed grabbed slapped or threw something at your child or your child was hit so hard that your child was injured or had marks your child lived with someone who had a problem with drinking or using drugs your child often felt unsupported unloved and/or unprotected at any point since your child was born your child was in foster care the child experienced harassment or bullying at school the child lived with a parent or guardian who died your child was separated from his or her primary caregiver through deportation or emigration your child had a serious medical procedure or life-threatening illness your child often saw or heard violence in the neighborhood or in his or her school neighborhood your child was often treated badly because of race sexual orientation place of birth disability or religion if this room matches the research that dr. Vera Burke Harris found 67% of us have at least one ace score and one in eight of us has four or more it would seem that we're all drinking from this well I would love to begin with the title of your book the deepest well healing the long-term effects of childhood adversity the metaphor of the well runs through the entire book can you talk to us more about how you arrived at that title did you know that that would be the title from the beginning so so it the book actually had a slightly different working title and initially the working title was just the well and that idea came as a double meaning between the well as the source of the problem and also the well in terms of the opportunity for all of us in terms of well-being and ultimately we ended up going with the deepest well because I think it was really important to communicate how fundamental the issue of childhood adversity is to so many of the fundamental things in our society that we're all grappling with and it feels like often times we are each [Music] you know feeling like it almost seems insurmountable and yet it's so critical for us to recognize the source of the problem and and begin to tackle the root of the root and when we do that it feels like we can be much more effective the first time I encountered your work was actually a few years ago when I was still a classroom teacher and the study that is at the core of this book was presented to us and we are sort of bowled over by the prevalence of early adverse childhood experiences in many of our students lives and we were sort of presented with this data and and left to think about these are many of your students in fact these are most of your students if the data translates right and then we were sort of left to our own devices about what to do with that information you took that same study and this has been your work doing something with that information what is your hope with this book what is your hope will come out of this so it's not just my hope it is my it is my fundamental belief that we can use this science and this information to transform the way our society responds to childhood adversity and I think a big part of that is one of our biggest obstacles is simply myth and misinformation and that is why I wrote the deepest well because we have this kind of intuitive this this sense and it's a false sense that oh well you know sure lots of us have been exposed to childhood adversity well so first the first myth is like this is what happens to those people right that doesn't happen in our neighborhood looks like I'm sorry the data took care of that 67% of Americans right so this is not those people I don't know who those people are the second piece was it was like okay so you know sure you know everyone's exposed but you know oh I had childhood adversity and I pulled myself up by my bootstraps look at me I am you know whatever I am and that's not what the research shows what the research shows is that is that yeah some people will develop behavioral symptoms but some people will develop heart disease some people will have a stroke some people will develop asthma or diabetes some people and when you look at that if we're only counting the people who have behavioral problems if we're only saying okay these are the folks this these are the folks who are affected by childhood adversity and we're not counting the rest then we are missing this massive opportunity for folks to begin to recognize not only how it's affecting themselves and their loved ones but also the fact that we are all drinking from the same well right you bring up this idea of pulling yourself up by your bootstraps this is such an American idea that combined with the medical community also had some resistance you said in your book one physician in the audience after you presented insisted that patients stories of abuse or fabrications meant to provide cover for their failed lives when I hear attitudes like that combined with this idea that we should all just pull ourselves up from with our bootstraps you're up against some pretty heavy-duty resistance to this work did you know going in that you are gonna be facing a lot of pushback to this so that that comment was originally made to Vince felitti who was the original researcher for that experience a study and you know a funny thing when I first started this work I I figured right when I read this research I figured that oh my god okay well people just don't know about it but the minute I say something like everyone's gonna be like yes let's do routine screening multi-disciplinary care crazy thing and yeah there were some huge headwinds and that's a big part of the reason why I started the Center for youth wellness because this whole concept of you know all of these myths that the thing about me which i think is makes me very well-suited for this work as two things