To ask or not to ask? That shouldn’t be a question

 

Russell Wilson, an ACEsConnection.com member from New Zealand, posted a question to the community in which he noted that a “heck of a lot of people” with ACEs who enter treatment are often never asked about those histories, and that this approach is not honoring their right to appropriate and adequate treatment. 

It’s an issue that’s come up often in many ways and in many settings besides mental health. Some trauma-informed training never mentions the CDC-Kaiser Permanente Adverse Childhood Experiences Study, but does provide some information about the neurobiology of toxic stress. Some training mentions the ACE Study, but only offers a slide or two and doesn’t explain what the 10 ACEs are, or that there are others. 

Some social service and health organizations have patients fill out an ACE questionnaire, but don’t provide them information about the ACE Study. Others talk about toxic stress, but in terms that explain it’s bad for you, and then jump right to how to incorporate protective factors in your life.

This approach explains only part of the story of this remarkable new understanding of human behavior. It leaves out a vital part that’s critical to  helping people and shifting our culture from blame, shame and punishment to understanding, nurturing, and healing.

ACEs science is the foundation of this new understanding of human behavior. ACEs science includes:

  • the epidemiology of adverse childhood experiences (ACEs),
  • the neurobiology of toxic stress (the brain),
  • the biomedical consequences of toxic stress (the body),
  • the epigenetic consequences of toxic stress (passing from parent to child),
  • and resilience research.

Without that foundation, trauma-informed understanding and practice can only go so far. If you tell parents who have high ACE scores, for example, that stress is bad and that they should reduce stress by practicing good parenting, that doesn’t help them understand why they’re triggered to hit back (and triggered means hitting without even thinking about it) when their two-year-old smacks them, as two-year-olds tend to do. They think they’re a bad parent, and obviously can’t learn to be a good parent if they’ve hit their kid after all that parenting training. However, if they learn about ACEs, they realize four important, life-changing beliefs about themselves:

  • They weren’t born bad.
  • They weren’t responsible for the things that happened to them when they were children.
  • They coped appropriately, given that they were offered no other ways to cope; it kept them alive and sane. 
  • They can change.

As a result of learning about ACEs, many parents say: “This explains my life.” And they want to know how not to pass their ACEs on to their kids. This knowledge engages them in a way that nothing else in the parenting classes has. They can get a better handle on understanding why they’re triggered, and begin to develop ways to prevent being triggered, and to handle stress in a healthier way.  

The NEAR@Home toolkit was developed for home visitors who work with new parents eligible for the program because they’re poor. They say that learning about ACEs is a social justice issue. There are some other pretty powerful points in the NEAR@Home toolkit: 

”Parents have the right to know the most powerful determinant of their children’s future health, safety and productivity.”  

The most powerful people for reducing ACE scores in the next generation are parenting adults. Parents have the most opportunity and the most potential for changing the trajectory of the public’s health for generations. But parents must actually know about ACEs and their effects in order to realize this potential. 

Parents deserve to know the largest public health discovery of our time. They should have the opportunity to talk about their own life experiences and consider how they might like to use new scientific discoveries to give their children greater health, safety, prosperity and happiness than they had. 

This is not a deficit-based approach, because it does not ask “What’s wrong with you?” It asks, “What happened to you?” And helps reframe people’s history so that they know that they weren’t born bad, that they are not responsible for their childhoods, and that they can have hope to change their lives and their children’s lives. 

Some people who do trauma-informed training in schools, public health departments, mental health clinics, social service agencies, law enforcement agencies, etc., are reluctant to bring up ACEs for fear of triggering people. But people with ACE scores are triggered all the time….by smells, sounds, people who look like their abusers, environments, etc. So, they’ve developed some coping skills. Also, what better place to learn about ACEs than in a safe place, such as a training by someone who understands trauma-informed practices and ACEs science. Of course, this means that people who do the training must understand their own ACEs, which is what the NEAR@Home toolkit advocates and does, and they must learn how to listen to those they’re educating about ACEs if those people want to talk about what happened to them as children and how it’s affected their lives. 

