Invisible Scars | Part 1

JUDY WOODRUFF: We begin a new series looking at an underreported public health crisis in this country, childhood trauma.

It affects millions of Americans.

In our first piece from correspondent Cat Wise and producer Jaywon Choe, we lay out the problem and what's at stake.

We are calling the series Invisible Scars: America's Childhood Trauma Crisis.

CAT WISE: This hotel room in Oakland, California, has been home to Iesha James and her sons for four months.

It's close quarters for three growing boys, ages 15, 13, and 12.

But they'd rather be here than return to their apartment, where a drive-by shooting in August upended their lives.

Jeremiah, the oldest, was hit in the leg.

IESHA JAMES, Mother: That was your entry wound.

BOY: Oh, yes, that's my entry wound.

IESHA JAMES: Entry wound.

Where's your...

BOY: Entry wound right here, and then it came out like up here.

IESHA JAMES: Up here, yes.

CAT WISE: Malachi, the youngest, was grazed in the arm and hand.

IESHA JAMES: I heard my youngest screaming and my oldest saying, "Mom, I have been shot."

It seemed unreal, like, this isn't, can't be happening.

CAT WISE: Jeremiah now gets physical therapy twice a week.

While the physical injuries are healing, the family's emotional wounds from the shooting are still with them.

IESHA JAMES: There's some good days and there's some bad days.

It's definitely a lot of PTSD going on.

CAT WISE: Iesha's family's story highlights a public health crisis in this country that's often overlooked.

Those affected are at much greater risk for short-term and long-term health impacts.

And amid a global pandemic, the problem is only getting worse.

The issue?

Childhood trauma.

Everyone is impacted differently by life events, but when we talk about childhood trauma, which is a broad term, we're talking about experiences that take a lasting emotional and/or physical toll.

And in the middle of a pandemic, kids today are increasingly vulnerable.

DR. NADINE BURKE HARRIS, California Surgeon General: We're seeing increased rates of domestic violence, increased rates of substance use and abuse, increased rates of mental health concerns and mental health disorders.

We also are seeing a dramatic reduction in reports of child maltreatment, which is not a good thing.

CAT WISE: Dr. Nadine Burke Harris is a pediatrician and California's first surgeon general.

DR. NADINE BURKE HARRIS: If we want to be preventing mental health concerns, if we want to be preventing substance dependence, if we want to be preventing cardiovascular disease and cancer, we see that adverse childhood experiences is a root cause for all of those things.

CAT WISE: That understanding is largely the result of a landmark study by researchers from Kaiser Permanente and the CDC in the late '90s.

They looked at 17,000 patients' histories of adverse childhood experiences, or ACEs, 10 potentially traumatic early life events, including physical, emotional and sexual abuse, exposure to domestic violence and divorce.

Researchers correlated those ACEs with health issues in adulthood.

The findings shook the world of medicine.

DR. NADINE BURKE HARRIS: Having four or more adverse childhood experiences is associated with more than double the risk of ischemic heart disease, the number one killer in the United States of America, two-and-a-half times the risk of stroke, triple the risk of chronic lung disease.

CAT WISE: In fact, having four or more ACEs is associated with significantly increased risks for at least five out of the 10 leading causes of death in the U.S.

But how exactly can adverse experiences cause these disparate health effects?

The answer is in the science of stress.

DR. NADINE BURKE HARRIS: When we experience something stressful, our body releases stress hormones.

Prolonged activation of the biological stress response, that can lead to long-term health problems, changes in the way the brain structure and function, changes in our immune system, our hormonal system, and even the way our DNA is read and transcribed.

CAT WISE: In the heart, stress hormones can make things go haywire.

DR. NADINE BURKE HARRIS: Those cause our heart to beat stronger and faster, so they actually exert more wear and tear on the lining of the inside of our arteries.

CAT WISE: And that could show up 20, 30 years down the road.

DR. NADINE BURKE HARRIS: Down the road as a heart attack or a stroke.

CAT WISE: And in the brain: DR. NADINE BURKE HARRIS: We see MRI studies that show that for children who are exposed to high doses of adversity, there are structural and functional changes in their brains.

