Removing Barriers To Care for Youth

I have been writing about encouraging trends in mental health (and substance abuse) treatment for children and adolescents for the past several weeks.  Most notably, the evolution of Adverse Childhood Experiences (ACEs) screening/assessment information and Trauma Informed Care protocols gives new hope for the most vulnerable among us.

But even as I celebrate these advances in the way we understand and care for kids who suffer and struggle, the systems which would bring them relief continue to slowly (painfully) creep along, stall out, and then start to crawl a little more.

The good news that we have developed incredible tools, scientific breakthroughs and individualized treatment models which offer a brighter life for untold thousands of children is tempered by legislative and societal hesitation to embrace and fund them for delivery.

Slow and Steady May Win the Race…But At the High Cost of Human Suffering

Consider how long it has taken for us to offer mental health and substance abuse treatment services to children and adolescents at a level similar to other illnesses.  In 1996 Congress passed the Wellstone/Domenici Mental Health Parity Act (MHPA) which basically asserts that insurance companies cannot charge more for mental health/substance abuse than medical/surgical coverage when (or if) it is offered in the benefit plan.

It was not until 2008 that The Mental Health and Addiction Parity Rule (MHPAEA) was passed to fill in obvious gaps. MHPAEA requires health insurers and group health plans to provide the same level of benefits for mental/substance use treatment and services that they do for medical/surgical care.

Finally, on March 29, 2016 the Final Parity Rule related to MHPAEA  was passed.  It requires Medicaid and Children’s Health Insurance Program (CHIP) managed-care plans to cover mental health and addiction treatment at the same level as medical and surgical care.  It has taken 22 years to get to this point.  And it’s still far from perfect. States have the authority to limit and restrict benefits.

While states like Texas have stepped forward to fully fund their programs others have not.  Insurance companies continue to deny coverage and to treat substance abuse disorders (SUDS) and mental illness (MI) as if they were non-essential.  Managed care companies fight providers every step of the way as services are attempted to be provided for kids who suffer.  The ideal of the Final Rule was to offer the same quality of comprehensive care to SUDS/MI as is offered to diabetes patients (including home health care benefits).

That just is not happening even though a nearly flawless model is provided by American Society of Addiction Medicine (ASAM) Placement, Continued Stay and Discharge Criteria which individualizes and guides treatment based on the severity of illness.

Charting a Way Forward

In 1989, I was chosen as one of the professionals that would help develop the ASAM guidelines for children and adolescents.  Dozens of us met in Cleveland, Ohio with the National Association of Addiction Treatment Providers core group.  We were challenged with the task of creating a system which would provide individualized treatment protocols for kids who were struggling with SUDS and dual diagnosis MI.

The plan was then coordinated with a similar adult model.  In 1992, ASAM unveiled the final draft to government officials, insurance providers and treatment professionals of every stripe in Atlanta.  We believed that we were ending a one-size-fits-all approach to these illnesses with a comprehensive one which truly addressed the needs of the individual patient/client.  It was an exciting time and universally accepted as the new Best Practice.

Unfortunately, most everyone went back home and continued the same old ways of operating.  A few of us made major programmatic changes and the results were incredible.  But mostly, we had just given insurance companies more efficient ways of denying coverage. Twenty years after the Atlanta unveiling, I ran into Dr. David Mee-Lee, MD who was one of the originators of ASAM at a conference.

We shared some reminiscences and I asked him what he was presenting.  He sighed, telling me he was promoting the use of the ASAM Criteria remarking; “After 20 years they still don’t get it…but they will.” David has the patience of Job.

Many Factors Influence the Underutilization of SUDS/MI Services by Parents and Children.

Despite the Final Rule of The Mental Health and Addiction Parity Act (MHPAEA), Medicaid and Children’s Health Insurance Program (CHIP) making it possible for people from all socio-economic levels to access mental health and substance abuse services for children and adolescents, the American Academy of Child and Adolescent Psychiatry (AACAP) continues to estimate that only 15% to 25% of children with psychiatric disorders receive specialty care.

Furthermore, The Department of Health and Human Services reports that only 6% to 8% of kids who could benefit from alcohol treatment, and 9% to 11% of those who could benefit from drug treatment are able to access treatment. Substance Abuse and Mental Health Services Administration (SAMHSA) informs us that;

  • An estimated 3 million U.S. children ages 12 to 17 had a substance use disorder in 2014.
  • About 1 in 10 kids ages 12 to 17 (11.4%) had a major depressive episode (MDE) in the past year. Among adolescents with MDE, only 41.2% received treatment or counseling for depression in 2014.

Insurance Companies, HMO’s and Managed Care continue to deny coverage based on the same levels provided to medical/surgical benefits. According to a 2017 column in the conservative Chicago Tribune, about 59 percent of providers in Illinois surveyed said Medicaid managed care organizations “always” or “often” denied coverage for inpatient treatment for addiction and mental health issues during the past year.

Gatekeepers to Treatment

Special patient advocate groups have had to be formed to help consumers fight the adversarial benefit gatekeepers. A friend of mine who works in the insurance industry told me that “We still hire people to say “No” when behavioral health claims are first received regardless of circumstances. Usually people won’t appeal and the company is saved millions.”

