ACEs – APtly Said

New AAP Policy recognizes value of nurturing family relationships

The American Academy of Pediatrics (AAP) has issued a new policy, Preventing childhood toxic stress: Partnering with families and communities to promote relational health.

We applaud this bold recognition of the value of nurturing parenting, given AAP’s influence on its global network of pediatricians:

Source: AAP

Safe, stable, and nurturing relationships can act as a powerful, protective buffer against the biological harms of toxic stress on children. These relationships are also key to building resilience—being able to bounce back from adverse childhood experiences.

When children feel connected and supported in the early years, according to the newly updated AAP report, they are more likely to become healthy, competent and educated citizens later in life.

The policy statement, “Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health,” was published in the August 2021 issue of the journal, Pediatrics. The statement focuses on just how important relationships and positive childhood experiences are in preventing and healing toxic stress.

This policy moves away from a problem-based model that focuses on a child’s past adverse experiences and instead presents a positive, strengths-based approach that fosters solutions at the family, community and societal levels.

A Slow-Moving Public Health Crisis

The AAP calls for pediatricians, parents, and policymakers to recognize toxic stress as a slow-moving public health threat that can be tempered by a preventive approach aimed at developing and strengthening healthy relationships.

“The concept of drawing on positive relationships as a shield against the toxic stress caused by adverse experiences has never been more relevant,” said Andrew Garner, MD, PhD, FAAP, a co-author of the policy statement generated by the Committee on Psychosocial Aspects of Child and Family Health, the Section on Developmental and Behavioral Pediatrics, and the Council on Early Childhood.

Forming Close, Healthy, and Nurturing Bonds

“Over the past few years, we’ve experienced a socially-isolating pandemic and reckoned with centuries of structural racism,” Dr. Garner said. “We must take steps to help kids form close, healthy and nurturing bonds, whether it is within the family, schools or community.”

The AAP recommends that pediatricians prioritize the trusted, respectful relationships that they share with patients and their families. They may refer families with strained relationships to evidence-based therapies, or work within their communities to make those therapies available if they are not offered.

New research also reveals that changes in the brains of parents who experienced trauma in their own childhoods may make it difficult for them to bond and nurture their children. These families can benefit from help from the community and others, especially after the pandemic.

“Families can help children adapt to harmful experiences and adversity by modeling their own skills at resilience,” said Michael Yogman, MD, FAAP, a co-author of the policy statement.

“This may mean demonstrating how to ask for help from family, friends, neighbors or others or demonstrating how to handle their own strong emotions,” he added. “Caregivers do not need to be perfect to help children feel safe, connected and supported.”

The AAP recommends that pediatricians watch for, screen, and address potential barriers to safe, stable, and nurturing relationships. Barriers include social determinants of health, such as inadequate housing, education inequities and food insecurity; the parents’ own adverse childhood experiences; intimate partner or neighborhood violence; parental depression; and/or substance use.

The pediatrician cannot do this work alone, however. The AAP calls for policy makers and community leaders to learn how relational health is influenced at all levels and support programs and funding that strengthen families.

This may include expanding family medical leave opportunities, increasing child tax credits, securing safe and affordable housing, supporting employment assistance and job training, promoting universal access to high-quality child care centers and schools, advancing preventive early childhood mental health services, promoting social emotional learning in schools, and expanding opportunities for playful learning in safe neighborhoods.

The AAP also offers recommendations for families, caregivers, teachers, coaches, and others:

Learn about positive parenting techniques and developmentally appropriate forms of play, such as shared reading, as these foster the warm relationships that enhance literacy, executive function, and other core 21st-century life skills.
Learn how to handle their own strong emotions, so they can model this skill and be emotionally available when their children are distressed (“put your own oxygen mask on before helping others”).
Consider therapy to address unresolved trauma in the caregivers’ own history. Children are watching as caregivers strive to become slightly better versions of themselves each day, and the development of a “growth mindset” is a powerful predictor of future success.
Help children understand that there is nothing wrong with having strong emotions: the challenge is helping them to channel that energy into a constructive outlet like a passion, hobby, or activity that brings them joy while at the same time building generalizable skills.

Policymakers are encouraged to consider how adverse childhood experiences and toxic stress lead to long-term health problems from depression to diabetes and heart disease that are bankrupting the healthcare system.

“Our nation’s children are suffering both a mental health crisis and an educational challenge amid the pandemic,” Dr. Yogman said. “We must seize this opportunity and make sure that all children have someone they can turn to, that they can trust within a consistent, positive and nurturing relationship. This benefits our children, our society and our future.”

