San Francisco’s Bayview district is best known for its gun violence, drugs, pollution and poverty, and not much else. But a community health clinic’s radical approach to healing children may change all that by turning the impoverished neighborhood into an epicenter for trauma-informed care.
Pediatrician Nadine Burke Harris transformed her Bayview clinic to incorporate a growing body of research linking emotional and physical abuse, neglect and household dysfunction to a long list of poor health and societal outcomes later in life. The stress that arises from chronic exposure to trauma is so severe that it is called toxic stress, which can alter a child’s developing brain and body.
Since Burke Harris began treating patients struggling with toxic stress, she and her wellness center have become a fixture in the childhood trauma world: with glowing descriptions in news articles, and most recently a proposed California resolution to include the science of childhood trauma and toxic stress into the state’s policy vernacular.
“Nadine Burke Harris is a natural leader. She’s just wonderful,” said Esta Soler, president of Futures Without Violence, a organization advocating for trauma-informed policies on a national level. “Center for Youth Wellness is an incredible organization, a laboratory that will help many young people and families living with a lot of adversity.”
Soler said she hopes what Burke Harris is doing in the Bayview will inspire other leaders across the nation to apply child trauma research to their work with children.
The idea of approaching child trauma as a public health problem, not just a mental health one, has gained prominence among researchers and practitioners and has also attracted the attention of highbrow media like The New Yorker.
Burke Harris is an advisory council member for Hillary Rodham Clinton’s “Too small to fail” campaign, which promotes childhood development brain science. She was even in a promotional video with Clinton.
The Tipping Point Community, an organization that gives grants to non-profits dedicated to ending poverty, funded Burke Harris’ relocation and renovations of larger building, which allowed for the expansion of wellness and advocacy centers.
The Center for Youth Wellness is across the hall from Harris’ pediatrics office, in a non-descript building on Third Street. A sour smell from a nearby sewage treatment plant hangs in the air 24/7, and the building is a stone’s throw from the silos and grain elevators that sit abandoned and dilapidated on the waterfront.
Despite the bleak surroundings, the wellness center acts like an oasis for traumatized children. The roughly 1,000 children who visit the pediatrics office each year are screened using the Adverse Childhood Experiences scoring system, or ACEs. In 1998, researchers Robert Anda and Vincent Felitti released a blockbuster study linking child trauma to future health problems. The more the trauma the greater the likelihood a person will develop health and behavioral problems as an adult. They created the ACE score to measure instances of adverse experiences, like a child who is sexually abused by a parent, living with an alcoholic family member, a parent diagnosed with a mental health illness or having an incarcerated father are all traumatic instances calculated into a score. The higher the score the more likely that the patient would end up with health problems and even an early death. Patients with an ACE of score of 3 or 4 are sent to the Wellness Center for further help.
“Pediatricians are often in the best position to evaluate whether further assessment is needed,” said Suzy Loftus, chief operating officer for the Center of Youth Wellness. “So they also might refer patients to Center for Youth Wellness regardless of their ACEs score if they observe that services are needed.”
Burke Harris has created an important model for other organizations that work with kids to follow because by screening every patient who comes in the door for ACEs, the wellness center can get a good sense of the population most affected by child trauma, said Lenore Anderson, executive director Californians for Safety and Justice, an advocacy nonprofit group pushing criminal justice reform, adding that resources can then be distributed accordingly. “There is a direct correlation to understanding the scope and scale of the problem and then how to find a solution.”
Loftus said she expects to see 300 kids this year. Most kids treated at the center have a 3 or 4 ACEs score, but the range is from 0 to 8. The wellness center works with the child and family to design an individualized response to the toxic stress. The treatment usually involves education about adverse childhood experiences and how toxic stress can alter a child’s brain, therapy for coping with stress, better eating habits, exercise and biofeedback—where sensors are attached the body to identify stress points in an effort to teach the patient to avoid stressful situations.
The wellness center does more than just heal stressed-out kids. Loftus said the center focuses on three elements: direct services, research and advocacy.
Loftus and Burke Harris went to Sacramento in June to advocate for a resolution acknowledging the harmful effects that ongoing trauma has on a child’s developing brain and body. Loftus said the resolution is meant to ignite the conversation around toxic stress and adverse childhood experiences—the first step before policy. The resolution is still making its way through the California Assembly.
“We’re not saying the problem of exposure to chronic adversity to childhood trauma can be solved in the doctor’s office but it’s one of the places that it can be addressed,” Loftus said. “We believe it is a public health threat that has implications across sectors.”
Brian Rinker is a Journalism for Social Change Fellow and a recent graduate from San Francisco State University’s journalism program.