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2014 Community Leader


DR. NADINE BURKE HARRIS, hands on with one of her young patients at the Bayview Child Health Center, is founder and CEO of the Center for Youth Wellness. She will be honored with a Community Leader Award at Leadership California's Legacy of Leadership celebration on April 28, 2014 in San Francisco.    

DR. NADINE BURKE HARRIS is founder and CEO of Center for Youth Wellness (CYW). She has earned international attention for her innovative approach to addressing adverse childhood experiences as a risk factor for adult disease such as heart disease and cancer. Her work has demonstrated that it’s time to reassess the relationship between poverty, child development and health, and how the practical applications of the Adverse Childhood Experiences (ACE) study can improve health outcomes.

Dr. Burke Harris serves as an expert advisor on the "Too Small To Fail" initiative championed by Hillary Clinton and the Clinton Foundation in association with Next Generation, which aims to help parents and businesses take meaningful actions to improve the health and well-being of children ages 0-5, so that more of America’s children are prepared to succeed in the 21st century. Dr. Burke Harris also serves as an advisor on Governor Jerry Brown’s “Let’s Get Healthy California Task Force” and the American Academy of Pediatrics Medical Home for Children Exposed to Violence Committee.

The goal of the Center for Youth Wellness is ambitious: to create a clinical model that recognizes and effectively treats toxic stress in children and to change the standard of pediatric practice in our nation. CYW works in close partnership with the CPMC Bayview Child Health Center where Dr. Burke Harris was the founding physician and where she maintains her clinical practice. Her areas of interest are in health disparities, child trauma, nutrition and asthma. Her focus is serving communities where issues of poverty and race present challenges to conventional healthcare and education.

Dr. Burke Harris will be honored with a Community Leader Award at Leadership California's Legacy of Leadership celebration on April 28 in San Francisco.


Dr. Nadine Burke Harris:
The Young Deserve Tranquil, Healthy Lives

by Carol Caley
December 3, 2013

Q: You’re the founder and CEO of an organization dedicated to identifying and reducing the toxic effects of stress and trauma on children. How did you become aware of this condition, and what motivated you to put your skills as a pediatric medical doctor to work on a health issue that has received so little attention?

A: When I finished my pediatric residency at Stanford, I came to work for California Pacific Medical Center in San Francisco. I was passionate and interested in serving a very underserved community, so we started a clinic in the Bayview Hunters Point neighborhood. I had the experience of taking care of so many children and families. I was hearing over and over again of tremendous histories of trauma. Families and school districts were bringing children to me, requesting medication for Attention Deficit Hyperactivity Disorder (ADHD). When I did a thorough history and physical exam, I found that most of these kids didn’t meet the criteria of ADHD. But they had experienced so much trauma in their lives.

The thing I love about medicine is that from ancient times, doctors have observed natural phenomena—for example, that every person who drinks from the well gets sick, right? So maybe there’s something contaminated in the well? That’s part of our job, to observe what’s going on. I started reading more about the impacts of trauma on the developing brains and bodies of kids. What I learned was that trauma is frankly toxic, and this completely validated the clinical picture that I was seeing every day. My next thought was, what are we going to do about this? I have so many kids who are in need, there really needs to be some healing work.

Q: Is this very much like PTSD?

A: It’s different than PTSD in many key ways. Number one is that PTSD is a psychiatric diagnosis referring to Post Traumatic Stress Disorder. I actually question that diagnosis, the validity of that term, because it is a constellation of symptoms: hyper-arousal, easy startle, flashbacks— this collection of symptoms, and if you’ve had a history of trauma, that’s PTSD. For many of our kids this doesn’t reflect the developmental nature of trauma on the developing brains and bodies of kids. When children are exposed to trauma, it changes the architecture of their brains.

Q: So PTSD is something that affects an adult brain?

A: Yes, by the time you’re an adult, the vast majority of your neurologic connections have formed. There is still some neuroplasticity, but it’s not remotely the same as what happens in the brain of a developing child.

