Lasting Damage: The Public Health Funder Linking Childhood Trauma and Illness

photo:  b7/shutterstock — photo: b7/shutterstock

Almost half of children in the U.S. have experienced trauma, according to new data released by the Child & Adolescent Health Measurement Initiative with support from the Robert Wood Johnson Foundation. This is troubling because other research shows that the consequences of trauma are far-reaching and can last into adulthood.

Kids who experience adverse childhood experiences (ACEs) are more likely to have trouble calming themselves down, focusing, and even making and keeping friends, the study found. That may not come as much of a surprise, but here’s something that might: Not only does childhood trauma link to behavioral issues and stunted social and emotional development, it also links to long-term physical health.

Trauma can include the death or incarceration of a parent, witnessing or experiencing domestic violence, living with a parent with an untreated mental illness like depression, or a drug or alcohol problem, divorce, or being treated unfairly due to race or ethnicity.

Typically, funders that help kids who have experienced trauma focus on their mental health. They focus on identifying traumatized kids early and connecting them with healthcare professionals who can treat them.

The Texas-based Hogg Foundation for Mental Health supports programs that help teenagers who have experienced trauma. The work is driven by the link between trauma and education outcomes and incarceration. The foundation works on mental health more broadly and focuses a lot of its grant work in the Houston and Harris County areas.

The Weyerhaeuser Family Foundation, another mental health funder, supports work with kids affected by domestic violence. The Tauber Family Foundation focuses on mental health more broadly, but has grants to train mental health professionals to identify and treat trauma in children.

These foundations support work that identifies and helps kids experiencing trauma in the relatively immediate aftermath. They also focus on the emotional and psychological consequences of trauma. However, few funders focus on the long-term, often physical, effects of trauma on kids who fall through the cracks and wear the scars long into adulthood.

Studies show that people with adverse childhood experiences are more susceptible to leading causes of death like cancer, heart disease and diabetes. This is one of the reasons the Robert Wood Johnson Foundation has gotten involved.

“Literally, ACEs can make you sick,” said Martha Davis, a senior program officer leading this work at RWJF.

Davis, who has 25 years of experience working in trauma, got her start helping victims of domestic violence. It was there that she started to wonder about the long-term effects on kids, as witnesses and victims of domestic abuse.

“I remember meeting this woman, actually I was running a support group, and her daughter watched her mom get raped at gunpoint. That girl always stuck with me,” Davis said. “I always thought, 'what happens to those kids who witness that kind of violence?'”

Research released in the 1990s gave Davis some answers. “You could see not only the psychological impact of living with high levels of stress, but also the long-term physical tolls of stress,” she said.

The research pointed to a link between adverse childhood experiences and poor health as an adult. Trauma left kids more likely to adopt such risky behaviors as smoking, drinking and drug use as coping mechanisms. Down the line, they were more likely to develop cancer, diabetes and heart disease.

“Those are the kids who are having a hard time at school, trouble making friends, or the ones acting out or the ones who are facing trust issues. Maybe they have low self-confidence and are withdrawn. In addition to all these risk factors, they’re also at risk for the leading causes of death—obesity, heart disease, lung disease, etc.,” Davis said.

That’s where RWJF’s work on childhood trauma crosses paths with another focus of the foundation and healthcare funders more broadly—complex care. The idea behind complex care is that about 5 percent of people using the healthcare system account for about 50 percent of the costs. Those people tend to have multiple complex, intertwining medical and social needs, said Susan Mende, a senior program officer at RWJF working with Davis.

RWJF is not alone in its focus on tackling complex care. The foundation is part of a collaborative focusing on complex care that also includes the Commonwealth Fund, the John A. Hartford Foundation, the Peterson Center on Healthcare and the SCAN Foundation. The group put out a playbook for healthcare organizations looking to lower costs for patients with complex needs.

Another wrinkle in complex care is that often, those patients have histories of trauma, Davis and Mende said.

“We really need to uncover and treat the trauma if we’re going to have any kind of impact on people’s complex health and social needs,” Mende said. That can mean working outside of the healthcare system to treat more than just the symptoms.

For that reason, collaboration across systems like healthcare, housing, education and criminal justice is the main focus of RWJF’s work on trauma these days.

“What we find more and more is that unless we address these systems, collaborate with each other, we have the same people bouncing between and among all these systems,” Mende said. “Unless they collaborate with each other, you’re really not able to have the kind of impact that we need.”

The goal is to create communities and systems that are aware of trauma and its long-term effects, Davis said. “No one sector can solve this problem.”

In that vein, the foundation supports several projects looking at trauma across systems. Sometimes cross-sector work can be as simple as sharing data to identify vulnerable populations, Mende said.

An initiative in Oregon is looking at the role of trauma in the criminal justice system. In San Francisco, the Public Health Department trains people across the city’s systems to identify trauma. In Alaska, a group working on the opioid crisis is looking at adverse childhood experiences as a root cause of addiction and tying it to generations of structural racism against indigenous people.

Another tactic is to support systems that don’t further traumatize children, Davis said. She gave the example of a school in Newark, New Jersey, that provides kids who act out with emotional and psychological support rather than punishing them with suspensions or expulsions.

While this all might sound daunting, there’s hope.

“The real story, here, is that all of this can be transformed. Kids are resilient. Even adults can be resilient,” Davis said. “Just because ACEs can last a lifetime—that’s what the science tells us—they don’t have to.”

The study mentioned earlier also found that small things, including positive interactions with healthcare providers and teaching kids how to stay in control of emotions, go a long way toward building children's resilience to trauma. For one project, RWJF partnered with Sesame Street to teach coping skills to kids and parents who have experienced trauma.

The foundation also supports policies that promote healthy childhoods, like paid parental leave, access to quality childcare, affordable housing and home visits.

Davis' big ambition is changing the popular mindset of how we address disruptive kid or adults with complex health problems. Rather than ask what’s wrong with someone or how to punish her, we should ask what happened to her, she said. “Until we get this mindset shift, that’s where I think we have the potential to have impact,” she said.