202: How to Heal from Adverse Childhood Experiences with Dr. Nadine Burke Harris and Jackie Thu-Huong Wong

Jessica: 00:03

Do you get tired of hearing the same old intros to podcast episodes? Me too. Hi, I'm not Jen. I'm Jessica. And I'm in rural East Panama. Jen has just created a new way for listeners to record the introductions to podcast episodes, and I got to test it out. There's no other resource out there quite like Your Parenting Mojo, which doesn't just tell you about the latest scientific research on parenting and child development, but puts it in context for you as well so you can decide whether and how to use this new information. If you'd like to get new episodes in your inbox along with a free infographic on 13 Reasons your child isn't listening to you--and what to do about each one, sign up at YourParentingMojo.com/subscribe, and come over to our free Facebook group to continue the conversation about this episode. You can also thank Jen for this episode by donating to keep the podcast ad free by going to the page for this or any other episode on YourParentingMojo.com. If you'd like to start a conversation with someone about this episode, or know someone who would find it useful, please vote it to them. Over time, you're gonna get sick of hearing me read this intro as well. So come and record on yourself. You can read from a script she's provided or have some real fun with it and write your own. Just go to YourParentingMojo.com and click Read the Intro. I can't wait to hear yours.

Jen Lumanlan: 01:26

Hello, and welcome to the Your Parenting Mojo podcast. I know that a lot of parents worry about the stressors that their children's face. And I even know of families who postpone experiences that they think their children may find traumatic like divorce to protect the children. But what kinds of experiences are actually harmful to children? What kinds of harm do these experiences create? And how can we support not just children but all people so they can live their fullest lives? That's what we'll look at today. And we'll discuss it with perhaps two of the most qualified people out there on this topic.

Jen Lumanlan: 02:00

So Dr. Nadine Burke Harris holds a bachelor's degree in Integrative Biology from the University of California Berkeley, a medical degree from the University of California Berkeley, and a Master's in Public Health from Harvard University. She was the founding physician of the Bayview Child Health Center in San Francisco, where she saw the connections between her parents' difficult life experiences and their health. She also founded the Center for Youth Wellness, and her very readable book is The Deepest Well: Healing the Long-Term Effects of Childhood Adversity. And beginning in January 2019, and then ending in February 2022, she also served as the State of California's first Surgeon General.

Jen Lumanlan: 02:36

And also with us is Jackie Thu-Huong Wong who is executive director of First Five California. Miss Wong holds a Bachelor of Arts in Social Welfare and Psychology from the University of California Berkeley, Master of Social Work from California State University Sacramento. She's worked as an advocate for equity, health, education, and to eliminate poverty among children, youth, and families in California for over three decades in roles such as the former President of Policy and Advocacy at GRACE, a private nonprofit dedicated to reducing child poverty in California. She is trustee of the Washington Unified School board in West Sacramento and is a professor for California State University Sacramento's nurse credential program.

Jen Lumanlan: 03:16

And I also just want to add a note before before this episode gets underway, and I welcome them, which I actually did on the call that we were on. I found out moments before this this recording was made that I, they, the PR team had reached out to me about interviewing the guests, had not passed on all of my questions to the to the guests. They passed on just the highest level questions and not the background research that I like to cite so that my guests know in which direction I'm going to actually take the conversation. So it was a little bit disturbing to me to find that out in the moments before we got like we went live and to have to deal with some administrative stuff. So I was a little bit disoriented as we went into the conversation. And because we also had a hard stop, we didn't get a chance to ask all the questions I really wanted to get into, so sort of consider this as an appetizer to whet your appetite for these questions, which I know we're going to be talking about here on the podcast for a long time to come. So here we go into the conversation. So welcome Dr. Burke Harris and Ms. Wong as well.

Dr. Burke Harris: 04:15

Thank you so much.

Jackie Thu-Huong Wong: 04:17

Thank you so much for having us. Yeah.

Jen Lumanlan: 04:20

And so I wonder maybe we can start at the beginning here and get on the same page about what an adverse childhood experience is, right? What is this idea of ?Where did it come from?

Dr. Burke Harris: 04:30

Yeah, I can jump in and answer that the term adverse childhood experiences comes from this seminal research that was done by the CDC, the Centers for Disease Control and Prevention, and Kaiser Permanente. And this study was published over 20 years ago now. And in it researchers asked over 17 and a half, 1000 adults at about 10 categories of experiences of stressful or traumatic events that happened in childhood. So these included physical, emotional or sexual abuse, physical or emotional neglect, or growing up in a household where a parent experienced mental illness, substance dependence was incarcerated, where there is parental separation or divorce, or intimate partner violence. So these are the 10 categories of events or experiences that are counted as part of the adverse childhood experiences. And the reason this research was so profound and impactful is that they found a couple of things that are really important. Number one, is that ACEs are incredibly common. So two thirds of folks had at least one, and one in eight individuals had experienced four or more adverse childhood experiences. Another key finding was that there was something that we scientists call a dose response relationship. So that means the more of these categories of ACEs that someone had experienced, the more likely they were to have poor health outcomes related to things like not just some of the stuff you'd expect, like I think for depression, or anxiety. For many of us, that makes intuitive sense. But where they also saw a very strong relationship was between ACEs and heart disease, between ACEs and an Alzheimer's, autoimmune disease. And so that really helped us to understand that what happens early in childhood sets the foundation for lifelong health.

