1 00:00:10,840 --> 00:00:14,520 Speaker 1: Welcome to the Therapy for Black Girls Podcast, a weekly 2 00:00:14,560 --> 00:00:19,320 Speaker 1: conversation about mental health, personal development, and all the small 3 00:00:19,360 --> 00:00:22,520 Speaker 1: decisions we can make to become the best possible versions 4 00:00:22,520 --> 00:00:26,640 Speaker 1: of ourselves. I'm your host, doctor Joy hard and Bradford, 5 00:00:27,000 --> 00:00:32,080 Speaker 1: a licensed psychologist in Atlanta, Georgia. For more information or 6 00:00:32,200 --> 00:00:35,600 Speaker 1: to find a therapist in your area, visit our website 7 00:00:35,720 --> 00:00:39,440 Speaker 1: at Therapy for Blackgirls dot com. While I hope you 8 00:00:39,479 --> 00:00:43,479 Speaker 1: love listening to and learning from the podcast, it is 9 00:00:43,520 --> 00:00:46,440 Speaker 1: not meant to be a substitute for a relationship with 10 00:00:46,479 --> 00:00:57,440 Speaker 1: a licensed mental health professional. Hey, y'all, thanks so much 11 00:00:57,480 --> 00:00:59,560 Speaker 1: for joining me for session four thirty two of the 12 00:00:59,560 --> 00:01:02,600 Speaker 1: Therapy for Black Girls Podcast. We'll get right into our 13 00:01:02,640 --> 00:01:14,760 Speaker 1: conversation afterword from our sponsors. Today, we're diving into a 14 00:01:14,800 --> 00:01:18,120 Speaker 1: topic that's transforming how we understand public health education in 15 00:01:18,120 --> 00:01:22,080 Speaker 1: this country, childhood trauma and its lifelong impact on the 16 00:01:22,120 --> 00:01:27,920 Speaker 1: brain and body. For decades, adverse childhood experiences are aces 17 00:01:28,400 --> 00:01:32,199 Speaker 1: like abuse, neglect, or exposure to violence. We're often seen 18 00:01:32,240 --> 00:01:36,120 Speaker 1: as just social or emotional issues, but research has revealed 19 00:01:36,160 --> 00:01:39,959 Speaker 1: the science of something much deeper. These experiences can rewire 20 00:01:40,000 --> 00:01:43,839 Speaker 1: a child's developing stress response system, leading to increased risk 21 00:01:43,880 --> 00:01:48,200 Speaker 1: of chronic disease, mental health disorders, substance dependence, and even 22 00:01:48,240 --> 00:01:52,320 Speaker 1: incarceration later in life. Joining us today is someone who's 23 00:01:52,360 --> 00:01:56,000 Speaker 1: pioneered the charge and translating that science into statewide action. 24 00:01:56,880 --> 00:02:01,400 Speaker 1: As California's very first Surgeon General, Nadine burg Harris helped 25 00:02:01,480 --> 00:02:04,960 Speaker 1: put childhood trauma at the center of public health policy. 26 00:02:05,120 --> 00:02:07,880 Speaker 1: She not only trained tens of thousands of providers to 27 00:02:07,920 --> 00:02:11,560 Speaker 1: screen for aces, but push for major changes like linking 28 00:02:11,639 --> 00:02:16,000 Speaker 1: juvenile justice reforms to health equity. Doctor burg Harris brings 29 00:02:16,000 --> 00:02:19,680 Speaker 1: a clinician's insight and an advocates persistence to a conversation 30 00:02:19,760 --> 00:02:23,680 Speaker 1: that challenges us to think bigger about prevention, healing, and 31 00:02:23,720 --> 00:02:26,760 Speaker 1: what it really means to create environments that build holistically 32 00:02:26,840 --> 00:02:30,600 Speaker 1: healthy and stable children. If something resonates with you while 33 00:02:30,680 --> 00:02:34,000 Speaker 1: enjoying our conversation, please share with us on social media 34 00:02:34,080 --> 00:02:38,160 Speaker 1: using the hashtag TVG in Session, or join us over 35 00:02:38,200 --> 00:02:40,760 Speaker 1: on our Patreon to talk more about the episode. You 36 00:02:40,800 --> 00:02:43,960 Speaker 1: can join us at community dot therapy for Blackgirls dot Com. 37 00:02:44,440 --> 00:02:50,680 Speaker 1: Here's our conversation. Thank you so much for joining us today, 38 00:02:50,680 --> 00:02:51,639 Speaker 1: Doctor ric Harris. 39 00:02:51,800 --> 00:02:52,960 Speaker 2: Oh, it's my pleasure. 40 00:02:53,400 --> 00:02:55,480 Speaker 1: I'm so excited to chat with you. I feel like 41 00:02:55,560 --> 00:02:58,040 Speaker 1: I remember seeing you years ago, I believe, on the 42 00:02:58,080 --> 00:03:01,480 Speaker 1: Oprah Show and I was like, oh my gosh, this 43 00:03:01,560 --> 00:03:04,359 Speaker 1: is such good work. I'm so glad that she has 44 00:03:04,360 --> 00:03:06,800 Speaker 1: discovered this and is talking more about acism. I'm so 45 00:03:06,880 --> 00:03:07,880 Speaker 1: honored to chat with you. 46 00:03:08,440 --> 00:03:11,000 Speaker 2: Yeah, thank you. That was fun. That was like a 47 00:03:11,080 --> 00:03:14,480 Speaker 2: pinch me moment talking to Oprah. I know it's a 48 00:03:14,480 --> 00:03:15,160 Speaker 2: little crazy. 49 00:03:17,160 --> 00:03:20,720 Speaker 1: So you were You made history as California's first surgeon 50 00:03:20,800 --> 00:03:24,640 Speaker 1: General and immediately got to work talking about childhood trauma 51 00:03:24,680 --> 00:03:27,120 Speaker 1: and made that a statewide priority. Can you talk about 52 00:03:27,160 --> 00:03:29,359 Speaker 1: what it was like stepping into that role and why 53 00:03:29,440 --> 00:03:33,120 Speaker 1: it felt important to address childhood trauma as your first priority. 54 00:03:35,080 --> 00:03:39,800 Speaker 2: That's so funny. It's actually a funny story because when 55 00:03:40,120 --> 00:03:43,120 Speaker 2: the Governor's office reached out to me about creating the 56 00:03:43,200 --> 00:03:47,480 Speaker 2: role of California Surgeon in General, I was like seriously. 57 00:03:49,000 --> 00:03:54,000 Speaker 2: And also because I'm fundamentally an advocate, I came into 58 00:03:55,160 --> 00:04:01,240 Speaker 2: my work really to help vulnerable communities and help vulnerable children. 59 00:04:01,920 --> 00:04:06,360 Speaker 2: And I remember when I sat down with Governor Newsom 60 00:04:06,360 --> 00:04:09,760 Speaker 2: before I took the role, and I said, hey, listen, 61 00:04:09,840 --> 00:04:14,000 Speaker 2: this is a big priority for me and he said. 62 00:04:14,040 --> 00:04:17,280 Speaker 2: One thing that actually just cooked me when I said 63 00:04:17,360 --> 00:04:21,480 Speaker 2: I really wanted to have average childhood experiences and toxic 64 00:04:21,520 --> 00:04:25,080 Speaker 2: stress be an area of focus, and not just the 65 00:04:25,240 --> 00:04:28,479 Speaker 2: impact on health, but how it affects our society in 66 00:04:28,520 --> 00:04:31,880 Speaker 2: a larger way. He said to me, I'll do you 67 00:04:31,920 --> 00:04:36,200 Speaker 2: one better. We are moving the Department of Juvenile Justice 68 00:04:36,839 --> 00:04:41,039 Speaker 2: under the Department of Health. And that really was the 69 00:04:41,080 --> 00:04:44,760 Speaker 2: thing that kind of hooked me. It was really exciting, 70 00:04:44,760 --> 00:04:48,440 Speaker 2: and it showed the way that when we think about 71 00:04:48,480 --> 00:04:55,000 Speaker 2: how we address really big public health challenges like childhood adversity, 72 00:04:55,360 --> 00:04:58,000 Speaker 2: we recognize that it has to be a public health approach. 73 00:04:58,640 --> 00:05:01,320 Speaker 2: I had been doing this work as a pediatrician and 74 00:05:01,360 --> 00:05:04,480 Speaker 2: a clinician working in the community for a really long time, 75 00:05:05,240 --> 00:05:07,720 Speaker 2: and people can be doing really good work, but if 76 00:05:07,760 --> 00:05:12,160 Speaker 2: our systems are set up to make that more difficult, 77 00:05:13,000 --> 00:05:15,520 Speaker 2: then what we will see is that we won't get 78 00:05:15,560 --> 00:05:18,880 Speaker 2: to those transformative outcomes that our communities really need. So 79 00:05:19,320 --> 00:05:21,760 Speaker 2: that's why I kind of hit the ground running in 80 00:05:21,839 --> 00:05:25,840 Speaker 2: my role as California Surgeon General, and I'm really pleased 81 00:05:26,320 --> 00:05:30,440 Speaker 2: that since twenty twenty, when we launched the initiative to 82 00:05:30,600 --> 00:05:35,760 Speaker 2: train clinicians to do early identification and evidence based intervention 83 00:05:36,600 --> 00:05:40,599 Speaker 2: for adverse childhood experiences and toxic stress. We've trained almost 84 00:05:40,680 --> 00:05:47,560 Speaker 2: fifty thousand providers and more than four million ACE screens 85 00:05:47,640 --> 00:05:51,440 Speaker 2: have happened in California, so it's we're doing the work 86 00:05:51,480 --> 00:05:53,560 Speaker 2: at a big scale. Yeah. 87 00:05:53,800 --> 00:05:56,040 Speaker 1: So I don't think I knew that about the departments 88 00:05:56,080 --> 00:05:58,080 Speaker 1: you now just as being moved under the Department of Hell. 89 00:05:58,160 --> 00:05:59,880 Speaker 1: But it makes perfect since when I could you see 90 00:05:59,920 --> 00:06:02,400 Speaker 1: it right? But sadly, I do not think it is 91 00:06:02,440 --> 00:06:05,440 Speaker 1: something that like more states have adopted, or at least 92 00:06:05,480 --> 00:06:07,960 Speaker 1: not enough of them. Can you talk more about the 93 00:06:08,000 --> 00:06:11,599 Speaker 1: connection that you think is important to really highlight between 94 00:06:11,680 --> 00:06:13,720 Speaker 1: Juvenile Justice and the Department of Hill. 95 00:06:14,040 --> 00:06:17,640 Speaker 2: Yeah, so, you know, I'll start by just backing up 96 00:06:17,680 --> 00:06:20,440 Speaker 2: a second and just giving listeners a little bit of 97 00:06:20,480 --> 00:06:26,000 Speaker 2: background on adverse childhood experiences. And for me as a clinician, 98 00:06:26,279 --> 00:06:31,000 Speaker 2: when I was taking care of patients in a very 99 00:06:31,120 --> 00:06:35,480 Speaker 2: vulnerable neighborhood of San Francisco, a lot of patients were 100 00:06:35,520 --> 00:06:41,200 Speaker 2: being referred to me for ADHD or attention deficit hyperactivity disorder, 101 00:06:42,120 --> 00:06:46,560 Speaker 2: and I also observed that so many of my patients 102 00:06:46,640 --> 00:06:50,800 Speaker 2: were experiencing just really difficult things at home. And in 103 00:06:50,839 --> 00:06:55,560 Speaker 2: the community, so they were being cared for by parents 104 00:06:55,560 --> 00:06:58,840 Speaker 2: who were struggling with mental health disorders or substance dependence, 105 00:06:59,080 --> 00:07:02,560 Speaker 2: where they were witnesses violence at home or in the community. 