Learn more about ACES and Resilience

ACEs are adverse childhood experiences that harm children’s developing brains and lead to changing how they respond to stress and damaging their immune systems so profoundly that the effects show up decades later. ACEs cause much of our burden of chronic disease, most mental illness, and are at the root of most violence.

The types of adverse experiences include:

The images above are taken from “Take The ACE Quiz — And Learn What It Does And Doesn’t Mean” (NPR, March 2, 2015).  Go to the article for a quick link to determine your own score.  You can also review this printable version of the questions.

ACEs came to attention through the CDC-Kaiser Adverse Childhood Experiences Study, a groundbreaking public health study that discovered that childhood trauma leads to the adult onset of chronic diseases, depression and other mental illness, violence and being a victim of violence, as well as financial and social problems. The ACE Study has published about 70 research papers since 1998. Hundreds of additional research papers based on the ACE Study have also been published.

Subsequent to the original ACE Study, other ACE surveys have expanded the types of ACEs to include such as witnessing a sibling being abused, witnessing violence outside the home, witnessing a father being abused by a mother, being bullied by a peer or adult, involvement with the foster care system, living in a war zone, living in an unsafe neighborhood, losing a family member to deportation, etc.

The link between ACEs and Toxic Stress is described well by the Harvard University Center on the Developing Child.  

A 5 min summary of the science from the makers of the film Resilience is posted below in this ACES Primer:

(Sources:  ACES Too High (https://acestoohigh.com/; NPR Take the Aces Quiz, March 2, 2015; Harvard Center for the Developing Child)

The good news is that the brain is plastic, and the body wants to heal.

The brain is continually changing in response to the environment. If the toxic stress stops and is replaced by experiences and practices that build resilience, the brain can slowly undo many of the stress-induced changes.  Cultivating resilience can happen at any age.

The single most common factor for children who develop resilience is at least one stable and committed relationship with a supportive parent, caregiver, or other adult.  

Research has identified a common set of factors that predispose children to positive outcomes in the face of significant adversity. Individuals who demonstrate resilience in response to one form of adversity may not necessarily do so in response to another. Yet when these positive influences are operating effectively, they “stack the scale” with positive weight and optimize resilience across multiple contexts. These counterbalancing factors include

1. supportive adult-child relationships;
2. a sense of self-efficacy and perceived control;
3. opportunities to strengthen adaptive skills and self-regulatory capacities; and
4.  sources of faith, hope, and cultural traditions.

In sum, these factors provide a sense of safety, connectedness, and an ability to self-regulate.

Learning to cope with manageable threats is critical for the development of resilience. Not all stress is harmful. There are numerous opportunities in every child’s life to experience manageable stress—and with the help of supportive adults, this “positive stress” can be growth-promoting.

The capabilities that underlie resilience can be strengthened at any age. The brain and other biological systems are most adaptable early in life. Yet while their development lays the foundation for a wide range of resilient behaviors, it is never too late to build resilience. Age-appropriate, health-promoting activities can significantly improve the odds that an individual will recover from stress-inducing experiences.

There is well documented research on how individuals’ brains and bodies become healthier through mindfulness practices, exercise, good nutrition, adequate sleep, and healthy social interactions.  Research on families shows that interventions — such as Nurse-Family Partnership, Healthy Steps, and Child First — can improve the lives of parents and children. Evidence-based parenting practices (Incredible Years, Triple P Parenting, etc.), increase the health of parents and children.

Take a look at our handouts for a sense of what you can do now to promote your own resilience.  See Actions for Resilience and Wellness and Hacking Your Vagus Nerve: Some Simple Ways to Shift into States of Social Engagement, Safety, and Self-Regulation.

For additional resources (articles, books, films, research reports, videos, and websites), see Learn more about ACES and Resilience.

