ACEs histories for mothers recovering from substance abuse


The aptly named Great Starts program at the Helen Ross McNabb Center in Knoxville, TN, provides a six-to-nine month residential treatment and two-year follow-up program for pregnant mothers and moms with newborns recovering from substance abuse. Earlier this year, curious about the early childhood history of its residents, the center started asking the women about their ACEs history.

The results would not have been surprising to those familiar with ACEs: Of the 16 moms who filled out the 10-question ACE survey from the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, the average score was a whopping 6.4.

Using the ACE survey, says mental health clinician and family treatment program manager Sarah Long, could allow staff members to identify those potential risk factors these new parents experienced as children that might in turn affect the parenting of their own children.

The ACE Study measured 10 types of childhood adversity, those that occurred before the age of 18. They are physical, verbal and sexual abuse; physical and emotional neglect; a family member with mental illness, or has been incarcerated or is abusing alcohol or other drugs; witnessing a mother being abused; losing a parent to divorce, separation or death.

Of the 17,000 mostly white, college-educated people with jobs and great health insurance who participated in the study, 64 percent had an ACE score of 1 or more; 12 percent had an ACE score of 4 or more. The researchers found that the higher a person’s ACE score, the greater the risk of chronic disease, mental illness, violence and being a victim of violence. For example, compared with someone who has an ACE score of zero, a person with an ACE score of 4 is 12 times more likely to attempt suicide, seven times more likely to become an alcoholic, and twice as likely to have heart disease, according to the data.

Great Starts hasn’t yet formally trained its 11-person staff in ACEs or determined how to integrate the ACE histories of its mothers into treatment protocols. However, the team has been trained in trauma-informed care and understands the background of why they do ACE scores, which they are now administering on all parents in the residential program.

In the meantime, Long says, she’d “love to hear how programs like ours use the ACE scores in treatment.”

Their goal is to help give the babies a low ACE score by building resiliency and reducing risk factors in parents. They do this by providing parents substance abuse treatment, mental health services, parenting education, family support, aftercare services, job training, and care coordination. And they plan to follow up with families for two years; the program has only recently released its first set of families.

Picture1Funding for Great Starts, which was founded in 1990, comes from Medicaid and two federal sources: the Abandoned Infants Acts, administered through the Chlidren’s Bureau (a division of the U.S. Department of Health and Human Services) to help create services for children who are at risk of abandonment. The other source of funding also comes from the Children’s Bureau, through a Regional Partnership Grant awarded to 12 grantees nationally, which aims to improve well being and permanency outcomes for children affected by parental substance abuse.

Obstetricians, child welfare agencies, or the criminal justice system refer the mothers, who voluntarily participate in the program. Great Starts only has the capacity to serve the 14 women and their families now receiving treatment and care.

All 14 women in the program have been using intravenous opiates, such as oxycodone and/or heroin. They range in age from 18 to mid-30s,

According to Long, over the last three years, eastern Tennessee has seen a 15-fold increase in the number of babies born dependent on opioids, with a surge of babies born with neonatal abstinence syndrome (NAS), as compared to a three-fold increase nationally. Last year, almost 1,000 babies born in Tennessee were physically dependent on opiates. If not weaned off drugs at birth by being administered decreasing levels of morphine, the babies can die from the effects of sudden withdrawal.

Long says “intergenerational patterns of dysfunction and trauma lead to these mothers using drugs.” She adds, “One of the biggest reasons women come to us is because of trauma-related problems.”

That’s why Great Starts treats the whole family. As part of the residential program, it hosts Celebrating Families, where parents and partners as well as other children of the mothers are invited to share in a meal and receive a little “psycho education,” learning new ways to cope. Long explains, “We primarily use Seeking Safety, which teachers mother to replace unsafe behaviors (like drug use and other unhealthy coping mechanisms) with safe ones.

“The families also receive education on how to stop the cycle of intergenerational substance abuse in their families, nurturing parenting skills, infant care, how to find a job, nutrition, wellness, exercise including yoga, how to build better social support in the community, how to develop a bedtime routine, how to take care of a home, and how to have a balanced schedule.”

One comment

  1. We see high ACE scores in our homeless population and among women in treatment for addiction in Atlanta–no surprise. Many come from backgrounds of disorganized attachment and need support to parent. We are just starting to teach the Community Resiliency Model (Trauma Resource Institute), which incorporates “bottom-up” mental self-care techniques to these populations with such intense needs and almost no mental health care.


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