106 00:07:03,160 --> 00:07:05,960 Speaker 2: And when I started reading the research about how this 107 00:07:06,000 --> 00:07:11,160 Speaker 2: affects kids developing brains and bodies, what I found in 108 00:07:11,240 --> 00:07:14,640 Speaker 2: this there was this big landmark study from the CDC 109 00:07:14,840 --> 00:07:20,440 Speaker 2: and Kaiser Permanente called the Adverse Childhood Experiences Study, And 110 00:07:20,520 --> 00:07:24,400 Speaker 2: what they found was that number one, when they looked 111 00:07:24,400 --> 00:07:28,600 Speaker 2: at ten categories of adverse childhood experiences and those include 112 00:07:28,640 --> 00:07:33,720 Speaker 2: physical emotional or sexual abuse, physical or emotional neglect, or 113 00:07:33,720 --> 00:07:36,400 Speaker 2: growing up in a household or a parent experience mental 114 00:07:36,440 --> 00:07:40,920 Speaker 2: health disorder or substance dependence, incarceration, parental separation or divorce, 115 00:07:41,080 --> 00:07:48,240 Speaker 2: or intimate partner violence, that those things were actually incredibly common, right, 116 00:07:48,360 --> 00:07:52,400 Speaker 2: So two thirds of folks had experienced at least one 117 00:07:52,920 --> 00:07:55,600 Speaker 2: one in eight folks had experienced four or more of 118 00:07:55,640 --> 00:08:01,360 Speaker 2: those categories of aces. And not only were they common, 119 00:08:01,520 --> 00:08:05,400 Speaker 2: what they found was that there was a dose response 120 00:08:05,480 --> 00:08:12,640 Speaker 2: relationship between these adverse childhood experiences and health outcomes. So 121 00:08:13,080 --> 00:08:15,800 Speaker 2: things like when I say dose response, I mean the 122 00:08:15,880 --> 00:08:19,600 Speaker 2: more categories of aces someone had experienced, the higher their 123 00:08:19,720 --> 00:08:29,400 Speaker 2: risk for things like heart disease, stroke, cancer, but also depression, anxiety, 124 00:08:30,000 --> 00:08:35,160 Speaker 2: substance dependence. And then we see this really powerful association 125 00:08:35,760 --> 00:08:45,720 Speaker 2: between these aces and incarceration. And we now understand that 126 00:08:45,800 --> 00:08:51,160 Speaker 2: when we're in childhood and we experience some things stressful 127 00:08:51,280 --> 00:08:56,400 Speaker 2: or traumatic, that activates our stress response. Right. Everybody's got 128 00:08:56,400 --> 00:09:00,679 Speaker 2: their biological stress response. Some people call it fight or flight, right, 129 00:09:01,520 --> 00:09:07,800 Speaker 2: and that when kids are exposed to stressful or traumatic 130 00:09:07,920 --> 00:09:13,720 Speaker 2: experiences too frequently or too intensely, it can actually change 131 00:09:13,800 --> 00:09:17,840 Speaker 2: the way our biological stress response is wired. And so 132 00:09:18,440 --> 00:09:23,880 Speaker 2: we see prolonged activation of the stress response, and that 133 00:09:23,960 --> 00:09:28,440 Speaker 2: we now understand is what leads to these increased risk 134 00:09:28,520 --> 00:09:32,640 Speaker 2: of physical, mental, and behavioral health disorders. So, at the 135 00:09:32,720 --> 00:09:36,880 Speaker 2: time when Governor Newsom asked me to serve as California's 136 00:09:36,880 --> 00:09:39,720 Speaker 2: first surgeon in general, part of the reason why it 137 00:09:39,800 --> 00:09:42,920 Speaker 2: was so important for me to look at this in 138 00:09:42,960 --> 00:09:46,079 Speaker 2: a really holistic way and the impact on our society 139 00:09:46,800 --> 00:09:51,320 Speaker 2: is because a research study coming out of Florida showed 140 00:09:51,559 --> 00:09:55,000 Speaker 2: that when they studied kids who were in the Florida 141 00:09:55,080 --> 00:10:00,120 Speaker 2: juvenile justice system, they found that more than ninety per 142 00:10:01,280 --> 00:10:07,160 Speaker 2: had experienced at least one ACE, and fifty percent had 143 00:10:07,200 --> 00:10:12,720 Speaker 2: experienced four or more. Right. So, when we look at 144 00:10:12,800 --> 00:10:17,760 Speaker 2: the impact of adverse childhood experiences and really the impact 145 00:10:17,880 --> 00:10:21,480 Speaker 2: of what happens when someone has a dysregulated stress response 146 00:10:21,920 --> 00:10:28,280 Speaker 2: and may have impaired impulse control for other difficulties, or 147 00:10:28,320 --> 00:10:31,040 Speaker 2: increased risk of substance dependence or other things like that, 148 00:10:31,760 --> 00:10:35,240 Speaker 2: it's making sure that we address the root cause so 149 00:10:35,280 --> 00:10:40,360 Speaker 2: that we can prevent these later life negative outcomes. And 150 00:10:41,160 --> 00:10:43,640 Speaker 2: just seeing that the governor was willing to make that 151 00:10:43,800 --> 00:10:47,960 Speaker 2: change for me, it reflected that he really understood that 152 00:10:48,040 --> 00:10:49,600 Speaker 2: we have to target the root causes. 153 00:10:49,760 --> 00:10:52,360 Speaker 1: Doctor burg Harris, can you talk about the impact of 154 00:10:52,400 --> 00:10:55,680 Speaker 1: like racism and discrimination on ACES, Like is there a 155 00:10:55,800 --> 00:10:59,240 Speaker 1: category for that in the scale? 156 00:10:59,400 --> 00:11:05,640 Speaker 2: So that's a great question. And in the original ACE study, 157 00:11:06,120 --> 00:11:11,080 Speaker 2: it was done in a population that was seventy percent Caucasian, 158 00:11:11,240 --> 00:11:15,920 Speaker 2: seventy percent college educated, right, And so they did not 159 00:11:16,240 --> 00:11:20,000 Speaker 2: include exposure to discrimination as one of the ACE criteria, 160 00:11:20,400 --> 00:11:24,240 Speaker 2: in part because that was not what they were seeing 161 00:11:24,440 --> 00:11:28,520 Speaker 2: in their patient population, so they didn't think to include it. 162 00:11:30,120 --> 00:11:32,880 Speaker 2: But this is why the science is so important, And 163 00:11:32,960 --> 00:11:38,479 Speaker 2: I'm going to confess that science is my love language. 164 00:11:38,800 --> 00:11:42,320 Speaker 2: One of the things that's really important. And so people 165 00:11:42,400 --> 00:11:46,160 Speaker 2: often ask me, like, isn't exposure to discrimination and ACE? 166 00:11:47,120 --> 00:11:49,000 Speaker 2: And I want to like, this is where the super 167 00:11:49,040 --> 00:11:51,559 Speaker 2: science nerd in me is going to like pull things 168 00:11:51,559 --> 00:11:54,839 Speaker 2: apart a little bit, which is that because it wasn't 169 00:11:54,880 --> 00:11:58,760 Speaker 2: included in the original ACE criteria, I wouldn't call it 170 00:11:58,800 --> 00:12:03,240 Speaker 2: an ACE, right. But what we do know, and this 171 00:12:03,360 --> 00:12:06,719 Speaker 2: is very clear, the science shows is that it is 172 00:12:06,880 --> 00:12:12,920 Speaker 2: a risk factor for the development of a dysregulated stress response, right, 173 00:12:12,960 --> 00:12:16,720 Speaker 2: which many doctors and clinicians now refer to as the 174 00:12:16,720 --> 00:12:20,560 Speaker 2: toxic stress response. And why that's an important distinction is 175 00:12:20,640 --> 00:12:24,880 Speaker 2: because right now we have data from more than twenty 176 00:12:24,960 --> 00:12:29,200 Speaker 2: countries that shows that, for example, an individual with four 177 00:12:29,280 --> 00:12:33,400 Speaker 2: more ACES, their relative risk of ischemic heart disease is 178 00:12:33,520 --> 00:12:35,600 Speaker 2: two point two right, So they're two point two times 179 00:12:35,679 --> 00:12:39,640 Speaker 2: is likely to experience a Scheming cart disease. And we're 180 00:12:39,760 --> 00:12:42,640 Speaker 2: able to do those calculations and those analysis when we're 181 00:12:42,679 --> 00:12:45,760 Speaker 2: looking at the traditional ACE criteria and we're looking at 182 00:12:45,760 --> 00:12:49,679 Speaker 2: this health outcome, and so we can use that to say, okay, well, 183 00:12:49,720 --> 00:12:53,600 Speaker 2: what's the cost of heart disease and how much of 184 00:12:53,600 --> 00:12:56,959 Speaker 2: the heart disease that's out there is due just to aces, right, 185 00:12:57,000 --> 00:13:00,600 Speaker 2: So the CDC has done this analysis. When you use 186 00:13:00,720 --> 00:13:05,360 Speaker 2: different factors, the ability to do those types of analysis 187 00:13:05,679 --> 00:13:11,240 Speaker 2: rigorously is right, Like you have to compare apples to 188 00:13:11,280 --> 00:13:14,280 Speaker 2: apples and oranges to oranges to be able to make 189 00:13:14,320 --> 00:13:21,120 Speaker 2: those analyzes. But what's important is that ass are a 190 00:13:21,240 --> 00:13:25,360 Speaker 2: risk factor for developing the toxic stress response. There are 191 00:13:25,400 --> 00:13:28,920 Speaker 2: other risk factors for developing the toxic stress response, including 192 00:13:28,960 --> 00:13:35,400 Speaker 2: exposure to discrimination, including for example, experiencing war, right, including 193 00:13:35,440 --> 00:13:38,600 Speaker 2: things like being separated from your parent or caregiver through 194 00:13:39,480 --> 00:13:40,880 Speaker 2: deportation or migration. 195 00:13:41,440 --> 00:13:41,680 Speaker 1: Right. 