So, the experiences of trauma in childhood are a specific danger. For example, in much the same way as we know that pregnant women are supposed to avoid certain foods and certain medications, because of the potential to cause developmental harm to the fetus, it’s a very similar way that trauma, in the developing brains and bodies of children, affects the way that growing brain will ultimately be shaped, and all the neurologic connections that will happen subsequently. That’s a huge impact.

Q: So the causes of this syndrome, called Adverse Childhood Experiences (ACE), would be things like violence in the home, mental illness of relatives in the home, creating stress that would cause the brain not to develop correctly?

A: Yes. The adverse childhood experiences that were evaluated by the Center for Disease Control and Kaiser San Diego—they did the study—looked at physical, emotional and sexual abuse, physical and emotional neglect, and several criteria of household dysfunction, including parental mental illness, incarceration, substance dependence, domestic violence, or parental separation or divorce. Those are the ten criteria. What they didn’t look at were things like community violence or homelessness, which are other traumatic experiences that can also affect kids’ development.

What we understand now is that being exposed to these traumatic experiences activates a stress response, including the release of stress hormones like adrenaline and cortisol that activate parts of the brain. Traumatic experiences also activate the immune system, and change the way that your DNA is read and transcribed, something called epigenetic regulation. It’s pretty profound, when you think that these stressors begin in early childhood, and a child is growing up in this environment, where they have all of these hormonal, immune, and neurologic changes that are going on in their bodies.


It’s been my calling to be a physician and to do true healing work, particularly in vulnerable communities...to leverage that on behalf of communities in need, and to recognize that if we do a good job, we’re talking about changing the life trajectory for so many kids.  

Q: That’s layering on a lot of problems.

A:  It’s worse than lead poisoning. It’s pretty profound. I thought: Oh my God, why isn’t anyone talking about this?

Q: You’ve been a pioneer in diagnosing and healing this disorder. What has been most personally rewarding about your role in promoting child health?

A: It’s been my calling to be a physician and to do true healing work, particularly in vulnerable communities. To be able to combine my training and any personal gifts or attributes that I may have, to leverage that on behalf of communities in need, and to recognize that if we do a good job, we’re talking about changing the life trajectory for so many kids, because this is not just an issue for kids in Bayview, but across the country, and frankly, around the world. Globally, this is an issue.

It’s been very rewarding on several fronts, one, because academically, and as a scientist and a physician, it feels like the discovery of antibiotics to me. It feels like something that’s incredibly important that’s advancing the field of medicine. But also on a personal level for the families that I see in clinic, to see kids that are struggling—they’re struggling in school, they’re suffering with impulse control, and even struggling with management of their chronic disease—and to be able to do education, and intervention with their families, then to see them do better over time, it’s indescribable. It’s very exciting.

Q: The success stories keep you going?

A: Absolutely. But there is one thing that’s so frustrating: I feel like I need to motivate and galvanize people to do something about it—physicians, hospitals and health systems— to do system change, and it’s been difficult to have them recognize that this is a disorder we’re seeing.

Q: This is such a new idea. This is cutting edge medicine, right?

A: Exactly right. I would go to the clinic and see my patients, and I felt like I saw the evidence in front of me. I would say, no one can tell me that this is not real. I am dealing with it every day. I know that when we do a good job, we change outcomes. I am committed to just doing that.

Q: What’s a good day like for you?

A: I had a family come in to the clinic. There was a tremendous amount of violence going on in their house. The parents were divorcing. There was a lot of discord, and firearms were involved. The children were witnessing all kinds of things, were missing school, and were experiencing behavior problems, and also developmental regression, so they were going back to bedwetting. We did a comprehensive intervention. We had a team meeting with folks from their school, and from Child Protective Services, all together at the clinic. We set out a plan: we got the mom and kids into therapy, and we made recommendations about other treatments. We treated the whole child, not just by giving medications for the bedwetting. We really dealt with all their issues. I saw them a year later, and the girls brought in their report cards. Both were on the honor roll. The mom had applied so many skills about her own self-regulation and had learned about how to provide a safe environment for her kids. The wonderful thing is that we can see the kids doing better. But also, one thing that’s harder to see is that we just reduced that child’s risk of heart disease or cancer, because this disorder can even ultimately influence an individual’s risk for chronic disease. All of this is part of giving kids that opportunity to grow up healthy.

