Hi, Corinna: Just curious....when all the case studies are all about how communities are developing solutions, why do you say the Community Resilience Cookbook promotes problems?

Hilary Cottan tells the story of bringing all the services together. I am of the belief  that any kind of CPR is better than none at all for the interim  http://www.ted.com/talks/hilar..._how_we_can_fix_them 

Jane, what I mean by "promote the problem," is talk on and on about the impact of trauma and the epigenetic s of trauma, and the bad news about trauma. And the action steps are about talking about trauma. None of the action steps in the back of that book are more than awareness raising about the problem.

If you look at the other book, you will see much more info on building resilience and not just raising awareness.

I didn't read all the case studies yet, I was going by the recipie since it was a "cookbook."

Why not just look at what the UK did?

It's very good and useful. There are more tools in the Roadmap. Also, the Roadmap advises cross-sector collaboration a bit more than the UK version, in that no one organization "owns" the process. The entire community does.
And, what we've observed is very important, is that people who understand the "unified science" of human development are more successful in implementing trauma-informed and resilience-building practices, and institutionalizing them in organizations.
The "unified science" includes the epidemiology of ACEs (ACE Study and the dozens of ACE surveys that have followed, including on that England did); the neurobiology of toxic stress; the long-term biomedical and epigenetic consequences of toxic stress; and resilience research.
For example, you can give parents all sorts of advice and training in how to be healthier parents, and it falls apart the moment they're triggered when, for example, their two-year-old hits them and they, automatically responding to having been hit in their own childhood, hit their child. (A trigger is the amygdala's response that activates before the prefrontal cortex can decide if the action is useful or not.) The parents then feel guilty that they're not able to comply with being a "good" parent.
But if they learn about ACEs and why they respond the way they do, they have a clearer idea about how to learn how to self-regulate, and why it's important. In parenting classes that integrate ACEs, the parents are much more engaged in learning how to do healthy parenting, and have been shown to be more empathetic toward their children because they understand their kids' behavior is not intentional to anger them.

OK, that makes sense. Thanks for the explanation. I, personally, find the neurobiology of ACES triggering which is why I dislike so much of what is happening with this process.

This is my hindbrain level reaction to 40 years of neurobiology being used to throw away the entire group of people receiving mental health services. As much as that book says, "A high ACE score is not a destiny," I think the research on mental health stimga clearly shows that linking problems to biology does make it more permanent and not less. See this article which is the MOST cited article on stigma reduction. http://www.ncbi.nlm.nih.gov/pubmed/20843872

So too much biology and you might be riding a fine line between understanding and demoralizing people.  I know that many of these committees are run by mental health providers, and mostly they don't understand that the mental health labels and the mental health providers themselves are the #1 and #2 biggest sources of stigma.

I just visualizing all these social service people going around preaching about ACES and making people feel hopeless and they might not notice any more than they ever noticed about the stigma stuff.  And yes, this is a trauma reaction because most mental health providers have no clue about how many people they have damaged. So now the same crew wants to go on and on about ACES? When they don't event realize they are the one perpetuating a bunch of the problems? And they don't have plans for real community engagement?  This process is downright scary, at least in my city. 

Just enough innovative words to hog up all the resources being needed to try new things, but not enough community engagement to actually help people.

The first words of advise by my local coalition educator (Susan Green) was "Baby Steps". I thought at the time " Why in the hell aren't we yelling this from the roof tops" It all takes time. As I began my studies of this revolution just short of a year ago, I just wanted enough information to keep my scope small. Of course that didn't happen. Now I'm contemplating a trip to Philadelphia for a 6 hour course. Imagine all you have learned and now you have to surround yourself with people to sign onto what you know. Baby Steps. I feel your frustrations. Every time I think of tiring to shortcut the process, I learn something new.

To me, ACEs is all of those sciences in the "unified science" of human development. If someone talks about the ACE Study, they should talk about all of it.
Take a look at some of the case studies in the Community Resilience Cookbook, Corinna. Tarpon Springs, FL, is a good one to start with. And you'll see resilience in action!
And I -- and many, many others -- agree with you that the mental health system needs to integrate all of this. The Robert Wood Johnson Foundation came out with a report that said organizations must institute trauma-informed, resilience-building practices themselves before they implement them with their  clients/students/patients/prisoners. That means acknowledging that we're all in this together. There is no them and us. And that mental health professionals are in partnership with their clients in helping them heal...not taking the approach that the mental health professionals are healthy and their job is to heal people who are ill.

I looked at the toolkit and it's the same problem. Resilience is defined as, "knowing what the top down hierarchy want me to know." The action plan again is all, "How to distribute information from top down to as many people as we can."

How about looking at some different definitions of resilience besides, "knowing about trauma?"

How about Promoting mental health and mental wellbeing, how about enhancing control of participants, promoting inclusion, how about increasing community asseses, facilitating participation? How about, "Connect, Be Active, Take Notice, Keep Learning, Give"?  How about Increasing social capital, increasing coping skills, increasing wellbeing?

Increasing knowledge didn't actually help in the mental health industry, I see this process promoting a lot of potential harmful knowledge. And the risk management plan to deal with potential harms? 

