A Pediatrician's Advice for Treating Student Trauma
Doctors and schools must work together to tackle student adversity
Even for a pediatrician like Nadine Burke Harris, who works with children who experience trauma, the data are startling: Nearly two-thirds of adults report having at least one adverse childhood experience, or ACE, such as abuse, neglect, or a family crisis. But these challenges aren't limited to the world beyond the schoolhouse walls. The deadly school shooting in Parkland, Fla., last month is a stark reminder that no place is immune to traumatic events, even designated "safe" spaces such as public schools.
These experiences create toxic stress and have an impact on a child's academic and social lives. But they also cause harmful health effects that last long after childhood is over, including raising the risk for cancer, heart disease, and diabetes. So why, Burke Harris wonders, are physicians medicating the side effects of toxic stress when they should be investigating the epidemic?
Since founding the Center for Youth Wellness in San Francisco in 2011, Burke Harris has gained national attention for her work to prevent, screen, and heal the impacts of ACEs. (Her 2014 TED Talk on childhood trauma and health has been viewed more than 3.5 million times.) In her recently published book, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, Burke Harris puts forth a rallying cry: The medical and education communities must see ACEs as a national public-health problem that requires the investment of anyone who comes in contact with children.
Commentary Associate Kate Stoltzfus recently spoke with Burke Harris by phone about the medical treatment necessary to stem the long-term effects of trauma and why a more coordinated effort on the part of doctors, parents, and educators is critical to making this happen.
You’ve become well-known for your work to stem the long-term effects of childhood adversity. Why did you decide to take on this challenge in the first place?
As a doctor, I was seeing symptoms in my patients and trying to get to the root of what those symptoms were. A lot of kids were being referred to me with learning and behavior problems—tremendous amounts. But then I was also seeing other things like the very high rates of asthma or kids coming in with weird rashes. When I dove into the science, that’s when I made this connection: What these kids are experiencing is changing the way their brains and bodies work in a way that’s really harming their health. I had no direction as a doctor of what to do about it. It would be one thing if I saw this awful trend, and all I had to do was pick up the pediatric textbook and, say, turn to page 22 and find out how you treat toxic stress. When I’m seeing huge numbers of my patients being affected by something that the medical community doesn't seem to be aware of, it felt like something I had to raise awareness about.
The title of your book comes from a common public-health parable about the effects of 100 people who get sick drinking water from the same well. In other words, you can either keep treating patients or you can get to the root of the problem. How do we get to the root of student trauma?
If the education community alone is trying to deal with the issue of childhood adversity, I think it's going to be really difficult. And if the medical community alone is trying to deal with the issue of childhood adversity, again, we're going to struggle. When we recognize that the problem is a public-health problem, it gives us an opportunity to understand that every sector of our society needs to be addressing this issue. One of the most important ways that we can tackle this as a society is No. 1, raising awareness, and No. 2, doing routine screening and early detection. There's an important opportunity for school environments to move away from being punitive when kids are dealing with symptoms of toxic stress, and to be able to recognize and be responsive to the impact of early adversity on the developing brains and bodies of children.
Last week, students and teachers returned to Marjory Stoneman Douglas High School in Parkland, Fla., after a school shooting that killed 17 people. The members of the school community, like many others who have experienced shootings, must be full of emotions returning to the scene of the tragedy. If you were working directly with this school—or another one that has undergone a similar trauma—where would you begin?
When there is something like an acute crisis or event, different students respond differently given whatever their individual history of adversity might be. We have some kids who are going to need the kind of typical level of support provided to the entire school and some kids, particularly those who have a history of ACEs, who actually need more support in these times. It's important to bring in mental-health supports for the entire community to help both adults and students in that environment understand what they can do for healing. At the same time, what has been really powerful and profound are the ways in which communities can come together. In this case, a school community is translating this process into an opportunity to make a difference and to raise to their voices, which seems quite empowering for many of the students. I don't have scientific data on how raising voices changes DNA, but one of the things it helps to do is change the narrative.
Diagnosing children who suffer from trauma requires resources. Screening for ACEs can be complicated by the fact that many students are reluctant to talk about personal issues. How do we make sure students are diagnosed and treated, especially those in communities or schools which lack resources?
I don't know that schools are the right place to screen. I advocate for screening in the primary-care clinic, in the doctor's office. If I have a patient who has asthma, I am sending them to school with their asthma-action plan, and folks in that school l know what to do when that child has an asthma attack. Similarly, what I would love to see is for that child who has toxic stress to go to school with their toxic-stress action plan. And if that child is stressed, everyone who is part of that child's care environment knows what to look out for, knows what the signs are, and knows what to do. But that requires some cross-systems work. For a population of kids where we can anticipate that a significant number are affected by early adversity and toxic stress, how do we work across systems to provide them the best care?
Any suggestions for how to destigmatize conversations about experiences that may be difficult for students to discuss?
We do what's called a de-identified screen, which means that in the context of a 15- or 20-minute doctor's visit, we say to our patients: You don't have to tell us which ones of these adversities you've experienced, only how many. What we find is that when we identify those kids who need additional services, they can work with a mental-health professional or social worker or counselor who can then unpack what that real number is. My dream is that one day, in the same way that in order to start kindergarten kids need their physical exam, I would love to see that they've had an ACE screen.
Anything else you want to add?
I think that educators are such powerful champions and advocates for children. And one of the most important things that we can be doing right now is just getting the word out, building this public will so that we can get the investments to provide the resources to change outcomes for our kids. We also want to keep in mind that all of us were kids at one point, and the data show that two-thirds of us have experienced at least one adverse childhood experience. As we move forward with this work, how do we sustain ourselves? It's really important that we practice self-care. We can be a source of buffering for children because we're being healthy in our own lives.
Vol. 37, Issue 23, Pages 18-19Published in Print: March 7, 2018, as In the Wake of Adversity, A Pediatrician's Guidance