That is just a great day for me, when my patients come in and give me big hugs, and I hear what’s going on with the family. I know that I’m part of why they’re healthy and thriving.

  We want to strengthen brain pathways in young children who are being subjected to adverse experiences.
Q: What interventions have you found to be successful in diminishing the effects of childhood stress and trauma?

A: We use, as part of our clinical interventions, biofeedback, mindfulness, home visits, exercise, therapy, nutrition, medication, psychiatry, psychotherapy, and something we call psychoeducation, which is educating families in how exposure to trauma affects their children. Education is really important, so we do a lot of that.

The interventions center around strengthening the brain. Particularly, young children have significant ability for neuroplasticity, so we want to strengthen brain pathways in young children who are being subjected to adverse experiences. You have to work with the child and their caregiver. It’s a two-generation approach.

Q: So neuroplastcity means there’s some resilience in the brain; that treatment could change something that was laid down previously?

A: Absolutely. The older a child gets, the more difficult that process is, and the more intensive the interventions have to be to yield the same results. Does that mean older kids can’t get the benefit of this work? That’s not the case at all. The brain doesn’t reach organizational maturity until about age 26. There’s certainly a great amount of work that can be done in adolescents. It requires more intensive intervention, and it may take more time: If you treat cancer in Stage 1, you have a higher cure rate and you can use more benign treatments. When you treat it in Stage 4, your cure rate is going to be lower and your intervention’s going to be more intensive.

Q: So you prefer to intervene when children are younger, because there are more treatment options then?

A: We treat ages 0-18, but we prefer to intervene when a child is in the younger range. I try to make sure that we are realistic about what we do. Since we’re just starting out as an organization, our full suite of interventions is targeted right now toward our younger kids, so that we can really evaluate our outcomes. We’re just 2 years old. We’ve been developing all of our clinical protocols and are just piloting them.
Q: Were there influences in your life that brought you to the career you have now?

A: Without a doubt what brought me into this work was that I grew up in a family where my father was a biochemist and my mother was a private nurse. As a kid, my parents didn’t have after-school childcare, so I would go with my mother to private homes and sit with her patients. I would read their mail to them, or work crosswords with them. So I have this experience of caring for people. I knew I wanted to be a doctor when I was four years old.

Q: What happened when you were four?

A: It’s a cross between my dad’s scientific mind and my mom’s caregiving. My dad has a Ph.D. in organic chemistry, and he loves science. So when I was growing up, I was super-passionate about it, curious about why things happen the way that they do. I remember sitting down with my mom, when I was four and a half. We wrote a letter to my doctor asking, why is it that when I want to wiggle my toes, they wiggle? I was a little kid, maybe four or five, when someone gave me a purse with a drawstring. I thought, oh, now I understand. Here’s how God got the skin on people, because we don’t have any buttons or zippers. You get the whole body inside the skin, and then cinch it up at the bellybutton! That was how my mind worked.

My parents instilled in us a very strong sense of caring for folks who are in hardship. I grew up tutoring kids who were in inner city schools in east Palo Alto, who were sometimes older than me and three grades behind. My parents were the ones who would have a homeless family at the Thanksgiving table. My dad took us out for Habitat for Humanity, for beach cleanup. There was a very strong sense of giving back.

  I would see the same homeless guy week after week. I would say, we have all these resources that we’re trying to connect him to, but what is the real obstacle, what is it that keeps this person in this obviously horrible situation that no one would choose?
Q: What other personal experiences inspired you?

