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ACEs: From Theory to Reality

Kerry Jamieson Blog, Fighting ACEs PBC, Latest News

For the past few years, our blog has shared information on ACEs: citing world-renowned studies and organizations, sharing solutions and strategies, and communicating ideas for building a more trauma-informed community. We know that knowledge is empowering, so a big part of our work involves letting people know about the lifelong mental and physical impact Adverse Childhood Experiences (ACEs) have on children. At some point, however, it helps to turn our attention away from theories and refocus it on reality…the real children who are affected, the real work we do, and the very real need for financial support.

But first, let’s recap the basics…

The Undisputed Facts

  • ACEs are traumatic experiences that occur in childhood as a result of abuse, neglect, or household dysfunction.
  • ACEs were first explored in a study conducted in the mid-1990s by the Centers for Disease Control and Prevention (CDC) and insurance giant Kaiser Permanante.
  • More than half the US population has at least one ACE (out of a possible score of ten); many people score far higher.
  • Breakthrough research in neurobiology shows that ACEs disrupt neurodevelopment and can have lasting effects on brain structure and function, which is why ACEs can dramatically alter the course of a person’s life.
  • ACEs are a root cause of many social, emotional, and cognitive impairments that lead to health risks, increased exposure to violence or revictimization, disease, disability, and premature mortality.
  • ACEs have huge financial costs to society, too. They burden social and healthcare systems and result in lost productivity.
  • The good news is that introducing just one positive, adult influence to buffer the effects of ACEs can make all the difference to a child.
  • Children can also be helped to develop their innate resilience, helping them cope with and overcome adversity and ultimately lead full, happy lives.

At Center for Child Counseling, we address all these issues by focusing on very young children because this approach offers children the best possible chance to heal.

When some people look at this issue, they are compelled by their hearts to act. For others, a concrete, facts-based argument is more persuasive. Setting aside the desire we all have to protect abused of children, as taxpayers we should be concerned about the cost of unaddressed childhood adversity, too.

The Real Cost to Communities

The CDC estimates the total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States was approximately $124 billion in 2008. A decade later, that cost has undoubtedly skyrocketed. In sensitivity analysis, the total burden is estimated to be as large as $585 billion.

Another study conducted in Washington State showed that up to 67% (an astonishing two-thirds) of behavioral and physical health problems that cause people to seek social services are attributable to ACEs. Many of these services are funded by the taxpayer. There is no doubt that doing the right thing morally (addressing the suffering of children) will, in the long-term, save us a great deal of money.

Just One Example Costs Us Billions

Let’s consider just one damaging adult behavior – excessive alcohol use. An ACE score of just 1, (which covers six out of ten Americans) can cause sufficient trauma to make a person twice as likely to become an alcoholic. Alcoholism is the most common addiction in the United States with 17.6 million people–one in every 12 adults–suffering from alcohol abuse. Several million more engage in risky, binge-drinking patterns that could lead to problems with alcohol. The cost of excessive alcohol use in the United States reached $249 billion in 2010, or about $2.05 for every alcoholic beverage consumed!

But beyond all this data are real children and we need to think about them as individuals. Brutal Russian dictator, Joseph Stalin, understood how easily big issues can become banal. He famously said: “If only one man dies of hunger, that is a tragedy. If millions die, that’s only statistics.” Taking in the big picture can sometimes obscure the very human toll of an epidemic or even dilute the urgency to act. We look at every one of our clients as a precious individual. Our work is focused on quality care for one child and one family at a time. Let’s consider some of the children we help every day.

The Real Children

The greatest heartache of watching children struggle is the knowledge that each child is brimming with potential. When that potential is fulfilled, the world benefits in uncountable ways. The converse is true, too. The world loses when children don’t grow up to thrive and contribute.

At Center for Child Counseling, we’ve helped children like siblings Jessica and Josiah, who experienced severe violence in their home and eventually witnessed their parents’ murder-suicide. Four-year-old Shawn was removed from his substance-addicted mother because he was living in dangerous conditions after a neighborhood drive-by shooting riddled his home with bullets. Four-year-old Raj, three-year-old Nicola, and two-year-old Titus were removed from their home after their parents’ overdosed on opioids. These three tots were so neglected that their little bodies were shutting down from severe malnutrition.

Of course, we help many other children, too. Children who are struggling to adjust to school or children who aren’t coping well with a separation or divorce in the family. We can help them all.

The Need in Real Terms

The greatest return on any investment comes when that investment effects future generations. Breaking the intergenerational cycle of abuse, neglect, and dysfunction that defines an ACEs household offers exponential benefits going forward. It results in stronger communities, a lower burden on social services, an larger tax base, and greater security for schools and neighborhoods.

“For us, fighting ACEs is a moral imperative as well as good financial sense,” says Center for Child Counseling’s CEO, Renée Layman. “A society that turns a blind eye to the suffering of children isn’t one we would want to live in…and if we do choose to live in it without addressing the issue, then we choose to rain down a storm of societal ills on ourselves and future generations.”

We Know Better, We Must Do Better

Rather than throwing up our hands and bemoaning the sky-high costs and devastating prevalence of ACEs, at Center for Child Counseling, we’ve chosen to take action.

We currently run seven robust programs through which we offer direct services to children and families and educate the community to recognize and address the issue of ACEs. While some programs receive full or partial funding through public agencies, grants, or government programs, there is a lot of work that remains sadly unfunded. In other words, we could be doing so much more!

Funding is needed to implement the full model of our existing projects like our School-Based Mental Health Program, which has crucial prevention and early intervention components. We need support to grow skilled, experienced therapists, ensuring that Palm Beach County offers cutting edge programs and advocacy that is based on best practice and evidence-based models. You can help us by taking a training on ACEs and many other subjects through our Institute for Clinical Training or by simply enjoying yourself at one of our upcoming events.

If you see the logic of helping very young children before they fall apart, or if the black-and-white economic argument is more powerful to you, please consider a donation or corporate sponsorship, As the year draws to a close, you have the opportunity to make a real difference in a real child’s life. Because beyond the data and the statistics, a little child is waiting, asking for help from a caring therapist who can undoubtedly make their 2020 a much happier, healthier year.

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ACEs and Juvenile Justice

Kerry Jamieson Blog, Fighting ACEs PBC, Latest News

Since the beginning, Adverse Childhood Experiences (ACEs) and the criminal justice system have been inextricably linked. The original 10-question survey acknowledged this by asking whether a child had a parent who was incarcerated. The effect of this kind of sudden loss on a child can be potentially devastating in the absence of a compensating buffering influence. But adversity and the justice system cross paths in many ways, let’s explore some of them here and discover ways in which we can become better at helping children with ACEs and those adults trying to address their own negative childhood experiences.

In the United States, there is undoubtedly a link between literacy and incarceration. 85 percent of all juveniles who interface with the juvenile court system are functionally low literate. These are likely youngsters who have been struggling at school. Partner with that the fact that juvenile incarceration reduces the probability of high school completion and increases the probability of incarceration later in life and you can see that early negative indicators like poor social skills and self-regulatory difficulties (often identified as early as kindergarten) are reliable in tracking poor future outcomes. It seems depressing to be betting against our children in this way but the correlation between early struggles and ultimate incarceration are so clear that these metrics are, sadly, reliable. It’s our job to intervene and disrupt the pipeline of despair that moves children from childhood adversity to contact with the juvenile justice system to adult incarceration. We need to help children before they fall apart through prevention and intervention services and improved education for those working in the juvenile justice system.

ACEs Among Juvenile Offenders

By the time any child comes into contact with law enforcement and the judicial system, it’s highly likely that they have already experienced trauma and adversity in their lives. 90% of young people in the juvenile justice system have at least one extreme stressor and usually far more. In fact, juvenile offenders in Florida have starkly higher rates of ACEs than the population as a whole, according to a study conducted by the state’s Office of Juvenile Justice and Delinquency Prevention and the University of Florida. The study (“The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders”) surveyed 64,329 juvenile offenders, only 2.8% reported no childhood adversity compared to 34% surveyed in the original CDC study. That means 97% of them had at least one ACE. 50% of the offenders surveyed reported 4 or more ACEs putting them in the high risk category (this compared to just 13% in the original study). This data is incredibly significant because numerous studies link a high ACE score with chronic disease, mental illness, violence, being a victim of violence, and early death. When you raise a child with violence, they have a tendency to become violent. Fortunately, the same is also true when you raise a child with love and kindness.

Who Are These Children?

But let’s consider the children behind the statistics because all of them are children under the age of 18. Children in the juvenile justice system have committed offenses that range from vandalism and delinquency to DUI and drug offenses to more serious crimes like assault, rape, and murder. In the US, the most common crime committed by juveniles is theft. This can include shoplifting, robbery, burglary, and other property theft. There may be a tendency to think of boys as more prone to ‘delinquency’ but the percentage of girls in the juvenile justice system has increased over the decades, accounting for approximately one-third of all arrests.

