October 14, 2021 • 38 mins
On this weeks Podcast we are delighted to welcome Sarah Marikos who is the Executive Director of the ACE Resource Network.
ACE standing for 'Adverse Childhood Experiences'.
Sarah’s professional career has focused on the science of things that can hurt us and heal us. As an undergraduate at the University of California Berkeley, Sarah studied and conducted research on the US national opioid epidemic, the emergence of 2009’s H1N1 in-fluenza, and other major public health problems.
But witnessing Hurricane Katrina’s devastating and inequitable impact on communities influenced her to pivot from the pre-med track to public health, deciding to pursue a master’s in public health (MPH) in epidemiology to better understand the confluence of factors that influence the health and well-being of people and communities.
Today Sarah says that she enjoys connecting people and data to improve systems in order to prevent harm and help people recover and heal.
In this episode we talk to Sarah about her journey and most importantly the impact that discovering the research around Adverse Childhood Experiences has on families and the impact that it could have on society if it was better understood by all.
Follow the My Number Story on Twitter here and visit their website for more details here.
Follow Dr Burke Harris on Twitter here. Discover her book The Deepest Well/Toxic Childhood Stress here.
Visit our shop here to purchase a copy of the Thinking of Oscar Cookbook - Made with Love or Face Coverings. THANK YOU!
Thinking of Oscar website and contact details can be found here.
Follow us on Twitter here or Instagram here.
Theme Music - ‘Mountain’
–
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths
Podcast editing - Right Royal Audio
Podcast artwork thanks to The Podcast Design Experts
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Sarah (00:00):
ACEs are strongly associated in a dose response
(00:03):
fashion, with some of the mostcommon and serious health
conditions that our societiesface. At least seven of the 10
leading causes of death. Soessentially, they found that the
more ACEs you experience, themore likely you are to
experience heart disease orstroke, depression, anxiety,
(00:27):
COPD, asthma, I could go on.
They found that it affects allof us. It crossed racial and
ethnic, socio economic, genderand geographic lines.
David (00:47):
Hello, and welcome back to the Not Mini Adults Podcast,
Pioneers for Children's HealthCare and Well Being. This is
season three and this is episode33. My name is David Cole and
once again I am joined by mywife Hannah and we are the
founders of UK children'scharity, Thinking of Oscar. Last
year I came across a book thathad a big impact on me, written
by the now Surgeon General ofCalifornia, Dr. Nadine Burke
(01:10):
Harris, the book, ToxicChildhood Stress, The Legacy of
Early Trauma and How to Heal,forms part of our conversation
today. We are delighted towelcome Sarah Marikos, who is
the Executive Director of theACE Research Network, a standard
for adverse childhoodexperiences. Sarah's
professional career has focusedon the science of things that
(01:32):
can hurt and heal us. As anundergraduate at the University
of California, Berkeley. Sarahstudied and conducted research
on the US National opioidepidemic, the emergence of
2009's H1N1 influenza and othermajor public health problems.
But witnessing hurricaneKatrina's devastating and
inequitable impact oncommunities influenced her to
(01:55):
pivot from the pre med track topublic health. Deciding to
pursue a master's in publichealth in epidemiology, to
better understand the confluenceof factors that influence the
health and well being of peopleand communities. Today Sarah
says that she enjoys connectingpeople and data to improve
systems in order to preventharm, and help people recover
(02:15):
and heal. In this episode, wetalk to Sarah about her journey
and most importantly, the impactthat discovering the work around
adverse childhood experienceshas on families and the impact
that it could have on society.
If it was better understood byall. We really hope you enjoy
today's episode.
(02:35):
Sarah, Hello, thank you so muchfor joining us on the Not Mini
Adults Podcast.
Sarah (02:40):
Thank you. It's a pleasure to be here.
David (02:42):
So the subject that we're going to be talking about today
has been so important to us totry and get on and to share.
Ever since I read Dr. NadineBurke Harris's book, I bought
it, I've shared it with people.
So we're so excited to be ableto share the work that she's
done, but just as importantly,your story as well and how
you've got to be doing the workthat you're doing. So maybe if
(03:04):
we could start there and tell usa little bit about yourself, for
our listeners, please.
Sarah (03:10):
Yes, thank you. Well, I've always been interested in
trauma in adversity and how itimpacts us as individuals and
how it impacts us ascommunities. This was really
informed by some of my earlylife experiences. So I really
(03:32):
always sought to understand andthat informed my university
experiences. I was interested inlarger scale events like natural
disasters. I was involved in theresponse to a different
pandemic, the 2009 H1N1pandemic and the impact of that
(03:56):
on our communities andindividuals. I always wanted to
better understand why were somepeople more impacted than
others? How do we prevent traumaand adversity? Then how do we
heal from it. This led me topursue a graduate degree in
(04:18):
epidemiology to betterunderstand the impacts of trauma
and it was through my graduatework that. I'd taken classes on
communicable diseaseepidemiology on chronic disease
epidemiology, learned theepidemiology of 100's of
conditions. It wasn't till thevery end of my schooling that I
(04:43):
had a lecture on the AdverseChildhood Experiences study or
the ACEs study as we refer toit. It was the at the end of
this chronic diseaseepidemiology course. It was just
like a lightbulb for me. We hadjust spent the whole semester
talking about heart disease andstrokes, diabetes and all these
(05:06):
conditions. Then we learnedabout Adverse Childhood
Experiences and how the impactof them. How widespread they are
and how they are associated withover 40 health conditions that
the medical field, thescientific field, the public
health field, puts all ourenergy and resources into. It
(05:27):
was like why aren't we talkingabout ACEs when we're talking
about the prevention andmitigation of disease? That is
how I came upon the study andlearned about Dr. Nadine Burke
Harris's work. I've just had theimmense privilege to be able to
do this work at a national scalein the United States and being
(05:51):
led really by Dr. Nadine BurkeHarris, who is the California
Surgeon General and apaediatrician.
David (05:58):
So before we get into ACEs in the study, and I'm
thinking a bit more about that,and I have to say, I know you've
taken it to obviously a fargreater level to me, but I felt
exactly the same way when I readabout ACEs in terms of why
aren't these known more? Why isthis not shared more? Obviously,
that's why we're here today totry and talk about that.But in
(06:18):
terms of the work that you'redoing now, you're now working
for a nonprofit, which ispromoting and trying to share
these ideas. Talk to us a littlebit about the nonprofit work
that you're doing, please.
Sarah (06:29):
Yeah, I will and I'll just share that. You know, after
I learned about the the ACEsstudy, I gave Dr. Burke Harris's
book, The Deepest Well, to myaunt, who ran the NICU at a
large hospital in California for30 years. I shared it with my
mom who ran infant toddlerprogramme's for 30 years and
(06:50):
they both had that response. Somany people that I talked to
have that response, like it'sthe light bulb, why haven't I
heard of this? So our group, TheACE Resource Network, we
recognise that only about 20% ofUS adults know about ACEs and
(07:10):
their impact. Then we wanted tolook deeper, we looked into
different professions. What doesthe medical field know about
ACEs? What do educators knowabout ACEs? What do mental
health or behavioural healthprofessionals know? We were
surprised to learn that not evenhalf of medical professionals in
the United States know aboutACEs. About 50% of educators do
(07:32):
a little bit more than 50%, ofbehavioural health
professionals. Seeing that dataand understanding the deep and
sometimes long lasting impact ofearly adversity and trauma. We
said what can we do to make morepeople aware. That's what led to
(07:54):
the launch of the first evernational public awareness
campaign on ACEs in the UnitedStates, we launched earlier this
year, we are working with avariety of partners from
celebrities and otherinfluencers, we believe that
everyone should know about ACEs,and it needs to be assessable.