How being stressed-out hurts the brain, and what parenting has to do with it: Video

There’s a lot of talk about family and personal stress during this worldwide COVID-19 pandemic, but stress is hardly a recent development. Neither are the roots of resiliency that some people tend to have.

Scientist-turned-journalist Madhumita Murgia created a TED-Ed short film back in 2015 to illustrate what exactly happens to the brain on stress and how to mitigate this multi-lifetime effect.

“How Chronic Stress Affects Your Brain” is available for public viewing at no cost. Some highlights:

Stress isn’t always a bad thing, unless you’re feeling regularly stressed-out
This chronic stress changes how our body’s systems work, including our brains…even shrinking certain brain regions while enlarging the brain’s fear center

These effects lead to it being harder to learn and remember things and control anxiety, and has been linked to eventual depression and Alzheimer’s dementia
Stress is inevitable in our modern lifestyles, but there are certain coping skills linked to greater resiliency including exercise and mindfulness

What’s parenting have to do with this? Turns out, parenting style changes how our genes are expressed…nurturing parenting sets up children for a lifetime of resiliency, negligent parenting sets up children for a lifetime of more susceptibility to stress’s effects

And these changes to our children’s genes are heritable, meaning that not only can we change the trajectory of our family tree by shifting to a nurturing parenting style but also that our children’s children and grandchildren benefit from this choice

Curious as to what nurturing parenting looks like? Check out API’s approach.

What about boys? Trinidad & Tobago advocates discuss ACE effects and buffers

On May 16, observed as World Day of the Boy Child, the Republic of Trinidad and Tobago’s Dr. Jerome Teelucksingh organized a virtual event with other Caribbean child advocates to discuss the effects of Adverse Childhood Experiences (ACEs) on boys and men, a problem found in many cultures around the world.

The recording of “ACEs and the Boy Child” is now available for public viewing at no cost. Here are some highlights:

Our culture has made monumental strides with girls and ACEs awareness, through the feminism movement, but we must be sure not to leave boys behind!
Our culture focuses a lot on adults’ mental health needs and less so on children’s mental well-being. Neglecting mental health in boys, however, comes out later as violence when those boys have grown into men.

When a child is exposed to chronic toxic stress, the amydala (the fear center of the brain) becomes overactive and the prefrontal cortex (the executive functioning region of the brain) remains under-developed, resulting in a child who has trouble focusing and learning, may be hyperactive, have oppositional issues, etc.
ACEs are listed as emotional, physical, or sexual abuse; emotional or physical neglect; mental illness in a parent; an incarcerated parent; domestic violence among the parents; a parent involved in substance abuse; and divorce in the family. Other possible stress events that researchers are considering for the ACE list include poverty, physical punishment such as spanking, child labor, generational trauma, and environmental issues. The original ACE study (1998) and many follow-up studies show a very strong correlation between number of ACEs with serious physical and mental health conditions in adulthood, as well as behavioral issues in the child while in school and the propensity for the physically abused child to become a violent adult.
ACEs aren’t about merely pointing out that certain childhood stresses have toxic effects on lifelong physical and mental health, but about identifying the reason for needed positive change in our children’s lives.

Healing from toxic stress is not related as much to what a child has been exposed to, but that he has the support he needs to process what he has been exposed to. Our main focus as parents and professionals must be on finding spaces and people where boys feel safe and emotionally supported to work through their questions and make sense of their experiences.
Masculinity is defined differently in different regions of the world, and that definition may or may not contribute to ACEs. Shame-based masculinity messages, as well as silent trauma accrued through punishments a child receives, affect the quality of nurturing that boys offer their own children when they become fathers.
The big takeaway for raising boys is to make sure our sons have a positive male role model in their lives; if not the father, a grandfather or neighbor or teacher/coach. It’s important that this role model embodies positive male character traits, especially humility.

It’s also important to guide our sons to value people in working-class occupations, not celebrities or pro-athletes, because most men in our culture (and probably our families) are in working-class jobs.
Mothers are equally important in boy development. Our sons need to feel welcomed and loved by their mothers. It’s important to guide them with the assurance that they can talk to their mothers about any problems they encounter.
We must take care in disciplining our children, both boys and girls.

