CHAIN OF FAM­ILY TRAUMA Child­hood wounds can linger in later life and bleed into larger com­mu­ni­ties

USA TODAY US Edition - - NEWS - John Sch­mid, Mil­wau­kee Jour­nal Sen­tinel

“The kids be­come the par­ents. They grow up and have kids, and the cy­cle can re­peat it­self.”

Alisha Fox be­gins her story mat­ter-of-factly: When she was 1, so­cial work­ers took her from her mother — sin­gle, work­ing poor, liv­ing in a run­down Mil­wau­kee neigh­bor­hood — and put her in foster care.

Three years later, she landed with her fa­ther, a some­times con­struc­tion worker prone to heavy mar­i­juana use and vi­o­lent bouts of de­pres­sion. Her life be­came a pro­gres­sion of ad­ver­sity: ne­glect, abuse, in­cest, de­pres­sion, men­tal health treat­ment, court­room ap­pear­ances, de­po­si­tions.

At 21, Fox works at La Causa Re­cov­ery Cen­ter on Mil­wau­kee’s south side, help­ing oth­ers re­claim their lives. “There’s still night­mares and flash­backs, but ev­ery day is bet­ter,” she says.

Mil­wau­kee and ur­ban cen­ters like it across the coun­try pro­duce far too many chil­dren ex­posed to trau­matic lev­els of abuse, ne­glect and vi­o­lence but not nearly enough who find a path in adult­hood to post-trau­matic heal­ing.

An emerg­ing na­tional net­work of pub­lic health and neu­ro­science re­searchers, com­mu­nity-minded foun­da­tions and law en­force­ment of­fi­cials be­lieve the pri­mary chal­lenge fac­ing high-poverty cities is not one of the usual sus­pects — ed­u­ca­tion, crime, even jobs — al­though all those play a role.

In­stead, it is an epi­demic of trauma passed from one gen­er­a­tion to an­other, one neigh­bor­hood to the next.

The per­pet­u­a­tion of trauma has been doc­u­mented in the fam­i­lies of those who sur­vived the Holo­caust, Hiroshima, the Viet­nam War and Cam­bo­dian geno­cide. Data show the same phe­nom­ena in fam­i­lies en­trenched in poverty, vi­o­lence and ne­glect.

That rev­e­la­tion is be­gin­ning to shift how Mil­wau­kee and other cities re­spond to so­cial and eco­nomic de­cline. Re­searchers ex­plore why some who are ex­posed to child­hood trauma emerge un­de­feated — and whether their re­silience can be coaxed out of oth­ers and even scaled to en­tire neigh­bor­hoods.

“We are be­yond the tip­ping point,” says Franklin Cum­ber­batch, project man­ager at Bader Phi­lan­thropies, ac­tive in some of the Mil­wau­kee’s hardest-hit neigh­bor­hoods. “We are at a cat­a­strophic point.”

The eco­nomic im­pact is enor­mous. For years, frus­trated in­dus­trial em­ploy­ers in Mil­wau­kee have strug­gled to fill job open­ings, even when they are lo­cated near pock­ets of un­em­ploy­ment. Good pay and ben­e­fits, even on-the-job train­ing, don’t help much.

“I try so hard to be a good stew­ard and hire from the neigh­bor­hood,” says David Mitchell, who has run man­u­fac­tur­ing com­pa­nies on the city’s north­west side for more than 15 years.

Through the years, Mitchell has of­fered free welder train­ing and given “fourth and fifth chances if I thought the per­son had po­ten­tial.” Many don’t pass a drug screen­ing, he says, and at­ten­dance is­sues are “bru­tal.” He’s been forced to hire out-of-town tem­po­rary em­ploy­ees, even pay­ing ho­tel fees.

Pub­lic health ex­perts around the na­tion see a direct link be­tween child­hood trauma and an in­ca­pac­i­tated work­force. Im­prov­ing the lat­ter is im­pos­si­ble with­out ad­dress­ing the for­mer.

Em­ploy­ers “are get­ting these dam­aged peo­ple,” says Pa­tri­cia McManus, pres­i­dent of the Black Health Coali­tion of Wis­con­sin.

Be­gin­ning in the early 1970s, a global eco­nomic up­heaval hit Mil­wau­kee’s in­dus­trial core, and en­gine-mak­ers, ma­chine shops, tan­ner­ies, even her­alded brew­eries shut down in rapid-fire suc­ces­sion.

