Within the UK and across the World more people are becoming aware of Adverse Childhood Experiences (ACEs), how common they are and the impact they can have on behaviour and health. So many people have been able to resonate with the subject within their own lives, whether that is on a personal or professional level or both. Having this realisation and an awareness of ACEs is important, but this is just the starting point. As a society it is paramount that we weave the ACEs science through our communities, address the impact of ACEs and understand how to make the necessary changes needed. However, it is evident from the question ‘how do we take the research and put it into practice?’, which I am very often asked, people do not always know how to do this. In response to the emerging evidence on ACEs, and to address such a poignant question, I founded a new and dynamic cultural change and leadership programme. Initially focussed within an educational setting, the programme has evolved to enable multi-agency programmes to adopt the approach and become Trauma-Informed. The cultural change programme is called ‘Emotionally and Brain Resilient to Adverse Childhood Experiences’, or EmBRACE for short. The strength of EmBRACE is that it is implemented over a period of time to embed and consider how the organisation becomes ACE Aware and ACE and Trauma Informed. EmBRACE also challenges resistance to change and recognises that each establishment is different. To achieve this various change management tools are implemented.
The use of language and buy in from staff have been two critical components which have provided the foundations for cultural change within the organisations I have worked with. Staff need to be given the time and: supported with their thinking; opportunities to reflect. Subsequently, they have been able to recognise that EmBRACE is not an initiative and identify already trauma informed good practice, which is empowering for practitioners. Staff need to feel confident with the trauma informed language and any new practices they may implement. Building this into procedures and policies must be addressed and led by the senior management team to ensure capacity building and sustainability.
Inspire Blackburn with Darwen (BwD), UK is an integrated Prevention and Drug Recovery Service. As an organisation they recognised the prevalence of ACEs for clients/service users and wanted to explore how they could make the necessary changes to become ACE and Trauma Informed to support further their service users. Subsequently, I was commissioned to work with them to implement EmBRACE. Recovery Support Coordinator from Inspire (BwD), and now lead ACE Champion, James Houghton, also recognised ‘There are reasons underpinning peoples’ negative behaviours, which are because of something else. All services e.g. substance mis-use, social services, dealing with depression, in general, are geared up to manage the symptoms. A high percentage of the causes and conditions of negative behaviours are based in the person’s thinking, often being that they have a negative perception of life in general, including the perception they have of themselves. This can lead to a manifestation of not only ACEs but adversity in adulthood too, which can come in various forms. The common denominator is perception and how this manifests within the thought process e.g. “I’m not as good” or “I’ll never be able to achieve what they have” The negative thoughts are then displayed in the behaviour. As a result of this, someone won’t then engage in activities they want to go to or apply for a job etc. For society in general, these negative thought patterns don’t manifest into something major. However, for the extremes, which are a minority of society, there are organisations like Inspire who deal with them. Because of an adverse experience people find coping strategies and display a variety of behaviours. The more adversity somebody experiences, the more susceptible they become to more negative behaviours. When this happens, what people do is mummify themselves. They protect themselves with a ‘bandage’ which enables them to manage, a process which will have no doubt taken years for them to do. Then as ‘Services’ we unwrap them without dealing with the issues as to why they are doing this’.
A number of key components when supporting Inspire (BwD) with their Trauma Informed Journey was for them as an organisation to strategically: realise the science and impact of ACEs; know how to weave this into practice, procedures and policies.
Working with James Houghton, these key components have been addressed through the delivery of the EmBRACE Workshops, which have also provided a platform for clients to reflect through an ACE lens. Below are the aims and objectives for the EmBRACE Workshops:
- show how identifying causes and conditions of negative behaviours opposed to finding solutions to address the by-product of those. This has provided clients with the ownership and confidence to have control of their own recovery
- Explain the brain’s structure and operation so that clients can relate to this within their own life
- Provide opportunity for discussion and examples of how thoughts, feelings, behaviours and consequences can dictate decision made/choices which ultimately affect behaviours
- Provide opportunities for reflections so that breaking the cycle can be achieved and managed by the client during recovery
- To educate around the physical health complications trauma can cause
The quotes below demonstrate the impact the EmBRACE Workshops have had on the clients/service users and the significance of understanding about ACEs, particularly in relation to their own lives and behaviours, breaking the cycle and looking at addiction from a different perspective:
‘I found the subject matter really interesting and a new way to look at addiction’
‘The workshops have helped me understand a lot about ACEs and helped put things into perspective’
‘ACEs are a major key part of the recovery process’ which highlights the need for ACE and Trauma Informed Practice to be an integral part of the culture within the organisation rather than a bolt on.
‘Understanding about ACEs has impacted on my decision making as well. My whole thought process on making a decision has been influenced through an ACE Lens. It has helped me to rationalise my thoughts rather than act on impulse’.
‘The focus in service has really shifted with the ACEs definitely’.
‘Being ACE Aware has affected more than just me. I have been able to reflect on the fact that my own children will have ACEs and how to address this. Breaking the Cycle has been a big part of this. The relationship with my siblings and mum has improved (now reconciled). In addition to this other people have cascaded their knowledge about ACEs which is a fantastic testament to the ACEs movement’.
James Houghton stresses “The EmBRACE Workshops explain that you have a drug solution, you don’t have a drug problem”. Looking at the bigger picture, James continues “Street homelessness is a big by-product of substance mis-use. The negative thought process of ‘I’m ok on the streets’ becomes part of someone’s belief system. People in this situation can’t function in society. Paying the bills or caring for their children is of secondary importance. The brain overrides this”. He nicely summarises “EmBRACE Workshops look at the root cause and are set up to educate around this. EmBRACE empowers the person to take responsibility” which is a fantastic testament to the ACEs movement and a key part of Cultural Change through an ACE Lens.