How facing ACEs makes us happier, healthier and more hopeful

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Won’t it depress people?

Isn’t it triggering?

Aren’t the topics troubling?

Won’t it make people sad or upset?

Fear is what I often fight when talking about ACEs — adverse childhood experiences. It’s not my fear though. It’s the fear others have about all things ACEs. Adversity. Abuse. Addiction. Abandonment. Neglect. Dsyfunction.

I don’t think this fear actually belongs to those of us who have lived with ACEs, who have lived through ACEs, who live with the aftermath of ACEs as adults.

When I found out about ACEs I was overwhelmed with joy. I felt radical relief. What I experienced was a profound sense of validation. It was epic.

I also felt rage because the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study and related science hadn’t been shared with me. Not my doctors, therapists, shrinks, teachers, social workers or anyone while I got ready to become a parent.

Why?

This one study and it’s 10-question survey changed my life. It changed the way I see myself and feel about myself. It changed the way I parent, prioritize parenting and self-care. It altered the way I think about my past and my parents. It didn’t just change my personal life but my professional life as a writer, health activist and survivor.

It’s a movement and a mission and the meaning is beyond me.

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Cissy White

The ACE Study looked at 10 types of childhood trauma: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused. Other subsequent ACE surveys include racism, witnessing violence outside the home, bullying, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, witnessing a father or other caregiver being abused, involvement with the criminal justice system, attending a zero-tolerance school, etc.

The ACE Study found that the higher someone’s ACE score – the more types of childhood adversity a person experienced – the higher their risk of chronic disease, mental illness, violence, being a victim of violence and a bunch of other consequences. The study found that most people (64%) have an ACE score of one; 12% of the population has an ACE score of 4. Having an ACE score of 4 nearly doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and the risk of attempted suicide by 1200 percent. (For more information, go to ACEs Science 101. To calculate your ACE and resilience scores, go to: Got Your ACE Score?)

The ACE Study also found that it didn’t matter what the types of ACEs were. An ACE score of 4 that included divorce, physical abuse, an incarcerated family member and a depressed family member had the same statistical health consequences as an ACE score of 4 that included living with an alcoholic, verbal abuse, emotional neglect and physical neglect.

This one study has done more for me than decades of therapy in helping me understand the impact of post-traumatic stress.

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A system of care for traumatized children

By the Hon. Ramona Gonzalez
Board Director, National Council of Juvenile and Family Court Judges
La Crosse County Circuit Court, Wisconsin

Sally is a seven-year-old girl who just disclosed physical abuse to her teacher. Over the next few days, Sally must relate her story multiple times to a social worker, an attorney, a foster parent, a police officer, and a judge. Each time she recounts her abuse, she spends the entire day unable to concentrate, and at night has she bad dreams preventing her from sleeping. By the end of the week, Sally is exhausted. She has barely slept, her grades are falling, and she is beginning to wonder why she spoke about the abuse in the first place.

Sally’s story happens all too frequently for youth who disclose abuse. Complex confidentiality systems can isolate or “silo” information, even when statutory sharing mechanisms are available. Professionals from different agencies often conduct their own investigation, only to find exactly the same information from the same victimized child. Being forced to relive abuse day after day is re-traumatizing and confusing for children, exacerbating trauma symptoms. Virtually everyone who has worked in the child abuse field acknowledges that there must be a better way to help children in need.

April is National Child Abuse Prevention Month, and is an opportunity to highlight a system of care for those children victimized and traumatized by abuse. In Montana, a collaborative team (the Linking Systems of Care Committee) and in Virginia (the Partner Agency Team) is involved in The Linking Systems of Care for Children and Youth Demonstration project funded by the Department of Justice, Office of Justice Programs, Office of Victims of Crime. This unique project is designed to provide or coordinate prevention and intervention services to youth and families experiencing trauma and victimization, and to build capacity within communities to meet the needs of youth exposed to violence. At the heart of this project is the idea that all systems of care are connected, and,
to be effective, they need to create a common vocabulary, share information, and create seamless and equitable access to victims.

The states of Montana and Virginia are working to develop a groundbreaking common-use screening tool to identify victimized youth whenever they interact with a system of care and refer them to needed services. Identification and referral of child victims is extremely important in these demonstration sites. More importantly, the common use of a screening tool illustrates that opportunities for healing occur at all points of contact, and by investing in common screening and assessment, systems of care can reduce the duplicative and redundant investigation that often re-traumatize victimized youth.

Using the guiding principles of the Linking Systems of Care Demonstration Project, Sally would have been screened for victimization immediately upon disclosure, and the subsequent intervention for Sally would avoid processes and practices that re-traumatize her, like telling her story repeatedly. Sally’s services would have been strength-based, holistic, and focused on resilience. Rather than treating Sally’s case as a vignette, her judge would also take into account the life-course perspective of victimization and trauma, and consider trauma experienced across lifespans and generations, including historical and structural trauma and racism. Finally, it would hold systems of care accountable to each other, and to the families the system serves.

To many of my colleagues in the judiciary, social services, and allied professions, this sounds like the better way to help victims. Healing happens when systems of care offer coordinated treatment and create the opportunity to make positive social-emotional connections and provide for self-determination. This is the “what” Linking Systems of Care is, the chance to build capacity within the communities of Montana and Virginia to meet the needs of youth exposed to violence. If you are interested in how you can become involved in this project, visit the National Council of Juvenile and Family Court Judges at http://www.ncjfcj.org.

The practice of ACEs science in the time of Trump

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As with any remarkable change, the 2016 presidential election, a swirl of intense acrimony that foreshadowed current events, actually produced a couple of major opportunities. It stripped away the ragged bandage covering a deep, festering wound of classism, racism, and economic inequality. This wound burst painfully, but it’s now open to the air and sunlight, the first step toward real healing. The second opportunity is how the election and its aftermath are engaging more Americans from many different walks of life. The election brought out people who hadn’t voted in years; its aftermath has engaged people who’d counted on someone else to do their citizenship work for them. All these people — all of us — now have an opportunity to work together to solve our most intractable problems. That knowledge is embodied in the science of adverse childhood experiences (ACEs).

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The most important thing I didn’t learn about in medical school: Adverse childhood experiences

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Dr. Nancy Hardt

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The most important thing I didn’t learn in medical school is about adverse childhood experiences, also known as ACEs.

To be sure, if I had understood them then the way I do now, I would have been a better and more compassionate physician. Importantly, I would have avoided lots of mistakes.

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Just one year of child abuse costs San Francisco, CA, $300 million….but it doesn’t have to

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In 2015, 5,545 children in San Francisco, CA, were reported to have experienced abuse. Of those, the reports of 753 children were substantiated. The expense to San Francisco for not preventing that abuse will cost $400,533 per child over his or her lifetime. That adds up to $301.6 million for just that one year, according to “The Economics of Child Abuse: A Study of San Francisco.”

And, because child abuse is profoundly underreported, the costs are likely to be as much as $5.6 billion for one year of children experiencing trauma, the report found.

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Dear doctor: A letter from a survivor of sexual trauma to all medical professionals

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Dear Doctor,

As a medical professional you have taken an oath to do no harm, but there are ways in which you can hurt your patients without even recognizing you are doing so. What seems to you as a simple exam may cause injury to those who have been victimized by someone’s touch. This is a subject that we, survivors of sexual violence, have been meaning to discuss with you for some time now, but your authority can be more intimidating than you may know. I am also unsure if you are aware just how much power you, as a physician, hold and to the extent that you affect the lives of all of your patients. Your interactions with us travel much deeper than the physical core.

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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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