These young people are obviously making bad choices but the ACEs they suffer from are not one of those bad choices. Their ACEs have been thrust upon them since birth. They have accumulated the trauma, risk factors, and toxic stress associated with high ACE scores. They come from troubled homes where substance abuse is rife, many have suicidal or mentally unstable parents, they are abused or neglected, they’ve witnessed violence at home and in their communities, and many of them have suffered the loss of a parent to death, divorce, or the criminal justice system. Often, their exposure comes from multiple types of interpersonal victimization—polyvictimization—but also from other childhood adversities (such as separation from their biological parents and/or impaired family relationships). In other word, these children have been traumatized from all sides before they ever commit an offense.

Without removing culpability for their crimes, it is important to consider the context in which those crimes were committed and how much blame can be laid at the feet of children for their actions. We’ve already learned that the human brain is not fully developed until the early twenties, making tweens and teens physiologically incapable of fully understanding consequences in the way a mature adult would.

The Current Situation

Each year, the United States locks up more than 130,000 young people under the age of 18 at a total cost of $6 billion, or an average of $88,000 per inmate. Currently, there are 70,000 juveniles living in correctional institutions. A study co-authored by MIT economist Joseph Doyle found that juveniles who were incarcerated for their offenses are 23 percentage points more likely to end up in adult jails later in life compared to those who were sentenced to alternates like counseling, rehabilitation, or community service. Put another way: 40 percent of kids who went into juvenile detention ended up in adult prison by the age of 25. Apparently, non-custodial sentences garner better results and it seems that locking kids up is just a great way to create future adult criminals.

Despite these facts, the juvenile justice system isn’t going away. Given that we know incarcerated kids are traumatized, at the very least, we need to work towards a more trauma-informed juvenile justice system.

What Exactly is a Trauma-Informed Juvenile Justice System?
(Based on SAMHSA’s Concept of Trauma-Informed)

A trauma-informed juvenile justice system…
• realizes the widespread impact of trauma and understands potential paths for recovery
• recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system
• responds by fully integrating knowledge about trauma into policies, procedures, and practices
• seeks to actively resist re-traumatizing already-traumatized children

Some juvenile justice systems across the country are committed to this approach. They’re talking about parent and caregiver trauma, and how best to reach and engage families in the process. They’re also developing best practices in cross-system collaboration with child welfare, the education system, and healthcare providers. They’re trying to break down the barriers to ‘continuity of care’ while still respecting established privacy legislation.

Goals for the Juvenile Justice System

Here are a few steps recommended to help make the juvenile justice system better at managing and helping the children in their care who suffer from high ACE scores:

1. Make trauma-informed screening, assessment and care the standard in juvenile justice services.
2. Abandon juvenile justice correctional practices that traumatize children and further reduce their opportunities to become productive
members of society.
3. Provide juvenile justice services appropriate to children’s ethno-cultural background that are based on an assessment of each child’s
individual needs.
4. Provide care and services to address the special circumstances and needs of girls.
5. Provide care and services to address the special circumstances and needs of LGBTQ (lesbian/gay/bisexual/transsexual/questioning) youth.
6. Develop and implement policies in every school system across the country that aim to keep children in school rather than relying on policies
that lead to suspension and expulsion and ultimately drive children into the juvenile justice system.
7. Guarantee that all violence-exposed children accused of a crime have legal representation.
8. Help (rather than punish) victims of child sex trafficking.
9. Whenever possible, prosecute young offenders in the juvenile justice system instead of transferring their cases to adult courts.

Prevention Would Preclude a Lot of Pain

No matter how sophisticated our juvenile justice system becomes, however, it’s clearly still better to prevent children ever getting on the path to incarceration in the first place. Prevention wins every time over the negative implications of incarceration for the individual and the cost, socially and financially, to society as a whole.

Every recent study on juvenile offenders strongly suggests that efforts should be focused on the early identification of ACEs and intervention to improve a youth’s life circumstances. This approach of intercepting the issue upstream will reduce the likelihood of criminal activities and the resulting impacts on the system.

Recent studies suggests:
• Funding primary prevention efforts like educating parents about encouraging a child’s brain development
• Making sure that health professionals are screen for ACEs at periodic intervals during childhood
• Educating school personnel on the signs and symptoms of ACEs, as well as the fact that maladaptive, antisocial behaviors often stem from
them. Suspending or expelling students from school may deprive youth of the safest environment they can access. In-school programs to
address bullying, disruptive behavior and aggression can help youth in safe environments while they learn regulatory skills.
• Ensuring that law enforcement and judicial awareness of ACEs will enhance the likelihood that the root causes of problematic behaviors will be
addressed with social and behavioral health services.

Prevention and early identification of ACEs will improve the general health of communities and reduce costs in medicine, social services, and criminal justice. Nancy Hardt, one of the authors of the Florida-based study says. “Development of educational curricula, health programs, and policies to detect and treat physical abuse, emotional abuse, sexual abuse and substance abuse among youth has the potential to reduce their involvement in the criminal justice system.” She also acknowledged that increased primary prevention will require collaborative efforts and effective communication across health, education, and community programs. We concur!

Schools provide a unique opportunity for experts like the therapists from the Center for Child Counseling to make a difference in children’s lives since teachers often see emerging issues long before the before the criminal justice becomes involved. As Hardt declares: “It’s time for justice, law enforcement, healthcare, and schools to all get together on behalf of these children who are experiencing ACEs.”

Together, we can build our children’s defenses, despite their ACEs, to make good choices and avoid going down the wrong path to incarceration and all its associated sadness, lost opportunity, wasted potential, and pain. You can help support our unique prevention and early intervention model in schools by donating directly to our School-Based Mental Health Program here.

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The Issue of “Other ACEs”

Kerry Jamieson Blog, Fighting ACEs PBC, Latest News, Uncategorized

The concept of Adverse Childhood Experiences (ACEs) is based on the 10-question survey originally developed for the first large-scale study on the subject conducted by the Centers for Disease Control (CDC) and insurance giant Keiser Permanente from 1995 to 1997. Using a purist’s definition of ACEs means we only consider the ten questions designed to identify incidents of abuse, neglect, and household dysfunction that might cause the kind of sustained toxic stress that define adversity and have lifelong mental and physical health implications.
Specifically, the initial questionnaire sought to unearth experiences that included:
• Physical, emotional, and sexual abuse
• Loss of a parent/caregiver to death, divorce, or incarceration
• Substance abuse and mental illness in the family or home

Keeping to the original ten questions allows for the accurate collection of data, as it ensures we compare ‘apples to apples’ and generate clean results. However, being a trauma-informed and ACEs-aware member of society doesn’t just mean knowing what ACEs are. We need to become a kind of mental detective to understand what else ACEs might be. We must identify situations that could be traumatic and develop insight into what causes feelings of sustained fear and anxiety in a child. It’s a bit like the difference between the letter of the law and the spirit of the law. One is a narrow, clear definition and the other seeks to understand implications beyond the literal (often limiting) definition.

As discussed in an earlier blog, we know that it’s really the repeated activation of the body’s natural flight, flight, or freeze response that causes the damage that might result in issues and challenges down the road. This prolonged toxic stress in the absence of positive buffers is what results in developmental issues, so whatever might cause toxic stress should draw our focus, not a strict list of specific yes or no answers.

By now, we also have a greater understanding of the mirror issue of Adverse Community Environments. Children growing up in communities where socio-economic deprivation is prevalent are likely to suffer higher doses of adversity, so we can expect higher levels of toxic stress among children in areas where poverty, discrimination, violence, substandard housing, and general lack of opportunity, economic mobility, and social resources are common.

Along with generally adverse environments, let’s consider some other negative experiences that weren’t explicitly identified in the original study but which can clearly result in toxic stress in the absence of effective buffers.

Accidents and/or Medical ACEs

Most of us have had an accident or undergone surgery of some kind in our lives. While stressful, these experiences fall into the short- or mid-term, tolerable type of stress because we deal with them, heal in an appropriate time period, and move on with our lives. This is especially true if the procedure is scheduled and we have time to plan for it; stress increases in correlation to the speed of the onset of the incident/condition, the complexity of the issue, and long-term, unexpected consequences of the event itself. The same is true when a child experiences the absence of a parent/caregiver due to an accident, or when a child experiences an accident or unexpected hospitalization.

The original ACEs study identified incarceration of a parent/caregiver as a potential ACE. The creators of the study obviously envisioned the long-term implications of the loss of a primary source of attachment from a young child’s life, but it’s not just death, divorce, or incarceration that can remove a caregiver. A severe accident that suddenly results in the loss of a parent can be difficult for a young child to understand. It can result in a change of caregiver or even a complete change in the home environment, leading to uncertainty, insecurity, failure to securely attached to an adult figure, and the toxic stress associated with those events. The same can also be true when a child endures an accident themselves, or suffers a severe illness that removes them from their home, especially when it involves insecurity and long periods in a hospital or rehab facility.

Of course, millions of children experience these events and come through them unscathed thanks to devoted parents, skilled counselors, and caring medical staff. Again, it is not necessarily the experience itself but rather the absence of a positive buffer in the face of the experience that really counts. This is why it’s so important to ensure that experiences are adequately explained and properly processed by children. It can make all the difference between an experience that results in healthy memories of personal resilience or one that causes lifelong psychological scars.

