Philadelphia, Pennsylvania Update 2014 – 2015

Read the start of the Philadelphia story here (2004 – 2013)

Members of the Philadelphia ACE Task Force decided it was time to move from talk to action.

After meeting quarterly since 2012, the task force—an increasingly diverse group of practitioners in pediatrics, primary care, education, juvenile justice, early childhood intervention and anti-violence work—invited each member to write down his or her vision for ACEs work in the city.

Health Federation organizers winnowed four dozen index cards into ten major areas, then helped the group distill those into three priorities:

• to educate the wider community about ACEs and their impact
• to develop a better understanding of trauma-informed programs and agencies in the city and to learn what kinds of interventions work best
• to help infuse graduate and professional education programs—in medicine and nursing, social work and counseling, education and law—with teaching on ACEs and resilience

Each of those priorities now has its own work group; to broaden leadership, the work groups are co-chaired by longtime and newer members of the ACE Task Force. A fourth group is focused on ACEs research.

“When we looked at the goals people had, we realized it was very action- and behavior-oriented,” said Joel Fein, a pediatrician at The Children’s Hospital of Philadelphia (CHOP), co-director of the Violence Prevention Initiative at CHOP and one of three co-chairs of the task force. The previous months of meeting regularly—building relationships, sharing questions and challenges, learning from one another—had paid off. “There was already an undercurrent of community. Task force members knew each other and respected each other.”

In addition, two of the work groups received the boost of funding from local or regional foundations: Atlantic Health System and First Hospital Foundation are funding the community education group to develop effective ways to “message” the general public about ACEs and resilience, while the group focused on graduate- and professional training has a grant from the Annie E. Casey Foundation.

The Philadelphia-based Stoneleigh Foundation, too, supports ACEs work in the city by funding individuals—practitioners, researchers and advocates working  to change the child welfare and juvenile justice systems.

Meantime, there are new voices at the table. The task force, which began with concerned practitioners in pediatrics and family violence prevention, has branched out to include those working in law enforcement, public health, early childhood education and mental health. One newer member, who now co-chairs the community education work group, is an artist, musician and activist who has worked with youth and homeless adults.

Beyond the task force and its quarterly meetings, virtual connections continue to spark: the Philadelphia ACEsConnection group, launched in February 2014, has grown to 150 members. Periodic in-person “meet-ups”—meant to be informal, awareness-building opportunities—have drawn young professionals to hear from speakers such as James Encinas, who trekked cross-country by bicycle to learn what brings resilience to people who have suffered trauma.

And ACEs awareness is spreading to other city sectors, including education. At Mastery Charter Schools, a network of 18 schools in Philadelphia and Camden, administrators completely transformed their discipline approach as part of a “transformational culture” re-boot of school practices. Teachers used to demand “demerit cards” from students who acted out, but that action often triggered angry or distressed student to escalate further, said Ivan Haskell, who directs social and psychological services at Mastery.

Now, after several trainings, presentations on trauma and ongoing “professional learning communities” in which staff can ask questions and share experiences, student misbehavior is more likely to elicit a conversation with a teacher or—in some Mastery schools—a brief trip to the “calming corner.”

“We changed from a traditional discipline to a restorative practices model,” Haskell said. “The onus is more on the teacher to be a deep thinker: to examine their own frustrations and what might be going on with student behavior.”

An understanding of childhood adversity and its impact is growing among Philadelphia public school educators, as well; superintendent William R. Hite noted the importance of social-behavioral learning and trauma-informed practices in his latest plan for the 140,000-student district, released in March 2015.

“I think a lot more people have become aware of how important this is and are really thinking about what they need to do in their systems,” said Sandy Bloom, a co-chair of the ACE Task Force who is currently involved in an effort to bring the Sanctuary model to an entire Philadelphia neighborhood.

Meantime, the ACE Task Force gathered in early April to hear the founder of the Worldwide Orphans Foundation describe toy libraries in Bulgaria. Play, she told the group, is a “secret weapon against the lack of understanding of early childhood development that exists in impoverished communities all over the world.” Another speaker, a professor from Drexel University’s School of Public Health, outlined ways of turning trauma-awareness into public policy.

Later, each of the work groups plunged into the gritty details of how to advance this work: How to respond to people who recoil at the language of ACEs, protesting, “My community is not traumatized!” How to gauge whether an agency or program is truly “trauma-informed.” How to translate complex ideas—for instance, epigenetics—for different groups of learners.

What’s still missing from the big picture? Health Federation’s Lieberman says that ACEs awareness in the city, while percolating steadily among professionals in a range of fields, hasn’t fully sunk in with the general public. The business community, faith-based organizations and the School District aren’t yet represented on the Task Force. Neither are policy-makers or economists. And while the city is dotted with projects and programs aiming to mitigate ACEs and boost resilience—from mental health screenings available on iPads at an urban farmer’s market to a trauma-informed campaign to curb youth violence in the 22^nd police district—those efforts aren’t yet woven into a robust, seamless whole.

“Now that we do have a good array of services available, we need more coordination and making sure people are getting linked. There’s still work that needs to be done,” says Lieberman.

Meantime, members of the ACE Task Force—and others around the city—put their knowledge of ACEs into practice every day.

Pediatrician Fein described a recent, heated exchange between a medical resident and the father of a baby. “The father wanted the baby tested for everything, testing we didn’t think was necessary,” Fein said. “Then we learned that the father’s first child had died of SIDS. The fact that we acknowledged his concern, that it wasn’t a hidden wall between us, allowed us to have a conversation that wouldn’t have been able to happen otherwise.”

Across town, during a routine check-up of a school aged boy, his mother discloses, “I’m a yeller,” when the pediatrician asks how she handles bad behavior. The mother is a single parent, working full-time while caring not only for her son but for another very ill relative. She is concerned because her son’s grades have slipped.

“By openly talking about discipline with this mother, I learned about the high level of stress in the family,” says the pediatrician, who wished to remain anonymous in order to protect the patient’s privacy.

“This child could have ongoing problems in school and not graduate or end up on the streets. If doctors can talk to parents about handling stress and ways to positively parent, then we might be able to keep children like this boy on track, and help him and others to have a better life.”