Author: Katy Carlsen, MD FAAP
Most people know how they would respond to a dangerous encounter such as meeting a bear in the woods. Our instincts would kick in and our adrenaline would be elevated, creating a fight or flight response to give our muscles and heart a performance advantage over our brains. This response is useful, particularly if there is a bear chasing you but now imagine what our bodies would do if they ran into this crisis on a daily basis? How children would be affected if their childhood was filled with crisis and danger. How their physical and mental health as adults would fare with the persistent elevation of stress hormones.
As a pediatrician and foster care advocate I have learned a great deal about how the barriers to providing good outcomes for children and youth in foster care are truly rooted in a much deeper problem. Recognizing how abuse and neglect impacts children is just the beginning of understanding how the traumatic childhood events or ACES that foster children experience can have long term consequences that may surprise people. The knowledge of this impact can also guide our policies if we approach the issues with the perspective of current medical science and research. My name is Katy Carlsen and today I am writing to share some information that some of you may already be aware of - the psychological and biological responses of children and youth exposed to chronic Adverse Childhood Events (ACES) and what protective resilience can do to overcome these changes.
Dr. Vincent Felitti , a San Diego Kaiser Permanente physician conducted a study with the CDC in 1998. This study of 17,000 adults with various health conditions showed a direct relationship between childhood trauma (ACEs) and illnesses in adulthood including heart disease, hypertension and chronic lung disease. The types of trauma tracked in this study were emotional abuse, physical abuse, parental substance abuse, parent incarceration, sexual abuse, parent separation/divorce, mother treated violently, household mental illness, physical neglect and emotional neglect. One can certainly see how these same events are common experiences for foster youth.
It was found that once a child had experienced 4 or more of the above there was 2-4 fold increase in risk in adulthood of many chronic health conditions. Since this study was performed, medical science has advanced its investigation and has truly mapped out the biological and neurochemical changes the brain undergoes when faced with chronic, recurrent, and stressful events.
I’m sure you are at this point asking yourself, is it too late? Social/behavioral even genetic systems are all influenced by early abuse and neglect, and interact as the child grows and develops. At the same time, protective environments and supports can help reverse the effects by building resilience and healthy coping skills and interactions. The key to addressing the effects of adverse childhood events, within the foster care system, is to be aware of their occurrence and to build systems that directly improve their effects. As most people know, some stress is important to help people move forward and adapt to new changes or challenges, like stress from taking a test at school. That is considered positive stress, as it is brief, mild, and causes no long-term effects. Toxic stress levels that occur too often for foster youth are different in that they are extended in length, and severe in nature with insufficient social and emotional buffers to allow the youth time to recover to their norm. This toxic stress occurs when children are exposed to long-term abuse or neglect or parental substance abuse. In addition, the uncertainty we have created with frequent changes in foster homes may reinforce this toxic stress that the system is trying to protect the child from by placing them in foster care in the first place.
“Every kid is one caring adult away from being a success story”. Josh Shipp, former foster youth and motivational speaker.
So what can be done about this problem of Adverse Childhood Events (ACEs) and their significant effects on foster youth? We need to foster and build relationships with foster children that are consistent and stable so they can develop the social and emotional buffers they need to overcome and stop further toxic stress. These relationships actually help to rewire and build neurological connections in the brain that creates resilience and adaptive behaviors for future health and development. The good news is that there has been a lot of education and outreach to health care providers, foster care networks, families and providers around trauma informed systems of care that attempt to address both past trauma as well as prevent future trauma for foster youth. Legislation is in place in many states mandating children and youth in foster care be treated with a trauma informed approach that deals with the effects of ACEs. It is important to educate foster care families to understand that some of the behaviors a foster youth is exhibiting while appearing “difficult to manage” or “aggressive” or “acting out” may have been the only behavior the child knew to use to survive in their trauma based home previously. Again think back to how you would behave if you lived with a bear in your house all of the time?
-Katy Carlsen, MD FAAP
Resources for those of you interested in learning more about ACES or trauma informed approach to services are below.
Helping Foster and Adoptive families cope with Trauma. www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/documents/guide.pdf
Healthy Foster Care America http://www.aap.org/fostercare
National Child Traumatic Stress Network www.nctsn.org
SAMHSA National Center for Trauma Informed Care http://www.samhsa.gov/nctic
Center for Youth Wellness www.centerforyouthwellness.org
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adulthood, American Journal of Preventive Medicine, 1998, Volume 14, pages 245-258.
Comentarios