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What should trauma-informed cities and counties ask their states for? 

 

The people who are doing most of the pioneering work to integrate trauma-informed, resilience-building practices based on ACEs research (writ large) are doing so in cities and counties across the U.S. Now that more state agencies are learning about ACEs, many people in local communities are wondering what they can ask states for to help grow local efforts. 

Karen Clemmer, the maternal child adolescent health coordinator for Sonoma County’s Department of Health Services, and I were exchanging comments on a blog post, when we stumbled across a very useful “ask” applicable in any state. Here’s how this came about:

Karen asked if a health economist could help the Sonoma County community better articulate the return on investment of preventing/healing/treating ACEs across the life course. “Making a business case for ACEs might be one way to engage key leaders such as Chamber of Commerce, Rotary, key business sectors and even elected officials,” she noted.

So, I did a search through the blog posts on ACEsConnection to see what’s been done on this already. 

The Ella Baker Center did an analysis of the cost of incarceration on families. The federal government is starting to study the health benefits and screening and linking to social services.  Here's an article that refers to Washington State's calculation of savings by addressing childhood trauma. 

Oregon calculated what one year of child abuse -- all the cases in 2011 -- would cost the state over a lifetime -- $2.5 billion. Here's a report that an organization in Australia put together that shows a savings if $9.1 billion annually by addressing the impacts of unresolved childhood trauma and abuse in adults. Alaska calculated the cost for alcoholism and other drug abuse.

Economist James Heckman has done a LOT of work in this area. Check out his web site.

And there's this, from an article I wrote in 2012:

Case in point: Let’s look at only the children who were abused in the U.S. in 2008. Add up the total lifetime economic burden resulting from their maltreatment. It’s a whopping $124 billion. Include all the people who were abused each year even for just the last 10 years, and begin including every year from 2012, and the number rolls into the trillions.

The CDC’s National Center for Injury Prevention and Control, which did those calculations, broke down that unfathomably large number into this:

The lifetime cost for one child who was a victim of maltreatment is $210,012 in 2010 dollars. This includes:

  • $32,648 in childhood health care costs;
  • $10,530 in adult medical costs;
  • $144,360 in productivity losses;
  • $7,728 in child welfare costs;
  • $6,747 in criminal justice costs;
  • $7,999 in special education costs.


So, here’s the “ask”: a county-by-county breakdown of lifetime costs of the impacts of unresolved childhood trauma, and the cost savings if addressed. Perhaps this can also be done by sector within a county. Many communities are talking about obtaining local ACEs data. In California, for example, Gail Kennedy from our ACEs Connection Network team, is talking with people from California Essentials for Childhood Initiative and Kidsdata.org about developing a data dashboard that combines ACEs data from the state BRFSS, the Child and Adolescent Health Measurement Initiative (CAHMI), and from the Maternal Infant Health Assessment (MIHA). 

But some people ask: Then what? What’s the use of communities having local ACEs data? 

Answer: To develop analyses of the short- and long-term impact if ACEs aren’t addressed, and the cost-savings if they are. If communities have reliable numbers, and people can share this information from community to community, that would help support and accelerate the integration of this vital knowledge.  

So, what do you think? No doubt, some states that have done BRFSS surveys and their counties are probably already figuring this out, and we’d love to hear about it.

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And as I reported earlier in a blog, Dr. Felitti, Sealaska Heritage Institute President Dr. Rosita Worl and I had a meeting with Alaska Governor Bill Walker, Lt. Governor Byron Mallott, Corrections Commissioner Dean Williams and Chief Medical Officer Jay Butler on Wednesday, February 10. Governor Walker committed to looking at the ACE Resolution (HCR 21) and consider supporting it. However, I had an additional conversation with Commissioner Williams. He had experience utilizing ACE research when he worked in Alaska's Juvenile Justice system and is looking for solutions. He committed to further discussions. Based on that, I just posted a blog on the research based assessment of benefits in teaching Vipassanā Meditation in Prisons. After 8 years of advocating for consideration of ACE's in Alaska, I finally see some hope that we can develop policy to address both prevention and effective intervention.

Tamar -- I think it takes a lot of time to move our trauma-organized culture (to borrow the phrase from K-Rahn Vallatine, from Live Above The Hype in LA). I once asked Teri Barila in Walla Walla, WA, how many presentations they'd done in their community of about 30K people, and she said, five years into the process they stopped counting at 500. This is mind- and life-shifting information that people have to hear many times to absorb personally before they can integrate professionally and then organizationally and then culturally.

That's why we've organized the groups in ACEsConnection to represent geographical areas (neighborhoods, cities, counties, states, nations) and interest-based groups (ACEs in Education, ACEs in Pediatrics, etc.). That way when people in an ACEs initiative in a town hit a wall with physicians, even though they're doing well with educators, they can then connect physicians -- who might doubt how an educator or advocate can offer any use information that concerns medical care -- to a physician who's integrating ACEs knowledge and is getting outstanding results, and will never go back to traditional approaches.

Thanks for posting the details about the report that Pat put out. He is indeed brilliant!

Yep, I agree that these estimates are probably on the low end of the cost spectrum. With ACEs capturing more damage than the traditional definition of child abuse on which we base intervention by child welfare, I'm sure we'll see more realistic cost estimates as time goes on. I'm sure it's a lot scarier than we know.

These are great questions and I applaud Jane and Karen for asking them AND finding some answers for us.  The numbers certainly bolster our case.

While those costs are staggering, Jane, it still feels like a "low" ball park to me.  Maybe I am just responding to the un-quantifiable damage to a child...

 

Pat Sidmore, a planner with the Alaska Mental Health Board and brilliant number cruncher has recently put out a report called "The Economic Costs of ACEs in Alaska." the report uses information he gathered through a study of more than 4,000 Alaskan adults and attaches $$ amounts to the costs the state pays in the long run for adults who experienced ACEs. Looking at only six outcomes of ACEs (Medicaid costs, smoking, diabetes...) and comparing with data from other states, Sidmore found that Alaska would save $90 million annually if we were able to reduce the state's ACE score by .5 alone. (reduce half the population's ACEs score by 1). We have been presenting this information around the state to anyone who'll listen, and currently have Dr. Vincent Felitti here in state's Capital talking to legislators and community leaders. On Monday, we introduced in front of the House an ACEs resolution asking for support of ACEs and trauma-informed practices, programs and research. Even with this concrete data in hand, we're still hitting a wall when trying to get buy-in from the people who matter. I'm very interested to follow this conversation and learn about what others are doing in their states and communities. 

There is interest also in Oregon in bringing data together from different systems and disentangling it at the county/community level to get this important information.  And certainly the understanding about the costs of childhood adversity is  critical and may generate new energy in the legislature.  However, I don't think there are going to be big surprises about where the greatest needs are or the impact on these challenged communities - at least not in our state.  What we need is to figure out the 'ask' for what to do about it.  We need to organize our thinking about whether we are asking for training across the board for public employees (city, county, state) who interact with the community, whether we are asking for demonstration projects such as a health literacy campaigns about ACEs and resilience at the community level, or technical assistance and coaching to work with agencies, providers, and systems to become more trauma informed.  I'd be interested to know what action steps others around the country are asking their legislators to consider supporting in 2017-19.  We are starting to think hard about this here and I'd love to hear what others are thinking.  

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