Jen Lumanlan: 06:37

Yeah, it's kind of wild when you think about it, right? That you can actually track from one to the other. And yet, then you think: Oh, yes, but of course, why wouldn't it? And so I was curious that that a lot of the early research very much focused on these family level indicators, right? The the things that are happening within the family, and Dr. Burke Harris I know that you did some research to expand the pool of things that we're looking at as we consider ACEs. Can you tell us about that work?

Dr. Burke Harris: 07:02

Yeah. So one of the things that we understand is, so of course, the the question that came to mind was like: How does this happen? Right, especially for me, as a physician, I'm trying to prevent my patients from having adverse health outcomes. So what we now understand is that when we are exposed to stressful or traumatic events, it actually activates our biological stress response. And when that stress response is activated in a repeated way, or a severe way, it can change the way our body's stress response is wired to respond to subsequent stressors. And that can actually affect children's brain development, the hormonal development, their immune system, and even the way their DNA is read and transcribed. So that is what doctors now refer to as the toxic stress response, this prolonged activation of our stress response. And when we understand that we recognize that ACEs aren't the only thing that can lead to changes in our biology of stress. So there are other factors like experiencing discrimination, or being separated from parents through deportation or migration. So things like that what we now understand is when there's a stressor, and there's somehow an inability of, there's not adequate buffering caregiving, because what we understand is that the real powerhouse in this is that parents, caregivers, other stable adults in the life of the child have the capacity to help to regulate that stress response through their nurturing care. And in the absence of adequate nurturing care, that's when it leads to long term health challenges.

Jen Lumanlan: 08:53

Yeah. And so I guess, to put all this in context, what I'm thinking is why does this matter? Right? What kinds of impacts are we looking at here? How big is the potential scope of what we're talking about?

Dr. Burke Harris: 09:05

Well, it matters profoundly for health and well-being. An individual with four or more adverse childhood experiences, when compared to someone who has experienced zero ACES is that twice the risk for heart disease (the number one killer in the United States), four and a half times the risk for depression, over 12 times the risk for suicidality. So we see this a profound impact. And when we look here in California, where we have really taken steps through the stronger start initiative and other initiatives in California, the annual cost, the annual cost of State of California has $112.5 billion per year from adverse childhood experiences. So we recognize that preventing and treating the impact of adverse childhood experiences is something that's in all of our interest.

Jen Lumanlan: 10:05

Yeah. And, and also, we're kind of at a period of time where, I mean, the incidence of many, you know, traumatic events are is much calmer, much less common now than it was 100 years ago, right? People dying in childbirth is way less common now, like 98%, lower over the last 100 years or so, of course, not evenly of rural populations, motor vehicle accidents are down, infectious diseases are down. And so I'm just trying to figure out from a historical perspective, was just everybody walking around traumatized 100 years ago, or did we just expect to have, you know, a relatively short life and so it wasn't so dramatic when it happened, right? How can we reconcile this idea with the fact that so many of these deaths are the death rate is declining? And yet, we see so many ACEs, because we're having such a hard time dealing with all this?

Dr. Burke Harris: 10:53

Well, what a wonderful question. So first of all, you know, it's a big challenge, because we didn't have the data, like the ACE study was published in 1997. So there's nothing to compare it about. Again, we don't know if ACEs are going up or going down. What we do know is that since the ACE study was published in 1997, and California really started tracking this data on a statewide level in 2009, the state of California, including first five, California, has taken bold steps to do public awareness and prevention so that in the future, right, what we're comparing those numbers of isn't going up or going down, we can see those numbers going down, right, because that's what stronger starts is all about--it's about arming parents and caregivers with the information they need to be able to be that buffering care for their, for the young people in their life, for their child, for their grandchild. And what that means I think a lot of us don't recognize this is that for many of us who have our own ACEs, right, addressing our own histories, and, and really doing the work of self-regulation, so that we can be that safe and stable place, is something that Jackie and I have talked quite a bit about around how we could do this, and provide those supports and best practices.