The co-principle investigators of the ACE Study — Drs. Vincent Felitti and Robert Anda — were required to have someone be on call 24 hours a day during the study in case one of the participants broke down and needed hospitalization. More than 17,000+ people participated in the study. Not one person called to ask for assistance because they were having a mental breakdown from answering the ACE questions. And in the years that followed, when Felitti integrated the ACE questions into the Health Appraisal Center at Kaiser Permanente in San Diego, and everyone was asked about their ACEs, nurse practitioners were trained to talk with each new patient about their ACEs in a caring way. If the questionnaire revealed that the patient had ACEs, one of the first questions the nurse practitioner asked in a caring, normalizing manner was: “I see that you were the one in your family who found your father after he hanged himself. How has that affected your health?” Or…”I see that you were sexually abused when you were seven. How do you think that has affected your health?” Felitti says that people were relieved to be able to talk about secrets they'd been carrying around their whole lives. 

Finally, this approach of integrating all of ACEs science into trauma-informed training takes the shame out of people’s experiences with ACEs, shame that has kept those secrets buried for decades to erode and even destroy people’s bodies, brains and spirits. Talking about ACEs normalizes the experiences of childhood adversity, brings them to light, and shows time and again how we’re all swimming in the same ACEs ocean, how we’re all breathing the same ACEs air. And the sooner these secrets are exposed to the cleansing light, the sooner they wither to dust and lose their power to continue oozing their dark poison into our hearts. 

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Barbie Nall posted:

Excellent article, but what about sharing ACEs with adolescents?  I work with youth in a drug and alcohol rehab program as a teacher.  I fear my students may blame parents or other care givers and often times, these same teenagers return to that environment.  Any one have advice for sharing ACEs with youth and how it turned out?

Great question! I think asking your students to consider their other family members' ACEs scores as well as their own ACEs to gain a perspective of what challenges the family as a whole and each member is contending with in creating a safe healthy environment to return to once rehab in completed.  That is a key part of planning for aftercare and relapse prevention.

Thank you Jane, we are asked this question all the time. I couldn't agree more with the article!  "Talking about ACEs normalizes the experiences of childhood adversity, brings them to light, and shows time and again how we’re all swimming in the same ACEs ocean, how we’re all breathing the same ACEs air. " 

Excellent article, but what about sharing ACEs with adolescents?  I work with youth in a drug and alcohol rehab program as a teacher.  I fear my students may blame parents or other care givers and often times, these same teenagers return to that environment.  Any one have advice for sharing ACEs with youth and how it turned out?

Don St John posted:

The obvious adverse experiences are one source of childhood distress. Two other categories are not so obvious. One is when an essential quality of development begins to emerge and is not met and supported, such as strength or sexuality; the second is an inadequate amount of positive affective resonance. Both can appear on the surface to be ok parenting but these experiences--being supported in essential aspects and adequate attunement are necessary to prevent feelings of deep shame, deficiency and inadequacy.

 Very well said.  These are the "lesser" ACEs that get less attention.  I experienced a lack of attunement growing up which affected me deeply.  But it hasn't been until the last few years that I uncovered the fuller truth studying ACE science that what no one else recognized as harmful had inflicted damage and it wasn't my fault.  

The obvious adverse experiences are one source of childhood distress. Two other categories are not so obvious. One is when an essential quality of development begins to emerge and is not met and supported, such as strength or sexuality; the second is an inadequate amount of positive affective resonance. Both can appear on the surface to be ok parenting but these experiences--being supported in essential aspects and adequate attunement are necessary to prevent feelings of deep shame, deficiency and inadequacy.

Jane, you have touched on every important topic. It could not be said any better. A whole community  effort for healing is required to help one to unravel the complexity of their experience and its impact on their life.

 

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