The vast majority of SUDS/MI treatment providers still offer consumers the same kind of treatment they were offering three decades ago…usually at higher costs than ever to payors.  I recently called a local inpatient treatment facility which only provides care for those who have health insurance or can afford to pay out-of-pocket.

Their program neither offered trauma informed care nor used ACEs assessments.  It was basically a 12 Step Recovery based program with daily group and individual counseling sessions even though it described “every service we provide is designed to produce the most clinically appropriate solutions to the serious problems facing our patients.”

That said, Memphis is a leader in providing care to kids who suffers SUDS/MI at little or no cost to consumers.  There is a long- term inpatient facility and community based outpatient organization which admit and serve children readily.  Treatment protocols could be more current, but they are forging ahead to meet critical needs unlike any others I have known.

Other factors which are affecting the ineffective delivery of services include stigma, cultural barriers, access to region-wide rather than local distribution of providers, and a shortage of child/adolescent psychiatrists.  Sometimes it is difficult to find treatment even though it might be nearby.  Here is a good resource to make the search easier:

What We Can Do To Help Right Now

SAMHSA released a statement in June 2018 which reports that opioids are responsible for one in five deaths for young adults.  We have to do something.  We are not powerless players in this country and can influence legislation to make things happen quickly.  We can join advocacy groups, volunteer as mentors and help people find treatment options.  Here are some points of action for you to consider:

  • The Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018 is in the Senate Finance Committee scheduled for markup on 6/12/2018. It will then (hopefully) move forward.  This Act provides sweeping changes that would alter the way we deal with SUDS/MI. Dr. Nora Volkow, Director of National Institute on Drug Abuse just announced that HEAL is being kicked off at current funding levels of $500 million.  It is a light at the end of the tunnel.  Contact your congressional representatives and Senators.  Encourage them to support HEAL.
  • Talk to pediatricians and other doctors you know. Pediatric primary care providers (PCPs) are in a unique position to take a leading role in this effort because families often turn to them first for help with mental health concerns. Although there are a number of systemic, cultural, and individual barriers to accessing mental health care, promising interventions and integrated behavioral health care models have emerged that can be implemented in the primary care setting to help PCPs close the enormous gap between mental health needs and access for children and families experiencing poverty.
  • Encourage legislators to change Juvenile Justice treatment of Medicaid eligibility requirements. When kids enter jail or prison, many states terminate their Medicaid enrollment, meaning they must reapply once back home or in the community.  This often leads to gaps in coverage and delays in access to treatment.  There is a House bill that would prohibit states from terminating Medicaid enrollment for youth under 21 who are incarcerated.  It would also require states to re-determine their eligibility prior to release so coverage is immediately available when they return to the community.
  • Building Blocks for a Healthy Future is a website where parents, caregivers, and educators can find great tips and tools that help children make healthy decisions as they grow up. Pass this information on to friends, family and associates.
  • National Children’s Mental Health Awareness Day raises awareness about the importance of emphasizing positive mental health as part of a child’s overall development from birth. This year’s national observance focused on the importance of an integrated health approach to supporting children, youth, and young adults with serious emotional disturbance who have experienced trauma. For more information and downloadable graphics, visit the continually updated Awareness Day 2018 page.
  • The Safe Schools/Healthy Students initiative is a program designed to prevent violence and substance abuse among our nation’s youth, schools, and communities. The Safe Schools/Healthy Students Initiative takes a comprehensive approach, drawing on the best practices and the latest thinking in education, justice, social services, and mental health to help communities take action. To date, SS/HS has provided services to over 13 million youth and more than $2 billion in funding and other resources to 386 communities in all 50 states across the Nation. For more details about the SS/HS Framework and how it can be used to assist communities engaged in this work, click here.

So let’s get started.  We still have a long way to go if we are serious about abating this life or death healthcare crisis. You are a critical link in making the changes necessary. Please help save our suffering children.

Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.

In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.

His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration and meditation.

Contact Bob Jones on Linkedin

Bob Jones’ blog An Elephant for Breakfast

The Profound Effect of Childhood Trauma; A Gentle Revolution of Trauma Informed Care

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“We are all impacted by trauma.  We are all paying the cost whether personal or societal. We help people heal when we promote connections to one another.” ~ Dr. Vicky Kelly

Nowadays we are witnesses of significant trauma and the consequences of trauma every time we connect with social or commercial media.  We are drawn into graphic displays of individual and community experiences which include violence, abuse, bullying, natural disasters, death, war, terrorism and the effects of an opioid epidemic.  And so, trauma has moved to the forefront of national consciousness.

It is important to note that every one of us has experienced some kind of trauma in our own lives as well. Trauma seems to be everywhere.  Of course it is.  And it always has been.  But with our increased awareness of the pervasiveness of trauma and our collective brokenness, a gentle revolution has evolved.  We have created and are developing behavioral, medical and mental health services that are effectively healing childhood and adult trauma.  This new approach to what the CDC is calling perhaps the single biggest healthcare problem facing our nation today is called Trauma Informed Care (TIC).

Just what is Trauma Informed Care?