Jen Lumanlan: 12:23

Yeah, maybe we can go there for a little bit, then because I know that we're you know, a lot of the families that I work with, sometimes there's one parent who's doing a lot of the work, right. I mean, in a in a patriarchal society, it's very often the mother who's the one doing the research on parenting approaches, and he was trying to heal herself, so she can show up differently for her children and the way her parents were able to show up for her given the tools and the traumas that they had. And maybe her co parent isn't necessarily on board with all this and is like, well, I just want to parent like intuitively, and I think I turned out fine. And my parents spanked me, so what's the problem? And so I'm wondering, can you speak a little bit to that buffering, right, the the effects that maybe one parent can have on the children in a family and a relationship and and how that can help the children potentially?

Jackie Thu-Huong Wong: 13:08

Yeah, I mean, it's one of the reasons that we work together, Dr. Burke Harris and I started the Stronger Starts campaign, and it really is about helping parents help their children when they go through these challenging times, right. I, I want to emphasize that we this is a fairly new research study, right, in the late 1900s, if you will, and the tools may not have been there when we were growing up. And so we're really excited to kind of bring forward this this massive campaign to really just elevate the conversation. So when you know better, you do better, right? So we know that difficult times are imminent within families, whether it's divorce or migration, or separation from parents mental illness and or violence in communities and the like. And we know that for children, these experiences can be traumatic. So we've come up with four specific, I love them, the four Be's so right that are the specific interventions that are easy to remember, right? As we kind of are going about our days: Be calm, Be steady, Be there, and Be nurturing, right? The first one is, again, taking those deep, kind of those beats, we take a beat as we rush through life, single parent, as you mentioned, or like you feel like you're a single parent is that okay? Let's be calm. Let's be present, because we know that children feel everything that we feel. And sometimes we are also triggered, if you will, from our own trauma. But again, this is so that we know that we can create a buffer against ACEs by creating safe, stable, nurturing relationships and environments. And the first one is to be calm, be present, and be steady, creating those routines that may not have been there when we were going through our events when we we're younger. Be present, be there right spending the time, even though five minutes with joy, hugging, singing and dancing. And the third one is to be we know that when we are nurturing to our children, we nurture ourselves, right, when we pour into our children that has a healing effect between the relationship, deep relationships that we are building with children.

Jen Lumanlan: 15:02

Yeah, and all of that makes absolute sense in terms of I know all of the research that I've done over the last years with with podcasts. And I guess what I'm coming back to is talking with parents who say things like: I know those things, and I'm on board with those things. And I 100% know that I should be doing them, when then when my kid does something, and just pushes my buttons. And I just my mind goes blank, and I can't remember any of the tools that I'm supposed to use, any of the things I'm supposed to do. What would you tell parents who are in that kind of situation?

Jackie Thu-Huong Wong: 15:36

Yeah. And I'm gonna go back to the four B's. The first one is breathe, take a beat, forgiving, you know, kind of take those that space. That's why our first one is to be calm. And again, pushing buttons is a normal thing that's happened when I when I parented right, and so we've created kind of really simple kind of memorable tools of just, it's okay to step away, right, to kind of find that space, so that again, you can go back into your steady routine and pace, right. And helping your child as you actually are connecting with your child of they are feeling a lot of different emotions in different environments. And once you kind of take that breath, exhale, and take the beat, able to actually work through those emotions, what that child what your child is experiencing, whether your grandma or your auntie or you're parenting, or you're a caregiver for that child is okay. It's okay to actually, but to recognize that your button is being pushed is that first kind of step and saying: Okay, I this is happening, it's normal, my child is going through something. And I'm gonna step away for a sec, but I and I will return right. And sometimes that's just taking those 10 seconds, five seconds to breathe.

Dr. Burke Harris: 16:51

And can I can I jump in here? Because I think that one of the important things about a campaign, like the Stronger Starts campaign is that so there's a real story I was in, I was actually in France, and I was taking a taking a class doing something to nurture my joy. And one of the women who was there was a woman who lives in LA. And I was just telling, we were chatting about what we do. And she was like: Oh, my God, I saw that billboard. And it got me thinking, she said, single mom, and she was like, it really got me thinking about what my reactions are, and how I respond to my daughter when she is, you know, driving me crazy. And I think that's the intention, the intention, like we know, 'cause my husband and I have four boys. Like being perfect in the moment, every time, it's not gonna happen. But what it does, and this is the great thing about public education campaign, is that it gives us the opportunity to think in those moments where we're not triggered or not upset or not like: oh, wow, how am I doing? And I think it's the same thing for the parent, where you have someone who is most likely to be the mom saying: Hey, I think this is really important. And then you have the other parent saying: Oh, I'm just intuitive parenting. And it's like, it's just a reinforcement. Right? It's that regular reinforcement so at least that that mom has the opportunity to say: Oh, honey, did you see the billboard? Like, it's not just me, I'm not crazy. Actually, you know, being calm, being steady, being present being nurturing, it sounds like, that's a thing. Like we, you know, we can do more of that in our household. And then it also connects to resources, right? So families can go to First5California.com and they can look at you know, get more tips, right, about how to do dragon breathing with their kids and worry that all out right and get some of that frustration out, stuff that is helpful for kids, but also helpful for us as caregivers.

