I see trauma informed care and "ACEs" or ACEs informed care used interchangeably anymore. Some folks disagree with that, and feel that trauma and TIC are different than dealing with all ACEs (but there is overlap). Help/advice for teaching a varied group of both clinical and nonclinical professionals in public health? Thank you!
What a great question! Great because it’s so useful to everyone! Here’s my attempt at answering it conversationally - because I think that’s what makes it useful to more people:
Trauma-unformed care is about bringing an educated mindset to the world, which may also be your business, job, task or simply environment. The educated refers to both knowing and understanding our best information to date about the traumatic experience - what generally constitutes this thing we call trauma or traumatic event, how the body and mind process and either store or release it, experience and best practices for accessing and guiding people through their individual experiences and memories of it, and so forth. ACEs is a component of a TIC mindset, and provides an excellent paradigm for seeing, gauging and working with a person's life experiences, particularly those they encountered in infancy and early childhood. It also provides an excellent structural way to speak about a person’s overall health and wellness expectations for the present and future.
The most remarkable thing is that in these days and times we DO have an amazing amount of data and practices we can use to help a world in need, to safely examine, deconstruct and release their traumatic experiences and once again find their strength and self-worth.
Thank you for such a great question to discuss .
I provide ACES awareness in my Emergency Medical Technician capacity. This year I shadowed CARE 7 teams in Tempe, AZ. They provide excellent trauma mitigation in a whole array of human traumatic experiences. Their clinicians, old and fresh out of college practice "Do no harm". Which I attempt to tip toe around when informing patients about ACES and how it has effected their lives.
I told them of the interaction I had with someone in the peripheral of the scene we were dispatched to. An adult male that had physical signs of poor health and drinking Jack and Coke from a 32 oz. insulated sippy Cup. If you have never been to Tempe, It's hot there. I asked him of his childhood. He likened himself to a red headed hated step son. He was beaten regularly by his father and once so badly that he couldn't get out of bed for 3 days. I connected the dots for him and told him that his present health was connected to his childhood treatment. His reply "Your kidding me". I told him I was not. The clinicians thought it was horrible that I addressed such a horrible childhood trauma outside of a formal clinical setting. Now understand, CARE 7 is TIC. But they have the overriding practice of Cause No Harm. When challenged by their CNH practice, I replied with how would he ever know about the connection of ACE and his present health. He would of taken his story to the grave. And probably is going to be buried by it.
TIC is the little secret that "I know something happened to you. So I won't judge you." Because of ACE Study the practice of TIC evolved. It is how you want to apply the study is the difference.
I know of two people that went to the same facility for counseling. The two have different counselors. One counselor had intake questionnaire with childhood trauma. The other only started sometime after the third session, down the path of childhood trauma. Only after being prompted by the patient. Both patients are ACE informed.
I would suggest browsing the ACEs Connection Resources Center. And navigating to the Blog Directory list where there may be some categories of interest to you: organizations (ACEs-informed), trauma-informed guides, presentations, and tools, training (for individuals, communities, organizations), etc. Additionally, looking through the Blog Directories and perhaps posting your question in Ask the Community in the communities ACEs in Pediatrics and Becoming Trauma-Informed and Beyond may be useful. Hope this helps!
We regard ACEs science — the epidemiology of adverse childhood experiences, the neurological effects of toxic stress from ACEs on the brain (especially the developing brain of a child), the short- and long-term health consequences of toxic stress, the epigenetic effects of toxic stress (including historical trauma), and resilience research — as the foundation to a new understanding of human behavior.
Trauma-informed practices, social-emotional learning (SEL), cognitive behavioral intervention therapy (CBIT), positive behavioral intervention support (PBIS), restorative justice, and many others, are all practices that can help heal the effects of ACEs and create a healthy familial, organizational, system and community environment.
In some quarters, for some contexts "PBIS" appropriateness and effectiveness would be debated. :-)
I agree, Daun. There are some people who realize that PBIS will only get you so far, and therefore are integrating ACEs science into it. I don't know what the result is, but it's worth looking into.
Thanks everyone! That's helpful. Re: PBIS I will check that out as I hadn't heard of it, but I often say (as an overgeneralization), that CBT fails where trauma begins....
Sorry if that sounds rude, not my intention!!!! I just am really excited about the learnings happening around limbic/connectome/brain/body healing, and for us to finally have some better rigor and evidence around all of this so we can move into the next generation of high quality intervention at all levels (1:1, group, organizational, community, etc).
Thank you, again. I am grateful for this community.
Andrea, "PBIS" in public schools generally focuses on external "behavior" (The "B" in PBIS). But, if you've seen the "Trauma Iceberg" illustration, external behaviors are only the "tip" of the trauma iceberg.
Some will argue that "positive" approaches to behavior can be a step in the right direction, when compared to "zero tolerance" (for the most egregious behaviors) in public schools. But being better than "zero tolerance", is not part of the definition of trauma-informed.
Other will argue that PBIS is simply a manifestation of the "Behaviorist" world view. A manipulative approach with extrinsic incentives. Sort of like training a pet, using "treats".
Sometimes there seems to be short-term success with PBIS and younger students. Nevertheless, there is very likely no internal or intrinsic connection (best case) between the external incentive and the trauma experience which underlies the behavior.
Sometimes, in fact, the PBIS goals or 'norms' can backfire in a confined space, like a classroom, with students who have a history of certain trauma (restraint) experiences . So again, best case, trauma injuries are not directly addressed via a focus on external behaviors.
Meanwhile the overriding importance of healing-in-relation (especially from relational trauma) and the deeper change via intrinsic motivation are often discounted or ignored in the focus on a PBIS "system".
My "two cents" of perspective from the front line....