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HOPE Summit speakers show how positive childhood experiences offset adversity

 

The Rev. Darrell Armstrong, pastor of the historic Shiloh Baptist Church in Trenton, New Jersey, is an accomplished man. He graduated from Stanford University in public policy and went on to get his master’s degree in divinity studies at Princeton. As a former director in the New Jersey Department of Human Services, he was responsible for New Jersey’s statewide strategy for preventing child abuse and neglect. Armstrong has also worked as an entrepreneur, workshop facilitator, and radio host.

But his journey to becoming a national leader in children’s health was anything but smooth – and it reflects the potential of positive childhood experiences to reduce and possibly even reverse the impact of even the most unfathomable childhood trauma.

Armstrong recalled, for example, the terror he felt as a 5-year-old when his 2-year-old brother was dropped into scalding bath water by his mother’s drug-addled boyfriend, causing second- and third-degree burns over two-thirds of his body.

“The pitch of those screams will never be forgotten,” said Armstrong.

“I don’t know who called the police, the ambulances, but as a result my brother stayed in the hospital recuperating from his injuries and I went to three different foster homes, not understanding why I couldn’t be with my mother.”

Prior to that Armstrong had also witnessed his mother and her boyfriend injecting heroin and crack cocaine, experienced the physical brutality of his mother’s boyfriend and witnessed it used against his mother as well as his younger brother.

From the time he was 5 until he was 6 ½-years-old, Armstrong lived in three different foster care homes, separated from the rest of his family. He then moved in with his grandfather and stepmom, “becoming the 6th child in a family of 8,” until high school when he lived with a teacher for a year. What got him through was a series of “angels,” he said. One was the late Rev. Richmond Brown, a pastor in Los Angeles, where Armstrong grew up.

“He often used to say God will be your mother when you don't have one, and God will be your father when you don’t have one,” said Armstrong. “And for me growing up in his congregation, that made a lot of sense. Because he didn't know I was in foster care. He didn't know what had happened. But his words gave me hope.”

Armstrong was a speaker at the April 9 HOPE Summit, a conference that focused on how positive childhood experiences can mitigate the harm and health burden associated with adverse childhood experiences (ACEs). The pastor talked about the experiences that helped him survive his childhood slide into calamity and go on to his current work in strengthening families.

Other speakers included Dr. Robert Sege of Tufts Children’s Hospital, one of the central architects of the resilience framework known as HOPE, which stands for healthy outcomes from positive experiences. Speakers leading interactive discussions included Dr. Christina Bethell a professor at the Johns Hopkins Bloomberg School of Public Health, whose research also underlies the HOPE framework; Dr. Jeff Linkenbach of the Montana Institute, which provides training and consultations about the science behind positive community norms; Jane Stevens, founder and publisher of PACEs Connection, a healing-centered social network spreading the science of positive and adverse childhood experiences to solve our most intractable problems, and many more.

When Armstrong discussed the adults who helped give him hope -- a group that included his grandmother, a high school teacher, and a social worker he’s known since elementary school -- he was illustrating one of the key tenets of the HOPE framework: Being in healthy, supportive and sustained relationships with peers and adults inside or outside the immediate family is essential to children’s ability to weather stress, including severe stress caused by trauma.

Other tenets of the HOPE framework include the need for safe, stable and equitable environments, including schools, neighborhoods and playgrounds; engagement, such as playing with friends and having responsibilities such as chores; and involvement in healthy communities, including participating in traditions and cultural rituals, which promote positive experiences in children and families.

Research by Bethell shows that the more positive experiences children have, the more likely they are to have positive social and emotional support as adults, regardless of whether they experienced childhood trauma.

Adults who had experienced six or seven types of consistent positive childhood experiences (PCEs), regardless of whether they had experienced up to eight different types of childhood trauma, were three and a half times more likely to say that they had strong social and emotional supports as adults, according to an analysis of surveys of 6,188 adults in Wisconsin.

Those with six or seven PCEs and no ACEs were less likely to report depression or poor mental health as adults. The analysis said PCEs showed a dose-response association with depression, poor mental health and social and emotional supports. In other words, the higher the number of PCEs, the less likely there were reports of depression or poor mental health.

Researchers concluded that “A joint inventory of ACEs and PCEs … may improve efforts to assess needs, target interventions, and engage individuals in addressing the adversities they face by leveraging existing assets and strengths.”

In a sense, Armstrong’s adult life is living proof of that research. He’s been engaged over the course of his adult life with ensuring that parents and children in his congregation and beyond have the opportunities to build those lasting connections, starting with teaching parents in his congregation about some fundamentals of parenting on home visits.

“So, I literally say to my families, ‘I’m not going to bless your child until you sit down with me and my team and go through at least seven sessions on the ages and stages of development,’” he said. “That program is yielding positive results. The outcomes that we’re seeing from this clergy home-visiting model is that parents have a hope-laden start to their baby’s future, and positive development is highlighted early.”

“Hidden untold goodness”

In a session entitled “The DNA of HOPE: The Science of the Positive Framework,” Linkenbach illustrated how hope from positive experiences can show up in unexpected ways. A co-investigator of the Healthy Outcomes for Positive Experiences research, he talked about how he and a handful of fellow teenage boys once got into trouble in their suburban neighborhood.

“We had spray paint, and it was about midnight,” he recalled. “We spray painted a neighbor's driveway. And then the lights came on outside, the lights came on in the house, so we dropped the can and we ran.”

