[00:01] SPEAKER_00:
Welcome to Principal Center Radio, bringing you the best in professional practice.
[00:06] Announcer:
Here's your host, Director of the Principal Center and Champion of High Performance Instructional Leadership, Justin Bader. Welcome everyone to Principal Center Radio.
[00:15] SPEAKER_01:
I'm your host, Justin Bader, and I'm honored to be joined today by Dr. Nadine Burke Harris. Dr. Burke Harris is a medical doctor, a pediatrician, and is founder and CEO of the Center for Youth Wellness in San Francisco's Bayview-Hunters Point area. She is the subject of a New Yorker profile by Paul Tuff, who you may have heard several times on Principal Center Radio previously. And she was the recipient of a prestigious Heinz Award in 2016, among many other honors.
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Her TED Talk, I Was Thinking Too Small, has been viewed millions and millions of times. And she is one of the architects of the ACE score concept that you are probably hearing a lot about lately. And we'll talk about that today. And she's the author of The Deepest Well, Healing the Long-Term Effects of Childhood Adversity.
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And now, our feature presentation.
[01:09] SPEAKER_01:
Dr. Burke Harris, welcome to Principal Center Radio.
[01:12] SPEAKER_02:
Thank you so much for having me.
[01:13] SPEAKER_01:
Thank you for being here, and I wonder if we could start by talking about the origin of this work. We have a lot of people we call doctor on Principal Center Radio, but I think you were the first medical doctor to come on the show. So you're a practicing pediatrician, and the work that we now know through the work of journalists and through the advocacy work that you've done around ACE scores and trauma, this actually came out of your medical practice. Is that right?
[01:38] SPEAKER_02:
Yes, that's right. So this started for me when I was seeing patients in my clinical practice. in Bayview-Hunters Point, and I was noticing a trend that a lot of patients were being referred to me for ADHD or attention deficit hyperactivity disorder. But what I found was that when I actually did the history and physical exam, my patients who had the worst outcomes were the ones who were exposed to the highest doses of adversity. And that's what got me looking into the science and trying to understand and investigate how early adversity affects the developing brains and bodies of kids.
[02:19] SPEAKER_01:
And I know one of the fastest spreading concepts from your work has been the ACE scale. So I wonder for anyone who's not familiar, if we could just kind of get into some of the specifics there of what those indicators or those traumatic experiences that have such a big impact are, and then we can talk more about how those show up later in life or possibly in the school setting.
[02:40] SPEAKER_02:
Yeah, so the term adverse childhood experiences or ACEs really came out of the groundbreaking research that was done by the Centers for Disease Control and Kaiser Permanente, the healthcare giant. And this came from a study that was published in 1998 where they asked 17,500 adults about their histories of 10 categories of adverse childhood experiences or ACEs. and these include physical, emotional, and sexual abuse, physical and emotional neglect, or growing up in a household where a parent was mentally ill, substance dependent, incarcerated, where there was parental separation or divorce, or domestic violence. And for every one of these a patient had experienced, for every yes that they endorsed, a patient would get a point on their ACE score.
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And what this big CDC study found was that, number one, ACEs were incredibly common. So two-thirds of their population had experienced one ACE, and one in eight folks had experienced four or more ACEs. But in addition, there was, you know, the higher the ACE score, the worse health outcomes were. So for an individual who had four or more ACEs, they were twice as likely to have heart disease, twice as likely to develop cancer, two and a half times as likely to to have a stroke, and 11 times as likely to develop Alzheimer's disease. So this was really the seminal research that talked about the health risks associated with childhood adversity. And then in my clinical practice, what I did was try to take this science and understand how I could use this to improve the health and well-being of my pediatric patients.
[04:35] SPEAKER_01:
Absolutely. And I want to get back into some of the medical details in just a moment. But just briefly, I wanted to touch on the idea of poverty. And I think one of the things that's surprising for a lot of educators about the adverse childhood experiences research is that a lot of the things that we associate with poverty are not the things that are on the list of aces. For example, Many are quite common among middle and upper middle class families, things like divorce, you know, things like emotional neglect that we might not think are right up there with, you know, perhaps unsafe housing or food insecurity. You know, it's kind of a different set of issues than we would just intuit.
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So I think it's a very both surprising and quite common list of phenomena that we see, you know, not just in our student population, but in society at large, as you said, quite a few people have experienced one or more of these.
