Adding layers to the ACEs pyramid -- What do you think?

 Pyramid

When the RYSE Center opened its doors in 2008 in Richmond, CA, says Kanwarpal Dhaliwal, community health director and a RYSE co-founder (and ACEsConnection member), staff members didn’t talk about complex trauma per se, but they recognized the many types of chronic trauma that the youth it was serving were experiencing. The youth services organization grew out of a youth movement in response to homicides near Richmond High School in 2000.

 

When RYSE Center staff members learned about the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, “it felt very validating,” says Dhaliwal. “It really helped to give language to the way we were working with young people."

 

But they also knew that there was more to a person’s trauma than just her or his experiences. The youth come “into this world in structures and conditions already established,” says Dhaliwal. These structures are often punitive (e.g., zero tolerance policies in schools) and embedded in racial bias; they limit opportunities and come with built-in economic and social inequities.

 

Last year, RYSE did a listening campaign with its youth, and earlier this year, staff members began talking about the findings and sharing them with activists, researchers, funders, etc. They decided to use the ACEs pyramid to leverage the existing science in communicating their major findings: that in helping young people, especially young people of color, there’s only so much that an organization like RYSE can do. It requires transformation at systems and community levels. The two new layers of the ACE pyramid – social conditions/local context and generational embodiment/historical trauma -- address that. 

 

In addition, they wanted to change the way risk is defined. “Risk-taking is critical for healthy development (of individuals and organizations),” says Dhaliwal, but risk-taking in the context of chronic trauma and inequity, often results in harm and burden. Also, many “health-risk” behaviors -- such as smoking, drinking or overeating -- are ways for young people to cope with their trauma. By using the word “coping”, it doesn’t put a negative or positive value on the behavior.

 

This new way of looking at the ACEs pyramid is a start to incorporating some important concepts into the ACEs discussion, says Dhaliwal, who wants to know what the ACEsConnection.com community thinks of it.

 

“What questions do you have?” she asks. “We’d like honest and gentle critiques to help make sure that our practice and praxis as an organization is reflective and responsive to the priorities, needs, and interests of young people, particularly to young people of color.”

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I think, this is a very good visual to incorporate the Pennsylvania study findings. However, this thinking to me is not about a "score", which I highly recommend against. This expands our conceptualization of trauma; the fact that we are not only individuals living in a family and we are not exposed to trauma only during childhood. That to me is much more important: Trauma is imposed upon us throughout our lives by our immediate family members, by our community, society, and nowadays global forces... thank you for generating it.

 

The ACEs score is brilliant and essential. And I think that one of the biggest omission in the Questionnaire is : ADOPTION  (as well as short-term and long-term Fostering) and BIRTH TRAUMA + FADS.   PS: looking forward to Dr Felitti being interviewed by Svava Brooks in her upcoming online Summit.

There are just so many potential ACEs that could be added that it'd be enormous as a way of introduction to what they are, for all the public to get their heads around. Which I think would be part of the goal...Perhaps later a more nuanced score could be collected. I have thought a few times, "Oh, could 'that' be an ACE?!

Not meaning to stir too much,  but I like conducting (in my head of course) a history of what other people contend with - a type of 'pissing contest' one could argue! Often people have as high or higher ACEs than me,  yet seem so much more together, and then with the scant info I can ascertain,  I realise their Resilience Score/History is so much higher than mine... usually.  There are a few on this website who've done the near impossible, but generally speaking... It's not a competition but rather a recognition/understanding, that makes me feel in a somewhat perverted way, 'better'!!! Clarification may be needed here: I feel more empowered, less vulnerable, more able to hold my head up.  This is really important in dealing with those they do not understand.  It's not an excuse, it's an explanation. Nothing beats an explanation. And surely this is an important understanding for practitioners of any kind, to understand? That's another reason why I don't think the two scores should be separated.  It's good to have backup/justification for those who have said and continue to bleat, "Look at ....., they've had it tough, but they're coming along fine."  Grrr.  Not just for me but for all those doing it tough(er than me).  They deserve acknowledgement for the very steep learning curve they've had to traverse.

This would include Vietnam Veterans, and others in stressful positions who haven't up to now, understood why and what is happening to them...