Institutionalized Abuse ACEs

The countless sexual abuse scandals that have rocked the world over the past few decades illustrate another type of ACE that has plagued our children. While sexual abuse is included in the original study, the institutional nature of church- or faith-based sexual abuse adds a whole new layer of complexity to this traumatic experience. Often, the abuser is associated with goodness and virtue; in some cases, the abuser is a direct appointee or representative of God himself in the child’s mind. Intertwining issues of religion, deep trust, and faith with the abuse scenario is psychologically devastating.

The millions of suffering victims worldwide show how insidious this kind of abuse can be. Survivors may require highly-skilled therapists to help them work through the issue while still maintaining their faith (should they wish to do so).

Child sex trafficking is an established system of abuse (albeit a black market one) that occurs in every country. In some regions of the world, a very real child sex tourism industry thrives. This degrading and catastrophic abuse results in extreme and complex ACEs among the victimized children as well as the adult victims who have endured these practices in their past.

Culture-Related ACEs

Certain cultural norms are accepted in parts of the world but abhorrent in others. These ‘hot potato’ issues pit individual/religious/personal rights against the accepted morality of the dominant culture and are deeply sensitive. One example of a cultural ACE is Female Genital Mutilation (FGM) which is a silent scourge that affects 200 million girls and women in approximately 30 countries in Africa, Asia and the Middle East. It is a growing issue in western society due to increasing immigration. FGM includes all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons. The mutilation is performed, usually by unskilled practitioners with little to no medical training, on girls from infancy to +-16 years old and is a violation of basic human rights — undoubtedly an ACE. The “ceremony” itself is traumatic, often conducted without anesthetic, and the lifelong consequences associated with it can be devastating. The numerous physical issues of infection, difficulty urinating of passing menstrual flow, infertility, pregnancy and childbirth complications can start in childhood and last for a lifetime. The guilt, shame, sense of otherness, and silent stigma of FGM can mean decades of suffering for victims of the practice.

Child marriage s another traumatic experience that is most common in certain Eastern culture but also still entertained by some cults and splinter groups in the United States. These circumstances may seem rare but without a doubt they do occur and would certainly qualify as adverse experiences for children.

ACEs Caused by War or Unrest

Societies in turmoil expose children to extraordinarily damaging experiences. Innocent victims of war, unrest, riots, or corrupt or inhumane political systems (such as the historic period of apartheid in South Africa or the current oppression of North Korea) undoubtedly carry the wounds and scars of their childhoods with them into adulthood. Many have witnessed brutal crimes like murder and rape, the results of terrorism such as explosions and genocide, as well as torture and the decimation of their communities. Again, this may seem extreme, but remember that millions of children worldwide are exposed to these events. Increased global mobility and the rise in numbers of people seeking refugee status in haven countries for these very reasons, it is not unreasonable to think we may encounter children suffering the effects of these devastating issues.

Racism Causes ACEs

Some types of ACEs are very prevalent closer to home. Studies show that racism is a deeply affecting adverse experience. Children from many minority groups (based on race, religion, disability, or national origin) suffer high doses of toxic stress resulting from the prejudice and hatefulness of others. You can learn more about how minorities experience ACEs to a disproportionate degree in our previous blog on ACEs and Minorities.

Technology-Associated ACES

Technology is evolving at a rapid pace, often faster than we can come up with ways to protect our children from exposure to unhealthy experiences. There has been a movement to include bullying (especially cyber bullying) as an ACE, as it can be protracted, isolating, and extremely emotionally damaging. In the worst cases, elements of blackmail may be involved where bullies hold the threat of sharing inappropriate or damning images or videos over the heads of their victims. The suicide rate among young and very young children is often correlated to bullying. There have been cases of suicide by children as young as 8 or 9 due to their inability to cope with the intense anxiety and fear of being in such a situation without perceived adult support.

The onus is on parents, teachers, and caregivers to:
1) Be vigilant in monitoring their child’s screen time and online interactions
2) Make sure their child knows they are always available to talk things through no matter what the situation might be
3) In general, it is appropriate to complete a contract with younger children that clearly includes an agreement of how/when the cellphone will be used, that the adult will always have free access to any of the child’s online activity, and that there are consequences for breaking the rules. Kidsafe Foundation has some great tools on their website, including internet safety tips and ideas for phone contracts.

Another aspect of increased screen time is the possibility of exposure to damaging age-inappropriate and material. This could include things like films with mature content, violent video games, and pornography. Depending on the nature and intensity of the material, repeated exposure can be considered an adverse experience particularly if a child sees very dark materials on a regular basis. Bear in mind that predators use pornography to groom and desensitize young children and make them vulnerable to abuse. While adults have the developmental ability to process and assess extreme material, young children do not. Early exposure to adult material can have a host of potential mental and physical health implications later in life including guilt, anxiety, inappropriate sexualization in very young children, promiscuity or sexual acting out, eating disorders, substance abuse, and many others.

Unearthing All ACEs

These examples of other ACEs are by no means a definitive list. Hopefully, they offer a starting point for a new way of thinking about ACEs because childhood trauma is not limited to the ten experiences identified in the original ACEs study. We need to work under the “spirit of the law” to identify what might be traumatic and cause long-term toxic stress in a child, causing developmental delays, brain functioning abnormalities, and difficulties with learning, forming happy relationships, and being a positive member of the community.

As we practice using our trauma-informed radar, more and more examples of potentially damaging experiences might come to us. By understanding what could negatively affect a child in the long term, we can equip ourselves to provide the antidote. We can only be effective buffers against trauma if we fully understand not only what ACEs are but what else they might also be.

Sign up now for news, events, and education about Adverse Childhood Experiences (ACEs) and promoting resilience.

By submitting this form, you are consenting to receive emails from: Center for Child Counseling, 8895 N. Military Trail, Palm Beach Gardens, FL, 33410. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email.

Teachers as Buffers Against ACEs

Kerry Jamieson Blog, Fighting ACEs PBC, Latest News, Uncategorized

We give teachers unprecedented access to our children. We entrust them to educate our children but we also allow them to influence our children’s thoughts, attitudes, and behavior for many hours every day. Fortunately, most teachers are special, dedicated people who care deeply for the well-being of little ones. Teachers also have a profound opportunity to positively affect the life of a child with ACEs. For this reason, teachers can be powerful buffers against adversity and should have all the knowledge and support they need to meet this enormous challenge.

We all know that teachers are basically superheroes. Many of us have a special teacher in our past, someone who came into our world at a crucial time and possibly changed the course of our lives. Even people who don’t have fond memories of school acknowledge that being a teacher is a calling more than a career, especially since teachers are often considered overworked and underpaid. Teachers tend to give of themselves above and beyond what could reasonably be expected. The very best teachers sacrifice their personal time and money to give their students richer learning experiences. These caring professionals may sometimes feel unappreciated, but they play a crucial role in supporting our children – not only in their academic pursuits, but in their development as flourishing, fulfilled human beings.

School is a Pivot Point in a Child’s Life

A child’s first experiences, positive and negative, come from interactions with their immediate family members or caregivers. After the age of 5 or 6 (and often younger) a new area of influence enters their lives: kindergarten or school. At school, children meet peers and teachers. Adjusting to mixing with other children who are not siblings is a challenge even for a well-adjusted child. For a child who has not benefitted from strong family supports, it may be almost impossible. Their backgrounds have not prepared them for life lessons like:
• Sharing, fairness, and negotiation;
• Self-expression of emotions, creativity, and personality;
• Kindness and compassion; and
• Simply getting along with others.

Sadly, every year millions of children start their school careers with very little preparation from the home front. They may come from chaotic, deprived, or even abusive backgrounds. They are among the 20% of little ones starting school disadvantaged by at least two ACEs. This puts them at risk for mental and physical health issues and diminishes their ability (at a bio-chemical level) to behave appropriately and be academically successful. There’s no doubt that teachers of very young children are up against many challenges!

Teachers likely spend more time with young children than their parents do. They are uniquely positioned to identify:
• Children struggling to adapt to school;
• Children with learning difficulties like dyslexia, ADHD, and numerous other concerns; and
• Children with physical challenges like vision, hearing, or coordination issues.

So, while already tasked with a full load of teaching and testing requirements, teachers are also often responsible for the social-emotional wellness of the little people in their charge.

Why Do Teachers Play This Role?

Of course, teachers don’t necessarily relish this aspect of the job. Their primary assignment is to educate but many are thrust into the position of having deal with emotional and behavioral issues simply to maintain order in their classrooms. It can be a constant battle to ensure that the many children trying to learn are not disrupted by the few who are “acting out”. How teachers approach this juggling act is absolutely crucial.

Throughout this series, we have learned about the alarming prevalence of ACEs. The statistics show that every classroom in America has several children who are trying to cope with experiences that even adults would struggle with. These issues are amplified in neighborhoods experiencing Adverse Community Environments (the mirroring component of the Adverse Childhood Experiences issue). Schools are challenged when they are located in areas troubled by inequity, poor resources, gang violence, weakened social supports, high rates of unemployment, and poor maintenance of communal areas like parks, roads, and sidewalks. These schools, which would benefit the most from prevention and early intervention childhood mental health services, often receive the least attention. Their teachers may be facing the most daunting and complex problems.