A: When I was in medical school, I was the director of a student-run clinic, and I had these questions. I would see the same homeless guy week after week. I would say, we have all these resources that we’re trying to connect him to, but what is the real obstacle, what is it that keeps this person in this obviously horrible situation that no one would choose? We would say, well, he had this or that opportunity, or we referred him, but he didn’t follow up. It’s that combination of the caregiver in me and the scientist in me that says, there’s something else going on here. 

When I finished medical school, I went on to do my master’s in public health at Harvard. I learned to see things on the population level. It’s one thing when you see one homeless guy in clinic over and over. It’s another thing to look at the population data, and realize that there are 10,000 or 50,000 of the same guy. Trying to understand what is the driver, what is the root of that. I remember thinking to myself, I wonder if this has to do with cortisol? When you work in the intensive care unit, sometimes you give stress doses of cortisol, and you see that the things that reliably change are blood pressure, blood sugar, and behavior. Then you look on the population level. I was studying the health disparities in Boston, and the three biggest problems of the African American population are diabetes, high blood pressure, and violence or behavior-related issues.

Q:  So they could have had high levels of cortisol due to their stress?

A: So that made me think, I wonder what would happen if I could measure their cortisol levels, and compare that, on a population level, to an upper-middle class population, and what would the difference be? That’s how my mind works. To this day I would like to do that study. That’s the type of thing that my brain goes to: the neurochemistry of a problem. In what we perceive as a social problem, I look at it and say, what are the biological underpinnings of that? That’s how I came to this work, how I ended up in Bayview Hunter’s Point, and how I started the clinic there. I saw so many kids, over and over again, having the same problem. Behavioral problem, impulse control problem, difficulty in school that everyone thought was Attention Deficit Disorder. I was asking the question, what’s really going on here?

Q:  Your organization has become a part of the launch of "Too Small to Fail," a new joint initiative with Hillary Clinton, the Clinton Foundation and Next Generation. Tell us about that.

A: The goal of the "Too Small to Fail" initiative is pretty simple: to make sure that our youngest Americans have every opportunity to succeed in terms of health, educational opportunity, and development. The Clinton Foundation and Next Generation is reaching out to parents, the scientific community, and the business community to engage folks in this effort to make sure that our kids 0-5 are getting the best start possible. That means asking the business community to make commitments to allow, for example, flexible work hours and family-friendly workplace policies that recognize and acknowledge the value of parents being able to parent.

The other part—one of the first initiatives that’s being tackled—is the word gap. There’s such a difference in the number of words that our children in upper-income households hear relative to lower income households. By the time they’re age 5, that makes a difference in children’s school performance. So, we spend time encouraging parents to read to kids, encouraging parents not to substitute screen time for family time, and advising parents on the value of narrating what you’re doing as you go through the grocery store with your child. Talking is teaching. Parents can start doing this with a newborn. Upper income families have read all the books, want to help their kid get ahead, and follow all the latest recommendations. We want our lower income and working-class families to have access to all those same resources and recommendations, and are able to receive them in a way that’s doable, that makes sense in the context of their lives.

Q: What has your role been in "Too Small to Fail?"

A: My role is to advise on the impact of toxic stress, how profoundly that affects health and development. Right now, we need to start doing a public awareness campaign around the impact of toxic stress on the health and development of our kids.

I was at the National Conference of the American Academy of Pediatrics in October, where there was a symposium on toxic stress. To start off the symposium, Secretary Clinton had recorded a message saying how important it was for pediatricians to address this important issue. To help educate pediatricians about toxic stress—because even within the pediatrician world we are still figuring it out—was huge, incredibly exciting.

I feel a huge sense of thanks to be involved in this. It’s such an honor for me. This work is right now an unaddressed public health crisis, impacting a huge number of Americans, that we have not come up with a solution for.

I’m excited to be helping to blaze a trail for part of the solution. We are working with colleagues around the country to increase public awareness, and to motivate folks and mobilize the resources to address the crisis, so we can make the difference in the lives of a whole lot of kids.




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