Prime Time Replay:

Dr. Bruce Perry
Executive Director of
the CIVITAS Child Trauma Programs


MsgId: *breakthrough(2)
Date: Wed Sep 17 20:55:39 EDT 1997
From: moderator At: 152.163.205.218

Hello, this is Madeleine Lebwohl, moderator of Breakthrough Medicine. Tonight I'll be speaking with Dr. Bruce Perry. Welcome, Dr. Perry! This is an exciting opportunity. It will be fun.

Much of your work centers on the effects of trauma on the brain. Could we talk a little about how children are affected by traumatic experience.

MsgId: *breakthrough(8)
Date: Wed Sep 17 21:03:29 EDT 1997
From: Bruce_Perry At: 152.163.205.87

Our work, and the work of many other clinicians and researchers, has been focusing on the impact of experiences on shaping the organization and functioning of the brain ... we have learned alot and have much more to study ... but what we do know is that traumatic experiences can alter the actual physiological functioning and functional organization of the brain ... and these changes appear to be related to, or even responsible for, a host of neuropsychiatric problems -- including anxiety, dissociation, impulsivity, depression, poor self esteem
MsgId: *breakthrough(9)
Date: Wed Sep 17 21:06:12 EDT 1997
From: moderator At: 152.163.205.218

Dr. Perry will try to address issues that may be helpful for some of these questions, but because of our time frame he won't be able to answer them specifically. At the end of the chat he will post a website that may be helpful for specific information.

What is the physiological aspect of trauma as it happens? Is it permanent? Or is this what can be treated with psychotherapy?

MsgId: *breakthrough(12)
Date: Wed Sep 17 21:11:07 EDT 1997
From: Bruce_Perry At: 152.163.205.87

The brain has some simple but powerful principles which guide its development and functioning ... one of these is that nerve cells and the systems they create when they become interconnected are designed to sense, process, store and act on information from the outside world to promote survival .... this means that these systems are designed to change -- change physically, physiologically -- in response to experience. And therefore brain changes in a use dependent fashion.

This means that the brain makes "internal representations" of experiences -- and stores these .... so if the experience is chaotic or fear-inducing, the fear-response systems of the brain will be activated .... and if the fear is chronic (such as in domestic violence or chronic sexual abuse) the fear state becomes a permanent "memory" -- the physiology of the fear state becomes burned into the individual such that they remain in a state of terror -- fear -- anxiety -- even when no external threat is present.

The important thing about childhood trauma is that the brain is easier to change and influence early in life -- and that the experiences of childhood literally organize the brain ... which means that childhood trauma -- chaos, neglect, fear -- can result in a disorganized, underdeveloped and "fearful" brain organization .... which then impacts all of the child's emotional, behavioral and cognitive functioning.

This can be very important for understanding why some of these children do so poorly in relationships, in school, in jobs -- The good news is that these biological, physiological, psychological wounds can be healed ... and more important -- since we know that early life chaos, neglect and trauma can profoundly impact the child, we have a rationale for policies in education, mental health, child protection and other areas that are designed to protect, nurture and heal children .... we have a biological rationale for proactive, preventative policies

MsgId: *breakthrough(22)
Date: Wed Sep 17 21:21:50 EDT 1997
From: moderator At: 152.163.205.218

As far as public health policy helps children in need, are these kind of issues adequately addressed or funded right now?
MsgId: *breakthrough(23)
Date: Wed Sep 17 21:24:44 EDT 1997
From: Bruce_Perry At: 152.163.205.87

One of the most important challenges of the next fifty years will be to educate professionals, the policy makers and the public about the crucial "public health" aspects of our evolving understanding of neurodevelopment. At present early childhood programs and research are horribly underfunded --- despite clear progress, we have so many areas that have not been adequately studied .... and so many service-delivery systems that are overburdened, inefficient and redundant.

When we can truly communicate and help policy makers understand that the childhood experiences -- good and bad -- cause biological effects -- effects that influence all aspects of the health and welfare of the individual -- and therefore the society -- we will be able to make rational policy. The costs (in human and economic terms) of child abuse and neglect far outweigh the costs of infectious disease -- yet we have no rational public health policies for violence, abuse, neglect.