As jobs dis­ap­peared, so did many of the dreams that came with them. Peo­ple and their fam­i­lies be­gan to break.

A half-cen­tury later, data re­veal that many have never healed, and poverty, job­less­ness and so­cial ills have con­tin­ued to spread like a slow-mo­tion shock wave.

Trauma re­searchers say the seeds of dis­tress were planted years ago when the cur­rent gen­er­a­tion of adults were chil­dren, and new seeds are be­ing planted.

“The kids be­come the par­ents,” says Gabriel McGaughey, direc­tor of child well-be­ing at the Chil­dren’s Hos­pi­tal of Wis­con­sin. “They grow up and have kids, and the cy­cle can re­peat it­self.” A RE­VEAL­ING SUR­VEY The most com­mon mea­sure of non-mil­i­tary trauma is a short sur­vey of “ad­verse child­hood ex­pe­ri­ences,” the ACE test.

The in­dex con­sists of sim­ple but in­tru­sive yes-or-no ques­tions: When you were grow­ing up, did a par­ent or adult in the house beat you? Beat each other? Did any of them ver­bally or sex­u­ally abuse you? Emo­tion­ally ig­nore you? Were any of them al­co­holics? Drug users? In­car­cer­ated? Men­tally ill?

Com­pared with some­one with zero “yes” an­swers, a per­son with four or more is six times as likely to strug­gle with de­pres­sion; seven times as likely to grow up al­co­holic; 10 times as likely to in­ject street drugs; and 12 times as likely to at­tempt sui­cide. They’re far less likely to hold a job and more likely to end up home­less.

Chil­dren with high scores tend to en­ter adult­hood with­out the nor­mal abil­ity to man­age stress, nav­i­gate re­la­tion­ships or prac­tice de­layed grat­i­fi­ca­tion. Fur­ther, those with an ACE score of four or higher are twice as likely to have heart dis­ease, twice as likely to be di­ag­nosed with cancer. For those who score six or higher, life ex­pectancy drops 20 years.

ACE sur­veys done across the USA and in other coun­tries show that no so­cial class, eth­nic­ity or ge­og­ra­phy spares their chil­dren.

ACE scores spike in en­vi­ron­ments of con­cen­trated poverty, wide­spread eco­nomic un­cer­tainty and high un­em­ploy­ment. Al­though high-poverty con­cen­tra­tions con­tinue to mul­ti­ply in the cities, the fastest growth of such tracts is found across the na­tion’s sub­urbs and small towns.

“The sub­urbs shouldn’t think they are im­mune,” says El­iz­a­beth Knee­bone, fel­low at the Metropoli­tan Pol­icy Pro­gram at Brook­ings In­sti­tu­tion.

The pro­fu­sion of high-poverty tracts can be found in red states and blue states, Rut­gers Univer­sity pub­lic pol­icy pro­fes­sor Paul Jar­gowsky says.

The Amer­i­can Cen­ters for Dis­ease Con­trol and Pre­ven­tion es­ti­mates the eco­nomic bur­den re­sult­ing from child abuse and ne­glect in the USA at $124 bil­lion.

“ACEs are the lead­ing de­ter­mi­nant of pub­lic health spend­ing ” and a ma­jor driver of in­car­cer­a­tion and child wel­fare costs, says Jen­nifer Jones of the Al­liance for Strong Fam­i­lies and Com­mu­ni­ties. Shift­ing pri­or­i­ties into pre­ven­tive pro­grams “would save on the deep-end cost” of in­car­cer­a­tion, med­i­cal care and men­tal health fa­cil­i­ties, Jones says. TRY­ING TO MOVE ON In Mil­wau­kee, ACE sur­veys lay bare en­tire neigh­bor­hoods where scores of four or higher are more the norm than the ex­cep­tion.

Jamee­lah Love scores a 10 out of 10, and she doesn’t re­gard her­self as a rar­ity. “You’d be shocked,” she says. “A lot of peo­ple don’t have a rain­bow in their story.”

She re­calls her fa­vorite house grow­ing up — a brick cot­tage perched on what seemed to her 5year-old eyes like a grassy hill.

“That house was so cute,” she re­mem­bers, “un­til we burned it down.”

Her mother woke her amid smoke and chaos and handed her out a win­dow.

Love, 26, hardly re­mem­bers all the other homes, the moves, the evic­tions. There was one home on the north side where she could not do home­work on the front porch with­out fear­ing for her life. There was one on the south side, next to a noisy tav­ern, where so­cial work­ers took her away from her trou­bled and abu­sive mother. She was 14 at the time.

