The “Trauma-Informed Care for Children and Families Act” (S. 774, H.R. 1757) was introduced on March 29 in the Senate by Sen. Heidi Heitkamp (D-ND) with co-sponsors Dick Durbin (D-IL), Al Franken (D-MN), and Cory Booker (D-NJ), and, for the first time in the House of Representatives, by Chicago Rep. Danny K. Davis (D-IL7). A version of the bill was introduced in the Senate in the final days of the last Congress. The bill’s sponsors were not successful in their efforts to gain bipartisan support in advance of its introduction.
The lawmakers who developed the comprehensive provisions of the bill to address trauma represent widely different constituencies. Sen. Heitkamp cites the importance of addressing trauma especially among children and families in Native communities in the rural state of North Dakota while Sen. Durbin and Rep. Davis are motivated by a desire to support children traumatized by community violence in urban neighborhoods.
The legislation creates a high-level multi-agency task force led by the assistant secretary for mental health and substance use (a position created in the mental health provisions of the 21st Century CURES Act) to recommend a set of best practices to promote “coordinate efforts and establish best practices for identifying and supporting children that have experienced trauma.”
Other provisions—summarized in a fact sheet provided by the bill sponsors—include:
Disseminate Best Practices. Provides more teachers, doctors, social service providers, and first responders with the tools to help children who have experienced trauma by creating an eligible use of funding for several federal grant programs to be used for this training;
Train Key Stakeholders. Creates law enforcement and Native American coordinating centers that will share information, improve awareness, and enhance training on trauma’s impact;
Test New Models. Increases funding for the National Child Traumatic Stress Initiative to evaluate new strategies for improving trauma-informed prevention and care;
Improve Understanding of Trauma. Requires the CDC to improve data collection on trauma prevalence, and directs CDC and GAO to conduct studies to identify barriers to coordination;
Expand Treatment Capacity. Pilots a Medicaid demonstration program to text expanded coverage of child trauma services, and expands mental health care in schools;
Support Workforce Development. Expands loan repayment programs for clinicians who serve in high-need communities; develops training guidelines for non-clinical providers in trauma care; and improves graduate school and pre-service training for teachers and clinicians;
Foster Community Coordination. Creates a grant program to bring together stakeholders to identify needs, collect data, and target efforts. Additionally, builds on the Performance Partnership Pilot to pool federal grants from multiple agencies and focus the funding on increasing trauma services for children and families.
The CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study) looked at 10 types of childhood trauma: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused. Other subsequent ACE surveys include racism, witnessing violence outside the home, bullying, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, witnessing a father or other caregiver being abused, involvement with the criminal justice system, attending a zero-tolerance school, etc.
The ACE Study found that the higher someone’s ACE score – the more types of childhood adversity a person experienced – the higher their risk of chronic disease, mental illness, violence, being a victim of violence and a bunch of other consequences. The study found that most people (64%) have an ACE score of one; 12% of the population has an ACE score of 4. Having an ACE score of 4 nearly doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and the risk of attempted suicide by 1200 percent. (For more information, go to ACEs Science 101. To calculate your ACE and resilience scores, go to: Got Your ACE Score?)
The ACE Study also found that it didn’t matter what the types of ACEs were. An ACE score of 4 that included divorce, physical abuse, an incarcerated family member and a depressed family member had the same statistical health consequences as an ACE score of 4 that included living with an alcoholic, verbal abuse, emotional neglect and physical neglect.
The ACE Study is one of five parts of ACEs science, which also includes how toxic stress from ACEs damage children’s developing brains, how toxic stress from ACEs cause chronic diseases, and how it can affect our genes and be passed from one generation to another (epigenetics), and resilience research, which shows the brain is plastic and the body wants to heal. Resilience research focuses on what happens when organizations and systems integrate trauma-informed and resilience-building practices, for example in education and in the family court system.
In contrast to the quiet introduction of the earlier version of the legislation (S. 3519) in the 114th Congress, a press conference was held on March 19 at the University of Chicago Duchossois Center for Advanced Medicine (DCAM) to announce plans for the bill’s upcoming introduction. Sen. Durbin and Rep. Davis were featured at the event held at the University of Chicago Medical Center, along the other participants including Dr. Colleen Cicchetti, executive director of the Center for Childhood Resilience at Children’s Hospital of Chicago and several medical professionals and advocates. The Chicago Tribune, Chicago Sun Times, and the Chicago Defender covered the event.
Rep. Davis, who lost a grandson last year to gun violence, was quoted in an editorial team piece in the Chicago Defender: “A new study from the Heartland Alliance has documented the deep nexus between violence, trauma and poverty. The study reinforces the urgency of treating trauma and how untreated trauma is not only destructive to the individual child but leads to more violence and poverty. We are desperately short of resources to address childhood trauma, to help heal children suffering from trauma and to begin to break the cycle leading to mass childhood trauma. This bill will begin to marshal effective evidence-based treatments and interventions for our youth.”
In addition to the Chicago event, a briefing on the bill will be held in April in Washington, DC.A series of three briefings, sponsored by Sen. Heitkamp and organized by the Campaign for Trauma-Informed Policy and Practice (CTIPP), was held during 2016 to educate policymakers and their staff about the science of adverse childhood experiences and trauma, and how this knowledge is being used to improve services and programs at the state and local levels. Cicchetti, who participated in the Chicago press event, also presented at the third and final briefing. CTIPP—a newly established organization to address trauma across the lifespan—has been actively involved in the development of the legislation, providing research, suggested approaches, and refinements to the bill.
The legislation has been endorsed by dozens of national, state, and local organizations.