Director of Child Well-Being with the Tennessee Commission on Children and Youth
Episode 13: The Link between Childhood Abuse and Health Issues in Adulthood
In this episode, EndCAN’s Executive Director Lori Poland discusses the link between childhood abuse and health issues later in life with Jenn Drake-Croft, Director of Child Well-Being with the Tennessee Commission on Children and Youth. Jenn explains the Adverse Childhood Experiences study (ACEs), and how a systemic public health approach can lead to lasting solutions when it comes to mitigating child abuse and neglect.
Transcript of the Louder than Silence Podcast
Episode #13: The Link between Childhood Traum and Health Issues in Adulthood
Transcribed by Adam Soisson
[Inspirational theme music plays.]
>> Lori: Thank you for joining us. In this podcast, we are real people, talking about real things. Child abuse and neglect: a topic that is all too often left in the shadows of silence, leaving survivors alone, fearful, and oftentimes without a voice. We’re having conversations to become louder than silence. It is here, where we will invite you to join us and be the change needed to end child abuse and neglect.
>> Lori: Hello everybody and welcome to the Louder Than Silence podcast. My name is Lori Poland, I am the Executive Director for the National Foundation to End Child Abuse and Neglect and today it is truly my privilege to have Jenn Croft with us. I met Jenn within this last year and I was just telling her off air how I can truly listen to her talk for 60 minutes straight without interrupting and at the end I’m like, “oh my gosh we’re out of time.” I feel like that’s the way every single meeting wraps up with you because what Jenn is doing in Tennessee and what the state collectively is doing ignites me and I hope it ignites you as our listener. There’s just been kind of this aura of people needing hope and needing to know that there are places across this country that are really just digging in and doing the work. The way you all have done it is mind-blowing to me and so beautiful and I don’t want to ruin it but I do want to introduce you as a colleague that I respect and look up to and your work is truly profound so ladies and gentlemen, please welcome Jenn Croft. Jenn tell us who you are, who you work for and a little bit about what you’re doing.
>> Jenn: My name is Jenn Drake-Croft, I work with the Tennessee Commission on Children and Youth and I’m their Director of Child Wellbeing. The Tennessee Commission on Youth has been around in some form or fashion since the 1950s and our mission is to lead systems improvement for all children and families through data-driven advocacy, education and collaboration. I often tell people that this work is my personal and professional fashion and I’m excited to be able to share.
>> Lori: That’s great and a bit of a mouth full. That’s a huge mission right? The stakes are high, we know where those are and yet you have found a way to work together and I think – this podcast is called Louder Than Silence and one of the things we’ve come to realize at EndCAN is it’s really going to take that togetherness for us to really ultimately end child abuse and neglect. The togetherness is not coming together to find somebody to blame but togetherness instead is saying, “you matter, you matter, you matter. We matter, all of us matter. Let’s do this together. All of us play a role in it, from the parent to the child to the educator to the doctor to the social worker to the grandparent. Doesn’t matter, everybody plays a role in the success of raising our children.” You guys have put together this really beautiful model that I would love our listeners to hear about. I was telling Jenn earlier, I have probably mentioned her and the work they’ve done in Tennessee at least 30 times in various meetings just in the last five months alone. I’ll say, “you guys have to talk to Tennessee.” I am saying that to everybody. I can’t wait for your white paper to come out. Is that what it’s called.
>> Jenn: It’ll be a report but it’s a six one, half dozen the other [laughs].
>> Lori: Well everybody needs to know about what you’re doing so tell us about what it is you’re doing
>> Jenn: Absolutely. Well I will start with a brief explanation of Adverse Childhood Experiences [ACEs] although I’m sure most of your listeners are familiar with ACEs. Basically back in the mid 1990s, one at Kaiser Permanente in San Diego and one that worked for the Centers for Disease Control and Prevention. They got together and both of them noticed there was a relationship between childhood adversity and later poor health outcomes, both physical and mental health outcomes later in life. They launched something called the Adverse Childhood Experiences Study looking at around 17,000 individuals who were part of the Kaiser Permanente membership in San Diego. They offered them basically a ten question questionnaire that looked at five types of abuse and neglect and five types of household dysfunction. For every experience you had, you selected yes I had this or no I didn’t. It didn’t look at frequency or intensity or duration or anything like that. It was just either it happened or it didn’t happen to you. Then they looked at the relationship between an ACE score – so everyone has a score whether your score is zero or ten.