Jen Lumanlan: 19:05

Yeah, and you mentioned resources. Right. And I think that's a really important point on this. And Dr. Burke Harris, in your book, The Deepest Well, I, one of the anecdotes that really stuck out to me is the perception that we have, culturally that this is an issue that people of low socioeconomic status face, right. And the story you mentioned in your book as well. You know, in the poor families, we just kind of we everybody knows who the molesting uncle is. In the rich families, we just don't talk about it. It's still there. All of the same crap is still there. We just don't talk about it. I wonder if you can speak a little bit to the ways that it shows up in families with different access to resources.

Dr. Burke Harris: 19:45

Yeah, so I think that what we see is that for our families with the most limited access to resources. It's the challenge can be overwhelming, in part, because there are fewer choices. So I've definitely cared for families where there was horrible things going on at home and the question was: Do we stay in the situation? Or do I take my kids and go out on the street? Right? So which is worse? And sometimes, if there's a household situation where there's physical abuse, then that makes that decision clearer. But if it's mental or verbal abuse, right, then we can, the choice can be okay, well, we'll just figure out a way to take it or deal with it. When it turns out what the science shows and what the biology shows is that it that the impact on our health, right emotional and psychological abuse can be just as damaging on a biological level as physical abuse. And so these are we definitely see that. I think that the child the on the flip side, right, and on the flip side, is that what we see in upper income families, is that in upper income families, there's more to lose, right? And so this, this perception, the desire to make everything seem like it's fine, often leads families the reputational risk. The all of that stuff can lead families to, again, not say anything, not seek help. Pretend like everything's okay. And I think, what the what the research is showing us is that safe, stable, and nurturing relationships and environments are an important buffer. So they're not, they don't just feel good, they literally change our biology down to the cellular level, and even to the DNA level. And so that ability to seek help and ask is, is what allows us to be able to access those safe and stable and nurturing relationships. And that's another thing that we, you know, that was another goal we had with the Stronger Starts campaign was to let people know, hey, this is important, safe, stable and nurturing relationships are healing. And if you need help to get access to that, you know.

Dr. Burke Harris: 22:37

Exactly.

Jen Lumanlan: 22:39

It or a billboard flashing across the screen. And so yeah, so I guess, I mean, that makes me think of a lot of the data that we have on ACEs is correlational in nature, right? So that we know these two things vary together. We're pretty confident in that. And I'm curious about how close we are to causal data and knowing that ACEs cause negative outcomes, rather than being two things that just vary together. What do we know about that?

Dr. Burke Harris: 23:04

That's so great. I'm so glad you asked this question. So I think we're there. I think we're there. So in the California Surgeon General's report on ACEs, toxic stress and health, the we actually use the criteria. So there's a set of criteria that call the Wilson and Jungner criteria for all the public health nerds out there. And they really do they help us assess whether or not something is causal. So it's not just is there a dose response relationship, which the ACE study gives us that data, which is population data about right, but we actually took so the team at the California Surgeon General's office actually looked at the molecular data, right, like does this happen? Do we see evidence of this on a molecular level? Do we see evidence of this on a clinical level? What happens is there for example, experimental data, and much of that data, unfortunately, is done in animal models. But there are some justice unfortunately, or perhaps more, unfortunately, that are in in human models as well, where we look at populations of individuals who for some reason, that are comparable, and then for some reason, one group of them has some severe stressor, right? Or one of the really well-documented studies with children who were in Romanian orphanages, and they actually randomize them into high quality nurturing caregiving. So they kind of did the opposite. Kids would have experienced adversity, and randomize them into high quality, nurturing caregiving. And what they saw was that the kids who received that high quality nurturing caregiving, actually on MRI, they could see changes in the structures of their brains, ah, following the, you know, several years of receiving this high quality nurturing caregiving. So the data is there on a molecular level, on a clinical level, on what we what we call the physiologic the way the body systems work. And then what the ACE study does is it's one piece of the puzzle that gives us great data to say: Okay, now we've looked at ACEs in more than 24 countries, and the the relationship is consistent. So we are at the point where we can make a statement of causality.

Jen Lumanlan: 25:36

Hmm, okay. And so I had done, I spent a fair bit of time looking at the research on this and not challenging you just looking to get your thoughts on some of the things I had read, right. And obviously, this is a fairly new concept. So we're not we don't have detailed longitudinal studies yet. And so it's hard for us to tease out whether there may be some sort of spurious correlation with something else that's, that's happening that we don't know of yet. And I guess that also leads me to sort of the, not necessarily always being sure of what precedes what, right, like so if we think of a child who might have ADHD, maybe there might be you know, that that child may have a difficult relationship with their parents. And we might not know if the parent then comes to believe that that child is oppositional is defiant is difficult to parent, and potentially, you know, does some things to the child that that we might hope wouldn't happen? You know, did the ADHD come first did the did the trauma come first? Did the difficult parenting come first? Right, all of it seems so tied up together. So how, I'm curious, how can you be so sure that this is a cau- cause-and-effect relationship with all these other things going on?

