Childhood trauma linked to poor health. Can parents find help in Stanislaus County?
Aguilar is tall with the lean, athletic physique of a soccer player, casually confident and with a magnetic smile.
It’s hard to imagine that a little more than a year ago, the 14-year-old was suffering with ticks that caused his head and neck to jerk to the side, incapacitating headaches and sometimes, body twitches.
His body was trying to cope with mental distress after witnessing the frightening event of a gang member threatening to murder his father and the whole family.
Living with fear of violence was affecting Aguilar’s health and ability to function.
Chatting at Golden Valley Health Center in Manteca last week, Aguilar was articulate and insightful about that trauma, but said at the time, he hadn’t connected the event with his physical symptoms.
Fortunately, his primary care doctor did and referred him to GVHC Behavioral Health.
Aguilar’s care was ideal. However, recognizing the need for and having ready access to mental health care is not the rule in Stanislaus County, the Central Valley or California.
There aren’t enough mental health care providers across the state to meet the current need, according to the California Health Care Foundation.
The demand for mental health providers is expected to increase with the January 2020 state law funding payment to Medi-Cal providers for screening their patients for adverse childhood experiences, or ACEs.
“There’s always a need (for more providers),” said Keri Magee, “But, for anyone who walks through our door, we work to get them services or to connect them with appropriate resources.”
Magee is the chief of children’s system of care for Stanislaus County Behavioral Health and Recovery Services.
In 2018-19, more than 4,200 children and teens received care with the county agency, including juvenile justice system, foster care, community-based clinics and crisis intervention.
Data are not available for the number of Stanislaus County youth with ACEs, however, 65% of adults have a history of at least one ACE and it’s likely the rate is similar for children.
Stanislaus County is home to about 145,000 children and teens younger than 18 and nearly 1 in 4 youth live at or below poverty.
Approximately half of county kids are insured by MediCal or CHIP, Child Health Insurance Program, and could have ACEs screening by their doctors.
What are ACEs?
“ACEs stands for adverse childhood experiences that children or even adults may have gone through that may impact their health or emotional well being,” said Heydi Herrera, assistant director of GVHC Behavioral Health.
ACEs include three broad categories of traumatic events incurred by children younger than 18, such as:
Abuse (physical, emotional or sexual)
Neglect (physical or emotional)
Household disruption, including domestic violence, mental illness and loss of a parent from death, substance abuse, divorce or incarceration
In the original ACEs research from the Centers for Disease Control and Prevention and Kaiser Permanente, more than 17,000 adults were surveyed about traumatic events as a child after their annual check-up
The highest ACE score is 10. The researchers found that the more ACEs reported, especially for scores of four and higher, the more likely the adult had mental and physical health problems, such as depression, addiction, diabetes, obesity, heart disease and even early death.
They also had more risk-taking behaviors, such as smoking, substance abuse and multiple sexual partners.
However a score of one, for example, due to one episode of sexual abuse, can warrant the need for psychological treatment.
“ACEs can have an impact upon a child’s growth, development and health” said Dr. Richa Verma, pediatrician at GVHC in Patterson and medical director of GVHC western region.
With that in mind, GVHC practitioners ask about risks for ACEs of children, teens and their parents at well-child checkups and pregnant women at their maternity visits.
Poverty is associated with ACEs, though experts debate if poverty causes ACEs or ACEs cause poverty.
Verma said more than 80% of GVHC clients live at or below the federal poverty level and have public insurance or no insurance.
“With our population, (we’re) concerned that high numbers will screen positive,” said Verma, “And we want to be able to do something about it.”
Patients with mental health needs are referred to GVHC Behavioral Health, and comprehensive evaluation for adversity is part of their mental health assessment.
Herrera said GVHC can provide behavioral health care for people with mild to moderate problems and they refer patients with higher needs to community providers or county behavioral health agency.
California’s new ACEs screening law
California’s surgeon general, Dr. Nadine Burke Harris, is an international expert in ACEs, childhood trauma, toxic stress and building resilience. She’s one of the driving forces for the new state law.
The law mandates that Medi-Cal providers must use the original CDC-Kaiser study questionnaire for adults and the Pediatric ACEs and Related Life-events Screening for youth to receive payment.
