Unintended Consequences

I did, but most of it in the Library as well. When I went to Michigan, I was married and lived on S. State Street until we could get married student housing on the North Campus. My recreational time was reserved for sports (never got out of the end zone for football games) and recreational basketball. I really enjoyed my 3 years there. Drives into apple orchard country was especially memorable with fresh pressed apple cider and hot fresh cake donuts. Wonderful memories for me. Thank you for asking.

Hi Patrick,

Did you spend a lot of time in The Quad? I did studying to the detriment of sunlight! It is a magnificent place and after a long weekend of studying, the first place I saw naked students running around the Diag for the Naked Mile.


Another interesting experience!

Tina

Tina,

 

For some reason, your question doesn't appear here, but I am answering here. The Restoration to Health Protocol I am working on does screening, but at various places and times. This thread has been focusing on identifying traumatized children and intervening. I believe that this is too late, but currently necessary as we change our culture to address intergenerational transfer of trauma systemically. Because developmental trauma seems to find expression in health problems, I have proposed an entry portal at primary care consisting of an MD to screen for and identify real medical issues. I believe that nutritional testing should happen to separate our nutritional deficits and address them separate from medical care, unless problems require MD intervention. Finally, a non traditional behavioral health specialist will screen for trauma through a 5 level screen. A client interview is the first step, if available. Young children will not likely be able to identify all that is happening, an I am not sure we want to interview them under a certain age. Adult interviewees may not recall events that occur prior to language development and before a certain age ranging from 4 to sometimes mid teen. The second and third levels of inquiry are hearsay from friends, relatives and neighbors, if available and official records (medical, juvenile justice, school, etc.) The nutrition test is the 4th level. The fifth level is behavior adoption identification. It is at this level that I propose we identify not only negative behavior adoption, but also look at neutral and positive behaviors. I try to explain why in the attachment I posted to this blog. Basically, I believe that we adopt other coping behaviors that some refer to as resilience, but they are really just behaviors that our brain feels rewarded for adopting. If we show artistic talent, for example, we continue to achieve and excel in order to get the approval that makes our brain produce feel good chemicals. Systemically, we can reach some parents by this process and help them change their behaviors before they inflict trauma on their children. As for children who are currently in need, I believe our punitive system is harsh enough to prompt defensive mechanisms on the part of parents. As an attorney, I understand that the more harsh penalties are, the greater the defensive mechanism employed. So what I have proposed is an alteration of how we screen and as we learn, we begin to identify "potential" negative outcome potential (I refer to is sometimes as a projected trajectory). This trajectory includes all possible negative outcomes-for health and poor behavior selection. If we can identify negative trajectories for behavior or health, we can have a conversation with the Client/Patient and suggest a healing protocol. But none of this works unless we have a healing protocol, and that is the second part of the paper I posted.

 

I have spend a great deal of time thinking about how to address ACE's. I believe that if we only look to intervene, we will not be successful because the damage has already been done. If we identify a negative trajectory, we might be able to intervene before the damage is done. If we have numerous entry points for assessment, such as schools, juvenile justice, healthcare, and children's services. And I don't see any benefit for it to be punitive to parents unless they are not open to change. What I have seen is that parents generally want to parent well, but are hindered by their own response to intergenerational trauma.

 

I hope this helps.

Appreciated comments Tina. I like what Portugal has done with their drug issue as a matter of policy. They have removed the punitive and accentuated the support. Imagine doing that for our parents, instead of punishing them through our bureaucratic systems. An essential element of the Restoration to Health Strategy I propose is to identify the antecedents of bad behaviors as early as we can in Kids, and start them on a path to healing and improving their ability to learn and become productive. We need to educate our politicians to the possibilities. I work on that every day I can. For our American Indian/Alaska Native politicians, I have asked Fr. Felitti to speak at the next National Congress of American Indian annual convention. I proposed this over 3 years ago but it wasn't accepted, I believe for political reasons that I don't yet understand. We do need to foster change, but I become frustrated with the dearth of real interest. That's why I appreciate your advocacy as a physician. It's important to recognize. Keep it up.

The gist of the Chronicles article is that We cannot screen because our child welfare system is woefully inadequate to identify and treat child abuse in America.   That is indeed the case.   We all know that.  See the so very hard work of "Kids at Risk".  

Make as many excuses as we want.  Prevention is the only appropriate policy and this can only be done with screening.  What politician would be willing to say "I  support child abuse and neglect because I refuse to vote for the resources that are needed for this system to care for all affected children.   It costs too much."

Maybe we should all become outraged enough to demand these politicians to stop skirting this important issue but either vote for the money that is needed and if not willing then say "I support child abuse and neglect."   To me this is pretty black and white.  Do we need a 2 million dollar mansion in an America where millions of kids are being beaten, raped, humiliated and shamed by their parents everyday?

