Iowa ACEs360: Catalyzing a Movement

Iowa ACEs Policy Coalition joins Iowa Gov. Kim Reynolds as she signs a “Resilient Iowa” proclamation in 2018. Photo courtesy of Lisa Cushatt.

For years, advocates for a statewide children’s mental health system would stand before Iowa legislators and speak passionately about their own particular concerns.

Psychiatrists pointed to a need for more inpatient beds for youth with severe mental illness. Pediatricians said the answer was better screening to identify mental health issues in children from birth to age five. Educators wanted more school-based mental health services, and advocates from grassroots groups like the National Alliance on Mental Illness (NAMI) asked for increased crisis services.

“We were all saying, ‘Throw money at this issue,’” says Chaney Yeast, co-chair of the policy coalition of Central Iowa ACEs 360, a multi-sector network formed in 2012. “That confused legislators; they felt it was this black hole, and they didn’t act.”

This year—thanks in part to connections forged by Iowa ACEs 360—advocates for a comprehensive child behavioral health system told a single story: Children whose mental health needs are met will be more likely to graduate, be employed and become productive members of the community. Current mental health services for children are fragmented and inconsistent. We know what it would take to fix that.

Group after group that testified before Iowa legislative committee members—officials from the sheriff’s department, mental health providers, community advocates, child welfare workers—drummed home talking points that the ACEs policy coalition had developed with a public policy messaging and research firm.

“That common messaging hit home. We were all on the same page,” says Yeast. The bill—which requires Iowa counties to implement a coordinated array of preventive, diagnostic and treatment services for children, and calls for parents of children with mental health issues to have a voice in designing those services—passed the legislature in April and was signed by the state’s governor in May.

“That was a huge win in terms of collaboration,” says Yeast. It was also a clear example of the power that cross-sector networks can wield when members move beyond their own silos to support a shared goal. Such work is not easy—“It takes a lot of time and effort to continually nurture those relationships and connections,” says Yeast—but it is essential to making long-term, systemic change.

That’s been the ambition of Iowa ACEs 360 since its start, when a small group of stakeholders—in public health, mental health, family support and community advocacy—gathered, with the support of the Mid-Iowa Health Foundation (MIHF), to discuss the original CDC-Kaiser Permanente ACE Study and how their work needed to change in response.

That group decided on two priorities: collect Iowa ACE data and spread awareness of the ACE Study, so others could be galvanized by its findings on the lifelong, corrosive effects of early childhood adversity.

After Rob Anda, the co-investigator of the 1998 ACE Study, did a presentation about the ACE Study to a small group of key stakeholders, an early step was to include the ACE module in Iowa’s Behavioral Risk Factor Surveillance System (BRFSS). Following an invitation-only summit in 2011 that featured a follow-up with Anda, he and Laura Porter, a nationally known expert on ACEs and population health, spoke to 800 people at the 2012 Iowa ACE Summit.

Suzanne Mineck, president of MIHF and one of the original committee members who launched ACEs 360, says “water cooler conversations” in the weeks following Anda’s visits that gave the work momentum. “We all had the privilege of learning about compelling research, but it was the lingering impact, both on those in decision-making places and those on the front lines, that was as much of an ‘aha.’”

As the coalition grew, hosting quarterly learning circles, developing work groups and, in 2014, acquiring a part-time program manager, it became a place where people from various sectors—juvenile justice, child welfare, health care and education—could learn together.

“It created a culture where there wasn’t a singular response…a culture of transparency, humility, honoring and supporting risk-taking,” says Mineck. “Many felt they were learning things for the first time together.”

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Investing in cross-sector networks to build a trauma-informed region

Participants at a Pottstown Trauma Informed Community Connection community meeting, which typically draw between 75 and 130 people. Courtesy of Valerie Jackson/PTICC.

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When Suzanne O’Connor first joined the Philadelphia ACE Task Force (PATF)—a group then composed mostly of pediatricians who wanted to put ACE science into practice—she did more listening than talking.

“I wasn’t a doctor, I wasn’t a clinician, but a teacher trying to integrate trauma-informed care into early childhood education,” she says. “What struck me the most was what educators didn’t know about social services, mental health and even physical health. We didn’t have language for what we were seeing with kids who were particularly challenging.”

