Nurse Wendie Skala worked with teens who were victims of street violence — and she always felt she was getting to them too late.
Eventually, she learned about something called “adverse childhood experiences,” or ACEs: The idea that trauma early in life can cause disruptive and unhealthy behavior. And that’s when Skala says a “huge light bulb” went on.
“Instead of saying, ‘What’s wrong with these kids?’ We could finally say, ‘What happened to these kids that they’re ending up in these gangs, shot, stabbed, or almost assaulted to death?’” she said.
Gov. Gavin Newsom’s first budget proposal, released last Thursday, could allocate $45 million for screenings to identify these experiences among children and adults on Medi-Cal. A growing body of research shows that if ACEs are spotted early, doctors and teachers can intervene to change a child’s trajectory.
Youth advocates say the proposed funding could move forward a plan to expand screenings, which they’ve been working on for years. Screenings for adverse childhood experiences involve questions about verbal and physical abuse, neglect, poverty, substance addiction and mental illness.
One landmark study showed people with four or more types of ACEs were twice as likely to be smokers, 12 times more likely to have attempted suicide, seven times more likely to be alcoholics, and 10 times more likely to have injected street drugs.
Dr. Richard Cohen, an educational psychologist at the University of Southern California, said experiences early in life actually alter brain development. Research has shown children impacted by trauma have fewer neuron connections, and a smaller amygdala — both of which reduce their ability to regulate emotions.
Children with high ACE scores may also be easily triggered by experiences that remind them of a traumatic event. When this happens, cortisol levels rise and the body’s “fight, flight, or freeze” response kicks in.
“We often get behavior in children that looks like defiant behavior, that is aggressive, that’s really a result of the reaction to being triggered rather than a kid just being intentionally bad,” Cohen said.
He noted that these children are often misdiagnosed as having attention deficit hyperactivity disorder, and are offered medication rather than trauma counseling. He said ACE screenings, unlike more established tests for developmental delays, don’t include a standard protocol for what to do next.
“Trauma-informed care has to be much more than just counting the number of traumas,” Cohen said. “It has to be understanding what’s happened to this child and how it’s affecting her or his life trajectory, and therefore what do we do in this specific case now.”
Advocates say screening children early can aid teachers and caregivers in creating safer environments for kids who test high for ACEs, such as time-out spaces that aren’t framed as punishment. They can also offer coping strategies such as meditation to help students fight the urge to lash out or isolate.
Skala says some schools have successfully trained teachers to look for students whose “brains have been hijacked by ACEs,” and adjust disciplinary protocols accordingly.
“We have all these kids that are sitting in the classrooms and not learning well,” she said. “There are ways we can teach them to calm themselves, so that they can learn again.”
First 5 programs, which use state and county funds to support low-income families with young children, already screen for this type of trauma during home visits. But Erin Gabel, a deputy director of First 5 California, said the governor’s proposal could go a long way toward making this more widespread.
The organization’s hope is to integrate ACE screenings into prenatal and well-baby visits that moms on Medi-Cal already receive. Gabel said conducting these screenings in a medical setting is helpful because families can be immediately connected to care and counseling.
At the Capitol, lawmakers have pushed multiple bills for more trauma screenings in the past. But advocates say they weren’t backed by funding.
Newsom’s proposed budget calls on the Department of Health Care Services to provide screenings to children and adults under age 65 at least once every three years, starting January 2020.