196 00:13:42,520 --> 00:13:46,400 Speaker 2: And what's important is that when we understand who is 197 00:13:46,440 --> 00:13:52,000 Speaker 2: at risk for having a dysregulated stress response, then we 198 00:13:52,200 --> 00:13:56,360 Speaker 2: can address that with evidence based interventions to help to 199 00:13:56,640 --> 00:14:00,960 Speaker 2: regulate the stress response. So it's really important that we 200 00:14:01,160 --> 00:14:05,280 Speaker 2: are very rigorous with the science, right because you know 201 00:14:06,400 --> 00:14:09,920 Speaker 2: the folks who there's always folks who say, oh, well 202 00:14:09,960 --> 00:14:13,680 Speaker 2: that's real bogus, that's this, that's that. And for those people, 203 00:14:15,200 --> 00:14:18,760 Speaker 2: I love to be able to come with very hardcore 204 00:14:18,880 --> 00:14:24,120 Speaker 2: analysis that really stands up to people trying to punch 205 00:14:24,120 --> 00:14:28,680 Speaker 2: holes in it. But what we understand, right, is that 206 00:14:30,160 --> 00:14:37,440 Speaker 2: we understand that the treatment, right, the treatment is the same, 207 00:14:37,920 --> 00:14:40,200 Speaker 2: and that's the piece that we have to work on. 208 00:14:40,840 --> 00:14:43,960 Speaker 2: Identifying who's at risk and someone is at increased risk 209 00:14:44,000 --> 00:14:47,400 Speaker 2: if they've experienced discrimination, and then understanding what are the 210 00:14:47,520 --> 00:14:49,240 Speaker 2: interventions that make a difference. 211 00:14:50,200 --> 00:14:52,560 Speaker 1: So let's dig into your love language of science a 212 00:14:52,560 --> 00:14:56,120 Speaker 1: little more. You've mentioned the term disregulated stress response, and 213 00:14:56,160 --> 00:14:59,160 Speaker 1: it sounds like you talked about impulse control is something 214 00:14:59,200 --> 00:15:02,320 Speaker 1: that is a bi product of having a disregulated stress response. 215 00:15:02,480 --> 00:15:05,240 Speaker 1: Can you talk about what a regulated stress response is 216 00:15:05,280 --> 00:15:07,200 Speaker 1: and like, what does this look like in the brain 217 00:15:07,640 --> 00:15:10,960 Speaker 1: when children and even adults are having a dysregulated stress response. 218 00:15:11,640 --> 00:15:14,800 Speaker 2: Yes, so, oh my gosh, this is so much fun. 219 00:15:16,720 --> 00:15:22,840 Speaker 2: So let's keep in mind that our stress response was 220 00:15:22,960 --> 00:15:26,160 Speaker 2: designed to save our lives from a mortal threat, right, 221 00:15:26,800 --> 00:15:30,640 Speaker 2: And the animals that didn't evolve a stress response, right, like, 222 00:15:31,000 --> 00:15:35,680 Speaker 2: they didn't live to reproduce. So when we think about 223 00:15:35,760 --> 00:15:37,400 Speaker 2: when we talk about the stress response, one of the 224 00:15:37,400 --> 00:15:40,480 Speaker 2: things I talk about a lot is like, imagine that 225 00:15:40,520 --> 00:15:43,520 Speaker 2: you're walking in the forest and you see up there right, 226 00:15:43,640 --> 00:15:47,360 Speaker 2: like what happens in our brain and body Immediately our 227 00:15:47,440 --> 00:15:52,280 Speaker 2: brain's fear response center, which is the amygdala, it gets 228 00:15:52,320 --> 00:15:56,320 Speaker 2: activated and it sounds the alarm, and it tells our 229 00:15:56,400 --> 00:16:01,080 Speaker 2: brains and our bodies to release stress hormones. And so 230 00:16:01,160 --> 00:16:05,400 Speaker 2: we release adrenaline and cortisol and a whole bunch of 231 00:16:05,440 --> 00:16:09,160 Speaker 2: other stress hormones. And what happens in our bodies right, 232 00:16:09,800 --> 00:16:16,000 Speaker 2: our hearts start to pound, right, our blood pressure and 233 00:16:16,080 --> 00:16:21,640 Speaker 2: our blood sugar increases, and we shunt blood to our 234 00:16:21,680 --> 00:16:26,400 Speaker 2: big muscles for running and jumping, and away from that 235 00:16:26,600 --> 00:16:29,160 Speaker 2: anabity muscle that holds your bladder close, so you may 236 00:16:29,240 --> 00:16:32,800 Speaker 2: pee your pants, but there's no judgment, right, so you 237 00:16:32,880 --> 00:16:35,760 Speaker 2: can be ready to either fight that bear or run 238 00:16:35,800 --> 00:16:38,040 Speaker 2: from the bear. And that's why we often call it 239 00:16:38,080 --> 00:16:42,080 Speaker 2: fight or flight. Now, if you were to think about it, 240 00:16:42,440 --> 00:16:44,640 Speaker 2: fighting a bear would not seem like a good idea 241 00:16:44,760 --> 00:16:47,200 Speaker 2: because he's way bigger, he's got teeth and claws, right, 242 00:16:47,240 --> 00:16:50,480 Speaker 2: all that stuff. And so what actually happens in our 243 00:16:50,520 --> 00:16:56,440 Speaker 2: brains is that the amygdala, the fear response center, sends projections, 244 00:16:56,480 --> 00:17:00,000 Speaker 2: it sends nerve cells to this part of the brain 245 00:17:00,240 --> 00:17:04,000 Speaker 2: up front. It's called the prefrontal cortex, and it's responsible 246 00:17:04,080 --> 00:17:08,879 Speaker 2: for impulse control, judgment, executive functioning, and it turns it 247 00:17:08,960 --> 00:17:11,840 Speaker 2: way down, because the last thing you want if you 248 00:17:12,080 --> 00:17:15,520 Speaker 2: are face to face with a bear is some impulse 249 00:17:15,560 --> 00:17:18,840 Speaker 2: control getting in the way of survival. And what it 250 00:17:18,920 --> 00:17:22,200 Speaker 2: does is it turns up a part of the brain 251 00:17:22,760 --> 00:17:27,600 Speaker 2: called the nor agenergic nucleus of the locus ceruleus, or 252 00:17:27,800 --> 00:17:29,720 Speaker 2: as I like to call it, the part of the 253 00:17:29,760 --> 00:17:32,720 Speaker 2: brain responsible for I don't know karate, but I do 254 00:17:32,880 --> 00:17:37,760 Speaker 2: know crazing. This is our within the brain stress response center, 255 00:17:37,800 --> 00:17:42,200 Speaker 2: and it gets us amped up. Now, the last thing 256 00:17:42,280 --> 00:17:46,000 Speaker 2: that happens when we activate our stress response is that 257 00:17:46,040 --> 00:17:51,680 Speaker 2: it also activates our immune response, because if that bear 258 00:17:51,760 --> 00:17:55,360 Speaker 2: gets his claws into you, you want your immune system 259 00:17:55,960 --> 00:18:00,600 Speaker 2: to be primed to bring inflammation to stabilize that wound 260 00:18:00,920 --> 00:18:03,280 Speaker 2: so you can live long enough to beat the bear 261 00:18:03,640 --> 00:18:08,440 Speaker 2: or get away. So this is genius. It was designed 262 00:18:08,440 --> 00:18:11,240 Speaker 2: to save our lives from a mortal threat. And then 263 00:18:11,560 --> 00:18:14,639 Speaker 2: when that threat is resolved, it turns itself off. It 264 00:18:14,640 --> 00:18:18,800 Speaker 2: does something called feedback inhibition, which is a little bit 265 00:18:18,960 --> 00:18:22,600 Speaker 2: like I would call it like the body's stress thermostat. 266 00:18:22,800 --> 00:18:26,359 Speaker 2: You know how you set the thermostat to whatever, let's 267 00:18:26,359 --> 00:18:31,240 Speaker 2: say it's seventy degrees, and your system will pump out 268 00:18:31,280 --> 00:18:33,320 Speaker 2: heat until it gets to seventy degrees and then it'll 269 00:18:33,359 --> 00:18:36,639 Speaker 2: turn itself off. That's how our stress response is designed, 270 00:18:37,240 --> 00:18:41,280 Speaker 2: is that it gets activated and we release lots of 271 00:18:41,280 --> 00:18:43,720 Speaker 2: stress hormones and when they get to a certain level, 272 00:18:43,920 --> 00:18:52,359 Speaker 2: it turns itself off. So children, because they typically aren't 273 00:18:52,400 --> 00:18:57,000 Speaker 2: in control of their environments, they require a safe and 274 00:18:57,160 --> 00:19:00,919 Speaker 2: caring adult to help them turn off their stress response system. 275 00:19:01,440 --> 00:19:06,920 Speaker 2: So safe, stable, and nurturing relationships are a fundamental prerequisite 276 00:19:06,960 --> 00:19:13,280 Speaker 2: for children's healthy development. And when children don't have that nurturing, 277 00:19:13,400 --> 00:19:17,840 Speaker 2: buffering relationship to help turn off their stress response, what 278 00:19:17,880 --> 00:19:22,399 Speaker 2: we see is something called loss of feedback inhibition. So 279 00:19:22,520 --> 00:19:27,359 Speaker 2: just imagine that the stress thermostat is broken and this 280 00:19:27,520 --> 00:19:31,560 Speaker 2: stress response system gets activated, and instead of turning off 281 00:19:31,600 --> 00:19:35,000 Speaker 2: when you reach certain levels of cortisol and adrenaline, it 282 00:19:35,160 --> 00:19:38,480 Speaker 2: just keeps going and higher and higher and higher. So 283 00:19:39,680 --> 00:19:41,840 Speaker 2: I don't know if you know anyone in your life. 284 00:19:41,880 --> 00:19:43,800 Speaker 2: I can think of a couple folks that I'm thinking 285 00:19:43,840 --> 00:19:48,560 Speaker 2: about who Number One, they can go from like zero 286 00:19:48,600 --> 00:19:52,439 Speaker 2: to sixty really quickly, right like it's just huge levels 287 00:19:52,480 --> 00:19:58,159 Speaker 2: of stress hormones just flood their system. Number Two, you 288 00:19:58,200 --> 00:20:01,880 Speaker 2: can see that the upset like kind of overshoots the mark, right, 289 00:20:02,280 --> 00:20:05,680 Speaker 2: and it's wow, the response is really intense. And then 290 00:20:05,840 --> 00:20:08,640 Speaker 2: number three, it can take them a really long time 291 00:20:08,680 --> 00:20:14,119 Speaker 2: to calm down. And those are signs of a disregulated 292 00:20:14,400 --> 00:20:18,040 Speaker 2: stress response. And for some folks you can see it 293 00:20:18,080 --> 00:20:23,040 Speaker 2: in like behavior and upset. For some folks you won't 294 00:20:23,080 --> 00:20:26,840 Speaker 2: see any behavioral symptoms. What you'll see is, for example, 295 00:20:27,520 --> 00:20:30,199 Speaker 2: they get sick really easily when they're overwhelmed. Like, the 296 00:20:30,280 --> 00:20:34,760 Speaker 2: issue is with their the responses with their immune system. Right. 