June 25, 2018
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Washington County to address health woes

Bangor Daily News | BDN
Bangor Daily News | BDN
Dr. Vincent Felitti (chief of preventive medicine at Kaiser Permanente managed care organization in San Diego)
By Meg Haskell, BDN Staff

BANGOR, Maine – Obesity, depression, drug addiction, heart disease: A noted researcher says many common medical problems in adults are rooted in traumatic experiences during childhood.

Physician Vincent Felitti, a researcher with the Kaiser Permanente health maintenance organization in San Diego, told an audience of health care providers and others at Eastern Maine Medical Center on Thursday that a surprising number of people experience profound physical and emotional trauma early in life and adopt self-destructive behaviors in response.

Felitti spoke in Bangor in advance of his keynote address this morning at the second annual Summer Institute hosted by the Community Caring Collaborative in Washington County. The two-day event at the University of Maine in Machias aims to explore the challenges of raising healthy families in one of the poorest and most rural areas of the country.

Childhood traumas such as growing up in an abusive or neglectful family; sexual abuse by a neighbor or family member; losing a parent to death or divorce; or regularly witnessing -the effects of mental illness and substance abuse can set the stage for a lifetime of chronic illness, Felitti said at EMMC.

“Adverse childhood experiences [which Felitti terms ACE in his research] are the most basic and most long-lasting determinants of health-risk behaviors,” he said. And yet, he said, “this is not the kind of information that patients bring up routinely, and the rest of us are too polite to ask about it.”

For more than 15 years, Felitti has routinely surveyed a broad cross-section of patients at Kaiser Permanente about taboo subjects such as incest and domestic violence. Slightly more than half report experiencing routine physical and emotional trauma during childhood. The study then correlates the incidence of these early experiences with medical disorders that develop later in life.

What the ACE study reveals, Felitti said, is that many people experience trauma in childhood and adopt detrimental behaviors in response, such as overeating, substance abuse, smoking and sexual promiscuity. These behaviors drive rates of obesity, heart disease, lung disease, mental illness, sexually transmitted diseases and other medical problems, as well as unwanted pregnancies, reduced job performance, poverty, family dysfunction and other social ills.

In addition, he said, emerging medical research shows that living with unrelieved psychological stress leads to long-lasting physiological changes that can cause high blood pressure, chronic heart and lung disease, and cancer, even in people who do not adopt overtly harmful behaviors.

At a time when the trend in health care is the prevention and management of chronic illness, Felitti said, the findings of the ACE study promise to guide the way medical and social services are provided in both rural and urban areas.

Perhaps there is nowhere in Maine where the impact of adverse childhood experiences, as studied in Felitti’s research, is more powerfully felt than in Washington County.

According to Marjorie Withers, director of the Community Caring Collaborative, one out of three infants born to women in Washington County has been exposed in the womb to illicit drugs, including prescription opiates. Many of these babies are born premature and underweight, and many come into the world already physiologically dependent on the drugs their mothers abused.

Stabilizing these infants and treating their complex needs often results in weeks or months of hospitalization, typically in the neonatal intensive care unit at Eastern Maine Medical Center. The lengthy hospitalization itself further stresses infants and their families, Withers noted.

Washington County’s prescription drug problem has earned it a national reputation, Withers said. But the county also has the highest rate in Maine of infants in protective custody, the highest percentage of parents whose custody of their children has been terminated, the highest percentage of children using special education services and the highest percentage of children who have been discharged from child care programs because of intractable behavioral problems, she said.

The Community Caring Collaborative is this year hosting its second annual Summer Institute, which will bring together families, teachers, medical and mental health providers and others from around the state to explore the unique challenges of raising a healthy family in Washington County.

In addition to Felitti’s keynote address on Friday, the two-day institute will feature sessions on effective mental health consultation and treatment and the impact on families and children of a stay in the NICU. It also offers a family-friendly activity session that includes Passamaquoddy basketmaking, drumming and singing.

Withers will present a slide-show lecture she calls Washington County 101, an intimate look at the unique environment of the county she calls home.

The goal, she said, is to help shine a light on the link between the kind of adverse childhood experience Felitti studies and their lifetime medical, psychological and cultural impacts in Washington County. For medical providers, mental health counselors, child welfare workers and others who care for the residents of Washington County, she said, understanding the root of the problems is key.

Felitti made numerous presentations in Maine this week, including at gatherings in Portland and Augusta. His trip was sponsored by the Bingham Program, a Maine-based philanthropy dedicated to promoting health and advancing medicine.

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