Thoughts?!

 

I viewed the World Health Organization's (WHO) ACE International Questionaire, on the WHO website, along with the questionaire administrator's guidebook. We may risk experiencing "Pluralistic Ignorance" by assuming those ten CDC ACE questions are comprehensive enough to cover all forms of oppression, or experiences creating "Toxic stress".

If we review the ACE sequel study, done in Texas, with 6,600 participants-not all of whom had health insurance, which was reported in the April 2010 issue of Preventing Chronic Disease journal, and compare those 10 questions to the proposed Vermont ACE questionaire-following the Vermont legislature's House Bill 762 in the 2013 session--requiring all Vermont health care providers to screen for ACEs of ALL patients regardless of age, and their rationale for wording a children's questionaire differently than a questionaire for adults, and compare it to the WHO ACE International Questionaire--which was used for WHO's 2013 Assessment of the world's healthiest children, we may be able to avoid what VietNam Veterans refer to as "Pissing Contests" (My trauma is worse than your trauma [or toxic stress]...). Hopefully we will find ourselves able to validate every person regardless of their ACE score, "cohesive narrative", and Resilience score.

After numerous visits to the Southeast Bronx, in NYC, during the early 1970's, and later hearing an Epidemiologist present at "Grand Rounds"-at Dartmouth (Geisel) Medical School in 2000, noting 52% of Detroit Metropolitan Area Schoolchildren met the then DSM-4 criteria for PTSD, I found this ACE model quite appropriate to those communities. The leading cause of death in the Southeast Bronx, in the early 1970's was Heroin Overdose; reported cases of Tuberculosis were six times the national average; Venereal Disease was four times the national average, according to the House-Staff Residency brochure at Lincoln Hospital at that time. Recent data from Philadelphia and Baltimore would seem to lend credence to this. Thanks for posting this link in reply to a previous post, Jane.

As a consumer (and advocate), I agree with those recommending keeping it as simple as possible.

The second triangle on the right with the green and purple additions are more nuanced/sophisticated than the left and give more depth of understanding. So it may be a good way to go.

Not so sure about distress vs disorder.  Often the distress leads to 'disorder', if it is not rectified in its early manifestations and can therefore be ongoing, leading to the so called disorder (not sure if others would necessarily agree with this). Therefore there's some overlap, which may be confusing for some.  I like the intention of the message, but it could be misinterpreted...  I know this may seem blatantly obvious...

I know one can't just tweak the ACE questionnaire ad hoc, 10 being a good number (Top Ten?!), but I think it's a great template and shouldn't be tampered with except for:

7. Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

Should to me read: ... or father, siblings or other relatives living in the home.  From reading Got Your Ace Score, many had trouble with this question, as it was often not necessarily the mother on the receiving end of violence. Or is it that seeing your main attachment figure (usually the case) being hurt had more impact than it would with other family members?

It is indeed so complex, with so many potential additions too numerous and varied, that to stay with those 10 makes sense to me.  Others have added additional questions knowing the community they're working with. So, again it's the template on which to base a history.

 

While I'm here writing, can I also say I dislike the question No. 10 in What's your resilience score:

10.  We had rules in our house and were expected to keep them. 

It is hardly a plus when they were contrary draconian rules, for which you were never really sure where you stood at any time.  Made for complete totalitarian rule by the perpetrators for the perpetrators! And then subject to change without notice!

 

I agree heartily with Dave's view.  The simplicity of the 10 categories laid out in the ACES Study has also made it eminently accessible to the general public and easily translatable by new media to a wide variety of audiences and interests.  I applaud the expanded directions and avenues that have been opened up to the field and as these mature and stand the test of time [and further application and research], hopefully they too, will find equally simple and concise ways to be shared.  But I hope they will do so without clogging the heretofore clean entry-way into the science of adverse childhood experiences and trauma informed care. 
 
escher1
 
Originally Posted by Dave Lockridge:

The beauty and power of the ACE Study is its simplicity. There are many experiences that can be traumatic, yet the ACE Study measured the effects of only 10 categories of abuse, neglect, and familial dysfunction. 

