Childhood traumas have deep, complex connections to other seemingly intractable problems, like poverty and racism. They can lead to mental and physical health problems and chemical changes in the brains of children, as well as addiction, violence and other problems in adults. The resulting struggles can repeat over generations — adding hundreds of billions of dollars to the cost of health and social services nationwide.
Panelists participating in NJ Spotlight’s roundtable on adverse childhood experiences, or ACES, dug into these and other weighty subjects Thursday during a 90-minute discussion. Despite the grim nature of the topics discussed, the group of experts also found reasons to be hopeful.
ACES include poverty, violence, sexual abuse, divorce and other jarring events. They can take a clinical toll on young people, and cause lifelong behavioral issues and chronic health problems, like alcoholism, obesity, and cancer — and even lead to early death.
The roundtable touched on how these traumas present themselves to healthcare providers, what the state and communities are doing to prevent and reduce the impact of various ACES, and how we can improve the Garden State’s system to protect and care for families.
New research shows four in 10 New Jersey youths are impacted by at least one of these traumas.
Poverty as childhood trauma
ACES are “a fairly universal phenomenon,” said panelist Dr. Denise Rodgers, vice chancellor for inter-professional programs at Rutgers School of Biomedical and Health Sciences and a chair at the Robert Wood Johnson Medical School.
“What we now know is that poverty in and of itself is an adverse experience,” said Rodgers, who also leads the Believe in a Healthy Newark Coalition, which is working to address many of these issues. She challenged the audience to consider how to eliminate poverty as it tackled childhood traumas.
That concept is actually not new, noted Dr. Kemi Alli, CEO of the Henry J. Austin Health Center in Trenton, who also participated. In fact, it dates back to the administration of President Lyndon B. Johnson, who declared a “war on poverty” in the 1960s. “This link between poverty and health was understood even then,” she said.
However, for too long healthcare systems have failed to appreciate and properly address the impact of ACES. At the same time, society has too often dismissed those afflicted as not “working hard enough” to rise above their difficult situation, the group agreed.
“We keep going on the treadmill over and over,” said Dr. Arturo Brito, executive director of The Nicholson Foundation, “and it feels like it doesn’t really take care of the root of the problem.”
Nicholson was one of three funders, along with the Burke Foundation and the Turrell Fund, which came together to form the NJ Funders ACES Collaborative. The group produced the recent study and is now gathering input for an action plan based on that work. (The collaborative, along with Horizon Blue Cross Blue Shield, also funded the NJ Spotlight conference.)
Reasons for optimism
Despite the difficult truths involved, the group agreed there is much to be hopeful about. They said new data and public discussions, like Thursday’s event, will help raise awareness about the problem. There are also multiple examples of successful partnerships that show promising results for children and caregivers in New Jersey. And healthcare providers are doing better at integrating medical and behavioral care into their protocols, they said.
“We have opportunities to change people’s trajectories,” said Christine Beyer, commissioner of the state Department of Children and Families, another panelist.
Her department — which serves more than 100,000 children and adults each month — is now working on programs to prevent and reduce the impact of ACES, in addition to other programs that treat the damage these traumas cause, she said. The DCF is also engaged in intensive training and efforts to protect the health and wellness of its workers, who often face traumatic situations daily.
And there is promise that these solutions can be scaled up, they agreed. For example, Horizon, the state’s largest health insurer, and RWJ Barnabas, one of the largest healthcare-provider systems, launched a program focused on improving social determinants of health in parts of Newark. The partnership is now looking to expand its work statewide, said Tracy Parris-Benjamin, director of clinical design and community health at Horizon, another panelist.
Parris-Benjamin said the new focus on social factors, like housing and healthy food, is a learning experience for traditional insurance companies. In the Newark project, for example, Horizon has used funds once reserved only for medical treatments to purchase an air-conditioning unit for a patient in danger of overheating, and helped another deal with an unstable housing situation so he could focus on controlling his diabetes.
“One of the challenges for health plans is that we see patients as claims,” she said, “and we don’t see the rest of that picture.”
Echoes through the generations
Another challenge is focusing on the multi-generational impacts of ACES, the panel noted. There is more that can be done to build communities that are more resilient to the impacts of these traumas and to help parents throughout their lives.
“If we only focus on the child, we are writing off a generation of adults who will die early from these traumas,” Rodgers noted. Adults with six or more ACES die two decades earlier than those without this history, she said.
“Children don’t live in isolation,” Ali added. “You can’t have a healthy child if you don’t have a healthy family unit.”