[05:29] SPEAKER_02:
Well, actually, this is what the data supports, right? The original ACE study was done in a population that was 70% Caucasian, 70% college-educated. And what we know is that although underserved communities have fewer resources to be able to mitigate the biological effects of adversity, ACEs happen in every community and are a health threat across our entire society.
[05:54] SPEAKER_01:
Well, when we talk about the medical side of these adverse childhood experiences, we sometimes think about students from poverty and we think about things like asthma. We think about respiratory distress or maybe obesity and cardiovascular health. But as you've studied this, as the CDC has studied this, what have been some of the specific mechanisms by which trauma in life translates into outcomes, translates into health effects, translates into various situations that people have to deal with later in life. What is that kind of biological cause and effect chain that occurs between some sort of experience, such as a parent with mental illness or a parent going to prison or substance abuse, and what actually happens in the body?
[06:39] SPEAKER_02:
So it all comes down to our body's stress response, right? Our fight or flight response that was evolved over a very long period of time to save our lives from a mortal threat. And one of the things I talk about in The Deepest Well is that if you're walking in the forest and you see a bear, right, what happens in our bodies? Our brain sends a signal to our adrenal glands, which sit down on top of our kidneys, to say, release stress hormones, which include adrenaline and cortisol. And these hormones are the chemicals in our body that are associated with a lot of the familiar feelings that we have of being terrified. And they activate the stress response.
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So our hearts start to beat harder and faster. Our airways open up. Our pupils dilate. And we're ready to either fight that bear or run from the bear. But if you were to think about it, fighting a bear would not seem like a good idea, right? Because bears...
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are big and they have teeth and they have claws. And so that is why the amygdala, the brain's alarm center, actually sends projections to the prefrontal cortex, the part of the brain responsible for executive functioning and judgment and impulse control. And when the stress response is activated, it actually turns down the functioning of the prefrontal cortex and turns up the functioning of a part of the brain called the noradrenergic nucleus of the locus coeruleus, or as I like to call it, the part of the brain that's responsible for, I don't know karate, but I do know karate. This is the within the brain stress response center, and it's responsible for getting you amped up, which is what you need to fight a bear.
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And then the other less obvious thing is that when you activate your stress response you actually you also activate your immune response because if that bear gets his claws into you you want your immune system to be primed to bring inflammation to stabilize that wound and so that is genius and makes sense if you are in a forest and there's a bear but the problem is what happens when the bear comes home every night and that system is activated and over and over and over again and it goes from being adaptive or life-saving to health damaging and kids especially are sensitive to high doses of adversity because their brains and bodies are just growing right so high doses of stress hormones in children actually changes the developmental trajectory of the brain and
[09:38]
the hormonal systems, our immune system, and even the way our DNA is read and transcribed.
[09:46] SPEAKER_01:
So I want to make sure I have this right. You're saying that because a threat typically, you know, in the wild, if we're facing a bear or something like that, is going to have some health consequences. You know, if we get injured, the immune system needs to be activated. And the immune system is also activated by something like a domestic violence situation or some sort of crisis in the family that triggers that same kind of stress response. It actually activates the immune system?
[10:14] SPEAKER_02:
That's right. So adrenaline is this chemical signal. It activates all this stuff in our brain. But it's also, you know, you want your body to have these shortcuts. And so the same time you're activating the fight or flight response, it's also activating the immune system.
[10:29] SPEAKER_01:
So that's the part that I think as educators is very counterintuitive for us because we'll see, you know, a kid who is amped up, you know, I was a middle school teacher, I've broken up fights, and we certainly see that, you know, that is not a time when young people are thinking rationally. And open to reason, you know, it is very much a fight or flight kind of situation. So that part makes sense to me. But I never would have thought, gee, I wonder if this child's immune system is being pushed into hyperdrive right now. It just would not have crossed my mind. And it sounds like, you know, you said when the bear comes home with you every night, there are some lasting effects developmentally on gene expression, you said.
[11:10]
So let's talk more about how that shows up both developmentally and in adulthood. What are some of the consequences of that stress?
[11:18] SPEAKER_02:
Sure. So one piece is that asthma is the number one reason health cause for missed school days, right? A child with four or more adverse childhood experiences is is twice as likely to have asthma as a child with zero ACEs. So there are many ways that we never even recognized previously in which this overactivity of the stress response is impacting kids' health and development and ultimately their school engagement and their school performance. In terms of DNA expression, right, like the way that early adversity leads to these long-term changes, is that when we have these high doses of stress hormones, they actually change the way our DNA is read and transcribed. So the activation of our stress hormones, if it happens over a long period of time, it changes a couple different ways that our bodies understand how to read and express our DNA.