Every professional will read the ACE Studyand make additional applications from their field of expertise. For the sake of everyone involved, let's leave the ACE Study simple, elegant, and powerful. In your practice make additional insights and applications, but please don't make others carry your water.  

 

escher1

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The beauty and power of the ACE Study is its simplicity. There are many experiences that can be traumatic, yet the ACE Study measured the effects of only 10 categories of abuse, neglect, and familial dysfunction. 

Every professional will read the ACE Study and make additional applications from their field of expertise. For the sake of everyone involved, let's leave the ACE Study simple, elegant, and powerful. In your practice make additional insights and applications, but please don't make others carry your water.  

Thank you Kanwarpal and RYSE. This addition to the ACE pyramid is well done and reminiscent of Mary Harvey's ecological model for understanding trauma (Harvey, 1996; Harvey et al., 2012), in which she and her colleagues explore the experience of trauma and resilience as influenced by factors related to event(s), individual, and environment. See also Bonnie Burstow (2003) and Laura Brown (2008) in which they build on Harvey's original ideas by highlighting the impact of multiple intersecting identities and social location as sources of adversity as well as resilience.

 

Jeff Levy & Amber Jones, two colleagues from Chicago, explore the impact of microagressions in their recent article for Positively Aware:

http://www.positivelyaware.com...microagression.shtml

 

As RYSE thoughtfully illustrates and describes, exposure alone does not account for everything and traumatic experiences come in many forms - far beyond those identified in the DSM.

 

Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback. Washington, DC: American Psychological Association.

 

Burstow, B. (2003). Toward a radical understanding of trauma and trauma work. Violence Against Women, 9(11), 1293-1317.

 

Harvey, M. (1996). An ecological view of psychological trauma and trauma recovery. Journal of Traumatic Stress, 9(1), 3-23.

 

Harvey, M. R., Tummala-Narra, P., & Hamm, B. (2012). An ecological view of recovery and resilience in trauma survivors: Implications for clinical and community intervention. In R. A. McMakin, E. Newman, J. M. Fogler, & T. M. Keane (Eds.), Trauma therapy in context: The science and craft of evidence-based practice (pp. 99-120). Washington DC: American Psychological Association.

 

 

 

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Hello everyone,

 

This is Kanwarpal from RYSE. Thank you for the comments and suggestions on RYSE’s complication of the ACEs pyramid.  We appreciate the validation of layering social location and historical trauma at the base of the pyramid.  We also appreciate the critiques and concerns regarding the salience of race(ism) and oppression, and blurring the clarity of the study with added layers. We pose this adaptation not as a better model, but as a frame from which to grapple with the intent, impact, and opportunities that ACEs affords us across our various fields, sectors, passions, and purposes.  
 
As discussed in the article, the pyramid and ACEs study provides a scientifically-validated legitimacy of what we know and experience as a community-based organization in service to young people of color. In Richmond, CA young people live, die, succeed, fail, dream, hope, celebrate, experience loss, and take risks in a context of chronic and ongoing trauma and violence that includes profound implicit and explicit systems harm and racial bias. Our work is to prioritize and elevate their dynamic subjectivities and narratives so they believe their lives matter, and that the systems, communities, organizations, families, and adults responsible for their well-being ensure their lives matter.
 
Our experience with conventional social science research, interventions, investments and approaches to supporting young people of color is that they assume and subsume black and brown youth as problems, burdens, and risk whose lives, dreams, and deaths are confounded into neat and tidy factors and variables, and churned into analyses that render them and their traumas as pathological, criminal, and delinquent. We believe these assumptions and processes are adverse to their/our individual and collective wellness. Our intent in deepening and adapting the pyramid is to reflect and engage in healthy struggle and deliberate dialogue with each other across fields, disciplines, experiences, and values in naming and addressing social conditions, including racism and structural violence.  Trauma impacts us all (as the ACEs study helps to convey), BUT with differentiated embodiment, empathy, validation, risk, vulnerability, protection and consequences that are historical, structural, and generational.  The adapted model allows us to shine past due light on the embodiment of privilege and coping in the context of privilege just as much as the embodiment and coping in the context of subjugation.
 