The next morning there were knocks on several doors, and Linkenbach and his co-conspirators were led by the neighbor over to his driveway. “We were thinking that this is not going to be good. And some of us had very authoritarian and even abusive parents, who would not have responded well had they been pulled into the loop.”

With their heads bowed, the boys listened as the neighbor held up the can of spray paint and said, “Guys, I think this is yours.” Linkenbach and his buddies were shaking. “And he said, ‘You know what I’m going to do?’ And we said, ‘No sir.’ He said, ‘I’m going to ask you to spell my name correctly.” His name had two Rs, not one, as they had written on his driveway, and they obliged. And he sent them on their way.

Linkenbach jokes that from that point on that neighbor had immunity from toilet-papering and any other teenage prank. But more to the point, he said, “We experienced what I call ‘hidden untold goodness’ – to have that positive experience was pretty amazing.” The neighbor’s unexpected response to their vandalism, he said, led Linkenbach to a strong relationship with the neighbor throughout his childhood.

Spirit-Science-Action-Return

While supportive relationships are one of the main tenets of the HOPE framework, Linkenbach said the framework also is rooted in developing a shared language around solutions rather than deficits. As an example of why that’s important, he recalled a published interview with Albert Einstein, during which a journalist asked Einstein, “What is the next big question that we need to ask?”

Einstein’s response was, “Is the universe a friendly place?” Linkenbach said Einstein went on to explain that “if we’re seeing the universe as a dangerous place, we’re going to stockpile munitions and build up defense systems. If we see it as a friendly place, we’re going to invest in benevolence.”

For transformational change to occur, said Linkenbach, you need to start with spirit or messaging from the heart, ground it in science, root it in action and show the outcome or return -- as he illustrated in the following slide.

SpiritScienceActionReturn1

The same approach of starting with the heart is embedded in the way that Dr. Baraka Floyd, a pediatrician with the Stanford School of Medicine, interacts with patients. To illustrate the importance of heart – or focusing on the positive — Floyd showed two different videos. In both, she interacts with someone playing a new mother who had been found to be experiencing severe postpartum depression.

The first video illustrates how focusing on the negative shuts down communication, while the positive video reflects the preferred approach in which she focuses on the patient’s own strengths and agency. In the second video, she taps one of the building blocks of the HOPE framework: building strong, nurturing relationships between her and the patient, and the between the patient and her newborn.

Here’s a summary of the two different approaches. In the first health care video, she starts out by reciting a litany of results: “Good morning, I need to go over your postpartum depression screen results with you. Thank you so much for completing the screener. So, it looks like you're struggling a bit, you know, having little interest or pleasure in doing things and feeling down, depressed or hopeless, not falling asleep, or sleeping too much, not having enough energy or appetite. feeling bad about yourself, not being able to concentrate, moving around so much that other people have noticed. Does that seem like it reflects how you feel?

She ends the visit by giving the “new mom” the choice of seeing a therapist or having a home visitor to provide support. The mother selects the home visitor and the visit ends.

In the preferred interaction Floyd employs an approach in which she’s connecting with the patient before going over the results and normalizing the mother’s feelings about the challenges of being a new mother. She also asks questions that affirm how the mother is building a relationship with her baby:

Dr. Floyd: Good morning, I'm Dr. Floyd, one of the pediatricians. How are you doing today?

New mom: I'm doing okay. How are you?Dr. Floyd: I’m doing well. Thanks for asking. I know it's been a little over three or four days since I last saw you guys. How's the baby doing?

New mom: She’s doing ok. I love when she makes her little faces. It brings me joy sometimes to see that.

Dr. Floyd: I bet it does. It sounds like you’re getting to know her is going well.

New mom: Yes.

Dr. Floyd: Do you have any questions or concerns for me?

New mom: Not really. I'm not really feeling like myself lately.

Dr. Floyd: You know it’s really common for moms to have at least a little bit of baby blues after having a new baby. And the purpose of our visit today is actually to talk about your postpartum depression screen. But first, it sounds like you already know you’re struggling a bit.

Floyd asks a number of other questions to gauge to what extent the mother has protective factors, such as a concrete support system. (The patient’s support system includes a sister, an aunt and a cousin.) The mother relays that sometimes it’s good to have them, sometimes it’s hard to have peace and quiet when they’re around.

Floyd encourages the mom to accept the help and encourages her to set boundaries when she needs quiet time. It’s only at that point that Floyd discusses the post-partum screening results and that the mom appears to have postpartum depression.

Floyd makes sure to end on a positive note. “What I’m really happy about is that you’re open to having a home visitor and I love that you have support at home. Because that extra support really, really helps.”

The 2nd video captured how Floyd and her colleagues use the tenets of the HOPE framework in their clinical practice. “We really start by identifying and validating strengths within a family, because it’s particularly powerful as families are often blamed for situations, like poverty, that are not within their control,” she said. “And then we use HOPE building blocks to bolster existing strengths.”

During the COVID-19 pandemic, said Floyd, she saw how integrating the HOPE building blocks into interactions with patients made such a difference. “I want to highlight, especially as we’re all going through this collective trauma together, that this is an opportunity for us to give our families back some power by really highlighting some areas where they’re really doing well.”

Click here to learn more about the HOPE Summit and to watch the video recordings.

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@Mark Nicoll posted:

Sounds like a great conference.

Are recordings of these sessions available online?

thanks

Hi Mark, I am checking with the conference organizers. There are no links to recordings at the moment. I’ll keep you posted. Thanks for writing!

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