>> Lori: So for every yes you answered you got a point
>> Jenn: Exactly right. So what they found was ACEs were incredibly common among their population but also that there was a graded dose response relationship where the greater your ACE score, the greater your likelihood for seven out of ten diseases, for lots of mental health issues, for addiction issue and other social problems. You know, this has been replicated many times. We have lots of states throughout the nation that include these questions on their behavioral risk factors survey. I think over 30 states at this point have included that ACE module. What we see time and time again is the same correlation between childhood adversity and the development of lots of physical disease and social problems.
>> Lori: Later on in life?
>> Jenn: Yes that’s right. I believe it’s Bill Gates that says, “what happens at two months old has so much to do with what the next 80 years of your life turn out.” When you think about Adverse Childhood Experiences, child maltreatment, really every single one of us has a stake in it no matter what it is we care about. Whether we care about heart disease prevention, whether we care about our local economy, whether we care about education or whether we care about at the most basic level the safety of ourself and our family right? All of that, those negative outcomes, often have their roots in childhood adversity so if we could get to the root cause, if we could support families so that children are either buffered from these experiences or don’t have them at all, we would see a healthier, more prosperous society for all of us. So very quickly I’ll say that understanding this science, understanding how children develop particularly understanding how important those earliest years of life are for all future learning behavior and health. That was really the impetus for all the work in Tennessee came. We understood that, as the CDC and others call it, one of the biggest public health problems we face in the world really and in the United States. That trauma, that childhood adversity is so prevalent and if we really want to move the needle in a meaningful way on these issues that plague us as a society then we absolutely have to take that public approach in addressing ACEs. Very quickly I’ll say, for those that may be less familiar with a public health approach I think increasingly with mask wearing we’re getting more familiar. We often compare it to smoking cessation. You can go on the street and talk to anyone and ask, “what are two diseases associated with smoking?” and they can tell you. You cannot go on the street and ask people, “what are two diseases associated with ACEs?” That’s a problem because ACEs lead to more poor health outcomes than smoking and there is a correlation between ACEs and picking up your first cigarette and becoming addicted in the first place. We really need to follow that model of not just treatment. The CDC says we will never have enough dollars to treat our way out of the epidemic of child maltreatment and ACEs. We don’t just need to do secondary prevention programs as I’ve been involved in the past. Both of those are important. Treatment and secondary prevention are important but equally but if not in some cases more important is that primary prevention where everybody understands child development. Whether that’s ACEs, trauma and toxic stress and how to build resilience among our youngest citizens and our families so that we’re a flourishing and thriving society. So that was the impetus and I’m happy to describe that.
>> Lori: You’re great and then so what I’d love to hear is what you’ve been doing in Tennessee. I don’t want to give away the secret sauce because I feel like you guys have really found this magical way of taking this issue that is ACEs and realizing and recognizing we all play a role in that primary prevention work to educate, inform, support, encourage, model, all of it. So many people play that role. What have you done there that’s different than the rest of our country? Not everybody, there’s not very many people like you guys doing what you are doing. You really started that snowball within the state of Tennessee so tell us about that.
>> Jenn: Absolutely. You know you had groups of people in the state government and outside of state government who understood this and wanted to see change. Without getting into bigger instance of history we all came together under the leadership of somebody who was the Commissioner of the Department of Children’s Services and later moved into a Deputy Governor position which was a huge benefit for us. When we all sat around this table, these people that had been talking about this for years, and we had this clear will and support behind us. The question was: what do we need to do as a state? How do we support this work at a statewide level? Almost immediately what emerged was we need people to understand this. People often do better when they know better and they understand this complex neuroscience, when it’s accessible to them. It’s going to change the way they parent, the way the policies they support, the way they go to church, the way they teach, the way they do everything and the truth is that every single sector is touching children so this cannot be a social work issue. It cannot be a psychologist issue. It can’t even be a pediatrics issue.
>> Lori: And educators
>> Jenn: Right. It needs to be media’s issue, it needs to be policymakers’ issues and police officers’ issues where we are engaging our entire community in a very similar way to smoking cessation. We think about the PSAs we saw at the movie theater or on TV or changes in legislation. All of that led to a cultural change around smoking. We want to see that same cultural change around ACEs.
