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Adding layers to the ACEs pyramid -- What do you think?

 Pyramid

When the RYSE Center opened its doors in 2008 in Richmond, CA, says Kanwarpal Dhaliwal, community health director and a RYSE co-founder (and ACEsConnection member), staff members didn’t talk about complex trauma per se, but they recognized the many types of chronic trauma that the youth it was serving were experiencing. The youth services organization grew out of a youth movement in response to homicides near Richmond High School in 2000.

 

When RYSE Center staff members learned about the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, “it felt very validating,” says Dhaliwal. “It really helped to give language to the way we were working with young people."

 

But they also knew that there was more to a person’s trauma than just her or his experiences. The youth come “into this world in structures and conditions already established,” says Dhaliwal. These structures are often punitive (e.g., zero tolerance policies in schools) and embedded in racial bias; they limit opportunities and come with built-in economic and social inequities.

 

Last year, RYSE did a listening campaign with its youth, and earlier this year, staff members began talking about the findings and sharing them with activists, researchers, funders, etc. They decided to use the ACEs pyramid to leverage the existing science in communicating their major findings: that in helping young people, especially young people of color, there’s only so much that an organization like RYSE can do. It requires transformation at systems and community levels. The two new layers of the ACE pyramid – social conditions/local context and generational embodiment/historical trauma -- address that. 

 

In addition, they wanted to change the way risk is defined. “Risk-taking is critical for healthy development (of individuals and organizations),” says Dhaliwal, but risk-taking in the context of chronic trauma and inequity, often results in harm and burden. Also, many “health-risk” behaviors -- such as smoking, drinking or overeating -- are ways for young people to cope with their trauma. By using the word “coping”, it doesn’t put a negative or positive value on the behavior.

 

This new way of looking at the ACEs pyramid is a start to incorporating some important concepts into the ACEs discussion, says Dhaliwal, who wants to know what the ACEsConnection.com community thinks of it.

 

“What questions do you have?” she asks. “We’d like honest and gentle critiques to help make sure that our practice and praxis as an organization is reflective and responsive to the priorities, needs, and interests of young people, particularly to young people of color.”

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There are just so many potential ACEs that could be added that it'd be enormous as a way of introduction to what they are, for all the public to get their heads around. Which I think would be part of the goal...Perhaps later a more nuanced score could be collected. I have thought a few times, "Oh, could 'that' be an ACE?!

Not meaning to stir too much,  but I like conducting (in my head of course) a history of what other people contend with - a type of 'pissing contest' one could argue! Often people have as high or higher ACEs than me,  yet seem so much more together, and then with the scant info I can ascertain,  I realise their Resilience Score/History is so much higher than mine... usually.  There are a few on this website who've done the near impossible, but generally speaking... It's not a competition but rather a recognition/understanding, that makes me feel in a somewhat perverted way, 'better'!!! Clarification may be needed here: I feel more empowered, less vulnerable, more able to hold my head up.  This is really important in dealing with those they do not understand.  It's not an excuse, it's an explanation. Nothing beats an explanation. And surely this is an important understanding for practitioners of any kind, to understand? That's another reason why I don't think the two scores should be separated.  It's good to have backup/justification for those who have said and continue to bleat, "Look at ....., they've had it tough, but they're coming along fine."  Grrr.  Not just for me but for all those doing it tough(er than me).  They deserve acknowledgement for the very steep learning curve they've had to traverse.

This would include Vietnam Veterans, and others in stressful positions who haven't up to now, understood why and what is happening to them...

Thoughts?!

 

Last edited by Mem Lang

The ACEs score is brilliant and essential. And I think that one of the biggest omission in the Questionnaire is : ADOPTION  (as well as short-term and long-term Fostering) and BIRTH TRAUMA + FADS.   PS: looking forward to Dr Felitti being interviewed by Svava Brooks in her upcoming online Summit.

I think, this is a very good visual to incorporate the Pennsylvania study findings. However, this thinking to me is not about a "score", which I highly recommend against. This expands our conceptualization of trauma; the fact that we are not only individuals living in a family and we are not exposed to trauma only during childhood. That to me is much more important: Trauma is imposed upon us throughout our lives by our immediate family members, by our community, society, and nowadays global forces... thank you for generating it.

 

For those of us in public health, the Socio-Ecological Model has been our model for understanding behavior, health and wellbeing. I think your evolved pyramid is an effective integration of the Socio-Ecological model (which itself has a substantial research base) with ACES. In my work, I have been introducing ACES and the simplified model but then verbally adding the layers you have represented. I also make sure to use the term ACES to not just mean Adverse Childhood Experiences but also Adverse Community Experiences. I am happy to have this image to use.

Moreover, I think it is necessary to recognize that the ACES study was done with middle class adults. It is important that those of us interested in advancing the cause of ACES recognition, start to push the conversation towards also incorporating the adverse experiences of more marginalized groups.

 

Last edited by Monica Bhagwan

I see the extension below the ACE event as a natural evolution of the ACE's theory. There has been scientific genome evidence of the epigenetic predisposition for ACES &/or PTSD. The scientific community also has clear evidence of the in vitro physiological change that also predisposes someone to be more susceptible to ACE's. Awareness is expanding and connecting the Physical, Mental, Emotional and even spiritual components of Who we are and why we do what we do.

Since this comes from the CDC, I would like to know more about the scientific basis for these additions. Here's a few questions I have:

  1. How are "Social Condition," "Local Context" "Generational Embodiment" and "Historical Trauma" defined?
  2. What studies have validated that these defined categories are substantiated as links proceeding ACEs?
  3. Are these underlying "mechanisms" substantiated by epidemiological evidence as independent categories individually or collectively?
  4. How are their distinctions and interplay accounted for?
  5. If these proceeding categories/mechanisms are not supported by scientific research, what is the theoretical basis or rationale for these additions?
  6. Is the CDC claiming that all ACEs are the product of "Social Condition," "Local Context," "Generational Embodiment" and "Historical Trauma"
  7. Seeing as these linkages proceed ACEs, does the CDC now recognize these factors as the attributable roots or causes of ACE outcomes?
  8. If not, what is the rationale for citing the ACEs--according to the CDC the third tier link in the chain--as the origin?
  9. If these are not validated by rigorous scientific methodology and peer review, what are the ethical implications of presenting these as factual and and scientifically confirmed?

In short, where is the science?

Edit: I know this specific iteration does not come from the CDC, but it is here: https://www.cdc.gov/violencepr...tion/aces/about.html

Last edited by Alex Winninghoff
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