Organizations like the Center for Child Counseling can make the most impact in these neighborhoods. Our skilled therapists are co-located in more than 30 schools (as well as numerous community centers) in at-risk zip codes but they alone cannot have as much influence as the numerous teachers working in those areas’ schools.

What is the Most Important Thing in a Classroom?

It’s not the behavior of the children, the number of students, or the facilities available in the school. When it comes to building successful children, the most important aspect of every classroom is the ATTITUDE OF THE TEACHER. Children are sponges who absorb words, feelings, and the atmospheres in which they live. They look to their teachers to provide examples and guidance about how to behave. The way teachers choose to respond to every situation with a child either escalates or deescalates that situation.

A child who smashes a toy in a rage can be labelled in a teacher’s mind as bad or naughty. However, the behavior can also be identified by the teacher as an indication of some intense emotion that child is experiencing. By avoiding the label of “bad”, teachers can decide to see this behavior as an opportunity to intervene and teach a great child who is full of potential! Accepting a child for who they are, even in moments when their behavior is challenging, means teachers can reserve judgement and avoid sending the message to a child that they are disliked, a failure, or simply a bad kid.

Attitude and acceptance work hand in hand to help build self esteem and resilience in children, and we already know that these qualities serve as antidotes to the adverse experiences they may be experiencing at home or in their community.

Special Care for Educators

Of course, all teachers were once children, too! Many teachers still carry the burdens of unresolved childhood adversity with them. They can bring their own pain, sadness, and insecurity into the classroom where children’s behavior can serve as a trigger that churns up past emotions. It’s vital for teachers to identify their own ACEs, what triggers negative feelings in them, and key ways to cope not only with a child’s behavior but their own responses to it.

We Offer Support for Teachers

Our training, designed specifically for teachers, offers practical, useful advice to help teachers become more trauma informed, so they can be the strongest possible buffers for our children. Society has assigned teachers a sacred role and we need to equip them to fulfill their calling to the best of their ability.

Our specialized therapists co-located in elementary and middle schools throughout Palm Beach County provide direct support to both students and teachers — a model that’s truly unique. Our approach offers prevention, early intervention, and targeted services for children while also creating a wraparound supports for teachers that build a positive learning environment throughout the school.

If you’re a teacher, or the parent of a child, ask for our training at your school. We offer basic and advanced modules through our Institute for Clinical Training. As members of the community, let’s support our teachers because they really are the front-line troops, the crucial buffers, against adversity in our war with ACEs.

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Toxic Stress and ACEs

Kerry Jamieson Fighting ACEs PBC, Latest News , , , , , ,

Stress is a strange thing. It’s both a feeling (a sense of being under intense pressure or emotional strain) and a mechanism by which the body’s systems respond to those feelings. We hear opposing statements about stress. Either stress is good for us because it motivates us to succeed, or all the stress in our lives in going to kill us… Which one is true? When it comes to stress, it’s a matter of degree. Yes, a little stress is part of human survival. It focuses us, energizes us, and helps us get things done. On the most primitive levels, feelings of danger trigger our body’s autonomic responses, flooding us with the hormones that once allowed us to flee from predators or enemies, or stand and fight them. Although that dramatic response is seldom needed these days, except in extreme cases of danger or sudden emergency, the stress response mechanism is still in place and vital in the rare instances when we need it. But this powerful system that’s built into every human body can be very dangerous—especially to children—when it’s triggered too frequently.

The body has several reactions to extreme danger or fear:
1.) It can embolden us to stand our ground and fight for our survival (FIGHT)
2.) It can trigger the strength and stamina we need to run away (FLIGHT)
3.) It can cause a state of near inertia in some people, thus the phrase “paralyzed with fear” (FREEZE)

It’s often hard to predict which response we’ll have in any given situation. In many cases, it seems that our body innately chooses for us but, in every case, the presence of danger sets off a series of chemical reactions in the body led by the brain and the endocrine (or glands and hormones) system.

The Immediate Effects of Adrenaline and Cortisol

The presence of danger or even severe unpredictability causes the brain to send a message to the glands to release adrenaline and cortisol. Between them, these two hormones do quite a lot to the body in a very short time:
1.) They increase the heart rate which raises blood pressure
2.) They expand the air passages to the lungs, bringing more oxygen to the body
3.) They rush sugar to the bloodstream
4.) They dilate the pupils of the eyes
5.) They prioritize the sharing of oxygen with muscles to give us power we may not know we had. Think about those news stories where people suddenly display incredible strength to save others, by lifting up a wrecked car to save a child, for example. Thank you, adrenaline!

However, adrenaline and cortisol are emergency measures — the last resort response for extreme situations. You might feel exhausted or quite nauseous after an extreme adrenaline dump, for example. That’s because your body is recovering from the intense activation and takes some time to manage and re-balance all the hormones in the blood. The body is always looking for homeostasis, or balance, where all systems are operating normally. Spikes of adrenaline and cortisol severely disrupt homeostasis and that’s a problem.

It’s true that there are good levels of stress. These are short periods of pressure that push us to complete tasks or focus on something we need to achieve. The stress passes and the body recovers quickly. However, when the stress is prolonged or repeated and there aren’t enough positive resources to counteract their effects, stress becomes dangerous and we call that toxic stress.

ACEs and Hormones

So why all this information on hormones and toxic stress? And how does it all tie back to understanding Adverse Childhood Experiences? Dr. Nadine Burke Harris, a pioneer in ACEs research, explains that adrenaline and cortisol are great if you encounter a bear in the woods. “The problem,” she says, “is what happens when the bear comes home single night?”

Continuous and repeated activation of the fight or flight response can “burn out” the system which is not intended to be in constant use. Adults suffer physical health issues if adrenaline and cortisol are released too frequently into their bodies. High blood pressure, chronic inflammation, high glucose levels, and low bone density are just a few of the numerous side effects which can result in:
• Anxiety
• Depression
• Digestive problems
• Headaches
• Heart disease
• Sleep problems
• Weight gain
• Memory and concentration impairment

The Effects on Children

For children, the situation is even worse. When little human brains and bodies are growing, there is a lot to do. The brain is developing at its fastest rate. Brain growth surges for the first 3 years of life, expands rapidly for the next ten years, then plateaus in the early 20s. But during the formative years, the body is using resources like the energy from food to accomplish countless tasks – building muscle, growing bone, honing the senses, and developing coordination and communication skills. With only a finite number of resources available, the brain allocates them to the most immediate and vital needs. In the case of constant fear and danger, the adrenaline process is triggered again and again at the expense of developing other parts of the brain and body.

Since survival must come first, that’s where all the energy goes, neglecting cognitive development and impeding those sectors of the brain vital for reasoning, self-regulation, and ultimately behavior and learning ability for the rest of a child’s life. In many cases, the lost ground is difficult, if not impossible, to make up.

A Life of Fear

So, imagine a child living in a home with domestic violence. He lives with daily uncertainty and apprehension. He is on constant alert, waiting for the next tragic event. He is always in fear of witnessing or being the victim of abuse. When it occurs, he suffers extreme terror and a sense of helplessness. He lives his life in a constant state of toxic stress. The healthy development we owe all children has, in a sense, been stolen from him.

Effects of Toxic Stress on the Body Systems of a Child

Nervous System:
Toxic stress disrupts the developing brain, including changes to the hippocampus, prefrontal cortex, and amygdala. This raises the risk of cognitive impairment, learning disabilities, hyperactivity, poor self-regulation, inhibited memory and attention span, and anxiety.

Cardiovascular System:
Toxic stress increases a child’s risk of developing high blood pressure later in life because it elevates levels of inflammation that can damage the arteries. This can lead to heart disease, stroke, and other serious heart issues.

Immune System:
Toxic stress raises the risk of infections and autoimmune diseases due to chronic inflammation and other factors. This can impair the normal development of the body’s immune system.

Endocrine System:
Toxic stress can inhibit the functioning of hormones that regulate growth and development. It can also lead to obesity and impede or accelerate the onset of puberty.

This is what toxic stress looks like: It’s the relentless fear, anxiety, uncertainty, and terror that can cripple a child’s developing brain and body.

ACEs are not just experiences, they are events that cause chemical disruption in the body and result in lifelong mental and physical health issues. When a child is traumatized, abused, or neglected, we are changing who they are at a cellular level and causing damage from which it is very difficult to recover.

But hormones are powerful agents for good, too. A few months ago, this blog series focused on resilience and how to be a buffer for a child. Science shows that the presence of just one positive adult influence in a child’s life can help mitigate against the detrimental effects of ACEs. How does that work on a cellular level?

The Science of Kindness
As well as hormones that protect us, we have hormones that keep us close as a society. Human beings are communal creatures and we’ve developed to co-operate and help one another. Our bodies are even programmed to want to do this because it facilitates our survival imperative: we are stronger together than we are alone.

Acts of kindness often bring us a good, warm feeling. That’s not just an emotion, it’s a chemical reaction in the body. Kindness or altruism releases a chemical in our blood called oxytocin which sends positive, self-affirming signals to our brain. It’s often called the happiness drug. Oxytocin, along with dopamine and serotonin, make up what’s called the Happiness Trifecta. They increase the production of neurochemicals that lift your mood.