Dr. Burke Harris: 26:43

That's such a great question. I'm so glad you asked it. So there are a couple of ways in which we understand. So first of all, that chicken egg cycle that you described, certainly can exist, and I've seen it countless times in my clinical practice. But when we're talking about longitudinal studies, I think one of the great example is to donate and sudden that the due date incident that they did in New Zealand, where they actually did do a longitudinal study. They started with individuals at birth, and they followed them forward. And then they identify the individuals who somehow throughout their life course were exposed to trauma, adversity, maltreatment, and then they looked at a number of markers. But that's actually one of the studies where we got the best data around the impact of early adversity on inflammation. So they tracked some of their molecular inflammatory markers. And they found that individuals who had they've been following everyone, right, but they, so we do have some data from longitudinal studies. And the way I think that the, to your point, and I just want to make sure that I'm, that I'm satisfying you by speaking to your point directly, is that if you take any one study individually, you always that's all of science, no good scientists would take one study individually and say, we are drawing a conclusion from this. But when you look at that, as you know, I and my team did before and as a surgeon general, like when you look at 20,000 studies, right, and you use the criteria to say: Okay, are there experimental models where they take individuals, and then they expose them to adversity, and then they see what the outcomes are. That obviously would not be ethical in humans, but they have done it in animal models. And they have seen the show, for example, one of the great studies was the one that was done at McGill University looking at the rat pups, right where they the pups were born. They expose them to a stressor with lots of handling and, you know, lab assistants, and then they looked and saw those, those rats had poor cognitive functioning, poor executive functioning, they actually measured their physiologic stress response and found that that stress, physiologic stress response was, was more overactive, and that it had a more difficult time bringing itself back down to the setpoint, or it had a difficult time with feedback inhibition, right, which is, interestingly, much of the similar things that I've seen in my patient population. And then they actually are you familiar with this, the study where they then they took, they found that that adversity in rat pups was actually associated with DNA marker. So epigenetic markers, these are markers that sit on top of the genome. And then this was a cool thing that they did this well, I love sides, the neck and that these, these markers were handed down from generation to generation. So they found that the the rat pups that got a lot of stress and some of them had moms that did lots of nurturing care, right, so coming back to nurturing care. And then some of them had moms that didn't do very much nurturing care, and the ones who got lots of nurturing care, they did better on executive functioning. They had a more normally functioning, stress response, and all those things. And then the next generation, and they found that that functioning was associated with certain epigenetic markers.

Dr. Burke Harris: 30:34

And then the next generation, they switch them at birth. Right. And then what they found was the the rats that were raised by moms that have lots of nurturing care, they they behaved performed better on cognitive tests. They had a more normally functioning stress response system. And when they, you know, when they looked at it, their genetic markers were that of the mom who beard them, not of the their biological mother, right? So this is where we take all these pieces of data and scientific evidence and say: Hey, we're seeing this clinically, what does this but is it consistent? Is there what we call in medicine and science, coherence between the population data like the ACE study, and a study where you're actually able to, you know, put a needle into the brain of a rat and look at their, you know, hippocampus and and look at the functioning and see the DNA markers that are on there?

Jen Lumanlan: 31:43

Okay, thank you. I appreciate that answer. Yeah. So So any one study is not necessarily going to give us the picture. But the, what you're saying is the preponderance of the evidence is pointing us in that direction.

Dr. Burke Harris: 31:52

Absolutely.

Jen Lumanlan: 31:53

Yeah. And of course, you bring up the intergenerational trauma as well, right. And that this, this canon is passed on through generations. And, gosh, I mean, I'm putting myself in the shoes of a parent who is struggling themselves at the moment and seeing the intergenerational transmission coming down, right, maybe I was parented in ways that were suboptimal? And, and maybe I exploded at my kids as well. And so maybe, you know, I'm not parenting in these, you know, calm, steady, connected ways. Should I feel bad about this? Should I like, what can I do to win when it is so hard for me to not always be on and be calm and connected? To know that I'm not like damaging my kids?