ACEs gave O’Connor that language. She became a passionate advocate for trauma training for early childhood and K-12 teachers. Now, as director of education for United Way of Greater Philadelphia and Southern New Jersey, O’Connor is helping trauma-informed practice to ripple across the region.

United Way, which recently honed its mission to focus on ending intergenerational poverty, funds and supports cross-sector networks in Philadelphia, surrounding counties and the borough of Pottstown, all part of United Way’s effort to “build a trauma-informed region.”

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Curiosity and reciprocity: Engaging community in the ACE & resilience movement

In an all-day workshop that Laura Porter was leading with community organizers and parents, she told the story of a woman from the Congo who had to leave her homeland. Before the woman left, she had a dream about living in the United States.

The woman said she imagined opening her door, letting her children run free, hearing them laugh and play. She envisioned people asking one another, “How are you?” without any compulsion to evade by answering, “Fine. I’m fine.” And, she added, “I could go with my children to the store and not have to be afraid that they would be arrested for being black.”

Porter was struck by the woman’s words—a vision of safety and belonging that is rarely voiced out loud. “As we’re engaging people, that dream is just under the surface,” says Porter. “When we touch on that, we touch on something very powerful: the core values…that go beyond political strife or individual experience. We can touch an aspirational world.”

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Putting Alaska Native hopes, voices at center of state’s ACEs movement

Lisa Wade is the Health, Education, and Social Services Director, tribal court judge, and elected tribal council member for the Alaska Native Village of Chickaloon.

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Before the Alaska Resilience Initiative could push forward on any of its goals—to grow a sustainable statewide network; to educate all Alaskans on brain development, adverse childhood experiences, and resilience-building; and to support organizational, policy and practice change to address trauma—its leaders had to start by listening.

Specifically, they had to listen to Alaska Native people.

Alaska Native people comprise nearly one-fifth of the state’s population, but historically their voices have been largely excluded from decision-making about social services, education and behavioral health.

That’s why Laura Norton-Cruz, program director of the Alaska Resilience Initiative, partnered with First Alaskans Institute and the Chickaloon Village Traditional Council in a May 2016 gathering that put Native perspectives, customs, history and hopes at the center.

That gathering of about 30 people “was setting a tone for the whole state that the voices of Alaska Native people matter in this process,” Norton-Cruz said. The goal was to seek input that could guide the Alaska Resilience Initiative, shape the curriculum for ACE/resilience trainers and frame a more inclusive and equitable approach to the work.

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Greater Kansas City first responders, educators, health care workers, sports & faith community embrace learning about childhood trauma, practicing resilience

In a video on the Resilient KC website, police officer Mikki Cassidy notes that “my regular day is everybody else’s worst day.” Then she describes how mindfulness training has helped her find peace amid the clamor: “This moment, right here, I’m okay.”

Later in the clip, Sonia Warshawski, a Holocaust survivor, recalls being shoved onto a train to Treblinka and, later, losing her mother to the gas chamber. “One of my highest points is when I speak in schools, when students tell me, ‘You changed my life,’” she says.

And Josiah Hoskins, a youth raised in foster care, talks about the mantra that helped him survive: “Even if all you have is yourself, with a wall behind you and the world coming at you, you can make peace with yourself.”

The video concludes with four words—“Stories Matter. What’s yours?”—and an invitation for others to share experiences of adversity and healing.


Awareness on Both Sides of the State Line

The campaign is just one prong of Kansas City’s multi-sector effort to raise awareness about adverse childhood experiences (ACEs) and build resilience on both sides of the state line. Resilient KC — a partnership between the pre-existing Trauma Matters Kansas City (TMKC) network and the Greater Kansas City Chamber of Commerce — has worked to cultivate “ambassadors” who can bring the ACEs message to colleagues, clients and community members in business, the armed services, education, justice and health care.

ACEs are adverse childhood experiences that harm children’s developing brains so profoundly that the effects show up decades later; they cause much of the U.S. and the world’s chronic disease, most mental illness, and are at the root of most violence.

The CDC-Kaiser Adverse Childhood Experiences Study (ACE Study), a groundbreaking public health study, discovered that childhood trauma leads to the adult onset of chronic diseases, depression and other mental illness, violence and being a victim of violence.