Kindness, care, support, warmth, compassion, and love all release these amazing chemicals which have positive health effects like lowered blood pressure, which reduces strain on the veins and arteries and can help stave off heart disease. These positive chemicals are fast-acting, too. In fact, chemicals resulting from a kind or loving interaction can positively influence the brain in as little as 3 seconds!

Remember a time when you felt anxious or depressed. Think how good a simple hug from a loved one felt at that time. That’s oxytocin! There’s a reason it’s called the “cuddle hormone”. Think about how uplifting an unexpected compliment can feel. That’s dopamine! The Happiness Trifecta help both the giver and the receiver to raise their levels of good, happy hormones. And its these hormones that counteract and neutralize the effects of adrenaline and cortisol.

Every time you have an interaction with a child that’s focused on giving something positive to them–even if it’s a high-five, a thumbs up or a big smile–that’s medicine that works as an antidote to ACEs. It hardly seems possible that it’s also doing great things for your own body, too.

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ACEs and Divorce

Kerry Jamieson Fighting ACEs PBC, Latest News , , , ,

Between 40 and 50 percent of US marriages end in divorce. Divorce may seem commonplace, even mundane, these days but its prevalence is exactly what makes it such a threat to the healthy mental and physical development of children. While divorce may have become more socially acceptable in recent decades (or even ‘normalized’) the experience for children is almost universally difficult. There is no doubt that the conflict and chronic stress involved in divorce is one of the leading causes of trauma in young children and a very significant ACE (Adverse Childhood Experience).

Even when both parents agree that it’s the best decision, divorce is a confusing, difficult process for adults, let alone children. Divorce introduces new stressors into a child’s life. Whether the separation occurs when they’re three or 13, children worry about what’s happening to their family. Often, children experience feelings of fear, uncertainty, anger, and disappointment. To a child, a divorce can feel like a violation of trust or a broken promise. Most children rely on their homes to be a place of security and safety. Breaking up that home shakes their world to its core. Little brains that are still forming cannot process information in the same way a more reasoning adult can. Children tend to internalize feelings of guilt or self-blame over their parents’ divorce that can affect them for the rest of their lives.

True, there are millions of successful adults who grew up as children of divorce. While ‘pro-marriage’ groups say all divorce has negative impact on children, other studies do seem to indicate that it is preferable for unhappy parents to separate and care individually for their children than for children to be raised in two-parent homes filled with resentment or even rage. A recent British study shows that 82% of children (aged 14 to 22) whose parents divorced  preferred their parents to separate agreeably than to ‘stay for the kids’. Divorce becomes an even more urgent decision when domestic abuse or violence against one or both partners (or the children themselves) is occurring. But there are as many adult children of divorce who are still trying to deal with the emotions and experiences their parents divorce caused them. Some studies indicate that the death of a parent (one of the most significant ACE indicators) may be easier for some children to understand and manage than divorce. In a child’s mind, it is easier to think that a parent died rather than that they left by choice.

Why is divorce such a powerful ACE?

• It introduces intense feelings of uncertainty, often for the first time if it happens very early in a child’s life
• It can cause an environment of chronic stress from anger, bitterness, and fighting
• It may cause economic strain on one of the divorcing parents
• It may separate the child not only from one parent but that parent’s family members who may have been a loving and stable influence
• It may expose a child to a parent’s new partners, which can increase risk of physical or sexual abuse

Of course, resilience levels among children are different. Some children cope and adapt better to divorce than others. Even among siblings experiencing the same divorce environment, the reactions may vary dramatically.

What Are the Warning Signs?

Here are just some of the indicators that your child may be having difficulties coping with your divorce:
• Poor performance or declining grades in school due to inability to focus
• Behavioral problems like attention seeking, “acting out”
• Mood swings or prolonged sadness/depression
• Apathy or loss of interest in places or activities they once enjoyed
• Less interest in spending time with friends
• Unwillingness to cooperate with everyday activities/defiance
• Low self-esteem and withdrawal
• Regressing to younger behaviors in an attempt to return to babyhood, clinginess
• New or increased irrational fears

If you’re dealing with divorce, be aware that even very young children may struggle emotionally. Short-term sadness and anger are normal. If negative emotions and behaviors continue beyond a few months, experts suggest counseling. Organizations like the Center for Child Counseling can provide expert, age-appropriate therapy to help children during and after a divorce. If an ACE like divorce is not addressed adequately, children may be impacted long-term and have a higher likelihood of using drugs and getting involved in criminal behavior later in life.

Adults Recall the Childhood Trauma of Divorce

When adult children of divorce look back on their childhood experiences, many express that it was the stress and conflict that was created by the divorce and not the splitting of parents itself that was so difficult to overcome. Often, children are used as pawns or become weapons in the fight between the separating partners. Asking children to choose between parents is extremely traumatic and brings feelings of anxiety and guilt that can last a lifetime.

Most times, parents go into self-protective, offensive mode and “lawyer up” which, while advised for many reasons, can create an immediately hostile and adversarial environment into which the children are inevitably dragged. The numerous emotions adults feel during a divorce—grief, anger, disappointment, loss of control, fear, loss of status, antagonism, bitterness, sadness, etc.—may also be experienced by children in different ways and for different reasons.…and if adults find it difficult to identify and cope with the emotions being raised, how much harder must it be for a child’s growing brain to process?

Parents who prioritize their children’s needs during a divorce should be viewed as heroes who have managed to look beyond their own emotions and chosen not to put their children at risk for long-term repercussions associated with ACEs.

Minimizing the Impact of the Process

You don’t have to put your own interests/needs last in order to put their children’s interests first. There are different ways to get a divorce. Parents can try to choose a non-adversarial form of divorce, if possible. They can consider mediation or collaborative resolution, if the nature of the divorce allows for it. It’s cheaper and often less traumatic for everyone involved.

Of course, there are as many different kinds of divorce as there are marriages. Some divorces are divisive and going to court may be inevitable. Center for Child Counseling board member and partner at Ward Damon, Eddie Stephens views ACEs from a family court perspective. He sees the trauma in families going through divorce: “There is an incredible amount of dysfunction out there. It is on full display in family courtrooms across the nation. Most professionals are just dealing with symptoms (substance abuse, violence, reckless behaviors), but little is done to address the root cause. In more cases then not, these individuals have suffered through some kind of traumatic experience(s) as a youth. That is the problem that needs to be addressed… not just the symptoms.”

Stephens sees how childhood trauma is transmitted from one generation to the next.

“The goal should be to create a trauma-informed society that appreciates the impact ACEs can have on an individual throughout their lives. If we shifted resources and provided the needed therapy when these kids were young, we would be more likely to stop the generational cycle which would lead to a healthier society. If we don’t embrace that approach as a society, we will continue to spend money on the symptoms while further generations become entrapped in this horrible cycle of dysfunction.”

Try to Have a ‘Grown-Up Divorce’

Children mimic grown-ups’ behavior. They learn what maturity is by watching adults. Parents teach us lessons of sharing, listening, playing fair, and being honest and kind, yet so often these simple rules are broken during a divorce. For a little brain seeking to process these events, it’s all very confusing. Positive or negative world views are being formed at this stage of life and witnessing a mature versus an acrimonious divorce can skew a child’s views on the safety or danger of adult relationships for the rest of their lives.

Mature parents can minimize the impact of their divorce by focusing on some simple guidelines. They may sound like common sense but, in the heat of the moment, practicing these rules can be a challenge. However, it will benefit your child during your divorce and for the rest of their lives.

Communicate:
Wherever possible, communicate decisions about the divorce as a family. Ideally, if all parties are present, the child will understand what is happening and see that both parents still love them. Do not share intimate details of the causes of the divorce; share age-appropriate facts only. Avoid the “blame game” or “he said, she said” story-telling.

Prepare:
Tell your children ahead of time what will be happening and when. Nobody, especially a child, likes to be sidelined by dramatic, unexpected events. Tell your children, as early as possible, about major life events like moving houses, changing schools, etc.

Acknowledge Emotions:
Don’t try to pretend that this decision is the best choice and “better for everybody”. Your child may not feel that way. Empathize with their sadness and fear and allow them to talk about their emotions. Always allow them to talk positively about the other parent.

Prevent Stress:
Try not to expose your child to adult concerns. Ensure they don’t overhear cruel arguments or intimate issues. You need to walk a fine line between keeping them informed and protecting them from age-inappropriate facts, no matter how true.

Provide Structure:
Some of the biggest changes for a child going through a divorce is the loss of significant time with one parent or the other and the constant moving between new living spaces. If you can agree on universal rules that are obeyed at both homes, it will reduce stress for your child. Try to maintain routines and not change/cancel plans at the last minute. This will only add to your child’s anxiety and insecurity.

Keep Loving Buffers in Their Lives:
Your child should never have to choose one parent over the other and that goes for extended family members, too. Your child may be very close to your ex’s siblings (their aunts, uncles, and cousins) and your ex’s parents (their grandparents). These positive influences in their lives can help buffer against the stress of the divorce and minimize the effects of ACEs. Do your best to nurture those relationships and let your child enjoy the stability of still having these good, kind people in their lives.

Use Kind Words:
In the case of biological children you have in common, it helps to remember that your amazing, precious children are 50% your ex. Every bad thing you say about him or her, you’re saying about the children you share, too.

