Alisa Santucci
By Alisa Santucci
For three decades, I have listened in awe to the brave voices of children, youth and families who have shared, in anguish, their past experiences — experiences that anyone would objectively call “adverse” and ones that can have lasting effects on health and well-being.
The seminal CDC-Kaiser Permanente Adverse Childhood Experiences Study opened my eyes to how pervasive their stories were and how these findings might influence the development of effective interventions and treatment, especially for system-involved young people.
In 1998, the Centers for Disease Control and Prevention and Kaiser Permanente released the first publication about the ACE Study, one of the largest studies of childhood abuse and neglect and their connections to later-life health risks. The study’s results, as well as subsequent related studies, have, in part, hastened the spread of “trauma-informed” approaches that have permeated into the nomenclature and delivery of human service today.
This research matters. It links childhood experiences of abuse, neglect, violence, substance use, mental illness and incarceration to risky health behaviors, chronic health conditions, low life potential and even early death. Almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more. A 2009 report funded by the U.S. Department of Justice corroborates the ACE Study findings, showing that almost 60 percent of children (ages 17 and younger) have been exposed to violence within the past year, either directly (as victims) or indirectly (as witnesses). The most recent child welfare data shows that approximately 702,208 children were victims of maltreatment in 2014.
Trauma-informed approaches offer frameworks grounded in an understanding of trauma, which provide safe spaces for engaging youth, delivering services and creating opportunities for individuals to successfully rebuild their lives. Embodied in the approach is a need to help youth heal, to pivot toward resiliency and ensure their voices are heard. As the literature base grows in trauma-informed approaches and what works in trauma-specific treatments, an important but often forgotten element is the role youth (and adult) clients play in shaping their effectiveness.
A 2015 exploratory study from Riebschleger, Day and Damashek exposes this need. The authors interviewed young people to discuss traumas experienced before, during and after placement in the foster care system and asked how they thought trauma-informed systems could be improved. Young people interviewed shared six important recommendations:
- Earlier intervention: Young people recommended enhanced supports for families struggling with poverty, substance abuse and mental illness. They also called for earlier interventions while they were in care — to “inspect [foster] homes for signs of trouble and abuse.”
When I was twelve, I was coming home from swimming at my neighbor’s dock when I saw an ambulance’s flashing lights in our driveway. I still remember the asphalt burning my feet as I stood, paralyzed, and watched the paramedics take away my father. It was as if I knew those flashing lights were a harbinger that my childhood was over.