Trauma Informed Care (TIC) is one of the most exciting things to happen in the way we provide psychosocial treatment (behavioral health) services for children and adults. We are shifting our perspective and treatment model from one which asks “What is the matter with you?” to “What happened to you…and how does that impact your life and functioning today?”  This basic modification in approach is offering a dramatic new strategy which is helping people cope and heal.  We are now equipped with new, extensive research and information about trauma, development, and the brain.

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We begin to be trauma-informed when we understand what trauma is;

“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” ~ Substance Abuse and Mental Health Services Administration (SAMHSA)

There you have it.  SAMSHA gives us a good definition for trauma.  With that understanding you have just become more trauma-informed.  And I believe that being trauma-informed is a way we can shape the future.

Where Did the TIC Model Come From?

The stage was set for Trauma Informed Care by two major research studies.

  1. Adverse Childhood Experiences (ACEs) Study (Kaiser Permanente from 1995 to 1997 and Centers for Disease Control and Prevention, 2013) was a large epidemiological study involving more than 17,000 individuals from United States; it analyzed the long-term effects of childhood and adolescent traumatic experiences on adult health risks, mental health, healthcare costs, and life expectancy.
  2. The Women, Co-Occurring Disorders and Violence Study (Multiple studies from 1998 to SAMHSA, 2007) was a large multisite study focused on the role of interpersonal and other traumatic stressors among women; the interrelatedness of trauma, violence, and co-occurring substance use and mental disorders; and the incorporation of trauma-informed and trauma-specific principles, models, and services.

These two studies generated action within the behavioral health systems creating a basic adjustment from short term biomedical/pharmaceutical and behavior modification in nature (diagnosis and symptom treatment) to a longer term, holistic model of neurological healing which treats the set of circumstances that have created the trauma/stress.  We have not abandoned the other treatments altogether of course. There is still a place for medications and traditional methodology.  We have just found a new and more effective approach.

Trauma Informed Care Comes From a Brain Thing

We can now help brains heal and rewire with Trauma Informed Care. As a result, there is new hope for victims of adult PTSD and Developmental Trauma Disorder (Childhood PTSD). Studies show that a healthy well-regulated brain where the thinking brain and survival brain work well in tandem can be facilitated with TIC.

It helps to understand that we have two brains and a mediator.  The thinking brain is the Cortex.  It is where our personality lives, where we make good decisions, and where our memories are stored. This is where we receive information, process it and take action based on that information.  The other brain is the midbrain and brainstem also known as the survival brain.  It is out autopilot. and runs our bodies so that we don’t have to think about those functions  It is where we are told to breathe, where our heart is told to beat, and where we are informed about how to digest food.  It is also where fight, flight and freeze responses reside. Trauma and stress have particular influence on the survival brain. The important mediator in the brain called the Thalamus which receives sensory information (sight, sound, touch, taste) and acts as a relay station that sends a signal to both brains. The survival brain is wired faster than thinking brain (because the faster you react the more likely you are to survive).

Here is why this is so vital to trauma informed care.  The brains of adults who suffer with PTSD and children with Developmental Trauma Disorder have been hyper-activated or hyper-aroused.  A soldier who is constantly facing an enemy who wants to kill him or a child who is being sexually, physically or emotionally abused is in a survival brain mode of operation of fight, flight or freeze twenty four hours a day.  When that soldier returns home from war, or when the abused child is placed in another home the brain is still programmed to expect trauma or abuse. The thinking brain has been informed of the change but the survival brain is still hyper-activated. They cannot think their way out of new stressful situations but react with programmed survival brain responses.

Traumatized brain impacts:

  1. Fear and lack of safety in the adult or child’s environment cause automatic conditioned behavioral responses of fight, flight and freeze (along with more complicated survival responses such as hiding, withdrawing, pretending, and so on). Brain studies show that the survival brain literally hijacks (turns off) the thinking brain. In other words, the traumatized brain cannot effectively discern good decisions from bad decisions because it cannot always access the thinking brain.
  2. The brain’s alarm system for danger becomes distorted. The traumatized brain perceives the presence of danger almost everywhere.  Impedes the ability to find help and establish relationships.
  3. An inability to appraise the present and to learn from experience. The traumatized brain becomes Velcro for bad and Teflon for good. Such that good experiences in later life cannot balance the negative trauma experiences of the past (childhood).

Now that we know all of these things about the brain and can actually see how it works in brain imaging and brain scans we are tasked with doing things to reduce the stress from trauma.

The hurt happens in powerful childhood relationships and it takes new relationships to promote the healing.  We have found that Trauma Informed Care actually causes the brain to reprogram.

TIC; A ‘Best Practice’ for Kids and Adults

During my 48 years as a provider of behavioral services for children and adolescents, I have seen the worst kinds of things that can happen to my clients. They have suffered multiple stressors that most people could never imagine.  And the effects are cumulative. These are kids who have been physically and sexually abused.  They have experienced their mothers enduring domestic violence and other disturbing chaos at home.  Many witness chronic substance abuse and the effects of mental illness every day along with frequent incarceration of family members. They are dependent and neglected.

