Toxic stress and a healing community in California’s Humboldt County

When people are put in a a stressful, traumatic situation, their bodies begin to release hormones and activate their fight-or-flight response. The hormones released during this process are healthy — in moderate amounts. It's a natural response our bodies undergo, but when the response is constantly triggered by a stressful environment it becomes hazardous, especially for children. Too much cortisol and adrenaline cause “toxic stress,” which is tied to poorer health outcomes later in life. 

Some of these health outcomes can be attributed to childhood trauma, known as adverse childhood experiences (ACEs). There are 10 types of ACEs that fall into three categories: abuse, neglect and household dysfunction. And there are subcategories further describing the three categories: Physical, emotional and sexual abuse; physical and emotional neglect; mental illness, incarcerated relative, mother treated violently, substance abuse and divorce. Each experience counts as one ACE. 

Taken together, this is a reality many residents of Northern California’s Humboldt County face: ACEs and loads of toxic stress that lead to poor health behaviors and increased risk of serious health conditions. 

Like many rural areas, Humboldt County tends to have very poor health outcomes. According to a 2018 Humboldt County Health Assessment report, the county’s suicide death rate is 2.4 times that of California’s average. Diabetes-related deaths are more than two times higher for Native Americans than for the population as a whole. Smoking and lung cancer rates are twice that of California’s at large, while mortality rates from chronic obstructive pulmonary disease are significantly higher than the state overall. In 2016 some areas of the county saw three times more opioid prescriptions than there were people. 

A 2014 study by the nonprofit Center for Youth Wellness (CYW) found that 75% of residents in Humboldt and Mendocino counties have experienced one or more ACE, higher than the state average. It also found that 30% of adults in these two counties have experienced four or more ACEs, nearly double the state average of 16.7%. The county health assessment also reports that “child maltreatment rates in Humboldt County have exceeded the state rate since 2012 and continue to rise. The most common type of maltreatment reported in Humboldt County is general neglect.”

The CYW study states that a person with four or more ACEs is 12.2 times as likely to attempt suicide, 2.4 times likely to have a stroke, 2.2 times as likely to have heart disease, 1.6 times as likely to have diabetes, 10.3 times as likely to use injection drugs, 7.4 times as likely to be an alcoholic and 1.9 times as likely to have cancer. 

California’s Surgeon General Dr. Nadine Burke Harris devoted her career to ACEs. She has said that there is a chance for people to build resilience, that ACEs are treatable and preventable through intervention. 

I’m going to concentrate my project on organizations that are currently working to build resilience and interventions in Humboldt County and California’s new process of screening childhood trauma. 

I’m going to be speaking to First 5 Humboldt’s Executive Director Mary Ann Hansen about First 5’s efforts. I’d like to go into more detail about First 5’s plan for promoting resilience, preventing ACEs and helping incorporate trauma-responsive practices, and how those practices are working. First 5 offers trauma-informed practices workshops and training to schools, clinics and community groups. 

I would like to sit in on one of the training sessions and report on what it offers, and speak to someone attending and interview them about their experience and how they’ll integrate trauma-informed practices into their work. I will also be asking Hansen if they can quantify how these efforts are working. 

I’ll also be speaking with Chris Hartley, Humboldt County’s superintendent of schools, to talk about the multi-tiered system of approach, a type of trauma-informed practice happening in county schools. 

I will also be speaking with Erika Tracy, the Hoopa Tribal Education Association’s executive director. The Humboldt County Health Assessment Report states that of 73.8% of substantiated general neglect cases in Humboldt County, 35.7% of children were Native American.

During a November ACEs town hall, Tracy spoke about the Hoopa Valley Tribe collecting their own ACEs data, since Native Americans are often underrepresented in important data. Out of 246 surveys, the study had found that 70.6% of people had a score of two or more ACEs and 31.4% had a score of four or more ACEs. I will be speaking with Tracy and others in the Trauma Informed Movement about their efforts in the Hoopa Valley community and report on how the effort may differ specifically for their tribal community.

In January 2019, the Trauma Informed Movement opened up a student wellness center at Hoopa Valley High School that’s open district-wide and offers students mental health services, wellness groups, substance abuse counseling and student and family case management. I will ask Tracy how the student wellness center works. Do students come into the center? Are they referred by teachers and counselors? What age groups are usually seen? I will also be looking at the student wellness center for McKinleyville Middle School and ask the same questions.

At the townhall, Hansen spoke about working with clinics to prepare for California’s ACEs screening. Trauma and ACEs screening is new to California. Gov. Gavin Newsom allocated $40 million for trauma screening adults and children on Medi-Cal, and $50 million to train health providers on trauma screening. I will interview some of the providers in partnership with First 5 Humboldt. I will ask them about how their training on screening for ACEs went, what their screening process looks like, and if they have any concerns or challenges with what comes after screening: referring patients to the proper resources. Tracy also said that the medical center in the Hoopa Valley has already begun screening. I would also like to try to speak with health care providers at the K’ima:w Medical Center about their screening process. I’d like to compare each screening process to see how each provider’s process differs, if at all. 

Overall, I will be highlighting the processes of screening, intervention and prevention of adverse childhood experiences and the challenges Humboldt County communities face in these systems.