In light of and in spite of the inequitable burden of adversity that RYSE’s communities of young people carry, there is immense hope, creativity, love, drive, leadership, and intelligence.  Our work, in a fundamental sense, is to race ACE so that we can explicate the inequitable burden of racial oppression, as well as the intersections of oppression, privilege and liberation in all their forms.  We seek to change the dominant inquiry of what’s wrong with black and brown young people in our communities to that of how are they making it and what feeds their hope, tenacity, and ability.  Attached you will find our framework of trauma and healing that we employ and seek to accomplish.

RYSE is not a research organization so we hear and recognize our scope, and what might be considered limitations. We are a social justice project that is part of larger movement building. That said, our work is to inquire and investigate the will and skill of young people of color to survive, thrive, lead, and cope, in the context of inequity and injustice.  This includes integrating, interrogating, and enacting research, policies, investments, and practices so that they prioritize, reflect, and respond to complexity.  To quote Franz Fanon, “There is a point at which our methods devour us”.  We leveraged the ACEs science in service to our communities of young people.  We understand we have not preserved the purity of the pyramid, and we grappled with the implications of this, many of which have been raised in the feedback.  That said, preservation is not our aim, liberation is.  So we pushed the pyramid’s possibilities deeper to unearth histories and context, to share with you and other stakeholders, and with the hope to spark interest and will for collective conversation, learning, and transformation. We need your help and partnership in creating the liberatory praxes that enable collective healing, transformation, and justice. Thank you for what you have offered. We are taking it all in. We will also be hosting a convening this year around this work, so hope we can see you there.  Please do not hesitate to contact us directly if you are interested in the convening or to further the conversation. We can be reached at communityhealth@ryse.org.  You can also check us out at www.rysecenter.org.

 

All my best,

Kanwarpal

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I love the revised version proposed here and deeply appreciate the work that went into creating it. I like the changes in the labeling to the upper layers of the pyramid and think they are appropriate and more accurate in almost all cases.

 

In terms of the layer labeled "Coping" - I totally hear where you're coming from and agree with you that risk-taking is appropriate for adolescents and that many of the risky healthy behaviors are coping mechanisms to deal with the trauma. But choosing a label that does not indicate positive or negative actually makes it a little less consistent with the other labels in the pyramid. I think the goal is to show the cascading effects of ACEs that can lead to early death, and that each of these effects is negative. If you take each layer as a consequence of the previous layer, then to say that Allostatic Load and Disrupted Neurological Development leads to Coping and that Coping leads to Burden of Disease, etc. is a little less clear, perhaps, than to say that it leads to something like Risky Coping Behaviors (feel free to choose a better term!).

 

In terms of the two new bottom layers - I think these are critical. When we were doing our research, coincidentally on ACEs-related experiences and consequences for school children in California (http://www.humanimpact.org/pro...icies-projects/#LCFF), we also felt that this piece was missing. We found that it is not without precedent for the ACEs questionnaire and categories to be revised or different, and ended up also referencing the World Health Organization version, which includes peer, community, and collective violence categories that are not included in the American version. (See: http://www.who.int/violence_in...hood_experiences/en/) However, I think the new layers you've added are more like what we were looking for in terms of community/historical trauma. 

 

Great work!

Tina,
Your writing reminded of a scene toward the end of The Glass Castle, where the author’s professor is shocked and outraged when she says “sometimes people get the lives they want,” speaking of homeless people. The author had grown up in profound poverty and hardship. She had experienced her parents seeming to choose this life.
We do not eat people alive in this conversation. There are many things about which reasonable people can disagree - passionately.