Don’t Force Them to Hide Things From You:
Your children are likely to feel torn or periodically disloyal during and after the divorce. Allow them to share positive thoughts or feelings about your ex. They shouldn’t feel that they have to hide funny stories or happy thoughts about your ex from you. You can find ways to reinforce these in a way that’s both honest and supportive of their feelings:
“I always loved how smart your mom is.”
“You dad always tells the best jokes.”

Love Them Extra:
It goes without saying that during this difficult time you should support your child even more than usual. Smother them with love and encouragement. In the case of an especially hard divorce, you might try to remind yourself that you love your child more than you hate your ex.

There is no reason your divorce should be a childhood trauma that scars your children for life. So many parents manage to get it right and provide two secure, stable and happy homes for their children after their divorce. The ultimate goal is not to “win your divorce” but for your children to have a lifelong positive relationship with both their parents.

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ACEs and Pregnancy

Kerry Jamieson Blog, Fighting ACEs PBC, Latest News, Uncategorized , , , ,

For many women, seeing a positive result on a pregnancy test is a moment of pure joy, the culmination of months (or even years) of hope, and the start of a fulfilling journey to motherhood. But pregnancy isn’t easy, physically or emotionally. It places extraordinary demands on a woman’s body and may cause stress in relationships, introduce financial hardship, and affect self-esteem. It is undoubtedly the most dramatic and permanent life change most women will ever face.

As wonderful as the prospect of bringing a new life into the world may be, it comes with its own unique set of challenges when viewed through a trauma-informed lens. The two lives of a mother and her growing infant are inextricably intertwined, and stress and trauma can have a startling impact on both. While a mother brings her own childhood experiences to her pregnancy, she may also be encountering new ones, and since the baby is exposed to all the hormones and emotions of the mother during its crucial in-utero development, pregnancy is a critical time to discuss Adverse Childhood Experiences (ACEs).

To discuss ACEs and pregnancy fully, we need to understand it from two points of view.
1.) How ACEs have affected the mother’s life, how they may still be affecting her mentally and physically, and how they might interfere with her ability to nurture and care for her child.
2.) How a mother’s ACEs affect her developing baby and what effects the infant might experience in the womb and during its first few years of life.

A Time of Change and Challenge

Some of the issues a prospective new mom might be going through include:
• identity shifts
• fear of inadequacy as a parent
• loss of independence
• delay or loss of personal goals and dreams
• relationship conflicts
• financial uncertainties
• ambivalence about bonding with her baby
• body image difficulties
• hormonal dysregulation
These issues are especially magnified if the pregnancy is unplanned or unwanted.

In addition to all these new feelings and insecurities, finding out that she is pregnant often focuses a mother-to-be's attention on the concept of parenting. This can bring past traumas to the surface, especially if she was a victim of childhood abuse or neglect. Symptoms of depression, anxiety, or post-traumatic stress may return, or surface for the first time, during pregnancy. It's a tumultuous time and one when the consequences of ACE can be clearly seen but also an opportunity to intervene and hopefully prevent the cycle of ACEs from continuing into the next generation.

For example, a recent study using data from the 2010 Nevada Behavioral Risk Factor Surveillance System showed that a history of childhood stressors, such as physical, sexual, and emotional abuse, influenced alcohol use among pregnant women. The research found a dose–response relationship between ACEs and alcohol use during pregnancy. This study contributes to a growing body of research that shows that the factors affecting alcohol use during pregnancy begin long before pregnancy...in fact, they likely begin in the pregnant mother’s own childhood.

Health Risks Associated with High ACE Scores

When adults become parents, the effects that ACEs have had on their own bodies, minds, and behaviors can influence how they experience their pregnancy as well as the physical health of their growing baby.

  • When a pregnant woman is exposed to chronic stress, large amounts of neurohormones are released into her blood stream and can change the developing fetus' own stress response system.
  • Maternal stress hormones can cross the placenta as early as 17 weeks into pregnancy.
  • Women with high ACE scores are more likely to develop gestational diabetes and high blood pressure.
  • They are more likely to deliver prematurely or have a baby that is underweight or requires NICU care.
  • Even when they deliver full-term, their babies are at greater risk for developmental delays.

The good news is that during pregnancy mothers are particularly receptive to ideas on how to positively impact their baby’s life and more open to positive reinforcement about improving their own lives. Pregnancy represents the perfect point to intervene on behalf of both mother and child. Often, just finding out that she is pregnant brings a new sense of hope and determination to a woman. Pregnancy offers the opportunity for her to discuss her own childhood issues, make improvements in her life, and perhaps really confront past traumas for the first time. Pregnant women should be encouraged to openly and honestly ask for support from family and friends. In most cases, once loved ones are aware of past trauma, they respond with concern and compassion, which can be a relief for the mother-to-be and a source of comfort. For some, this may well be the right time to consider counselling or seek professional support, if needed.

Identifying At-Risk Moms

Identifying moms-to-be with high ACE scores is crucial. A simple ACE questionnaire conducted during routine pre-natal care visits can indicate the need for early intervention. This tool can help begin discussion around the concept of ACEs -- that a mom's (and other caregivers') behaviors when the baby is in utero and during its first few years of life can position their baby either for success and wellbeing or for possible lifelong poor health outcomes.

According to a study published earlier this year in the Journal of Women’s Health, when moms-to-be were surveyed at two Kaiser Permanente clinics in Antioch and Richmond, CA, from March through June 2016, clinicians discovered that the women were receptive to filling out an Adverse Childhood Experiences (ACE) survey. The researchers found that the vast majority of the pregnant women — 91 percent of the 375 surveyed— were “very or somewhat comfortable” filling out the ACE survey. Even more, 93 percent, said that they were comfortable talking about the results with their doctors. Simply using the ACE questionnaire as a tool provides an opening for discussion and thus plays a small part in providing a safeguard for the unborn baby and hopefully preventing multigenerational trauma transmission. For the most at-risk women, an intensive course of action might be necessary.

How Can We Protect a Baby in utero When ACE Scores are High?

Providing an at-risk pregnant woman with intensive support and practical resources will benefit her, her baby, and those around her.
The ideal approach would include all or most of the following:

  • Conduct joint counseling sessions with a professional therapist, the mother, the father, and other children in the home. This can be extremely helpful and informative for all involved.
  • Fully integrate behavioral health services with the mother’s medical team to optimize outcomes.
  • Train all medical staff (including pediatricians, midwives, OB-GYN practitioners, and ultrasound technicians) to be trauma-informed.
  • Connect the mother with a nutritionist and other ancillary support services for after she delivers.
  • Encourage the mother to connect with the baby in utero to promote bonding and stimulate mothering instincts.

Center for Child Counseling works extensively to implement some of these best practices. Therapists in our Infant Mental Health Program (funded by the Children's Services Council) provide services throughout Palm Beach County for pregnant women, new mothers, and young children. We also partner with Healthy Mothers, Healthy Babies in their efforts to provide support to all new moms and their babies born in the County.

Research increasingly shows that the connection between a pregnant mother and her unborn baby is even more powerful than previously imagined. While love may be instantaneous and natural for most moms-to-be, it may not be as intuitive for women who have a history of abuse, neglect, or trauma. These mothers can work on building that bond by practicing some loving exercises with their unborn baby.

For example, here are some ideas to help a pregnant woman connect with her growing baby girl:

  • Tell the baby often that she is loved.
  • Share how happy you are that she is a girl.
  • Reassure the baby that you are eagerly waiting to meet her.
  • You are ready to care for her, meet her needs, and protect her.
  • Her birth is welcome. She is good news.
  • Read stories to her, sing to her, and laugh as often as possible.
  • Choose and use silly, loving nicknames for her.
  • Babies seem to respond strongly to music and rocking/swaying. Dance with her.
  • Your voice forms a bond with your baby. Talk to her.

The Role of "Buffers" for Moms and Babies

Since we know that “buffers” are the single greatest weapon in the fight against ACEs, pregnancy is the perfect time to be the buffer for an expectant mom.

Listening, showing genuine concern, and offering love and support is the single greatest gift you can give a mom with a high ACE score.

You might share strengths you see in her. Constantly reassure her that she is a kind, capable, strong woman and that she is going to be a wonderful, giving mom. She does not have to repeat mistakes from her past and can give her baby the gift of a happy childhood, even if she never experienced that herself. Support should come, crucially, from spouses or partners (if they are present), but friends, family members, and neighbors can help, too. Community support is key. Women who connect with no- or low-cost community support programs fare better than those who remain isolated. Mothers-to-be support groups, centering circles, and even children’s reading groups at local libraries are places where pregnant women and new moms can meet and share with one another.

Pregnancy is a time for teamwork at every level. When mothers who have experienced childhood trauma feel supported by the people around them, their risk of pregnancy complications and repeating negative patterns are substantially reduced.

ACEs don’t define who we are or who we will become. Every pregnancy is a brand-new start, a fresh chance to bring a happy, healthy new life into the world. With support, people who have endured ACEs can achieve emotional and physical well-being and be given a better chance to avoid repeating trauma-causing cycles. It is compelling to realize the real difference each of us can make in someone else’s life – simply by choosing to be a kinder, more compassionate, and more giving person.

