Dr. Espinoza Feature Article - North Bay Women

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Everyone Has a Story

Under Dr. Jenny Espinoza, nonprofit Back to the Start unwinds San Quentin inmates’ stories of childhood trauma

By Sarah Moseley

On a clear day last January, policy makers, families and incarcerated individuals at San Quentin Rehabilitation Center gathered in the chapel. More than a dozen incarcerated musicians performed festive music, others mingled with visitors and proudly introduced their service dogs.

The 16 incarcerated men stood before a backdrop of their own childhood photos to share their stories of past traumas and childhood experiences in front of more than 300 guests. Some shared poetry, others shared short stories — all the result of a 26-week intensive program called Back to the Start.

The program, co-led by Dr. Jenny Espinoza and incarcerated team leaders, explored the process of writing to overcome not only past traumas, but to help inform those setting future policies affecting children, especially those in marginalized communities.

Supporting these communities is something she says she’s always been drawn to. Growing up in Central and Southern California, Espinoza was interested in underserved populations, particularly the homeless.

But her career path into medicine and eventually her work with the California prison system was not a straight trajectory. A teen mother, she finished high school and went on to UC Irvine. There, she met a group of women just like her — single mothers who studied at night and took their toddlers to the park during the day after classes. At playdates, they talked about how they wished someone would have given them encouragement to continue their education.

“They kept saying, ‘I wish someone had told me I could do this,’” Espinoza said. “So I said, ‘Why don’t we?’”

And so Espinoza and her friends started visiting high schools. Their teen parent program focused on the importance of education, despite the negativity and stereotypes they might be subject to.

“I never felt there wasn’t anything I couldn’t do. It never even occurred to me that this wouldn’t work out, that I wouldn’t be a doctor,” she said.

After getting her medical degree and specializing in internal medicine at UCSF, she served on faculty at UCSF as well as the medical director at the San Francisco VA Medical Center Downtown (Homeless) Clinic. There she saw first hand the effects of homelessness, chronic illness and trauma on veterans and those who lack services and health care.

In 2009, after a federal receiver was tasked with prison health care reform, Espinoza was brought into San Quentin as a primary care provider. She was eventually recruited to a statewide role as a chief physician and surgeon to develop a clinical training program at 18 prisons for doctors, nurses and other health care professionals to develop competency and comfort caring for incarcerated patients as part of their medical training. The goal of the program was to fill in gaps in care for a population that’s often overlooked and historically has lacked access to care not only within the prison system but in the years leading to incarceration.

Her time as a primary care provider was the most instrumental in opening her eyes to the multitude of barriers and inequities that this population faces, starting at birth. What especially moved her were the stories that her patients share about growing up, their families and home environments, and unimaginable adversity and trauma they endured at such a young age.

“Why don’t we as a society systematically provide comprehensive support and services to eliminate health and educational disparities in children rather than wait for them to grow up and have lives all too often punctuated by tragedy, dealing with the downstream effects of trauma, poor educational achievement, poverty and incarceration? Besides making logical sense, being more effective and the right thing to do, upstream investments deliver huge cost savings,” she said.

Adverse experiences

According to the Centers for Disease Control, adverse childhood experiences are potentially traumatic events that occur from birth to 17 years. Examples include experiencing violence, abuse or neglect, witnessing violence in the home or community, or having a family member attempt or die by suicide. Other aspects of a child’s environment can undermine their sense of safety, stability and bonding including substance use problems, mental health issues, instability due to parental separation or instability due to household members being in jail or prison.

“A lot of people think, ‘Oh, these kids just got on the wrong track.’ What we’re learning is that they were never on any track to begin with,” said Espinoza. She became consumed with the idea that if investments in her patients had been made early, when they were children, many would have not ended up in prison and in her care.

During a three-year fellowship in The Robert Wood Johnson Foundation Culture of Health Leadership Program she began looking at why, despite decades of studies and data, has our nation not prioritized upstream evidence-based investments and interventions. The answer to that question changed her career path in a direction she never could have imagined.

She came to understand that it came down to stories – because it’s the stories, or the dominant narrative, that are actually the main driver of policy and social change — not data.

“That’s how human brains are hardwired, to make decisions and decide what’s right and what’s wrong. It’s all about a story or image that first comes to mind when someone thinks of an issue, and collectively it’s the stories that permeate the general societal consciousness that drive our collective values and policies,” Espinoza said.

She also noticed that there were few stories in the public domain offering insight into the incarcerated space, especially connecting back to the innocence of childhood. What she noticed instead were the stereotypes and tropes that portrayed incarcerated people as one-dimensional and violent.

“I also realized that the stories I had been hearing from my patients all these years in clinic about growing up were the exact stories that were needed to educate the public and policy makers,” Espinoza recalled.

So in early 2021, she arranged to meet with a group of incarcerated journalists and writers at the San Quentin media center and asked them what they thought about starting a narrative writing program at San Quentin to teach incarcerated residents how to write and produce stories about childhood.

“I was only going to do this if the project was co-founded and led by incarcerated individuals. Otherwise it wouldn’t be authentic or empowering for the community it was meant to serve,” she said. When she returned a week later, she was handed a sheet of paper with the signatures of those who wanted to start the program together. And so they got to work, creating the program from the ground up.

Together with the incarcerated co-leads, the program was built around six different writing prompts, allowing the participants to explore childhood experiences. Topics included reflections about home and school environment, child care, access to support services, involvement in the foster system, trauma and loss and first contact with the criminal justice system. During the sessions, the writings were workshopped in small groups.

“Using a trauma-informed approach, we provided participants time and space for processing emotions that can be triggered by these stories and reflections,” Espinoza said.

Initially, they viewed the program as a one-off project. But she says the response from those inside the walls of San Quentin was so positive that she resigned from her job with the prison to fully build out the program as a nonprofit.

“The response was a bit overwhelming,” Espinoza said. “There was so much demand, we ran out of room in our second cohort. But one gentleman that we ultimately added to the program was so eager to be involved he got the writing prompts from a friend and did the work anyway.”

By writing about these events, participants were able to look at their childhood experiences in a new light. But it’s done more than that. Espinoza has called on local and state policymakers to take a harder look at the longer term impact of what’s called “adverse childhood experiences” or ACEs.

Espinoza now spends much of time in Sacramento, sharing the stories she’s heard behind bars to help inform and change policy for children, especially those from marginalized communities who are at significantly greater risk for adverse childhood traumas.

The Back to the Start project was brought to the attention of Sundance and Emmy-award winning filmmaker Jacob Kornbluth, who collaborated with Espinoza to film the January event and turn it into a short documentary. The film, “Breaking the Cycle — Reflections Behind Bars,” will be screened at multiple locations in the Bay Area and has already become a powerful tool in her advocacy efforts. And, she said, there are more San Quentin co-horts planned.

“Everyone has a story. And those stories are what can drive change.”

For more information, visit backtothestart.org. See the documentary trailer at backtothestart.org/video-trailer.