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WASHINGTON – When she was 16, Tonier Cain-Muldrow's mother agreed to marry her daughter off to a 24-year-old man who offered her all the alcohol she could want in return.
It may not have even been the worst trauma in Cain-Muldrow's troubled early years.
She was raped, beaten and neglected throughout her childhood and it was those "adverse childhood experiences" (ACEs) that she says drove her to 19 years of coping mechanisms that included alcoholism, prostitution, 83 arrests and an "insatiable drug addiction to crack."
It wasn’t until a nurse looked at her and said, “You can’t do it alone, but you can do it with some help,” that she felt she'd be alright.
Two decades after its ground-breaking study with the Centers for Disease Control and Prevention (CDC) quantified the connection between ACEs and long-term physical and mental health, Kaiser Permanente convened health industry leaders recently in Washington to examine how to create more trauma-informed schools and communities.
ACEs are stressful or traumatic events including abuse and having an addicted or incarcerated parent that occur before age 18. They are typically denoted on a 10-point scale with higher numbers leading to higher risks of learning, mental and physical health challenges.
In Oregon, where Kaiser Permanente internist Imelda Dacones is based, nearly 20 percent of children have experienced at least four ACEs, which makes them four times more likely to experience depression in their lifetimes.
"That’s the power of the knowledge and science behind adverse childhood experiences," says Dacones, who is executive medical director of the Northwest Permanente Medicine group at Kaiser Permanente.
For children and families in the Northwest, Kaiser Permanente is working on creating a “health complexity” score that is made up of “medical complexity” and “social complexity” scores, says Dacones.
The “social complexity” score would be based on information from the Oregon health and human services agency, which would track ACEs as children and families move through various services for food, housing, financial help, or correctional facilities.
This would sometimes eliminate the need to go through long interviews, which can trigger traumatic memories. The scores would help connect people with social organizations and develop a system to help Kaiser Permanente study the type of interventions that work.
Dacones says Kaiser is building its analytics and scoring methodology based on existing data. Once the methodology is fully developed, Kaiser Permanente will determine how to best use it and share what it's learned with the other parts of the Kaiser network for possible expansion.
It's the kind of attention to the big picture problems that Cain-Muldrow applauds.
Cain-Muldrow, who founded the non-profit Neen Cares, works with businesses, healthcare providers and other public and private organizations to increase awareness of the characteristics and effects of trauma.
"Trauma seems to be the flavor of the week now. Showing my (documentary) or having me speak does not make you trauma informed,” says Cain-Muldrow, who tried alcohol the first time at age 9. "It takes work."
For its part, Kaiser Permanente has invested nearly $9 million over the past four years to prevent and treat trauma in children.
"If we can prevent or treat trauma early in a child’s life, we may have a better chance of preventing the greater burden of chronic illnesses such as depression, substance abuse and heart disease," says psychiatrist Don Mordecai, Kaiser Permanente's national leader for mental health and wellness. "One path to prevention is education."
Kaiser Permanente’s Thriving Schools initiative provides funding to improve student and staff resilience and connect schools to clinical and community mental health programs and trauma resources.  More than 50 schools, serving 25,500 students across Kaiser Permanente regions have piloted projects towards improving the well-being of children.
Parents with high ACE scores put their children at risk of ACEs. Kaiser Permanente is helping these parents understand the role ACEs played in their lives and how to provide stable environments to help break the cycle of trauma, says Mordecai.
Physician and former Surgeon General Vivek Murthy described the challenges in getting federal funding for health and wellness.
“Equity has to be a priority, but it will only be if we as voters demand that," says Murthy.
University of California, San Francisco's Healthy Environments And Responses to Trauma in Schools (HEARTS) works with school systems to create trauma-informed schools that foster resilience and wellness for everyone.
"We all have a stake in doing what needs to happen to heal," says psychologist Joyce Dorado, HEARTS director and co-founder.
Tonette Walker, wife of Wisconsin Gov. Scott Walker (R) and a speaker at the Kaiser event, started the program Fostering Futures to better recognize, understand, and address the effects of trauma.
“Knowing about trauma care, changed my life” said Walker. “When you hear it, you can’t forget it, you can’t walk away from it.”
Gilyard and Lewter are interns with the Urban Health Media Project, which was co-founded by O'Donnell, USA TODAY's health care policy reporter.
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