(SOURCES:  Harvard Center for the Developing Child and ACES Too High and The Center for the Study of Social Policy.  Rev. September 2019)

Individuals, families and communities face the challenge of achieving and maintaining good health in the face of daunting adversity. Dr. Wendy Ellis of George Washington University Milken Institute of Public Health discusses this challenge as “The Pair of ACEs” – adverse childhood experiences and adverse community environments. An exploration of this model illustrates the importance how adverse community environments must be addressed to effectively support individuals and families.

Often, the soil (the community environment) in which our children and families grow lacks equity, characterized by concentrated poverty, poor housing conditions, higher risk to violence and victimization, and homelessness. This implies a community with little access to supports or buffers that support resilience.

Many of the mental health service organizations in Westchester County provide both individual therapy and run community programs that are designed to support individual and community resilience. These organizations have worked hard to embed a trauma-informed care principles into their operation. Approaches include Trauma Systems Therapy, Child Parent Psychotherapy, and Dialectical Behavior Therapy (also called Trauma-focused Cognitive Behavioral Therapy). (Now that you know some of the terms, feel free to ask your provider what approach they follow!)

Individuals can engage in mind-body practices that have been proven to address the impact of trauma and build resilience. These practices are among the things that we are all encouraged to do to promote overall wellness, from eating in a way that nourishes our bodies to getting enough exercise and sleep. Specific to trauma, coordinated movement and breathing activities such as yoga and mindfulness practices have been shown to decrease the anxiety, negative thought-patterns, and insomnia associated with trauma.

Thinking about the Adverse Community Environments, it is clear that community and cross-sector dialog and action are critical if the occurrence and impact of adverse childhood experiences are to be seriously addressed.

The Building Resilience Communities Collaborative (a project of the George Washington University Milken Institute School of Public Health) describes a holistic approach to fostering community dialog and partnerships that address inequities in the community and promote resilience. The web site includes materials for community conversations and summaries of work at different locations across the US.

Resources for further exploration

While it is logical that the importance of this topic would drive coordinated planning both from the community up and organizations on down, in almost all instances it starts where motivated people chose to step forward and take action. Explore the selected list of resources linked below for ideas

Community Resilience Initiative (CRI) – Inspired by Dr. Anda’s presentation of the ACEs data, organizations from Walla Walla Washington joined to take action. This site offers a number of informative resources and tools for others to copy.

Community Resiliency Model (CRM) – This model (and the linked workbook) teaches skills that people can use to help themselves and their communities. See also this report on its implementation in San Bernadino CA.

New York State Trauma Informed Care Network – A clearing house for resources and events. Also offers access to TRUST (formerly the TIC-OSAT) a free online self-assessment tool for organizations (including schools) to assess their progress in implementing practice change initiatives.

Understanding Trauma: When Bad Things Happen to Good People. This 2 page document outlines characteristics of trauma-informed care and guidance for service providers.

For additional resources (articles, books, films, research reports, videos, and websites), see Learn more about ACES and Resilience.

Books can be wonderful tools to use with children who have experienced difficult times such as trauma or loss. Reading (or being read to) and talking with adults can help them understand and cope with their feelings in a developmentally appropriate way. Reading also offers a great way to spend time with a child, reinforce a sense of normalcy and security, and connect with them, all of which are important to recovery from a traumatic experience.

Following is a list of books that are recommended by grief and crisis experts working with children. Each image is linked to the record in the Westchester Library System catalog.  Parents and caregivers who want to find other books should look for books that address children’s grief and loss, natural disasters, anxiety, and dealing with tragedy. Talk to a children’s librarian for other appropriate search terms.

Tips for Using Books to Engage With Children, CLICK HERE

A printable list of books appropriate for YOUNG children is provided HERE

A printable list of books appropriate for OLDER children is provided HERE

BOOKS (Selected suggested reads, by title)

Are u ok?: A Guide to Caring for Your Mental Health (c2018, Kati Morgan) offers accessible advice from a licensed family therapist and You Tube personality to answer commonly asked questions about mental health, including when to get help , where to find it, and how to evaluate it.