>> Lori: I’m even thinking about car seats and seatbelts. That alone, it was a safety and wellbeing issue of the people in the vehicles and everybody else that came in contact with them. It took a minute but we did it. Now, of course, we wear our seatbelts. Of course my child is strapped in a contraption that keeps them safer than if I was holding them in the front seat. It’s really a no brainer for us now but I even remember when I was a new mom and my parents said “I’m amazed that you made it. We didn’t even have car seats for you.” They were giving me a hard time because I was so rigid about the way my daughter was in a car seat and the way it faced and what kind of car seat we got and making sure it had the five stars and that it was sealed and approved and we went to the fire station to make sur that they approved it. I mean, and of course it’s a no brainer for me. We want child safety and ACEs and really ultimately the impact of healthy child development to be a no brainer. If a child has a healthy upbringing where they’re provided with security, safety, and all their needs are met. No brainer, they’re going to have a much more successful opportunity if they age to not have later in life diseases or various struggles from mental illness to obesity to heart disease, on and on. So we just want it to be a no brainer.
>> Jenn: Part of the way we’ve done this when you say secret sauce, we often say that using evidence-based language which sounds like a mouthful but we’re really going to get into it when we start talking about the metaphors but using evidence-based language that resonates with people where people understand complex scientific issues like neuroscience, like child development, like stress related disease, etc. is key to us changing all of the things that need to change for us to create a flourishing society. We partnered with an amazing organization called the Frameworks Institute and when I said that you would be familiar, they came up with the terms brain architecture, toxic stress, resilience scale, things that when you’re playing in this world of child welfare we use these terms all the time.
>> Lori: It’s become our language.
>> Jenn: So we leveraged that partnership to expand that evidence-based, sticky language so that people and partners from every single sector could understand it and why it matters to them. That is the crux. Then we have something, a diagram that we use that’s really our philosophy. When you’re trying to change what we call the four Ps. We want to change people’s Philosophy. We want to change Policies and Funding. We want to change Programs and we want to change Professional Practice to the best of our abilities with the science that ultimately support thriving children. You know, that changing the philosophy perhaps if you’re an educator or a teacher on behaviors you’ve seen so instead of saying, “wow, this kid can’t keep it together. This kid is a troubled kid. This kid hates me.” Something along those lines. You see that troubling or challenging behavior in certain areas and you say, “I wonder why this child is acting that way.” Police officers now, across our state as an example, engage in something called Handle With Care where they are understanding the impact of a child seeing a traumatic incident or the arrest of their parent and understand they need to make a connection with the school system so they do not misunderstand that behavior and they can wrap around that support. These are two small examples that we have so to put it as succinctly as possible because I know that we have limited time in our podcast, to move those four Ps we’ve done a lot of public awareness using that evidenced-based language. We also had a wonderful investment from our prior governor that continues to be maintained by our current governor which is $2.45 million in recuring funds for ACEs innovation grants. So we’re able to support all these people across the state that know what they want to do but they don’t have the seed money to do it. As a result of that we’ve had everything from higher education change their competencies for their school health. We’ve had trauma-informed school districts, one here in Nashville where that touches 88,000 kids. We’ve seen changes in pediatric practices and research. All kinds of beautiful things emerge and many of these efforts are now national models.
>> Lori: You’re leading the way for sure.
>> Jenn: Another thing that we’ve done is we’ve really intentionally made this public/private partnership that is incredibly inclusive. Even though I’m here on this podcast talking about this, this is not my work. I’m happy to do it but this, nobody owns this work. We have a coordinating team that’s made up of lots of folks from different departments and some folks from the private sector. Then we have public and private sector groups that meet quarterly to really drive changes so we’ve seen as a result of that changes in funding particularly at the state level, graded funding, we’ve seen changes in policy whether it be in Human Services or the Department of Health. We’ve seen this breakdown of siloes among state government and this collective movement. We are also partnering with insurers, trade organizations, businesses, nonprofits and the private sector to all come together and amplify this work and to work in a coordinated, collective way that can bring the most change. So there’s a lot that goes into all of that but you can take away training, awareness, and real changes in policies and funding in all of these different parts of the state and all of these different entities then you can really begin to grasp the impact. Quick example, I know I keep saying that, we have this thing called Training for Trainers where we train folks to go out and present on the use of this evidence-based language and present on these concepts, right? In one of our Training for Trainers centers in Chattanooga, we had the people that we’d typically be in the sandbox with. We had the teachers, we had the counselors, we had the nonprofits but we also had the Police Chief in Chattanooga and the Chief Medical Officer for the children’s hospital. To have everybody in that room, from grassroots to tips, that’s what it takes to create a movement. That’s what we’re doing.
