A cartoon outline of a child – in a video – stands alone near a cracked sidewalk heaped with obstacles: giant red bricks labeled “neglect,” “abuse” and “parental addiction.” The voice-over says: “It’s possible to fix some of the damage of toxic stress later on, but it’s easier, more effective and less expensive to build solid brain architecture in the first place.”
The four-minute animation—which covers toxic stress, caregiver-child interaction and the role of communities in building healthy brains—has reached many people since its release in October 2013. But the video is just one snippet of the Alberta Family Wellness Initiative (AFWI), a project aimed to better the lives of children and families in one of Canada’s westernmost provinces.
The AFWI, launched in 2007 by the private Norlien Foundation, has an ambitious agenda: to promote the use of scientific knowledge about early brain and biological development in order to change beliefs, policies and practices related to children, families and communities—in short, to “bridge the gap between what we know and what we do,” according to a 2013 AFWI report.
The AFWI began its work by capturing the attention and engagement of high-level “change-makers”—government officials, community leaders, policy experts, academics and administrators who could learn the newest science, discuss it in depth, then take that story home to influence research, policy and practice.
“In the early days, the focus of our effort was on policy-makers and professionals rather than the public. You need to start changing the thinking of those in the system who are making decisions before you start focusing on a public audience,” said Dr. Michelle Gagnon, vice president of Norlien.
AFWI focuses on the “core story of brain development,” a series of metaphors grounded in emerging biomedical science and developed with the help of the FrameWorks Institute and the Center for the Developing Child at Harvard University.
- Brains are not just born; they are built through a child’s experiences and interaction.
- “Serve-and-return” exchanges with caregivers—eye contact, singing, playing peek-a-boo—help to create a healthy foundation in an infant’s and young child’s brain.
- While good stress—meeting new people, trying out for a team—helps build resourcefulness and problem-solving strategies, toxic stress, such as parental neglect or abuse, is bad for brain development.
- Sturdy brain architecture fosters social, emotional and cognitive skills—often called “executive functioning”—that help children regulate their feelings and actions, the way an air-traffic controller directs movement in the skies.
- The community has a role, and a responsibility, in helping all young people develop and grow.
One way the AFWI chose to share and explore these key concepts was through a three-year program of symposia, with one series focused on early brain development and one on addiction. Norlien invited 100 people—leaders in education, health, social services and justice—to each series. The intensive five-day symposia combined lectures from nationally and internationally known experts in the field with small-group, interdisciplinary teams so participants could discuss how to implement what they were learning. Between symposia, attendees connected through e-mail, phone calls and networking events. As part of their commitment to the symposia process, they were required to put their new learning into practice and policy and to report back on whether those changes were making a difference.
“The basis of our work,” said Gagnon, “is creating a big network of people across the province who now regard themselves as change agents in their arenas.”
Already, AFWI is producing results:
- “Together, We Raise Tomorrow: An Alberta Approach to Early Childhood Development,” a 2013 province-wide government initiative to support children’s well-being, is based on the core story of early brain development and the need for safe, supportive communities.
- Alberta’s new strategy on addiction and mental health connects local change strategy to the “core story” of the lifelong consequences of toxic stress early in life.
- Every physician in the province, on learning that a patient is pregnant, now gives that woman resources on healthy pregnancy and early child development.
- The Association of Faculties of Undergraduate Medicine of Canada created a series of short podcasts, based on lectures from AFWI, about early brain development, mental health and addiction, to be used in medical education.
- Alberta’s corrections system is shifting to a trauma-informed chronic-care model of treatment for inmates with addictions.
- The AFWI web site, which includes information and resources on brain development, toxic stress, addiction and recovery, received just over 80,000 hits since it was launched in 2011.
What led to the success of AFWI? Sheryl Fricke, executive director of the Early Childhood Development Priority Initiative for the province of Alberta, calls it “a perfect storm.” For years, she said, attempts to create an integrated early childhood strategy for the province floundered before they reached the level of actual policy. While human service providers certainly witnessed the impact of early childhood experiences on adult behavior and health, other sectors—doctors, economists and justice officials—tended to see the theories of human development as “soft science.”
