One day, when she was 14 and feeling ill, Daylesha Brown’s mother took her to a Baltimore hospital and did not return for her. Child Protective Services (CPS) placed her in a group home and she was forced to move to other homes for the next three years.
“My mother, she pushed me away,” Brown, now 23, said softly. “I was always getting in trouble with my mother.”
So last year when Brown discovered her daughter, Sa-Maji, had lead poisoning, a lingering problem in Baltimore where the rate of poisoning among children is nearly twice the national average, she was wary that she would lose her child to CPS because of her transient lifestyle. She wanted to spare her child the misfortunes she had experienced.
But her social workers at DRU/Mondawmin Healthy Families Inc., a nonprofit home-visiting agency that focuses on pregnant and young moms, encouraged her to seek treatment for her daughter.
Patients like Brown usually come from tough backgrounds and their childhoods can shape their lives, and the lives of their children, said Charlene Batts-Thomas, program manager at DRU/Mondawmin. Her agency’s job is, in part, to connect the clients’ past and present using a relatively new understanding of how adverse childhood experiences, known as ACEs, can impact people throughout their life spans. Then by providing the proper help, social workers seek to prevent the next generation from struggling in the same ways.
DRU/Mondawmin participates along with other nonprofits and city agencies in a program launched in Baltimore last year to help police, schools and health personnel understand trauma and use that knowledge in dealing with residents.
The agency was already using knowledge of trauma in providing care when Brown walked through the doors three years ago — homeless, pregnant and suffering from bouts of depression. Social workers’ assessment of Brown found that she was emotionally and sexually abused as a child. Her mother was a substance abuser and she had little support at home. Brown also had learning disabilities. Batts-Thomas said Brown had at least four adverse childhood experiences.
Assessing childhood traumas “gives us insight about what was, and then what we do is build on her strengths,” Batts-Thomas said. “We know these things happen to you, we’re sorry about them, we can’t change it, but we can change it for Sa-Maji. We can turn some stuff around for her.”
As Baltimore seeks to improve the health and well-being of residents like Brown and her daughter, the burgeoning field of research into ACEs could be key to formulating solutions. A landmark study begun in the 1990s by the Centers for Disease Control and Prevention showed the long-term damage of ACEs, which can shape someone’s future for decades.
Growing up in economic hardship, witnessing violence at home or on the street, living through a parental divorce or separation — these and other traumas can lead to emotional and cognitive impairment, risky behavior, obesity, substance abuse, mental illness and an early death.
A study published late last year revealed that multiple ACEs increase the likelihood of lifelong poverty. That, in turn, can put poor children at greater risk for remaining poor, with worse health and fewer opportunities.
Brown, who grew up in the Upton/Druid Heights neighborhood on the west side of Baltimore, experienced and witnessed several traumatic and violent events as a child and teen, among them the stabbing of a close relative.
At home, Brown’s relationship with her mother was fractious. She felt emotionally neglected.
While she has a better relationship with her father than her mother, Brown didn’t know who he was until she was a teen, and that was after she set out to find him.
ACEs are common: According to the CDC national study, two-thirds of Americans have at least one ACE, and more than 1 in 5 reported three or more ACE factors. But the percentages rise sharply in cities with large numbers of low-income residents.
Nadine Burke Harris, a pediatrician based in San Francisco whose work has promoted awareness of ACEs, describes it as a “national public health crisis.”
She speculates that most people associate trauma only with big events, such as physical or sexual abuse — and are missing the larger picture.
“The number of people growing up in this country who have a mother or a father who’ve experienced depression or something like that, many of those folks don’t think of themselves as having a traumatic childhood, that was just how their household was,” Harris said. “Adversities that fall outside of the traditional definition of a traumatic childhood” also have long-term impact.
A 2014 study by the University of Maryland School of Medicine, the Maryland Coalition of Families and the Baltimore City Health Department (BCHD) found that 60 percent of Baltimore women in a survey experienced four or more ACEs as children. The health department reported recently that 30 percent of children in the city have at least two ACEs.
The more ACEs people have, the more likely they will suffer from health and behavioral problems, according to numerous studies. If left untreated, toxic stress from repeated and frequent exposure to extreme behaviors and environments increases the risk of developing diseases as an adult, including asthma, heart disease, depression, stroke and diabetes. The presence of ACEs also has been linked to teenage pregnancy and fetal death. Brown, who was a teenage mom, experienced a miscarriage in the past year.
Her experience is not unlike that of others in Upton/Druid Heights. The neighborhood, which is 94 percent black, was regarded as the “Harlem of Baltimore” in the first half of the 20th century, with a thriving middle class and commercial district.
Today, the family poverty rate in Upton is double that of Baltimore and unemployment is 17.5 percent, compared with 11.1 percent in the city. There’s a similar gap in health status.
Residents with a high number of ACES also have a 2½ times-higher risk of developing cancer, the second-leading cause of death in the community. Life expectancy in Upton/Druid Heights is 62.9, eight years less than the city as a whole and almost 16 years less than the national average, according to the BCHD.
Experts who study ACEs recommend a more integrated approach to assessment and care than is found in most places in the United States, including routine screening for ACEs and support systems for affected children. Screening in Maryland for ACEs is not widespread. Harris wants to see standard screening for ACEs across the country.
Cathy Costa, who is the infant mortality and child fatality review director at the BCHD, agrees that could make a difference. There isn’t widespread screening, she says, largely because of the concern about “screening for something that you don’t know how to handle afterward.”
While there is a universal, prenatal risk assessment, she says, it is now mainly focused on health behaviors.
Brown, for example, benefited from B’More for Healthy Babies, a program launched in 2010 that has helped reduce the infant mortality rate and improve birth outcomes in Baltimore. Home visits helped Brown get her life on track after getting pregnant at 19, just two years after emerging from a group home.
Social worker Linda Smith, who works for DRU/Mondawmin, visits Brown weekly and helps her with major issues, such as housing and getting her social security number, to smaller tasks such as ensuring that she and Sa-Maji are eating properly. Since working with her, she has seen Brown make enormous strides.
“She moved into another place and the baby is getting medicine,” Smith said. “She will start therapy soon; she feels better about herself.”
Kathy Carroll, program director of DRU/Mondawmin, says one way to combat ACEs and stop the generational transference is to ensure that the mothers and other women in the program hit their goals.
“Some of our successes” are helping families find work, move into stable housing or obtain cars and feel “that their family is better off than they were before,” she said.
Brown has big dreams for herself and her child, whose health has improved since moving. Brown herself is a couple of classes away from completing her associate degree in early-childhood education. She wants to give Sa-Maji the life she never had growing up.
“I want to have a car, to be driving,” she said. “I’ll take my baby anywhere she wants to go. I’m trying to be the mother I never had.”