"Well, make sure to mention resilience. But it's on your own to figure out how to support increasing resilience, because we define resilience as knowledge about trauma."

I like understanding the neurobiology and the epigenetics because I feel like the outcomes are understandable and logical.  The individual wasn't born flawed and what you see is a logical outcome of adversity in childhood.    So whether the psychiatrist knows it or not --- soon he or she will as you bring the information over and over and never let up.  

I also think it helps others to buy in.  

Just my two cents.  

Bottom line, the patient has to buy in on their own healing. A lesson my dad taught me 30 years ago was " You can't please everyone and some people you can't even help". In EMS we can do everything right and our patient can still die.

Here's a hypothetical... I've watched the UK fir 20+ years re: facial disfigurement, and they have been light years ahead of us here in the colonies. Light years. ... And then I was looking at how they deal with workplace bullying in education. Again.., they are light years ahead. They have done stuff ahead of where we'd like to be. So... And this is 'shooting from the hip', is it possible that they can assume their rank-and-file is familiar with ACEs and our folks are still in the dark?

I think this is a great fundamental question to raise and can see both sides of the discussion. Hope I’m adding rather than detracting to this conversation!

Brevity has never been my forte…!

Our brains endeavor to make sense of what has happened to us. It’s a natural human drive. Some of us will seek very detailed analysis, some won’t. I believe as one gets older there is more seeking of the ‘truth’ as one has more time to reflect than act or react.

Naturally most people on this website have thought about such questions, and it can seem like the trauma analysis, etc does indeed go on and on without solution/resolution.

But until everyone has a deeper understanding of the trauma people may have endured – and I think we’re still a long way off, in terms of mainstream and even most therapists themselves, then this part of the story, the evolution of understanding trauma, if you like, is still in its infancy. The current research is demonstrating just how complex our oh so important organ, the brain, is. I really engage with the brain research imparted to laypeople. Does it help? Somewhat, but of course it is only part of the answer, fascinating as it is. But it’s also one of the main drivers of understanding TIC. Hope there’s no contradiction here.

So I agree with Jane, in that parents need more than resilience skills ‘thrown at them’ (my words), if they’ve come from dysfunctional families, especially intergenerational ones, that on the surface seem appropriate to use, only to find down the track these people simply cannot sustain the ‘superficiality’ of the skills ‘taught’ without further knowledge/deeper understanding. One needs to be taught the skill of objectivity, once there is further grasp of what’s actually been going on. In my experience most people love to learn such things. Because at last their experiences are making sense to them, as never before. ACEs etc also does that.

One has to go to the SOURCE, I think. For how long and how deep the understanding is up to the individual. But life throws some curved balls, and if you haven’t ‘properly’ understood what has happened to you, then you will repeat it in SOME form. – Whether on yourself or others.

So to say it is up to individuals to seek help in healing is a little more complex, unfortunately. Of course it is, BUT how much understanding and expertise the therapist has is crucial. I have found there is truly a superficial understanding from many. This could be because of the time constraint as much as other factors. There has been a discussion on vicarious trauma. Who wants to risk that? Etc etc.

Thanks to what could be viewed as an ‘indulgent’ website on narcissism, I’m quite fascinated how this guy has honed in on the fine details of growing up with narcissists, for example. And all the abuse that can occur with it – sexual, physical etc etc. I’ve had so many aha moments from his insight. Yet it is a guilty secret pleasure (well it was secret until I'm telling you). Surely I’ve got over it by now. But the abuse can be so very insidious, and as said earlier, if you encounter it again in later in life, which the chances are you will, as you’ve been trained to accept such abuse, you need to understand it on a deeper level. I consider myself reasonably intelligent, yet the emotional acceptance on an intellectual level is not fully embedded. The scars of toxic stress and shame are so very deep that I wonder if any therapist can get through, unless they do something radically different. And it’s not ‘stubborness’!  It doesn't help that narcs are so good at showing such a different face to the world, which then means it looks as if you're the one lying or exaggerating to the extreme and therefore the problem resides in you...!

I was trained to accept abuse, even though as a teenager and beyond I fought it with the energy and understanding I could, yet I ‘stupidly’ believed that she must love me underneath it all. A counselor once barked, “Of course your mother loved you!” But the sad fact is she couldn’t, nor could my father, also a narcissist, that’s why they couldn’t be together. I know now yes, it happened, yes they were that bad. And yes, they had very difficult childhoods too. BUT… You have to have experienced genuine malignant narcissists to even begin to understand them. They're usually of reasonably high intelligence, though not always.

The younger one is arriving at the bigger picture understanding, the better skilled they are in dealing with it. Not wasting their lives in nebulous suffering that so often has occurred in the past. The ‘truth’ as much as it can be has been unveiled or understood. Thanks to the web, etc there is more understanding and sharing. I am in no way advocating wallowing. I am advocating fully understanding what you experienced, and why, and then taking positive steps forward. Initiating what is called resilience, but I prefer the term ‘bouncing back’, as you’ve had to learn what resilience skills look like in the context of prior trauma experiences. They then have decades to embrace the understanding in order to be able to be more fully resilient. Will this make them better, more conscious/cognizant and conscientious parents?   I think chances are, yes.

