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Surgeon General of the State of California | |
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Reports to | Governor of California |
Appointer | Governor Gavin Newsom |
Formation | January 7, 2019 |
First holder | Dr. Nadine Burke Harris, MD |
Salary | $216,420 |
The Surgeon General of California is the leading spokesperson on matters of public health within the State of California. The Surgeon General is one of only five State Surgeons General in the United States. The office was created on January 7, 2019, by Governor Gavin Newsom [1] and requires confirmation from the California State Senate. [2]
On August 25, 2022, Governor Gavin Newsom appointed Dr. Diana Ramos, MD as the current California Surgeon General. [3]
The first Surgeon General was Dr. Nadine Burke Harris, who served from February 11, 2019 to February 11, 2022. [4] [5]
The Surgeon General of California is one key component of the Governor's "California for All" agenda which includes a proposed $1.7 billion in funding for expanded early childhood education and early interventions.
Dr. Nadine Burke Harris has given many speeches and testimony to the impact of Toxic Stress on Children and how it impacts their future.
A PBS NewsHour opinion piece highlighted Nadine Burke Harris experience with Toxic Stress and how it is under-diagnosed in children.
A Washington Post video with Nadine Burke Harris explains Toxic Stress with powerful visuals and sound added to Dr. Burke Harris' explanation.
There are many websites and toolkits to better understand Toxic Stress and Adverse Childhood Experiences and their impact on health over a lifetime including ACES Too High, Harvard Center on the Developing Child,
Dr. Nadine Burke Harris has given multiple talks and had conversations [12] that have been made public and available to the public on Toxic Stress including a Ted Talk [13] that addresses Toxic Stress from a Public Health standpoint.
Necessary resources for medical, behavioral and educational professionals include resources to provide trauma-informed care. [14] Systems that work with children and their parents and extended families will need to create trauma-informed systems where the children and their families are supported by staff who are also supported while caring for survivors of trauma. [15]
A service system with a trauma-informed perspective is one in which agencies, programs, and service providers:
These activities are rooted in an understanding that trauma-informed agencies, programs, and service providers:
Children who come to the attention of the juvenile justice system [16] are a challenging and under-served population, with high rates of exposure to trauma.
Unaccompanied Migrant Children who may have Complex trauma [17] prior to encounters with systems like Border Patrol or the Foster Care system.
In a Q&A Dr. Burke Harris was asked, "Gov. Newsom has made funding early education one of his highest priorities. How do you plan on incorporating trauma-informed teaching into the overall effort?". In response she answered, "We’re understanding more than we ever had before the role of experience and environment in early childhood in shaping lifelong health outcomes. That is the data and research we are seeing across the board. So, when you look at something that is such a huge public health issue then we must recognize that to implement public health solutions we need to be engaging across sectors. So, in our educational system, in our health system, in our justice system — across the board — we need to have broad-scale and coordinated efforts to address the impact of early adversity on health and development. Healthcare and early education go hand-in-hand." [18]
"Imagine identifying a toxin so potent it could rewire a child’s brain and erode his immune system. A substance that, in high doses, tripled the risk of heart disease and lung cancer and reduced life expectancy by 20 years. And then realizing that tens of millions of American children had been exposed. Nadine Burke Harris, is a leading voice in a movement trying to transform our understanding of how the traumatic experiences that affect children, can trigger serious physical and mental illness, and looking at it using epidemiology, like John Snow did in 1800s London.
Decades of research that has found that children who endure sustained stresses in their day-to-day lives undergo biochemical changes to their brains and bodies that can dramatically increase their risk of developing serious health problems, including heart disease, lung cancer, asthma, and depression." [19]
The Surgeon General of California was first created with the signing of Executive Order N-02-19 [20] —one of the first acts taken by Governor Gavin Newsom on his first day in office—on January 7, 2019.
Governor Newsom appointed Dr. Nadine Burke Harris as California's first-ever surgeon general. She held office from February 11, 2019 until her resignation February 11, 2022, citing a desire for more time for her family and her personal wellness. [21]
On August 25, 2022, Governor Gavin Newsom appointed Dr. Diana Ramos, MD as Surgeon General.
# | Name | Service | Prior offices |
---|---|---|---|
1 | Dr. Nadine Burke Harris | February 11, 2019 – February 11, 2022 | none |
2 | Dr. Diana Ramos | September 1, 2022 – Present | California Department of Public Health- Assistant Deputy Director of Chronic Disease Prevention |
Psychological trauma is an emotional response caused by severe distressing events, such as bodily injury, sexual violence, or other threats to the life of the subject or their loved ones; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not always produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.
Complex post-traumatic stress disorder is a stress-related mental and behavioral disorder generally occurring in response to complex traumas.
