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Overcoming ACEs: A Panel Discussion

The Overcoming ACEs Panel, hosted by Children’s Center, featured voices from the spectrum of child services, including national expert Dr. Nadine Burke Harris, author of The Deepest Well; RJ Gillespie, pediatrician at The Children’s Clinic; Amy Stoeber, child and adolescent psychologist; Sue Skinner, medical examiner at Children’s Center; Ellen Baltus, social worker in the North Clackamas school district; and Fariborz Pakseresht, Director of Oregon’s Department of Human Services.

For Dr. Nadine Burke Harris, a patient named Diego crystalized her understanding of Adverse Childhood Experiences and their impact on children’s health. Diego was a six-year-old boy the size of a small four-year-old. Brought to her attention for ADHD and behavioral issues, Diego also showed signs of asthma and eczema. Dr. Burke Harris knew the workup for kids experiencing these issues, but what caught her attention was the history portion of her examination: Diego had experienced a sexual assault at age four – the same age he stopped growing.

“I started asking myself the question, what is going on in this child’s body? Is it possible that these things are related?” said Dr. Burke Harris.

The 1998 CDC-Kaiser Permanente ACEs study found that there was a profound association with adverse childhood events, such as abuse and neglect, and later life health and health behaviors. Dr. David Labby, Chief Medical Officer at Health Share of Oregon, introduced the topic at the panel.

“It took a while for the world to understand the implications of this,” said Dr. Labby. “People realized that these adverse childhood experiences were happening at a very critical time in human development: when the infant is building the brain.”

Dr. Burke Harris read the ACEs study years after its release and in conjunction with subsequent research suggesting that, regardless of health damaging behavior, individuals with high ACE scores were still at higher risk for health problems.

“The further out I get in this work,” she said, “there is another piece that I think is really important, which is that the science is not enough. We have to pair the science with advocacy.”

For pediatrician Dr. R.J. Gillespie, opening lines of communication with parents and caregivers about their own ACEs, and providing a supportive environment, made all the difference in identifying and treating their kids’ ACEs. Listening, he said, was key.

“Families who have experienced trauma can have in the back of their head that they may somehow pass that trauma on to their kids,” said Dr. Gillespie. “It’s a worry in the back of their mind that is unspoken. But when that worry is out on the table, they realize that they have a partner in their pediatrician, someone who is really going to walk with them on this journey.”

At Lot Whitcomb Elementary in Milwaukie, OR, Ellen Baltus is a school social worker working with kids and their teachers. Specially designed and staffed spaces in the school, such as “Pause Areas” and the “Wolf Den,” provide calming atmospheres where kids can self-regulate and reset. As a result, she says, teachers are calmer, too.

“Teachers aren’t trained on how to respond to trauma and vicarious trauma,” said Ms. Baltus. “One of the biggest things we do at Whitcomb is to meet with teachers individually each week to debrief some of those situations and look at their own self care.”

Dr. Sue Skinner is the Medical Examiner Supervisor at Children’s Center. ACEs, she said, affect both the child and the caregiver. This is why Children’s Center, a child abuse prevention and assessment clinic, has a masters-level therapist talk with parents and caregivers while the child is being seen by a medical examiner.

“Screening for ACEs is not just the child and it’s not just the caretaker. It’s both,” she said.

Dr. Skinner, and many panelists, stressed the difficulty in ‘passing the baton’ between systems. Without intentional collaboration, complex problems like child abuse cannot be solved. Fariborz Pakseresht, Director of Oregon Department of Human Services, agreed.

“Today, many youth in correctional facilities are there because there are no community systems that will take them,” said Mr. Pakseresht. “So, we were forced to create a program that focuses on emotional regulation, trauma-informed care, skill-building and giving these kids a community that they feel they could belong to.”

Dr. Burke Harris ends her book The Deepest Well with her vision of a future in which ACE screenings are a routine part of pediatric examinations and required at entry into Kindergarten. Dr. Gillespie hopes all parents will come to him, asking when they can talk about their ACE score.

For Dr. Sue Skinner of Children’s Center, her vision is simple:

“I hope I don’t have a place to work.”

The Overcoming ACEs panel aired on OPB’s Think Out Loud on April 30. See the audio recording here. Children’s Center would like to thank Dave Miller for moderating this panel, Health Share of Oregon for sponsoring, and Providence Willamette Falls Community Center for hosting.

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