number one I'm hopeful and number two I'm a science geek so I'm just like okay we are going to lay out the data because this is not something that we just made up there's ridiculous amounts of evidence now and in fact our team at the Center for youth wellness reviewed over 16,000 research articles to pull together a lot of the science that is in this book our team works incredibly hard and and at this point I feel like using that science and that data and and and making sure that this is an unimpeachable argument we're just laying out the facts yeah it's part of beginning to do some of this myth-busting Arvind your book begins that way you the first half the book it does feel undeniable by few chapters and your grizzling yes like this is obviously a problem and this is obviously a very simple and actionable solution you are you fill us with case studies and statistics and data and it seems undeniable what I'm struck by with this power of this book is that you start there but then it arcs to arrive at that other part of you that is that hopeful very human mother and human being and and the impact I think of this book is that it really does combine that science geek side of you with that hopeful optimistic or human side of you was that planned from the beginning did you outline that out did you know that you had to lead with the science lead with those statistics that's a great question it it wasn't that intentional so as a doctor and a researcher my inclination is always to lead with the science and and in fact there was a way in which that I think for myself I think up until this book the focus of my work has been putting the science forward and in the process of writing this book I've really come to this understanding that this is us this is all of us and by the time I got to the end of the book I think I felt more comfortable putting more of myself as a mom and as just a human being into the book and that was it felt very vulnerable and at the same time I think I'm asking every person in this room every person across this country to to go on this journey with me and in doing so I think it was really important to recognize that it's going to be a personal and difficult and vulnerable journey for many for all of us and so that's why I ended up including more of myself in there to bring in mindfulness into the center in Bayview and you were looking for someone to help lead that with your patience and you said that you didn't want to have like someone named Moonbeam [Laughter] what about some chakras into crystals was there fear with bringing that personal side of yourself into this book because your TED talk is absolutely staggering it's so powerful but what this book has that the TED talk doesn't is that personal side of your story and what was their fear for you in writing this and sharing that side of yourself with not only your readers but with the medical community that you would become moonbeam so I mean that's probably part of the reason why I kind of lead with the science a little bit because by the time you get to Moonbeam you realize like I'm not totally you know it's not a hundred percent like crystals and chakras but I and also I think when I talk about things like meditation as an important intervention for this work I I also talk about randomized controlled trials in which you know one group is randomized to into meditation and the other one is in is randomized simply into health education and of these patients with heart disease the the patients with who are randomized to meditation had better performance on their EKGs had better performance on their cardiac stress tests right and had you know improved heart functioning right so even when I'm talking about something like meditation I'm talking about it because that is what the research shows I want to hear a little more about sister Jay which is an incredible story for those that you have not read this really pushing back very hard against the creation of the center which is an interesting criticism because it's like she sees you as kind of kind of the enemy in a way that it's like taking advantage of the children right which is a different kind of it she doesn't question the science she doesn't - and so I don't think that was actually it so I think sister Jay I'm so wind so for those who haven't read the book yet when we were getting ready to start the Center for youth wellness and in Bayview Hunters Point in San Francisco very underserved neighborhood there was this tiny pocket of resistance and it was some fierce resistance and what's in the book is an understatement of what happened I'm just going to say that much it really is but and can I say it won't give it away I don't think I can say so one day one of my team members right because my team it's like hustling we got to get permits for this you know this building we're trying to get this up and running and one of my team members is out in the community and there is sister Jay passing out flyers and these flyers the headline is stop the massacre dr. Burke wants to experiment on our children I am not joking I wish that I had kept this flyer just for two for historic purposes and it was crazy I mean you can imagine for me as a community pediatrician working in an underserved neighborhood and especially especially as a black woman as a black doctor knowing the history of what the medical community has done in black communities and Here I am I've dedicated my life to serving this community to improving the health of our children and this woman is now taking that historical fear that historical trauma and using it against me because she heard that a foundation had raised some money for us to open the center and frankly