> On Apr 8, 2015, at 11:43 PM, ACEsConnection <communitymanager@acesconnection.com> wrote:
>
> <http://www.acesconnection.com/>
> I want to say something w/o being eaten alive. I have an ace score of 9 (10 if you count dad in jail for a year). Homeless adolescent, almost put in foster care ---sister was. Youngest brother lead poisoned. Tortured by my dad for 16 years with guns, burns and near constant death threats, watched him kill my gm at 4 and a migrant worker stabbed on the front porch at 14... I went to medical school at UMich. That nearly killed me due to aggressive attendants throwing things which gave me panic terrible--- my parents refused to complete the FAFSA so I almost couldn't go to school even though accepted...there was scholarship for disadvantaged students ... I couldn't get them because of my skin color they went to other students whose parents were doctors and lawyers... The privilege can sometimes go both ways...do I think there are positive things to having white skin of course I am not stupid but are things much more complex... Yes they are ... but I think there maybe some limiting of possibilities if we don't try to rise above whatever hand we were dealt.. I have to constantly try to rise above fear of everyone. Please don't eat me alive. I like the changes to the ACE pyramid but I have to agree with a lot of Edwin's response.
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> I want to say something w/o being eaten alive. I have an ace score of 9 (10 if you count dad in jail for a year). Homeless adolescent, almost put in foster care ---sister was. Youngest brother lead poisoned. Tortured by my dad for 16 years with guns, burns and near constant death threats, watched him kill my gm at 4 and a migrant worker stabbed on the front porch at 14... I went to medical school at UMich. That nearly killed me due to aggressive attendants throwing things which gave me panic terrible--- my parents refused to complete the FAFSA so I almost couldn't go to school even though accepted...there was scholarship for disadvantaged students ... I couldn't get them because of my skin color they went to other students whose parents were doctors and lawyers... The privilege can sometimes go both ways...do I think there are positive things to having white skin of course I am not stupid but are things much more complex... Yes they are ... but I think there maybe some limiting of possibilities if we don't try to rise above whatever hand we were dealt.. I have to constantly try to rise above fear of everyone. Please don't eat me alive. I like the changes to the ACE pyramid but I have to agree with a lot of Edwin's response.
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I want to say something w/o being eaten alive. I have an ace score of 9 (10 if you count dad in jail for a year). Homeless adolescent, almost put in foster care ---sister was. Youngest brother lead poisoned. Tortured by my dad for 16 years with guns, burns and near constant death threats, watched him kill my gm at 4 and a migrant worker stabbed on the front porch at 14... I went to medical school at UMich. That nearly killed me due to aggressive attendants throwing things which gave me panic terrible--- my parents refused to complete the FAFSA so I almost couldn't go to school even though accepted...there was scholarship for disadvantaged students ... I couldn't get them because of my skin color they went to other students whose parents were doctors and lawyers... The privilege can sometimes go both ways...do I think there are positive things to having white skin of course I am not stupid but are things much more complex... Yes they are ... but I think there maybe some limiting of possibilities if we don't try to rise above whatever hand we were dealt.. I have to constantly try to rise above fear of everyone. I have another problem for example the trailer for Raising of America....I think that's the one... Shows only racial minorities. I honestly think this helps privileged white males and females to think "I don't have to care, doesn't matter to me, not white like me".   I think this is terribly hurtful towards ending ACEs and racism and discrimination and hate of all kinds. We need those privileged white males to see that this IS a matter important to them, that affects them, and about which they MUST care and act.  I like the changes to the ACE pyramid but I have to agree with a lot of Edwin's response.

I am afraid I will be the voice of dissent here somewhat in that although the issues of race, social inequities, historical and cultural contexts, are important and deserving of understanding and acknowledgement when addressing issues in disadvantaged neighborhoods and communities, I am not in favor of prematurely linking it so directly to the original ACES pyramid.  As I've referenced before, in My ACES and Me, Part 3: Trauma and How it Gets That Way, I argued for the power of the mathematic-like purity and beauty of the ACES study and scores.  I admit that I may be over-protective of the original conception of the model, but the author of the post does ask for 'honest and gentle critiques' of their premise.  I offer this as an honest critique, how gentle it is experienced is not for me to decide.

 

My reasoning is this:

The ACES Study premise is elegantly simple: experience these categories of childhood "trauma," and these are the potential consequences [behavioral and health] that might accrue in a proportional fashion to the number of these ace's one has had visited upon them.  The very real circumstances and issues that are described within Kanwarpal Dhaliwal's post, in my mind bring in a complex set of factors that I do not see as having been as elegantly researched and with such clarity.  Furthermore, those racial, social injustice issues [for sake of brevity I will just call them BIG ISSUES from here on] often bring with them subjective biases on both sides that can stifle objective debate or preclude honest and open data analysis.  