Trauma Informed care has allowed me to see my clients through a new pair of glasses.  I believe that this exciting treatment model is the emerging framework for human service delivery. Until recently, the toxic stress and trauma these kids faced went largely untreated or undertreated.  Trauma Informed Care is now effectively healing the effects of the traumatic events which result in adverse physical, social, emotional, or spiritual consequences. One example of a TIC program in action can be found at St. Aemilian-Lakeside in Milwaukee, Wisconsin. SaintA is in the forefront of trauma informed care therapeutic practices.  They teach that there are seven essential ingredients in understanding what trauma informed care is and how to implement it. These elements are;

  1. Prevalence — Exposure to and difficulty adjusting to adverse experiences is significantly more common than we previously had known. A keen appreciation for the scope of adverse events, especially on children, is a key element to understanding the needs of people who have been exposed to events such as domestic violence and substance abuse, separation/divorce, mental illness, physical and sexual abuse, emotional and physical neglect, and acts of violence.
  2. Impact — Trauma occurs when a person’s ability to cope with an adverse event is overwhelmed and contributes to difficulties in functioning. The impact of this process is profound, especially when the adverse event occurs during key developmental timeframes. The seminal ACE (adverse childhood experiences) study shows how early trauma also can have a serious effect on a person’s physical health in later life and ultimately impact life expectancy.
  3. Perspective Shift — A shift in perspective can bring a new reality. Helping those charged with caring for people struggling with trauma by simply changing the question from “What is wrong with you?” to “What has happened to you and how can I support you?” can bring enormous understanding.
  4. Regulation — Knowledge of the basic architecture of the brain provides both an understanding of the impact of trauma and a key toward effective treatment. Many of the interventions that have been offered to people struggling with trauma have focused on the cognitive or “thinking” parts of the brain. Trauma informed interventions often prioritize enhancing emotional and behavioral regulation. This could include the use of sensory and regulating strategies such as drumming, singing, dancing, yoga, etc., which have been shown to be effective in addressing the impact of trauma.
  5. Relationship — Relationships are key to reaching a traumatized child and to mitigating trauma. Strong relationships help create resilience and shield a child from the effects of trauma.
  6. Reason to Be — Reason to be creates a sense of purpose or direction for individuals by ensuring they’re connected to family, community, and culture. It is bolstered by resiliency – a combination of the individual’s internal attributes and the external resources that support them.
  7. Caregiver Capacity — To effectively work with traumatized individuals, caregivers must take care of themselves and find a work/life balance. Critical is identifying our limits, knowing sometimes we will be pushed beyond them, and what we will do to find balance.

They have a YouTube video which is terrific at telling the story of Trauma Informed Care.  I suggest that you connect with it at the following web address:

SAMHSA offers some sobering statistics in their recent Treatment Improvement Protocol (TIP 57) that have compelled service providers of all stripes from educators to chaplains to behavior and mental health professionals to juvenile justice institutions and police officers to embrace trauma-specific interventions in their work.  How can we not when we learn that;

  • 71 percent of all children are exposed to violence every year
  • 3 million children are maltreated or neglected each year
  • 5-10 million kids witness violence against their mother each year
  • 1 in 4 girls and 1 in 6 boys are sexually abused before adulthood
  • 94 percent of children in juvenile justice settings have experienced extreme trauma

Finally, Trauma Informed Care is about healing through building safe relationships and developing trust. When mentors extend a helping hand to kids and adults who have suffered so much they begin to develop a reason for being.  Peer support and mutual self-help are also key vehicles for establishing safety and hope, building trust, enhancing collaboration, serving as models of recovery, healing, and maximizing a sense of empowerment.

We can make this happen by encouraging politicians to sponsor ACEs and TIC legislation.  We can make this happen by making noise in the public square at PTA meetings, Service Clubs, Town Hall gatherings and the like.  We can make this happen by offering ourselves as available mentors. There is a groundswell of hope.  38 states and the District of Columbia are gearing up.  It’s time to join the movement.

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Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.

In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.

His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration and meditation.

Contact Bob Jones on Linkedin

Bob Jones’ blog An Elephant for Breakfast


Kids in Trouble; Injustice Posing as Justice in America

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“I think it’s important for us as a society to remember that the youth within juvenile justice systems are, most of the time, youths who simply haven’t had the right mentors and supporters around them because of circumstances beyond their control.”  ~ Q’orianka Kilcher

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I am worried about the way we treat children in trouble.

This is not a new feeling or experience for me.  But it has intensified.  It’s not new because I have been struggling with the system which incarcerates warehouses, punishes and abuses kids since 1973.  It has intensified because, despite domestic progress made over the past 45 years, recent treatment of children rounded up and separated from their parents at our southern border set off alarms that cannot be ignored.  They, like approximately 50,000 children in the United States are incarcerated.

This number represents one of the highest rates of juvenile detention in the world. Shockingly, it is also true that every state in the union allows children to be tried as adults under some circumstances, and approximately 5,000 child offenders are held in adult jails or prisons at any point in time.

We must understand that these children in our juvenile justice system and those detained at our border are always suffering from the effects of serious trauma. My worries have intensified because we are exacerbating this trauma by the way we are treating our most vulnerable.

Incarceration of Children; Harsh Conditions Which Re-traumatize

Incarceration is defined for adults as a process by which a person is forcibly taken into custody and deprived of liberty.  The same definition should be recognized for kids.  But we try to dress up child incarceration facilities by giving them ambiguous names.  They are rarely called prisons or jails.  We know them as wilderness camps, youth centers, juvenile halls, training schools, development centers and dozens of other names.  I was the executive director of one such place called Lighthouse Care Center.  The pleasant name obscured the fact that within our cottages, many of the most abusive elements of adult incarceration were going on every day.