Learning More about ACEs and Fostering Positive Childhood Experiences with Becky Haas: Part 3 of 3

Continued from part 2 of 3

Becky Haas Interview with API for AP Month 2020:

Parenting with PEACE, Part 3 of 3

You’re a parent and this is a community of parents that we’re talking to, and people who serve parents. We’re providing individual help as well as getting communities together, working in coalitions, working in small groups. Mostly, it’s individual parents, day to day, navigating life with their children. What would you want them to know about ACEs? What kinds of messages are you sharing with parents?

That’s a fabulous question. I’m the mother of two sons who are married and grown now. When I was preparing to have our first child, I remember thinking to myself, I have a wonderful mother. I feel I had a good childhood and all, but I remember thinking as I carried that child, of all the things I’ve ever done in life, any jobs or volunteerism, it came with training. Being a mother did not come with any training. I felt it was the most important thing I was entering into in life. I applaud the work of the Attachment Parenting International community in the fact that you all are having conversations around things that many more families need to understand. What we see now with ACEs is how the fulcrum is slanted in a negative way because that attachment was not there.

In 2010, the Tennessee census revealed…that 11% of Tennessee grandparents had custody of children 18 years and younger.

The other thing that we’re seeing is that there can be a hybrid attachment, that it can be community members or foster parents, but that attachment has to happen for a child to grow up. I didn’t know about attachment until my boys were grown and married, but I have two grandchildren that are four and two. I’ll tell you, I never read a book to them without thinking about ‘serve and return.’ If they fall down, I am there lickety-split, which I would have been anyway. But now I know that the way they’re learning self-regulation it starts first with external regulation. Then they’re going to learn co-regulation then it’s going to be self-regulation. Now, with my two-year-old grandson, it’s all that. “Nammy” is what they call me. The four-year-old, if she’s watching a movie with me, she knows where the comforters are. She’ll say, “Nammy, I’m cold.” I’ll say, “Well, go get a blanket,” and she’ll go get it. And then there’ll be a time where she won’t even ask, she’ll just run, go get the blanket. I didn’t know what all that was until I learned about ACEs.

That’s so encouraging for parents, and grandparents too. Even though you didn’t know about it before, you take the information you get along the way and you start to apply it.

I didn’t realize how much grandparent care and custodial care there was until I worked at ETSU in car seat safety. In 2010, the Tennessee census revealed (a new number on the census I understand) that 11% of Tennessee grandparents had custody of children 18 years and younger. We’ve been super slow on getting support for the grandparents now that they are raising grandchildren, or those aunts or uncles. It also impacts the community because of instead of retiring, now you’re starting over raising grandchildren because their mom and their dad are in the drug culture.

A child needs in their life two or three adults; they need more than just the parent.

There is no guidebook, as you mentioned, but with the Principles API has, we talk about preparing for pregnancy, childbirth, and parenting – growing in your knowledge. We share with parents about feeding our children with love and respect, about healthy eating. We help parents understand about responding with sensitivity, which is the hallmark of attachment, as well as providing consistent and loving care. We discuss how it’s important to practice serve and return, and not to have ever-changing childcare figures because that primary early secure attachment is so critical. We guide parents about sleep because sleep can be challenging for parents and for children, especially with separations. We address positive discipline: what’s really effective, including learning to parent with creativity, patience, responsiveness, and curiosity.

We help parents foster good relationships and not chip away at that attachment relationship as children grow because you’re teaching them to problem solve, not using a heavy hand to ‘handle’ them. Then we talk about balance and the family, parenting together and in community, as well as self care. All of this to foster positive childhood experiences, which is not just referring to a good day out at the park or going to Dollywood, although those are nice. It’s really more about creating stability, predictability, connections, support, play, memories, and traditions that are vital to strong, secure, and stable environment for a child to grow and optimally develop.

When I get a chance to talk to parents, some of my work in training school districts, I’ve had a parent night and I’ll have maybe 30 minutes. Always, my go-to is protective factors, that parents understand that a child needs to have a healthy relationship with a teacher or an uncle or a coach. A child needs in their life two or three adults; they need more than just the parent. I know our boys were growing up, my husband and I, we could see that they were headed in a wrong direction and they might not take it from us. But if the coach in the weight room said something to one of my seniors… I did a training in a school district and the coach came up to me and he said, ‘I’m going to be as humble as I can about this, but maybe I’m partially responsible for one of your children never trying drugs, because I told him to meet me in the weight room.’ I remember when that happened. So parents need to understand that children need to have these protective factors. To me, that’s the top part of the funnel, being involved in Girl Scouts or whatever, where you have these other adult caring voices, nurturing voices, that are able to help in that child’s life.

