The Academy for Social Justice in the United Kingdom reported one of the highest number of attendees (340) present during a monthly session, as Becky Haas and Dr. Warren Larkin co-presented on February 3, 2021. The title of their virtual presentation was, ACEs, Trauma and System Change – The Bigger Picture. Two hundred and fifty members of the diverse group of professionals were so engaged after the presentation, that they remained on the call for 40 minutes for a time of Q&A.
Working to advance the practice of resilience science in their respective nations, Haas and Larkin began collaborating in 2019. In early 2021, impacted by the trauma being experienced worldwide due to COVID-19, convinced Haas and Larkin of a need to raise global awareness to other forms of trauma which are often not discussed as publicly as the pandemic has been. While devastating effects have been caused by COVID-19, every nation has been challenged for decades by a drug addiction epidemic, growing rates of domestic or intimate partner violence, human trafficking, individuals experiencing homelessness, child abuse and neglect. Combined now with the isolation and quarantines needed to navigate COVID-19, have only served to exacerbate other forms of existing trauma.
Dr. Larkin who is a consultant clinical psychologist and visiting professor at the University of Sunderland – outlined his case for a future where prevention rather than cure is the new status quo. Warren started by outlining some key pillars of ACEs science, trauma informed care and resilience. He went on to describe the conclusions from several recent evidence reviews published by public health agencies around the world – all of which agree – in that it is entirely possible to prevent ACES and child maltreatment by focusing on four key tasks:
Prevent adverse childhood experiences (ACEs)
- Support child and family wellbeing and parenting
- Detect and mitigate the impact of ACEs
- Promote resilience across the life course
Warren pointed out that while it is within our grasp to transform health and wellbeing for the next generation – it will require system change and a cross-sector, long-term commitment to ’moving upstream’. He went on to illustrate the potential impact that could be achieved by talking about studies of parenting programs that have been offered universally rather than in a targeted way. He cited the work of Professor Ron Prinz and told the audience about the study of Triple P (positive parenting program) in South Carolina that showed a reduction by 23.5 (7.9% increase in control counties) after parenting courses had been made universally available to all parents in the state, regardless of the age of their children. The state also saw child out-of-home placements decrease by 9.1% (22.6% increase in control counties) and child maltreatment injuries decreased by 10.5% (23.6% increase in control counties) Prinz et al, (2009, 2016). Not only was this program effective in decreasing harm, but it also led to a saving of around $9 for every $1 spent on the program. Dr. Larkin concluded by briefly describing his approach to systems change work with local partnerships and coalitions. He suggested asking senior leadership groups the following questions:
- Does your partnership have a shared vision of the desired future for the people of your region or county?
- How will you ensure your citizens co-produce and own the vision and solutions?
- How do we ensure racial and social inequalities are addressed and remain prominent in your shared vision?
- How do you ensure, through your leadership, a consistent, long-term approach and cross-sector commitment to the shared vision?
Warren finished by talking through his TASC (Trauma Aware System Change) model, which provides a conceptual framework for partnerships and cross-sector collaboratives to guide thinking and planning as they come together around a shared vision for the people of their place or region. Warren pointed out that he has used this framework in many regions of the UK and that it has proven to be a reliable way of providing a sense of direction and clarity when the natural reaction to thinking about long term system change is to feel overwhelmed by the challenge. He ended his presentation with the words of Arthur Ashe, the celebrated athlete, civil rights campaigner, author and the only black male tennis player to win Wimbledon (1975) and the U.S. Open (1968), “Start where you are. Use what you have. Do what you can.”
Following Dr. Larkin’s overview, Becky Haas who is nationally recognized for her pioneering work to create a trauma informed community, shared the story of creating the Northeast Tennessee ACEs Community. Northeast Tennessee is a region that sadly is no stranger to challenges. This is a region with overcrowded prisons, hospitals delivering babies whose mothers are addicted to substances at staggering rates, foster care shortfalls, and public-school systems where it’s common to hear phrases like cradle to prison and school to prison pipeline.
The aim of her presentation was to not only illustrate system change but to show how in only four years’ time they obtained regional awareness that childhood adversity without healthy support is a social determinant to poor health. Using a rigorous approach that included the steps, Advocate, Educate and Collaborate, the two leaders of Northeast Tennessee ACEs Community trained over 4,000 professionals from a wide array of sectors and had grown to a System of Care with 40 affiliated organizations. In 2018 this system of care was recognized by members of the Substance Abuse Mental Health Services Administration (SAMHSA) as a model for other cities to follow in growing community resilience. In her presentation, Haas explained they had approached raising awareness to the Adverse Childhood Experiences (ACEs) study with great urgency resulting in professionals understanding this now provided an upstream approach to addressing regional challenges.
Becky compared building greater community resilience by cross sector training to the public placement of Automated External Defibrillators (AED’s). These lifesaving medical devices are put in areas where they will most likely be needed and quick service by Emergency Responders is not available. The key to proper use is training. The same is true with community-wide Trauma-Informed Care training. Community resilience is growing as professionals receive training in the basics of using a trauma informed approach to service delivery. After training, several school districts are moving towards becoming trauma sensitive and many are implementing the Handle With Care program in partnership with police. Haas provided examples of trauma informed programming being implemented in libraries, by healthcare, in juvenile justice, domestic violence, the faith community, Parks and Rec and the Boys and Girls Club. One of the most significant things learned as a result of the ACEs study is what is fact doesn’t have to be fate. By increasing community resilience there is new found hope throughout rural Appalachia that many children growing up in household dysfunction will be diverted from experiencing the possible consequences of it.
By teaming up for this presentation, Warren and Becky were able to illustrate to the diverse group of professionals joining the Academy for Social Justice event, that with training, assessment and collaboration, mitigating the effects of childhood adversity can become an effective upstream approach for impacting the challenges faced in both countries.