Andrew Turner posted:
Advice sought please! We are a public health team in a UK local authority, and have been raising awareness of ACEs and trauma-informed interventions for some time, with some success. We have recently been made aware of an issue around ‘ACE training for enquiry’ and in particular the impact for those staff who would ask the ACE questions. We have a local centre that specialises in helping women experiencing domestic abuse (along with a wide variety of other complex needs and generally high ACE scores). Many of the staff at the centre are volunteers and some have had similar experiences. We have received feedback that learning about ACEs and their impact has caused distress to some staff – we have reports of some feeling guilt about having ‘passed on their ACEs’ to their children, especially having learned that this could potentially have been prevented. Obviously, these staff were taught about ACEs in order to be able to help their clients in a more trauma-informed manner, and the last thing we wanted to happen was for them to be upset themselves. We will be looking into this further to understand their perspective, but I was wondering whether any of you have had similar experiences and how you tackled any negativity or distress arising from education around ACEs. Many thanks.
I think if you check out my previous post regarding the proposal from NHS Scotland (now attached), you'll see a number of different levels. I think this can be used to structure a set of guidelines for preparing people for this sort of work,at whatever level they feel prepared and comfortable. If you've seen posts of talks by Anda or Felitti, there's nothing unusual about finding sets of helpers in their audiences with levels of ACEs "above the norm" -- meaning that in the Kaiser studies. But such groups also tend to have resilience resources above the norm, including time spent de-sensitizing to the material, and "vicariously" dealing with it. For most, victim and "therapist", this sort of work might best be done by older or wiser souls -- look at the demographics of those who make use of the call line for the Blue Knot Foundation in Australia -- typically in their fifties or older -- you need a certain amount of real-world strength to get into it, your own or others histories.
So, the level of support etc needed depends on the person's degree of involvement with the issues. On the one hand, it appears relatively "easy" for primary care doctors to conduct screening evaluations (ACEs Q, PTSD screen), and refer people on. On the other hand, those who choose to go further with the material, who aspire to become involved as "therapists", or as "educators" need to be better prepared, personally as well as professionally. Many would say "don't do the work if you ain't done the work" -- do the work on addressing the leftovers from your own history if you want to approach doing this work professionally -- I don't treat fellow workers / speakers "with kid gloves" "just in case" -- if they haven't acted responsibly to do their work, then they shouldn't do it, pure and simple -- they'll be hurting not only themselves but putting their clients at unnecessary risk. This view is shared by many others, for example, see McPherson's resources, the book "Victims No Longer" by Mike Lew etc etc.
Thus. this field really is no different from any other "peer support work" in mental health in these regards -- have understanding supportive management; fellow supports nearby for debriefing; if you're speaking, your own pre-prepared "script"; personal and professional boundaries sorted out -- AND RIGIDLY MAINTAINED as necessary. There are guides around in the MH field for responsible use of "lived experience", and this is just one particularly common form of "lived experience".