(08:16):
We're working with educators,we're working with health care
providers, and we hope to beworking with 1000s of more
partners in many differentfields, any field that works
with children, or works withadults who've experienced trauma
or adversity. So you can learnmore about the campaign at
(08:39):
numberstory.org If you'reinterested in learning more
about our activities this year,
David (08:47):
We will make sure that there's a link to your website
in the show notes for thispodcast. I think it's it's funny
that obviously we both kind ofcame across this in in a similar
way. The book now, it was calledThe Deepest Well, I think it's
been republished and the copy Icertainly haven't, that I've
shared is now called ToxicsChildhood Stress, but you just
touched upon it. But one of thekind of headlines within the
(09:09):
book is that actually, twothirds of us have experienced at
least one adverse childhoodexperience or one Ace Which is
an incredible amount of peoplein the world, if you think of it
from that perspective. So maybeif you could tell us a little
bit more about the initial studyand actually, you know, what are
ACEs?
Sarah (09:28):
So the Adverse Childhood Sxperiences Study or ACEs study
was conducted by the centres fordisease control and prevention
in the United States and KaiserPermanente at large health
system. They essentiallysurveyed about 17,000 adults who
had health insurance andenrolled in this health system
(09:51):
in Southern California and theyask them about their adverse
experiences. The 10 types ofadversities that they queried
this group about, we're aboutthree types of abuse, physical,
emotional, and sexual abusebefore the age of 18. Neglect,
(10:11):
two types of neglect, physicaland emotional neglect. Five
types of what we call householdchallenges. So these include
having a parent or caregiverwith substance use issues,
mental health challenges,witnessing domestic violence,
having a parent or caregiverincarcerated, and then divorce
(10:35):
or separation of one's parentsor caregivers. What they found
and you shared, what was sopowerful for many is that two
out of three of these adults hadexperienced at least one and one
in eight, reported four or moreACEs. So it showed the field how
(10:58):
prevalent childhood adversityis. Again, this is only defining
childhood adversity with these10 categories. Then what they
found is that ACEs are stronglyassociated in a dose response
fashion, with some of the mostcommon and serious health
conditions that our societiesface. Atleast 7 of the 10
(11:22):
leading causes of death. Soessentially, they found that the
more ACEs you experience, themore likely you are to
experience heart disease, orstroke, depression, anxiety,
COPD, asthma, I could go on, andthey found that it affects all
(11:43):
of us at cross racial andethnic, socio economic, gender,
and geographic lines.
David (11:52):
That for me is why this is so phenomenally important to
share that, the experiences justdon't do cause all of these
multitude of problems. We'vetalked quite a bit on on this
podcast and, you know, in dayto day, just in terms of
preventative care. We have asick care system, basically,
wherever you look, whether it bethe US, the UK, or any other
(12:13):
country. We treat people thatcome in that are unwell, we
don't think about itnecessarily, completely from a
preventative perspective. Iguess actually, when I listened
to what you're talking about,and trying to get people to
understand more about ACEs thatreally is preventative care.
It's trying to get thatpreventative measure up.
Sarah (12:29):
Absolutely, because there are things that we can do in our
communities, in our familiesthat can prevent ACEs from
occurring. One of the thingsthat I think is really important
for our healthcare systems andDr. Burke Harris talks a lot
about this. Is that,identification or screening of
(12:51):
ACEs or early childhood traumaby paediatricians and other
health professionals canactually be a form of
prevention. So we talked aboutprimary prevention where you
know, the harm never happens.
But secondary preventioninvolves that you've been
exposed to some some trauma, butwe're going to identify it
(13:12):
early. So we're going to be ableto intervene and get the
diagnosis correct, to informwhatever that child and that
family needs to prevent what thefield calls the toxic stress
response. So that I think isreally critical to understand
that many of us experience ACEs.
(13:39):
Parents are going to have mentalillness, there are going to be
adversities that our childrenface and ACEs aren't
deterministic. Just because youexperience a lot of childhood
adversity doesn't mean you'regoing to have these negative
health outcomes. What leads tothese negative health outcomes
(14:00):
are when you develop a toxicstress response. What we mean by
that is when you know, kids aregrowing and developing and these
sensitive periods of developmentwhen they experience adversity
that is overwhelming and theydon't have sufficient buffering
(14:22):
protections from healthyrelationships or healthy and
safe environments. That's whatcan lead to the disruptions of
brain development, immune andmetabolic systems. This leads to
the toxic stress response thatcan lead to these negative
health outcomes. So from aprevention standpoint, in
(14:43):
healthcare settings, there's agreat and broader. There's a
great opportunity to identifyand intervene early to really
give that child that dose ofbuffering that antidote to the
adversity.
Hannah (14:58):
Well, you've made me think about then is that, you
have the group of ACEs and thefactors that can lead to the
toxic stress. What you'reexplaining is, so by identifying
it early, the early interventionis going to have a very positive
impact. But also mulling over isis it also as much about being a
barometer as a kind of menu ofinterventions that a caregiver
(15:24):
or whichever as you say,whichever party it is that's
involved in the child, or indeedadults life that can see the
traumas that have occurred. Soyou can see that there say three
or four given traumas that mayhave occurred and then there are
associated interventions ofthose. But I think what I'm
hearing you say, as well I mightbe able to cope with one of the
traumas and my body may have thebuffering for that. But if I'm
(15:47):
experiencing four or six, thenthat is what I mean by the
barometer does it also as acaregiver, or a stakeholder who
can help get that kind of giveyou a sense of the pressure that
this human being has beenenduring so far?
Sarah (16:04):
Yeah, if I understand your question. The science shows
and we say over and over andover, a caring adult can
absolutely make a difference ina child's life. No matter the
cumulative adversity, the numberof experiences, whether they
were chronic or acute. This iswhere I think there's so, I
(16:26):
think the field has been sofocused on these adverse
childhood experiences. I thinkwhat's so important and what's
coming up for me is that we alsotalk and stress and influence
the positive experiences in achild's life. The positive
(16:50):
experiences matter more than theadverse ones. So it's really
critical that as much as we can,we want to mitigate and prevent
the adverse ones, that we havethose supportive, positive
experiences for children. Evenif a person experiences six, or
(17:13):
seven, or eight, and we haven'teven talked about other types of
childhood adversity, that canlead to that toxic stress
response, like living inpoverty, like discrimination,
like racism, like losing aparent or caregiver. If we have
those buffering supports forchildren, we can prevent or
(17:36):
mitigate that longer termimpact.