It’s a very micro kind of level of change, but sometimes when you’re parenting young kids, that’s as much as you can do. It’s individual, it takes time, and it’s deep work. We are each other’s and our children’s protective factors.

Sometimes our protective factors change. If a child was to lose a parent to divorce, or heaven forbid to death, navigating things ahead will be difficult. I never had any grandparents around with me, because my family is from Miami, and we just were not involved with our grandparents. So I taught a senior Sunday school class at my church for 15 years. I adopted about 50 grandparents that were in this group. The one man that I mentioned that was orphaned as a young child – on the worst single day of my life, I could not get to his house fast enough to see him and his wife. I honestly didn’t know how my life would go on the next day, but I knew if I could get there, they would help me make sense of it. And they did. So, I’m a champion for protective factors.

That’s what our support groups are about. The people with whom I’ve spent time in support groups have taken my kids for the weekend because I had a work commitment, and I felt full confidence that I didn’t have to worry. They have also been an influence, saying here’s an opportunity your children might be interested in because they know and love my children. At API, we talk a lot about building your support network because those people in your support system become those caring adults in your children’s life too, along with the ballet teacher and the theater director in my kids’ lives.

And then you’re someone else’s protective factor too. I do try to bring that out. When you think about who could you call on in the middle of the night who’s that close and how are you giving back? Would anyone name you in their protective factors?

…in a world where kindness seems a lost art and where there’s violence, I hope maybe some of this conversation will shift people and just say we will not enter into hatred. We will hold to our ground to be someone who is going to spread kindness.

Absolutely. I love that. For a lot of our leaders that’s why they come to API. They see themselves in this serving, giving role and want to help. It’s a very micro kind of level of change, but sometimes when you’re parenting young kids, that’s as much as you can do. It’s individual, it takes time, and it’s deep work. We are each other’s and our children’s protective factors.

My boys would bring kids over and we would be sitting downstairs playing a Donkey Kong or just engaged in something. Next time they’re over and they’re going to stay for supper. One of them began to tell me how long it’d been since he’d had a family meal because this family was broken by alcoholism. By building these little conversations over a video game where nobody’s got their guard up, then you have that trust.

Recently on social media, a young man who was in college with one of our sons had some challenges and the family from another state reached out and I got involved. This young man was just married over the weekend and I sent a lot of messages of cheers on social media. I haven’t seen him in 10 years but at that time there was a need. Those people don’t just walk right out of my heart. I guess I feel in a world where kindness seems a lost art and where there’s violence, I hope maybe some of this conversation will shift people and just say we will not enter into hatred. We will hold to our ground to be someone who is going to spread kindness.

When I was doing the whole police journey, my husband said to me, one day you should write a book – because he’s lived with me 36 years now. So I did write a book, Your City’s Waiting On You. It’s really a little bit of a Bible study, but chapter seven is all about ACEs. It’s about treating your city with kindness, but there’s chapters in the back, all about nonprofits and foster care and schools. I saw that evolve, not in a religious way, you know, but Jesus said in the kingdom is a servant. If you just get involved and serve, you’re going to build relationships. In another scripture it says I came to seek and to save the lost. I think a lot of times in church, we totally focus on the saving, but what about the seeking part, who’s going out? A cosmetologist, after reading the book, she got it for her mom and they decided to launch a ministry called Bridges to Beauty. They’re going downtown where women are, and they’re doing their cosmetology services for free…

Stories of kindness in practice. Of course. Thank you, Becky, for choosing to do something once you knew.

Parts 1, 2, and 3

Learning More about ACEs and Fostering Positive Childhood Experiences with Becky Haas: Part 2 of 3

Continued from part 1 of 3

Becky Haas Interview with API for AP Month 2020:

Parenting with PEACE, Part 2 of 3

In our work, Becky, we have parenting leaders and educators in local communities. We’re also training, and we’re helping them deal with preconceived ideas about parenting, preparing them to facilitate group meetings – to love, accept, welcome, and help caregivers with their parenting. We support those whose stress is affecting their coping and creativity as parents. We wrap this in the API Principles that are very foundational and grounded in research. We’re doing a lot of your infusing the community with empathy, understanding, and warm handholding.

As ACEs awareness is integral to understanding resilience, what childhood environments are more likely to predispose people to grow up without developing a high level of resilience?

The Milken Institute of The George Washington University School of Public Health’s Dr. Wendy Ellis and some of her team developed a graphic called the Pair of ACEs. With that graphic, they show that poor soil creates poor fruit on the tree. The soil illustrates the challenges like lack of affordable housing, food scarcity, and lack of employment. A tree growing in this soil is then likely to grow the fruit of domestic violence, drug addictions, or an incarcerated parent.