The 12 to 17 year old girls were committed to indefinite lengths of stay with us by the Department of Corrections.  Very little of our camp-like atmosphere resembled the guiding beam of a lighthouse to the kids who lived there.  Counselors were more like gatekeepers who kept score of behavioral infractions which lengthened the amount of time the girls would be living there.  The kids were regularly restrained for aggressive behavior.  They had no freedom to choose any personal or community activity.  There was very little compassion or care at Lighthouse Care. I don’t intend to single out that one juvenile facility.  My work within the prison system informed me that all of them were about the same.

Harsh conditions, or policies and procedures within places of confinement for troubled children hinder normal child development, traumatize children, worsen physical and emotional disabilities and cause a lifetime of health problems. Too many kids are incarcerated in solitary confinement for 22-24 hours per day. Imagine what it must be like for a child locked up alone in a small empty room for days, weeks, or even months. This is exactly what is happening in every community.  Solitary confinement can cause permanent psychological damage and may lead to self-harm, schizophrenia, psychotic disorders, and suicide. Studies suggest that youth of colorLGBTQI kids, and those with disabilities are more likely to be placed in solitary confinement “for their own protection,” or because the facility lacks appropriate services or accommodations.

Strip searches likewise are traumatic, degrading, and humiliating. Children, especially those who have been sexually abused, can be re-traumatized  by strip searches.  They often feel like their perpetrator is violating them all over again by these searches. Although federal law prohibits sexual violence against incarcerated kids, children still remain at risk of sexual assault in juvenile facilities.

Incarcerated kids are also subject to shackles, pepper sprays and sleep on nothing more than a lightly padded concrete slabs. These abusive practices cause physical injuries, emotional trauma, psychological damage, and interrupt healthy development. Children in these facilities face physical and sexual violence at the hands of adult employees charged with their care and by other children.  This compounds the trauma imposed by their isolation and separation from families, friends and schools. Furthermore, few of the institutions provide quality education services or access to mental health care. Under these cruel and harsh conditions, a system which was designed to habilitate children and provide them second chances, causes more harm than good and does little to protect our communities.

Perhaps the most startling indictment among the many discussed above is this; The United States is the only country in the world that sentences people to die in prison for offenses committed while under the age of 18.

The Child and Adolescent Brain; Understanding Diminished Reasoning or “Why Teenagers Act Crazy”

Brain-science research was cited by Supreme Court Justice Anthony Kennedy in the 2005 ruling (Roper v. Simmons) which banned capital punishment for crimes that were committed when a defendant was under the age of 18.  The Court ruled that “standards of decency” had evolved to recognize that a juvenile’s “lack of maturity and an underdeveloped sense of responsibility” distinguished his crimes from those of an adult. The ruling was based on research showing that the brain is still developing during adolescence, making young people especially vulnerable to impulsive behaviors.

Despite the common sense stand of the Supreme Court, forty-four states and the District of Columbia continue to regard children as young as 14 years of age as mature enough to be held just as responsible as adults in the criminal court. They virtually ignore what is known about child and adolescent brain development and give little support or full consideration of age-appropriate services and supports. Governors and legislatures still operate within the tough-on-crime framework that led to the rise in the misguided imposition of life without parole on so many juveniles based on the false notion that they were “superpredators.”

These are some of the most important things to know about current findings in adolescent neuroscience:

  • During adolescence, the brain begins its final stages of maturation and continues to rapidly develop well into a person’s early 20s, concluding around the age of 25.5
  • The prefrontal cortex, which governs the “executive functions” of reasoning, advanced thought and impulse control, is the final area of the human brain to mature
  • Adolescents generally seek greater risks for various social, emotional and physical reasons, including changes in the brain’s neurotransmitters, such as dopamine, which influence memory, concentration, problem-solving and other mental functions. Dopamine is not yet at its most effective level in adolescence
  • Adolescents commonly experience “reward-deficiency syndrome,” which means they are no longer stimulated by activities that thrilled them as younger children. Thus, they often engage in activities of greater risk and higher stimulation in efforts to achieve similar levels of excitement
  • Adolescents must rely heavily on the parts of the brain that house the emotional centers when making decisions, because the frontal regions of their brains are not fully developed

Scientists and clinicians interested in the practical application of neuroscience have created a substantive body of work that should inform juvenile justice policy. The MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice established and expanded the knowledge base on adolescents and crime, and dissemination of that knowledge to juvenile justice practitioners and policy-makers has played a critical role in policy change.

Organizations like the National Conference of State Legislatures have summarized research for application to law, such as “bright line” age limits. Nonprofit groups such as the Juvenile Law Center use brain science research to produce recommendations for the improvement of the juvenile justice system. Models for Change, a multi-state initiative relying on a network of court officials, legal advocates, and researchers, produces research-based tools and techniques to make juvenile justice systems more fair, effective, rational, and developmentally appropriate.

Other scientific groups, including the American Association for the Advancement of Science, are examining juvenile justice through their existing brain science lens. And the National Academy of Science’s National Research Council recent report, Reforming Juvenile Justice, organizes all recent research to promote a developmental agenda for juvenile justice in the future.

