Monroe Community Coalition coordinator mixing methods

For more than a decade, Sultan resident Joe Neigel has worked to improve the health of communities throughout Snohomish County using focused, evidence-based strategies meant to help prevent young people from abusing drugs and alcohol.

Last year, after nearly 11 years as a prevention coordinator with Snohomish County, Neigel shifted gears and went to work as a prevention specialist for Monroe Public Schools. His decision came on the heels of the county’s announcement it would no longer serve as the fiscal agent for the grant-funded Monroe Community Coalition, a nonprofit prevention group that Neigel has headed up since its inception in 2013.

Monroe Public Schools stepped forward to serve as the group’s fiscal agent, and Neigel was offered a full-time position, so as to preserve his role as the coalition coordinator. 

In addition to enhancing coalition efforts through grants and fostering community partnerships, Neigel has made it his mission to inform prevention efforts through a customized training that incorporates Adverse Childhood Experiences (ACEs) and evidence-based prevention kernels, two completely separate fields of study that Neigel found can actually work together.

ACEs examines the long-term results of trauma-induced brain injury in children, while evidence-based prevention kernels are corrective measures that can be easily implemented by parents, educators and other human service professionals to improve outcomes for kids.

Initially, the training covered the foundation of ACEs and its implications, but offered little in the way of recourse. By bringing in evidence-based kernels, Neigel was able to transform a despairing message into one of hope.

“My early presentations left people feeling bleak, like there was nothing they could do about trauma, and I made the decision to leave folks feeling uplifted and empowered to make a difference,” Neigel said. “Unleashing access to prevention kernels while talking about adverse childhood experiences felt like a natural marriage.”

Adverse childhood experiences

Neigel was first introduced to the study of ACEs in 2006 during a retreat in Stanwood.

ACEs started at an obesity clinic in Southern California operated by Kaiser-Permanente chief of preventative medicine Dr. Vincent Felitti. Some of Felitti’s most successful weight-loss clients were dropping out of the program, and he wanted to understand why. Initially, the study bore little fruit, until Felitti discovered a common denominator: most of his dropouts had some past exposure to trauma.

From there, it grew into a massive effort.

“It ended up becoming the largest epidemiological study ever conducted in the United States,” Neigel said.

The study involved Centers for Disease Control (CDC) investigator Dr. Robert Anda, and comprehensively examined the impacts that traumatic childhood experiences had on people over their lifespan. It looked at general forms of abuse and household dysfunction, creating a mechanism for assessing a person’s trauma level — an ACE score — based on how many specific conditions were present in their home growing up.

Things like childhood physical abuse, having a drug-addicted family member and childhood neglect were all considered. A person’s ACE score can range from zero — no traumatic conditions — to 10, which would indicate trauma across all categories. 

ACEs are extremely common, Neigel said. In an average classroom of 30 students, only about six have ACE scores of zero.

“The rest of the class has some trauma exposure, with 10 students being exposed to four ACEs or more in every classroom,” Neigel said. “These aren’t kids in Asia or Europe or Africa. These are our kids in Washington state.”

The science behind ACEs and the way adverse experiences shape behavior and health is overwhelming, Neigel said. Research shows that during times of intense stress, the hormone cortisol is released in the brain, which can have long-term impacts on learning, self-control and concentration.

“Prolonged exposure to cortisol and other stress hormones is toxic,” Neigel said. “It makes permanent changes to the brain. This means that you’re likely to encounter a student who is perfectly suited to survive in their home environment, but really doesn’t know how to act or behave in normal situations like in the classroom.”

In a troubled home, a young person has used their own “personal solutions” to survive whatever is going on around them. But in the classroom, personal solutions often appear as “problem behaviors.” ACEs advocates for a different approach when confronted by problem behaviors, and asserts social workers and educators need to ask new questions.

It’s a crucial transformation, Neigel said. ACEs encourages people to ask, “What happened to this kid?” rather than “What’s wrong with this kid?”

“From my perspective, this is the issue every person who works with youth and families should be required to learn about,” Neigel said. “The shift from asking ‘What’s wrong with this kid?’ to ‘What happened to him?’ changes everything.”