We have early screening for PKU, we have manditory pediatric exams and immunizations -- all focused on the health of our other organs .... we need to develop similar early screening models for the brain -- and the psychosocial factor which "shape" the brain during childhood .... and by early identification, protection, enrichment and healing of our youngest, we can develop a healthier, more creative society.

MsgId: *breakthrough(28)
Date: Wed Sep 17 21:32:06 EDT 1997
From: moderator At: 152.163.205.218

When you explain the cost to society caused by these problems, what kind of response do you get from the policy makers?
MsgId: *breakthrough(29)
Date: Wed Sep 17 21:33:33 EDT 1997
From: Bruce_Perry At: 152.163.205.87

When we have the opportunity to talk to governors, legislators and other policy makers, and de-mystify neurodevelopment, they see the clear rationale for proactive, child-focused policies .... it has been very gratifying - and, actually, surprising.

For many years, I think, the problem has been one of translation and communication. Thousands of studies in many different disciplines are published each year .... and taking this, sometimes confusing, information -- and making it understandable and useful for policy makers is difficult.

I am the Senior Fellow of an organization, CIVITAS Initiative, that is dedicated to the process of identifying new and imporant practices and principles in child development and neurodevelopment, translating these into practical programs and policies and then communicating this to professionals and the public.

MsgId: *breakthrough(33)
Date: Wed Sep 17 21:38:29 EDT 1997
From: moderator At: 152.163.205.218

When you make your presentation, what has been your most successful tactic for opening people's minds to funding?
MsgId: *breakthrough(34)
Date: Wed Sep 17 21:39:34 EDT 1997
From: Bruce_Perry At: 152.163.205.87

The most important part of this process is knowing who you are trying to talk with -- when you try to communicate to any group you must use the "language" they are familiar with ... and make your presentations clear and focused ... but visual and use "stories".

Humans are very visual -- so if I tell a lawmaker that neglect can impact the biology of the brain it does not have the same impact that I can have if I show them an MRI of a normal versus a neglected child .... they can "see" the difference .... and then the point sinks in.

MsgId: *breakthrough(36)
Date: Wed Sep 17 21:41:57 EDT 1997
From: moderator At: 152.163.205.218

Do you have to be aware of the different problems in the different regions across the country?
MsgId: *breakthrough(37)
Date: Wed Sep 17 21:42:42 EDT 1997
From: Bruce_Perry At: 152.163.205.87

That is a great question -- and very important for developing rational policies -- each community is different -- with different strengths and different needs. Different communities have various sociocultural issues that are important .... and all of these need to be considered. Yet within this amazing diversity there are common and pervasive needs and wishes ... and the same principles of brain development and use-dependent organization of the brain apply. Each community can solve problems in their unique fashion -- but each will benefit programs that help create and support consistent, predictable, enriching, nurturing and safe environments for children.
MsgId: *breakthrough(40)
Date: Wed Sep 17 21:47:00 EDT 1997
From: moderator At: 152.163.205.218

Could we discuss your most recent project -- how exactly do children benefit from all the research?
MsgId: *breakthrough(41)
Date: Wed Sep 17 21:48:30 EDT 1997
From: Bruce_Perry At: 152.163.205.87

We have developed a unique public-private consortium in Houston -- involving academia, state and county child protective agencies, the corporate sector and the "arts" community -- to put in place (and test) some new practices that we think can better help high risk children. In this model the "Living Laboratory", we conduct a broad-based assessment of the strengths and weaknesses of each child entering the model .... these children have been removed from their families due to abuse and neglect. The evaluation involves measuring aspects of the child's emotional, behavioral, physiological, family, social, cognitive functioning .... and then specifically targeted enrichment and therapeutic services.

So for example a child may be seen to have some motor problems, some anxiety, some speech and language problems ... and they are sent to get interventions in these areas ... it is proactive, cost-effective and enriching.