David (17:39):
So you just mentioned kind of two elements actually,
that we wanted to discuss. Onewas I think you actually call it
the PACEs? So the positive...
Sarah (17:50):
And adverse childhood experiences.
David (17:53):
Yeah. Okay. The other one is that actually, there was an
original 10, which you wentthrough in terms of the ACEs
study. But there's now a longerlist that has been looked at and
identified that actually cancause ACEs.
Sarah (18:07):
Yeah, so I'll first talk about PACEs and so there's a
there's a great global groupcalled the PACEs Connection,
that I highly encourage peopleto look into, if they're
interested in learning moreabout what's happening in this
world, in their community or intheir profession. So PACES
(18:29):
Connection works across theglobe, geographic base
communities, education base,medical based, legal based
initiatives. They supportcommunities on the ground to
really bring in the science ofboth positive and adverse
childhood experiences. Theychange their name. They were
(18:51):
called the ACEs Connection formany years and recently changed
their name to PACEs connectionto reflect what we're learning
about the importance of positivechildhood experiences and
mitigating the adverse ones. Butyes, and I want to clarify
around language a little bit. Sowhen we talk about the ACES
(19:11):
study, it will always refer tothose original 10 ACEs,
identified in that study. That'swhere there's been a tremendous
amount of research since theiroriginal study 25 years ago and
continues to be regularlyconducted in the US and in other
countries. But what we've seenand many have known for a long
(19:33):
time is that we now have, justin the last 15 - 20 -25 years
with new medical technologiesare really seeing the impact on
our bodies and brains as aresult of living in poverty as a
child and know that that canlead to disruptions in our
(19:53):
development that can affect uslong term. So that's critically
important. Witnessing communityviolence. So the original ACEs,
talked about witnessing domesticviolence, but living in a
community where there's violenceand witnessing that violence.
That makes sense, right? When wethink about ACEs, well, that's
not a traditional, at the coreof aces is adversity and not
(20:17):
living in that safe or stable orpredictable environment. So
witnessing community violencecan also disrupt the healthy
development of a child anddiscrimination, whether that's
because of our sexualorientation, or gender identity,
our racial ethnic group, ourcountry of origin, our levels of
(20:39):
ability, can also have a reallycritical impact on us as we
develop as children.
David (20:46):
Knowing this and being able to identify the ACEs. Is it
that you can actually reversesome of the impact on the
individual to help them youknow, move through life? How is
that kind of being addressed?
Hannah (21:01):
Another part of the same question is, and who can do
that, because I'm listening toyou thinking, you know, school
units run by us. Schools orfoster parents or other folks
that are involved as well. Howqualified do you need to be to
take advantage of the research?
Sarah (21:18):
Yeah, no. Great, great questions. So the science now
shows, it's not just a fancy,fun phrase that people throw
around. But that our bodies andbrains can heal and recover.
That can be done in a variety ofways. At an individual level,
(21:43):
what that can look like ifyou've experienced ACEs or other
childhood adversities, andexperienced toxic stress, or
have a dysregulated toxic stresssystem. That can look like,
they're sort of seven differentstrategies that are good for all
of us. But particularlyimportant for people who've
(22:03):
experienced a lot of earlyadversity. Those seven are
things like healthyrelationships, being in
connection with people that youtrust and feel safe. We know
that isolation is really bad forour health. But particularly for
those of us who've experiencedearly adversity, it's really
(22:24):
important to be in healthyrelationships. Mindfulness can
help us heal, feel better andrecover. Movement, physical
activity is really important. Alot of our trauma is stored in
our body, physical movement isreally healthy and good for us.
Good nutrition, whatever thatmeans for us. That's defined
differently for people,particularly people who've
(22:47):
experienced ACEs. Good sleep canhelp mitigate the impact of
toxic stress on our bodies. Thenmental health care can be
critically important for some ofus who've experienced early
adversity. Then lastly, isaccess to nature and being in
nature. We know that being innature can lower blood pressure.
(23:10):
There's lots of things that itcan do. Now, not all of us have
the same level of access tonature, but nature can be very
healing places. It doesn't haveto be, I think a lot of times
what people think is like, Ihave to be in like a national
park or on a Island. It canreally be trying to find some
green space where you can letyour body you know, rest and
(23:31):
regulate.
David (23:32):
It strikes me that all of those measures that you just
described seem all the thingsthat we would love to be able to
provide to our children and toyou know, ourselves. But many of
the individuals, many of thechildren that will have
experienced ACEs won'tnecessarily have the opportunity
(23:52):
to get a lot of that support. Iguess that's potentially where
the work that you're doing comesin and also the education for
caregivers and care providers,clinicians, and everything else.
It's so important to do it, butnot wanting to be negative, but
I guess there's always going tobe, you know, some challenges
(24:13):
trying to give a lot of thosethings to individuals.
Sarah (24:15):
Absolutely. I love to comment on that. That's, you
know, our campaign is a publichealth awareness campaign. This
is not, the solutions are notjust individualised. The
solutions are in our communitiesand in our systems. That's why
for example, Dr. Burke Harrisand her role as California
(24:39):
Surgeon General is traininghealthcare providers and
understanding ACEs and how torespond to them. That's why
educators, I spoke to a group of1000 educators and a large Los
Angeles school districtyesterday. Why educators are
learning about ACEs? How it canshow up in the classroom of the
(24:59):
child is experiencing adversity?
What may that look like in theclassroom? A lot of times what I
think happens is, people noticebehaviours, right. They
oftentimes kids may be punishedfor behaviours be viewed as, you
know, a bad kid or a badbehaviour. But when you bring an
ACEs lens, to working withchildren and with adults, it
(25:23):
helps you, you know, get to theroot of what an understanding.
Like I mentioned before, youknow, diagnosis equals
treatment, if we don't diagnosewhat's happening correctly, the
things we're doing to try tohelp may not help. So it's
bringing that ACEs lens to allour systems and our communities
(25:44):
so that we can really tacklethis as a true public health
problem. Oprah Winfrey recentlypublished a book called What
happened to you? That's part ofthe question, right? It's not
what's wrong with you, but whathappened to you. When you can
(26:04):
bring that to your work, itreally shifts things. With that,
it's what happened to you andthen it's what can we do to help
and support you. It's not justup to that individual who may be
experiencing negative healthoutcomes associated with it.
(26:26):
Negative, you know, workplaceoutcomes, negative relationships
associated with it. It's reallyabout what can we do to, how can
we help individuals andcommunities who have
particularly havedisproportionately experienced
early adversity? How can we one,what can we do to prevent that?
(26:47):
Then two what can we do toensure that there are the
resources which include fundinginfrastructure that can mitigate
the impact of the earlyadversity in some communities
throughout the United States andthe globe?
David (27:08):
You mentioned Oprah and I know that you don't know when
this is necessarily going to bebut two things, I guess, people
for whom to look out for one isthat Dr. Nadine, Burke Harris
has actually got a TED talk. Soyou can go and listen to that.
That is, you know, out in thecommunity, YouTube, whatever it
might be. But she's alsorecently spoken to Oprah to and
can you give us a little bit ofinsight as to hopefully that'll
(27:29):
be available, but but some ofthe things that they discussed
that, you know, the importanceof that discussion and some of
the things that they discussedduring that conversation?
