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California's first surgeon general: Screen every student for childhood trauma

"One thing that tipped me off was the number of kids being sent to me by schools"
Image: Nadine Burke Harris
Dr. Nadine Burke Harris, founder and CEO of the Center for Youth Wellness, attends a briefing in Dirksen Building on "substance use and childhood trauma," on June 5, 2018.Tom Williams / AP

Dr. Nadine Burke Harris has an ambitious dream: screen every student for childhood trauma before entering school.

"A school nurse would also get a note from a physician that says: 'Here is the care plan for this child's toxic stress. And this is how it shows up,'" said Burke Harris, who was appointed California's first surgeon general in January.

"It could be it shows up in tummy aches. Or it's impulse control and behavior, and we offer a care plan. Instead of reacting harshly and punitively, every educator is trained in recognizing these things. Instead of suspending and expelling or saying, 'What's wrong with you?' we say, 'What happened to you?'"

Burke Harris has dedicated her career to changing the way society responds to childhood trauma, which research has shown affects brain development and creates lifelong health problems.

"This involves public education, routine screening to enable early detection and early intervention, and cross-sector coordinated care," she said at a hearing on providing care in schools held by the House Committee on Education and Labor in September. "The opportunity ahead of us is about a true intersection of health care and education."

A study on youth trauma, known as Adverse Childhood Experiences, or ACES, was a landmark when it was published in 1998 by the Centers for Disease Control and Prevention and Kaiser Permanente. The study specified 10 categories of stressful or traumatic childhood events, including abuse, parental incarceration, and divorce or parental separation; its research showed that sustained stress caused biochemical changes in the brain and body and drastically increased the risk of developing mental illness and health problems.

Burke Harris first noticed this connection while treating children at a clinic in San Francisco.

"One thing that tipped me off was the number of kids being sent to me by schools -- principals, teachers and administrators -- with ADHD,” she said, referring to attention deficit hyperactivity disorder). “What I found was that many of the kids were experiencing signs of adversity, and there seemed to be a strong association between adversity and the trauma they experienced and school functioning."

This finding spurred her to review the health records of over 700 of her patients. Her research team found that patients who had experienced severe trauma were 32 times more likely to be diagnosed with learning and behavioral problems than kids who had not.

Trauma in general leads to a surge in stress hormones. When this trauma goes unchecked and is sustained, it can disrupt a child's brain development, interfering with functions children depend on in school such as memory recall, focus and impulse control.

"When we talk about the effect of ACEs on learning, part of the impact is on the child's ability to sit still in class and ... be able to receive and process information," Burke Harris said.

She found that too often the children she saw at her clinic had been prescribed drugs that actually stimulated parts of the brain that did not need it -- and children did not improve as a result. If the children had been diagnosed with ACEs, Burke Harris said she believes treatment may have been as easy as teaching them how to calm themselves down.

She recalled seeing a boy, 14, who had recurrent abdominal pain. Instead of testing for ulcers, she tested for ACEs and found he scored six out of 10. His parents were going through a divorce and his father refused to see him. Burke Harris said the teen had a number of support systems in place, and she added another.

"I said, ‘We are going to have you join a sports team,’" she said. "A month later his abdominal pain was gone and we didn't have to have expensive tests.”

"When we are talking about addressing the root cause, science shows that safe, stable environments are healing for kids," said Burke Harris, who is also the author of "The Deepest Well: Healing the Long-Term Effects of Childhood Adversity."

"What research tells us is that sleep, exercise, nutrition, mindfulness and a nurturing environment can reduce stress hormones and enhance the ability of the brain to recover from stress," Burke Harris said. "As we're thinking about how to help students be successful, we must recognize that PE and team sports are part of a comprehensive response to address ACEs. What we put in our kids' lunches or provide in a school environment makes a difference in a child's ability to regulate stress response."

Toxic stress suffered by children because of ACEs can also result in health issues that cause absentism.

"The higher the ACEs score, the more likely a child is to miss a day in school," Burke Harris noted. "Asthma is the No 1 reason for chronic absenteeism, and kids with four or more ACEs experience a higher percentage of asthma."

In her congressional testimony, Burke Harris cited a pilot program in San Francisco in which students learn a form of deep meditation to reduce their stress.

"Not only did they see a reduction in school suspension rates and episodes of violence, but they also saw an increase in GPA and standardized tests," Burke Harris told NBCBLK.

As California's first surgeon general, Burke Harris sees herself as a leader in a national movement toward the creation of "trauma sensitive and trauma-informed" education programs that she hopes will lead to changes in school policies. She said she plans to travel the U.S. to call for a public initiative to address ACEs, which she refers to as "one of the most serious, expensive and widespread public health crises of our time."

"Ultimately, as a doctor I don't spend all day with a child,” she said. “Part of treatment is recognizing that everyone in the educational environment has an opportunity to administer buffering care for kids. That's the power of a public initiative. Everyone from the superintendent to the teacher to the bus driver and the person cleaning recognizes and understands this information.”

"When you have a whole community making real change,” Burke Harris said, “you can have a big and lasting change."

This story appears as part of coverage for "NBC News Learn Presents: Education Now Detroit," a two-hour live community event supported by the Chan Zuckerberg Initiative. For more information, go to