I think it was she thought we were deep pockets and this is a person who has done incredible activism in many positive ways in the community but who any activism she does some of it ends up in her pocket and and and that process was heartbreaking and discouraging and it's the type of thing that makes you want to say forget this I'm gonna go work across town and by the way I'll get paid better but the the thing the lesson that I took from that that was so powerful to me that actually redoubled my commitment to this community is oh this is community trauma this is trauma happening at the community level and I recognized it because I was going to bed at night and I couldn't sleep my heart is pounding I'm thinking oh my god is this really going to stop this Center from being built and and when I recognize that that endemic community trauma is actually it's part of the system and the cycle and that there was a lot that we could do to be part of breaking the cycle in this community it was that is what kept me going and meeting sister Jay with empathy could you share a little bit about what you realized about her own story well it's so funny right this is the case and we almost want to call it ironic but it's not ironic it's actually causal like this is this is how it works so I you know went to sister Jays home to sit down with her and hopefully you know knowing that we were both advocates for this community that we both loved maybe I could reason with her you know because she had appealed our building permits and as I sat down with her and we had tea in her house I was at her house for over two hours I got an almost zero words edgewise in fact when I arrived at her house she handed me her business card and it said sister Jay that's right community icon right like that was I'm not joking that's real right that's what her business card said community icon and and we sat we sat down and she went through for that two hours and told me all about her life and it was one of those you know she was like the the the african-american matriarch you guys can get a picture of what I'm talking about where you you sit and you listen and she spoke and I listened and as she was talking about her life and how she had grown up in the south and then came to San Francisco and all of her experiences the the thing that to me that was so ironic was that by the time she finished just regularly telling me the story of her life in my mind I was doing a mental tally and she had probably you know eight adverse childhood experiences and it's like yeah this is this is how this is transmitted right this is how this and and it also helped me understand that that's a big part of why I was dealing with the resistance that I was dealing with and how important again this healing is on a community-wide level pediatricians and also teachers would have the time and training to be able to listen like you did with sister Jay to all of the stories of the children that we care for but of course there's never enough time and there's never enough training and you talk about that frustration and you say that the problem with before there was the questionnaire doctors had to just rely on asking patients about their history and the problem with this approach you say is that it took a long time and sometimes that that the doctor asking questions had to navigate a serious emotional obstacle course that most primary care clinicians neither have the time or training to navigate thoughtfully in addition to Universal screenings of aces where where can we also talk about training of not only primary care doctors but also teachers to be learning how to listen to kids perhaps similar to the way that you listen to sister's day with empathy so I think this is one of the most important things that I want to talk about this evening which is that I think especially given the fact that you know 2/3 of us have experienced adverse childhood experiences right and oftentimes what that does is so let me you know when for when folks first talked to me about this when I first I talked about this issue oh she's like oh it's 2/3 of Americans it's too big you can't solve it you can't solve it and I was just like hmm that means 2/3 of people know what this feels like and probably a hundred percent of people have a loved one who this is affected so actually that's the cavalry right these this is this is the this is the bench but the challenge with that often times especially for folks who do know what this experience feels like we want to rush into the burning building right we want to run in and and save folks and oftentimes if we are not thoughtful about how we do that it's really easy for us to get burned out it's really easy for us to experience vicarious trauma it's written and so one of the most important things that I think that we can do when I talk to doctors they say this is too overwhelming how are we supposed to respond to this in clinic we can't screen everyone we don't have the resources it's too much to do I talk to teachers oh well how are we supposed to respond to this we don't have the resources too much to do you know social workers well you know and and for me it's just getting clearer and clearer that we don't each all have to do everything doctors have to screen universally because all the science shows that the earlier we identify the earlier we intervene the better the outcomes are the more efficient this work is the more effective this work is educators have a really important role to implement trauma-informed and trauma sensitive educational environments and that means training everyone in the child's educational environment from the bus driver to the lunch person to the teacher to the