Learn more about ACES and Resilience2022-01-12T18:14:20-05:00

Learn more about ACES and Resilience

What are ACEs?2021-02-19T10:39:09-05:00

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:

Types of Adverse Childhood Experiences - Abuse, Neglect, and Household Disfunction
Health challenges resulting from Adverse Childhood Experiences - Behavioral, Physical, and Mental Health

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)

What is resilience in children?2021-02-19T10:46:21-05:00

Resilience is the ability to thrive, adapt and cope despite tough and stressful times.  Resilience is a natural counter-weight to ACEs (Adverse Childhood Events).  It is a skill that can be taught, learned and practiced.  We can reduce the amount of adversity in our community and cultivate resilience in our children and the adults who support them.

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 PartnershipHealthy Steps, and Child First — can improve the lives of parents and children. Evidence-based parenting practices (Incredible YearsTriple 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)

What is resilience in a community?2021-02-19T12:47:29-05:00

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 TherapyChild 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 on trauma for children2021-02-19T12:45:16-05:00

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

Learn more: Books on trauma affecting children and adults2022-07-08T18:03:48-04:00
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.

Learn more: Films and Video2021-02-19T12:59:40-05:00

Once you begin to see through the lens of trauma, there are many films that portray its occurrence and impact. A few recent films are listed below. These might be helpful in prompting community/group discussion.

  • Paper Tigers (2015). This film chronicles a year in the life of Lincoln High School in the community of Walla Walla, Washington. The kids who come to Lincoln have a history of truancy, behavioral problems and substance abuse. After Lincoln’s principal is exposed to research about the effects of Adverse Childhood Experiences (ACEs), he decides to radically change the school’s approach to discipline. With the aid of diary camera footage, the film follows six students. From getting into fights, grappling with traumatic events in their lives, and on the cusp of dropping out, they find healing, support and academic promise at Lincoln High. Note that the KPJR website (https://kpjrfilms.co/films/) offers additional resources to support further research and group discussion. Individuals can this film on Amazon Prime.
  • ResilienceThe Biology of Stress and the Science of Hope (2016). This documentary explains how toxic stress can trigger hormones that wreak havoc on the brains and bodies of children, putting them at a greater risk for disease, homelessness, prison time, and early death. While the broader impacts of poverty worsen the risk, no segment of society is immune. The film chronicles the dawn of a movement that is determined to fight back. Note that the KPJR website (https://kpjrfilms.co/films/) offers additional resources to support further research and group discussion.
  • Wrestling Ghosts, (2018). This documentary follows the epic inner journey of Kim, a young mother who, over two heart-breaking and inspiring years, battles the traumas from her past to create a new present and future for her and her family. With counseling, Kim opens up to new ways of thinking and uncovers what has blocked her from experiencing the joy and connection she most desires. She learns about the impact of childhood trauma on her brain, and how, tragically, this very damage causes the trauma to be passed on to her own children. Armed with knowledge and compassion, she pursues new strategies to heal herself, including counseling, Neurofeedback, and EFT (tapping). Note the resources for individual and group exploration available at the film’s website: https://www.wrestlingghosts.com/. Available for individuals to view on Kanopy for those with a Westchester Library System card.

ACES in the News:  The importance of this topic is communicated quickly in this 14 minute 60 Minutes broadcast (March 2018) hosted by Oprah Winfrey (you need CBS AllAcess to view.  Accessible to all is this  5 min interview with Oprah about the segment, which she called “life-changing”.   

Author of the Deepest Well, Ms. Harris’ did this 2015 Ted Talk, which provides a passionate summary of her experience.

Three core-concepts in early childhood development are explained in this three-part video series from the Harvard Center on the Developing Child.

MOVIES: Several documentary films are available that convey the challenges of trauma and the opportunities to foster resilience. A short list TK.

Learn more: Websites with information on trauma affecting children and adults2022-03-24T15:36:53-04:00

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:

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.

Facilitation materials for screenings and discussions about resilience2021-11-23T11:58:15-05:00

Event Resources

Information – General

Information – Children & ACEs

Recursos en Español (Resources in Spanish)

Are ACES appropriate as a screening tool2022-11-16T10:53:01-05:00
In a 2020 article by Laura E. Porter, BA, David W. Brown, DSc, MScPH, MSc – Inside the Adverse Childhood Experience Score: Strengths, Limitations, and Misapplications – cautions were raised and guidance offered.
The conclusions are pasted below (click link above for the free full text).  Bold is added by the web editor.
“The ACE score is a powerful tool for describing the population impact of the cumulative effect of childhood stress and provides a framework for understanding how prevention of ACEs can reduce the burden of many public health problems and concerns. However, the ACE score is neither a diagnostic tool nor is it predictive at the individual level. Thus, great care should be used when obtaining ACE scores for children and adults as a part of community-wide screening, service, or treatment.

Inferences about an individual’s risk for health or social problems should not be made based upon an ACE score, and no arbitrary ACE score, or range of scores, should be designated as a cut point for decision making or used to infer knowledge about individual risk for health outcomes. California’s recent release of statewide guidelines for Medi-Cal patients as part of the ACEs Aware initiative provides a useful example for consideration of these issues.

The ACEs Aware initiative reimburses providers for screening children and adults using questions about ACEs and guides providers in administering ACE questions and applying ACE score cut points. Client ACE scores are combined with the presence or absence of a list of 35 health conditions using an algorithm to group clients into low-, medium-, and high-risk categories for what is termed toxic-stress physiology that informs counseling, follow-up, treatment planning, and support services. Many of the health conditions included in the list have complex etiologies rather than developing from a single cause, making the ACE and Toxic Stress Risk Assessment Algorithm employed in the ACEs Aware initiative problematic. Attributable risks are relatively small for ACEs and health conditions such as cardiovascular disease, cancer, diabetes, kidney disease, and others on the list for adults. Although the health conditions listed within the algorithm have been associated with ACEs in epidemiologic studies, most occurrences of many listed conditions are caused by factors other than ACEs.

Given the limitations of the ACE score and its lack of standardization in combination with a list of health outcomes with widely varying etiologies, this algorithm will inherently lead to both over- and underestimation of individual risk. Although there are potential benefits for clients in the intent of this initiative, in its current form, the algorithm may stigmatize or lead to discrimination based upon an ACE score, generate client anxiety about toxic-stress physiology, or misclassify individual risk, which could result in the withholding of useful, necessary services or, alternatively, steer clients toward unnecessary services.
The understanding of childhood adversity and its long-term effects continues to evolve. More research is needed to explore innovative assessment approaches that address the limitations of the ACE score. Until the evidence base further develops, the authors caution against misapplications of ACE scores that assume an ACE score associated with risks derived from epidemiologic studies can sensibly be used to infer risk or make decisions about services, treatment, or care of individuals.
The authors encourage continued efforts by policymakers and legislators to provide knowledge and resources for human service systems as part of the rapidly growing movement to provide trauma-informed care and promote accurate and compassionate public understanding of ACEs as an endemic public health problem. At the same time, providers and patients deserve the kind of rigor that would be provided by a USPSTF review before promulgating community-wide screening, service, or treatment recommendations that use ACE scores.
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