Jackie Thu-Huong Wong: 32:35

It's really what our campaign is about, right? Stronger Starts really says that we all experience an ACE or trauma. And it's okay. Failure is not the right word. Right. It's not about failure. And I think it's not I think sometimes people think parenting is a, it's an all-or-nothing game. It's definitely a process and relationship-building with your with your child. And even though there's epigenetics, we also know based on the research that Dr. Burke Harris was just citing is that we can buffer against the impacts, right. Even though there's a kind of epigenetic factor of relating to ACEs and toxic, long term toxic stress, it's the tools that we are saying like: okay, when you see the bill, we're like, okay, like, there is a way to buffer against protect my child against kind of these negative effects that may be actually in, in my parenting style. But the first very first step, this is why it's so important and why we were Dr. Burke Harris and I was so just overwhelmed when we kick started this campaign back in March here in Sacramento was like: Do you know what it can do when we're just doing this major public education campaign to make people aware of that, it's, you know, it's what happened to you. It's not who you are, And it doesn't have to actually really affect your your child. Again, in our focus groups, we have learned that people of different generations we've done grandpa's grandma's, like different cultural backgrounds, that people have a sense that they all every single focus group that I've been on, I've seen is that they know that the way that they they grew up isn't necessarily kind of how they want to raise their grandchildren and children.

Dr. Burke Harris: 34:16

When we're really struggling, or when we're blowing up at our kids or when we recognize that because of how we were parented, we really struggle. And I feel like that is where understanding ACEs has been really helpful to me, because I recognize for myself as someone who has experienced ACEs. Oh, oh, that's why. You know what I was, here I am this doctor and pediatrician and all this stuff. Why do I struggle so much? Why do I have such a hard time when my kids are, you know, doing X, Y And Z, right? And I recognize, oh, I need more help. I actually need more support because of what I've experienced in my own childhood. And so that really allows me to also give myself some grace. And that's what I would say to anyone in that situation. You can actually take that understanding of your own history, and use that as an opportunity for self-compassion, and then recognize, okay, this just means I need a little extra support. So let's figure out how we're gonna get that. And I would also say, like, as a parent, who I'm going to confess, has raised my voice. And I feel that step one, right is you can give yourself some grace, right? None of this is about doing it perfectly. But when we have the information, hopefully, that's a little bit of extra motivation for us to to say: You know, what I recognize that I probably need to get my workout in because when I'm when I'm healthier, my kids are healthier. Right. So that's also an opportunity, and hopefully a little bit of a motivation for some self-care. And just, no one is expected to get it perfect. And by the way, I would say that, you know, being short with your kids, you know, one time is not, it's not going to give them disease. The point is, the point is, when we talk about being being calm, being connected, doing those things, if we didn't have some intentionality around that, that helps anything, any, any awareness, or any little incremental step that we were that we apply to try to, okay, well, let me just try to maybe do a little better than I would have done otherwise. Right? The hope is that the information is not there to make parents feel badly about what they're doing, but hopefully to inspire and raise awareness about what a can be doing.

Jen Lumanlan: 37:08

And that kind of brings me to a question that came from a listener who spent a lot of time thinking about these kinds of things. And you're trying to relate the experiences that she had in childhood to what are considered you know, societally speaking, the good kind of parenting, right? Dr. Diana Baumrind's work and I always forget if it's authoritarian, authoritative.

Dr. Burke Harris: 37:29

Authoritative.

Jen Lumanlan: 37:30

Thank you. Okay, Yeah.

Jen Lumanlan: 37:32

Why did you call them something different? Actually, remember, so I can remember. So the the authoritative the good kind, right? Dr. Baumrind was a huge advocate of spanking. She published a number of papers advocating for spanking, and Dr. Andrew Grogan Kaylor has done a lot of work on this and came on this show and told me, he thinks spanking should be an ACE. You know, the use of shaming as a standard parenting tool, and her parents were not alcoholics per se, but they were using tools like alcohol and shopping, and you know, those kinds of things to self-medicate from the hurts that they've experienced. And so, you know, what she's trying to figure out is, you know, it seems like there's this huge gulf between an ACE of hitting so hard that it leaves a mark, and trust a belonging, which is where we all want to be right and, and the kind of parenting that you're advocating for through this program. And so when this most common sighted way of parenting, the good kind of parenting advocates for all these tools that I personally believe are really harmful to children? Like, how can we get far enough toward where it seems like the three of us think that we want to go?

Dr. Burke Harris: 38:40

So I mean, I want to be clear that one of the things that I love about this Stronger Starts campaign is that it's based on the latest research. And let's keep in mind that science evolves over time. So I don't know if you've ever as a public health person, I spent a lot of time researching just what effective public health campaigns have been. And I think we forget that, like, in the 1930s And 1940s, doctors were advertising cigarettes. It was like literally a picture of a doctor in the magazine with his with a cigarette, you know, in their mouth, right. And, and then we get more information, right, we get more information. And then we realize, oh, you know what, we had said that, but it turns out that the saw the science no longer supports that. And I think it's a similar thing with spanking, like, I grew up in a culture of 'spare the rod and spoil the child.' This is what there's, and by the way, corporal punishment is still like legal in many states in the United States, right for like teachers to be hitting kids. And the science has advanced and the science now tells us actually you know what, that's not helpful, in fact that can harm children's health. I know that we grew up with it. But now that the sciences have advanced, we're going to advance our practices.