principal about what symptoms of toxic stress look like and being able to create educational environments that are responsive but often teachers ask me oh well how can we should we be screening for aces in our school no you don't have to scream you let us but let's let's divide and conquer let's decide who's gonna scream okay doctors we want to get kids from the time there's zero so we're gonna say you know every child serving medical professional is doing the screening right we'll we'll figure out all the protocols wheel because that's work we're gonna have to figure that out educators you figure out what a trauma-informed educational environment trauma sensitive and responsive educational environment looks like all right um social workers you figure out your piece mental health practitioners you you make sure you know you guys are the furthest down the field you're the ones who've been knowing about this and responding to it the the longest and as we each take our piece right whether you're you know at employer and you're thinking about how to have family friendly and family supportive work environments and policies whether you're a policymaker whether you are a funder and you are part of creating this infrastructure what's important right now as people are waking up to this issue is making sure that we are creating the right linkage the right infrastructure the right systems for us to be able to work together so that we can create an ecosystem of support for children that changes outcomes the screen is so simple yes and it's so it seems so easy to implement and part of what makes it so simple and so actionable is that it de-identified screen mm-hmm and that seems so simple but it actually blew my mind coming from an education background to think that we need to know if fish trauma is present in a child's life in order to move forward but that doesn't mean at that moment we also need to know all of the details and unpack that trauma at that time and that the first step is knowing the number can you talk more about how important it was to to realize that the screen had to be de-identified in other words we just want the number and that patients didn't have to explain the specific trauma or which ones that they had a number one next to so when people think about innovation right in the in the in the science of aces and toxic stress oftentimes people are thinking oh well you're going to develop a pill are you gonna develop it and and people underestimate the importance of process innovation as opposed to product innovation it's not necessarily creating a new thing it's doing things differently so when you talked about like the doctors who had to go through this really difficult experience of screening you know I'm talking about myself right right it was years when I first read the ACE study for me it was critical to be able to do this early identification but it started out I was just asking right and then we you know in our Center we were doing this you know trying to make the process easier and faster and and then you know we had a paper checklist and then the next piece was figuring out okay how do we improve on this and there was actually I talked to a guy at Hopkins who was the the a researcher who mentioned that for one of the screens that they did they actually had a de-identified screen and I was like oh my goodness we're in the house of the Lord and so the reason that this de-identified screen is so important we don't ask our patients which ones of the Aces that they experience only how many and this is because in order to make sure that every child is screened the screening has to happen in primary care if if you're waiting for a child to get to the mental health practitioner it means that that child is already symptomatic which means that the biological process has been going on for long enough that it has changed the child's biology right so rather than waiting for them to be symptomatic and then reacting to that how do we get upstream to identify kids are at high risk to put in the supports and the two generation work for families to prevent kids from developing toxic stress in the first place but in order to be able to do that right you have to have a fast and easy screen because my appointments are 15 minutes long right 20 if I'm lucky and I may have 10 of them in an afternoon right so in order to be able to do consistently for every patient day-in day-out at scale we had to figure out a way that I did not have to unpack this the entire history of adversity for each of my patients and the de-identify screen allows a pediatrician to be able to assess a child's risk high a certain you know low moderate or high risk for toxic stress in three minutes or less and then connects them to someone who has the expertise who has the time who has the capacity not only to be able to contain that process both for the the family right but also for themselves right we're trying to think about water how do we thoughtfully design these systems that allow us to be able to do this work at scale in a way that is sustainable and that is what you know our team at the Center for youth wellness is thinking about day-in day-out every single day is that you know our goal is that every pediatrician in America will be screening for adverse childhood experiences and right now we're only at 4% so we have a long way to go but I believe that we will get that your hopes for that comes through loud and clear in the book and but you wait you wait to bring that on which is like such as you go on a journey in this book and before you arrive at the hope it's so clear that this is such a crisis it's a crisis in the medical world it's a crisis in our education