(Part Two of a Four-Part ACEs Series)
By Kyle Taylor Lucas, Tulalip News
This is the second story in a series on the intersection of chronic health and addiction issues and Adverse Childhood Experiences (ACEs among American Indians. The series focuses upon contributing factors of high ACE numbers and substance abuse and behavioral and health disparities in American Indians.
The ACEs Study became a reality due to a breakthrough from an unexpected source—an obesity clinic led in 1985 by Dr. Vincent Felitti, chief of Kaiser Permanente’s Department of Preventive Medicine, San Diego. Dr. Felitti was shocked when more than fifty percent of his patients dropped out of the study despite their desperate desire to lose weight. His refusal to give up on them led to individual interviews where he learned that a majority had experienced childhood sexual trauma. That led to a 25-year research project by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. The landmark study linked childhood adversity to major chronic illness, social problems, and early death.
According to the CDC, “the Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being.” The study included more than 17,000 Health Maintenance Organization members who in routine physicals provided detailed information about childhood experiences of abuse, neglect, and family dysfunction. The ACEs Study links childhood trauma to social and emotional problems as well as chronic adult diseases such as disease, diabetes, depression, violence, being a victim of violence, and suicide.
Since the ACEs Study, hundreds of published scientific articles, workshops, and conferences have helped practitioners better understand the importance of reducing childhood adversity to overcome myriad social and health issues facing American society. See the ACEs questionnaire, here: http://www.acestudy.org/files/ACE_Score_Calculator.pdf. Learn more about the ACEs Study here: http://www.cdc.gov/violenceprevention/acestudy/
The ACEs research is of significant relevance to American Indian/Alaska Native (AIAN) communities beset with behavioral and physical health issues—disproportionately high as compared to the general population.
Unquestionably, any discussion of social and health disparities in Indian Country must include historic trauma, and the political and economic realities affecting American Indians and tribes. Research into epigenetics subsequent to the original ACEs Study indicates that historic trauma is likely one of the primary contributors to disparate behavioral and physical health issues affecting AIANs. Subsequent stories will more fully explore the physiological brain changes that result from childhood adversity.
Native Strategies – Addressing Historic Trauma in Native Communities
Tribal experts in the area of historic trauma emphasize that while the ACEs Study is important, it is also important to ensure concurrent address of historical trauma on AIANs and tribal communities.
One of those experts is Pam James who is co-founder of Native Strategies, a non-profit organization established with her husband and partner, Gordon James, in 2009. Pam is a member of the Colville Confederated Tribes and Gordon is a Skokomish Tribal member. The two have been consulting on historic trauma and Native wellness in tribal communities for the past thirty years. Pam earned a B.A. Degree in Psychology and Native American Studies from The Evergreen State College and a BHA in community health from the University of Washington.
“Until we established our non-profit, we did freelance consulting. We worked with the Native Wellness organization, sought grant funding, and wrote a wellness book. Then we used our book to write a curriculum that we’ve applied in our work,” said James.
The non-profit allows better access to funding and resources to further their work empowering tribal people and communities. “We are able to provide training and technical assistance absent tribal politics,” said James who noted they are also free to be creative in designing a broad array of programs, training, services, and technical assistance. “We’ve helped several organizations start their own non-profits. We do a lot of grant writing. We do workshops around historical trauma, parenting, healthy relationships, and government-to-government training. We also do planning and program evaluations and help organizations get into compliance.”
James said one of the most sensitive and impactful of their workshops is healthy workplace training. “We look at it holistically, at interpersonal relationships, family relationships, and relationships to all things–earth and to all creation.” She asks, “How do you create a healthy workplace? You can’t do that until you begin to address the historic trauma.” In their work, James said they help to rewire the brain for positive impact, noting, “Behavior is just a habit. We have to change the habit. I do it from a cultural perspective and I blend in humor.”
However, James is mindful of her approach. She said, “every workshop, every training I do, people get triggered,” so she is careful with her audience. They try to unlearn negative behaviors. In the communities, she finds, “Though it doesn’t work, people do the same thing over and over again expecting a different result.” She said their training “takes people back to that value system that our people always had, treating people with honor and respect. We have a roadmap that asks, “What do you want in your life, spiritually, emotionally, and how do you start creating the life you want?”” She said repetitiveness in practice and training is critical and noted the impossibility of creating change in a workshop or two.
Asked whether training the trainer is part of their work, James replied that it was and that it is essential. “We help train the trainer for tribes so that they can teach it themselves. First, we do community training, then a three-day “train the trainer” workshop, and then we come back in 3-6 months to assist them with their first training. It’s very sensitive. What do you do when someone gets triggered? We help to prepare them.”