Change-able: How Collaborative Problem-Solving Changes Lives at Home, at School and at Work (c2019, J. Stuart Ablon, PhD) presents an approach to problem-solving that asks for this perspective shift: What if people don’t misbehave because they want to, but because they lack the skills to do better? Based on more than twenty-five years of clinical work with juvenile offenders as well training parents, teachers, counselors and law enforcement, and supported by research in neuroscience, Changeable presents a radical new way of thinking about challenging and unwanted behavior — Collaborative Problem Solving — that builds empathy, helps others reach their full potential, and most of all really works.

The Boy Who Was Raised As A Dog (c2006, Bruce Perry, M.D., Ph.D. and Maia Szalavitz) takes you through a psychiatrist’s journey of discovery of the impact of trauma on the developing brain using unforgettable examples from his practice.

The Deepest Well (c2017, Dr. Nadine Burke Harris) explains the research behind ACES,  her own experience using ACES to guide her practice in California, and a review of ways in which this information can guide services to children and adults.

The Pocket Guide to the Polyvagal Theory: The transformative power of feeling safe (c2017, Stephen W. Porges) explains the theory and its implications in an accessible format; a bit more technical than othe other titles listed here.

The Telomere Effect (c2017, Elizabeth Blackburn, PhD and Elissa Epel, PhD) is an account of Dr. Blackburn’s Nobel Prize winning science on how stress impacts our chromosomes blended with a variety of actionable advice on how to manage stress to improve health.

What Happened to You? Conversations on Trauma, Resilience, and Healing (c2021, Dr. Bruce Perry, Oprah Winfrey) blends Ms. Winfrey’s review of traumatic events in her life and how she addressed and overcame them with Dr. Perry’s explanation of the science guiding our understanding of stress and resilience.

WEB SITES

Two starting points:

1. CDC – Adverse Childhood Experiences is an excellent starting point for understanding the data, impact, and actions to prevent and address adverse childhood experiences.
2. PACES (Positive + Adverse Childhood Experiences, formerly ACES Connection) is a host site for dialog among local resilience efforts and across states.
3. The New York State Trauma Champions Collaborative offers excellent set of resources to support organizational work to build a foundational understanding about trauma.

Continuing the deep dive:

• ACES Too High News (acestoohigh.com) is a news site for the general public on all things ACEs-, trauma-informed, and resilience-building.
• Center on the Developing Child of Harvard University (developingchild.harvard.edu/) offers clear explanations (video) and deep dive resources on the impact of stress on children and tools for fostering resilience. Its approach is based on engaging families, programs and communities in building five protective factors:  parental resilience, social connections, knowledge of parenting and child development, concrete support in times of need, and social and emotional competence of children.
• Fostering Resilience (fosteringresilience.com/) A resource with a focus on skill-building strategies for children, teens and parents. Applies the 7Cs – The Essential Building Blocks of Resilience. See this applied to parent/teen communications at parentandteen.com/
• National Child Traumatic Stress Initiative (www.samhsa.gov/child-trauma) is a comprehensive resource portal from the Substance Abuse and Mental Health Services Administration. Note the “Evidence-based practices resource center” under Programs.
• New York State Trauma Informed Network (traumainformedny.org) provides a searchable database of resources and events, as well as a directory of service providers in NYS.
• No Limit Generation (nolimitgen.org) provides evidence-based, trauma-informed training videos designed to support an organization’s commitment to child well-being.  See this series of videos on Emotional Well-being & Breath Body Mnd Practices for Children.
• Trauma Informed Schools (traumainformedschools.org/) is where you can find more on how Miss Kendra’s List can be implemented in schools. Our handout on the program is linked here.

With a focus on orgaizational and systems change:

• Trauma Informed Oregon (traumainformedoregon.org) provides learning resources for individuals and organizations, including a free training (2 hours total) available in English and Spanish.  You can register for the training here. See also their resource library.
• Institute for Trauma and Trauma-Informed Care (University at Buffalo Center for Social Research; socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care.html) provides research and training for organizations on trauma and trauma-informed care through evaluation, trauma-specific treatment interventions, technical assistance and consultation. See their detailed manal on Trauma Informed Organizational Change.