[12:18]
And one of the big ways is DNA methylation. Our body just puts a mark on the DNA, and that helps our reading mechanisms understand it. Do we need to read a lot of this segment of DNA? Do we need to read a little, you know, should we just stop expressing this gene completely? And I like to think about it, uh, like, you know, musical notations. I am not a musical person at all.
[12:42]
I have no musical talents, but I did learn how to read music when I was in the fifth grade. And it's a little bit like, you know, there are the notes on the page and those are like our genetic code, right? They tell you which notes to play. But then the musical notations tell us whether to play that piece strong, like forte, or soft, or to repeat one section if you see this musical notation, or skip one section if you see that musical notation. That's exactly how our body reads our DNA. And when we have high doses of adversity, it marks the DNA in ways that changes the way that we express our DNA.
[13:26]
And so what it leads to is an overactivity of the DNA mechanisms that tell us to respond to stress, right? Because if you're a baby and you are in a highly stressful situation, your body actually wants you to be very stress reactive so that you can stay alive. And so we overexpress our mechanisms in the body for activating the stress response.
[13:56] SPEAKER_01:
And the cumulative effect of that is all kinds of chronic illnesses. So let's talk more about some of the long-term outcomes. So you said the CDC has actually identified quite a few outcomes, both in childhood and in adulthood that are correlated with that pervasive level of stress.
[14:12] SPEAKER_02:
Yeah, that's right. And these aren't just like some health outcomes. If you look at the 10 leading causes of death in the United States of America, having an ACE score of four or more is associated with dramatically increased risk for 7 out of 10 of the leading causes of death. So childhood adversity is having a profound impact on not only our health outcomes, but as you can imagine, healthcare costs, right? How much money we're spending on treating these chronic diseases that is now no longer available for doing early care and education. So thinking about how we are redirecting or redeploying the limited resources that we have is actually critically important.
[15:00] SPEAKER_01:
Well, let's start to get into some of those implications for educators, for policymakers. Obviously, as educators, we want to do everything we can to minimize the trauma and the harm that students are experiencing. But often we are on the after the fact kind of end of serving students. We're dealing with maybe the consequences of behavior or the consequences of stress. and often we have fairly punitive systems in place for dealing with you know a student who comes to school you know dysregulated or just having experienced a lot that they're they're kind of carrying with them as baggage to school what are some things that we can do as educators to a be be aware of how trauma is affecting our students but b serve them more effectively because you know we have ieps we have 504 plans we know
[15:50]
how to work with students who have learning disabilities or who have Down syndrome. But when it comes to trauma, we're really just becoming aware that this research even exists. So being on the cutting edge of that, what are some of your recommendations for us as educators and as educational leaders as to how we respond and serve students effectively who have experienced trauma?
[16:12] SPEAKER_02:
Well, awareness is certainly the first step, but we need to transform that awareness into action on behalf of young people. Some of the folks who are doing this really well right now who are bringing the science of toxic stress into the classroom include Turnaround for Children that's based in New York that is doing work in several cities in the U.S. and also the Center for Wellness and Achievement in Education that's based out in San Francisco. And what these folks are doing is number one, educating everyone in the school environment about the biology of toxic stress and the symptoms, how that can show up and what that looks like. Because oftentimes right now, districts that are not informed about the symptoms of toxic stress may be inadvertently taking a situation where a child has an overactive stress response, right?
[17:09]
And then implementing harsh or putative measures, which only further inflame that child's activated stress response. So one of the things that, for example, Turnaround is doing, in addition to making sure that everyone in the educational environment understands this science, is also doing things like, for example, when a child is or a young person is dysregulated, giving them, you know, 20 minutes to sit down and cool down. Let their levels of adrenaline and cortisol kind of calm down a little bit before you try to sit down and have a conversation with that child. Because guess what? If they're really activated, their prefrontal cortex is not engaged, right? So it's going to be more difficult to make that connection.
[18:00]
And one of the things that I really recommend is, for example, starting with asking questions that help to encourage reflection and actually reengage that prefrontal cortex. So, for example, asking, you know, how are you feeling right now, right? Giving that young person an opportunity to reflect on how the heck are they feeling? Are they overwhelmed? Are they dysregulated, you know? And then from there, implementing interventions that can hopefully help to calm or regulate an overactive stress response.