Jen Lumanlan: 40:10

Yes. Thank you for coming back where I think we should be going. Yeah. I mean, it's just hard when you're consistently seeing Dr. Baumrind's work constantly cited as this. This is what good parenting looks like, is the authoritative kind and it looks like this. And I find it frustrating that we aren't further along in that journey. But you're wrong. Oh, sorry. I was wrong. It looked like you.

Jackie Thu-Huong Wong: 40:33

I've been promoted, I'll say. Thank you. No, I was saying that's that's the magic of this campaign. Right, that hopefully, our the research that we had we know that poured into this campaign will be cited more often than that research. Yes. But we're just beginning. It's only a couple of decades. Like, we know it innately like we're talking having this conversation, you're saying: I wish everybody kind of knew this, but I look back and like, it's just, it's only been a couple of decades. And this campaign has only been a couple of years to put out in the world. And I have absolute faith that as this campaign evolves and grows, that our research will be cited more, right, just like I love the kind of I love the smoking analogy, Dr. Burke Harris says that's exactly right. We didn't know the research said something else different. And we get to put different and more modern and evolved research on the world about parenting. And and so I'm grateful for this campaign to be in this to have this opportunity to have this conversation with you. Right. Okay. And so we will continue to do our research. We will continue to bore pour money into this so that we can actually begin to change the environments that we have in these parenting conversations. And, again, that's why a public health campaign around toxic stress response and ACEs is just so transformative for the next generation and beyond.

Jen Lumanlan: 41:58

Yeah, and I know that Dr. Burke Harris, you've done a lot of work on screeners. I'm wondering is is there any aspect of screening in this campaign? Or is that completely separate from it? Like what what how do you think about screeners is a useful tool sort of practically on a level of understanding what's actually happening for an individual child?

Dr. Burke Harris: 42:20

Yeah, so the Stronger Starts campaign is part of a statewide response to understanding the risks that are posed by adverse childhood experiences and toxic stress. And First5California, which is the champion for supporting children 0 to 5 and their parents and caregivers, is, you know, taking the lead on doing this public education, to let families know the importance of safe, stable and nurturing relationships and environments. The Office of the Surgeon General, and the Department of Health Care Services, has led another initiative to educate physicians and health care providers about the importance of ACE screening, and also improving access to care for individuals who have who are identified as having significant ACEs and being at risk of having a toxic stress response. And so that has been an initiative that that we poured resources and research into, it's being led by UCLA and UCSF, two of the leading health centers in the world. And also the the governor's office, the Precision Medicine Initiative, so there is a an initiative within from a research standpoint around California's initiative to advance precision medicine, that is also focusing on the research looking at a screening and identifying toxic stress and looking at biological markers for toxic stress. So different areas we also have within the state of California, they have a huge investment on children and youth mental and behavioral health, that is really focused on also providing those supports building that infrastructure to be able to support children and youth who have experienced ACEs but also other mental and behavioral health challenges as well. And so we're really taking this multi pronged approach. There's also an initiative called the safe spaces initiative, which is educating at educators right, so our educators and our child care providers about the role that they play, and being that safe space for our children. So When we have the data when we have the science and the evidence, it's just like, and I think smoking and tobacco is a really great example like, yeah, so first we said, you know, smoking in bars, you can't do it anymore. And everyone was up in arms, like, how can you not smoking apart, right? And then they're like smoking on airplanes. Remember that? Remember this airplane trip to the US? Working session? Right? We're like, okay, we're not gonna allow that anymore. And then we say, oh, you know, tobacco, we're going to tax it, right.

Dr. Burke Harris: 45:29

So there's never just one approach to addressing a public health problem. It's always in order, in order if you want to be successful, you have to address it from multiple arenas. And so California is supporting our health care providers and understanding ACEs and toxic stress and responding appropriately. It's helping our parents and caregivers understand a toxic stress and respond appropriately. It's helping our teachers and our educators and those in the educational environment, understand the issue and respond appropriately. And it's supporting our researchers to advance the science because everything that we do is based in science, and research and the best possible data.

Jen Lumanlan: 46:18

Yeah, and what you're reminding me of is the idea that this is not just a problem between parents and children, this exhibit has a much broader context within our culture. And if we don't look at it through that broader context, then we're going to miss things that are really important. And we're not going to provide the support that parents and families really need. And so I think that that kind of brings us towards our conclusion. So we're sort of experimenting a little bit here in the new year, whether with a different format to our conclusions. And so I had said, offered some details that hopefully made it through to you on the format of this conclusion.

Jen Lumanlan: 46:50

So what I would like to try to offer to parents is a mild option, a medium option, and a spicy option based on the things that we've talked about today. Right? Like if you are if you're hearing about this, maybe you've heard about it before, and it's it's but it's still fairly new to like what how could you dip your toe in the water if just being calm seems very far out of reach? Right? If you're if you're heard a lot about ACEs, you understand what they are, you're looking for a more advanced practice, we're kind of you know, what's the spiciest option that we how far can we push this? And where's the medium in between? What would you leave listeners with for three different ways they can engage depending on where they are with their understanding of the concept?