Sarah (27:38):
Yeah, I'd be happy to. It was such a wonderful experience
to be able to listen to twopowerful voices, who have been
dedicated to this work fordecades. They've done it in
different ways. But both usetheir voices to raise this
(28:00):
issue. So Oprah has worked inmany different places. But she
spoke a lot about her work inSouth Africa, and her learnings
about the impact of early, thelong term impact of early
adversity. That experience MissWinfrey talks about led her to
(28:20):
working with Dr. Bruce Perry,who is a co author on the book
with Oprah to have a traumaresponsive trauma informed
school in South Africa. Afterthey recognise that the young
girls in their school, we'recoming from backgrounds with
lots of adversity and trauma andit was disrupting their ability
(28:42):
to learn in school. So she spokea lot about that, where Dr.
Burke Harris spoke about herefforts in California to train
healthcare providers. I'vementioned this, but just right
before the pandemic started.
California began an initiativeto train healthcare providers in
recognising ACEs and toxicstress. Over 20,000 healthcare
(29:04):
providers have been trained,there is state reimbursement for
screening. There's a big, abouta $4 billion investment as part
of the governor's budget toimprove the behavioural health
system for young people 0 to 25.
(29:24):
So what was really exciting tosee through their conversation
as they're both applying it inspaces where it's so critical. I
talked about sort of that ACESlens, and Miss Winfrey's
question, what happened to youis, I believe really the same.
It's trying to understand theroot of many of the challenges
(29:50):
that lots of us face.
David (29:52):
One thing I do need to point out to listeners that are
not in the US, I guess is thatDr. Nadine Burke Harris is title
of Surgeon General, is basicallythe chief medical officer for
California, right? It's notnecessarily a title that kind of
translates that particularlywell, but she is a head
(30:12):
clinician in California. Sothat's a pretty, that's a
pretty, pretty big role. Veryconscious of time and, you know,
very grateful for everythingthat you've been sharing. One
question I need to ask is, ifthere's people listening to this
podcast, and they want to startto learn more about ACEs, or
they know, clinicians who havepatients, and they think that
(30:34):
actually, you know, this couldhelp them. What could they do?
What would you advise from thatpoint of view?
Sarah (30:39):
Great question. So for health care providers, I'd
encourage them and medicalprofessionals to go to
acesaware.org, that is theCalifornia site where they've
collected the latest research,screening algorithms, guidance,
(30:59):
there's webinars on a monthlybasis. I think there's a great
opportunity for healthcareproviders to get resources and
information there. For thegeneral public, for those of us
still learning about ACEs. Iencourage people to go to
numberstory.org, we'veessentially taken all the
research and the science andwork to make it more accessible
(31:23):
for all of us. So we don't allhave to read white papers and
peer reviewed articles. Thereare videos, there are
infographics, lots of ways toassess this information and make
sense of what it may mean foryou and your family or for the
children in your life. So thoseare the two places, I would
encourage people to look as wellas Dr. Burke Harris's TED Talk
(31:46):
is a great starting point aswell.
David (31:48):
Thank you and we will share all of those links in the
notes for this podcast ofcourse.
Before we we wrap up, one of thethings I just wanted to mention
was I think there's a lot ofexamples in Dr. Burke Harris's
book around actually not justchildren, but adults. That when
they start to hear about ACEs,there's a light bulb that goes
off and they realise thatactually, they too, were
(32:08):
subjected to a lot of thesethings and it can account for,
you know, some of the thingsthat have happened in their
life. So I guess just thinkingabout that from all
perspectives, not just from fromchildren, and, you know,
everyone kind of thinking about.
How powerful the work is thatyou are doing and Dr. Nadine
Burke Harris has done and youknow, this discussion, I guess.
Sarah (32:30):
Particularly for people who have children, it's
critically important for us todo that self examination and
sort of do our, take our ownACEs history. Because we know
that trauma, we can pass traumadown to the next generation, you
know. When we know better, wecan do better. I think we can
(33:00):
leave different legacies for ourchildren. So I think it's
definitely, we don't want peopleto think of this purely as a an
issue among children, right?
It's the theimprint, as Oprahsaid, can stay with us forever.
So I think one of the mostpowerful things we can do is
take an inventory for ourselves,for our loved ones for our
(33:22):
children. What I find whenpeople do that, that it can
bring up a lot of grief. It canbe really painful. It can also,
I've seen be very freeing forsome people to learn that they
are not alone. That other peopleexperienced similar things. That
there are, you know, people whoare not damaged and that there
(33:45):
are things we can do to takecare of ourselves and feel
better. So I think it'scritically important for adults
to have a better understandinghow early adversity may have
affected us.
David (34:01):
So thank you, I promise.
Last two questions. The firstone is what next? Where is your
work and where do you think thatthe work of you and your
colleagues is going?
Sarah (34:13):
Well, I'll be brief, but I'll just say we just
started.Only 20% of US adultsknow about ACES. We want 70%,
80%, 90% of us to know aboutACEs. So we're just getting
started with our partnerships.
In 2022, we will be continuingbroad awareness and be working
in some of the sectors that wenamed to increase awareness
(34:36):
among professionals who workwith children and adults.
Hannah (34:42):
Last question today. So if you had a magic wand, and we
asked this at the end of most ofour conversations and you could
wave a magic wand to achieve onething, one change in child
health. What would that be, foryou?
Sarah (34:57):
Within our healthcare systems It would be what's
happening piecemeal in differentsystems already. It would be
that early identification andscreening of everything that
impacts children and theirhealth. Not just ACEs and the
resources to actually respond tothem. So we know
(35:19):
multidisciplinary teams work. Weknow that children who are
experiencing food insecurity orhousing insecurity or poverty,
that there is resources that wecan bring to them that will
improve their health. If thosesystems are working, if the data
and information systems areworking. So within healthcare
(35:40):
systems, it's really buildingthat early identification and
true response to supportchildren. I would love to see
that and then outside of thehealth care system, you know, if
we could make everything perfectand the health care system. We
would not see the games we'dwant to see in child health, it
also has to happen outside thehealthcare system, because the
(36:00):
science makes clear howpowerfully our experiences and
our environments affect ourbiology. So that would be if we
want to improve child health,it's working on things like
reducing poverty, it's so thatevery child has clean air safe
(36:22):
water, safe food. We'refortunate in the United States
that most kids do enjoy thosethings. But not everyone does.
So I think we'd have to makesome real improvements in the
the communities, where ourchildren live and grow to see
major gains in child health, aswell.
David (36:42):
Sarah thank you so much, we've had a theme on this season
of the podcast, which is aboutimpact. I think the work that
you are doing, the ACEs work andsharing this conversation will
hopefully have and we can see ishaving, you know a big impact.
The other thing and I know wesaid this at the beginning, but
we talk a lot about preventativecare. There's been almost a
(37:03):
little bit of an epiphany momentfor me during this conversation
around the opportunity forpreventative care by sharing the
ACEs story and all the workyou're doing and everything
else. So thank you so much forgiving us your time. It's been,
you know, it's been a wonderfulconversation and good luck with
everything that you're doing.