The PEARLS questionnaire queries for ACEs, as well as other social factors for health, including food insecurity, housing instability, community violence and discrimination.
The goal of screening is to permit early identification and treatment to improve Californians health and to lessen the related financial burden, which approaches $102 billion annually, according to the Pacific Institute for Research & Evaluation.
“Nadine talks about ACEs like how the Germ Theory found that viruses and bacteria were the root cause of infectious diseases,” said Dr. Eric Ball, “ACEs may be part of the root cause of many diseases.”
Ball is a practicing pediatrician in Orange County and the California American Academy of Pediatrics representative to the surgeon general’s Trauma-Informed Primary Care Implementation Advisory Committee.
He said screening for ACEs is very exciting because it affords the opportunity to intervene against the negative health effects of ACEs.
Ball said he’s not concerned about the state’s limited mental health resources for a few reasons: the law includes training for practitioners about ACEs care, mental health care is not needed for all ACEs and he thinks the demand may lead to an increase in supply, which he referred to as “If you build it, they will come.”
However, some California medical professionals have concerns about not being able to meet an increased demand for mental health care, according to ACEs Connection.
In an email, Anthony Cava, spokesperson for CA Dept. of Human Services stated, “Much of the provider training discusses how a primary care provider can use the information obtained through an ACEs screen to improve their own care of a patient. For Medi-Cal managed care members, providers can also work with their contracted health plan for assistance with referrals when needed.”
Mitigating toxic stress and ACEs
Research suggests that that psychological trauma can lead to physical illness in part due to “toxic stress,” which results from chronic elevation of the body’s stress hormones, including cortisol and adrenaline.
These chemicals are essential for the “fight or flight” response to danger to prepare a person to mount a defense or run for safety. However, if the stress response stays activated, it becomes caustic and undermines normal brain development and a child’s sense of well-being.
However, living through ACEs does not seal a child’s fate. Timely identification and intervention can mitigate the negative health effects in the short term, as well as later in life.
The Harvard Center for the Developing Child has documented that the effects of adversity can be lessened if the child has a caring, attentive adult in their life. The adult, who doesn’t have to be the parent, can comfort a child and help “reset” their stress level.
Neighborhoods and the surrounding community can also make a difference for a traumatized child by offering supportive programs, local health care and social services, as well as opportunities to cultivate a relationship with a caring adult.
One example of the local community working to support traumatized children is F.O.C.U.S., Focus On Children Under Stress program, developed by the Stanislaus County Office of Education.
Vicki Bauman, director of SCOE prevention programs, said SCOE developed the F.O.C.U.S. app, which allows local law enforcement agencies and other first responders to notify a child’s school if the child incurred a traumatic event, such as a parent taken into police custody, domestic violence or was in a car crash.
The specific event is not disclosed, but the child’s school and teacher know that the student likely needs a little extra support. The school personnel can also refer the child for therapy if needed.
When trauma has occurred, psychological therapy has proven benefits for recovery, according to a 2016 scientific review of nearly 100 publications.
This was the case for Aguilar.
Guadalupe Laros-Garcia, a licensed clinical social worker at GVHC and Aguilar’s therapist said working closely with his primary doctor, they provided a treatment regimen that included behavioral therapy and physical therapy for his muscle spasms. However, she emphasized that his parents support was the key to his successful outcome.
Aguilar said, “I feel great now. If it wasn’t for them, I wouldn’t be how I am, playing sports, doing my school work, being best friends with my dad and just being a new person.”
His advice to other kids who have experienced trauma, “Don’t be scared to tell people about it, because if you tell someone, they can help.”
The ACEs adult questionnaire can be found at: https://acestoohigh.com/got-your-ace-score/
For non-emergency help, contact your primary care provider or Stanislaus County Behavior Health and Recovery Services at http://www.stancounty.com/bhrs/
For emergency help, call 911 or the county agency at (209) 558-4600.
This story was produced with financial support from The Stanislaus County Office of Education and the Stanislaus Community Foundation, along with the GroundTruth Project’s Report for America initiative. The Modesto Bee maintains full editorial control of this work.
This story was originally published February 25, 2020 at 6:00 AM.
