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Telling the story of trauma’s tragedy and treatment in Newark, New Jersey

Telling the story of trauma’s tragedy and treatment in Newark, New Jersey

Picture of Michael Hill
Telling the story of trauma’s tragedy and treatment in Newark, New Jersey
Michael Hill interviews a Newark resident for his series on trauma and its aftermath.

I had no idea what the well-dressed woman — composed and confident — was about to tell me. Ashanti Jones’ story was so overwhelming it made me cry during the interview — a first in my four-decade career. It literally incapacitated me. Ashanti’s story inspired me and influenced my five-part series, “Trauma’s Tragedy and Treatment.”

The first report in the series told Ashanti’s tragedy-to-triumph tale: A gripping account of early childhood adversity: drug addiction, incarceration, separation, but also, a realization of whose life she had to lead, how she did it and how she now uses that life’s experience to relate to residents of Newark, New Jersey’s most economically disadvantaged ward, the South Ward. 

I was determined to show the city and state what’s possible and to document and demonstrate resilience throughout the series. No ‘Woe is me’ helplessness and hopeless endings 21 years after the landmark ACE study. Instead, a series of reports showing how that study and scientific research are influencing our understanding of the impact of adverse childhood experiences and chronic toxic stress.

The National Fellowship training at the USC Annenberg Center for Health Journalism last year helped me rely on the science to explain trauma and its impact. Without the science, it would be too easy for doubters to dismissively discount the impact of adversity and interventions. The science provided the intellectual heft. Our first report drills that home. It shares the results of the original San Diego ACE study from 1998 and includes analysis of the lessons that can be drawn about the impact of ACEs for the rest of society. It also includes the results of the first national study from September 2018 which, for providers and advocates, seems to document their concerns about the prevalence of ACEs for the demographic groups under-represented in the 1998 study. 

Stats can be compelling — but a scholar even more so. I drove to the University of Maryland to interview Dr. Natalie Slopen, an assistant professor of epidemiology and biostatistics. The on-camera interview and post-interview takeaways covered how childhood trauma can alter biology, lead to the onset of diseases and shorten life spans. But she also discussed how science is beginning to look at it from the other end of the spectrum: does early exposure to trauma so damage or destroy genes and organs that they under-perform or over-perform and invite disease and premature death? And are there biomarkers that can show the presence of those later-in-life chronic health conditions, so that some kind of intervention can be designed to improve health outcomes?

That first report, of course, could not answer that question and neither could it speculate about any outcome for Ashanti Jones. But, it does show that an early life filled with trauma and tragedy does not spell automatic doom. Ashanti graduated with honors from an Ivy League school and is now using her degree and life experiences as the head of an outreach program at the South Ward Children’s Alliance in Newark. I focus on Newark because my research showed the city had high ACEs awareness, action and collaboration, and the goal was to capture that in motion.

Great connections led to great access early on. A conversation with the executive director of Advocates for Children of New Jersey led to a long list of names of heads of organizations and phone numbers and recommendations to call. I did. A conversation with Keri Logosso-Misurell of the Greater Newark Healthcare Coalition opened the floodgates. Seconds after our call ended she sent emails introducing me to other advocates and funders, encouraging them — with this quote — to get on board: “Our approach coincides with the theme(s) of his project and with his focus on outcomes and what determines/influences outcomes.”

I mention that to urge anyone taking on such a project to contact those who have been at their profession for a while and are well respected. That credibility gave me immediate access to those in the field doing the work. And the people benefitting from their efforts.

For example, the second report in the series focuses on Ashanti’s employer. It documents the work of the Alliance in a ward that’s a statistical nightmare of high unemployment, low post-secondary achievement, low reading and math scores and low access to fresh produce — the list goes on and on. The Alliance acts as the social wing of a charter school organization and has nearly two-dozen partners. It combined its mission and those stats and applied for and received a $30 million U.S. Department of Education “Promise Neighborhood” grant. 

Our third report addresses how loss and grief are the overlooked adverse experiences and it captures one partner preparing to set up a grief and loss peer-support center in Newark, training the staff of a charter school on how to recognize loss and grief, how to empathize and how to intervene.

The series was really moving along well with great cooperation and access. Then came the stonewalls. Promises to grant us access to a successful state-funded program to screen for ACEs were disappointedly unfulfilled. And I had to pull the plug on a hospital violence intervention program involving a man who survived two shootings — 18 gunshot blasts in the second one — because of a lack of cooperation. Not his, but the hospital running the program!

But other connections came through. That phone call with Keri led to an invitation to a private reception with deep-pocketed philanthropists and funders who had invited perhaps the foremost authority on childhood toxic stress to speak, Dr. Nadine Burke Harris, the San Francisco pediatrician and founder of the Center for Youth Wellness who was recently appointed California’s first “surgeon general.” I focused on her national campaign to get doctors and others to do ACE screenings. And, again, the phone call with Keri paid another huge dividend: An organization I learned of at the “Building a Culture of Health in Newark” event that Keri had invited me to — does the screenings, offers advice on nutrition and runs Double Dutch jump rope programs to connect with kids, get them talking and to learn about their needs in an area of the city home to halfway houses and statistics that rival the South Ward’s.