Sarah (37:22):
Thank you both very much.
It was a pleasure.
David (37:27):
Thank you so much to Sarah for joining us on this
week's Not Mini Adults Podcast.
Impact is a word that isprobably overused. But as I said
on the podcast for me, peoplebeing able to understand ACEs
and the consequences around themand then being able to prevent
that really could have a massiveimpact on children's lives. Next
week, we continue the theme ofinequalities and we are
(37:48):
delighted to welcome ProfessorIan Sinner from Alderhey
Children's Hospital to discussthat very topic. Thank you so
much for listening to thepodcast. If you're enjoying it
then please do leave us a reviewand we really hope that you can
join us next time.
ACEs are strongly associated in a dose response
(00:03):
fashion, with some of the mostcommon and serious health
conditions that our societiesface. At least seven of the 10
leading causes of death. Soessentially, they found that the
more ACEs you experience, themore likely you are to
experience heart disease orstroke, depression, anxiety,
(00:27):
COPD, asthma, I could go on.
They found that it affects allof us. It crossed racial and
ethnic, socio economic, genderand geographic lines.
David (00:47):
Hello, and welcome back to the Not Mini Adults Podcast,
Pioneers for Children's HealthCare and Well Being. This is
season three and this is episode33. My name is David Cole and
once again I am joined by mywife Hannah and we are the
founders of UK children'scharity, Thinking of Oscar. Last
year I came across a book thathad a big impact on me, written
by the now Surgeon General ofCalifornia, Dr. Nadine Burke
(01:10):
Harris, the book, ToxicChildhood Stress, The Legacy of
Early Trauma and How to Heal,forms part of our conversation
today. We are delighted towelcome Sarah Marikos, who is
the Executive Director of theACE Research Network, a standard
for adverse childhoodexperiences. Sarah's
professional career has focusedon the science of things that
(01:32):
can hurt and heal us. As anundergraduate at the University
of California, Berkeley. Sarahstudied and conducted research
on the US National opioidepidemic, the emergence of
2009's H1N1 influenza and othermajor public health problems.
But witnessing hurricaneKatrina's devastating and
inequitable impact oncommunities influenced her to
(01:55):
pivot from the pre med track topublic health. Deciding to
pursue a master's in publichealth in epidemiology, to
better understand the confluenceof factors that influence the
health and well being of peopleand communities. Today Sarah
says that she enjoys connectingpeople and data to improve
systems in order to preventharm, and help people recover
(02:15):
and heal. In this episode, wetalk to Sarah about her journey
and most importantly, the impactthat discovering the work around
adverse childhood experienceshas on families and the impact
that it could have on society.
If it was better understood byall. We really hope you enjoy
today's episode.
(02:35):
Sarah, Hello, thank you so muchfor joining us on the Not Mini
Adults Podcast.
Sarah (02:40):
Thank you. It's a pleasure to be here.
David (02:42):
So the subject that we're going to be talking about today
has been so important to us totry and get on and to share.
Ever since I read Dr. NadineBurke Harris's book, I bought
it, I've shared it with people.
So we're so excited to be ableto share the work that she's
done, but just as importantly,your story as well and how
you've got to be doing the workthat you're doing. So maybe if
(03:04):
we could start there and tell usa little bit about yourself, for
our listeners, please.
Sarah (03:10):
Yes, thank you. Well, I've always been interested in
trauma in adversity and how itimpacts us as individuals and
how it impacts us ascommunities. This was really
informed by some of my earlylife experiences. So I really
(03:32):
always sought to understand andthat informed my university
experiences. I was interested inlarger scale events like natural
disasters. I was involved in theresponse to a different
pandemic, the 2009 H1N1pandemic and the impact of that
(03:56):
on our communities andindividuals. I always wanted to
better understand why were somepeople more impacted than
others? How do we prevent traumaand adversity? Then how do we
heal from it. This led me topursue a graduate degree in
(04:18):
epidemiology to betterunderstand the impacts of trauma
and it was through my graduatework that. I'd taken classes on
communicable diseaseepidemiology on chronic disease
epidemiology, learned theepidemiology of 100's of
conditions. It wasn't till thevery end of my schooling that I
(04:43):
had a lecture on the AdverseChildhood Experiences study or
the ACEs study as we refer toit. It was the at the end of
this chronic diseaseepidemiology course. It was just
like a lightbulb for me. We hadjust spent the whole semester
talking about heart disease andstrokes, diabetes and all these
(05:06):
conditions. Then we learnedabout Adverse Childhood
Experiences and how the impactof them. How widespread they are
and how they are associated withover 40 health conditions that
the medical field, thescientific field, the public
health field, puts all ourenergy and resources into. It
(05:27):
was like why aren't we talkingabout ACEs when we're talking
about the prevention andmitigation of disease? That is
how I came upon the study andlearned about Dr. Nadine Burke
Harris's work. I've just had theimmense privilege to be able to
do this work at a national scalein the United States and being
(05:51):
led really by Dr. Nadine BurkeHarris, who is the California
Surgeon General and apaediatrician.
David (05:58):
So before we get into ACEs in the study, and I'm
thinking a bit more about that,and I have to say, I know you've
taken it to obviously a fargreater level to me, but I felt
exactly the same way when I readabout ACEs in terms of why
aren't these known more? Why isthis not shared more? Obviously,
that's why we're here today totry and talk about that.But in
(06:18):
terms of the work that you'redoing now, you're now working
for a nonprofit, which ispromoting and trying to share
these ideas. Talk to us a littlebit about the nonprofit work
that you're doing, please.
Sarah (06:29):
Yeah, I will and I'll just share that. You know, after
I learned about the the ACEsstudy, I gave Dr. Burke Harris's
book, The Deepest Well, to myaunt, who ran the NICU at a
large hospital in California for30 years. I shared it with my
mom who ran infant toddlerprogramme's for 30 years and
(06:50):
they both had that response. Somany people that I talked to
have that response, like it'sthe light bulb, why haven't I
heard of this? So our group, TheACE Resource Network, we
recognise that only about 20% ofUS adults know about ACEs and
(07:10):
their impact. Then we wanted tolook deeper, we looked into
different professions. What doesthe medical field know about
ACEs? What do educators knowabout ACEs? What do mental
health or behavioural healthprofessionals know? We were
surprised to learn that not evenhalf of medical professionals in
the United States know aboutACEs. About 50% of educators do
(07:32):
a little bit more than 50%, ofbehavioural health
professionals. Seeing that dataand understanding the deep and
sometimes long lasting impact ofearly adversity and trauma. We
said what can we do to make morepeople aware. That's what led to
(07:54):
the launch of the first evernational public awareness
campaign on ACEs in the UnitedStates, we launched earlier this
year, we are working with avariety of partners from
celebrities and otherinfluencers, we believe that
everyone should know about ACEs,and it needs to be assessable.