Like so many peo­ple deal­ing with trauma, Love says, both her par­ents would have had high scores as well. She was the tar­get of her mother’s abuse “for al­most every­thing.” Her left hand still bears a scar from one of the times her mother whipped her with an ex­ten­sion cord.

Nev­er­the­less, to­day, she’s a cer­ti­fied nurs­ing as­sis­tant and is work­ing to­ward a po­lit­i­cal sci­ence de­gree.

“No mat­ter how I look at my story, there might be some­one whose story is worse than mine,” she says. “And so I’m grate­ful that I’ve moved past it.” Many can­not move past it. “There’s a be­lief in the United States that if you work hard enough, you can pull your­self out of any sit­u­a­tion,” says Ge­of­frey Swain, chief med­i­cal of­fi­cer for the Mil­wau­kee Health Depart­ment. “But not all can.”

With that in mind, Mil­wau- kee’s lead­ing foun­da­tions and non-profit groups qui­etly are aban­don­ing many of the left­over con­ven­tions of the past cen­tury. They no longer pre­tend to cover the en­tire city. Rather than spread fi­nite funds ran­domly across the re­gion, they tar­get a hand­ful of strate­gic neigh­bor­hoods with a bar­rage of fo­cused fund­ing and clus­tered sup­port.

The idea is that agen­cies, ac­tivists, non-profit groups, foun­da­tions, even law en­force­ment pile on to­gether in hopes of reach­ing a crit­i­cal mass, turn­ing enough in­di­vid­ual lives around that ul­ti­mately a whole neigh­bor­hood sta­bi­lizes, and hope­fully re­bounds. A foot­ball fan might call it “flood­ing the zone.”

The ef­forts in Mil­wau­kee are watched na­tion­wide.

More than two dozen pro­grams are fo­cused in one high­poverty Mil­wau­kee en­clave, the Amani neigh­bor­hood, which re­ceives day care, preschool, par­ent guid­ance, adult ba­sic ed­u­ca­tion, fam­ily coun­sel­ing, per­form­ing arts, ath­let­ics, free meals and a sum­mer camp. Res­i­dents have a place to call when their heat and elec­tric­ity are shut off. The neigh­bor­hood has landed its own med­i­cal clinic.

It’s too early to draw con­clu­sions, but over the past four years, Amani has seen crime de­crease 26%.

The idea is that along­side a de­crease in crime, other so­cial ills may drop — and there might fi­nally be a floor un­der the down­ward cy­cle.

On an in­di­vid­ual level, one of the most com­mon strate­gies to coax re­silience out of trauma vic­tims is to help them cre­ate a dif­fer­ent nar­ra­tive for their own lives — a process called re­script­ing.

The ob­jec­tive is to map out a fu­ture that moves be­yond the auto-re­peat memories of the past.

On the ACE trauma scale, Alisha Fox scores a nine out of 10. But she has found a new in­ner nar­ra­tive that guides her.

She speaks at con­fer­ences on sui­cide pre­ven­tion and trauma-in­formed so­cial work. She plans to get a de-gree and be­come a ther­a­pist.

“I’m de­fy­ing the odds,” she says. “If I kill my­self, I can’t be a mom. So it’s like, I want to stay alive, so I can be a mom. One day, I’m go­ing to be a mom. And it’s go­ing to be awe­some.”

Gabriel McGaughey, Chil­dren’s Hos­pi­tal of Wis­con­sin

PHO­TOS BY MIKE DE SISTI, MIL­WAU­KEE JOUR­NAL SEN­TINEL

Alisha Fox, 21, is a sur­vivor of post­trau­matic stress dis­or­der and an ex­am­ple of re­cov­ery and re­silience. She works as a men­tal health peer coun­selor at La Causa Re­cov­ery Cen­ter in Mil­wau­kee, help­ing oth­ers learn that re­cov­ery is real.

Dionne Bai­ley, a teacher in the Burke Early Ed­u­ca­tion Cen­ter, cares for in­fants at the COA Goldin Cen­ter. Mil­wau­kee foun­da­tions and agen­cies have sin­gled out a hand­ful of com­mu­ni­ties that es­pe­cially need their re­sources, such as the Amani neigh­bor­hood.

Tim Grove, chief clin­i­cal of­fi­cer at SaintA, a non-profit child wel­fare agency, hugs Alisha Fox. SaintA in­ter­vened in Fox’s life, which she says was marked by abuse and de­pres­sion.

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