In her work with families that struggle to create and maintain a healthy home environment, April Oschmann, a solutions-based case manager at The Extra Mile in Lafayette, has noticed a trend. Often, those who are tasked with taking care of children have unresolved childhood trauma of their own, making it difficult to be adequate caregivers.
One of her clients is a grandmother who became the primary caregiver for a child after the girl’s mother struggled with substance abuse and was eventually killed in a car accident.
“This is a deep, deep pocket in this family of the presence of ACEs,” Oschmann said, describing traumatic childhood experiences that span generations.
Adverse childhood experiences — trauma — can have long-term health impacts that shape a person’s life long after those experiences occur. There is an increasing awareness of ACEs as a health and community metric to follow and address, but how to do it systematically remains an open question.
“With this shift of ACE awareness and education in our community, I'm really hoping that we'll start to implement some level of assessment and a path for outsourcing and referring [to care],” Oschmann said.
Some of that work is already happening.
In Acadiana, PACES Alliances is working to increase awareness and provide education on how to work with people who have experienced trauma as children, and with children currently going through scarring experiences.
On Friday, PACES convened a summit of researchers, providers and public officials to chart a path toward a more trauma-informed approach toward health care, education and criminal justice.
The path toward that, however, isn’t easy.
City Court Judge Jules Edwards said he is frustrated with how long it takes for him to be able to assess and then refer out children and families to the services they need to stabilize their lives and keep the young people who end up before his bench out of trouble.
Edwards says the state bears at least some of the responsibility for the long lead times and overall lack of resources; for example, when assessments are performed ineffectively because there isn’t the staff available to guide children and their families through the process.
“The state departments don’t have the funding to implement the remediation with fidelity,” Edwards said. “That’s a resource decision.”
Reginald Lemelle, a licensed professional counselor focused on youth in crisis and assistant clinical director at Tree of Life Counseling and Consulting in Lafayette, said there is a lack of resources on the local level too. Lemelle points to a lack of counselors in schools and insufficient follow through on anti-bullying policies as examples, leaving kids without anyone to go to.
“They’re doing it by themselves,” Lemelle said. “They’re holding on to each other because they can’t find safe adults.”
Regional Medical Director Dr. Tina Stefanski agreed about the lack of school counselors, but otherwise shared a more optimistic perspective.
“When I was in my residency, this is not something that was talked about,” Stefanski said. “Everyone’s a little bit more aware and empathetic.”
And efforts are underway on state and local levels to create a more systematic approach to remediating the effects of childhood trauma.
The Whole Healthy Louisiana initiative, led by the Kathleen Babineaux Blanco Public Policy Center at the University of Louisiana Lafayette, was set up to “support and promote the implementation of an organizational cultural shift toward trauma informed practice throughout Louisiana.”
The initiative started hosting regional trainings last month. Other components include survey and data collection, “lunch and learn” sessions, coalition building and virtual summits.
The initiative expands much of the work that Acadiana PACES Alliance has done on a local level to the rest of the state. Comprised of roughly 60 members from a variety of fields, the alliance has been hosting events such as Friday’s summit, along with providing training resources to local providers and institutions in the Acadiana region on the impacts of childhood trauma.
“We've tried really hard to just begin educating people, increasing awareness, and also just getting more people from across the various sectors to be committed,” Chair Dr. Paula Zeanah said.
By addressing ACEs, Zeanah added, Louisiana has the potential to make strides not just in addressing the mental health of residents, along with downstream effects on the criminal justice system and other governmental institutions, but the state’s low-ranking physical health as well.
Childhood trauma has been linked to worse physical health outcomes, along with symptoms of trauma exposure often being misdiagnosed as mental and developmental health issues such as attention deficit disorder.
“We are trying many things,” Zeanah said of the state’s efforts to improve the overall health of its population. “It is not some lack of trying, but we haven't hit the right thing yet.”
That thing, or at least part of it, might be addressing childhood trauma, she argued.