About their generational trauma and wellness work, James added, “In our training, we’re opening awareness. The second step is intervention. How do we implement and make change? The third step is continuing education and putting it into practice. It is developing new ways of coping, replacing behaviors, and doing it on a consistent basis. It’s a theory and it’s ongoing.”
However, she said, “Most of our tribal communities are in crisis mode by the time they call. I urge them to call us before that.” She noted three stages—prevention, emergent, and intervention. “I urge them to look at those areas and ask, “How do we get to the place where we’re doing prevention rather than intervention?” Tribes have to start looking at this type of training as ongoing. Just like computer classes. This is not a one-time shot.”
In their training, James said they often support eight-week parenting classes. However, she recommends to clients, “Before we do that, let’s do a healthy relationship class!” Again, she says it is a matter of steps, mentally, emotionally, and educationally. “First of all, we start with the parents to help them learn how to interact with each other. We are in a society that wants a quick fix, but there is no quick fix. It’s about awareness, learning new skills and behaviors, and then we have to practice, practice, practice. It’s not about the end result it’s the journey.”
James said she attended one of Laura Porter’s workshops on ACEs and thought, “Wow, this would have been great to know years ago! Oh my gosh, I wish we had been involved.” To date, only a few tribes have engaged with the state’s research work around the CDC ACEs Study and measurements. James believes “ACEs is one piece of the puzzle, one piece of the process for Native people.” She said her non-profit is looking at funding opportunities to develop a curricula based on their 30 years of work. They plan to work with an advisory team of Native people and the curricula will be designed for implementation by tribal communities, and culturally appropriate to their needs.
Specific to generational historic trauma, James believes “The ACEs information doesn’t go far enough. The State is a very good example of a sense of guilt. They don’t really want to acknowledge it. It’s painful to acknowledge what was done to Native people. There is a lot of effort being made to change it, but it’s still there.”
ACEs and Physiological Rewiring of the Developing Brain
Asked about her knowledge of current scientific research on the relationship of childhood adversity and epigenetics—the study of physiological brain changes and potential application to the study of historic trauma in Native communities, James becomes animated. She noted a weeklong workshop she attended with Dr. Bruce Perry, the author of “The Boy Who was Raised as a Dog” and “Born for Love.” She said, “What an amazing man. His focus has been trauma.” She said he validated the tribal community’s long assertions of unresolved multigenerational trauma, and that the brain is actually hard-wired for empathy, but things happen to the brain when babies and children experience adversity and trauma.
James discussed the work of Dr. Patricia K. Kuhl who of the University of Washington, whose trainings she has attended. She co-authored the book, “The Scientist in the Crib.”
At one workshop, Dr. Kuhl presented studies of two children’s brains from newborn to age three–one child from a happy home and the other from a neglected home. They conducted CAT scans at ages 3, 6, and 9 months. At the beginning, their brains were identical, but by the time they were nine months old, the brain of the neglected child was visibly shrinking. Considered in the context of social and health disparities and life chances for AIANs, this is quite remarkable. The above study demonstrated that disparities begin in the crib, but as the ACEs Study and ensuing research has shown, it is intergenerational, and even in the womb. If the mother and father have high ACE scores based upon their own childhood adversity, the children are also likely to have high ACE scores unless there is intervention.
James is optimistic. She said that although the research shows adversity is generational, “It also validates that we can reverse it. It doesn’t have to be permanent. Some of it might be, but we can reverse much of it. Our ancestors adapted. We learned how to adapt for our environment; it is human nature to survive. Those are the pieces that are not happening in our community.”
Family and Community Roles and Traditions
Lamenting the negative impacts of technology, James said, “Televisions, iPads, Xboxes are the babysitters of today. They are impacting how our children develop, how their brains develop. Technology has disconnected us as people.” She grew up in Inchelium where they did not have a telephone until 1978. “All the grandmothers and everyone would come together, bring old clothes, and make quilts. They lined them with old army blankets. There was a spiritual part of that. Every newborn received a quilt. We’re not doing those kinds of activities that inspire and help our children to learn about community.” James is concerned that technology today limits human contact important to a sense of being part of something greater and of the responsibility accompanying it.
Another significant hurdle is overcoming the lateral violence that is a symptom of ACEs. James said that in her counseling work, she discovered, “We get addicted to pity, to negativity, and we become chaos junkies.” She believes people have forgotten about how just to be. “The Vision Quest taught us how to be alone, to be one with nature, to be alone physically and mentally. It taught us how to control our mind, our spirit, and our bodies.” She thinks some of those teachings can be built into the curricula to teach people how to, again, “sit quietly with themselves, to sit and listen.”