Child/Adolescent neuroscience research confirms that we have no business treating children and adolescents the way we do under the current Juvenile Justice model.  The distinction between youth and adults is not simply one of age.  Our brains operate differently.  Our bodies operate differently.  And when trauma has shaped early childhood behavior there is no way that we can expect good judgement, impulse control or predictable responses to consequences.

Adverse Childhood Experiences (ACEs) and Trauma Informed Care (TIC) for Juvenile Offenders

I recently wrote a column on Adverse Childhood Experiences (ACEs) for ChaplainUSA. To summarize it I would re-iterate that decades of research have solidified the link between childhood trauma and poor outcomes later in life. The number of adverse childhood experiences (ACEs) determines the 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 person has, the higher their risk for chronic disease and a shorter than average lifespan.

It has also been shown that 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 kids being arrested 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.  Kids in the juvenile justice system have often have been exposed to multiple types of victimization and other childhood adversities. In total, this more than doubles the number of traumatized youth in juvenile justice programs (67 to 75 percent) who need effective services in order to recover from Childhood PTSD and a wide range of related emotional, developmental, academic and behavioral problems such as substance use, attention deficit, oppositional-defiant, sleep and eating disorders, suicidality self-harm, exploitation and sexual trafficking.

These stark facts have led to an international call to action in the past decade for juvenile justice systems to become trauma-informed. The 2012 report of the U.S. Attorney General’s Task Force on Children Exposed to Violence identified nine practical steps based on the experience of experts in law enforcement, the judiciary, juvenile justice services, child protective services, racial and ethnic disparities, and traumatic stress. This was done under the leadership of Robert Listenbee, the administrator of the Office of Juvenile Justice and Delinquency Prevention:

  1. Make trauma-informed (Aces) screening, assessment and care the standard in juvenile justice services.
  2. Abandon juvenile justice correctional practices that traumatize children and further reduce their opportunities to become productive members of society.
  3. Provide juvenile justice services appropriate to children’s ethnocultural background that are based on an assessment of each violence-exposed child’s individual needs.
  4. Provide care and services to address the special circumstances and needs of girls.
  5. Provide care and services to address the special circumstances and needs of LGBTQ (lesbian/gay/bisexual/transsexual/questioning) youth.
  6. Develop and implement policies in every school system across the country that aim to keep children in school rather than relying on policies that lead to suspension and expulsion and ultimately drive children into the juvenile justice system.
  7. Guarantee that all violence-exposed children accused of a crime have legal representation.
  8. Help, do not punish, child victims of sex trafficking.
  9. Whenever possible, prosecute young offenders in the juvenile justice system instead of transferring their cases to adult courts.

Nadine Burke Harris, CEO of the Center for Youth Wellness recently reported that “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. 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.”

The good news is that Juvenile jails are adopting ACE and trauma-informed practices. Jane Halladay, of the National Child Traumatic Stress Network has been working to disseminate best practices in partnership with the federal Office of Juvenile Justice and Delinquency Prevention, says the political and funding climate for trauma-informed juvenile justice work has brightened in recent years. “It’s now infiltrating the federal mandates, or at least it’s becoming part of the language,” she says. “There are more strategies and practices available. There’s also a really long way to go.”

It seems obvious to me that using ACEs and TICs will bring about changes that will forever change the broken juvenile justice system.


The Movement to Change Juvenile Law and the Treatment of Kids in Trouble

“There are no monsters, villains, or bad guys.  There are only folks who carry unspeakable pain.” ~ Gregory Boyle


Gregory Boyle, founder of Homeboy Industries, is a leader in reforming the way we look at and treat both kids and adults who have been incarcerated.  He asks us to refrain from an us versus them attitude.  The successful results of his work have commanded the attention of people across the country.  He simply does not recognize good and evil.  Instead, he offers unconditional love and compassion to those who have suffered through pain few of us can imagine.  The community, not an institution of confinement, is the vehicle that will bring healing to kids in trouble.

A report by Wendy Sawyer called “Youth Confinement: The Whole Pie” addresses the grim statistics and facts surrounding the juvenile incarceration problem. She detailed some action steps that we can encourage legislators to take in addressing the issues she discussed in her study:

  • Updating laws to reflect our current understanding of brain development and criminal behavior over the life course, such as raising the age of juvenile court jurisdiction and ending the prosecution of youth as adults;
  • Removing all youth from adult jails and prisons;
  • Shifting youth away from confinement and investing in non-residential community-based programs;
  • Limiting pretrial detention and youth confinement to the very few who, if released, would pose a clear risk to public safety;
  • Eliminating detention or residential placement for technical violations of probation and diverting status offenses away from the juvenile justice system;
  • Strengthening and reauthorizing the Juvenile Justice and Delinquency Prevention Act to promote alternatives to youth incarceration and support critical juvenile justice system improvements.

Juvenile Law Center describes itself as one of the leading advocates for the abolition of solitary confinement and other harmful conditions that youth face in the justice system. Juvenile Law Center’s work focuses on: eliminating solitary confinement, strip searches, and the use of excessive force against kids; keeping kids safe from harm — whether from facility staff, other youth, or themselves; ensuring kids have developmentally appropriate care, treatment and programming; fair treatment, regardless of race, ethnicity, gender, gender identity, gender expression, sexual orientation, or disability status; and reducing the over-incarceration of youth and promoting alternatives to incarceration.

