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The Problem with ACEs Implementation

 

The Adverse Childhood Experiences study was ground-breaking in its recognition that childhood trauma impacts individuals across their lifespan. This was the big take-away, that adults are living with unrecognized and thus untreated physical, mental and emotional consequences that have massive detrimental impacts on their quality (and quantity) of life.

And yet, when we see the research and programming that has been implemented following the ACE study, the consensus seems to be that the effort and expense involved in treating those adults is just too much to expend. The majority of efforts are focused on prevention or early childhood intervention rather than treatment of the traumatized adult. And so the conversation about ACEs revolves around children, not around the adults from whom this study originated.

Further, when the traumatized adults are referenced at all, it is as a supportive player in the child’s story, or as researchers put it, the adult’s role is to be an effective “buffer” for children. When looking at the traumatized adult, support and treatment for them is seen as valid only insofar as it relates to their child’s well-being, not as having value in and of itself.

I often read complaints by those who are working to forward the integration of ACEs science into health care that they are frustrated by the “silo” effect, with each physical and mental health specialty working separately instead of in coordination to address the impacts of trauma.

It seems to me that the missing picture here is that we are not just silo-ing our treatment, we are silo-ing those we are treating. When we are talking about Adverse Childhood Experiences, we are talking about inter-generational trauma. We are talking about families. And yet what I see in the programs that are being created, and the research that is being done, is a child-centered focus. The mother, when mentioned, only exists to “buffer” the child, and the father does not exist at all.

Where is the whole-family approach? I see glimpses of it in discussions about child-parent psychotherapy, but then I see that the goal of this therapy is “returning the child to a normal developmental trajectory”. Returning the child? What about the parent? What is the goal for the parent in this scenario? Is their development irrelevant? If we are truly engaged in creating trauma-informed systems change, we need to be engaged from a whole family framework. ALL the traumatized people matter.

Further, all the systems that perpetuate trauma matter. If we are not looking at creating change from an intersectional, social justice informed framework, we are just spouting the same bullshit that the privileged upper class have been spouting for eons, about how those poor mothers are responsible for all the evils of the world. We must acknowledge the systems of oppression that lead to inter-generational trauma. Then we must tear those systems down, and re-build. I am encouraged to see a new framework arising in this area which recognizes the Pair of Aces: Adverse Childhood Experiences, and Adverse Community Environments.

We must also acknowledge that adverse childhood experiences do not only exist in impoverished communities, they exist in all communities. The original ACEs research came from a group that was for the most part, Caucasian and middle class. What this shows us is that the systems we live in are not just harmful to the oppressed, they are harmful to all. This does not mean that we ignore systemic oppression and discrimination. It does mean we acknowledge the pair of ACEs, Adverse Childhood Experiences and Adverse Community Environments, and how they are intertwined, while still acknowledging that childhood trauma is a universal issue.

When we are creating systems to address trauma, we need to ensure that we are not profiling a certain demographic and only creating change in the systems that serve that demographic. We need to be creating change in all systems. What does this mean? This means instituting a trauma informed framework in the inner-city school and the private school. This means educating social workers and business leaders about creating trauma informed workplaces.

We need to zoom out the lens we are using to view Adverse Childhood Experiences. Firstly, to the whole family system, and then, to the systemic discrimination that perpetuate violence and oppression. We can’t solve this complex issue unless we acknowledge the universal nature of childhood trauma, and see that ACEs touch every family and every community.

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Comments (13)

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This is a great discussion.  I do want to mention that emphasizing protecting children can be a good route to reach the parent who may not know much about their own ACEs.  So it's a subtle line to walk.  Plenty of traumatized people are in denial, but concern about helping their children might be a way in.

Dennis Haffron posted:

I'm trying to reach out, to my community college, to my state union, to my township senior center, and to anybody who wants to learn. 

 

Dennis thank you for so generously sharing your presentation! I have added it to my resource folder.

Theresa Barila posted:

Hi Joyelle,

Thanks for your post. In our own work in Walla Walla, we saw the same issue (Jane Stevens already noted the tendency to stay trapped in our silos in her response to you) and in fact, we changed our name to Community Resilience Initiative (from Children's Resilience Initiative) to expressly and intentionally address both the silo effect AND the thinking that this is only about helping the children impacted by ACEs. To us, it is ALL about community, and how we create a thriving community focused on the common framework the ACE Study and an understanding of how our brains develop, to then understand help, hope and healing. We try to help the adult to understand the impact of their own personal experience of negative experiences AND opportunities for resilience building strategies to do the personal insight work first. Like the airline directive to put our own oxygen mask on first if needed, before attending to the child's, we must take care of ourselves first, to then be effective to others. When we bring a community together to do this, from all sectors, we begin to bring what the newest research is telling us about resilience-- that is must be community based to truly be effective. And that makes so much sense, because we live our lives across all domains of our daily lives, and across all sectors which touch our lives. Community resilience is where the focus should be place, and community engagement with all sectors takes us there. Thank you.