(08:16):
We're working with educators,we're working with health care
providers, and we hope to beworking with 1000s of more
partners in many differentfields, any field that works
with children, or works withadults who've experienced trauma
or adversity. So you can learnmore about the campaign at
(08:39):
numberstory.org If you'reinterested in learning more
about our activities this year,
David (08:47):
We will make sure that there's a link to your website
in the show notes for thispodcast. I think it's it's funny
that obviously we both kind ofcame across this in in a similar
way. The book now, it was calledThe Deepest Well, I think it's
been republished and the copy Icertainly haven't, that I've
shared is now called ToxicsChildhood Stress, but you just
touched upon it. But one of thekind of headlines within the
(09:09):
book is that actually, twothirds of us have experienced at
least one adverse childhoodexperience or one Ace Which is
an incredible amount of peoplein the world, if you think of it
from that perspective. So maybeif you could tell us a little
bit more about the initial studyand actually, you know, what are
ACEs?
Sarah (09:28):
So the Adverse Childhood Sxperiences Study or ACEs study
was conducted by the centres fordisease control and prevention
in the United States and KaiserPermanente at large health
system. They essentiallysurveyed about 17,000 adults who
had health insurance andenrolled in this health system
(09:51):
in Southern California and theyask them about their adverse
experiences. The 10 types ofadversities that they queried
this group about, we're aboutthree types of abuse, physical,
emotional, and sexual abusebefore the age of 18. Neglect,
(10:11):
two types of neglect, physicaland emotional neglect. Five
types of what we call householdchallenges. So these include
having a parent or caregiverwith substance use issues,
mental health challenges,witnessing domestic violence,
having a parent or caregiverincarcerated, and then divorce
(10:35):
or separation of one's parentsor caregivers. What they found
and you shared, what was sopowerful for many is that two
out of three of these adults hadexperienced at least one and one
in eight, reported four or moreACEs. So it showed the field how
(10:58):
prevalent childhood adversityis. Again, this is only defining
childhood adversity with these10 categories. Then what they
found is that ACEs are stronglyassociated in a dose response
fashion, with some of the mostcommon and serious health
conditions that our societiesface. Atleast 7 of the 10
(11:22):
leading causes of death. Soessentially, they found that the
more ACEs you experience, themore likely you are to
experience heart disease, orstroke, depression, anxiety,
COPD, asthma, I could go on, andthey found that it affects all
(11:43):
of us at cross racial andethnic, socio economic, gender,
and geographic lines.
David (11:52):
That for me is why this is so phenomenally important to
share that, the experiences justdon't do cause all of these
multitude of problems. We'vetalked quite a bit on on this
podcast and, you know, in dayto day, just in terms of
preventative care. We have asick care system, basically,
wherever you look, whether it bethe US, the UK, or any other
(12:13):
country. We treat people thatcome in that are unwell, we
don't think about itnecessarily, completely from a
preventative perspective. Iguess actually, when I listened
to what you're talking about,and trying to get people to
understand more about ACEs thatreally is preventative care.
It's trying to get thatpreventative measure up.
Sarah (12:29):
Absolutely, because there are things that we can do in our
communities, in our familiesthat can prevent ACEs from
occurring. One of the thingsthat I think is really important
for our healthcare systems andDr. Burke Harris talks a lot
about this. Is that,identification or screening of
(12:51):
ACEs or early childhood traumaby paediatricians and other
health professionals canactually be a form of
prevention. So we talked aboutprimary prevention where you
know, the harm never happens.
But secondary preventioninvolves that you've been
exposed to some some trauma, butwe're going to identify it
(13:12):
early. So we're going to be ableto intervene and get the
diagnosis correct, to informwhatever that child and that
family needs to prevent what thefield calls the toxic stress
response. So that I think isreally critical to understand
that many of us experience ACEs.
(13:39):
Parents are going to have mentalillness, there are going to be
adversities that our childrenface and ACEs aren't
deterministic. Just because youexperience a lot of childhood
adversity doesn't mean you'regoing to have these negative
health outcomes. What leads tothese negative health outcomes
(14:00):
are when you develop a toxicstress response. What we mean by
that is when you know, kids aregrowing and developing and these
sensitive periods of developmentwhen they experience adversity
that is overwhelming and theydon't have sufficient buffering
(14:22):
protections from healthyrelationships or healthy and
safe environments. That's whatcan lead to the disruptions of
brain development, immune andmetabolic systems. This leads to
the toxic stress response thatcan lead to these negative
health outcomes. So from aprevention standpoint, in
(14:43):
healthcare settings, there's agreat and broader. There's a
great opportunity to identifyand intervene early to really
give that child that dose ofbuffering that antidote to the
adversity.
Hannah (14:58):
Well, you've made me think about then is that, you
have the group of ACEs and thefactors that can lead to the
toxic stress. What you'reexplaining is, so by identifying
it early, the early interventionis going to have a very positive
impact. But also mulling over isis it also as much about being a
barometer as a kind of menu ofinterventions that a caregiver
(15:24):
or whichever as you say,whichever party it is that's
involved in the child, or indeedadults life that can see the
traumas that have occurred. Soyou can see that there say three
or four given traumas that mayhave occurred and then there are
associated interventions ofthose. But I think what I'm
hearing you say, as well I mightbe able to cope with one of the
traumas and my body may have thebuffering for that. But if I'm
(15:47):
experiencing four or six, thenthat is what I mean by the
barometer does it also as acaregiver, or a stakeholder who
can help get that kind of giveyou a sense of the pressure that
this human being has beenenduring so far?
Sarah (16:04):
Yeah, if I understand your question. The science shows
and we say over and over andover, a caring adult can
absolutely make a difference ina child's life. No matter the
cumulative adversity, the numberof experiences, whether they
were chronic or acute. This iswhere I think there's so, I
(16:26):
think the field has been sofocused on these adverse
childhood experiences. I thinkwhat's so important and what's
coming up for me is that we alsotalk and stress and influence
the positive experiences in achild's life. The positive
(16:50):
experiences matter more than theadverse ones. So it's really
critical that as much as we can,we want to mitigate and prevent
the adverse ones, that we havethose supportive, positive
experiences for children. Evenif a person experiences six, or
(17:13):
seven, or eight, and we haven'teven talked about other types of
childhood adversity, that canlead to that toxic stress
response, like living inpoverty, like discrimination,
like racism, like losing aparent or caregiver. If we have
those buffering supports forchildren, we can prevent or
(17:36):
mitigate that longer termimpact.
David (17:39):
So you just mentioned kind of two elements actually,
that we wanted to discuss. Onewas I think you actually call it
the PACEs? So the positive...
Sarah (17:50):
And adverse childhood experiences.
David (17:53):
Yeah. Okay. The other one is that actually, there was an
original 10, which you wentthrough in terms of the ACEs
study. But there's now a longerlist that has been looked at and
identified that actually cancause ACEs.