Then came the emerging research on brain development, the influence of early stress and epigenetics—the idea that environment and experience can shape the expression of our genes. In 2007, the Norlien Foundation invited Dr. Vincent Felitti, co-founder of the U.S. Centers for Disease Control-Kaiser Adverse Childhood Experiences Study (ACE Study), to speak at an AFWI symposium. He shared the study’s findings, which revealed a direct link between 10 types of childhood adversity and the adult onset of chronic disease (cancer, heart disease, diabetes, autoimmune diseases, etc.), mental illness, violence and being a victim of violence. It showed that childhood trauma was very common — two-thirds of adults have experienced at least one type. It showed that if people had experienced one, they usually experienced more. And the study showed the more types of trauma experienced, the higher the risk of chronic disease and mental illness. For example, an ACE score of 4 increased the risk of suicide by 1200 percent and alcoholism by 700 percent.
Norlien, with its generous resources and the flexibility of a private philanthropy, continued to bring that science to practitioners in a range of fields. Slowly, the conversation began to change. In 2011, Alberta’s chief medical officer of health issued a report, “Let’s Talk About the Early Years,” underscoring the importance of a child’s first five years and urging all Albertans to get involved in supporting children and families.
In Alberta, where frontier culture tends to prize individual responsibility and a brand of rugged independence, the AFWI had to jostle mental models, instilling the idea that everyone needs help to grow and that achieving wellness is a collective obligation.
“Over time, we’ve seen a real shift in public awareness; people are seeing a role for themselves in supporting others who are experiencing periods of vulnerability, and children in particular, to be successful,” said Fricke.
A survey of participants in AFWI initiatives in the first three years bolsters her claim:
- Nearly half the respondents (participants in the AFWI’s symposia) said they had observed or experienced changes in attitudes and increased awareness of the “core story” of brain development.
- Nearly half the respondents said they were using research to inform their practice—for instance, through a trauma-informed approach to addiction treatment or a more family-centered approach to primary and pediatric care.
- A Family and Youth Court judge said judges have become more aware of the impact of toxic stress on children and teens; one judge created a video for her colleagues on how to integrate the understanding of brain development into child placement and custody decisions.
The Norlien Foundation’s role as a convener is critical. “We bring in experts to talk about the science. We’re a foundation that is trying to influence and catalyze change,” said Gagnon. The next phase of the AFWI involves 21 “innovation teams,” such as one comprised of physicians and leaders of health organizations, working to integrate knowledge of early childhood and brain development into their practices. The foundation also wants to bring the “core story” to the general public through vehicles such as the animated video on brain-building.
Changing minds, and then policy, is a gradual and time-consuming process, said Gagnon. “There’s obviously resistance that you can expect when you’re really trying to change long-held cultural beliefs in an area. This has taken a number of years of intensive engagement, and relationships are fundamental to that—supporting others to be change leaders in their own domains.”
Across the province, that is now happening. Lana Wells, a professor of social work at the University of Calgary who participated in the most recent AFWI symposium, is rewriting her course outlines for next year, adding information on neuroscience and early childhood development to her classes on public policy and leadership.
Participating in the AFWI also prompted Donnelly to change the way her agency hired, trained and managed staff, building a more professional mix of employees who possessed both compassion and a commitment to measurable outcomes.
“We’d always measured our success on a short stick,” she said. “But the science forces you to think long-term and hold people accountable to that long-term goal…it’s amazing information. Before, we saw what came from a damaged soul and brain; we didn’t always understand it. Now we can explain it to parents. There’s this relief. They realize it’s not their fault, what happened to them. They absolutely feel now that they can change the course for their children.”
This is one of several articles about how different towns, cities, states and provinces are beginning to embrace an ACEs movement and become engaged in preventing/treating ACEs and promoting resilience. They were done as part of a Community Resilience Cookbook, produced by the Health Federation of Philadelphia with support from the Robert Wood Johnson Foundation.