As a mental health agency for children, we have witnessed the impact of adverse childhood experiences (ACEs) in the lives of children, families, and our community of Orange County since 1972.
Resilience is the antidote to trauma. Metaphorically, think of it like a scale that tips back and forth with trauma on one side and resilience on the other. External and environmental factors determine the outcome and which way the scale leans. The key is to find the balance, to learn to identify the trauma and prevent it when possible by having a resilience toolbox filled with ways to counter the trauma that keeps coming, it’s part of life, understanding how the teeter-totter works and knowing how to swing back are life skills we all need.
Throughout the years our work has aligned with the ACE Study, the landmark 1998 study by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. It describes ten categories of adversities in three domains experienced by age 18 years: abuse, neglect, and/or household dysfunction and is an invaluable tool in determining the course of treatment for our clients.
The ACE Study was established in 1998, yet it has been under the radar for many years and has only recently come into the mainstream by celebrities like Oprah Winfrey and champions like Dr. Nadine Burke Harris, California Surgeon General, and Dr. Karen Mark, Medical Director of the Department of Health Care Services spreading awareness through books, interviews, collaborative partnerships, and by the launch of organizations like ACEs Aware.
WYS views mental health and wellness through the lens of ACEs and we are mindful of the impact that ACEs have on mental, physical, and emotional health outcomes.
Our approach focuses on building resilience in the children, families, and communities we serve. Wherever possible, we use preventative methodologies and early intervention to stop a crisis before it happens. The combination of the ACE Survey and The Pediatric ACEs and Related Life-events Screener (PEARLS) is an integral part of our intake process and allows us an inside view of what happened to a child and to craft a nurturing, evidence-based treatment plan based on what they need NOW. This is what changes the trajectory of their life path to one of healing and hope.
Part of the educational platform we’ve built is to bring awareness of ACEs, preventative methodologies that can be taught to others, and available resources. We believe strongly that by empowering the people on the front lines such as teachers and other youth-serving organizations we can work together to make a collective impact.
Our educational platform consists of:
- Currently, more than 15 WYS staff are trained in the ACE Interface methodology, including seven Master Trainers. The focus of this training is on the science behind ACES, the program was created by Dr. Robert Anda and Laura Porter, originators of the science and community application of the original ACE Study.
- Our Resilience Workshops include regular screenings of the award-winning documentary Resilience: The Biology of Stress and the Science of Hope, and an accompanying guided conversation.
- Through the Behavioral Health Training Collaborative (BHTC) we offer 20+ trainings and workshops each month on mitigating the impact of ACE’s and other topics related to supporting mental wellness. They are available at no-cost to residents of Orange County and there are offerings for individuals, families, professionals, and medical providers.
- We offer Network of Care and Peer-to-Peer sessions also available and no-cost and covering topics for individuals that include resilient parenting and community empowerment and topics for medical providers that include provider compassion and building a resilient roadmap.
- In 2016 we started a grassroots ACEs Cohort in the Orange County community to bring awareness of the impact of ACEs to different organizations. The cohort has grown significantly, there are more than 3,500 community members from more than 80 organizations who have received training through our ACEs Education campaign. These organizations and individuals include agencies, educators, hospitals, afterschool programs, workforce development agencies, low-income housing agencies, and many other networks of care.
About the ACEs Aware initiative
ACEs Aware is an initiative of the Office of the California Surgeon General and the California Department of Health Care Services, it’s led by Dr. Nadine Burke Harris, California Surgeon General, and Dr. Karen Mark, Medical Director of the Department of Health Care Services. The ACEs Aware effort is part of Gov. Newsom’s California For All initiative and the California Surgeon General, Dr. Nadine Burke Harris has set a bold goal to cut ACEs in half in one generation. The ACEs Aware website is a wealth of information, visit there often to keep up to date on ACEs and their good work.
Part of the ACEs Aware initiative is a Grantee Program, Western Youth Services (WYS) was included in this program with an initial focus on offering Medi-Cal providers training, screening tools, clinical protocols, and payment for screening children and adults for ACEs. Screening for ACEs, assessing risk for toxic stress, and responding with evidence-based interventions and trauma-informed care can significantly improve the health and well-being of individuals and families.
As an agency and as individuals, we fully embrace the ACEs Aware mission into every aspect of our organization—from education and outreach to screening and treatment. In our commitment to continually improve our services and advance the larger body of ACEs research, we evaluate our outcomes and are eager to share the results of our work in the grantee program.
This article shares insights and resources from our work and others who are leading the way to help Dr. Nadine Burke Harris realize her bold goal.