Dominic Cappello is a strategist, writer, designer, and educator. He is the creator of the Ten Talks book series published by Hyperion in 2000 and 2001. Ten Talks received national attention when Oprah Winfrey created a show around the book on sex and character in October 2000, featuring parents who had used the books' approaches to family communication.
Childhood trauma is often described as serious adverse childhood experiences. Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse. They may also witness abuse of a sibling or parent, or have a mentally ill parent. These events can have profound psychological, physiological, and sociological impacts leading to lasting negative effects on health and well-being. These events may include antisocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Additionally, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.
Daniel S. Schechter is an American and Swiss psychiatrist known for his clinical work and research on intergenerational transmission or "communication" of violent trauma and related psychopathology involving parents and very young children. His published work in this area following the terrorist attacks on the World Trade Center in New York of September 11, 2001 led to a co-edited book entitled "September 11: Trauma and Human Bonds" (2003) and additional original articles with clinical psychologist Susan Coates that were translated into multiple languages and remain among the first accounts of 9/11 related loss and trauma described by mental health professionals who also experienced the attacks and their aftermath Schechter observed that separation anxiety among infants and young children who had either lost or feared loss of their caregivers triggered posttraumatic stress symptoms in the surviving caregivers. These observations validated his prior work on the adverse impact of family violence on the early parent-child relationship, formative social-emotional development and related attachment disturbances involving mutual dysregulation of emotion and arousal. This body of work on trauma and attachment has been cited by prominent authors in the attachment theory, psychological trauma, developmental psychobiology and neuroscience literatures
Early childhood is a critical period in a child's life that includes ages from birth to five years old. Psychological stress is an inevitable part of life. Human beings can experience stress from an early age. Although stress is a factor for the average human being, it can be a positive or negative molding aspect in a young child's life.
Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary mode of transmission is the shared family environment of the infant causing psychological, behavioral and social changes in the individual.
The National Child Traumatic Stress Network (NCTSN) is an American organization whose "mission is to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States". According to its website, the NCTSN "offers training, support, and resources to providers who work with children and families exposed to a wide range of traumatic experiences, including physical and sexual abuse; domestic, school, and community violence; natural disasters, terrorism, or military family challenges; and life-threatening injury and illness."
Nadine Burke Harris is a Canadian-American pediatrician who was the Surgeon General of California between 2019 and 2022; she is the first person appointed to that position. She is known for linking adverse childhood experiences and toxic stress with harmful effects to health later in life. Hailed as a pioneer in the treatment of toxic stress, she is an advisory council member for the Clinton Foundation's "Too Small to Fail" campaign, and the founder and former chief executive officer of the Center for Youth Wellness. Her work was also featured in Paul Tough's book How Children Succeed.
The Child PTSD Symptom Scale (CPSS) is a free checklist designed for children and adolescents to report traumatic events and symptoms that they might feel afterward. The items cover the symptoms of posttraumatic stress disorder (PTSD), specifically, the symptoms and clusters used in the DSM-IV. Although relatively new, there has been a fair amount of research on the CPSS due to the frequency of traumatic events involving children. The CPSS is usually administered to school children within school boundaries, or in an off-site location to assess symptoms of trauma. Some, but not all, people experience symptoms after a traumatic event, and in serious cases, these people may not get better on their own. Early and accurate identification, especially in children, of experiencing distress following a trauma could help with early interventions. The CPSS is one of a handful of promising measures that has accrued good evidence for reliability and validity, along with low cost, giving it good clinical utility as it addresses a public health need for better and larger scale assessment.
Early childhood trauma refers to various types of adversity and traumatic events experienced during the early years of a person's life. This is deemed the most critical developmental period in human life by psychologists. A critical period refers to a sensitive time during the early years of childhood in which children may be more vulnerable to be affected by environmental stimulation. These traumatic events can include serious illness, natural disasters, family violence, sudden separation from a family member, being the victim of abuse, or suffering the loss of a loved one. Traumatic experiences in early childhood can result in severe consequences throughout adulthood, for instance developing post-traumatic stress disorder, depression, or anxiety. The effects of this trauma can be experienced very differently depending on factors such as how long the trauma was, how severe and even the age of the child when it occurred. Negative childhood experiences can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. However, not all children who are exposed to negative stimuli in early childhood will be affected severely in later life; some children come out unscathed after being faced with traumatic events, which is known as resilience. Many factors can account for the invulnerability displayed by certain children in response to adverse social conditions: gender, vulnerability, social support systems, and innate character traits. Much of the research in this area has referred to the Adverse Childhood Experiences Study (ACE) study. The ACE study found several protective factors against developing mental health disorders, including mother-child relations, parental health, and community support. However, having adverse childhood experiences creates long-lasting impacts on psychosocial functioning, such as a heightened awareness of environmental threats, feelings of loneliness, and cognitive deficits. Individuals with ACEs are more prone to developing severe symptoms than individuals in the same diagnostic category.