>> Lori: That’s so cool and you know one thing I really appreciate is the humility when you said “this isn’t mine. I educate on this work, I support it, I play a role in it.” I think that’s the biggest piece. You know sometimes in life that’s the biggest thing. I think we can all get wrapped up in our ego and not intentionally. We’re all human beings. Every single human being only has the capacity to see the world from first-person. So innately we’re ego-driven but the fact that your Governor and now your new Governor, which I would imagine there were different view points, maybe they’re even on different sides of the aisle but the fact that they both equally stood up and said, “this isn’t about me and my political view or my party’s following. This is really about how we want the people in our world which was Tennessee to live and thrive in the word. That’s not something that I as the Governor can do single-handedly. That’s not something that you as the educator or the teacher, or you as the doctor or you as the therapist or you as the social worker and most importantly, you as the parent, can do alone.” I’m a mom and it is hard stuff. I mean, I cannot do it alone. I have learned fast and furiously this year alone that I cannot educate my children alone. I just can’t, and run two businesses. I can’t do it. It’s impossible and they deserve better so for me to even begin to think that I can be their doctor and be a plumber and I can do the house electricity, I can be the cleaner, I can be the chef, I can be the mom, I can be the teacher. There’s no way. I don’t even pretend that I know electrical stuff. I would just hire somebody to come and do that but we can do that so simply and it makes so much sense that I would hire somebody to come and fix my breaker box and yet, I’m not saying to hire out help but knowing that I can’t do the whole parenting thing singlehandedly. I play a huge role in it and as long as I nurture it and provide for it and do the best that I can within my capacity. Some days that capacity is not very high. But if I do the best that I can within my capacity and then fill in the rest with the support of my friends and community and teachers and doctor and all those extra people, my kids might make it out of this. At the end of the day it’s going to be my fault because it’s always our parents’ fault, right, I look at my parents like “YOU!” [laughs] and they look at me like, “you!” and that’s just the way of parenting right? My hope is that in 50 years that’s not the way of parenting. I hope it’s like, “hey, nice work. Way to go guys.” I’m certainly not shaming my parents, I’m just being silly and cheeky a little bit about how hard it is to be a parent. Ultimately we can’t do it alone and you guys over there are doing some pretty magical things. I’m impressed by it. I want to put you on the spot so I’m going to. When your paper is done I would love, love, love for us to have a link to it, we would obviously give all credit to those of you that have done this work so that our listeners can go on our website and find that. But as one element, we could potentially get a link to the diagram you’re describing. I’d love to put that on our resource page so we’ll find a way at the bottom of this podcast to put that link to that information. Since you visibly nodded your head I’ll say she’s saying yes people so we’ll put that on our website as well so they have access to that. This is the first of many conversations I know so Jenn thank you for being here today and being a part of Louder Than Silence and especially for your work to better families and communities because that’s what we’re doing here and it’s pretty neat. What an honor that we get to be here with you so thanks for sharing with us.
>> Jenn: Thank you Lori, thanks for having me.
>> Lori: Yeah. Have a great day. Ladies and gentlemen, thanks so much for listening to our Louder Than Silence podcast. It’s just been such a pleasure to be here with you. Stay tuned for future podcasts. Let us know if you have any questions or concerns. I’m Lori Poland being Louder Than Silence. Have a great day. Take care.
[Inspirational theme music plays.]
>>Lori: I want to thank each of you again for joining us today and listening in. If you or someone you know is being abused, please call 1-800-4-A-CHILD. To learn more about EndCAN, visit www.endcan.org or find us on all social media platforms. Join us in being Louder than Silence and being a part of the change. Please leave a comment, like our podcast, or share with your friends. The more the word spreads, the more of a collective impact we can have. If you have a question or you know someone who would want to be a guest on our podcast, please contact email@example.com. Thanks again, and have a great day.