Anyone who thinks living in excess in a society where there is such basic needs for our children, whether they know it or not, also agrees that my own personal and selfish need for something that destroys the environment and shows that I posses the same lack of sharing skills of a toddler etc also agrees that I am  okay in a society where children are abused as long as I get to keep my Mercedes.

This may seem over the top but if one looks deeply there is also a lot of truth.  Denial or a desire not to see or know can get in the way of our compassion and our better more humane selves.

Thanks

In hindsight Patrick I should have said I was responding to the link you included "Considering the unintended consequences...", rather than the "Lean Thinking" approach etc you discuss!  I can see from your attached file that you are very involved in the healing process and the thoughtful steps it requires. We're on the same page, as they say. Although I think I need to also humbly say, I am but a novice and acknowledge most people on this website have read widely, thought long and hard and work in the health fields in all its facets, which I do not!  I wish you every success in your important work.

Thank you for your thoughtful comments, Mem. I actually believe that we should know about our developmental trauma, and have developed a screening protocol that I believe provides a good assessment of how developmental trauma has affected us. And the healing protocol I am working on is simple, and does not always require counselors. The first of five steps in the healing protocol is, as you believe it should be, "Knowledge." When I spoke with Dr. Vincent Felitti the first time, he mentioned that the patients in his study at Kaiser Permanente, when told about the impact of ACE's on their behaviors, had a third fewer doctor visits for a period of 2 years. I believe that Knowledge is a relief to those of us with developmental trauma and wrote it into the healing protocol as the first step. What I am also discovering is that we don't always respond with just negative behaviors like alcohol abuse, smoking, violence and the other responses that were studied. I believe that there are also neutral and positively viewed behaviors that help us cope just like negative behaviors do. Most often, I find that traumatized adult have all three types of behavior because one behavior alone cannot provide all of the self healing we need. I sent the attached writeup to the National Institute of Mental Health in response to their request for idea's. It explains my thinking. I truly appreciate your comments and understand how much of a relief it is to understand why we sometimes do what we do.

I think the ACE and Resilience screening questionnaire will probably always include unresolved issues in terms of it's implementation.  But that's not a reason I think for people to be precluded from this information. It seems very complex yet simultaneously so simple a procedure.  I heartedly agree it is the parents that are the main priority.  What concerns me is the possibility of never actually reaching a full agreement as to how the ACE screening should be rolled out. The what and to whom and the potential legal consequences.

However, as a person who has just discovered ACEs (not being part of the mental health arena) I know that I would rather know.   Even if I don't necessarily have access to good trauma informed care.  I'm no longer in the dark.  I'm guessing pretty much all the people who discover ACEs feel the same.  It's like the cancer analogy: years ago some doctors didn't tell their patients.  There will always be a minority of course who would rather not know.  But if you look at how things have changed: people mostly insist on the truth about their health: to make INFORMED choices.  

Why should mental health be treated any differently? Especially with the necessary tweaking of the personal understanding of this is why you are thinking and behaving as you do...  Not many health professionals do this.  It's key to hope and empowerment.  I wish I had known about this when I left home and when I was expecting my first child, which forces rethinking about your own childhood.  - But without knowledge you have no language or conversely with the key concepts of ACEs you have a framework for such language and therefore to seek further understanding.  Less futile searching in the wrong places and less likely to be retraumatised with such awareness.  It would've saved a lot of suffering.  A LOT of energy can be expended in mainly unhelpful resources - people, books, etc.  If you have high ACEs there is enormous intellectual and emotional etc work to be done.  It is the core message people need to know.  It gives people the possibility of making better choices through clarity of understanding. I think I've said this a few times now...!

I have a problem with research, etc being held in the ivory towers of the 'experts' and not filtering down to those who actually need such information. Do we really need another decade of darkness?!  It seems like a withholding of potential life changing information.  It also means a gradual awareness for all those involved in health (and later education - trickier I know) to be more trauma informed.  Some health professionals and other experts do not embrace change.  It can be quite threatening.

So, as I wrote in the beginning, I think there will be a long debate.  In the meantime many will suffer - the parents, the children from abuse and the fog of ignorance will not be lifted.  That would be a shame.  In the intervening time there at least could be a gentle approach:  by leaving brochures around about ACEs at all health reception desks.  These could at least include links for understanding them more and support. Seeking online understanding and support is better than nothing!  Resources are expensive and we don't want people to drown with such information without help, but to not do anything I think would be a grave mistake.

We need everyone to know about this as a given...  Well, this is my view at least!  I know Patrick you meant we need to think carefully about this, it's complex.  And I do get it.  This is just a plea that the sitting on hands is worse in the meantime and even if we're hitting a nail with a sledgehammer at least people can know there's a nail and its material properties!! Having access to people educated in the field eg the ACE Master Trainer program etc etc must surely help support those who are cautious in its implementation...