My thinking about ACEs is informed by a systems approach I learned while adopting and implementing a management concept called “Lean Thinking.” There are two essential elements to Lean Thinking: respect for people and continuous improvement.
As I analyze how knowledge about ACE’s moves into the public consciousness, it is gratifying to see the discussion of potential solutions. However, one lesson I learned many years ago was not to jump to solutions before you understand the facts. I am not saying study everything to death. We assess the current level of factual knowledge available to us, and we act on that knowledge with appropriate experimental solutions. We discuss how to improve a system in an event called Kaizen.
In business settings, Kaizen is a one-week improvement event where many participants in the process being analyzed identify relevant facts, map out the current state, propose countermeasures to the problems/defects they identify, put together a project plan to test the countermeasures, review the progress regularly, and if the countermeasures are successful, add them to the most effective way you have identified to do the work. It uses the PDCA Cycle (plan-do-check-act/adjust) as a scientific method for problem identification, research, systems analysis, solution proposal and testing. It truly works for improving already existing systems.
Kaikaku is a different process. Years ago, I studied the concept of Blue Ocean Strategy. The concept discusses how you identify a place in the market that is not occupied. When you find Blue Ocean, you generally have the market to yourself. Kaikaku is the Lean process of finding Blue Ocean. It introduces radical change, and that can be difficult. However, when you compete in the Red Ocean, you face constant pressure from competitors. When you find Blue Ocean, you have great freedom to access the market and great benefit.
I worked in health care delivery in rural Alaska for 10 years. Kaizen is not applied in Alaska Tribal health care. We spend about a billion dollars annually for health care for Alaska Natives. I estimate that we could recapture about $300 million in value from our current systems with an effective Lean transformation. Imagine what that could do for Alaska Native health care. I am not sure how much additional revenue could be captured, but I suspect it’s considerable. Many Alaska Natives do not use their Tribal Health care systems because they do not address their needs—either because of lack of capacity or long wait times.
Recognition of ACEs and development of a new response system for health care is Blue Ocean. Kaikaku is the process I used to envision a different system of care that promotes healing instead of profit. The Red Ocean that we are engaged in is interesting. Consultants, researchers and funding agencies are all focused on problem identification and are seeking new and innovative approaches. But they do not have the foundational, systemic facts that are required for new solutions. Nor are there many minds open to new solutions and new ideas. It is basic human nature to resist change and innovation. We have to change that, and Acesconnection is a wonderful tool for sharing ideas and thoughts on how to change.
I wanted to share my thought process because what I see on AcesConnection are many wonderful people going through the fact-collection stage. Solutions are being proposed, but they are based on Red Ocean. That space is already occupied, and we need to find the Blue Ocean. Funding agencies need to think about Blue Ocean. I had a chance to think about this when the National Institute of Mental Health put out a Request for Information on how to address the issue of suicide prevention in Indian Country. NIMH is mining the Red Ocean and seeking Blue Ocean. I fear they don’t have a mindset that allows them to see it. You can respond to the RFI until February 12th if you want.
I responded to the RFI. My basic approach states that the facts implicate developmental trauma (ACEs) in the development of suicidal thoughts and actions. If we approach identification of developmental trauma causation and its effect on all behaviors and health issue, we have a factual basis on identification of an at risk population. The countermeasures will have to be individually developed, but the earlier we can identify someone who has risk markers for development of suicide, the earlier we can intervene. And our intervention will not only help to reduce suicide, it will help to reduce many other risks that we currently address through what I refer to as “silos.” Addressing developmental trauma should help address many issues.
I know this might sound like a strange post. But we have been addressing many developmental trauma-based issues for decades and developed a deep Red Ocean. I hope there are enough people who understand this concept and can start the movement to identify new practices. If you have made it this far, thank you for reading.
Upon receipt of an email from a MN state legislator directing my attention to the cost of Governor Dayton’s trying to improve conditions for Minnesota's at-risk youth, I penned this response and would ask you to write something like it and send it to your state representative (I have altered it slightly for this post).
We should all send at least a few notes to our state representatives each year – and this is a worthy cause). If you get the chance, drop by and get to know them. Most legislators have offices in your community as well as at the State House.
Dear Representative Lohmer,
Responding to your note to me below (decrying the cost of early childhood programs being recommended by Governor Mark Dayton), I’ve been a volunteer CASA guardian ad-Litem for almost 20 years and watched what short changing MN children does to our schools, city streets, and state budget.
One of (I have 50 stories) my case-load boys cost the county between $2 and 3 million and that does not include the people he has stabbed, the teacher he beat up, or hundreds of others he has caused great suffering to in his young life.
He’s in his early 20’s today and recently aged out of foster care (I met him in 1996 when he was 7). Today, he has AIDS, is on the most expensive medicines in the nation, has always been a state ward, and I expect will always be a state ward.