Applying the ACEs Study and Measurements to Native Wellness
James’ family of origin was not unlike many Native homes. She and her eight brothers and sisters grew up with domestic violence, alcoholism, and physical and sexual abuse. She began doing this work in 1986 when the Seattle Indian Health Board received a federal grant to put together a curriculum. She was among 40 chosen from different tribes to participate in a two-week intensive training that was life changing for her. “They stripped us spiritually and emotionally. We had to address our own trauma. We could not help others until we worked on ourselves and healed ourselves. There was no college that could give me what that training did!”
In the training, Jane Middelton-Moz, an internationally known speaker and author with decades of experience in childhood trauma and community intervention took part in the training. She addressed the pain of adult children of alcoholics (ACoA), a topic about which she has written extensively. “It was basically an ACE’s study done with Native people and it was all about the trauma.” James recounted Middleton-Moz’s journey to Germany where she worked with holocaust survivors and her later study of American Indian tribes. She discovered that they had developed the same trauma characteristics. “She was a psychotherapist and I felt blessed to have the opportunity to be mentored by her.” James noted that their work has essentially taken Middleton-Moz’s study of ACoA and applied it to multi-generational trauma among tribal communities.
Asked how the new research on childhood adversity can help Native communities, James said, “The ACEs Study is good in that it gives us the validation and affirms what we’ve known. This is what has been happening in our communities for hundreds of years.” She noted the mental and physical health issues evidenced by high juvenile suicide rates, 638 percent higher incidence of alcoholism than the general population, addiction, and disparate social, and health issues in Indian Country are all traceable to generational trauma and adverse childhood experiences.
However, James believes the survey mechanisms must be appropriate. She said, “The reality is that a lot of times when so-called experts go in and do the surveys, the tribal members don’t tell the whole truth.” Tribal communities are tight-knit and everyone knows everyone and their business. It may be that a special survey mechanism is necessary for tribal communities. James said, “It will be difficult to get reliable data if the members don’t trust enough to give accurate information, to tell the whole truth.”
Those involved in tribal wellness have said for years, and James echoes this, that it is important to put the disparate social and health issues in Indian Country into context. “We have people who have suffered such trauma in their lifetimes, in their parents, and grandparent’s lives!” said James.
People forget that generations of American Indians experienced breaks in the family unit caused by the government’s forcible removal of children placed into Indian boarding schools. Indian children were deprived of parental nurturing; many were physically and sexually abused. They did not learn how to parent and nurture their children, but at adulthood, they were returned to the reservation to start their own families and the same cycle was repeated.
In their workshops, James stresses traditions. “We’ve adopted behaviors that were not ours traditionally. Instead, we go back to the medicine wheel, it teaches you everything—body and mind. When you look at what is happening with our communities, we’ve lost touch with all of the ceremonies, languages, and the practices that kept us resilient. There is a veneer of positivity, but underneath there’s all this pain.”
Clearly passionate about her work, James makes the call, “Someone has to be the voice of our children, someone has to stand up and take the arrows, stand up and say this is not what our ancestors wanted. I really believe this is the core work if we can get it into our communities, we’re going to change, and it has to take place for our survival.”
Integration of ACEs Research in Tribal Family Services and Other Programs
As Sherry Guzman, Mental Health Manager in the Tulalip Family Services Department said, about the ACEs Study, “Most tribes were very leery at first, but I went forward with it because I saw the value of it. It enabled me to see the difference in average of Washington State versus Tulalip Tribes. I like the ACEs model because it gives a base to compare something to.” She, too, felt the ACEs measurements validated what she and others in Indian Country have advocated—that unresolved generational trauma is a significant contributor to social and health disparities among tribes.
Guzman’s department has scheduled an all-staff meeting focused upon the ACEs Study and Tulalip’s work with the statewide network a few years ago. They hope to re-establish a dialogue and consider the future direction the Tribe may take in applying the ACEs Study and measurements in its programs.
In communities utilizing the ACEs measurement across the nation, the subsequent application of community resilience building has consistently demonstrated success in lowering of ACE scores in community members, which in turn helps build stronger and more resilient communities. Imagine the possibilities if communities invested in families on the front end, supporting pre-natal work, pre-school and all day kindergarten, rather than building juvenile detention centers and adult prisons.
At least twenty-one states have communities actively engaged in ACEs work.
Future stories in this series look at that work and new developments in ACEs research, including neurobiology, epigenetics, and the developing brain. Also featured will be tribal organizations applying similar intervention and measurements to address generational trauma. Because ACEs extend beyond the nuclear family to educational and child welfare policies, and to racism in social, police, courts, and other institutions controlling the lives of Indians, those intersections are reviewed along with the economics. Finally, the series will explore the potential of ACEs measurement in prevention and for building resiliency for American Indian people and tribes.
Kyle Taylor Lucas is a freelance journalist and speaker. She is a member of The Tulalip Tribes and can be reached at KyleTaylorLucas@msn.com / Linkedin: http://www.linkedin.com/in/kyletaylorlucas / 360.259.0535 cell