MsgId: *breakthrough(45)
Date: Wed Sep 17 21:53:28 EDT 1997
From: moderator At: 152.163.205.218

Have you had any follow up yet on children who have gone through this? What have the results been?
MsgId: *breakthrough(46)
Date: Wed Sep 17 21:54:12 EDT 1997
From: Bruce_Perry At: 152.163.205.87

The program has been in place for over two years --- they are doing much better than a comparison group (fewer failed placements, less need for mental health services, better academic acheivment) and, very important, they "cost" the system much less money to take care of. We are taking this system "to scale" in Houston so that all of the children in the child protective system here will get this by the year 2000 .... and other states including Maine, Washington and Illinois have expressed interest in this model
MsgId: *breakthrough(48)
Date: Wed Sep 17 21:57:13 EDT 1997
From: moderator At: 152.163.205.218

Since you've been involved in these programs, what kinds of trends have you seen?
MsgId: *breakthrough(49)
Date: Wed Sep 17 21:58:02 EDT 1997
From: Bruce_Perry At: 152.163.205.87

My experience is that as individuals -- individual teachers, police officers, caseworkers -- we treat children well -- we care, we are respectful -- we try -- but our systems are very child unfriendly. I think it is interesting that in the child service delivery areas most of the frontline service delivery people who work with the children are not the people that end up in admistration -- making policy.

If you look at teachers or social workers or case workers -- the frontline staff are 85 % females -- working with the children -- seeing their lives .... but in the organizations that design and control public education, mental health service delivery or child protective services, 90 % of the administration (policy and practice makers) are males .... who spend almost no time with children.

MsgId: *breakthrough(52)
Date: Wed Sep 17 22:03:11 EDT 1997
From: moderator At: 152.163.205.218

So what do you see as the consequences of this situation?
MsgId: *breakthrough(53)
Date: Wed Sep 17 22:04:24 EDT 1997
From: Bruce_Perry At: 152.163.205.87

The effects of this are that the people who define policy know very little about the real lives of children and families in duress ...... and make policies which are much less "child" centered ... while the frontline workers who have to live with the foolish policy limitations are frustrated, burned out and get cynical about their inabilities to impact "the system".
MsgId: *breakthrough(54)
Date: Wed Sep 17 22:05:28 EDT 1997
From: moderator At: 152.163.205.218

Do you see things improving?
MsgId: *breakthrough(55)
Date: Wed Sep 17 22:06:21 EDT 1997
From: Bruce_Perry At: 152.163.205.87

In most areas -- no ... things are getting worse ... the welfare to work efforts (well intended) but poorly conceived ... and the decrease in resources for social areas are all impacting in a negative way, the lives of children. There are pockets of optimism ... we think that innovative public-private partnerships ... use of new technologies ... breaking down the traditional institutional barriers that impede progress -- can all help. CIVITAS Initiative is designed to do this ... and is making great progress in this regard in Houston and Chicago.
MsgId: *breakthrough(57)
Date: Wed Sep 17 22:09:27 EDT 1997
From: moderator At: 152.163.205.218

If someone is bothered by this negative trend, is there anything they can do?
MsgId: *breakthrough(58)
Date: Wed Sep 17 22:09:58 EDT 1997
From: Bruce_Perry At: 152.163.205.87

Anyone who is interested in concrete ways to help, I would urge them to contact us at http://www.civitas.org/ and we would be happy to give them more information about our programs and other innovative efforts in their community.
MsgId: *breakthrough(59)
Date: Wed Sep 17 22:10:46 EDT 1997
From: moderator At: 152.163.205.218

Where do you hope to make your greatest impact?
MsgId: *breakthrough(60)
Date: Wed Sep 17 22:12:09 EDT 1997
From: Bruce_Perry At: 152.163.205.87

If this work can help define new ways of integrating basic neuroscience, clinical service delivery and policy -- I will feel happy. The content is always out there .... the process by which we encorporate new things, however, is not ... if my work can impact and help facilitate the process of systemic change, I will be very happy.
MsgId: *breakthrough(61)
Date: Wed Sep 17 22:13:40 EDT 1997
From: moderator At: 152.163.205.218

Our time is up, Dr. Perry. Thanks so much for joining me tonight. Goodnight!
MsgId: *breakthrough(62)
Date: Wed Sep 17 22:14:32 EDT 1997
From: Bruce_Perry At: 152.163.205.87

Thank you very much for the opportunity to be here ... communication is a key to any systemic change .... and forum like these help tremendously.
MsgId: *breakthrough(63)
Date: Wed Sep 17 22:16:40 EDT 1997
From: moderator At: 152.163.205.218

Great to have you. Goodnight! Please join me next week when I speak with Ichiro Kawachi, M.D., Ph.D., of the Harvard School of Public Health, who will discuss the health dangers of passive smoking and psychosocial factors linked to heart disease.


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