The last report tackles upstream measures: Prevent Child Abuse NJ’s long-running program counseling teen mothers about care to prevent abuse and stay in school, excel, graduate and go on to college. The other part of the last report tackles the social determinants of health, a Horizon Blue Cross Blue Shield NJ and RWJBarnabas Health collaboration. I learned about it at that private reception. A program using analytics to identify members in four South Ward zip codes who were skipping primary care visits and others who were over-using the emergency room or using it for primary care. An elderly woman who adopts kids says one of those adoptees with psychiatric issues almost drove her to her death. She speaks of how she got a call one day out of the blue from a community health worker who helped get the adoptee placed in a facility and got her back on track with her meds and doctor visits. The insurer said care costs, admissions and ER visits had double-digit reductions while behavioral health visits increased by a third. The mother said about the caller: “If not for her, I probably would have had my heart attack by now and went on.”

This exercise was both rewarding and grueling. It’s the first time for any project that I did all the research, all the set up, all the driving, all the filming, all the writing, and all the editing. It was well worth the journey and I plan to explore and report much more about trauma, thanks to this fellowship project.

Comments

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The ACE checklist is grossly inadequate to assess exposure to trauma. Its 10 items give equal weight to parental divorce and parents being murdered. It considers 'Romeo and Julliet' romantic relationships between younger and older teens inherently traumatic, regardless of the teens' perceptions. It ignores incestuous rape by a sibling close in age. The ACE is grossly culturally and racially insensitive and inappropriate to use in diverse populations. Lots of us behavioral and social scientists could have corrected the inaccuracies that are conveyed in this article.

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Thank you to Michael Dennis Hill for the blog post and for writing a series of articles about early adversity. It is very important for everyone to learn how common such adversity is and what it, far too often, means in people's lives even decades later.

As Mr. Coyne states, the ACE study is not all-encompassing, but then, it wasn't meant to be. It was a study done on 17,000 patients, mostly white, mostly college-educated, at the Kaiser-Permanente practice in San Diego. My understanding is that the "top 10 ACEs" are the ones that were most often mentioned by the participants, and so they reflect the population studied. The power of the ACE study is that it made the first data-supported links between early experiences and later health and behavioral outcomes, and made it plain that such experiences are not limited to "those people" who live in poverty, chaos, etc. etc (or however people blame others for their circumstances). It is not exhaustive. No study or list could be - what is traumatic to one person is not to another, and the role of a supportive parent in the child's life changes everything. What the study showed, before we even had the term, was the effect of "toxic stress." So yes, while losing a parent to divorce is very different than losing a parent to murder, what the researchers found was that it was the overall burden of stress that was associated with worse outcomes - a classic "dose-response" relationship that was so strong it could be called causal. So while losing a parent to murder is horrific, if the child has proper support from even a single caring adult, that child may well do better than another child who grew up with two parents but no support from either. Genetics and other resilience factors also play into this. All that said, it does not mean that I am an ACE-study "booster," or one who thinks the ACE study will solve everything.
Many of us working in the early adversity field find the ACE study a two-edged sword, if that's not too tired an expression. It got the attention of the medical world in a way that those working for at least the previous two decades in the mental health field on early trauma could only dream of. Suddenly, with the links to chronic physical disease laid bare, the medical doctors took notice and are still taking notice. That's a good thing. Unfortunately, the response is too often to medicalize the response, when therapy. prevention and other non-medical supports are what's needed. In addition, most respond to the ACE study by wanting everyone to "know their ACE score," with little or no attention paid to the risk of triggering traumatized people with the ACE questions. The 10 questions that make up the ACE score are not a validated screen- they're ten questions that basically fell out of the ACE study. And so they do not recognize structural racism, genocide and much, much more.
It is critically important that we know the burden of early adversity across all socio-economic groups, and the ACE study is a big part of that. Mr. Coyne is correct that we need to do far better documenting the experiences of those not represented in the classic ACE study. And, we need to begin looking at how we support strengths and help young adults understand this entire picture so they can parent differently, or if they do not have children one day, to interact with children (and everyone else, actually) in a far healthier way than our culture tends to support. To that end, I would like to see use of resilience screens - looking at how so many people with so many challenges in their history still thrive. Not only would that help policy makers and others support building strong communities that support people's health, it also helps individuals recognize their own strengths and build on those, rather than answering a list of questions about the worst things that ever happened to them and leaving them with that.
I would also like to read Mr. Hill's series, but there were no links in the blog post. Is it possible to get a link?

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Hi Kathleen, you can find Michael's stories at the following link: https://www.centerforhealthjournalism.org/user/91616/stories Thanks!
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Thank you, Ryan!

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