297 00:20:35,359 --> 00:20:39,159 Speaker 2: For some folks, it's like they experience something traumatic. And 298 00:20:39,200 --> 00:20:41,080 Speaker 2: this is one of the things that I saw in 299 00:20:41,080 --> 00:20:46,280 Speaker 2: my patient population. A child experiences something traumatic, and where 300 00:20:46,320 --> 00:20:49,800 Speaker 2: you see the difference is in their hormonal response. 301 00:20:50,040 --> 00:20:50,240 Speaker 1: Right. 302 00:20:50,600 --> 00:20:55,120 Speaker 2: So for example, someone experiences a trauma and then they 303 00:20:55,160 --> 00:21:01,800 Speaker 2: gain fifty pounds, right, or they stop eating, right, they 304 00:21:02,480 --> 00:21:06,640 Speaker 2: and they either kids are not growing or adolescents may 305 00:21:06,680 --> 00:21:10,240 Speaker 2: develop an eating disorder. Right. That's where we start seeing 306 00:21:10,840 --> 00:21:14,720 Speaker 2: these changes. So for some it's in their behavior, for 307 00:21:14,840 --> 00:21:18,640 Speaker 2: some it's in their metabolism, for some it's in their 308 00:21:18,640 --> 00:21:21,840 Speaker 2: immune system. More. 309 00:21:21,880 --> 00:21:33,720 Speaker 1: From our conversation after the break and to burk Hare 310 00:21:33,840 --> 00:21:36,879 Speaker 1: is like, how is toxic stress different from like the 311 00:21:37,000 --> 00:21:38,920 Speaker 1: everyday stress that we might experience. 312 00:21:39,920 --> 00:21:45,440 Speaker 2: Yeah, so everyday stress is a normal and regular part 313 00:21:45,480 --> 00:21:48,200 Speaker 2: of life, and it's actually kind of important for learning, 314 00:21:48,600 --> 00:21:52,960 Speaker 2: and it helps us be able to figure out what 315 00:21:53,080 --> 00:21:56,280 Speaker 2: to pay attention to and all of that good stuff. 316 00:21:57,600 --> 00:22:02,760 Speaker 2: The kind of the medical way that we assess toxic stress, right, 317 00:22:03,359 --> 00:22:08,639 Speaker 2: is that it's associated with changes in brain architecture, So 318 00:22:08,880 --> 00:22:13,120 Speaker 2: changes in the structure and function of children's developing brains 319 00:22:13,320 --> 00:22:18,760 Speaker 2: and then on into adulthood, or changes in the immune system, 320 00:22:18,920 --> 00:22:22,080 Speaker 2: the hormonal system, even the way our DNA is read 321 00:22:22,119 --> 00:22:26,800 Speaker 2: and transcribed. And so for example, what we see is 322 00:22:26,840 --> 00:22:31,199 Speaker 2: that like homework, let's just give homework as an example, 323 00:22:31,200 --> 00:22:33,639 Speaker 2: because people have asked me about that. So homework for 324 00:22:33,640 --> 00:22:37,280 Speaker 2: a lot of kids is stressful, right, But when we 325 00:22:37,400 --> 00:22:40,879 Speaker 2: look at the data around kids who received homework and 326 00:22:40,960 --> 00:22:44,960 Speaker 2: kids who didn't receive homework, we don't see increased risk 327 00:22:45,000 --> 00:22:49,199 Speaker 2: of cardiovascular disease in kids who received homework, right, And 328 00:22:49,280 --> 00:22:53,400 Speaker 2: so that's the place where we look at, is there 329 00:22:53,440 --> 00:22:58,560 Speaker 2: a stressor does it biologically meet the criteria right where 330 00:22:58,600 --> 00:23:02,120 Speaker 2: you have the stressor that kind of overwhelms the physiologic 331 00:23:02,160 --> 00:23:06,560 Speaker 2: stress response and actually leads to a dysregulation of the 332 00:23:06,560 --> 00:23:09,760 Speaker 2: biological stress response, and then does it also lead to 333 00:23:09,880 --> 00:23:13,400 Speaker 2: increase risk of disease. And so that's how we're able 334 00:23:13,440 --> 00:23:17,520 Speaker 2: to assess whether it's kind of an everyday stressor or 335 00:23:17,600 --> 00:23:21,080 Speaker 2: whether it's like a really severe stressor that leads to 336 00:23:21,119 --> 00:23:23,760 Speaker 2: increased risk of toxic stress. One thing that I want 337 00:23:23,760 --> 00:23:28,360 Speaker 2: to say that's really important is that when doctors talk 338 00:23:28,400 --> 00:23:31,240 Speaker 2: about the stress response, we talk about three different types. 339 00:23:31,480 --> 00:23:33,760 Speaker 2: So you've heard me talk about the toxic stress response, 340 00:23:33,800 --> 00:23:36,639 Speaker 2: and that is when you have actually a change to 341 00:23:36,720 --> 00:23:40,560 Speaker 2: the way that your stress response is wired that increases 342 00:23:40,600 --> 00:23:44,359 Speaker 2: the risk for lifelong health challenges. And then on the 343 00:23:44,359 --> 00:23:47,240 Speaker 2: other side of that, when it's functioning normally, we call 344 00:23:47,280 --> 00:23:50,160 Speaker 2: that the positive stress response. Right, it's a good thing. 345 00:23:50,240 --> 00:23:54,439 Speaker 2: It's protecting you from danger. And in between, when the 346 00:23:54,480 --> 00:24:00,159 Speaker 2: stress is more more intense, right, or more severe. But 347 00:24:00,560 --> 00:24:08,360 Speaker 2: and this is key that kids receive adequate buffering caregiving structures, 348 00:24:09,080 --> 00:24:11,359 Speaker 2: and I would advocate that the same is true for 349 00:24:11,400 --> 00:24:17,000 Speaker 2: adults as well. That the body's biological balance, what we 350 00:24:17,119 --> 00:24:22,639 Speaker 2: call homeostasis, can actually recover. And so that is what 351 00:24:22,720 --> 00:24:26,000 Speaker 2: is called the tolerable stress response. When we start to 352 00:24:26,040 --> 00:24:31,119 Speaker 2: see increases in stress hormones maybe the beginning of symptomatology, 353 00:24:31,760 --> 00:24:36,720 Speaker 2: but then the individual is wrapped with the right supports, 354 00:24:37,359 --> 00:24:41,199 Speaker 2: the right care, and that helps the body to be 355 00:24:41,320 --> 00:24:45,240 Speaker 2: able to regulate itself again. And so that is the 356 00:24:45,320 --> 00:24:47,800 Speaker 2: tolerable stress response. And one of the things that's really 357 00:24:47,800 --> 00:24:50,639 Speaker 2: important about that is that that's what we're trying to 358 00:24:50,760 --> 00:25:00,679 Speaker 2: leverage because experiencing something stressful or potentially traumatic, we're not 359 00:25:00,720 --> 00:25:03,399 Speaker 2: going to be able to prevent all of that, right, 360 00:25:04,240 --> 00:25:07,960 Speaker 2: but we do know that with the right supports, the 361 00:25:08,040 --> 00:25:12,600 Speaker 2: right scaffolding in place, that we can prevent the development 362 00:25:12,600 --> 00:25:17,639 Speaker 2: of the toxic stress response through early detection, early intervention, 363 00:25:18,320 --> 00:25:20,720 Speaker 2: and nurturing buffering care. 364 00:25:22,080 --> 00:25:25,240 Speaker 1: Let's stay with the early detection in kind of early intervention. 365 00:25:25,359 --> 00:25:28,440 Speaker 1: For doctor Burg here is so, what are your recommendations 366 00:25:28,720 --> 00:25:31,919 Speaker 1: for like how often pediatricians and other people involved with 367 00:25:32,000 --> 00:25:34,600 Speaker 1: kids are assessing for ACES. 368 00:25:35,359 --> 00:25:40,800 Speaker 2: Yeah, so I can tell you this is something that 369 00:25:40,880 --> 00:25:47,680 Speaker 2: I feel so proud of Fields really so in California 370 00:25:47,960 --> 00:25:50,800 Speaker 2: during my tenure as Surgeon General, we launched the ACES 371 00:25:50,920 --> 00:25:55,280 Speaker 2: Aware Initiative, and essentially what we did was we took 372 00:25:55,320 --> 00:25:57,840 Speaker 2: the research and I was on a committee for the 373 00:25:57,920 --> 00:26:01,080 Speaker 2: National Academies of sciences, engineering in medicine, and one of 374 00:26:01,119 --> 00:26:04,760 Speaker 2: the key findings looking at the impact of stress and health, 375 00:26:05,200 --> 00:26:10,639 Speaker 2: and like the number one finding was early intervention improves outcomes. 376 00:26:10,680 --> 00:26:15,000 Speaker 2: That is like been proven in the science, right, early 377 00:26:15,080 --> 00:26:20,560 Speaker 2: intervention and nurturing care can actually allow the brain to 378 00:26:21,320 --> 00:26:26,240 Speaker 2: can actually change brain architecture. Right. Like if even in kids, 379 00:26:26,520 --> 00:26:30,000 Speaker 2: for example, who were in groove homes, in like a 380 00:26:30,040 --> 00:26:34,359 Speaker 2: foster care setting, when they got high doses of nurturing caregiving, 381 00:26:35,040 --> 00:26:40,640 Speaker 2: we were able to see on MRI normalization of the 382 00:26:40,680 --> 00:26:44,280 Speaker 2: white matter structure of kid's brain. So we're talking about 383 00:26:44,720 --> 00:26:48,520 Speaker 2: it really makes a difference. And so, but the challenge 384 00:26:48,520 --> 00:26:55,639 Speaker 2: is our system doesn't enable early detection, right, So most 385 00:26:55,720 --> 00:26:59,200 Speaker 2: kids don't come to any attention unless they develop mental 386 00:26:59,200 --> 00:27:05,400 Speaker 2: health sentimental. And similarly, even if a child comes to attention, 387 00:27:06,320 --> 00:27:09,119 Speaker 2: if you're a mental health provider or you're trying to 388 00:27:09,160 --> 00:27:13,240 Speaker 2: provide the wrap round care the supports for the family, oftentimes, 389 00:27:13,280 --> 00:27:17,399 Speaker 2: like in my clinical practice, we were doing this, but 390 00:27:17,960 --> 00:27:22,880 Speaker 2: we couldn't build for mental health or support services if 391 00:27:22,920 --> 00:27:26,439 Speaker 2: the child didn't have a mental health diagnosis. Right. So 392 00:27:26,560 --> 00:27:32,800 Speaker 2: here we have a systemic structure that requires someone to 393 00:27:32,880 --> 00:27:37,359 Speaker 2: be harmed before they can get access to care right, 394 00:27:37,520 --> 00:27:44,040 Speaker 2: and that seems a little backwards, especially considering that the 395 00:27:44,119 --> 00:27:47,720 Speaker 2: data is so strong about the risk of harm. So 396 00:27:47,800 --> 00:27:51,560 Speaker 2: what we did in as part of the ass Aware 397 00:27:51,600 --> 00:27:56,280 Speaker 2: initiative was, in addition to training providers and how to 398 00:27:56,359 --> 00:28:02,440 Speaker 2: screen for ass and training them on evidence based interventions 399 00:28:02,480 --> 00:28:07,360 Speaker 2: to respond to risk of toxic stress right, we also 400 00:28:07,840 --> 00:28:11,000 Speaker 2: in California made it so that a child could get 401 00:28:11,040 --> 00:28:15,680 Speaker 2: access to services based on the result of their ACE 402 00:28:15,760 --> 00:28:19,679 Speaker 2: screen and they didn't require a mental health diagnosis. A 403 00:28:19,760 --> 00:28:22,600 Speaker 2: child with four more ACES could get access to wrap 404 00:28:22,600 --> 00:28:28,000 Speaker 2: around services paid for by Medicaid because rather than wait 405 00:28:28,080 --> 00:28:32,120 Speaker 2: for them to develop physical health symptoms or mental health 406 00:28:32,119 --> 00:28:36,120 Speaker 2: symptoms or as we started this conversation, right, rather than 407 00:28:36,200 --> 00:28:40,040 Speaker 2: waiting for them to go into our juvenile justice system right, 408 00:28:40,240 --> 00:28:42,320 Speaker 2: which again is going to cost us way more money. 