In 2017, when the documentary “Resilience” sold out three weeks before its screening date in the Amherst Cinema’s largest theater, we knew we’d hit on something big. When we had to close registrations for the 2018 Roads to Resilience conference at 225, we knew for sure we were onto something really important.
Both the documentary and conference focused on the science underlying landmark research known as the Adverse Childhood Experiences (ACE) study launched by the Centers for Disease Control and the Kaiser Permanente HMO in 1995-1997. Both events also addressed the strategies, known as trauma-informed care, that organizations, schools, agencies — in some places even entire communities — have adopted in response to the research findings.
Hampshire HOPE, the Strategic Planning Initiative for Families and Youth (SPIFFY) and the Northwestern District Attorney’s Office teamed up to work with Amherst Cinema for the “Resilience” screening and reached out to Clinical and Support Options (CSO) and other organizations for the Roads to Resilience conference. The response to these initiatives show there is intense interest in these topics. People are eager to wrestle with the implications of the ACE study and put energy into finding ways our community can best address them.
What is it about the ACE research that so strikes a chord for people? It may be because the study proved something many people intuitively know: that when people experience adversity in childhood, their grown up years are impacted. That’s common sense, right? It’s basically the rationale behind programs like Head Start — to build resilience in children from at-risk populations.
But the ACES research made connections even the researchers themselves found mind-boggling, which is why some say it represents the greatest public health discovery of a generation.
Here’s what happened: Dr. Robert Anda, a CDC epidemiologist and Dr. Vincent Felitti, a physician at the California-based HMO Kaiser Permanente teamed up to conduct a study that would look at the impact of childhood adversity. Using a study group of 17,000 Kaiser Permanente patients, they posed questions to determine how common and what kind of childhood traumas people experienced.
These questions were asked of adults who answered retrospectively about their childhood experiences with emotional, physical and sexual abuse, neglect, whether people had parents who had been incarcerated, mentally ill, alcoholic or experienced domestic abuse. The answers to these 10 questions were tallied up into something researchers called a person’s ACE score — one point for each of these traumas experienced as a child.
The study also examined the health histories of participants and followed them over time to monitor health outcomes. Researchers discovered that the higher ACE scores people had, the greater their chances of developing any number of health problems. People with ACE scores of 4, for example, had double the risk of heart disease and double the risk for cancer. The study also found that those with ACE scores of 6 died, on average, 20 years earlier than those with lower ACE scores.
It seems intuitive that a person with a high ACE score would be at higher risk for substance use problems, since substance misuse is a common coping mechanism. But, it was ground-breaking to link childhood adversity to physical health problems as diverse as liver and autoimmune diseases, fetal death, chronic obstructive pulmonary disease and ischemic heart disease.
As prevention coalitions who promote practices and policies to keep alcohol and other drugs out of the hands of adolescents in order to protect their developing brains from the detrimental effects of early use, we are always looking at what is known in the prevention field as risk and protective factors.
We promote policies and practices aimed at increasing protective factors like parental connection, involvement in positive social activities, connections with school and trusted adults because they actually buffer a teen against the pressure to use. We seek to reduce risk factors, which are situations within a person’s orbit that might make them more likely to use substances, such as lack of parental supervision, a perception that drug use is not harmful, and easy access to drugs, by educating families and school communities that surround young people.
And evidence also shows that a high ACE score is another big risk factor. So yes, prevention coalitions like HOPE and SPIFFY are eager to incorporate ACE science and data into our work.
One of the exciting things about the ACE study is that it offers communities a way to measure risk factors and look at an entire community in light of the prevalence of traumatic childhood events, also known as toxic stress. We can then work on approaches that aim to address community-wide problems with roots in personal trauma.
It’s important to note that, as is pointed out in the documentary “Resilience,” a high individual ACE score is not destiny. There are many evidence-based strategies to counteract high ACE scores. It’s imperative that we do this work together in multiple arenas because high ACE scores affect the way students learn, how easily patients get better when they are sick, how well people function in a workplace.
As this information seeps into common knowledge, new players are at the table with prevention coalitions like Hampshire HOPE and SPIFFY as we see that prevention, intervention and treatment really do work together.
Trauma Informed Hampshire County: A Network Responding to Adverse Childhood Experiences by Building Resilience, a group that has been working together since the “Resilience” screening, has drawn participants from the criminal justice system, health care, police departments, mental health agencies, schools, health departments as well as people in public health.
Our efforts focusing on ACE and trauma-informed practices represent a conscious decision to break down silos and build bridges between sectors. ACE science gives us a common framework in which to build healthier communities.
There are many specific practices that can be incorporated into institutions seeking to be sensitive to ACEs. Here are some examples of trauma-informed initiatives that piqued the interest of our Trauma-Informed Hampshire network:
“Handle with Care,” a bridge between police and schools. It’s a simple concept that would, for example, have police officers who responded to a domestic disturbance where children were present reach out to the child’s school to notify them that an incident at home likely impacted the child. This information is a cue to teachers that if a child is exhibiting concerning behavior, there might be a reason behind it and they should respond to that child with special care.
Another idea with potential is trauma informed audits, in which programs or agencies working with vulnerable populations examine their facilities and practices with an eye to determine how improvements could be made to be sensitive to clients with high ACE scores. This can be everything from a warm greeting or soft lighting and comfortable chairs in a waiting room to adapting questions on intake forms.
·Community-wide education about the ACE study and trauma-informed practices is being done in communities around the country and we’d like to do that here, too.
Heather Warner, coordinator for the SPIFFY Coalition housed at the Collaborative for Educational Services, is a member of the Hampshire HOPE opioid prevention coalition run out of the city of Northampton’s Health Department. Members of the coalition contribute to a monthly column in this space about local efforts underway to address the opioid epidemic.