[18:35]
Now, one of the things that we understand is that as humans, we have the ability to biologically buffer each other's stress, right? We know just as I can activate your stress response, I can also, you know, buffer your stress response through our engagement. So there's actually a lot that folks of the educational environment can do to help to de-escalate and re-regulate kids who have an overactive stress response. And so, you know, one great example, what they're doing at the Center for Wellness and Achievement in Education is is using mindfulness as a practice throughout the school environment, both for young folks, for learners, and also for educators because that not only reduces stress among the learners, it also reduces stress among the educators so that they themselves are more able to be a buffer to help de-escalate a dysregulated child.
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With the Center for Wellness and Achievement in Education, One thing I just want to add, when they implemented this mindfulness protocol in junior high and high schools in San Francisco, what they saw was a decrease in suspensions, a decrease in expulsions, an increase in GPA, and an increase in standardized test scores, and a reduction in the African-American achievement gap. And all of that data is available on their website, cwae.org.
[20:06] SPEAKER_01:
So the idea there is that if we give students a chance to calm down, to get their thoughts together and ask reflective questions, get kids thinking, reactivating that prefrontal cortex, then that opportunity can really make a huge difference for kids who are in that situation. That's exactly right. I wonder if we could talk about the same thing for educators, because I will definitely say I've had my moments of being somewhat dysregulated when dealing with a tough situation or dealing with students who are escalated. And I've read a little bit about this idea of kind of secondary trauma for teachers or secondary stress that kind of accompanies working with students. students who are experiencing very high levels of trauma or stress. I'm seeing that in the headlines a little bit, that idea of secondary trauma, and I wonder what you've come across in your work.
[20:59] SPEAKER_02:
It's certainly a significant issue and understanding. I think it's part of the reason why I feel like this science provides us additional tools because if you're working with a lot of students who have an overactive stress response, it's almost like understanding how to do basic hygiene for yourself to be able to prevent yourself from becoming overstimulated and dysregulated. It's actually really critically important to understand what you're being exposed to. And at the same time, recognizing that when we're talking about ACEs, right, we're not just talking about our students or the young people that we're working with because ACEs Two thirds of us have our own ACEs, right? And recognizing that that can also make us more susceptible to vicarious trauma and activation of our own stress response.
[21:52]
And that's why it's really important for us to understand that we need to put our own oxygen masks on, right? It's like, you know that old saying, you got to put your own oxygen mask on before you put it on the child. we really have to make sure that we are practicing self-care. And there are actually trainings that educational communities can do about vicarious trauma, how to implement the policies and practices to support caregivers who are working with a highly traumatized community of children. Because I think it's really critical to recognize that if we don't do that, what we're going to see is really high rates of burnout, really high rates of teacher turnover. And having those safe and stable relationships are actually exactly what we need to see better outcomes for these kids.
[22:44]
So investing in our teachers' well-being is critical for doing this work in the long term.
[22:52] SPEAKER_01:
Well, Dr. Burke-Harris, I know one of the things that we go to as educators is intervention and screening is often a first part of intervention. And we're starting to hear a little bit now about ACE screeners. And I've personally taken the ACE quiz that you can find on npr.org. But as to this question of how we serve students and how we identify students for interventions, what do you think of this idea of giving a screener and asking students, you know, has this happened to you?
[23:18]
Has that happened to you? as just a normal part of our educational practice? Do you see that happening? Do you think it's good? What should we be doing in terms of screening for adverse childhood experiences?
[23:29] SPEAKER_02:
So I actually don't recommend that schools necessarily screen for ACEs for a couple of different reasons. Number one is that you guys already have a lot of really important work to do. And number two, when we're looking at ACEs as a public health crisis, one of the really important things for us to do is be really thoughtful and strategic about how we actually create an integrated response across our society. And in order for us to get the political will and the resources to do the screening that is required for early detection and early intervention, because all of the science tells us that early intervention improves outcomes, all of the science. But in order to do that, we have to show policymakers that the entity that is doing the screening has both a moral and a legal accountability to address the outcomes.
[24:29]
And what I want to make sure is that families and caregivers have confidence in the fidelity that when they are filling out that ACE screen, it means that they're going to get the care that they need, right? And one of the big concerns that I have about screening outside of the primary care home is that there are lots of downstream impacts of ACEs on health, on learning, on development. And the doctor's office, I believe, has the moral and the legal obligation to address all of those outcomes. And we also don't want to reinvent the wheel. We also don't want to be investing a ton of resources to figure out how to screen for ACEs. But rather what I'd like to see is what we do, for example, with asthma, where it's my job as a doctor to screen for asthma, to identify and diagnose that, and then to send my patient to school with an asthma action plan and an emergency care plan and a release to use medications on the school premises, right?