world it's a crisis not only for all of our children but for for many of us as well and it really is so beautiful at the end to feel that hope from you not only as a doctor but as a mother and then ultimately also as a daughter and then you not only infuse this with optimism you give us an action plan which is excellent and in fact you outlined six things so if you're if you're learning about these days and you agree that this is a crisis and that we do need Universal screenings and that it's tragic and yet somehow comforting perhaps to find out how common this is how linked we all are to this know that there is an action plan and you lay out six things that we can do it and here are the six things you say suite exercise nutrition mindfulness mental health and healthy relationships which all sounds great like I'm in for that action plan but but for those of us who are busy perhaps working or going to school or parenting or all of the above is there like a priority are there like a couple yeah so the action plan happens in the context of the framing the action plan and the framing go together and them I would say the most important thing that we can do is understand that the fundamental problem is an overactive stress response that's that's the biology and when I when we list out the six things those are the six things that we have some of the strongest evidence for that actually mitigate the impacts of toxic stress so they they reduce stress hormones they reduce inflammation they enhance neuroplasticity but one of the most important things about that is doing it in the context of you know we know that this is a combination between nature and nurture there's individual variability how our adversity affects us but recognizing like oh hey wait a minute do I have is it possible I might have a little bit of an overactive stress response let me just take a little pulse check here and then understand what seems to work the most for me right like for some folks and I see this with my patients for some of my kids you know the the pieces that are really critical are you know making sure that they get regular exercise for you know making sure that they're getting the the mental health care and for kids and particularly that two generation approach but for us as adults I think we kind of know like oh you know what when I go for that run and I do it you know five times a week I just feel right right like I feel better or you know when things are really difficult with my spouse or I'm dealing with all kinds of pressure and I'm sin I can feel like the stress hormones you're building up in my body like I know I have that one girlfriend that if I can you know if I reach out to her and I or you know we got to get together for a cup of tea that that heal that relationship is healing to me it's it's those pieces of putting the two together and when we understand what the problem is we can begin to individually calibrate what works best for us and he said that as a human being I was brought to my knees by it as a scientist and doctor I got up off those knees and began asking questions your questions have led to such a powerful tool that I agree should be universally implemented but what would you like to leave us with if we're if we're not a pediatrician if we're not no place to implement this questionnaire what can we do every single one of us is a very important part of this solution and if there's one thing that I want to leave folks with is one of the biggest things that we need right now is we need the public well because in order to implement all these things to put into place all of these this infrastructure the right support for educational environments right the actual funding for you know the reimbursement for doctors to be able to screen universally right now all the work that our team is doing we gotta raise money for it we don't even get any reimbursement at the Center for you all this so in order that's not gonna work if every doctor in America has to be raises the money to do an ice cream right we need the the public will to demand demand investment in the infrastructure in the policies and the practices in the supports for parents for educators for judges for lawyers for police officers for doctors to be able to be part of the solution without having to be wearing themselves out throwing themselves up against the same wall over and over again because this is long work and we have to make sure that we can do this in a way that is sustainable for long enough to achieve public health scale change it's so much your book you're talking for being with us here at Town Hall tonight we know that men at Town Hall many of our speakers inspire lots of our audience members to tell stories but I suspect that dr. Burke Harris's book especially might inspire us to share where we've come from but we know that there will be probably a lot of questions tonight so if you could please keep your questions succinct and also in question format we would love to hear from as many people as possible please come up and use the microphones on either side of the stage and form a line and hello hello hi hello um I've a two-part question my name is Jodi Ann and it's both around two disproportionate uptake of the interventions that you're talking about and so the first part is when you're talking about really marginalized communities be it by class race etc when you're how do you get this public will and targeting those resources to the communities that actually need them right I mean everyone needs them yes but I've worked in some schools in New York where they were really wealthy have the money they have the Peet the strong PTA to advocate for themselves they had