A child comes into the world ‘believing’ that they will be loved. Ie have their needs taken care of. Society tells you it is so. Mother’s and Father’s Day Hallmark cards tell you what wonderful people they have been to you, as did a good Christian neighbour I believed… Those that go non contact as early as possible have the best chances in life, in these situations I believe. Yet all around me, they were telling me to stick at it.

Bad bad ignorant advice. I think such advice is slowly changing.

As an aside, I had to endure the abuse by myself, my codependent sister much older than me, without any other siblings and/or witnesses, so I believe the impact is greater in these circumstances. Another ACE?!!

So when I stumbled on the ACE and resilience score I found a far better explanation than I had found prior to this, together with the brain research, etc.

So, briefly summarizing (!), yes, resilience is absolutely crucial, but not until trauma is understood in a more holistic way than it has been. Trauma is deep and complex. And every individual is different having experienced individual circumstances. Hence healing by therapists is not by any means, an easy task.

And yes, unfortunately, some clients may die, Peter. Better to die, trying to heal, I think.  Or as Midnight Oil, an Australian rock band sang in their lyrics: "It's better to die on your feet, than live on your knees"...

Apologies Peter, I'm not referring to EMS, I'm referring to all therapy/therapists.

As for the big picture Corrina, I know I haven't really answered or addressed this as such, but have tried to say what is needed for clientele IMHO...  because what's happening in mainstream therapy right now, is really only bandage care for most.  It should inform what's important though, I believe.

I believe it was Dr. Anda, maybe Dr. Felitti, said just get the information out there. I just watched Resilience with 6 other EMTs and made believers out of them. One of them is a nurse just out of college. Her outrage with my practice of ACEs in the field is that there is no patient discharge plan. Lets say there are 20% of America with a score of 4+. 60+million people. Do we have to wait until all the ducks are in a row before pulling the trigger on delivering services? I'm pushing up from the bottom. I hate the idea of one more child entering into the pipeline of trauma while some are trying to reinvent the wheel. The patients I see that are receiving treatment have not been asked the ACEs survey. Young and old. So debating the age old question "What came first. The chicken or the egg" doesn't matter. 

Everyone have a good evening. It's midnight. Off to bed.

Nighty night! 

Just before you sleep, an analogy:

Doctor says to patient, "Here, take these cholesterol reducing tablets for your broken leg".

I just watched the film "Resilience" as well.  I loved Dr. Nadine Burke-Harris' analogy to cough syrup.  In the film she says that if a patient comes to her with a cough she can prescribe a strong cough suppressant; however, if they have tuberculosis or lung cancer, all she has done is mask the symptoms and not treated the problem.  

For too long we have treated the symptoms of toxic stress in children  and adults without even perceiving the source of the symptoms. Most psychiatrists and other behavioral health practitioners have yet to recognize that "developmental trauma" is distinct from PTSD.  Now we have a opportunity to educate everyone (medical providers, teachers, parents) about the potentially serious and enduring harm done to children who are exposed to chronic stress. 

We are just starting to gather evidence of how wide-spread the problems is. We are just starting to learn how to identify children who are being affected by toxic stress.  We are only beginning to develop effective prevention and treatment. We need the support of legislatures, private funders, and thousands of individuals to spread the word that ACEs are the greatest public health concern of our time. We have a long way to go, but we are finally on the right path.  

Thank you for listening.

Deborah Bock
Anchorage, Alaska 

I'm not arguing whether trauma info is useful. Of course it's useful.

But why does the Aces Connection lack real info on resilience building beyond trauma knowledge? And why is there no plan to minimize damage being done to those who DON'T benefit from neurobiology narratives? Those people who feel defeated by the "broken brain" message?

1. Trauma awareness is good, but what about practical solutions to prevent and deal with trauma? The ACEs connection community seems to have defined resilience as "trauma knowledge" instead of increasing defining resilience as "protective factors like coping skills, enhancing control, social inclusion, and increasing wellbeing."  Why not a broader definition and a more robust program / toolkit? Awareness is one thing, action is another.

 2. The neurobiology education around trauma helps some people BUT ALSO has great potential to do harm. The mental health stigma research field has lots of documentation around neurobiology narratives harming people. The ACES Connections harm management plan? "If people feel demoralized by hearing they have a broken brain, just tell them to build more resilience." Why not a realistic reckoning of harms vs. Benefits and a realistic harm minimization plan?

 3. If the harm minimization plan is to tell people to "build resilience" but then see #1 there are no concrete tools to build resilience you have set people up in a blind alley. Awareness without action. 

Corrina, I believe this is where your creative skill development comes into play. At times I have to depend on my gut-heart instincts and make it up as I go. The information is there. Seek and you ye will find. NEAR@Home and National Critteton ACE tool kits have been a source for my practice of ACEs in the field. I do feel your pain in what seems the lack of effort in prevention of more kids entering into the pipeline of trauma and only the ones that leak out get noticed and treated. But it's happening. It's getting there. I have been referred to as a bull in a china shop. But I do get noticed.