USA TODAY US Edition
CHAIN OF FAMILY TRAUMA Childhood wounds can linger in later life and bleed into larger communities
“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