 

One quick, yet still not fully conclusive, test of the impact of the BIG ISSUES, might be to examine the original ACES study population disaggregated by race/culture.  Are there discernible patterns/differences between, let's say, the Hispanic/brown-skinned Kaiser members, [who might be assumed to be carrying the added effects of the BIG ISSUES] as opposed to their lesser-societally and historically oppressed white counterparts?  Do they have poorer health outcomes?  And if so, how to incorporate it into the ACES score?  Do I get extra ACE points for being Puerto Rican [I am]? or raised in a poor neighborhood [I was]?

 

And how to factor in the fact that my first [and then frequent] observation of racism occurred between one set of brown-skinned latinos and another....where the predominant in number Puerto Ricans [remember, I am], looked down upon newly arrived Central Americans, who disparaged as the lowest of the lows, the funny-talking Ecuadorians, who looked upon with stereotypical fear the dark-skinned Cubans in the neighborhood, etc., etc.?

 

All I'm saying is that I would rather that the pyramid on the right of the illustration be de-coupled for the time being from the traditional ACES pyramid on the left of the illustration.  I would also suggest 'de-coupling' it stylistically from the ACES pyramid as well, for example by applying a different color scheme, so as not to have the two seen as meaning the same thing, or having been arrived at by the same methodology. 

 

Then, I would like the research methodology that arrived at the pyramid on the right be laid out as elegantly and simply as that of the original ACES work that resulted in the original ACES pyramid.  Then, at least for this non-scientist, will I be able to grok how the two are truly related to each other or conversely, as a guy named Johnny Cochrane once put it, "If it don't fit, you must acquit."

I think the new pyramid is fantastic!

Please, could we consider calling the blue layer "Complex & Developmental Trauma/ACE" ?  So many human babies have their brains damaged in utero from stress to the mother. Details for "developmental trauma" at http://attachmentdisorderheali...evelopmental-trauma/

And thank you, Lou Godbold and others: "No one is raised devoid of a historical and social context." 

Like Lou, I was raised in what looked like lily-white society.  But my maternal great-grandmother was knocked up at 13 and spent her life in the belly of tramp steamers roaming the world having 13 children, half of whom died; the 12th was my grandmother who got less mothering than the luggage. She passed no mothering to my mother who gave me nothing but "Still Face Experiment," to where I couldn't even procreate.  I'm the "butt end of evolution."

This explains why our government, corporate, judicial, medical, and other leaders often act so inhumanely. Like Lou and me, they may appear accomplished, but inside, I'd estimate more than half of them have similar complex and often developmental trauma, which can remain deeply buried for a lifetime.

This is not just "me, too." This is why our society tolerates such injustice to people of color!  As Dr. Felitti says, for example, most medical professionals "resist" the ACE Study conclusions, published 1998, for fear of "looking within."

To cite Dr. Bessel van der Kolk, MD, most of Congress is "dissociated," or they'd feel the simple human compassion to know that sending youth to war brings back a flood of PTSD victims (search on "Congress" or see footnote 9 in "developmental trauma" blog, above).

I am very happy to see the new additions to the ACEs pyramid. They ground the model in social context. It is quite impossible to understand a person or persons only as individuals.

I am with Julianne on the race issue. Additional trauma. Robert Carter at Columbia University has written eloquently on race-based traumatic stress.

I am very glad to see a new pyramid that incorporates ideas of social location and historical trauma. I also like the phrase "collective trauma," because to me it describes trauma that is systemic, historical and ongoing. Such a phrase also invites ideas like "collective resilience," which I imagine as being similar to what P describes above when talking about communities and cultures as potential stabilizing forces. I don't think I could begin to heal from internalized racism until I began organizing with other people of color.

Living in a society with collective trauma (aka systemic oppression) has an impact on all of us--oppressors, victims, and bystanders, though that trauma shows up differently in each of us. And most of us play multiple roles depending on the situation. (At the very least, each of us has experienced the challenge of being a child in an adultist world. And most of us live long enough to experience the power that comes with being an adult in an adultist world.)

On the flip side, working creatively and collectively for liberation also has an impact on all of us--healers, survivors, and witnesses, though the resilience built shows up differently in each of us. And again, we can play each role at different times (and sometimes simultaneously).