Recognizing the issue is an important part of interrupting the trajectory, and through infusing the school district with ACEs education, Neigel hopes to improve outcomes for youth. The ACEs outlook can be grim; without protective measures, adverse childhood experiences can contribute to victimization, depression and other mental health issues, domestic violence, obesity, heart disease, high-risk sexual activity, alcoholism and addiction.

“To put it simply, we know that childhood experiences are the most powerful determinants of who we become as adults,” Neigel said. 

According to the CDC, there is a high correlation between illicit drug use and ACEs, with nearly 68 percent of all illicit drug use attributable to adverse childhood experiences. If a person could wave a magic wand and take away trauma, they would see an overnight reduction in illicit drug use on the magnitude of about 68 percent, Neigel said.

“We’ve just won the war on drugs because we’ve eliminated trauma,” Neigel said.

Evidence-based kernels

Neigel was introduced to evidence-based kernels during a conference in Kentucky in 2006, about six months prior to his exposure to ACEs. Based on scientific research conducted by Dr. Dennis Embry, a kernel is an action or remedy that has been proven effective at influencing behavior in a positive way.

“A kernel is the smallest unit of scientifically-proven behavioral influence,” Neigel said.

The beauty of kernels, Neigel said, is that because they’ve been broken down so far, they cost little or nothing to implement. They are often so simple that many people engage in kernels without even knowing it.

“We know through application that kernels can produce quick, easily-measured change that can grow into much bigger change over time,” Neigel said. “They can be used alone, or you can combine kernels to form a behavioral vaccine and literally start inoculating young people against their personal solutions or problem behaviors.”

A kernel can be an action, such as play, or something as simple as a note left for a child in their lunch sack. Using verbal praise to reinforce positive behaviors is a kernel, and the study has identified the importance of rewarding positive behaviors like paying attention, rather than focusing on admonishment to address disruptive behaviors.

“Turtle breathing,” a kernel that helps children learn to control anger, is known to reduce anxiety and tantrums while increasing resiliency and self-control. There are dozens of kernels backed by scientific evidence that can be used to help reverse the ill effects of ACEs, Neigel said.   

It was while Neigel was still at the county that he realized the importance of combining ACEs and kernels.

“We started a kernels initiative out of the prevention office called ‘Prevention on a shoestring budget,’ and even flew Dr. Embry out for a countywide training event that left about 300 people feeling empowered and hopeful,” Neigel said. “It was really then that I realized we needed to marry ACEs with kernels.”

Omega 3 supplementation is recognized as a kernel for its natural ability to improve mental health, alleviate anxiety and reduce depression. Research has established that dietary changes over the last 50 to 75 years have resulted in a much lower consumption of Omega 3 fatty acids — found in foods like avocados, salmon and other fish, spinach and pumpkin seeds — and a much higher consumption of Omega 6s, which are found in fried foods, potato chips, fast food and bread.

This has contributed to an increase in depression, bipolar disorder, autism, violence and academic problems. 

The science around Omega 3s has been highly researched and documented. One study conducted inside a prison showed a 37 percent reduction in violent aggression among male prisoners, simply by supplementing their diets with Omega 3s.

Countries in which people consume large amounts of fish reported the least incidents of major depression across the population; as Omega 3 intake decreases, major depression steadily rises. Omega 3 expert researcher Dr. Joe Hibbeln has engaged in countless studies that have connected Omega 3 consumption with positive outcomes.

Neigel and the Monroe Community Coalition are working to educate the community on ACEs and kernels, and to implement different kernel-based programs in Monroe schools. Combinations of kernels, referred to as behavioral vaccines, can make the technology more powerful. There is evidence to show that first-grade implementation of a program called the Good Behavior Game — a behavioral vaccine using six prevention kernels — can have a positive effect up to 35 years later, Neigel said.

“It’s not a silver bullet because that would imply that one thing does everything,” he said. “But it may be silver buckshot.”

For more information about ACEs and evidence-based kernels, visit monroecommunitycoalition.com.