Unlike some of her staff at Benchmarks, a nonprofit alliance partnering with private and public health agencies in North Carolina, Chief Research & Development Officer Jenny Cooper has an ACE score of 0.
Jenny, who joined Benchmarks to work on the Partnering for Excellence Initiative, which seeks to enhance child welfare services and outcomes, attributes her low score to her parents. They made sure to treat her and her sibling well and provide opportunities in their lives. She notes that she saw the impact of childhood adversities in her extended family, and those experiences had a lasting impact on her.
Twenty years ago, when she majored in biology and psychology at Belmont Abbey College in Charlotte, NC — both ideal fields for understanding the science of ACEs — people didn’t realize that the effects of toxic stress from childhood adversity on early brain development and physiology linked to later illness, including cancer, heart disease, diabetes, alcoholism, and mental illness.
Although the CDC-Kaiser Permanente Adverse Childhood Experiences Studywas first published in 1998, it’s been just in the last few years that colleges have started teaching about ACEs science and organizations have been integrating trauma-informed practices based on ACEs science. One part of ACEs science, the ACE Study, links 10 types of adverse childhood experiences (ACEs) to adult onset of chronic disease, mental illness, violence, or being a victim of violence. The original 10 ACEs include experiencing physical, sexual or verbal abuse; physical or emotional neglect; living with a family member who abuses alcohol or drugs or is mentally ill; experiencing divorce; having a family member who is incarcerated and witnessing a mother being abused. The researchers recognized that there were many other ACEs than those they chose to look at, including racism, bullying, involvement with the foster care system, community violence, war, homelessness, etc.
The other parts of ACEs science include:
- How toxic stress from ACEs damages children’s developing brains (neurobiology or brain science).
- How toxic stress from ACEs affects our short- and long-term health.
- How we pass ACEs from generation to generation through our genes (epigenetics).
- And how resilience research shows that our brains are plastic and our bodies can heal through implementing protective factors and resilience-building practices based on ACEs science.
After college, Cooper was waitressing when she overheard people at one of her tables talking about their work in mental health. She was so intrigued, she says, that “within a week I was doing community mental health and foster care.”
Cooper learned about the effects of ACEs on brain development from Dr. Bruce Perry, head of the Child Trauma Academyin Houston. Later, she studied public health, which focused on the epidemiology of ACEs. She says that rather than get into a war of words about “trauma” versus “ACEs,” “We typically talk about potentially traumatic events. I like that term so much because it opens the door and personalizes the term a little bit. What’s traumatic for one person might not be traumatic for another person,” she explains.
At Benchmarks, for community-level events, “We use the ACEs questionnaire because of all the data that has been completed. It’s a bit easier.”
For the state’s child welfare system, they use the Project Broadcast Trauma Screening Tool (attached). This tool, which was developed through a SAMHSA grant, includes questions about more than the 10 original ACEs as well as trauma symptoms.
The Trauma Screening Tool uses 17 adverse experiences. These include the 10 original ACEs, severe bullying and natural disasters, such as hurricanes, plus 23 traumatic symptoms a child might express, such as hyperactivity, sleeping problems, and chronic sadness. Youth who screen positive are referred for evidence-informed and trauma-focused mental health assessments that can take up to 10 hours. The child is then referred to evidence-based practices for mental health services; agencies that partner with Benchmarks oversee the process to make sure that child health services focus on the child’s well-being.
This seems like an enormous task, and Cooper says Benchmarks uses implementation coordinators to help with the task and to encourage local partnerships through this culture shift.
Benchmarks’ Partnering for Excellence Initiative has been “wildly successful,” she says. “We saved 44 percent in costs for Medicaid behavioral health services for children in foster care in just one year.”
She cites other equally important reasons: “Parents say understanding trauma gives them a better understanding of their children. Providers understand what triggers kids into bad behaviors. And our partners understand how to work better together.”
Although Benchmarks was founded after the Civil War as an orphanage association, it’s since become a national leader of association agencies. The nonprofit just held its 4thAnnual Benchmarks Partnering for Excellence conference where 12 of the 17 ACEs networking communities shared best practices and experiences. They also celebrated the launch of a new ACEs communityon ACEsConnection to help community managers throughout the state connect and improve the services for children in the welfare system.
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