409 00:28:43,360 --> 00:28:45,920 Speaker 2: We said, children can get access on the basis of 410 00:28:45,960 --> 00:28:49,000 Speaker 2: the result of their ACE screen if they're identified at 411 00:28:49,040 --> 00:28:52,400 Speaker 2: being at high risk of having a toxic stress response, 412 00:28:52,800 --> 00:28:56,080 Speaker 2: and so we recommend and the way that we ruled 413 00:28:56,120 --> 00:29:01,320 Speaker 2: it out in California was that providers could get paid 414 00:29:02,160 --> 00:29:05,760 Speaker 2: for doing screening for kids once a year, so just 415 00:29:05,880 --> 00:29:11,360 Speaker 2: typically at their regular physical and one of the things 416 00:29:11,400 --> 00:29:13,719 Speaker 2: I think is really important about that is that when 417 00:29:13,760 --> 00:29:19,000 Speaker 2: we launched it, initially folks thought like, oh wait, why 418 00:29:19,040 --> 00:29:22,800 Speaker 2: isn't the screening happening, for example, at a mental health 419 00:29:22,920 --> 00:29:25,479 Speaker 2: People thought, oh, yeah, no, we should be the screening 420 00:29:25,480 --> 00:29:28,440 Speaker 2: should happen as part of a mental health visit. But 421 00:29:28,520 --> 00:29:31,080 Speaker 2: as we know, right if we're trying to do prevention, 422 00:29:32,880 --> 00:29:36,120 Speaker 2: then if we're doing it at the mental health visit, 423 00:29:36,200 --> 00:29:39,520 Speaker 2: that's going to be after someone's already symptomatic from a 424 00:29:39,520 --> 00:29:42,280 Speaker 2: mental health standpoint, So we really want to do it 425 00:29:42,640 --> 00:29:46,640 Speaker 2: as part of their regular well child exam, whether that's 426 00:29:46,680 --> 00:29:50,240 Speaker 2: by a pediatrician or family physician, so that we can 427 00:29:50,480 --> 00:29:55,040 Speaker 2: actually do prevention, which is the data shows that when 428 00:29:55,040 --> 00:29:59,640 Speaker 2: we actually do early identification, early intervention, we can improve 429 00:29:59,680 --> 00:30:00,400 Speaker 2: health comes. 430 00:30:01,560 --> 00:30:03,760 Speaker 1: So we've talked a lot about that homework study, right, 431 00:30:03,800 --> 00:30:06,080 Speaker 1: like the very first study, but I would imagine there's 432 00:30:06,120 --> 00:30:09,400 Speaker 1: been lots and lots of research done on ACES since then. 433 00:30:09,880 --> 00:30:12,160 Speaker 1: Can you talk about, like any of the research that 434 00:30:12,400 --> 00:30:15,040 Speaker 1: talks about specifically like what ACES look like in the 435 00:30:15,040 --> 00:30:20,760 Speaker 1: black community and how either intervention or detection might look different. 436 00:30:22,480 --> 00:30:26,920 Speaker 2: Yes, So one of the most interesting studies. It was 437 00:30:27,000 --> 00:30:31,040 Speaker 2: really eye opening for me was a study called a 438 00:30:31,080 --> 00:30:37,760 Speaker 2: Strong African American Family Study, and they looked at aces 439 00:30:37,800 --> 00:30:42,640 Speaker 2: and experiences of early adversity, and what they found was 440 00:30:42,760 --> 00:30:48,960 Speaker 2: that for some folks, their exposure to early adversity was 441 00:30:49,000 --> 00:30:54,280 Speaker 2: associated with increased risk of mental or behavioral health disorders. 442 00:30:55,560 --> 00:31:00,320 Speaker 2: But what they found in looking at this community of 443 00:31:00,440 --> 00:31:04,680 Speaker 2: African Americans was that for the folks who didn't have 444 00:31:04,880 --> 00:31:10,760 Speaker 2: any mental or behavioral health symtomatology, that when they measured 445 00:31:11,280 --> 00:31:15,440 Speaker 2: what we call something that researchers call alistatic load. It's 446 00:31:15,560 --> 00:31:24,560 Speaker 2: essentially the effect of stress on your cells. Right, Increased 447 00:31:24,600 --> 00:31:30,480 Speaker 2: alistatic load is associated with increased cardiovascular disease. It's literally 448 00:31:31,120 --> 00:31:35,640 Speaker 2: the physical changes to your body. Those who didn't have 449 00:31:35,760 --> 00:31:41,360 Speaker 2: mental health symtomatology had a higher alistatic load, meaning that 450 00:31:42,080 --> 00:31:46,920 Speaker 2: their physiology and their cells were more affected and that 451 00:31:47,000 --> 00:31:52,960 Speaker 2: they had increased risk of chronic disease. Part of the 452 00:31:53,040 --> 00:32:02,520 Speaker 2: reason why that's so important is again because some folks say, like, well, 453 00:32:03,160 --> 00:32:06,160 Speaker 2: you know, we should just be we should just be 454 00:32:06,200 --> 00:32:08,880 Speaker 2: screening for mental health disorders and if someone has a 455 00:32:08,880 --> 00:32:12,040 Speaker 2: mental health disorder, that's who should get care. When we 456 00:32:12,080 --> 00:32:16,400 Speaker 2: look at health disparities, particular in the African American community, right, 457 00:32:16,840 --> 00:32:20,040 Speaker 2: and we look at rates of diabetes. Okay, a person 458 00:32:20,120 --> 00:32:22,920 Speaker 2: with four more aces, he has a seventy percent increased 459 00:32:23,000 --> 00:32:27,680 Speaker 2: risk of diabetes. Okay, when we look at cardiovascular disease, 460 00:32:28,040 --> 00:32:31,880 Speaker 2: you know, all of these different things. What we see 461 00:32:32,160 --> 00:32:37,000 Speaker 2: is that are you familiar with the term John Henryism? Right? 462 00:32:37,040 --> 00:32:40,240 Speaker 2: Where it's like John Henry like working on the railroad line. 463 00:32:42,080 --> 00:32:45,320 Speaker 2: So I may not remember it perfectly, but essentially it 464 00:32:45,640 --> 00:32:49,600 Speaker 2: was the story of a laborer by the name of 465 00:32:49,680 --> 00:32:52,800 Speaker 2: John Henry who was working on the railroad line. And 466 00:32:52,920 --> 00:33:01,040 Speaker 2: essentially he performed this like absolutely heroic fee of physical 467 00:33:01,080 --> 00:33:06,600 Speaker 2: strengths in what he did, and then he dropped dead, right. 468 00:33:07,280 --> 00:33:12,560 Speaker 2: And so when people refer to John henryism, often they 469 00:33:12,640 --> 00:33:17,560 Speaker 2: talk about the ability to perform or the ability to 470 00:33:17,800 --> 00:33:24,760 Speaker 2: seem like we're okay and doing well, but really there's 471 00:33:24,800 --> 00:33:30,440 Speaker 2: a profound internal toll that's not being measured. And this 472 00:33:30,640 --> 00:33:34,680 Speaker 2: is why the Strong African American Families study was so 473 00:33:34,760 --> 00:33:41,240 Speaker 2: important because for many of the folks who don't have 474 00:33:42,040 --> 00:33:48,560 Speaker 2: mental health or behavioral health symptomatology, they get no care. 475 00:33:49,440 --> 00:33:53,200 Speaker 2: They don't I'm just gonna say this because I was 476 00:33:53,400 --> 00:33:56,440 Speaker 2: just speaking at a conference last week, I was at 477 00:33:56,560 --> 00:34:02,120 Speaker 2: the Prevent Child Abuse America conference in in Portland, and 478 00:34:03,760 --> 00:34:07,560 Speaker 2: I was giving the keynote address. And I'm going to 479 00:34:07,640 --> 00:34:12,400 Speaker 2: say that no fewer than fifteen people came up to 480 00:34:12,440 --> 00:34:16,200 Speaker 2: me during that conference, either before or after I gave 481 00:34:16,239 --> 00:34:20,160 Speaker 2: my talk, and they say, doctor Burcerris, thank you so 482 00:34:20,239 --> 00:34:23,840 Speaker 2: much for your work. What you described that was me 483 00:34:25,239 --> 00:34:28,440 Speaker 2: I experienced. And they told me, however many ass they 484 00:34:28,440 --> 00:34:34,200 Speaker 2: had experienced and I didn't have mental health sentematology. I 485 00:34:34,360 --> 00:34:40,839 Speaker 2: had really bad headaches, I had really bad stomach pain. 486 00:34:41,400 --> 00:34:45,839 Speaker 2: I developed an autoimmune disease at this age, but I 487 00:34:45,960 --> 00:34:50,200 Speaker 2: never had behavioral problems. And this is I just like 488 00:34:50,239 --> 00:34:55,840 Speaker 2: I'm so. I hear it now so often that the 489 00:34:56,000 --> 00:35:01,319 Speaker 2: notion that for me, it just our systems need to 490 00:35:02,040 --> 00:35:03,680 Speaker 2: our systems need to get better. 491 00:35:04,320 --> 00:35:04,480 Speaker 1: Right. 492 00:35:04,840 --> 00:35:09,800 Speaker 2: We can't wait until someone has mental health sentomatology before 493 00:35:09,880 --> 00:35:11,399 Speaker 2: we provide them services. 494 00:35:12,040 --> 00:35:14,320 Speaker 1: Well, can you talk a little bit about that, doctor Burghers. 495 00:35:14,320 --> 00:35:16,120 Speaker 1: I mean, because of course you are your training is 496 00:35:16,120 --> 00:35:20,520 Speaker 1: as a pediatrician, so that's your ideal population. But because 497 00:35:20,560 --> 00:35:22,200 Speaker 1: a lot of people who will be listening to this 498 00:35:22,280 --> 00:35:25,919 Speaker 1: and will who have heard your work recognize it themselves. 