Surgeon General’s report highlights need for cross-sector cooperation to support children and families

California Surgeon General Nadine Burke Harris released a report Dec. 9 to help support communities to recognize and effectively address Adverse Childhood Experiences — experiences that can include neglect, homelessness and witnessing violence in the home or community.

In a press conference the following day, Dr. Burke Harris noted the report recognizes the impact of the COVID-19 pandemic’s association with significant increases in ACEs, as well as California’s wildfires and a national reckoning with racial inequities.

“ACEs and toxic stress are the root cause to some of the most harmful, persistent and expensive societal and health challenges facing our world today,” Dr. Burke Harris said. “And that has never been more poignant than in reflection of what we’ve experienced in 2020.”

The report, Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health, provides clear and equitable response solutions, models and best practices to be replicated or tailored to serve community needs.

ACEs can significantly impair a student’s education

Among the most direct and profound effects of ACEs and toxic stress is their impact on learning and school success, according to the report. Though not all stress is bad, toxic stress can impact learning, relationships and other aspects of functioning in school by impairing the areas of the brain responsible for learning, memory, threat detection, emotional regulation, impulse control and executive functioning. The immune, metabolic and inflammatory changes that result from the toxic-stress response can lead to an increased risk of infections, asthma and other conditions, poor dental health, headaches and abdominal pain —all of which can contribute to higher absenteeism rates and impair a child’s ability to fully engage, even when present.

Extensive research has linked ACEs to several relational, educational and learning difficulties. In school, the effects of ACEs and toxic stress include trouble concentrating in class, lack of school engagement, not completing homework, school failure and noncompletion, learning disabilities, impaired executive and relational functioning, and an increased need for special education.

Strategies to combat ACEs

Schools can build their capacity to implement evidence-based interventions for the prevention of toxic stress in children. Primary prevention strategies rely on interventions that target the general population rather than a specific subgroup, with the goal of preventing the adversity that leads to toxic stress and increasing “buffering factors.” For instance, within school settings, adults can model behaviors of kindness, empathy and compassion, which can promote supportive, safe and nurturing learning environments that provide a buffer for toxic stress.

Secondary prevention strategies use more selective interventions that target student groups at higher risk for toxic stress due to prior exposure to ACEs or other risk factors. These can include small-group or one-on-one mentorship and supports, family engagement, and/or coordination with community-based organizations that provide supports to families experiencing challenges such as poverty, addiction, intimate partner violence, housing insecurity or mental illness.

The final prevention strategies target students who are already exhibiting signs of toxic stress. School personnel may have to work closely with the child’s family and healthcare provider to ensure that all aspects of school and health are well coordinated with the child’s primary medical provider. Needed resources may include therapeutic counseling and wraparound services that include healthcare, social services and trauma-specific therapy.

Unsurprisingly, important adaptations will have to be made to nearly every intervention strategy as a result of the pandemic. With that in mind, Dr. Burke Harris said the educational system should not expect to shoulder the burden of addressing ACEs alone. Rather, it needs to be a cross-sector approach.

“Addressing this public health crisis requires shared language, shared understanding of the problem, clarity of roles, shared metrics and accountability,” Dr. Burke Harris said. To reduce ACEs countywide, leaders in the health, education justice and social services sectors will need to act as partners and communicate in ways that will allow for the coordination of care while maintaining privacy.

The report includes cross-sector strategies for addressing ACEs and toxic stress, with sections targeting healthcare; public health; social services; early childhood; and education and justice.

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