Sarah (18:07):
Yeah, so I'll first talk about PACEs and so there's a
there's a great global groupcalled the PACEs Connection,
that I highly encourage peopleto look into, if they're
interested in learning moreabout what's happening in this
world, in their community or intheir profession. So PACES
(18:29):
Connection works across theglobe, geographic base
communities, education base,medical based, legal based
initiatives. They supportcommunities on the ground to
really bring in the science ofboth positive and adverse
childhood experiences. Theychange their name. They were
(18:51):
called the ACEs Connection formany years and recently changed
their name to PACEs connectionto reflect what we're learning
about the importance of positivechildhood experiences and
mitigating the adverse ones. Butyes, and I want to clarify
around language a little bit. Sowhen we talk about the ACES
(19:11):
study, it will always refer tothose original 10 ACEs,
identified in that study. That'swhere there's been a tremendous
amount of research since theiroriginal study 25 years ago and
continues to be regularlyconducted in the US and in other
countries. But what we've seenand many have known for a long
(19:33):
time is that we now have, justin the last 15 - 20 -25 years
with new medical technologiesare really seeing the impact on
our bodies and brains as aresult of living in poverty as a
child and know that that canlead to disruptions in our
(19:53):
development that can affect uslong term. So that's critically
important. Witnessing communityviolence. So the original ACEs,
talked about witnessing domesticviolence, but living in a
community where there's violenceand witnessing that violence.
That makes sense, right? When wethink about ACEs, well, that's
not a traditional, at the coreof aces is adversity and not
(20:17):
living in that safe or stable orpredictable environment. So
witnessing community violencecan also disrupt the healthy
development of a child anddiscrimination, whether that's
because of our sexualorientation, or gender identity,
our racial ethnic group, ourcountry of origin, our levels of
(20:39):
ability, can also have a reallycritical impact on us as we
develop as children.
David (20:46):
Knowing this and being able to identify the ACEs. Is it
that you can actually reversesome of the impact on the
individual to help them youknow, move through life? How is
that kind of being addressed?
Hannah (21:01):
Another part of the same question is, and who can do
that, because I'm listening toyou thinking, you know, school
units run by us. Schools orfoster parents or other folks
that are involved as well. Howqualified do you need to be to
take advantage of the research?
Sarah (21:18):
Yeah, no. Great, great questions. So the science now
shows, it's not just a fancy,fun phrase that people throw
around. But that our bodies andbrains can heal and recover.
That can be done in a variety ofways. At an individual level,
(21:43):
what that can look like ifyou've experienced ACEs or other
childhood adversities, andexperienced toxic stress, or
have a dysregulated toxic stresssystem. That can look like,
they're sort of seven differentstrategies that are good for all
of us. But particularlyimportant for people who've
(22:03):
experienced a lot of earlyadversity. Those seven are
things like healthyrelationships, being in
connection with people that youtrust and feel safe. We know
that isolation is really bad forour health. But particularly for
those of us who've experiencedearly adversity, it's really
(22:24):
important to be in healthyrelationships. Mindfulness can
help us heal, feel better andrecover. Movement, physical
activity is really important. Alot of our trauma is stored in
our body, physical movement isreally healthy and good for us.
Good nutrition, whatever thatmeans for us. That's defined
differently for people,particularly people who've
(22:47):
experienced ACEs. Good sleep canhelp mitigate the impact of
toxic stress on our bodies. Thenmental health care can be
critically important for some ofus who've experienced early
adversity. Then lastly, isaccess to nature and being in
nature. We know that being innature can lower blood pressure.
(23:10):
There's lots of things that itcan do. Now, not all of us have
the same level of access tonature, but nature can be very
healing places. It doesn't haveto be, I think a lot of times
what people think is like, Ihave to be in like a national
park or on a Island. It canreally be trying to find some
green space where you can letyour body you know, rest and
(23:31):
regulate.
David (23:32):
It strikes me that all of those measures that you just
described seem all the thingsthat we would love to be able to
provide to our children and toyou know, ourselves. But many of
the individuals, many of thechildren that will have
experienced ACEs won'tnecessarily have the opportunity
(23:52):
to get a lot of that support. Iguess that's potentially where
the work that you're doing comesin and also the education for
caregivers and care providers,clinicians, and everything else.
It's so important to do it, butnot wanting to be negative, but
I guess there's always going tobe, you know, some challenges
(24:13):
trying to give a lot of thosethings to individuals.
Sarah (24:15):
Absolutely. I love to comment on that. That's, you
know, our campaign is a publichealth awareness campaign. This
is not, the solutions are notjust individualised. The
solutions are in our communitiesand in our systems. That's why
for example, Dr. Burke Harrisand her role as California
(24:39):
Surgeon General is traininghealthcare providers and
understanding ACEs and how torespond to them. That's why
educators, I spoke to a group of1000 educators and a large Los
Angeles school districtyesterday. Why educators are
learning about ACEs? How it canshow up in the classroom of the
(24:59):
child is experiencing adversity?
What may that look like in theclassroom? A lot of times what I
think happens is, people noticebehaviours, right. They
oftentimes kids may be punishedfor behaviours be viewed as, you
know, a bad kid or a badbehaviour. But when you bring an
ACEs lens, to working withchildren and with adults, it
(25:23):
helps you, you know, get to theroot of what an understanding.
Like I mentioned before, youknow, diagnosis equals
treatment, if we don't diagnosewhat's happening correctly, the
things we're doing to try tohelp may not help. So it's
bringing that ACEs lens to allour systems and our communities
(25:44):
so that we can really tacklethis as a true public health
problem. Oprah Winfrey recentlypublished a book called What
happened to you? That's part ofthe question, right? It's not
what's wrong with you, but whathappened to you. When you can
(26:04):
bring that to your work, itreally shifts things. With that,
it's what happened to you andthen it's what can we do to help
and support you. It's not justup to that individual who may be
experiencing negative healthoutcomes associated with it.
(26:26):
Negative, you know, workplaceoutcomes, negative relationships
associated with it. It's reallyabout what can we do to, how can
we help individuals andcommunities who have
particularly havedisproportionately experienced
early adversity? How can we one,what can we do to prevent that?
(26:47):
Then two what can we do toensure that there are the
resources which include fundinginfrastructure that can mitigate
the impact of the earlyadversity in some communities
throughout the United States andthe globe?
David (27:08):
You mentioned Oprah and I know that you don't know when
this is necessarily going to bebut two things, I guess, people
for whom to look out for one isthat Dr. Nadine, Burke Harris
has actually got a TED talk. Soyou can go and listen to that.
That is, you know, out in thecommunity, YouTube, whatever it
might be. But she's alsorecently spoken to Oprah to and
can you give us a little bit ofinsight as to hopefully that'll
(27:29):
be available, but but some ofthe things that they discussed
that, you know, the importanceof that discussion and some of
the things that they discussedduring that conversation?
Sarah (27:38):
Yeah, I'd be happy to. It was such a wonderful experience
to be able to listen to twopowerful voices, who have been
dedicated to this work fordecades. They've done it in
different ways. But both usetheir voices to raise this
(28:00):
issue. So Oprah has worked inmany different places. But she
spoke a lot about her work inSouth Africa, and her learnings
about the impact of early, thelong term impact of early
adversity. That experience MissWinfrey talks about led her to
(28:20):
working with Dr. Bruce Perry,who is a co author on the book
with Oprah to have a traumaresponsive trauma informed
school in South Africa. Afterthey recognise that the young
girls in their school, we'recoming from backgrounds with
lots of adversity and trauma andit was disrupting their ability
(28:42):
to learn in school. So she spokea lot about that, where Dr.