I am currently associated with innovative community leaders who drive the Shelby County, (Memphis) Tennessee Juvenile Detention Alternative Initiative. which was designed to support the Annie E Casey Foundation’s vision that all youth involved in the juvenile justice system have opportunities to develop into healthy, productive adults. Shelby County has drastically reduced the number of youth admitted to detention.  It is also actively addressing the gross racial disparity issue with incarcerated kids of color who are five times more likely to be jailed than white kids.

Where to Turn for Help

There are more organizations out there advocating in the public area for reform.  Among them is the The Southern Poverty Law Center which recently told the story of Tyler Haire who was 16 when he was locked up.  The boy spent 1,266 days waiting in a Pittsboro, Mississippi jail awaiting a mental health evaluation. SPLC informs us rightly that the system has let him (and us) down. Another organization,  The John Howard Association of Illinois actively watches over the five juvenile prisons in the state.  It reports that the average annual cost for keeping a child in the state’s facilities is $141,428. Can you imagine what could be done to help a traumatized child with that kind of money? We have already discovered the ways to affect healing changes necessary to help our kids in trouble. The time for action is now.  Our children are waiting.
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Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.

In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.

His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration and meditation.

Contact Bob Jones on Linkedin

Bob Jones’ blog An Elephant for Breakfast


How Trauma Is Killing Us: Understanding Adverse Childhood Experiences (ACES)

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“If we do not transform our pain, we will most assuredly transmit it.” ~ Richard Rohr

Another tragic mass shooting resulted in the deaths of ten people at Santa Fe High School near Houston on Friday May 19, 2018. There have been 22 school shootings so far this year where someone was injured or died.

It is hard to comprehend.  There has been more than one shooting each week. What is going on? Our children are killing each other in a very public forum at the places where nurturing, learning and growing into good citizens should be happening for them all.

Instead, the threat and fear of death and violence is following them into every classroom.  Why do we adults seem powerless to put measures into effect that would change the situation immediately? We seem to be passively accepting that this is the new normal…that nobody is safe anywhere.  Of course, this is not true. My sense is that we are overwhelmed and don’t understand that unimaginable pain, mental illness and trauma are culprits behind all the violence.

I have learned a lot about (and from) kids through my professional involvement over the past four decades. Even though I would love to pour all of my experiences and wisdom shared by mentors and the kids themselves regarding childhood trauma into these pages, there would never be enough room.  So allow me to synthesize some of what I know about violent children and relate it to school shootings.

  1. Childhood trauma is an underpinning of the rage which creates horrific violence.
  2. Traumatized kids cannot imagine a future without more pain. Usually they lead lives filled with current conditions of chaos and unpredictability leaving them continually re-damaged.
  3. Aggressive behavior is the last survival behavior a kid uses. He has already tried to find relief in every other way.
  4. No hopeful kid ever picked up guns or explosives, took them to school, and started a killing spree. Only hopelessness can create it.
  5. No kid ever thought that killing his classmates and teachers would bring him attention and fame. He just wanted to die.

“The status quo is only interested in incessant judging, comparisons, measuring, scapegoating and competition.” ~ Gregory Boyle

In each case, experts have lined up to offer all kinds of solutions.  Mostly they involve gun control of one kind or another on one side and the arming/hardening of schools on the other.  We seem to be stuck in debates which lead to very little action.  Unfortunately, almost all of the proposals are reactive.  Rather than putting our efforts into primary prevention, we seem bent on expending massive resources fighting a losing battle against the NRA or by turning schools into impenetrable fortresses.  I wrote a column several weeks ago about the folly of these tertiary interventions as they apply to our addiction epidemic.  The same applies when it comes to this problem.

Since childhood trauma, Adverse Childhood Experiences (ACEs), seem to have a causal relationship to violence and school shootings, I believe that we can develop screening and assessment protocols to identify at-risk people and circumstances.  We will then be able change our modus operandi from blaming, shaming and punishing people to understanding, encouraging and healing them.

Graphic from Center for Child Counseling.

What are ACEs?

ACEs are Adverse Childhood Experiences.  These are events which occur before age 18 (most damaging are those which happen prior to age 6) and are beyond a young person’s control.  A lifetime of hardship and adversity can follow which could be passed on from generation to generation.

The principal types of ACEs are:

  • Emotional, physical of sexual abuse
  • Emotional and physical neglect
  • Living in seriously troubled households (homes that have domestic violence, or mental and/or substance (alcohol or drug) disorders, or parental separation or divorce, or a family member who is incarcerated.

As the number of ACEs a youth experiences increase, so too does the risk for these health and mental health problems – often before they depart their teen years. The greater the number of ACEs a youth experiences, the greater is the likelihood of multiple problems. ACEs science clearly shows that childhood trauma results in adolescent and adult onset of chronic physical and mental illness, violence, and being a victim of violence.