499 00:35:25,960 --> 00:35:28,000 Speaker 1: As a child right, like, oh my gosh, Like if 500 00:35:28,040 --> 00:35:30,720 Speaker 1: I took this test, this is where I would score. 501 00:35:31,120 --> 00:35:32,920 Speaker 1: And so can you talk about what it looks like 502 00:35:33,040 --> 00:35:36,759 Speaker 1: to kind of recognize that you maybe have high experiences 503 00:35:36,760 --> 00:35:39,400 Speaker 1: of aces as an adult and what that looks like 504 00:35:39,440 --> 00:35:40,280 Speaker 1: and how it might. 505 00:35:40,160 --> 00:35:45,040 Speaker 2: Present Yeah, and so I can talk about that and 506 00:35:45,120 --> 00:35:51,480 Speaker 2: I will. Honestly, I feel like it would be I 507 00:35:51,520 --> 00:35:53,400 Speaker 2: don't know, it would be a mess for me to 508 00:35:53,440 --> 00:35:56,640 Speaker 2: talk about it without talking about my own experiences. I 509 00:35:56,680 --> 00:35:59,840 Speaker 2: think part of the reason that I am so passionate 510 00:36:00,560 --> 00:36:06,640 Speaker 2: about this work is because I myself really experienced a 511 00:36:06,680 --> 00:36:11,239 Speaker 2: lot of aces, like significant number of aces, and it 512 00:36:11,320 --> 00:36:15,400 Speaker 2: was really funny to me, because not funny as in humorous, 513 00:36:15,480 --> 00:36:19,759 Speaker 2: but like when I came into this work, I came 514 00:36:19,760 --> 00:36:23,719 Speaker 2: into this work for my patients. I think that my 515 00:36:23,880 --> 00:36:28,160 Speaker 2: own experience of aces, what that did for me was 516 00:36:28,200 --> 00:36:34,320 Speaker 2: it made it intolerable that to just be leaving folks 517 00:36:34,600 --> 00:36:38,160 Speaker 2: to kind of fend for themselves, that wasn't okay with me. 518 00:36:38,280 --> 00:36:44,640 Speaker 2: I think, because I know what it feels like to 519 00:36:45,160 --> 00:36:51,759 Speaker 2: have these experiences and to really struggle, I think it 520 00:36:51,840 --> 00:36:55,000 Speaker 2: was important to Like, when I started taking care of 521 00:36:55,000 --> 00:36:59,279 Speaker 2: my patients, I was like, Okay, let me understand this better, 522 00:36:59,320 --> 00:37:01,960 Speaker 2: what is the biology behind it? And then how do 523 00:37:02,040 --> 00:37:05,600 Speaker 2: we intervene? And it turns out that the good news 524 00:37:05,640 --> 00:37:07,640 Speaker 2: and this is why this work is so important to me, 525 00:37:08,239 --> 00:37:10,840 Speaker 2: and I feel like it is so hopeful for anyone 526 00:37:10,880 --> 00:37:13,760 Speaker 2: who has experienced aces, Like the ACE data is based 527 00:37:13,800 --> 00:37:18,800 Speaker 2: on what happens when you experience aces and you get 528 00:37:19,000 --> 00:37:23,759 Speaker 2: nothing right, And now there's been thirty years worth of 529 00:37:23,800 --> 00:37:28,040 Speaker 2: research to say, what can we do? So Number one, 530 00:37:29,000 --> 00:37:34,839 Speaker 2: knowing that a dysregulated stress response is that what we're 531 00:37:34,880 --> 00:37:39,080 Speaker 2: trying to treat is key. Okay, So it's like, how 532 00:37:39,080 --> 00:37:44,320 Speaker 2: do we regulate the stress response? And one is things 533 00:37:44,520 --> 00:37:48,879 Speaker 2: like so number one is safe, stable, and nurturing relationships 534 00:37:48,880 --> 00:37:52,319 Speaker 2: and environments, right, that is absolutely key. And I think 535 00:37:52,400 --> 00:37:55,840 Speaker 2: that one of the things that's tricky. It's easy to say, 536 00:37:56,239 --> 00:37:59,400 Speaker 2: but I will say it's another thing to do because 537 00:38:00,000 --> 00:38:01,560 Speaker 2: one of the things that gets really tricky is that 538 00:38:01,600 --> 00:38:04,400 Speaker 2: if you grow up in an environment where there was 539 00:38:04,440 --> 00:38:10,439 Speaker 2: a lot of chaos, or where you really loved your 540 00:38:10,680 --> 00:38:14,560 Speaker 2: parent or caregiver, but your parent or caregiver was also 541 00:38:15,400 --> 00:38:21,000 Speaker 2: the source of a lot of drama and harm, verbal 542 00:38:21,040 --> 00:38:27,160 Speaker 2: abuse or physical abuse, right, then we get in like 543 00:38:27,200 --> 00:38:31,759 Speaker 2: our nervous system can really become wired to kind of 544 00:38:31,880 --> 00:38:44,759 Speaker 2: intermingle intimacy with chaos and violence, really, right, Yeah, and 545 00:38:44,840 --> 00:38:47,840 Speaker 2: so we have to unlearn that. So that's one of 546 00:38:47,840 --> 00:38:52,200 Speaker 2: the reasons why therapy is so important. Therapy is really key, 547 00:38:52,239 --> 00:38:57,560 Speaker 2: and it helps us learn how to keep ourselves safe. 548 00:38:57,760 --> 00:39:01,359 Speaker 2: I think one of the things that's really tricky is 549 00:39:01,400 --> 00:39:04,320 Speaker 2: that when you're a kid and you don't have you 550 00:39:05,000 --> 00:39:10,160 Speaker 2: don't have the capacity to keep yourself safe. We sometimes 551 00:39:10,239 --> 00:39:13,480 Speaker 2: learn some coping mechanisms that are intended to try to 552 00:39:13,560 --> 00:39:17,520 Speaker 2: keep us safe that we bring into our adult lives, right, 553 00:39:17,640 --> 00:39:22,200 Speaker 2: And so there are times when we have to when 554 00:39:22,200 --> 00:39:25,160 Speaker 2: we look at how we're reacting and how we're responding 555 00:39:25,160 --> 00:39:28,480 Speaker 2: to a situation. And it's really helpful to have someone 556 00:39:28,680 --> 00:39:32,040 Speaker 2: like a professional to check in with and say, like, WHOA, 557 00:39:32,600 --> 00:39:36,839 Speaker 2: I had this experience, because this is what's key. We 558 00:39:36,880 --> 00:39:39,759 Speaker 2: know that when we experience, you know, stressful autumatic experiences 559 00:39:39,800 --> 00:39:43,960 Speaker 2: in childhood, when we're exposed to something that reminds of 560 00:39:44,080 --> 00:39:47,759 Speaker 2: us of those experiences, that can be a trigger and 561 00:39:47,800 --> 00:39:50,480 Speaker 2: then you get the full activation of your biological stress 562 00:39:50,520 --> 00:39:54,319 Speaker 2: response with those triggers. And so every time my biological 563 00:39:54,360 --> 00:39:59,919 Speaker 2: stress response gets activated. That also increases our risk for health, ment, 564 00:40:00,160 --> 00:40:03,919 Speaker 2: health and behavioral health challenges. Right. And so even though 565 00:40:03,960 --> 00:40:08,080 Speaker 2: whatever it was happened when we were kids, our biology 566 00:40:08,160 --> 00:40:11,759 Speaker 2: is still responding as though that's what's going on today, right, 567 00:40:12,080 --> 00:40:14,960 Speaker 2: And so we see things like safe, stable, and nurturing 568 00:40:15,000 --> 00:40:21,239 Speaker 2: relationships and environments mindfulness, like meditation that helps to strengthen 569 00:40:21,360 --> 00:40:25,680 Speaker 2: the parasympathetic nervous system, which is like the resting and digesting, 570 00:40:25,719 --> 00:40:29,440 Speaker 2: and it counteracts the fight or flight response. So really 571 00:40:29,520 --> 00:40:34,760 Speaker 2: strengthening our ability to counteract our fight or flight response 572 00:40:34,880 --> 00:40:39,880 Speaker 2: is really important. Exercise is really important, So daily exercise 573 00:40:40,520 --> 00:40:44,279 Speaker 2: to be able to burn up those stress hormones and 574 00:40:44,440 --> 00:40:49,120 Speaker 2: also to strengthen the release of endorphins and other feel 575 00:40:49,160 --> 00:40:54,240 Speaker 2: good hormones that counteract our stress hormones. Time in nature. 576 00:40:54,840 --> 00:40:57,640 Speaker 2: I don't know if you've ever experienced this, but getting 577 00:40:57,680 --> 00:41:00,719 Speaker 2: out into nature going for a high is like a 578 00:41:00,760 --> 00:41:05,279 Speaker 2: combination between exercise and but one of the things that 579 00:41:05,320 --> 00:41:10,480 Speaker 2: I learn from my mental health colleagues is something called coregulation. 580 00:41:10,640 --> 00:41:12,680 Speaker 2: You probably know this a lot better than I do, 581 00:41:13,120 --> 00:41:17,560 Speaker 2: which is actually part of what happens when kids are 582 00:41:17,600 --> 00:41:20,880 Speaker 2: supported by safe, stable, and nurturing folks. It's that you. 583 00:41:21,280 --> 00:41:26,840 Speaker 2: If you're regulated, then the child will calibrate their nervous 584 00:41:26,880 --> 00:41:32,160 Speaker 2: system to how you are right, and we can we 585 00:41:32,480 --> 00:41:36,000 Speaker 2: can co regulate with nature, right like just being in 586 00:41:36,920 --> 00:41:41,080 Speaker 2: experiencing nature actually helps to reduce the activation of the 587 00:41:41,080 --> 00:41:45,319 Speaker 2: fight or flight response and increase the activation of the 588 00:41:45,360 --> 00:41:53,120 Speaker 2: parasympathetic the resting and digesting. So sleep, exercise, nutrition, mindfulness, 589 00:41:53,280 --> 00:41:57,200 Speaker 2: mental health, healthy relationships, and time in nature are some 590 00:41:57,280 --> 00:42:02,279 Speaker 2: of the key interventions. And I should say I talk 591 00:42:02,520 --> 00:42:04,640 Speaker 2: a bit more about this for folks who are looking 592 00:42:04,680 --> 00:42:09,120 Speaker 2: for resource and my book The Deepest Well, which kind 593 00:42:09,120 --> 00:42:11,400 Speaker 2: of for folks who want to do more of a 594 00:42:11,440 --> 00:42:14,120 Speaker 2: deep dive and understanding a little bit about how toxic 595 00:42:14,200 --> 00:42:16,800 Speaker 2: stress works and what things help to counteract it. 596 00:42:17,920 --> 00:42:31,600 Speaker 1: More from our conversation after the break. So I am hereious, 597 00:42:31,640 --> 00:42:33,799 Speaker 1: doctor Burke Harris. Are you aware, and it may be 598 00:42:33,840 --> 00:42:36,200 Speaker 1: too soon for this, Are you aware of any