What We’ve Learned as ACEs Aware Grantees
Although we have both worked with and researched the effects of trauma for many years, it’s been an incredible experience of continued learning and validation working with ACEs Aware and the other grantees.
The initial mission of the grantee program was to change and save lives by helping providers understand the importance of screening for ACEs and training providers to respond with trauma-informed care to mitigate the health impacts of toxic stress. It has been so much more. By being active participants in this first round of ACEs Aware grantees, we all learned and grew together. This work is bigger than any one of us and as an agency, we have learned so much more than we already knew.
It will take a village to create change on a community level and the good news is ACEs Aware has brought together this village. Help is available through WYS, ACEs Aware, and many other resources. The path is through collaboration and creating a call to action for schools, health care providers, community-based organizations, government, and social service agencies to work together and become key partners in spreading awareness and educating as many people as possible about ACEs and related avenues of support. Specifically, screening for Adversities, fostering resilience and protective factors, and linking children and families to evidence-based mental health treatment and other services they might need. Together we can achieve Dr. Nadine Burke Harris’ bold goal to reduce ACEs and toxic stress by half in one generation.
Components of our Work as an ACEs Aware Grantee
Two of the components of our work in the grantee program included:
Development of a Practice Paper
Adverse Childhood Experiences and Related Life Events: Understanding their Prevalence, Impacts, and Best Practices in Intervening - WYS in partnership with Measurement Resources Company (MRC) prepared this Practice Paper to provide a current overview of Adversities, their prevalence, and impact on children, families, and communities.
The Practice Paper includes a case study exploring the increasing prevalence of ACEs after the onset of the COVID-19 pandemic, the relationship between Adversities and mental health diagnoses and functioning, and evidence-based practices linked to improvements in mental health functioning among children who have experienced many Adversities. The paper concludes with a discussion of common challenges and best practices for providers in screening, preventing, and intervening for Adversities based on information gathered from providers through ongoing provider engagement sessions.
Providing Network of Care and Peer to Peer Convenings
Participation in Orange County’s Trauma-Informed Network of Care (TINoC) implementation project. A group of interdisciplinary health, education, and human service professionals, community members, and organizations, primarily Medi-Cal providers who support adults, children, and families.
The intention of this project was to expand awareness of ACEs and provide evidence-based “buffering” resources and support to expand and empower the network of providers to help to prevent, treat, and heal the harmful consequences of toxic stress.
Over the course of the grantee period, we offered monthly Network of Care sessions and Peer-to-Peer sessions on various topics to provide education and guidance to a significant amount of providers in and beyond Orange County.
We look forward to developing new ways to come together to prevent adversity and buffer toxic stress in all communities. Here are a few ways we are continuing our work:
- Ongoing participation in the TINoC steering committee workgroups: Coordinating Infrastructure, Community-Clinical, Equity and Inclusion.
- Our CEO, Dr. Lorry Leigh Belhumeur co-facilitates the Community-Clinical workgroup along with representatives from CHOC and First 5 OC.
- Working to align community initiatives and grassroots groups with the TINoC and the Surgeon General’s Trauma-Informed Network of Care Roadmap and our programs
- OC ACEs Cohort
- Children’s Mental Health Access Collaborative (CMHA)
- Behavioral Health Training Collaborative (BHTC)
- ACE Interface Continued Education and Training
Key Findings of the Practice Paper
ACEs are stressful events occurring in the first 18 years of life that can result in chronic toxic stress without mitigating or buffering support. ACEs are specifically defined as 10 types of adversities, categorized into three domains (abuse, neglect, and household challenges). Beyond ACEs, there are other adversities, defined as Related Life Events (RLEs), that a child can experience that are also risk factors for chronic toxic stress. These factors include living below the poverty line and exposure to discrimination. The collective term for ACEs and RLEs is Adversities.
Decades of work demonstrate that cumulative exposure to adversity, especially during childhood, relates to negative health, economic, and social outcomes for children, families, and communities. As the COVID-19 pandemic brought about increased stress, uncertainty, and disruption to daily routines, children’s exposure to Adversities is heightened, increasing the need for coordinated screening, prevention, and intervention of Adversities across sectors (education, healthcare, social services).
Fortunately, experiencing Adversities in childhood does not necessarily dictate a child’s future.
When toxic stress is countered with caring interventions, there is an opportunity to build resilience. It’s almost like trading up. In many cases, it can be as simple as teaching a child mindfulness techniques that form lifelong resilience-building habits and create a ripple effect.