ACEs and the Extreme State

Most of us have been exposed to at least one ACE in our lives.  But very few of us can relate to the impact of real life, hard core trauma experiences which cause the ‘survival brain’ to take control of our behavior. Children who have suffered cigarette burns at the hands of parents or those who are abused sexually every night endure torture which most of us cannot imagine.   These events or series of events have been referred to as the extreme state by Dr. Corinne Gerwe.

Sigmund Freud theorized survival as a predominant driving factor in human behavior.  When trauma is experienced it is followed by an intense feeling such as fear or anger.  Physical symptoms follow like a racing heart or nausea.  The survival brain goes into high gear, virtually closing down the ‘learning brain’ sensing an emergency situation.  The behavior(s) which are enacted and relieve the intensity of the feeling are logged in the memory and become intrinsically linked to emotional survival.  They will be continually reactivated by their inter-related feeling/physical symptom states whenever the intense feeling shows up.  They can develop into persistent and often obsessive patterns that are not grounded in rational thinking or intention.  They can be described as behaviors that a person will swear never to do again and yet repeat despite attempts to resist.  These behaviors can be difficult to explain and even a mystery to the person enacting them as noted by Gerald M. Edelman in his 2003 study of neuronal consciousness.

Understanding ACEs and the extreme state should allow us to stop wasting time looking for scapegoats, endlessly searching for motives, slapping the dismissive labels of evil, loser, or bad guy on a person who has inflicted terrible damage.  It will enable our communities to own their part in violence when little has been done to prevent it.  Healing only occurs when we recognize the true nature of a problem, understand its’ defeating nature, and apply steps to change the way we deal with it.  Prevention is the only long term solution.

“Denial is perfectly beneficial until it’s not anymore.  Then we need to find a safe place to peel back the layers of our own pain.” ~ Gregory Boyle

Primary Prevention and Intervention Using ACEs

We have a golden opportunity to solve this most intractable school shooting problem as well as other less dramatic consequences of ACEs.  One community where systems are in place to change the dynamic is Memphis, Tennessee.  Their ACE Awareness Foundation takes a three-step approach.

  1. Universal Parenting Places (UPP sites) ~ UPP sites are judgment-free zones where parents can go for help. They can talk with counselors, explore their own ACEs and learn how to alter their behaviors in their homes. Counseling is offered at no cost to the consumer. Research has shown that being able to trust another adult and “just let it out” helps people work through their experiences and take control. For some adults with a high ACE score, finding out that there may be a scientific reason their minds and bodies react in certain ways can also be liberating.
  2. Parent Support Warm Line ~ At home, caregivers can call a free phone line (844-UPP-WARM) administered by Le Bonheur Children’s Hospital for guidance and support with parenting issues in real-time. It’s manned by licensed therapists who have trauma training. ACEs are more likely to occur during peak hours of parenting — late afternoon to bedtime — so the Warm Line is available for parents who need to talk through something or who just need a timeout.
  3. Community Outreach ~ Healthcare providers, organizations and civic leaders attend workshops focused on creating trauma-informed citizens. The State of Tennessee has also held statewide summits and created task forces to combat the issue, creating ACE Awareness Partners.

“We envision a Memphis where everyone knows where to get the help they need. Every adult and child should be able to take control of their own destiny.” ~ Ellen Rolfes

The more we can do to prevent ACEs, the closer we will come to ending school violence, bullying and even mass shootings.  With this in mind, I propose that every student in every school, and every parent or caretaker should complete an ACEs assessment.  Those who are deemed at risk would receive immediate referral and help.  This is a full systems change from intervention to prevention that won’t come easy. But we need to create a critical mass of people who understand ACEs, can speak that language and can take action.

The Work Has Already Begun

There are now 38 states and the District of Columbia who have done their own ACE surveys through the Behavioral Risk Factor Surveillance System (BRFSS) since 2009.  The BRFSS is an ongoing data collection program designed to measure behavioral risk factors for the adult population (18 years of age or older) living in households.  The original Kaiser-CDC ACE Study began in 1995 and completed in 1997, but participants were followed for 20 years. New data on the more than 17,000 participants continues to be collected.

ACEs assessments and questionnaires are being used in education, healthcare, parenting programs and juvenile justice systems around the country.  A group called ACEs Connection describes themselves as “a social network that accelerates the global movement toward recognizing the impact of adverse childhood experiences in shaping adult behavior and health, and reforming all communities and institutions — from schools to prisons to hospitals and churches — to help heal and develop resilience rather than to continue to traumatize already traumatized people.”  They have organized concise methods for communities to start up local ACEs Networks.

Below you will find pdf downloadable tools from my Google Drive that can be used to determine ACEs risk for adults, children and teens. Start by finding your own ACE score. Let’s join the effort to bring about some real, long lasting change.

ACEs Toolbox; Questionnaires and User Guide

ACEs User Guide

Finding Your (Adult) ACE Score

ACEs Child Questionnaire

ACEs Teen Questionnaire

ACEs Teen Self Report

[/et_pb_text][et_pb_team_member admin_label=”Robert Kenneth Jones” name=”Robert Kenneth Jones” position=”Columnist” image_url=”” facebook_url=”” linkedin_url=”” _builder_version=”3.0.101″ global_module=”26968″ saved_tabs=”all”]

Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.

In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.

His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration and meditation.

Contact Bob Jones on Linkedin

Bob Jones’ blog An Elephant for Breakfast