Race-based traumatic stress is the traumatic response to stress following a racial encounter. Robert T. Carter's (2007) theory of race-based traumatic stress implies that there are individuals of color who experience racial discrimination as traumatic, and often generate responses similar to post-traumatic stress. Race-based traumatic stress combines theories of stress, trauma and race-based discrimination to describe a particular response to negative racial encounters.
Adverse childhood experiences (ACEs) include childhood emotional, physical, or sexual abuse and household dysfunction during childhood. The categories are verbal abuse, physical abuse, contact sexual abuse, a battered mother/father, household substance abuse, household mental illness, incarcerated household members, and parental separation or divorce. The experiences chosen were based upon prior research that has shown to them to have significant negative health or social implications, and for which substantial efforts are being made in the public and private sector to reduce their frequency of occurrence. Scientific evidence is mounting that such adverse childhood experiences (ACEs) have a profound long-term effect on health. Research shows that exposure to abuse and to serious forms of family dysfunction in the childhood family environment are likely to activate the stress response, thus potentially disrupting the developing nervous, immune, and metabolic systems of children. ACEs are associated with lifelong physical and mental health problems that emerge in adolescence and persist into adulthood, including cardiovascular disease, chronic obstructive pulmonary disease, autoimmune diseases, substance abuse, and depression.
Religious trauma syndrome (RTS) is classified as a set of symptoms, ranging in severity, experienced by those who have participated in or left behind authoritarian, dogmatic, and controlling religious groups and belief systems. It is not present in the Diagnostic and Statistical Manual (DSM-5) or the ICD-10 as a diagnosable condition, but is included in Other Conditions that May Be a Focus of Clinical Attention. Symptoms include cognitive, affective, functional, and social/cultural issues as well as developmental delays.
Adverse childhood experiences (ACEs) are identified as serious and traumatizing experiences, such as abuse, neglect, exposure to violence, substance use, and other harmful events or situations that occur within a child's household or environment. Unfortunately, exposure to ACEs within the child's community is all too common in low-income households and neighborhoods, with close to 43% of children in the United States (U.S.) living in low-income families. ACEs were first identified by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente's Adverse Childhood Experiences Study conducted from 1995 to 1997, where ACEs were examined and correlated with later-life well-being. With one in four children experiencing or witnessing a potentially traumatic event, children who grow up in an unsafe environment are at risk for developing adverse health outcomes, affecting brain development, immune systems, and regulatory systems.
Hispanic immigrants living in the United States have been found to have higher levels of exposure to trauma and lower mental health service utilization than the general population. Those who met the criteria for asylum and experience trauma before migrating are vulnerable to post-traumatic stress disorder (PTSD) symptoms. Higher levels of trauma-related symptoms are associated with increased post-migration living difficulties. Despite the need for mental health services for Hispanic immigrants living in the United States, cultural and structural barriers make accessing treatment challenging.
Diana Ramos is an American obstetrician and gynecologist who was appointed to serve as the Surgeon General of California by Governor Gavin Newsom.
Trauma-informed care (TIC) or Trauma-and violence-informed care (TVIC), is a framework for relating to and helping people who have experienced negative consequences after exposure to dangerous experiences. There is no one single TIC framework, or model, and some go by slightly different names, including Trauma- and violence-Informed Care (TVIC). They incorporate a number of perspectives, principles and skills. TIC frameworks can be applied in many contexts including medicine, mental health, law, education, architecture, addiction, gender, culture, and interpersonal relationships. They can be applied by individuals and organizations.
Trauma-informed approaches in education (TIE) are educational techniques that acknowledge the prevalence of adverse childhood experiences and other traumas on students and attempt to mitigate the widespread impact of such trauma. By adopting trauma-informed principles, educational organizations aim to create a supportive environment that facilitates learning and promotes the emotional well-being of students. Trauma-informed education is referred to with varying terminology.
Katherine Ortega Courtney is an American psychologist and author who co-developed the 100% Community model, a theoretical framework designed to guide the state and local work of preventing two interrelated public health and education challenges: adverse childhood experiences (ACEs) and adverse social determinants of health (SDH). As bureau chief of New Mexico's Child Protective Services Research, Assessment, and Data Bureau and developer of a data-scholars program for child welfare managers across the nation, she saw firsthand child welfare's lack of capacity to implement a data-driven strategy to prevent maltreatment by ensuring families had access to the vital services of medical care, mental health care, food security programs, and safe housing.
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