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Expert to speak on childhood trauma

Looking for solutions: Mark Cloutier, the chief executive of Caminar, a behavioural healthcare organisation in California (Photograph by Fiona McWhirter)

Traumatic events in childhood have become a “public health emergency” that policymakers must tackle from the top, an expert warned yesterday.

Mark Cloutier said legislators need to understand how the wider community is affected not only socially but also economically by issues like abuse.

The chief executive of Caminar, a behavioural healthcare organisation in several counties across California, will be a keynote speaker at the Adverse Childhood Experiences conference in Bermuda today.

The veteran health worker told The Royal Gazette yesterday: “A good way to frame what Aces offers us is, it’s really the unaddressed non-infectious public health emergency of our lifetime, in that we now have the evidence from an epidemiological perspective — what is a major driver of lifetime adult chronic diseases.

“If you look at it through that framework you then begin to understand the cost effectiveness of investing earlier, so that you can reduce or eliminate the human suffering that’s caused by untreated Aces and then save your country and the health and the insurance system lots of money.”

Mr Cloutier, who was invited to the island by the United States Consulate as part of the US State Department’s Speaker Programme, said policymakers must be aware that diagnoses of heart disease and hypertension are “the surface of the iceberg and what we need to understand is what’s below that, what is it that led to this chronic physiological condition”.

The San Francisco-based Caminar chief executive officer’s talk will be about how Aces affect communities and he explained that, in addition to commonly identified traumatic events, places like Bermuda would consider “other aspects of what they know to be systematic experiences of harm or oppression”, such as racism.

More than 600 people took part in a survey by the Bermuda Health Council in partnership with Family Centre, which found a third of its respondents lived in a household where substance abuse was an issue.

One in ten were in a home where a member had been imprisoned.

The research also showed that one in three respondents said they experienced some form of sexual abuse as a child and more than half felt they were sometimes treated unfairly because of race. Mr Cloutier explained: “In the absence of a protective buffering adult, when that exposure happens on a sustained basis it can have what is known to be a toxic stress effect on that child.

“Toxic stress basically describes the biological effect. When you’re exposed to something like a bear in the forest your cortisol and your adrenalin goes up very fast so you know either to fight the bear or to flee.

“What happens with systematic exposure to adversity is that adrenalin and cortisol keeps getting released and that then leads to disease processes such as hypertension, coronary heart disease and puts children at higher risk of developing lifetime chronic diseases such as cancer and diabetes.

“We also know that it has an effect on long-term mental health disorders, such as depression, anxiety disorders and thought disorders like schizophrenia, and then substance abuse disorders — addiction to drugs and alcohol.”

He said it was important to develop a “two generation solution” that included screening children for exposure and early intervention.

Mr Cloutier added: “Obviously Aces, in most cases, occur because of the behaviour of adults, parents or other adults in the children’s life, who are exposing them to abuse or neglect.”

He said measures included appropriate domestic violence and child abuse laws “to separate the perpetrator from the victim”.

Mr Cloutier explained: “It’s also very important to have a treatment component for the perpetrator.

“As you can appreciate these sort of behaviours are often transmitted intergenerationally so you want to break the cycle of domestic violence, of physical abuse, of emotional abuse by intervening with the adult and doing the right kinds of therapeutic interventions, so that they stop being a perpetrator and appreciate they were probably a victim themself.”

He said teachers should be equipped and protocols should be in place to help them respond if they were concerned about a child, and children should be taught in school about resilience and how to deal with emotional issues.

Mr Cloutier added: “I think probably the biggest effect you can have is by focusing on public policy and starting with laws to deal with abuse and neglect, and domestic violence, having appropriate early intervention and supportive insurance and healthcare reimbursement processes for intervening in the paediatric setting, then intervening with mental health treatment.”

The BHeC and Family Centre survey found that one in five respondents said cost prevented them from seeing a doctor in the past year.

Mr Cloutier suggested if individual families were unable to access appropriate treatment or rehabilitation programmes, “community-based organisations or faith-based organisations have an opportunity to step in”.

However, he added: “I think they need to have proper training.”