By Dominic Cappello
We have lived with childhood trauma for millennia and only in the last century have we adults begun to view children as something other than property. And to illustrate why we as a society are having such a hard time eradicating childhood trauma, let’s talk about your lattes.
You want to avoid the empire of Starbucks so you invest your time in a local independent coffee shop. You really want to like this place, their cool baristas, and coffee. But it’s just not very good. Why are the lattes so less satisfying? Bad coffee? The machines? The water? Are baristas not really coffee drinkers? We call this process root cause analysis. We ask questions to understand the causes of things—from coffee to childhood trauma. One does not try to solve a problem without investing in this process.
The problem of childhood trauma is pretty straightforward: Let’s make every childhood trauma-free. It’s not so complicated, right? Or is it? We need to ask, what is behind the rates of childhood trauma, a problem impacting most extended families and in every community across all socioeconomic lines. Consider the following ten root causes and how you and your colleagues can begin addressing them.
Root Cause One: We have a long history of violence.
Adults have been doing horrible things to children and other adults as long as there have been humans. And as mentioned, children only became “people with rights” recently, after women, African-Americans, and after men who were not landowners. It’s a long winding road from living in a society where only the male, white 1% run everything to one where, at least on paper, we all have the right to have a life safe from violence and pursue liberty and happiness. The lists of challenges below is a starting point for community mobilizing around evidence-informed solutions.
Root Cause Two: Mental llness goes untreated.
We don’t yet guarantee quality mental health care in our states. If you can’t afford it, you don’t get it. Yes, some program might give access for short term talk therapy, but for long term behavioral health care, we are not there yet. This means a parent struggling with stressors and an as yet undiagnosed mental health condition might just snap—and the consequences for her or his children’s safety could be tragic. We also don’t address the stigma around mental health–as in some cultures, it’s scary to access–it means sharing family secrets. Not getting diagnosed and treated for challenges means generational cycles of parents with untreated mental illness raising kids.
Root Cause Three: Poverty dooms most families to a life of daily, if not hourly, stress.
Our public health gurus will acknowledge that poverty is a risk factor of childhood trauma. Poverty impacts all families differently. For many, it can mean unstable and underpaid work, unsafe housing, underperforming schools and living in households where there is mental illness, substance misuse, and forms of domestic violence. While families living near the federal poverty level can create healthy and resilient households, it’s not easy. And we, living in such a wealthy county, have no excuses for not sharing vital resources when it could so easily be done.
Root Cause Four: We self-medicate with many substances.
Substance misuse is another big factor in childhood trauma and certainly, from the data we get from child protective services’ assessments of parents who have had their children taken into custody, we know substance misuse, along with untreated mental illness and domestic violence play a role in child maltreatment. And yes, we could devote another article to the root cause of substance misuse, but for now, let’s agree it is a huge address that merits our attention.
Root Cause Five: We lack extended families.
We have communities in every large city where many of the households are headed by single females tasked with raising children. On their own, often without a nearby aunt or grandma, these women balance work and parenting. And this can lead to huge stressors that can lead to various forms of child neglect. We are not saying that living in extended family units prevents childhood trauma, but we do think that children have a better chance of being monitored with more eyes on them than just one parent or two overworked and underpaid parents.
Root Cause Six: Child Welfare is not always supported.
About a century ago the modern child welfare bureaucracy was born in the US. Broadly speaking, their mandate is simple: Find the kids who are being hurt, and figure out a
way to stop the hurt. It is a very difficult process and we are not always funding and supporting the child protective workforce as best as we can. We must ensure that all workloads fall within best practice limits (meaning if best practice says an investigator should never have more than 15 cases, we don’t expect them to keep every kid safe if they have 35 cases).
Root Cause Seven: The tools to measure and understand childhood trauma are new and not fully implemented.
We have, in the past decades, invented a term called Adverse Childhood Experiences (ACEs), which describes ten experiences a child may be subjected to in the home. Half of ACEs are forms of child abuse and neglect, while the other half is focused on living in a home where people have untreated mental health challenges, or parents divorced or misused alcohol and other substances, or there was domestic violence, or if someone went to jail.
ACEs are still barely on the radar screen–since the science of childhood adversity is new. But by understanding the impact of high ACEs scores, we can better screen, assess and treat the trauma associated with ACEs. We can find strategies to treat both children and their parents. And this will take some very strategic and long term mobilizing. The good news is that there are models in both school-based and community-based environments where ACEs are being addressed effectively.
Root Cause Eight: Our lives become cluttered, distracted and banal
Significant percentages of the population devote hours daily to posting online their feelings about their childhood, movie stars, singers, and corrupt politicians. Both the right and left and everybody in between can get so focused on a website and who tweeted what to whom, that we literally forget that 60% of our adults are reporting various levels of ACEs—which indicates that the cycle of ACEs and childhood trauma is unfolding as you read this blog. As I saw recently on a trip to NYC, painted over a ten story building was the huge text: “It’s time to put down our phones and start living again.”
Root Cause Nine: Governments will work on hunches rather than science
We have good-hearted people coming up with strategies that tackle narrow parts of the problem because there is not an analysis of the entire system working for kids and families in distress. Many non-profit organizations, foundations, and gov’t agencies tasked with addressing childhood trauma are not data-informed decision-making nor promoting evidence-based strategies. We are not using any data-driven frameworks to get us to meaningful and measurable solutions. Yet we could so easily.
Root Cause Ten: We focus on the kids when it’s a family and community problem
We all want to help kids, but kids usually live with adults in community setting. We need to address what’s impacting children, teens, all their adults household members and then assess the safety of the community in which everyone lives. Ending childhood trauma demands a comprehensive approach. This is when we must remind all of us of the cycle of trauma within families and how-dare we say, everything and everyone is connected.
WHAT DO ALL THESE ROOT CAUSES MEAN?
The collection of interrelated problems and root causes that answer the question of why we haven’t solved this problem of childhood trauma already are certainly complex, just like the much-needed response will be. The solution will no doubt require endless refinement that, in the best case scenario, will keep us busy for decades. Where to begin? Pull together some committed representatives from the sectors paid to serve families, sprinkle in some technology and data experts, add local community residents of all ages, then you can commit to a data-driven process of achieving a goal that has eluded most of humanity forever-the end of childhood trauma.
Dominic Cappello is the Senior Director Quality Improvement and Design for Healthy Gen. He also leads the implementation of the Child Welfare Data Leaders and Quality Improvement Initiatives in New York, New Mexico and Connecticut, funded by Casey Family Programs. He worked for the NM Department of Health’s Epidemiology and Response Division and the NM Protective Services-Research, Assessment and Data Bureau. He has a Master of Arts in Liberal Studies with an emphasis in Language and Communication from Regis University.