Our website offers our findings as we continue to evaluate and learn from our journey.    www.resiliencetrumpsaces.org

Hi Theresa,

Thank you for your thoughtful message. I am so glad to learn of your organization! I'll be following all the amazing work you are doing. Good luck with your upcoming conference!

Joyelle

www.parentingwithptsd.com

 

Jane Stevens posted:

So, what do you think about changing it to read:

The problem with the silo-ing, one-gen, them-and-us approach

?

I changed the title to The Problem with ACEs Implementation. I think that sums it up.

Dennis Haffron posted:

I'm trying to reach out, to my community college, to my state union, to my township senior center, and to anybody who wants to learn. 

 

Thanks for sharing your presentation, Dennis!

I feel that the original ACEs study was very important, but it represents where we started from, not where we are going. Preventing ACEs (the "pair of ACEs" you mention) is a laudable goal, but the reality is that we see many adults who experienced ACEs in the past, and may continue to do so, and they need support and help now. For me, the great revelation of the study was how common these experiences are: stop pretending that it only happens to "those" folks.

As anyone who works in health, human services or education knows, people's issues rarely conform to the requirements of our agencies. Physical health issues are often complicated by employment, housing and mental heath issues, and so on. As important as it is to improve healthcare or education, the real goal is to improve the community. Just making one agency more trauma-informed, is like fixing the roof of a tornado-damaged house: one down, two hundred more things to go.

As someone with several decades of experience in health and human services, I get a bit worried when the discussion involves only professionals, It's too easy to see the problem only from the lens of your particular service, and to become self-congratulatory over your expanded awareness and reasonable pace of change.  We need more folks to tell (yell at?) us to think more broad;y and to move a heck of a lot faster.

Hi Joyelle,

Thanks for your post. In our own work in Walla Walla, we saw the same issue (Jane Stevens already noted the tendency to stay trapped in our silos in her response to you) and in fact, we changed our name to Community Resilience Initiative (from Children's Resilience Initiative) to expressly and intentionally address both the silo effect AND the thinking that this is only about helping the children impacted by ACEs. To us, it is ALL about community, and how we create a thriving community focused on the common framework the ACE Study and an understanding of how our brains develop, to then understand help, hope and healing. We try to help the adult to understand the impact of their own personal experience of negative experiences AND opportunities for resilience building strategies to do the personal insight work first. Like the airline directive to put our own oxygen mask on first if needed, before attending to the child's, we must take care of ourselves first, to then be effective to others. When we bring a community together to do this, from all sectors, we begin to bring what the newest research is telling us about resilience-- that is must be community based to truly be effective. And that makes so much sense, because we live our lives across all domains of our daily lives, and across all sectors which touch our lives. Community resilience is where the focus should be place, and community engagement with all sectors takes us there. Thank you.

Our website offers our findings as we continue to evaluate and learn from our journey.    www.resiliencetrumpsaces.org

Jane Stevens posted:

Gee, Joyelle:

After reading this, I think the headline is misleading. It's not a problem with ACEs, it's a problem with silo-ing, not taking a whole-family, two-gen approach (which the American Academy of Pediatrics has been advocating), and people continuing to think of ACES as a problem of "them, not us".

-- Jane

Yes, Jane, I totally agree.

Joyelle:

"It seems to me that the missing picture here is that we are not just silo-ing our treatment, we are silo-ing those we are treating. When we are talking about Adverse Childhood Experiences, we are talking about inter-generational trauma. We are talking about families. And yet what I see in the programs that are being created, and the research that is being done, is a child-centered focus. The mother, when mentioned, only exists to “buffer” the child, and the father does not exist at all."

It's so true. Parents, if considered at all, are often discussed as an afterthought. It's not just in research though, it's true in the pediatrician's office, at conferences and even programs aimed at parents (which is mind-boggling mystifying). 

Solutions often focus on education and positive or strength-based approaches while ignoring the negative realities of social injustice and hose resilience robbing it is for families to be traumatized/re-traumatized by systems.



I'm going to share this in the Parenting with ACEs community. 

Cis

Gee, Joyelle:

After reading this, I think the headline is misleading. It's not a problem with ACEs, it's a problem with silo-ing, not taking a whole-family, two-gen approach (which the American Academy of Pediatrics has been advocating), and people continuing to think of ACES as a problem of "them, not us".

-- Jane

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