Vestal: County has decision to make on trauma

It’s an awkward name for lousy events: Adverse Childhood Experiences.

Abuse. Trauma. Divorce. Neglect. “Adverse Childhood Experiences” is academic and impersonal jargon that describes experiences that are anything but academic and impersonal. It is a relatively new lens through which researchers are looking at lifelong effects of the lousy things that happen to kids.

Instead of gauging a single problem – such as abuse – they consider a range of traumatic experiences. Most people have experienced one or two. But the most vulnerable people – those with the most health problems, the least education, the lowest incomes, the shortest lives – tend to have accumulated clusters of these lousy experiences. And they’re more likely to be raising another generation of kids with similar experiences.

“If your parent was impacted by traumatic stress, you were probably raised in such a way that you were subjected to trauma,” said Elaine Conley, director of the Spokane Regional Health District’s Community and Family Services Program. “It tends to be generational. People parent the way they were parented.”

Which is sobering news for Spokane, because we’re a trauma town. Nearly half of women ages 18-44 in Spokane had four or more adverse experiences as a child; that’s based on research conducted by state workers in 2010. That rate of 46 percent is above the statewide rate of 33 percent; it’s well above the national rate for all adults, between 12 percent and 17 percent in various studies.

This legacy is being handed down. Researchers at Washington State University looking at the Spokane school system found that 12 percent of students in grades K-6 already have three or more ACEs. ACEs included abuse or neglect, living in a home with domestic abuse, drug abuse or incarceration, and divorce.

We’re a trauma town. And yet we’re cutting back on helping those who need it most – the kids and the soon-to-be born kids of the traumatized.

Throughout the past four years, the state has steadily pared away at programs that help at-risk moms in poverty. Which means that we are nurturing long-term, intergenerational poverty – we are tending it like a garden, providing what makes it grow.

Between 2009 and 2012, the budget for the Community and Family Services Division of the Health District shrank by 10 percent, from roughly $5.4 million to $4.9 million. The division’s state and federal funding has dropped by even more than that, actually – a loss of 18 percent. The health district has tried to make up for that by shifting money within its own budget, made up of local tax sources.

How does this pan out in human terms? The health district now has 12 public health nurses, down from 22 just five years ago. Public health nurses who work with maternal and child health are front-line warriors in the battle against poverty and its traumatic cluster bombs; they go into the homes of women who need help and provide treatment, education and resources. There may be no more effective way to help at-risk mothers and their young kids than to put a nurse in their home on a regular basis – and we do less of that now than we used to.

Another example of our retreat is the loss of the First Steps program – one of 10 programs that have been cut from the family health division in the past five years. This program provided prenatal care, access to medical and family planning services, and newborn care. It served the population at ground zero of generational poverty: young, single, at-risk mothers. The state whittled away the funding for the First Steps program in recent budgets; four years ago, faced with making up a $700,000 shortfall out of other programs, the health district canceled its First Steps program. Nearly 1,000 young mothers lost that care.

Do these cuts contribute to our high trauma rates? Conley thinks so. She points to a recent report produced by the health district on maternal and early childhood care; the report included the city’s high ACEs scores.

“Many of the indicators in the report are getting worse,” she said. “I think that loss of revenue is one contributing factor.”

ACEs are serious business, for the people who experience them and for society at large. Researchers draw direct correlations between trauma and shorter life expectancy. A 1998 study published in the American Journal of Preventative Medicine found that people who had four or more adverse childhood experiences were much more likely to become alcoholics, addicts, depressed, suicidal, obese. They were far more likely to be sexually promiscuous – more than 50 partners – and to contract sexually transmitted diseases. There was a “graded relationship” between ACEs and heart disease, cancer, lung disease and liver disease – even broken bones.

The Health District report, titled “Healthy Families, Better Beginnings,” makes an inarguable case that poverty is deep-wired in this community. It shows its face not in one or two ways but in a vast network of interconnected ways.

Of course, this inarguable case has been made before, in different ways. Conley says a vigorous new approach is needed. Given the realities of public budgets, she says a broad effort among community organizations is needed to collaborate, find savings and prioritize resources.

“I think as a county we have to come together and decide how or if we are going to address this problem,” she said.

How or, sadly, if.