Just four minutes from downtown Durham, a two-story red brick building sits on a street corner adjacent to a food co-op and across from a Joe Van Gogh. The building, which looks like your average office building, is easy for the average resident to miss. But for the people seeking it out, it’s impossible to ignore.
That’s because the families who need this building are suffering and the people inside are uniquely positioned to help.
This is the Center for Child and Family Health (CCFH), where some of North Carolina’s leading experts in child mental health are actively defining, practicing, and teaching the highest standards of care in the treatment and prevention of childhood trauma.
Childhood trauma is common across all cultures and that’s certainly the case for North Carolina, where periodic statewide surveys have found that 58% of respondents endured at least one adverse experience during childhood and 22% had three or more.
To create a healthier community, organizations like the Center for Child and Family Health understand that they have to begin at the source, eliminating trauma before it happens and also treating it after the fact.
To do so, they’ve developed programs that make it easier than ever for all children and parents residing in Durham to access quality care.
“I think one of the stories that’s important to tell about Durham, generally speaking, is that it’s a community of riches and challenges. We have a lot of universities and medical facilities and a lot of people who are in those fields or tech fields. There’s a lot of money but also a lot of people who haven’t benefited from equal access to those privileges and that wealth,” said Karen Carmody, Director of Early Childhood Prevention Programs at the Center. “I help to oversee the prevention program, working with children ages birth to 3 primarily, to really help the families get off to a good start and to build protective factors against adverse childhood experiences that might occur.”
The prevention programs that Carmody is referring to are called Family Connects Durham and Healthy Families Durham. The distinction between the programs comes down to the length of engagement with families and the level of social-emotional care needed to support positive interactions between families and children.
To get more specific, any family with a newborn living in Durham can enroll in the Family Connects Durham program and can expect to receive one or two in-home visits with a trained nurse shortly after birth. The Healthy Families Durham program offers a deeper level of care and treatment, providing up to three years of weekly in-home coaching and support for families of infants and toddlers. The families enrolled in this program are identified through a screening program as needing additional support to overcome toxic stress and create safe healthy homes for their children. following traumatic experiences.
“Family Connects Durham is a universal approach to see every baby. Healthy Families Durham narrows that focus to families who have experienced challenges like teen parenting, mental health challenges, substance use, domestic, or community violence,” explained Carmody.
To be clear, CCFH’s focus on prevention to ultimately create a mentally healthier community isn’t just a nice idea. It’s based on scientific research that shows that adverse childhood experiences can have long-term health effects into adulthood.
That research began 24 years ago when Kaiser Permanente and the Centers for Disease Control and Prevention embarked on a mission to understand how adverse childhood experiences (ACEs) like abuse, household challenges, and neglect can affect an individual’s long-term health outcomes.
The initial study interviewed 17,000 of Kaiser Permanente’s HMO plan members and found that almost 2/3rd of them had experienced at least one adverse childhood experience while 1 in 5 reported experiencing three or more.
The study – now commonly referred to as the ACEs Study – also found that these traumatic childhood experiences have a tremendous impact on that individual’s potential for future violence victimization and perpetration. At its core, they found that the more adverse childhood experiences someone reported in their survey, the more likely they were to experience negative health outcomes in adulthood.
“The ACEs Study essentially tells the story that if you were to count up the number of traumas or adverse childhood experiences someone experiences in their life, that number is a very strong predictor of their later outcomes including mental illness and mental health,” explained Karen Carmody. “That’s absolutely where [CCFH] sits, to either reduce those ACEs or reduce the impact of those ACEs so that we can break that cycle. So that when kids grow up they don’t befall those same negative outcomes.”
The known and tracked ACEs include physical, emotional, and/or sexual abuse, physical and/or emotional neglect, and household dysfunction including the presence of mental illness, violence against the mother, having an incarcerated relative, substance abuse, and/or parental seperation or divorce.
The more ACEs someone has in their history, the more likely they are to experience everything from chronic obstructive pulmonary disease to illicit drug use.
“If you have 7 or more ACEs, on average you’re likely to die 20 years earlier than a person with no ACEs. But it just means you’re at risk of that. It doesn’t mean it’s predictive,” said Kelly Sullivan, Director of Mental Health Services.
In 2018, two researchers from Child Trends — a leading research organization focused on improving the lives of children and youth — published a study that examined where children aged 17 or under are more likely to experience trauma.
Using data from the 2016 National Survey of Children’s Health, they examined which states reported percentages of ACEs that were significantly higher or lower than the national average. Nationally, 10% of children report three or more ACEs. In North Carolina, it’s 12%.
But there was one factor that stood out across the data: some of the states with the most reported ACEs also have high rates of child poverty.
Locally, the Center for Child and Family Health is making great strides in their efforts to prevent trauma but they know that they can’t reach everyone. That’s where the treatment side comes in.
Sarah Cengel is a Licensed Clinical Social Worker and serves as one of CCFH’s bilingual home visitors, providing a specific therapy called Child-Parent Psychotherapy. This type of therapy utilizes play-based intervention in which the therapist offers comments and observations that help parent and child to better understand each other. The intended results of these sessions are often tied to concrete goals related to treating each participant’s trauma.
While CCFH’s programs don’t screen for financial income, Cengel thinks it’s fair to say that the majority of her clients live in poverty.
“Poverty exacerbates all of these things so the case management aspect can be really useful for people living in poverty,” Cengel said.
Last year, CCFH’s treatment and prevention programs served 2,537 children and their families.
And thanks to a $50,000, one-year grant from United Way of the Greater Triangle, they expect to be able to help an additional 70 individuals with everything from improving or stabilizing clinical symptoms to achieving treatment goals. Those success indicators will come as a result of increasing interactions through referrals as well as long-term treatment plans.
Breaking the cycle of trauma in Durham is a lofty goal but Kelly Sullivan says she’s already seeing a shift in the way that the community perceives it.
“There’s a huge recognition in the Durham community about how adverse events in childhood can make lifelong impacts that are potentially detrimental and I’ve seen a huge shift in that in our community for a variety of reasons,” she said.
That recognition, they hope, will ultimately support CCFH’s long-term success.
“We really know that kids and families can get better.”