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ACEs and Minorities

Kerry Jamieson Fighting ACEs PBC, Latest News , , ,

ACEs and Minorities

ACEs can affect anybody, anywhere. Children experiencing adverse situations, and adults who experienced adversity when they were children, come from all walks of life. ACEs are not confined to any particular race, religion, socio-economic background, or nationality. Any child can experience the sustained toxic stress associated with untreated trauma and suffer negative mental and physical health effects.

The original study on Adverse Childhood Experiences conducted by the Centers for Disease Control and insurance giant Kaiser Permanente in the mid-1990s unearthed this fact early in their research. Their study was conducted among 17,000 middle-class Americans living in Southern California. Even though these original participants were not necessarily representative of the average American, approximately half of them had still experienced at least one ACE.

Subsequent US-based ACE studies, including the largest study conducted to date between 2011 and 2014, have consistently shown the same general prevalence of ACEs among American children. This far larger sample group, and the data accumulated from many studies, highlighted some startling differences in who is most likely to suffer from ACEs. Children from minority backgrounds—whether based on race, socio-economic standing, or sexual orientation—were at distinctly higher risk of ACEs and their devastating life-long effects than middle-class white children.

At-Risk Minority Groups

Children of different races and ethnicities across the country do not experience the same exposure to ACEs. In the United States, 61% of black children and 51% of Hispanic children have experienced at least one ACE, compared to 40% of white children. In every part of the country, the lowest rate of ACEs was among Asian children. In most areas, the population most at risk was black children.

Geographic regions also showed different results. Compared to the national average of 1 in 10 children experiencing and ACE score of 3 or more, in 5 states—Arizona, Arkansas, Montana, New Mexico, and Ohio—1 in 7 children had experienced the same.

In Florida, 49% of children between birth and 17 reported no ACEs. 26% reported 1 ACE, 14% reported 2 ACEs and 10% reported 3 or more ACEs. This is generally in line with national averages.

The high occurrence of ACEs among minorities can likely be attributed to the uneven provision of services and opportunities in minority neighborhoods. This inequity is caused by social determinants of health. The World Health Organization describes the social determinants of health as “the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources.” These result in the unfair but avoidable differences in health status seen between different neighborhoods, zip codes, and even states. The social determinants of health are responsible for most health and other social disparities.

ACEs Clusters

ACEs are the result of not only situations children face within their own homes or families but the general circumstances in which they live. Because the impact of ACEs is cumulative, we see high rates in areas where several detrimental situations are occurring simultaneously. For example, a neighborhood where there is a high rate of unemployment, few educational opportunities, a strong gang presence, and high rates of domestic violence is likely to produce children who are suffering from clusters of ACEs. Because of this, ACE studies now look at the cumulative effects of ACEs rather than the individual effects of any one specific ACE.

ACEs caused by the community environments where a child is raised go hand-in-hand with the ACEs occurring in individual homes and within families.

So, ACEs aren’t a racial issue; they’re a societal one. People with low incomes and limited education are also more likely to experience ACEs, as are people who identify as gay, lesbian, bisexual, transgender, or are questioning their gender or sexuality (the LGBTQ community). According to numerous research papers, including one published by the US National Library of medicine/National Institutes of Health, this group has a dramatically higher chance of experiencing childhood trauma, probably the result of lack of understanding among family members, the taboo of discussing these issues in some communities, and the stigma often imposed by society at large.

Helping children in these particular minority groups involves cultural sensitivity and the kind of community education that takes a long time to penetrate established ways of thinking. For many children confronting overwhelming adversity and inequity, buffering relationships are needed. It is essential to address the rejection and hardships they are statistically likely to experience in their lives - with a mental health professional or caring mentor or teacher who understands the impact of these experiences. Success among marginalized groups involves developing strong internal fortitude in children and encouraging them to eventually find accepting, supportive friends, if these relationships are not available at home or school.

It’s clear that minorities, children living in economically challenged neighborhoods, and members of traditionally marginalized groups are in particular need of support in the fight against ACEs.

Solutions

Now that we know that certain groups are more likely to experience ACEs, what can we do? As individuals and communities, we can channel our efforts. A high ACE score does not predestine a child for poor life outcomes, but it does identify that child as vulnerable. Since the fight against ACEs has two primary weapons, namely 1.) building resilience and 2) promoting healthy relationships (the internal and external supports, if you like), we can provide two practical forms of assistance to targeted groups.

Building Internal Coping Skills

To build resilience in children, they need to be taught how to self-regulate and cope. Anybody can help a child to develop these vital skills. Simple techniques like providing encouragement, supporting special interests, and even just taking notice of a child is, in some small way, building self-esteem and promoting independence and strength. Children will copy the actions of adults, especially those they admire. Showing children how to calmly and fairly negotiate, compromise, demonstrate empathy, and look at all sides of an issue can help them establish a new way of thinking. Remember that children mimic both positive and negative behaviors, so it’s important to carefully consider the messages you’re sending with your behaviors and choices.

Providing External Support Systems

Of course, the most at-risk children may need professional assistance to build effective coping skills and resilience. Offering age-appropriate early intervention and mental health care in childcare centers and elementary schools (especially in at-risk neighborhoods) is the obvious place to start. Center for Child Counseling, with support from local funders including Quantum Foundation, has developed a comprehensive model for childcare centers and schools, including trauma-informed education for all caregivers, classroom-based mindfulness activities, and direct services for children identified as needing assistance. The model focuses on transforming the school environment, which in the long-term, impacts all students.

Another approach is to provide supplemental support systems in at-risk neighborhoods. Many highly-respected nonprofits do just this by creating places where children can meet, play, and be in contact with positive, caring role models and mentors. Local organizations like Urban Youth Impact, the YMCA, Compass, and Big Brothers Big Sisters are all examples of nonprofits in Palm Beach County  focused on creating positive relationships that may be absent from the home.

And, as always, every one of us can play a role in the fight against ACEs by advocating for children, encouraging every child we encounter in our lives, and being on the alert for children who may need the support and help of a caring, ACEs-aware adult.

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ACEs: How to Be a Buffer for a Child

Kerry Jamieson Fighting ACEs PBC, Latest News , , , , ,

Research shows that just one positive adult can dramatically improve the outlook for a child suffering from Adverse Childhood Experiences (ACEs). Learn how your simple actions can provide a buffer against toxic stress and change the course of a child's life.

Remember when you were a child. Think back. Remind yourself how vulnerable you were. The world was big; you were little. Was there ever a time when someone protected you? For many of us, it was an older sibling, maybe a big brother, who stepped in, literally, and came between us and a bully or danger. Do you remember how safe that made you feel? How exhilarating it was, in your moment of need, to know that you could rely on help to arrive. When you hurt yourself or had your feelings hurt, you probably ran to a parent who gave you a caring hug and soothed you. Without consciously knowing it, those of us with these sorts of memories were running to a buffer, looking for the concern and protection every single child needs and deserves…but which not every child gets.

For millions of children worldwide, Adverse Childhood Experiences (ACEs) make growing up a challenge at best and a chaotic nightmare at worst. The brain of a child growing up in a home with attentive parents will create a world view where adults as safe, predictable, and a source of love and sustenance. But the brain of a child living in a home plagued by domestic violence or neglect will create a world view where adults are unreliable and a source of fear and pain. Children carry these ideas with them and they color all future relationships. Depending on their experiences and outlook, children can grow to become nurturing, invested adults or mistrustful, suspicious and withholding.

During this blog series, we’ve learned about ACEs, their tragic lifelong consequences for individuals and communities, and how we must urgently address this greatest of all public health crises. Rather than being overwhelmed by the statistics though, let’s focus on hope because healing is possible.

As a society, we now know more about ACEs than ever before. That knowledge empowers us. On a system level in Palm Beach County, we’ve mobilized the community to fight ACEs, but the truly encouraging news is that you don’t need to be an expert to help turn a child’s life around. Of course, severely traumatized children might need the professional help and compassion provided by skilled therapists like those at the Center for Child Counseling, but for many of the others the answer is relatively straight-forward. The answer is you.

As someone who loves and cares for a child, or who interacts with children often, it is vital to be ACEs educated and trauma informed. Simply by reading this educational blog series, you’ve demonstrated an interest in the subject. You’re already equipped to play your small but vital part in the fight.

Adjust Your Approach
Being trauma-informed really means adjusting our thinking and the way we respond and react to a child’s behavior. Instead of asking: “What’s wrong with you?” the focus should be: “What happened to you?” This changes our attitude to consider what the child has experienced rather than the resulting behaviors which may be frustrating. Follow-up questions will help get to the cause of the problem, questions like: “When did this happen?”, “How long has it been going on?” and “Who has been there to help you since this happened?” This way of approaching children helps to avoid re-traumatizing already traumatized people. It creates a safe, non-judgmental place where children feel secure enough to share their experiences and ask for help without fear of punishment or retribution.

Be a Buffer
Supportive, loving caregivers can buffer the effects of toxic environmental stress. There are many ways you can support a child with ACEs. Studies show that a positive, nurturing relationship with even one engaged adult can help a child cope with adversity. Consider how you interact with children—your own and other people’s—and focus on being loving, kind, and genuinely interested in them.

