Do many health and human service workers have adverse childhood experiences (ACEs) in their background? How does that affect their work? Those questions arose after the Sonoma County (CA) Department of Health Services hosted several presentations this year about ACEs, including one by Dr. Vincent Felitti, one of the co-founders of the Adverse Childhood Experiences (ACE) Study. The participants scored themselves and many were shocked by the results. About 75% had an ACE score of two or greater. In the original ACE Study, 38 percent had a score of two or higher.
After the presentations, I met with three staff members to discuss how ACEs affected them personally and professionally. They included Kem Mahiri, program manager, Teen Parent Connections, a program that encourages teens to complete high school and learn parenting skills; Tracie Barrow, program manager, Women, Infants and Children (WIC); and Yvonne Ezenwa, program planning analyst, Program Support Innovations Team.
Allen Nishikawa: What was your first reaction to hearing about adverse childhood experiences (ACEs)?
Kem Mahiri: My first reaction was, "My gosh, I am ACEs." I started really seeing myself, how I handled things in life, my sensibilities and fears, they were all there on paper. I had an alcoholic parent, my parents were teenagers when they were forced to get married. And now I run a program for teen parents!
Tracie Barrow: I first heard Dr. Felitti speak in 2003. So fast forward to now, it's turned into quite a science. The interesting thing is, I was driving home with my husband after one of the recent presentations and we scored his childhood. While I knew I had ACEs in my background, I found out that he had more. My score was two and his was five. I had no idea! I had been married to him for 27 years and discovered things I hadn't known. It was a real "Aha" moment. The puzzle pieces finally fit together.
Yvonne Ezenwa: I come from a biological sciences background, so it was really interesting to see how anxiety and stress manifest as physiological symptoms. That part really resonated with me. People go to the doctor looking for medication. They can go for years exploring increasingly more complex medical solutions, but what they are really suffering from is anxiety. We live in a society where there is so much suppression of who people are and repression of what people have experienced, and the truth of our lives never gets to be seen. Our bodies try to filter out toxins and when we don't allow it to do that, this kind of result makes perfect sense. What's mind boggling is the extent to which it is happening.
Allen: I wonder if people with ACEs are drawn to the helping professions. On an anecdotal basis, you hear a lot of personal stories of folks in health or social services who see their work as part of their own healing process.
Kem: I think we have a lot of ACEs survivors in social services. Many ACEs survivors want to help others because they are looking for a way to make their personal experience useful. At the community presentations that Dr. Felitti spoke at, the whole room scored so high in ACEs that it shocked us. A lot of people actually didn't know how to deal with it. It was the first time that some people realized how it manifested in their lives.
Tracie: I found that my childhood experiences turned me into a mama bear. What happened to me was not going to happen to my kids. I knew firsthand that people who looked good on the outside could do bad things. I think it made me a good mom, and hopefully, a good boss, so there are some positives from ACEs.
Allen: When we hear someone tell us about a traumatic childhood incident, our first instinct is to try and fix it. And if we can't fix it, we feel we are not helping, and perhaps even avoid asking in the first place. What do you tell your staff about bringing up the subject of ACEs?
Kem: Dr. Felitti talked about the resistance from professionals who asked, “Why would you open up that can of worms?" He said, "Do people heal or do they just conceal?" I've had staff say that it is irresponsible to ask something that you cannot address.
Tracie: That's what my staff said also. They want resources. Here's a practical positive example. I was counseling a mom with an overweight child. As a dietician you think "calories in, calories out" but now I realize there is more to the picture. So I asked the mom, "I noticed your daughter has gained twelve pounds in the last six months. Anything out of the ordinary happen?" And she said "Oh her dad left, we separated." Of course the girl was overeating, but now we had a reason why she was overeating. It was a real eye-opener for me.
Kem: I feel one of the most important things we can do to become more "trauma informed" is to understand that talking about it is part of the process of healing. You might be the first person they have ever told. At the presentation, some people could not even answer the questions, so that points out how hard it is for some people to talk about. It was too much to even say, "Yes that happened to me."
Tracie: I was at one of those presentations and I have to say that tears came to my eyes as I checked "yes" to some questions.
Kem: So what do we say to people when they disclose? You can say, "I am sorry." And that's important because many ACEs children have only heard "That's not what it means" or "You don't understand" not "I'm sorry." The second thing is to say is: "These behaviors are not about you, but about what happened to you." It's important to say: "What has happened to you?" rather than "What's wrong with you?" The third thing is to say, "Thank you for sharing." They may feel sad and low, but this is the beginning of healing.
Allen: How do you feel ACEs shaped you?
Kem: The gift for me was that the things I learned were so disgusting that I had no choice but to find a better way. I turned my back against those pretenses, moralizing about others when they themselves had done similar things. My father was an angry alcoholic, so I have a constant hyper vigilance of where I am and what might happen. I'm so grateful I discovered meditation! As the oldest child, I began to see myself as very competent in comparison to those around me. I was capable, smart and felt early on that I was going to be successful in life. The problem was that I took on too much.
Tracie: I can tell that you became the caretaker, there was so much pain that you had to make it go away.
Yvonne: For some, ACEs gives you a high tolerance for stress, you are used to having people depend on you.
Kem: Yes, if you are needed, you are safe.
Allen: It's clear that you found ways to turn ACEs into positives, but that is not always true for everyone. A common problem in social services is over identifying with the client, reliving your own trauma in their situation.
Kem: I think that's very common, so that's why we have started using motivational interviewing. We have to train staff to avoid transference, putting your own stuff on other people and avoiding the compulsion to rescue. What's important to remember is that people are resilient.
Tracie: My staff see a lot of families with poor parenting skills, and I want them to realize that they weren't properly parented themselves.
Yvonne: We have to shift to asking, "Why is this person behaving this way?" We need to make it safe so that people can own up to the truth about themselves and not feel ashamed about it, so that they can make improvements.
Kem: What we say in our parenting classes is that what happened to you affects how you parent. The most important thing is that we cannot be afraid to discuss it.
Allen: What role do you as supervisors play in looking for burnout and over extension in staff?
Kem: I have to start by caring for myself. I have check-in with myself and give myself permission to do things. Am I tired or feeling stressed? It's okay to close the door for a half hour. People with ACEs are so used to having their boundaries pushed or violated that they don't know what's normal or okay.
Tracie: Burnout is a problem. We have a big busy clinic and a hundred families come through every day. My staff identify with our clients, some almost too much so. They come into my office and pour their hearts out and I am just now learning to set boundaries. They take so much home with them because they want to take care of people. I make a lot of referrals to the Employee Assistance Program (a confidential counseling and support program for county workers). I'm pretty much an open book to my staff; I don't pretend I'm perfect, and I tell them about the things I need to do to keep my sanity.
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Final note: I grew up on military bases and have worked in health and human services for many years. I am intrigued by what seems to be a large number of persons with ACES in these fields. Do persons with ACEs seek out certain careers? Are they hoping to heal others, seeking a sense of restorative justice, or looking to find a “better family?” I would like to hear from others with thoughts or observations on this subject.
The article was originally written for Health in Your Hands, a SCDHS Public Health Division newsletter.
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