Jackie Thu-Huong Wong: 47:29

I'll start with a mild option. Come visit First5California.com. Learn more about us, new thoughts on campaign. We have a lot of tips and tools I would actually say the mild but also mild there actually you can actually explore our website and go to the other websites that Dr. Burke Harris sent to the Office of the Surgeon General and the research is there. So I would say um, that's my mild to non-spicy. Okay, I forget the the mild to the spicy mild option. Burke Harris is the expert in this. So what is the spicy option, which I love this framing?

Jackie Thu-Huong Wong: 47:37

I absolutely love this framing as well. Oh, wait, do I only get to offer spicy or all of it? Okay.

Jen Lumanlan: 48:15

Medium and spicy.

Dr. Burke Harris: 48:17

Okay. So medium option. And I, I really want to be intentional about not being self promotional. So I will say go to the library and check out The Deepest Well. I don't I don't want you people don't need to buy it. But I think learning more right learning more about understanding about how early adversity affects so that would be the medium option for those who are ready to go there. And then that's basically option would be talk to your healthcare provider. And if if you if there's something of concern or something that comes up in this conversation that you are wondering about for your own family, and you as a parent, or a caregiver, I would say talk to your child, provide health care provider. I think if you're an adult, you know, one of the things that's really unfortunate is that we're working on training and arming adult medicine physicians to with this information with these resources, but the work and the resource is much further advanced in in pediatrics and family medicine. So I don't want to tell anyone, like talk to your doctor and then their doctor doesn't know anything about it. But I would say there might be if there's something at First, First5california.com or another great resources is NumberStory.org where you can just get a little information that you can bring to your provider and say: You know what I want to talk about and I want to get support and actually breaking that intergenerational cycle in my own household.

Jen Lumanlan: 50:07

That feels spicy.

Dr. Burke Harris: 50:09

That's a spicy? Yeah.

Jen Lumanlan: 50:12

Yeah. And presumably, I mean this, that could have a couple of different approaches, right, from a mental health perspective, like I want to actually get support right now. And also, potentially, from a physical health perspective, if you're going in for a physical, right, if you have access to health care, and letting your doctor know that, I mean, this is a risk factor, this is a, this is a risk factor for certain kinds of illnesses. So

Dr. Burke Harris: 50:32

That's right, and it really, your doctor should be able to support you. And if they, if they haven't done the research, if they don't have the resource to say, don't don't know, they can go to AcesAware.org and learn more, take the training, get all the resources that we have there for healthcare providers. I will throw in my mild option, which is an option that I love. And I feel like it's maybe the bread and butter option is for all of us, our own support system, right? Does it take a little moment, and think about how we can shore up our seat, our support system, so who are our safe, stable and nurturing relationships, and whether it's a walk and talk with a girlfriend, or, you know, connecting with someone who you love and trust, or someone who has always been a source of support in your life, that is a great place to start just shoring up our own support systems, so that we can because we don't, you know, none of us does it alone. We you know, we know that we can't do it alone. And so supporting our own support systems is a great start.

Jackie Thu-Huong Wong: 51:46

Our own safe, stable, nurturing relationships because we all have experienced this at some level.

Dr. Burke Harris: 51:53

And we all need it, right? Like we all like in case anybody was wondering, like, I'm feeling like they had to go it alone, or they had to be the solution or they had to be a superhero. You know, the good news is that science tells us that like, that is a myth. None of us can do it. We need support. We need partnership. We need others to lift us up. And so the, to the extent that we feel safe, and that we have even if it's one person like the science shows, for kids, one safe, stable adult can be enough to help to prevent that toxic stress response. Similarly for us as adults, even one safe and stable and nurturing person in our lives can be enough to begin our own healing journey.

Jen Lumanlan: 52:37

Yep. And maybe reserve a moment for anger in our toxic, White supremacist, patriarchal capitalist culture for another episode, and nurture ourselves for the moment. So thank you so much for being here for sharing this research with us. I jotted down all the websites that you mentioned. I will gather them all up especially the First5California that will be at the top of the list of resources we gather. All of the 20 papers that I read for this episode will be referenced on the episode page as well, along with Dr. Burke Harris's book available in libraries and in bookstores, local bookstores and on websites named after rivers. The book is The Deepest Well and so all of that information can be found at YourParentingMojo.com/ACEs.

Jessica: 53:24

Hi, this is just from verlies Panama. I'm a Your Parenting Mojo fan and I hope you enjoy this show as much as I do. If you found this episode especially enlightening or useful, you can also donate to help Jen produce more content like this and also save us from those interminable mattress ads. Then you can do that and also subscribe in the link that Jen just mentioned. And don't forget to head to YourParentingMojo.com to record your own message for the show.