'What happened' vs. 'what's wrong': Recognizing how trauma impacts us all | Perspective

There is a toxin in Philadelphia that our children and families are being exposed to near constantly: trauma.

Trauma lingers and isn't just limited to a single incident, like a gunshot. Trauma manifests in hunger, housing instability, or living without utilities. It can include exposure to abuse, neglect, gun violence, police brutality, imprisonment, and domestic violence. And trauma can pass through generations as the result of historical violence, slavery, redlining, and mass incarceration. Very much like a toxin, the longer it goes unnoticed and untreated, the worse things can get.

Last Sunday, on 60 Minutes, Oprah Winfrey spoke with a leading trauma researcher, Bruce Perry, MD, about trauma, adversity, and how exposure to them affects our bodies and minds over the course of our lives. Not only does trauma affect our health, but it can adversely impact our behavior and economic success. For example, according to researchers from the Center on the Developing Child at Harvard, adverse experiences in early life impair the building of the brain's architecture, which can adversely impact how we learn, how we feel and how we behave. And trauma exposure is related to serious physical consequences that go beyond the original injury that includes depression, diabetes, cardiovascular disease, and substance use.

Those of us working on the front lines in fields like health care, social services, education, the arts, and job training witness daily the effects of trauma. We see it in our patients struggling with drug addiction, young mothers wrestling with depression and low self-esteem, in children's exasperated outbursts at school, in the 11-year-old child who regularly shows up by himself to eat at our community café and cannot read the menu, our clients losing their third job in a year, and, of course, in so many young people with great potential who fall victim to street violence.

These aren't just isolated stories, either. The numbers back us up.

In a recent study conducted by Children's HealthWatch, we interviewed families at St. Christopher's Hospital for Children and collected data on "Adverse Childhood Experiences," or "ACEs," a term that captures people's exposure to neglect, abuse, and things like witnessing domestic violence or drug use in their homes as children. We found that mothers who had four or more ACEs were 12 times more likely to report very low food security or hunger.

Additionally, the Philadelphia Expanded ACEs study found that 40 percent of Philadelphia adults witnessed violence while growing up, which included seeing or hearing someone being beaten, stabbed, or shot.  Additionally, we found that more than one-third of adults reported experiencing discrimination based on their race or ethnicity, and the same percentage of people reported feeling unsafe in their neighborhoods. In all, more than 37 percent of Philadelphia respondents reported four or more ACEs.

Over the last 20 years, many of us in Philadelphia have been utilizing "trauma-informed" practices, which encourage people to stop asking "What's wrong with us?" but, instead, ask, "What's happened to us?" It's about addressing the past, not the symptoms of it.

So these practices recognize the effects of trauma, and seek to prevent re-traumatization. By focusing on safety, emotional management,  and loss and letting go, people affected by trauma can develop sense of future and freedom.

Many of the homeless shelters in the city have adopted these approaches. They are also utilized in residential treatment facilities, in foster care, and in health and social services settings to stem opioid addiction.

You can see trauma-informed care in Healing Hurt People, which provides wrap-around services for young people who survived violence, in the Building Wealth and Health Network, which uses trauma-informed protocols in our welfare system's education and training programs for caregivers of young children; and in youth programs providing protective and growth-centered spaces and relationships such as Porch Light, Philly Young Playwrights, The Village of Arts and Humanities, and Storiez.  Philadelphia is known as a national leader in this space as we host many conferences such as the Trauma Training Conference to gather hundreds of organizations devoted to healing children, families, and communities.

But no matter how bold we are in our programming, the health and social service sectors are not far enough upstream to address the root causes of trauma: systemic neglect and ethnic, racial and gender discrimination. To truly be effective, we must have trauma-informed policymaking. We need action at the city level and above.

Examples include less punitive policing and more trauma-informed social and health-care supports in our schools. This would help stop adverse childhood experiences in their tracks and prevent the pervasive school-to-prison pipeline. Trauma-informed policy could also manifest as a greater investment in safe, affordable housing and infrastructure in our poorest neighborhoods, where decades of governmental neglect produced fertile ground for trauma.

No matter what, our city Health Department workforce should undergo basic trauma training to ensure that the public health system can be responsive to effects of trauma, while also helping prevent it for generations to come. Other cities such as San Francisco have provided this; Philadelphia should too.

We all know what happens when a toxin is left alone for too long and, in Philadelphia, trauma has been allowed to persist. Many organizations across the city are showing what can be done and the potential such action has for our residents. It's time for our leaders to catch on and develop more widespread and meaningful policies to heal our city.

Mariana Chilton is director of the Center for Hunger-Free Communities at the Drexel University Dornsife School of Public Health. She is a member of the Campaign for Trauma Informed Policy and Practice (CTIPP), which is meant to create a resilient, trauma-informed society where all individuals and families have the opportunity and supports necessary to thrive. Members signing this letter include: Sandra Bloom, MD, founder, the Sanctuary Model, associate professor, Dornsife School of Public Health; Jeanne Felter, PhD, LPC, program director, Community and Trauma Counseling, Philadelphia University + Thomas Jefferson University; Leslie Lieberman, MSW, senior director of special initiatives and  consulting, Health Federation of Philadelphia; Sherita Mouzon, member, Witnesses to Hunger, motivational speaker; Mike O'Bryan, director, Youth and Young Adult Programs, the Village of Arts and Humanities; Suzanne J. O'Connor, director of education, United Way of Greater Philadelphia and Southern New Jersey; Jonathan Purtle, DrpH assistant professor, Dornsife School of Public Health; Joe Pyle, president, The Scattergood Foundation