[25:37]
So what I think is important, especially at this time, is an investment in the coordination of services between our healthcare, our educational environments, and other child-serving environments so that we're not all scrambling to duplicate efforts and that we can concentrate our resources in, you know, for example, for schools, really creating trauma-informed environments for learning and supporting educators in this process.
[26:07] SPEAKER_01:
I think we got the idea as educators that we could solve all problems if we just buckled down and worked hard enough. We took that accountability idea a little too seriously, but it definitely sounds like addressing these challenges is a team sport. And I appreciate your perspective as a healthcare provider and a researcher in bringing that medical perspective and taking the time to share it with us as educators and also with a general audience. And I wanted to ask in kind of closing here, who specifically you had in mind in writing the book, The Deepest Well, Healing the Long-Term Effects of Childhood Adversity? Because I know this is getting a very wide distribution. This is not just a book for doctors or educators.
[26:46]
Who did you have in mind to impact with the book?
[26:49] SPEAKER_02:
Yeah, I was definitely specifically thinking about anyone who has a child, anyone who was a child, anyone who may work with a child, anyone who cares about children, or frankly, anyone who cares about long-term health or well-being or our economy or Yeah, so I wrote it for everybody.
[27:18] SPEAKER_01:
It's hard to think of any aspect of our society and life that these issues don't touch. So really, it is great to see that book reaching such a wide audience. And again, the TED Talk that you did in 2014, having been watched more than 3 million times, this is information that we need to have, a message that needs to get out. And I just want to thank you, Dr. Burke Harris, for taking the time to share it with us on Principal Center Radio.
[27:42] SPEAKER_02:
Thank you so much for having me.
[27:44] SPEAKER_01:
So again, the book is The Deepest Well, Healing the Long-Term Effects of Childhood Adversity by Dr. Nadine Burke Harris. And Dr. Burke Harris, where can people go online to find out more about your work?
[27:57] SPEAKER_02:
Centerforyouthwellness.org.
[27:59] SPEAKER_01:
All right. Well, thank you so much for your time. And it's been a pleasure to speak with you and really enjoyed it. Thank you so much.
[28:05] SPEAKER_02:
Thank you. This has been fantastic. Thank you. I appreciate it.
[28:08] SPEAKER_00:
And now, Justin Bader on high-performance instructional leadership.
[28:13] SPEAKER_01:
So high-performance instructional leaders, what did you take away from my conversation with Dr. Nadine Burke-Harris about ACE scores and adverse childhood experiences? One of the things that I'm really struck by after our conversation is the importance of having a plan. You know, it's one thing to read a book or watch a TED talk and become aware of something, or as I mentioned, take the ACE quiz on the NPR website, which we'll link to in the show notes. But it's another thing entirely to have a systematic approach to educating your staff about these issues and putting interventions in place to serve students effectively. And personally, I don't offer anything at the Principal Center that is really equipped to help you with that.
[28:57]
But I want to recommend to you my friends, Chris and Courtney Dacos of Continua Consulting Group. If you go to Continua, C-O-N-T-I-N-U-A, consulting.com. Chris and Courtney went to grad school with me and really it's just been exciting to see their work grow over the last couple of years. They're working intensively with schools, particularly schools that have large populations of students who've experienced adverse childhood experiences or high ACEs, and they help schools develop trauma-informed, multi-tiered systems of support. Chris and Courtney have been on Principal Center Radio previously and probably will be again But I want to encourage you to start a conversation with them at ContinuaConsulting.com if this is something that you are ready to address in your school or your district.
[29:46]
And this is big work. This is important work. Just as we have become aware of the need to have solutions for students who have learning disabilities, who have particular other needs that we have a plan for addressing. We have got to get this figured out in our profession. And I'm just so privileged to know Chris and Courtney and to be able to keep up with their work at Continua Consulting. And you'll probably hear more from us on that.
[30:12]
But check out their work at continuaconsulting.com. And of course, check out Dr. Burke Harris's book, The Deepest Well, Healing the Long-Term Effects of Childhood Adversity.
[30:22] Announcer:
Thanks for listening to Principal Center Radio. For more great episodes, subscribe on our website at principalcenter.com slash radio.