research 599 00:42:36,239 --> 00:42:40,280 Speaker 1: that's been done related to aces in the pandemic? Because 600 00:42:40,320 --> 00:42:42,600 Speaker 1: when I think about, you know, like that period of 601 00:42:42,640 --> 00:42:44,800 Speaker 1: time where it felt very much like a bear is 602 00:42:44,840 --> 00:42:47,799 Speaker 1: chasing us, right like, oh my gosh, what's happening? It 603 00:42:47,840 --> 00:42:50,680 Speaker 1: feels like a time when the stress thermostad like you 604 00:42:50,719 --> 00:42:51,640 Speaker 1: weren't sure how to. 605 00:42:51,600 --> 00:42:52,400 Speaker 2: Turn it off. 606 00:42:52,680 --> 00:42:55,040 Speaker 1: Are you aware of any research that's been done there 607 00:42:55,160 --> 00:42:57,480 Speaker 1: in terms of kids and aces? 608 00:42:57,560 --> 00:43:02,120 Speaker 2: Yeah? Yes. So I was working in the California Surgeon 609 00:43:02,160 --> 00:43:08,000 Speaker 2: General's office when the COVID nineteen pandemic hit, and I 610 00:43:08,080 --> 00:43:11,280 Speaker 2: remember when we were getting ready to issue the remain 611 00:43:11,320 --> 00:43:16,880 Speaker 2: at home orders, and you know, we had epidemiologists and 612 00:43:17,080 --> 00:43:21,279 Speaker 2: disease modeling specialists and infectious disease specialists looking at this, 613 00:43:22,160 --> 00:43:26,000 Speaker 2: and I was looking at something else, and I was 614 00:43:26,080 --> 00:43:30,080 Speaker 2: just like, wait a minute, if we're this is a 615 00:43:30,200 --> 00:43:35,000 Speaker 2: major stressor, right, there's a lot of people who if 616 00:43:35,000 --> 00:43:38,920 Speaker 2: we're getting ready to issue remain at home orders, the 617 00:43:39,040 --> 00:43:43,840 Speaker 2: biology of stress physiology can just tell us. So we 618 00:43:43,880 --> 00:43:50,879 Speaker 2: can predict now that stress related health conditions are going 619 00:43:50,920 --> 00:43:56,600 Speaker 2: to increase, right. And I actually wrote a memo to 620 00:43:56,640 --> 00:43:59,319 Speaker 2: the governor and was just like, hey, we need to 621 00:43:59,320 --> 00:44:02,360 Speaker 2: get ahead of this because we're about to see this increase. 622 00:44:03,080 --> 00:44:07,400 Speaker 2: And what we saw was and by the way, this 623 00:44:07,520 --> 00:44:11,440 Speaker 2: data has been shown in other natural disasters as well, right, 624 00:44:11,760 --> 00:44:18,120 Speaker 2: so from Hurricane Katrina to earthquakes in Japan to stars 625 00:44:18,280 --> 00:44:21,960 Speaker 2: and mers like we see that when there is a 626 00:44:22,120 --> 00:44:28,919 Speaker 2: major public health emergency that stress related health disorders can increase, right, 627 00:44:29,400 --> 00:44:34,360 Speaker 2: And so there was actually global data that was published 628 00:44:34,960 --> 00:44:38,360 Speaker 2: in twenty twenty one that showed that between twenty nineteen 629 00:44:39,120 --> 00:44:44,960 Speaker 2: and twenty twenty one, anxiety global rates of anxiety and 630 00:44:45,000 --> 00:44:52,400 Speaker 2: depression among youth doubled across the world. Okay, now, obviously 631 00:44:53,280 --> 00:44:57,120 Speaker 2: it wasn't that all of a sudden twice the number 632 00:44:57,160 --> 00:45:02,640 Speaker 2: of children and youth had a netic predisposition to depression anxiety. 633 00:45:03,040 --> 00:45:09,280 Speaker 2: It's that we have this massive stressor that predictably activating 634 00:45:09,520 --> 00:45:16,839 Speaker 2: the biological stress response. We also saw that that initially 635 00:45:17,080 --> 00:45:20,320 Speaker 2: in the pandemic, we saw rates of child maltreatment going down, 636 00:45:21,400 --> 00:45:24,719 Speaker 2: which likely because they were not being reported right like 637 00:45:24,800 --> 00:45:28,600 Speaker 2: kids are not at schools or in other places where 638 00:45:29,680 --> 00:45:33,319 Speaker 2: where reports would come from where concerned adults would see 639 00:45:33,320 --> 00:45:35,560 Speaker 2: it and be able to make a report. But what 640 00:45:35,600 --> 00:45:41,520 Speaker 2: we did see was that the severity of injury and 641 00:45:41,560 --> 00:45:46,879 Speaker 2: the hospitalization rate from child maltreatment went up. So we 642 00:45:46,920 --> 00:45:51,479 Speaker 2: see that the number of kids being hospitalized for child 643 00:45:51,520 --> 00:45:55,799 Speaker 2: abuse essentially went up. And so we definitely saw this, 644 00:45:55,880 --> 00:45:58,879 Speaker 2: and this is part of the reason why it was 645 00:45:58,960 --> 00:46:03,640 Speaker 2: so important that we put into place these initiatives to 646 00:46:03,760 --> 00:46:10,759 Speaker 2: do early detection and evidence based intervention with the supports 647 00:46:10,840 --> 00:46:13,759 Speaker 2: that we know help to regulate the stress response and 648 00:46:13,840 --> 00:46:16,400 Speaker 2: help to prevent these long term harms. 649 00:46:18,640 --> 00:46:21,200 Speaker 1: You've already talked a lot about, like why you think 650 00:46:21,239 --> 00:46:23,880 Speaker 1: at the policy level we should be addressing some of this. 651 00:46:24,360 --> 00:46:27,279 Speaker 1: What kinds of policies and systemic kinds of things do 652 00:46:27,360 --> 00:46:30,440 Speaker 1: you think would be important for states and governmental institute 653 00:46:30,719 --> 00:46:33,840 Speaker 1: to really focus more on, like a prevention early intervention 654 00:46:34,360 --> 00:46:36,960 Speaker 1: As we're thinking about ACES. 655 00:46:36,680 --> 00:46:40,319 Speaker 2: It's really important for our policies obviously to be supported 656 00:46:40,360 --> 00:46:46,239 Speaker 2: by the science. I actually right now I'm working with 657 00:46:46,640 --> 00:46:51,160 Speaker 2: a team to help other states that are interested in 658 00:46:51,200 --> 00:46:56,200 Speaker 2: implementing the ACES aware a model to provide them with 659 00:46:56,600 --> 00:47:01,360 Speaker 2: the technical assistance and the expertise to be able to 660 00:47:01,960 --> 00:47:08,440 Speaker 2: do that. Right. But essentially, when we think about the 661 00:47:08,480 --> 00:47:12,560 Speaker 2: ACE is aware model focuses on early detection so that 662 00:47:12,600 --> 00:47:15,799 Speaker 2: we can do early intervention, which is really important. But 663 00:47:15,880 --> 00:47:19,280 Speaker 2: that's part of a spectrum, right, Like number one is prevention. 664 00:47:20,520 --> 00:47:25,200 Speaker 2: We want to prevent ACES and other risk factors for 665 00:47:25,360 --> 00:47:32,240 Speaker 2: toxic stress, including discrimination. Right. So, I think it's super 666 00:47:32,360 --> 00:47:41,720 Speaker 2: clear now that understanding how ACES and other risk factors 667 00:47:41,719 --> 00:47:48,000 Speaker 2: for toxic stress impact health is massive, And the CDC 668 00:47:48,320 --> 00:47:53,160 Speaker 2: actually published a report of the cost of ACES to 669 00:47:53,200 --> 00:47:58,360 Speaker 2: the United States and estimated the cost at around fourteen 670 00:47:58,400 --> 00:48:05,359 Speaker 2: point one trillion dollars annually. Right, that's massive, Like, that's 671 00:48:05,400 --> 00:48:10,880 Speaker 2: just absolutely massive. And when we look at that cost, 672 00:48:11,160 --> 00:48:14,000 Speaker 2: of course, when they did that analysis, they looked at 673 00:48:14,040 --> 00:48:17,399 Speaker 2: a lot of things. They looked at IRS data, they 674 00:48:17,440 --> 00:48:19,880 Speaker 2: looked at Department of Justice data, they looked at Department 675 00:48:19,880 --> 00:48:23,080 Speaker 2: of Education data. So it's not just the health outcomes, 676 00:48:23,120 --> 00:48:26,600 Speaker 2: but all of the all of the costs, all of 677 00:48:26,640 --> 00:48:30,600 Speaker 2: the social costs that are associated with ACES. So that's 678 00:48:30,760 --> 00:48:36,040 Speaker 2: just astronomical. So when we think about that, right, that 679 00:48:36,239 --> 00:48:42,640 Speaker 2: huge amount of money. Again, I think that for policymakers, 680 00:48:43,840 --> 00:48:46,960 Speaker 2: regardless of what side of the aisle you're on, Right, 681 00:48:47,040 --> 00:48:51,800 Speaker 2: So for nowadays it feels like our society is so polarized, 682 00:48:52,440 --> 00:48:55,000 Speaker 2: but I think there's a lot of room for folks 683 00:48:55,040 --> 00:49:02,080 Speaker 2: to agree that preventing ACES and other risk factors for 684 00:49:02,160 --> 00:49:09,319 Speaker 2: toxic stress, doing early detection and effective intervention and then 685 00:49:09,520 --> 00:49:16,719 Speaker 2: treatment obviously for the ACE associated health conditions, that is, 686 00:49:17,080 --> 00:49:19,839 Speaker 2: that is what a full continuum looks like. Right, Like 687 00:49:20,200 --> 00:49:21,959 Speaker 2: I can just say from being on the front lines 688 00:49:21,960 --> 00:49:27,440 Speaker 2: of our COVID response that we weren't just like, Okay, 689 00:49:27,760 --> 00:49:31,320 Speaker 2: if someone gets COVID, we're gonna, you know, we're gonna 690 00:49:31,440 --> 00:49:33,840 Speaker 2: treat them. We're gonna put them on a ventilator or whatever. 691 00:49:33,920 --> 00:49:37,360 Speaker 2: Like we're gonna wait until they get We're like, whoa whoah. No, 692 00:49:38,200 --> 00:49:40,000 Speaker 2: we got to prevent it. So we got a distance, 693 00:49:40,000 --> 00:49:41,319 Speaker 2: So we got to wash our hands out, we got 694 00:49:41,400 --> 00:49:43,240 Speaker 2: to wear masks, we got to do all that stuff. 