the mindfulness and the breathing classes and whatever and I've worked in really low income schools and they don't have the resources they don't have the ability to uptake the things that you're talking about and then the second part is the disproportionate uptake of the action plan of the interventions because often these people in these communities don't have you know really strong ability to access help like exercise taking time to go for a run or have the right foods or you know have those healthy relationships and so I understand what you're saying but it's going to land in different communities differently and just curious about your thoughts on that I think that's a great question and I think the crux of the question is how do we ensure that the science does helps to narrow the gap instead of widening it as the communities that have the greatest resources are able to avail themselves of those resources while other communities are left behind and I think that a big part of that ultimately is around how do we ensure that all communities have access to the healing interventions that make a difference for kids and I think it's a big challenge that we have to face as we're moving forward in this question and one of the big pieces of it is one of the just the ways that that I've approached it is I believe that with some of our with investments in research in investments in so let me give accent let me give an example hiv/aids right initially you know folks thought it was a gay men's disease and then we you know Ryan White yeah I don't know folks remember there's a you know a little Caucasian kid by the name of Ryan White who got who got HIV and when when Ryan White got it all of a sudden it was very important for all of us to make sure that we had a cure for AIDS okay and and then the federal and then folks unified and the federal government invested huge amounts of dollars in advancing the the research into detection early detection developing the HIV AIDS test investing in antiretrovirals and hiv/aids went from a mean mortality of six months right 50% of people were dead six months from diagnosis to now on standard antiretroviral therapy the the life expectancy is more than 50 years when folks got that self interest when they looked at Ryan white and said ah man that could be my kid then we poured the money into the resources that lifted everybody up and now even though we still still see disparities in outcomes what we see is that for everyone the outcomes are far in a way just unbelievably better than they were six months ago and that is what I'm hoping will happen with the science of toxic stress I wrote it down so you've talked a bit about the importance of pediatricians and other doctors who work with kids doing Universal screening starting at birth and I wonder if you could share your thoughts a little bit on including and expanding preventive services to include folks like obstetricians to screen new mothers and talk about their lived experiences and really addressing this intergenerational transmission of trauma amen my sister [Laughter] [Applause] so so there are actually in in in in California and Kaiser Richmond they actually did a pilot of a screening in pregnant moms and that is ideally something that I would absolutely love to see because I'm not an OB our team has been focused on like the the protocols of doing this in Pediatrics but I mean frankly to be honest if we want it to do better medical care we'd be doing it in OB we would be doing it in pediatrics we would be doing it in adult medicine we would be doing it across a life course because the impacts of aces are across the life course hi thank you so much for talking with us and I just gonna ask where and how do we thoughtfully community design systems that permit eco therapy and practices that you mentioned such as mindfulness to be accessed by underserved and underrepresented populations that increasingly live in the urban environment and as a result of things like segregation and redlining have often lived fragmented from healthy green space and habitats oh that's a great question so the I think that increasingly so this is why raising national awareness is such a critical part of the solution to this work because the you know as one of the things that I say in the book is that when you understand the fundamental mechanism when you understand that what folks are exposed to changes their biology in ways that affect our entire society then you don't have to be a doctor to be part of the solution you can be somebody building community housing you can be part you know part of Housing and Urban Development Ben Carson can you hear me right you can you can you can be a community-based organization you can be someone designing green space and and that is the point is that when we put this knowledge into every aspect of our society then we can it will change the way that we do things in ways that you or I or the folks in this room might not ever even imagine right there's someone out there who is so deep in this work who are now everything that they do is being is being filtered through this lens and and and hopefully those folks are thinking about how can I be part of the solution sure hi Nadine hi so unfortunately I feel like many of us here interact with kiddos in an emergency situation it's pretty reflective of our Western culture of Medicine where it's it's in that crisis management moment I wanted to ask you for any pointers and like a who what when where how like what the best ways that we should be implementing ace questionnaires in obtaining those a scores in a crisis management situation for example an inpatient adolescent psych unit so you know it's