I think addressing ACEs successfully requires addressing collective trauma, and I'm glad to see that represented visually.
Tina, I agree that poverty/classism is a major trauma and oppression. I also think that racism is an additional trauma and oppression, and it's valuable to acknowledge both.

For example, in the aftermath of Katrina, people of all races were resourceful in gathering the supplies they needed for their survival, but the press reported differently on white and black survivors in the same situation ("finding food" vs. "looting"):
http://m.huffpost.com/us/entry/6614

This example is just a symptom of a larger system. For more general info on this topic, written by someone white who grew up in extreme poverty, I really appreciated this article ("Explaining White Privilege to a Broke White Person" by Gina Crosley-Corcoran):
http://thefeministbreeder.com/...-broke-white-person/

I think it's important to end all oppressions, and it can be particularly useful to consider how different collective traumas are interwoven and hold each other up.

Culture and the Impact of ACES by SES -  The impact of one's culture (ethnicity, class and income) can set in motion perspectives and beliefs that impact resilience patterns which impact lives of youth - and adults.  Life in rural America is very different from urban New York City or Chicago - particularly in perceptions of pace, speed, degrees of socialization, appreciation of art and music, dietary patterns, interpersonal interactions, family and emotional pressures, competencies of adults working with children and the notion of culture impacting survival skills.  Holding someone accountable for successful interactions with different cultures implies a recognition of distinct cultures and their differences. Articulating the dynamics of a foster mother's child care management implies some degree of familiarity with them - either direct or indirect. A hypothetical question on a Scholastics Aptitude Test might be "What is the alcohol content in 'pot liquor' - 0%, 3%, 6%, 12%, 20% or 40%?  The fundamental question is "What is pot liquor?"   If you are familiar with a country way of life, you know that pot liquor is the juice is derived from cooking green vegetables - and is sometimes used as a tea or laxative. In an urban context, few people understand even what it is - unless rural behaviors were brought up from the south. There is no alcohol content in pot liquor. As such, Kanwarpal,  I am not sure how you mean to "Generational Embodiment" - perhaps as a synonym for culture.  I would submit that the healing of people who experience adverse childhood experiences depends on how they are socialized and how they are prepared and conditioned to respond to what happens to them.  Having come from a family that is six generations post slavery (USA), what is missing in the ACE structure is the role that communities and cultures can play in a stabilizing force, to balance the deprivation of disparities.  Young men and women who witness murder in their neighborhoods display Post Traumatic Stress Disorder (PTSD) - sometimes with images of hostilities and self-demise exchanged for flashbacks. We screened several groups of African American men in Men's Group settings with the ACE Score.  The responses were tri-modal - with one in the "0-1" range, one group in the "3-4" range and the third group in the "6-7" range.  Our team is looking at Re-Entry issues from correctional settings and will integrate ACE evaluations into the release assessment - both as a baseline measure for mental wellness and a motivational tool against which we will couple strategies that teach survival skills in an environment that is not welcoming.  Once we spend the next year evaluating the dynamics of ACE on different cultures, we will report out again.

 

Paul B. Simms, Vice President

San Diego Black Health Associates, Inc.

This all makes perfect sense. No one is raised devoid of a historical and social context. We know that poverty and unemployment, for example, exacerbate stress. I, for one, am delighted to see historical trauma and family legacy included. At Echo Parenting & Education we always teach parents about generational trauma because it often explains so much. I suffered as a child because my mother was raised by a father who spent 5 years in a Nazi POW camp. But the problems started earlier with his father's early death, his twin sent to live with a relative, and my poor grandfather left with a bitter and vicious mother who took in sewing to make a living. He had to leave school and sell vegetables from a push cart at the age of 12. Sounds Dickensian, doesn't it? Once I understood this legacy, so many things made sense. It wasn't just my childhood, it was generations of trauma that I was in turn visiting on my own son.

 

For this reason, I am particularly interested in epigenetics. There is not just a psychological legacy but a physical one too. The two additional layers on the pyramid captures all this and I think it is a great improvement. (Sorry about the side track on my own personal history. Feeling very connected to the ACES folk this morning and grateful for your existence!)

 

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