Pediatric patients giving their health histories at the Center for Youth Wellness, a health clinic in the impoverished Bayview Hunter’s Point area of San Francisco, are asked for more than the usual details about allergies and current prescriptions. Doctors there need a different kind of medical history: did their parents use drugs or have a mental illness? Were any family member in jail or prison? Have their parents divorced or separated? Have they suffered from physical, emotional or sexual abuse?
The questions may seem beyond the scope of a primary care physician, but decades of research have solidified the link between such childhood trauma and poor outcomes later in life. The number of adverse childhood experiences (ACEs) determines the patient’s risk for a wide range of health problems including heart disease, chronic bronchitis or emphysema, diabetes, severe obesity, substance abuse, suicide attempts, cancers of all kinds and early death. The more ACEs a patient has, the higher their risk for chronic disease and a shorter than average lifespan.
Childhood adversity comes at a high social cost as well. Experts say there’s increasing evidence that childhood trauma is a problem for the criminal justice system as well as a public health problem. ACEs result in a range of behaviors punishable by the law. According to figures from the National Institute of Justice, abuse or neglect in childhood raised the chances of juvenile arrest by 59 percent. The likelihood of criminal behavior in adulthood increased by 28 percent and violent crime by 30 percent, according to another study cited by the Centers for Disease Control and Prevention.
Such facts have prompted statewide efforts to respond to adverse experiences in childhood, including the October launch of the Bay Area Research Consortium on Toxic Stress and Health, a collaboration between UCSF, Benioff Children’s Hospital Oakland, UCSF and the Center for Youth Wellness. One area of focus will be the connection between ACEs and the criminal justice system.
“Many of the kids who end up in the juvenile justice system, the vast majority of them have been exposed to high doses of adversity,” said Nadine Burke Harris, CEO of the Center for Youth Wellness and a pediatrician. Screening is the key to prevention, not just for illness but for jail time, too. “We’re looking at it from a health standpoint, but we know for a fact that if we’re screening for ACEs and doing effective intervention, it’s going to impact justice outcomes.”
Bayview Hunters Point is an economically distressed neighborhood, but Burke Harris knows that exposure to childhood adversity is not unique to people who live in poverty. In fact, she said, an ACE survey among their clients closely matched national averages: about two-thirds had at least one ACE — the most common factor in Bayview Hunters Point is parental separation — and 12 percent had four or more.
Yet the consequences of behavioral problems for children of color, especially those who live in poverty-stricken urban areas, are strikingly different compared to white and more affluent children.
There’s an indisputable disparity in the way that justice is administered, says Lenore Anderson, executive director of Californians for Safety and Justice. Nationwide, young people of color have far higher incarceration rates than their white counterparts — black youth are 4.6 times more like to be incarcerated, Native Americans are 3.3 times more likely, and Latino youth are 1.7 times more likely, according to 2013 data from the U.S. Justice Department.
“We know enough to know who is at risk of falling through the cracks later in life, and it should shock the conscious of every Californian that we don’t do anything despite what we know,” Anderson said.
James Bell, executive director of the W. Hayward Burns Institute, has investigated these types of disparities on behalf of jurisdictions that are concerned about the overrepresentation of youth of color in their systems. “When we look at why those kids are in the justice system, we find out they’re there for high social needs, i.e. trauma, toxic stress [that’s] undiagnosed and unaddressed,” Bell said.
“In many ways, the juvenile and adult criminal justice systems exacerbate the trauma. They actually make matters worse, by the very nature of how the system works,” said Anderson. “In addition to exacerbating trauma, it’s also just ineffective.” The increased understanding of the connection between childhood adversity and criminal justice offers an opportunity for prevention, she added.
Bell, however, questioned the idea that a trauma informed approach help remedy such significant disparities. Over the last 11 years, Bell and his colleagues have worked in more than 140 counties in about 20 states, and have found a pattern of youth of color being detained more often and held longer for the same behaviors as white youth.
“The justice system does not have the bandwidth…to distinguish between high social needs and high public safety risk,” he said.
“Unfortunately, because of structural racism, if you are a kid of color, the justice system is not really interested in sorting it out,” Bell continued. “No one is going to say explicitly, but it’s just so baked into the way that justice is administered.”
Bell says that in order for meaningful changes to happen, systems need to do more than adopt buzzwords such as trauma-informed.
“I don’t know very many justice systems that are trauma-responsive; I know a ton of them that are trauma-informed, but it’s not clear to me that they’ve done one thing different to change their practice.”
To Bell, a better goal is to be trauma-responsive — to actually change practices that are known to cause trauma.
“That is a much heavier lift for the justice system because rarely are they going to get rid of the tools of trauma — which are handcuffs, solitary confinement, isolation, and pepper spray,” Bell continued. “If you’re going to forgo those instruments, now we’re talking that you’re trauma-responsive. But being informed about it, that doesn’t move me in any way.”