CAT WISE: And the areas that can be affected are responsible for key functions, like processing fear, controlling impulses, as well as learning and remembering, all issues Iesha James says she's seen in her boys, who experienced considerable trauma even before the shooting.

Iesha took Malachi and Mickel in when they were just 1 and 2.

IESHA JAMES: My maternal cousin, while carrying both boys, was into prostitution, drugs, alcohol.

CAT WISE: Those early traumas and others had wide-ranging impacts on their daily life.

IESHA JAMES: Abandonment, separation anxiety all became a major issue.

Mickel wasn't even talking.

He was 2 going into his third year of age, and it was just a very hard time.

CAT WISE: And when faced with stressful situations, they struggled with how to respond.

MALACHI KING, California: I cried.

Lots of crying.

I did not know how to speak my emotions.

So, the only way I knew how is just from crying.

CAT WISE: Later, the kids struggled in school, had behavior issues, and they dealt with physical health problems too, most notably severe asthma, which can be associated with trauma.

IESHA JAMES: We ended up in the E.R.

two and three times, what, every other month.

CAT WISE: The James family's experience with trauma is, unfortunately, not unique.

Just over 60 percent of adults in the U.S. have had at least one adverse childhood experience, and 15 percent have had four or more.

Women and communities of color are at greater risk of experiencing significant trauma, but everyone can be impacted.

In Marin, just north of San Francisco, Dedalus Hyde treats trauma in one of the most affluent counties in the country.

But he's also spent years practicing in low-resourced communities.

DEDALUS HYDE, Bay Area Trauma Center: In my experience, these traumatic events in childhood are the memories that are most imbued with shame.

And that makes it incredibly difficult to talk about these experiences, whether they have resources or not.

CAT WISE: Hyde is also personally affected by trauma.

DEDALUS HYDE: One of the more significant traumas of my life was my parents' divorce.

They divorced when I was quite young.

In the trauma world, we tend to consider divorce as one of the top 10 traumas.

CAT WISE: Later, in his adolescence, he experienced another trauma:, a sexual assault by someone he trusted.

DEDALUS HYDE: Undoubtedly, one of the things that contributes to a child or an individual being vulnerable is previous trauma.

It did set up for me a need that the man who came into my life noticed, I believe, and took advantage of.

CAT WISE: He says having conversations about trauma, as hard as it may be, is vital.

DEDALUS HYDE: To people who haven't shared their stories yet, please try to do so.

That is where so much healing can occur, is in the telling of our stories.

DR. NADINE BURKE HARRIS: This is treatable.

CAT WISE: For Dr. Nadine Burke Harris, that's the key takeaway.

DR. NADINE BURKE HARRIS: What the science shows is that it's never too late to actually begin healing from the effects of early adversity.

Number two, what the research shows, that, although it's never too late, early detection and early intervention dramatically improves outcomes.

CAT WISE: With that in mind, late last year, California launched an initiative to train medical providers on how to screen for adverse childhood experiences.

And those screenings are now covered under Medi-Cal, the state's Medicaid program.

Iesha James and her family have benefited from the growing understanding of ACEs and their health impact.

Her sons' pediatrician is Dr. Dayna Long at UCSF Benioff Hospital in Oakland.

DR. DAYNA LONG, UCSF Benioff: It is a piece of information that allows me to help guide and shape a treatment plan, with an understanding that this kid is experiencing a lot, and it is traumatic, and it's influencing them on a biologic level, so that we can actually get to a place of healing.

CAT WISE: And they're not just relying on traditional medical interventions.

She and a team of colleagues connect families in need with resources, like food, school interventions, and therapy.

And they coach them on stress relief techniques, like meditation and breathing.

DR. DAYNA LONG: We can't make the stress go away, but they are able to regulate the stress through techniques and tools.

CAT WISE: Iesha has worked hard to incorporate those tools into her family's day-to-day life.

IESHA JAMES: It just opened all of us up to a different way of how to deal with things before just getting into them verbally, combatively banging our head up against a brick wall, slamming doors.

CAT WISE: And while life isn't perfect, things have gotten better.

The boys' asthma is under control.

They're having fewer issues in school.

And they're also able to better manage their stress.

Which, in times like this, means everything.

For the "PBS NewsHour," I'm Cat Wise in the Bay Area.