Burke Harris spoke about herefforts in California to train
healthcare providers. I'vementioned this, but just right
before the pandemic started.
California began an initiativeto train healthcare providers in
recognising ACEs and toxicstress. Over 20,000 healthcare
(29:04):
providers have been trained,there is state reimbursement for
screening. There's a big, abouta $4 billion investment as part
of the governor's budget toimprove the behavioural health
system for young people 0 to 25.
(29:24):
So what was really exciting tosee through their conversation
as they're both applying it inspaces where it's so critical. I
talked about sort of that ACESlens, and Miss Winfrey's
question, what happened to youis, I believe really the same.
It's trying to understand theroot of many of the challenges
(29:50):
that lots of us face.
David (29:52):
One thing I do need to point out to listeners that are
not in the US, I guess is thatDr. Nadine Burke Harris is title
of Surgeon General, is basicallythe chief medical officer for
California, right? It's notnecessarily a title that kind of
translates that particularlywell, but she is a head
(30:12):
clinician in California. Sothat's a pretty, that's a
pretty, pretty big role. Veryconscious of time and, you know,
very grateful for everythingthat you've been sharing. One
question I need to ask is, ifthere's people listening to this
podcast, and they want to startto learn more about ACEs, or
they know, clinicians who havepatients, and they think that
(30:34):
actually, you know, this couldhelp them. What could they do?
What would you advise from thatpoint of view?
Sarah (30:39):
Great question. So for health care providers, I'd
encourage them and medicalprofessionals to go to
acesaware.org, that is theCalifornia site where they've
collected the latest research,screening algorithms, guidance,
(30:59):
there's webinars on a monthlybasis. I think there's a great
opportunity for healthcareproviders to get resources and
information there. For thegeneral public, for those of us
still learning about ACEs. Iencourage people to go to
numberstory.org, we'veessentially taken all the
research and the science andwork to make it more accessible
(31:23):
for all of us. So we don't allhave to read white papers and
peer reviewed articles. Thereare videos, there are
infographics, lots of ways toassess this information and make
sense of what it may mean foryou and your family or for the
children in your life. So thoseare the two places, I would
encourage people to look as wellas Dr. Burke Harris's TED Talk
(31:46):
is a great starting point aswell.
David (31:48):
Thank you and we will share all of those links in the
notes for this podcast ofcourse.
Before we we wrap up, one of thethings I just wanted to mention
was I think there's a lot ofexamples in Dr. Burke Harris's
book around actually not justchildren, but adults. That when
they start to hear about ACEs,there's a light bulb that goes
off and they realise thatactually, they too, were
(32:08):
subjected to a lot of thesethings and it can account for,
you know, some of the thingsthat have happened in their
life. So I guess just thinkingabout that from all
perspectives, not just from fromchildren, and, you know,
everyone kind of thinking about.
How powerful the work is thatyou are doing and Dr. Nadine
Burke Harris has done and youknow, this discussion, I guess.
Sarah (32:30):
Particularly for people who have children, it's
critically important for us todo that self examination and
sort of do our, take our ownACEs history. Because we know
that trauma, we can pass traumadown to the next generation, you
know. When we know better, wecan do better. I think we can
(33:00):
leave different legacies for ourchildren. So I think it's
definitely, we don't want peopleto think of this purely as a an
issue among children, right?
It's the theimprint, as Oprahsaid, can stay with us forever.
So I think one of the mostpowerful things we can do is
take an inventory for ourselves,for our loved ones for our
(33:22):
children. What I find whenpeople do that, that it can
bring up a lot of grief. It canbe really painful. It can also,
I've seen be very freeing forsome people to learn that they
are not alone. That other peopleexperienced similar things. That
there are, you know, people whoare not damaged and that there
(33:45):
are things we can do to takecare of ourselves and feel
better. So I think it'scritically important for adults
to have a better understandinghow early adversity may have
affected us.
David (34:01):
So thank you, I promise.
Last two questions. The firstone is what next? Where is your
work and where do you think thatthe work of you and your
colleagues is going?
Sarah (34:13):
Well, I'll be brief, but I'll just say we just
started.Only 20% of US adultsknow about ACES. We want 70%,
80%, 90% of us to know aboutACEs. So we're just getting
started with our partnerships.
In 2022, we will be continuingbroad awareness and be working
in some of the sectors that wenamed to increase awareness
(34:36):
among professionals who workwith children and adults.
Hannah (34:42):
Last question today. So if you had a magic wand, and we
asked this at the end of most ofour conversations and you could
wave a magic wand to achieve onething, one change in child
health. What would that be, foryou?
Sarah (34:57):
Within our healthcare systems It would be what's
happening piecemeal in differentsystems already. It would be
that early identification andscreening of everything that
impacts children and theirhealth. Not just ACEs and the
resources to actually respond tothem. So we know
(35:19):
multidisciplinary teams work. Weknow that children who are
experiencing food insecurity orhousing insecurity or poverty,
that there is resources that wecan bring to them that will
improve their health. If thosesystems are working, if the data
and information systems areworking. So within healthcare
(35:40):
systems, it's really buildingthat early identification and
true response to supportchildren. I would love to see
that and then outside of thehealth care system, you know, if
we could make everything perfectand the health care system. We
would not see the games we'dwant to see in child health, it
also has to happen outside thehealthcare system, because the
(36:00):
science makes clear howpowerfully our experiences and
our environments affect ourbiology. So that would be if we
want to improve child health,it's working on things like
reducing poverty, it's so thatevery child has clean air safe
(36:22):
water, safe food. We'refortunate in the United States
that most kids do enjoy thosethings. But not everyone does.
So I think we'd have to makesome real improvements in the
the communities, where ourchildren live and grow to see
major gains in child health, aswell.
David (36:42):
Sarah thank you so much, we've had a theme on this season
of the podcast, which is aboutimpact. I think the work that
you are doing, the ACEs work andsharing this conversation will
hopefully have and we can see ishaving, you know a big impact.
The other thing and I know wesaid this at the beginning, but
we talk a lot about preventativecare. There's been almost a
(37:03):
little bit of an epiphany momentfor me during this conversation
around the opportunity forpreventative care by sharing the
ACEs story and all the workyou're doing and everything
else. So thank you so much forgiving us your time. It's been,
you know, it's been a wonderfulconversation and good luck with
everything that you're doing.
Sarah (37:22):
Thank you both very much.
It was a pleasure.
David (37:27):
Thank you so much to Sarah for joining us on this
week's Not Mini Adults Podcast.
Impact is a word that isprobably overused. But as I said
on the podcast for me, peoplebeing able to understand ACEs
and the consequences around themand then being able to prevent
that really could have a massiveimpact on children's lives. Next
week, we continue the theme ofinequalities and we are
(37:48):
delighted to welcome ProfessorIan Sinner from Alderhey
Children's Hospital to discussthat very topic. Thank you so
much for listening to thepodcast. If you're enjoying it
then please do leave us a reviewand we really hope that you can
join us next time.
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