To not support programs that could have helped him lead a normal life is fiscally irresponsible and morally reprehensible.
If I were to describe to you the costs some of the other 50 children I have worked with as a volunteer in child protection, you would make better decisions concerning early childhood programs.
We launch a new generation of abused and neglected children with or without coping skills every five years (by five a child is able to cope with his or her environment, go on to school and succeed or not).
It hurts me to meet smart powerful people that don’t understand this. Quit thinking of a generation as 20 years. It is not. It is five years for the children we are talking about and it determines success or failure in life (all of life for that child).
If you are not aware of Federal Reserve Board Director Art Rolnick’s 2003 study on early childhood investment returns, you are short-changing yourself, thousands of Minnesota children, and your constituents.
Knowledge is power and our bad legislative decisions last these children and our communities a lifetime.
Please consider talking to me about the 50 children I have lobbied to remove from toxic homes, and their financial costs, the problems visited on educators, foster parents, the justice system and the impact on quality of life in our community.
From the age of four through seven, the boy I mentioned above was sexually abused, beaten bloody, left alone for days in an apartment tied to a bed without food or water, all because the county did not have the resources to protect him. My first visit to one four-year-old girl, a CASA case, was at the suicide ward of Fairview Hospital.
Please don’t blame the people doing the work. It ain’t them, it’s us for not having systems, training, and resources to deal with the inadequate state of child protection in Minnesota today. Social work, teaching, and foster/adoption parenting could not be any more difficult. Let’s help them get better results and make our communities happier and safer at the same time.
At-Risk Children Need A Voice & KARA Needs You To Help Us Speak!
Help us grow Kids At Risk Action to make it a strong force to change to child protection and help at risk children.
Dinner is served in the West Philadelphia neighborhood of Mantua.
"You look like you're ready to have a great Dornsife neighborhood partnership meal! Am I right about it?" Rose Samuel-Evans asks the crowd at a free community dinner of chicken marsala and stuffed flounder hosted by Drexel University.
Samuel-Evans works in this two-story, orange-brick schoolhouse; it's one of three refurbished buildings that opened last summer north of campus as part of Drexel's Dornsife Center for Neighborhood Partnerships.
Like many expanding colleges and universities, Drexel has put real estate pressure on its surrounding neighborhoods including Mantua, a predominantly black community and one of Philadelphia's poorest neighborhoods. The school is now trying to counteract that pressure with a center designed to serve not just faculty and students but mainly local residents.
"Developers were looking at this beautiful 1.3-acre site and were saying, 'Boy, we could put a lot of student housing on the block!' " explains Lucy Kerman, who oversees the Dornsife Center as Drexel's vice provost for university and community partnerships. "What's intentional is to look at this as a resource for the community and to say, 'No, that's not what's going to happen.' "
States seeking to develop or improve policies and practices that divert justice-involved youth with behavioral health disorders to appropriate community-based programs and services are encouraged to apply for the 2015-16 Integrated Policy Academy-Action Network Initiative.
Up to four states will be selected to participate in this effort based on their commitment to improving policies and practices for these youth. Throughout the duration of the initiative, selected states will receive technical assistance to guide the establishment of sustainable models and strategies for diverting youth with behavioral health disorders as early as possible. This initiative will focus specifically on school-based and probation-intake diversion strategies, with special attention paid to the following:
Integrated responses to co-occurring mental and substance use disorders
Research-based screening and assessment
Evidence-based and promising-practice approaches
Disparity in treatment of youth of color within the juvenile justice system
The role of trauma in lives of youth in contact with the juvenile justice system
Deliberate coordination among youth-serving systems to improve outcomes for youth with behavioral disorders who are involved in the juvenile justice system
"What we do to our children, they will do to society" Pliny the Elder, 2000 years ago. Closer to home, Becky Roloff, CEO of the Minneapolis YWCA, made the powerful point that concerning child development, as generation should be defined...
While teaching a course on Child Sexual Abuse in Chennai, India I used the ACEs research. It was very well received. Several professionals in the audience not only found it relevant but could see its application in their own lives. It adds to further...
Hi everyone. I wanted to get some input. Our Lutheran Church has asked if I might be interested in working with mothers at risk due to ACEs in their own childhood's for negative outcomes in their children and to work with the church to develop a...
Good morning colleagues, Recently we have gotten requests from a number of organizations seeking training and consultation on integrating screening for ACEs into their routine intake and assessment processes. These requests have come from...
This community of practice uses trauma-informed, resilience-building practices to prevent Adverse Childhood Experiences (ACEs), and to change systems to stop traumatizing already traumatized people. ACES CONNECTION NETWORK OVERVIEW ACEsTooHigh is a news site for the general public on all things ACEs-, trauma-informed, and resilience-building. ACEsConnection is a social networking site...