This is also why it was important to increase awareness and offer training to Medi-Cal and other healthcare providers who are on the frontlines of caring for children.
Prevalence and Impact of Adversities on Children, Families, and Communities
- In California 4 in 10 children and 6 in 10 adults (by the age of 18) are estimated to have experienced at least one ACE.
- ACEs are strongly associated with social inequities. While present in all populations, females, LGBTQ+, people of color, and those experiencing income disparities are at a greater risk of experiencing multiple ACEs.
- Sadly when ACEs are not addressed, our children carry their unresolved trauma into adulthood resulting in health issues. Adults with one or more ACE are more likely to be diagnosed with health concerns such as heart disease, obesity, diabetes, lung disease, or mental health issues.
- ACEs constitute an economic crisis. In 2013, ACEs reported by California residents were estimated to cost each adult reporting ACEs an average of $589 in personal healthcare expenses for the year, totaling $10.5 billion across the state overall.
Findings from a Case Study Based on Children Receiving Mental Health Treatment from WYS During COVID-19
- Exposure to Adversities increased during the rapid onset of the COVID-19 pandemic.
- With each ACE reported, the odds of being diagnosed with Post-Traumatic Stress Disorder (PTSD), depression, and adjustment disorders increase by 1.3, 1.1, and 1.1, respectively.
- Related Life Events are more common in children that are diagnosed with depression above and beyond ACEs. For every additional RLE reported, the odds of being diagnosed with depression increases by 1.2.
- Children exposed to many Adversities are experiencing significant improvements in their mental health during their treatment at WYS. Mental health treatment helps.
- Our research has shown that Eye Movement Desensitization and Reprocessing (EMDR) and individual therapy are linked to the strongest improvements in mental wellness among children with Adversities. This has led us to increase EDMR training for our clinicians and include it in individual therapy sessions.
- By researching Related Life Events in addition to ACEs the results clearly show that the need for greater system-wide coordination of efforts in screening, prevention, and intervention of ACEs is imperative to change lives.
Read the entire Practice Paper, including citiations: Adverse Childhood Experiences and Related Life Events: Understanding their Prevalence, Impacts, and Best Practices in Intervening.
Key Findings from Participating in Orange County’s Trauma-Informed Network of Care Implementation Project
The Roadmap for Resilience
As a result of hosting a series of Network of Care events for healthcare providers, one question that came up often is what do we do next? How can we help? The Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health, is an invaluable tool to help healthcare providers and organizations build an effective system for responding to Adversity screenings and to recognize and respond to the effects of ACEs and toxic stress.
The Roadmap For Resilience is a whole-community response to Adversities. It uncovers systemic barriers that exist as well as best practices, lessons learned, and actionable steps for professionals to create their own systems and become part of the network-wide efforts to prevent, screen, and intervene so that experiencing Adversity does not dictate a child’s future.
ACEs and PEARLS - Adversities
We began utilizing the PEARLS as part of the ACE screening in our client intake process, this is the related life events addition described above. By asking these additional questions in our own agency, we were able to gain a better understanding of what our clients need from a sociological standpoint which allows us to pull from our various internal and external resources and quickly provide the help needed. This could include assistance with mental health services, education, finding jobs, addressing food or housing insecurity, and more.
What we learned about introducing the PEARLS as part of the ACE screening as an educational component, is that the addition of the related life events provided validation for the health providers was new even to the attendees that were familiar with ACEs. They immediately saw the value of a more whole-life vantage point and the correlation between life experiences and health disparities.
What’s Next
We learned that attendees of our events were at different levels of readiness and understanding in their ACEs work. There is a need to provide continued education and resources to get our community on a level playing field to address the impact of toxic stress.
By combining our own resources with the resources provided by ACEs Aware, we enhanced our educational content and broadened our reach. This has allowed us to become even more aligned with our ACEs work. Over the year, we provided a series of educational events for healthcare providers and were able to increase our reach and build our network of care in Orange County and beyond.
There is still work to be done to expand awareness of Adversities. As part of our on-going plan, we will continue to provide Network of Care events, expand upon the content based on new information and the needs of the attendees, and incorporate the use of the Roadmap for Resilience for individuals, organizations, and communities.
Our work with ACEs Aware and developing new ways to work together to prevent adversity and buffer toxic stress continues.
Visit the ACEs Aware page of our website to learn more about available workshops and trainings.
It takes a village, would you like to join us?
Lorry Leigh Belhumeur, Ph.D.
Chief Executive Officer
Western Youth Services
Pronouns: She/Her/Hers
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