695 00:49:43,800 --> 00:49:46,480 Speaker 2: Then testing, right, like, we got to make sure that 696 00:49:46,520 --> 00:49:49,280 Speaker 2: folks can get tested and they know that if they 697 00:49:49,520 --> 00:49:52,040 Speaker 2: are positive, they're going to try to prevent it the 698 00:49:52,120 --> 00:49:55,360 Speaker 2: spread to others. And we got to give people ppe, 699 00:49:55,640 --> 00:49:58,879 Speaker 2: you know, personal protective equipment, all of that stuff. That's 700 00:49:58,880 --> 00:50:02,560 Speaker 2: what a full public health was spons looks like right prevention, 701 00:50:03,800 --> 00:50:08,000 Speaker 2: early detection, and intervention, and we want that intervention to 702 00:50:08,040 --> 00:50:10,680 Speaker 2: be as early as possible and as evidence based as possible, 703 00:50:10,880 --> 00:50:15,800 Speaker 2: and ultimately right vaccines made such a huge difference with COVID. 704 00:50:16,280 --> 00:50:20,040 Speaker 2: And similarly, when it comes to this public health issue, 705 00:50:20,560 --> 00:50:23,880 Speaker 2: when we're talking about two thirds of Americans have experienced 706 00:50:23,880 --> 00:50:28,520 Speaker 2: at least one ACE, right, then when we're talking about policies, 707 00:50:29,239 --> 00:50:34,440 Speaker 2: those policies involve preventing aces from happening to begin with, 708 00:50:34,920 --> 00:50:39,000 Speaker 2: and that means like supporting families, making sure that parents 709 00:50:39,120 --> 00:50:44,600 Speaker 2: or caregivers are able to you know, are supported to 710 00:50:44,719 --> 00:50:50,200 Speaker 2: provide safe, stable, and nurturing relationships and environments, doing that 711 00:50:50,360 --> 00:50:58,120 Speaker 2: early detection, and covering early intervention, making those services available. Right, So, 712 00:50:58,480 --> 00:51:01,799 Speaker 2: all of those pieces are necessary as part of a 713 00:51:01,840 --> 00:51:05,400 Speaker 2: policy strategy to address ACES and toxic stress. 714 00:51:05,680 --> 00:51:08,520 Speaker 1: Doctor Burke Harris, what gives you hope about the future 715 00:51:08,520 --> 00:51:09,200 Speaker 1: of this work? 716 00:51:09,760 --> 00:51:13,920 Speaker 2: Oh, my gosh, so much, I would say, what gives 717 00:51:13,960 --> 00:51:19,840 Speaker 2: me hope? Number one is that So when I started 718 00:51:19,840 --> 00:51:23,120 Speaker 2: doing this work, I started screening my patients for ACES 719 00:51:23,239 --> 00:51:28,040 Speaker 2: in two thousand and nine, right, so it's twenty twenty 720 00:51:28,080 --> 00:51:31,879 Speaker 2: five now. And at the time that I started doing that, 721 00:51:31,960 --> 00:51:35,600 Speaker 2: I would go give a talk and I'd be speaking 722 00:51:35,600 --> 00:51:37,359 Speaker 2: to a room of a thousand people and I'd say, 723 00:51:37,360 --> 00:51:40,000 Speaker 2: how many of you have heard of ACES or toxic stress? 724 00:51:40,719 --> 00:51:45,799 Speaker 2: And three people would raise their hands literally, right. And 725 00:51:46,000 --> 00:51:50,799 Speaker 2: between that time and where we are today, I have 726 00:51:51,080 --> 00:51:57,000 Speaker 2: just seen a transformation. I have seen number one, more 727 00:51:57,080 --> 00:52:02,200 Speaker 2: and more people being aware of this issue. And it 728 00:52:02,360 --> 00:52:07,880 Speaker 2: started with folks being aware and initially the response was 729 00:52:07,960 --> 00:52:11,600 Speaker 2: kind of like, Okay, what can we do on this 730 00:52:11,719 --> 00:52:14,200 Speaker 2: personal level, which is really important? Right, So like how 731 00:52:14,200 --> 00:52:16,520 Speaker 2: do we address it? You know, how do I address 732 00:52:16,600 --> 00:52:18,800 Speaker 2: up for myself? What do I do? And that's frankly 733 00:52:18,800 --> 00:52:20,480 Speaker 2: that's where I started too, like what do I do 734 00:52:20,520 --> 00:52:24,640 Speaker 2: with my patients? What are these evidence based interventions? And 735 00:52:24,680 --> 00:52:30,760 Speaker 2: then as those become more widely known, I think folks 736 00:52:30,800 --> 00:52:35,520 Speaker 2: have really taken to looking at our systems and saying, Okay, 737 00:52:35,560 --> 00:52:38,120 Speaker 2: wait a minute, how do we set up our systems 738 00:52:38,719 --> 00:52:48,240 Speaker 2: so that we can respond systematically at scale with these 739 00:52:48,360 --> 00:52:54,800 Speaker 2: evidence based interventions? Because I think before people were thinking like, okay, 740 00:52:55,360 --> 00:52:58,799 Speaker 2: you have ass and you have increased risk, but is 741 00:52:58,800 --> 00:53:01,160 Speaker 2: there anything you can do about it? Right? I think 742 00:53:01,200 --> 00:53:04,560 Speaker 2: now we're past that. I think the science is clear 743 00:53:05,080 --> 00:53:07,000 Speaker 2: that there is actually a lot that we can do 744 00:53:07,520 --> 00:53:10,520 Speaker 2: that when we apply these evidence based interventions, we actually 745 00:53:10,560 --> 00:53:15,239 Speaker 2: can improve outcomes for folks. And so just like the 746 00:53:15,400 --> 00:53:22,440 Speaker 2: fact that between science and technology and research, when we 747 00:53:22,560 --> 00:53:28,040 Speaker 2: come together and we make this a priority and we 748 00:53:28,160 --> 00:53:32,759 Speaker 2: raise our voices and we advocate, we actually can transform 749 00:53:32,800 --> 00:53:36,520 Speaker 2: our systems. And that's what makes me excited and gives 750 00:53:36,560 --> 00:53:36,960 Speaker 2: me hope. 751 00:53:38,360 --> 00:53:40,400 Speaker 1: Thank you so much for the doctor bird Cares. It 752 00:53:40,440 --> 00:53:42,439 Speaker 1: has been such a pleasure to hear so much more 753 00:53:42,480 --> 00:53:45,040 Speaker 1: about your work. Please let us know where we can 754 00:53:45,080 --> 00:53:47,319 Speaker 1: stay connected with you. What is your website as well 755 00:53:47,360 --> 00:53:49,520 Speaker 1: as any social media channels you'd like to share. 756 00:53:50,760 --> 00:53:53,200 Speaker 2: So I'm like big on Insta, which is where I 757 00:53:53,320 --> 00:53:57,960 Speaker 2: share updates and also all of my gardening tips because 758 00:53:58,360 --> 00:54:02,080 Speaker 2: gardening is my self care and it is what brings 759 00:54:02,120 --> 00:54:05,640 Speaker 2: me so much joy. So that's at doctor Burke Harris 760 00:54:06,000 --> 00:54:12,280 Speaker 2: on Insta and also Nadineburgharris dot com is my website 761 00:54:12,320 --> 00:54:15,879 Speaker 2: and so folks can can look there to follow more 762 00:54:15,920 --> 00:54:17,440 Speaker 2: about my speaking and other stuff. 763 00:54:18,000 --> 00:54:20,040 Speaker 1: Perfect well, we should include all of that in the 764 00:54:20,080 --> 00:54:22,000 Speaker 1: show notes. Thank you so much for spending some time 765 00:54:22,000 --> 00:54:23,399 Speaker 1: with us today. I appreciate it. 766 00:54:23,800 --> 00:54:26,239 Speaker 2: Oh, it's been my privilege. Thank you so much for 767 00:54:26,280 --> 00:54:26,680 Speaker 2: having me. 768 00:54:27,120 --> 00:54:35,880 Speaker 1: Absolutely, I'm so glad Doctor Burke Harris was able to 769 00:54:35,960 --> 00:54:39,200 Speaker 1: join us for such an insightful conversation today. To learn 770 00:54:39,200 --> 00:54:41,439 Speaker 1: more about her and her work, be sure to visit 771 00:54:41,440 --> 00:54:43,960 Speaker 1: the show notes at Therapy for Blackgirls dot com slash 772 00:54:44,000 --> 00:54:46,440 Speaker 1: Session four three to two, and don't forget to text 773 00:54:46,480 --> 00:54:48,200 Speaker 1: two of your girls right now to tell them to 774 00:54:48,280 --> 00:54:51,719 Speaker 1: check out the episode before we go. I also want 775 00:54:51,760 --> 00:54:55,320 Speaker 1: to highlight another important conversation from our archives. In session 776 00:54:55,400 --> 00:54:58,839 Speaker 1: three seventy six, Sexuality as We Age I was joined 777 00:54:58,840 --> 00:55:01,759 Speaker 1: by doctor Schera malone one who shared powerful insights about 778 00:55:01,800 --> 00:55:05,759 Speaker 1: embracing our sexuality throughout life. And now doctor Sharon has 779 00:55:05,840 --> 00:55:08,880 Speaker 1: just launched her very own podcast, The Second Opinion with 780 00:55:08,960 --> 00:55:12,200 Speaker 1: Doctor Sharon, where women take back the conversation on health 781 00:55:12,239 --> 00:55:16,120 Speaker 1: with honesty, expertise, and the care we all deserve. Make 782 00:55:16,160 --> 00:55:18,640 Speaker 1: sure to check out our earlier conversation in session three 783 00:55:18,719 --> 00:55:21,520 Speaker 1: seventy six and then subscribe to her new show wherever 784 00:55:21,560 --> 00:55:24,520 Speaker 1: you get your podcast. Did you know that you could 785 00:55:24,560 --> 00:55:26,960 Speaker 1: leave us a voicemail with your questions or suggestions for 786 00:55:27,040 --> 00:55:29,799 Speaker 1: the podcast. If you have a topic you'd like us 787 00:55:29,840 --> 00:55:32,440 Speaker 1: to discuss or a guest you'd like to hear, leave 788 00:55:32,520 --> 00:55:34,960 Speaker 1: us a message at memo dot fm slash Therapy for 789 00:55:35,000 --> 00:55:37,360 Speaker 1: Black Girls and let us know what's on your mind. 790 00:55:37,480 --> 00:55:40,440 Speaker 1: We just might feature it on the podcast. If you're 791 00:55:40,440 --> 00:55:43,280 Speaker 1: looking for a therapist in your area, visit our therapist 792 00:55:43,320 --> 00:55:47,600 Speaker 1: directory at Therapy for Blackgirls dot com slash directory. Don't 793 00:55:47,600 --> 00:55:50,080 Speaker 1: forget to follow us on Instagram at Therapy for Black 794 00:55:50,080 --> 00:55:52,319 Speaker 1: Girls and come on over and join us in our 795 00:55:52,360 --> 00:55:56,160 Speaker 1: Patreon channel. For more exclusive updates and behind the scenes content, 796 00:55:56,600 --> 00:55:59,120 Speaker 1: you can join us at community dot therapy for blackgirls 797 00:55:59,160 --> 00:56:03,680 Speaker 1: dot com. This episode was produced by Lise Ellis, Indechubu 798 00:56:03,800 --> 00:56:07,719 Speaker 1: and Tyree Rush. Editing was done by Dennison Bradford. Thank 799 00:56:07,800 --> 00:56:10,080 Speaker 1: y'all so much for joining me again this week. I'll 800 00:56:10,120 --> 00:56:13,280 Speaker 1: look forward to continuing this conversation with you all real soon. 801 00:56:13,800 --> 00:56:14,479 Speaker 2: Take good care.