interesting I I'm not totally sure if well I do think that it's important but I I feel like I feel like in an inpatient adolescent psych unit I feel like you so many more sophisticated tools for assessing and responding to am i wrong but no right now we're kind of just is it a high as it done unfortunately right now I feel like we're utilizing a scores by throwing darts in the dark we don't have that we don't have adequate training and my personal opinion we don't have we're not so we're not asking these questions anonymously we're asking these kids straight out and so they're they're unpacking on top of coming in in this crisis situation whether it's they try to kill themselves or they ended up in police custody whatever on top of that we're asked we're sitting down and asking them these questions and they're unpacking it I just want to get your perspective on our end on the place of utilizing eighth questionnaires in that setting so I'm gonna turn it around and throw it right back at you and this is what I'm going to ask you to do I'm going to ask you first of all to make sure that in your organization everybody's got a copy of my book they write and then I'm all theirs funders in the room funders did you hear this they need donated books over here right so what I wanted to make sure that everyone in the in your organization has a copy of my book and then I want you guys to sit down together and start doing some you know plan do study act these these you know tests of intervention about what you guys can do differently because you know better than I do all of the ins and outs the details and the intricacies of what the challenges are in your day to day and what I would ask you to do is work together with your team to start generating thinking about solutions and and working together to evaluate them maybe there are some funders in there what's the name of your organization Unity behavioral health in Portland Oregon alright so maybe there are some folks in the room who want to reach out to universe unity behavioral health to help them go through that process and develop the resources to be a to be able to do this work so that you guys can feel like you have good systems for solving this problem hi thanks so much for all of your insights so far this evening I only just got the book and have not read it yet so I apologize this is something you've addressed already but I'm curious what your thoughts are on community different driven such solutions to toxic stress I know you mentioned like sister Jay earlier and she may have been beyond convincing but how do you take leaders like her and bringing this knowledge back to their communities where accessing these entities medical these like professional institutions may be a little bit out of reach if that makes sense yeah I am so at the Center for youth wellness way this you know in addition to doing the clinical work and the research the biggest and actually one of the most important now things that we do is this movement building work and we just started something called the stress health campaign a the stress health public education initiative for anyone who wants information or who wants to direct parents who can get more information or even to do their own ace test its stress health STR ESS - health.org and our initiative right so this is my like secret plan so the the book and the TED talk and all of this stuff is part of what we call the air game and we're working on doing you know a social media campaign to educate folks but the other piece of it is the ground game and one of the things that we are in process in working on is pulling together a toolkit for communities to be able because we know the the power of community the power of connection the power of the people leading right and to give folks resources so what's going to be included in that toolkit is okay so what are the resources for doctors to be able to screen what are the resources for educators what are the resources for parents and and a community toolkit to be able to deploy this work hopefully at scale at a community level so coming soon we're in process if we get the funding so we'll see I hope we will we will that we yeah so a child who experiences a traumatic loss or a traumatic event do you think that if they had such severe toxic stress that it could actually cause an acute medical event that couldn't be explained medically like not not just you know chronic illness or down the road but an acute medical event like a brain bleed or something like that that can't be explained by other means I think that what we are learning more and more and the the research about toxic stress is that we're now beginning to make the connection between our early adversity the toxic stress response and some of these health outcomes and in fact in the beginning of my book I talk about it was an adult in this case who had a stroke right and and this acute medical event this crisis that he had that he was at dramatically increased risk for because of his history of adverse childhood experiences but nobody knew it he didn't know it his doctors didn't know it and so they didn't know to look out for it and I think that's a big part of the reason why we need more investment in research [Applause] dr. Park Harris will be signing books in the back you will line up to the right

Channel: Town Hall Seattle

Views: 4,705

Keywords: Town Hall Seattle, Town Hall, Nadine Burke Harris, Kristin Leong, Childhood Adversity, childhood, stress, illness, neural system, lifetime, childhood stress, pediatric, research, trauma, adversity, medicine, pediatrician, health, longevity

Id: 4_B0s2Rb6_4

Length: 60min 42sec (3642 seconds)

Published: Tue Feb 06 2018