The ACE Study looked at 10 types of childhood trauma: physical, emotional and sexual abuse; physical and emotional neglect; living with a family

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Artists in the ACEs and resilience movement: Creative avenues to change

 

From "Airings...Voices of our Youth", created by staff from the Bellingham and Mount Baker School Districts (WA), the Whatcom Family and Community Network, faculty at Western Washington University’s Psychology Department and, more than 20 teenagers from the community who have shared their stories (Photo: Angela Kiser and Nolan McNally).

From “Airings…Voices of our Youth”, created by staff from the Bellingham and Mount Baker School Districts (WA), the Whatcom Family and Community Network, faculty at Western Washington University’s Psychology Department and, more than 20 teenagers from the community who have shared their stories (Photo: Angela Kiser and Nolan McNally).

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At a June summit in Whatcom County, WA, titled “Our Resilient Community: A Community Conversation on Resilience and Equity,” the arts played a starring role.

Kristi Slette, executive director of the Whatcom Family and Community Network, one of two Washington sites participating in the Mobilizing Action for Resilient Communities (MARC) project, says the arts—music, dance, sculpture, storytelling—can help audiences understand trauma, resilience and hope in a visceral way.

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Business leaders in the ACEs science and resilience movement: A different kind of bottom line

Vigor Alaska's Ketchikan shipyard at dawn.

Vigor Alaska’s Ketchikan shipyard at dawn.

The owner of the biggest construction firm in Walla Walla, Washington, sat through a seminar that framed adverse childhood experiences (ACEs) science in ways a business person could understand: how childhood trauma could translate into low productivity, high turnover, sinking morale and rising health care costs.

The top cause of on-the-job injury at the construction firm was substance abuse by young male workers. Suddenly, the dots connected. The owner leaned toward Teri Barila, co-founder of the Children’s Resilience Initiative, and said, “Now I know what you’ve been trying to tell us.”

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Teens lead way in teaching Camden, NJ, about ACEs and resilience

Hopeworks teens lead a workshop about ACEs science

Hopeworks teens lead a workshop about ACEs science

 

Two volunteers race against the clock to stack red Solo cups into the highest tower they can manage.

Queenie Smith keeps knocking them down.

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Alberta Family Wellness Initiative changes minds by informing Canadians about effects of toxic stress on kids’ brains

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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.

Dr. Michelle Gagnon, vice president, Norlien Foundation

Dr. Michelle Gagnon, vice president, Norlien Foundation

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.

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Maine Resilience Building Network changes how people think about childhood trauma

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Sue Mackey Andrews will talk to anyone about adverse childhood experiences, or ACEs: Pediatricians. Early childcare workers. Parent advocacy groups. And those on the front lines who work with kids, like the longtime school bus driver from rural Maine, a gruff and taciturn man who insisted, during a half-day school district inservice, that trauma and resilience had nothing to do with his work.

The driver also told Andrews that he would not start the bus each day until he had made eye contact with every single child and greeted him or her by name. And that, Andrews responded, was exactly the relevance of his work to build resilience.

The tagline of the Maine Resilience Building Network (MRBN), which Andrews co-facilitates, is “Join the Conversation.” The

Sue Mackey Andrews, co-facilitator, Maine Resilience Building Network

Sue Mackey Andrews, co-facilitator, Maine Resilience Building Network

group, formed in the spring of 2012, brings together practitioners in medical care, education and behavioral health, along with those working in business, law enforcement, the military, juvenile justice and faith communities.

Since its early meetings, comprising a half-dozen people, all of them doing work based on research into childhood adversity, MRBN has grown to include 77 members, with reach into all of Maine’s 16 counties.

From the beginning, said Andrews and MRBN co-facilitator Leslie Forstadt, associate professor with the University of Maine Cooperative Extension, the group agreed that the message should focus on wellness and healing rather than illness and trauma.

The word “resilience” had to be part of the name because, said Andrews, “we talk about how it’s never too late to realize your ACEs and, through support and personal discovery, overcome them.” The term “building” captured the sense of a growing effort, and “network” aptly described how individual sites would function autonomously while sharing their innovations, challenges and questions.

The term “ACEs” has its origins in the CDC-Kaiser Adverse Childhood Experiences Study. The study 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

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