Understanding Urban ACES Is Critical to Milwaukee

“This is not a theoretical issue for the city,” Mayor Tom Barrett said in opening a SaintA- co-sponsored seminar April 12 on trauma, poverty and the links to health and violence. “This is about as real as it gets.”

Mayor With Panel
Mayor Tom Barrett addressing the panel and audience

“Childhood Adversity & Poverty: Creating a Collaborative Response,” co-sponsored by the Milwaukee Health Department and the Center for the Study of Social Policy, featured Dr. Roy Wade. He is a pediatrician with the Children’s Hospital of Philadelphia who has researched how urban issues such as poverty, racism and neighborhood violence compound the discoveries of the original 1998 ACE study. That study involved primarily middle-class white individuals in San Diego.

Critical to Dr. Wade’s research was going directly to urban young people to ask them about adversity, through their own experiences and in their own words. He conducted 17 focus groups with individuals aged 18-26 who had grown up in high-poverty areas of Philadelphia. Responses helped him construct a new childhood adversity measure.

Caring connections help mitigate effects of ACEs

His findings also underscored that having a caring adult is critical to mitigating ACES. “Intervention is about connections,” he said.

In addition, Dr. Wade found that that those with high ACE scores often internalize what has happened to them and think that it is their fault. As ACE scores increased so did stress, while connections and the ability to cope decreased. “Those who need to be the most connected are usually the least connected,” he concluded.

Primary care doctors work to identify ACEs

Urban ACEs Panel
From left, Roy Wade, Mary Triggiano, Terri Strodthoff, David Pate, Tim Grove and Hendriel Anderson

His research findings began to impact how he practiced medicine. When meeting with patients, Dr. Wade began mentally calculating their ACE scores. He would ask colleagues to lend a hand with his scheduling, so he could spend more time with families known to have high ACEs. And he nurtured and expanded contacts with outside organizations to be able to refer his patients for services. “Primary care doesn’t have all the resources to address ACEs,” he said.

He also recommends, among other things, parenting and in-home visitation programs, Parent-Child Interaction Therapy, and mindfulness training for pregnant women. Dr. Wade said it is also important for staff who works with individuals with high ACE scores learn about their own scores.

Having knowledge of clients’ ACE history is critical to trying to secure additional resources and to push for policy changes, he said, noting that interventional offerings often are poorly funded. Anyone who comes in contact with kids should ask questions about trauma to figure out the kinds of resources that are needed, he said.

Review Dr. Wade’s presentation, “Childhood Stress and Urban Poverty: The Impact of Adverse Childhood Experiences on Health.”

Urban ACEs: Milwaukee Experts Respond

Dr. Wade’s presentation was followed by a panel discussion with area experts sharing what can be implemented in Milwaukee to recognize childhood ACEs and respond accordingly. Panelists included:

Judge Mary Triggiano said prevention and education are of utmost importance. She cited the successes of “therapeutic court,” such as the Family Drug Treatment Court, which helps families navigate through their addictions in a trauma informed way. Also in the works is Early Matters, a court centered around infant health.

Both courts are very hands-on, with frequent status updates, functioning in a safe environment that provides connections and helps families rewrite their narratives. Trainings for many sectors of the criminal justice system, including judges, public defenders and law enforcement, are important. “Every interaction provides an opportunity to mitigate or prevent ACES. We need to put what we have learned into practice, and we need multiple community players to make it work,” says Judge Triggiano.

Hendriel Anderson, of MUTT said, “People respond to people.” Cooperation in a trauma-response team is vital, working with the city, police and Wraparound.

Milwaukee needs a culture change in which police, for example, understand everything they need to know in terms of having empathy, being present and not viewing a family as just another call. His group stresses connecting police and clinicians, improving responses to families, increasing trauma awareness, ensuring the family is part of the process and educating the family.

Terri Strodthoff, Alma Center, founded and manages an agency that works with domestic violence offenders, with the understanding that, “Any pain that is not transformed will be transferred.”

Key to the work is knowing that the men who commit this violence were the little boys who grew up with tremendous adversity. More than 50% come in with ACE scores of four or more, and the vast majority of perpetrators stay with the victims. Without intervention, the cycle will continue with their children.

Alma’s approach is to treat every client as a human being, to realize that achieving success takes time and dedication, and that trauma cannot be accepted as an excuse.

“Everyone can heal,” says Strodthoff.

Dr. David Pate, UWM and University of Wisconsin: “People need to be able to live lives that are safe and decent,” says Dr. Pate, whose work has focused on toxic stress in black males. When he started investigating, he found information such as: a large number of white teachers think black children are stupid, doctors often give less treatment and pain medication to blacks, and that black people often treat mental health as a white issue.

Dr. Pate’s research has underscored that simply being poor can cause a lot of trauma and that many social welfare policies “make it hard just to be human.” Movements such as Black Lives Matter are important because they focus on the need for human rights, respect and acknowledging people who have made contributions.

Tim Grove, SaintA’s Clinical Services: Dr. Wade courageously said the original ACE study was not pertinent to everyone, and his Urban ACES research represents a quest for truth. People who have experienced trauma pay attention to who you are, not what you say, so how to “be” is a fundamental question to working with the people we serve.

We need to bring ACES knowledge to the community through non-clinicians such as teachers, police and the police department, in addition to human services workers. We can understand trauma in one generation, but what about over 10 or 20?

“The truth about trauma revolves around understanding historical trauma,” says Grove.

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