Easy Ways to be a Buffer
In the bestselling novel “The Help” by Kathryn Stockett, a devoted nanny repeatedly tells the young child in her care: “You are kind. You are smart. You are important.” Let that be your mantra when helping a child who has experienced ACEs. Whether you’re a teacher, neighbor, coach, community volunteer, or friend of the family, being a buffer means employing several different approaches aimed at:
• Reducing stress
• Building positive relationship
• Strengthening life skills

Here are some practical, real-world ways you can combat the toxic stress caused by ACEs.

Celebrate:
When we celebrate a child’s achievements and challenges, both big and small, and affirm who they are as individuals, we support the development of their self-identity and remind them of their competence, importance, and lovability. When we acknowledge their birthdays, graduations, or everyday accomplishments like completing their homework, making a new friend, or doing chores, we help children build positive self-esteem. It may be something as simple as a clap, a smile, or a ‘thumbs up’. These simple gestures are expressions of support that can build self-confidence and help a child to thrive.

Comfort = Safety:
Children who have experienced trauma or toxic stress need comfort. Often, they need help to manage their emotions and to calm themselves down. Practicing relaxation, patience, and emotional regulation may help them connect with their feelings. Creating a safe environment is one of the most valuable components in re-establishing a sense of security and stability for a child. Whether the issue seems big or small, offer reassurance and always reinforce your commitment to be there for them. Sometimes it can be difficult to stay calm and supportive when a child exhibits the behaviors associated with toxic stress, but a measured response tells them that you are solid and reliable.

Help Children Collaborate:
Science shows that children who have been exposed to toxic stress may struggle to appreciate others’ perspectives. They may lack a sense of belonging. They may not have the skills or the know-how to reach out. And they may need help controlling their emotions, working through their problems, and gaining independence. Every day there are opportunities to collaborate or work with children towards common goals. With simple examples, you can teach problem solving and basic negotiating techniques to deal with conflict. When children learn to collaborate fairly, they feel like part of a team rather than isolated.

Grow Optimism:
We’ve already learned that a young child’s growing brain has plasticity – it’s still forming neural pathways and those pathways can be altered for the better. Brain science shows that we can actually train our brains to be more optimistic and hopeful about the future by practicing positive self-talk. You can reinforce this kind of positive brain growth in the children you know.

Don’t Just Hear…Listen:
It may sound easy, but listening is a skill we all need to practice. For all children, especially those who have experienced traumatic stress and violence, a patient and receptive adult who listens can help them feel safe and valued. Active listening means paying careful attention to what is being said, rather than simply hearing it. Listening is the foundation of learning and understanding what a child is trying to communicate. It shows care and concern. Listening to a child and teaching them how to listen helps them communicate and see situations from other people’s perspective – a key to empathy. Whether children are sharing happiness, sadness, anger, or fear, having someone truly listen to them matters.

Hold on to Healthy Relationships:
Often, when parents separate or divorce, it becomes a challenge to help kids maintain healthy contact with grandparents, supportive adults, and extended family members. One key to reducing stress is making the effort to maintain contact with these positive influences. It’s never a bad idea to let your children interact with people who truly love them…sometimes it means setting aside personal feelings in the best interest of the child.

Inspire:
To inspire someone means to lift them up with your words. Children need constant encouragement to recognize and reach their full potential. They need help identifying dreams and working towards them. Children who have witnessed violence and experienced traumatic stress can become negative, often have a low sense of self-worth, expect to be unsuccessful, and fail to foresee a positive future. But caring adults can help children reverse these negative responses. You can help inspire a child by identifying their strengths and natural talents and by connecting them to programs that help develop self-confidence.

Those who spend more time with children, like teachers, caregivers and, of course, parents have a greater opportunity to provide the tools that can really have a positive impact. Increasingly, schools, sports clubs and community events aimed at children are including elements of mindfulness training, self-care, and self-regulation activities in their work. But every one of us, even those of us who only have time to give a child a quick high-five, can consider it a privilege that we are contributing to that child’s resilience, health, and wellbeing.

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The Alarming Effects of ACEs on Our Community

Kerry Jamieson Fighting ACEs PBC, Latest News

We have to share the world we live in. That might seem obvious but consider the hundreds of ways we interact with others every day, adhering to an unwritten social contract. When a traffic light turns red, we stop. We rely on others to obey this signal, too. We share space with total strangers in grocery stores, at gas stations, and on public transport. We spend hours a day with co-workers we need to get along with. No matter the natural human inclination towards self-interest, we all have high stakes in keeping our communities as healthy and safe as possible. We’re social creatures and we’re in this together – sharing communal space.

This makes us vulnerable to the behavior of others. When there’s another tragic school shooting, our community’s children lose their lives. When a local teenager overdoses on drugs, we suffer the pain and confusion of that senseless loss. When a child in the neighborhood watches his father hit his mother, science indicates that the behavior tends to be repeated generation after generation. All these ACEs (Adverse Childhood Experiences) affect us. Nobody is insulated by the location of their home, their economic privilege, or perhaps even their conscious efforts to isolate and protect themselves and their families. Whether for humanitarian, religious, altruistic, or even selfish reasons, it’s in our best interests as individuals and a society, to care about others.

Through this blog series, we’ve learned what ACEs are and the profound implications they have on the lives of individuals, but whenever children are exposed to ACEs, each and every one of us may end up paying the price. Domestic and community violence is directly correlated to ACEs. So are substance abuse, alcoholism, depression and many diseases.

However, we can reduce future violence, substance abuse and many other social ills by intervening and acting as a buffer for our community’s children. Anne-Marie Brown, LCSW, MCAP, CIP, ICADC, Director of Center for Child Counseling’s Childhood Trauma Response Program, has seen the results of non-intervention firsthand. Before joining CfCC, she spent over a decade working with adults overcoming substance abuse and, without fail, Anne-Marie saw where her clients’ problems began.

Every single adult she encountered had a history of childhood trauma, illustrating a direct link between ACEs and greater societal issues. Palm Beach County has a significant number of parents who abuse substances or suffer the cycle of domestic abuse.

In the County and State, children aged 0-6 enter the child welfare system at very high rates. In just one four-day week recently, Center for Child Counseling (CfCC) handled calls for 20 children who needed assessments because they were removed from their families, most due to substance abuse and domestic violence.

The Negative Toll on Community Wellness

ACEs often negatively affect a family for generations. Kids who are abused or neglected grow up and find themselves in similar situations with domestic violence or substance abuse. Their children suffer abuse and neglect, turn to drugs or alcohol, and the cycle starts all over again.

Karen Baldwin, a clinical therapist for the Palm Beach County Sheriff’s Office Crisis Intervention Team, says she receives calls every day about situations where people are unable to regulate their emotions or think rationally.

“Adults who experienced ACEs and didn’t get some sort of intervention have been using coping mechanisms for a very long time. Unfortunately, most of them don’t work,” she says. “Eighty percent of the women in our jail system have a history of trauma they’ve likely never dealt with. They get trauma counseling when they’re released, but they needed it long before then.”

The lack of community awareness about ACEs’ generational impact is a roadblock to securing more resources and greater involvement. That’s why CfCC works so hard to educate, train, and build the skills of a wide range of community stakeholders.

The Economic Argument

The financial implications for society are staggering.

Besides the obvious losses caused by a criminal act, determining the true economic impact of antisocial behavior on a community is complicated. A research paper co-authored by Dr. Kathryn E. McCollister of Miami’s Miller School of Medicine estimates the total tangible cost of one murder at $1.5 million, one rape/sexual assault at $47,500, and one aggravated assault at $23,000 – not to mention the psychological damage perpetuated by a violent act over several generations. (Figures adjusted for inflation.)

Fighting the Immediate and Lifelong Impact

Organizations and individuals do fight back. Since 1999, the Center for Child Counseling has been addressing the immediate and lifelong impact that exposure to toxic stress and traumatic experiences has on children. Two years ago, CfCC’s Childhood Trauma Response (CTR) Program was developed in collaboration with ChildNet to serve children aged 0-5 entering the foster care system. In the last eight months, through funding from the Moran Foundation, CTR has assessed more than 130 children. The program provides services that help build resilience and provide coping techniques, so children can process what they’ve experienced.

Both Brown and Baldwin say they need the community’s help. Here are some of their goals:
1.) Every clinician and every adult in contact with children needs to commit to early intervention.
2.) Every adult in a child’s life must be aware of ACEs and their dire consequences.
3.) All of us can find ways to share information about ACEs.

Evidence shows that early intervention for ACEs, like that provided by CfCC, can reduce or prevent someone from engaging in harmful or violent behaviors later in life. Every child should grow up feeling safe and loved. You can be a buffer against childhood trauma and adversity by joining us in the fight against ACEs in Palm Beach County. How do you become a buffer? What does a buffer need to do to be an effective shield for a child? You’ll learn the answers in our next blog.

Sign up now for news, events, and education about Adverse Childhood Experiences (ACEs) and promoting resilience.

By submitting this form, you are consenting to receive emails from: Center for Child Counseling, 8895 N. Military Trail, Palm Beach Gardens, FL, 33410. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email.
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