Graphic of tree titled The Pair of ACEs demonstrating adverse community environments at the roots and adverse childhood experiences in the branches — The Pair of ACEs. Source: George Washington University

Referring again to the funnel of hope, some schools locally, for instance, have hired a social worker through a nonprofit called Community in Schools. That social worker gets referrals from the teachers or the principal for families that might be struggling with housing or medical needs. I was surprised to learn when I worked at the police department, our city schools reported every year they had 300 to 400 kids classified as homeless. That didn’t mean many of them lived under a bridge or slept in a car, but it meant when they left the classroom every day, the teachers did not know where they could be found. They had no permanent address. But as we understand trauma-informed care, providing a social worker in the school can help address needs that students and their families are facing outside of school.

Statistically, it takes seven acts of violence before someone will reach out to an advocate. That means there is a lot of unreported violence children are witnessing in their homes.

We can see that ACEs occur from the wealthiest parts of town to the most difficult parts. Domestic violence is not socioeconomic; there is no barrier there. In 2015, in my zip code, we averaged nine calls a day that were coded domestic violence. Statistically, it takes seven acts of violence before someone will reach out to an advocate. That means there is a lot of unreported violence children are witnessing in their homes. This is what gave me the idea to train police. Police are likely called to the home and they can provide a small intervention to children who are present to help reduce the trauma. When police are trained in trauma-informed policing, they step in and they say to the child, “You did the right thing. If you feel unsafe, you call us.” Training also directs the role of police in communities as a guardian instead of a force.

ACEs inventories identify people at high risk, but you also talk about “universal precautions,” keeping a trauma-informed lens based in the 70% statistic of those around us.

Since 2014, as an ACEs educator, I have always presented the national statistics on violence. There are 65% of women in substance abuse treatment who report histories of trauma, 75% of men treated for drugs have a history of trauma, 92% of homeless women have histories of trauma. In 2013, the American Journal of Public Health said homeless individuals have the highest ACEs scores of any population. When I give an ACEs education presentation, we talk about the ACEs test itself, but I’ve never even recommended a group to screen for ACEs. Not that I would be opposed to it, but I feel that if you screen, then you just need to make sure you have services to connect someone once you see what the score reveals. I strongly recommend the universal precautions method because those numbers I’ve cited pretty much tell us that of all the staff we hire, as well as all the consumers we serve, for instance, almost 70% are trauma survivors in some form or fashion.

What if 70% of the people you serve are trauma survivors – then how welcoming are you?

Some have had much more trauma and no healthy support, even among our staff. I do a training where professionals that were in my training, email me, or send me a chat in the chat box of their own story of some abuse and neglect that they’ve overcome. So, I did some work. Back two summers ago, I spoke at the Senator Tommy Burke’s Victims Academy, which is a statewide victim advocate academy that’s held every summer. They asked me to speak about why we need to have trauma informed multidisciplinary teams as best practice. The reasoning that I gave was if you knew that 70% of your services were going to go to people who were hearing impaired, how would you prepare? You would have videos with closed captioning. You would have people who knew sign language. What if 70% of those you serve, were going to face mobility challenges? Federal guidelines say we need to have handicap ramps and handicap accessibility and restrooms. What if 70% of the people you serve are trauma survivors – then how welcoming are you? How can we ensure our services are not re-traumatizing consumers? That, to me, is when you accept a universal precautions approach.

There are several trauma-informed descriptors – aware, sensitive, responsive. Can you talk about what those are at the individual and societal levels?

Often, I’m asked to conduct training on the Missouri Model. In the national work I do it’s pretty much recognized as a best practice. It has a paradigm that starts with trauma-aware, then it goes to trauma-sensitive and trauma-responsive, then to trauma-informed. Sitting through a two- or three-hour training does not make someone trauma-informed. This is a journey. If you compare this to tobacco use, we have seen it go over several decades from a popular fad in culture to now being banned from most public properties. How to transform the culture of an organization is addressed by the Missouri Model; in a three-hour workshop, I can help leadership create an action plan for how to change the culture of an organization to become trauma-informed.

I feel like this field found you, shifting culture toward empathy and understanding that is deep and sustainable; you have a gift for helping people understand trauma and how to be sensitive. Like many, I felt very inspired after I was trained by you. When you train, you tell a lot of stories and your approach with these stories is very engaging. You collect stories. Can you share why and how your service and story collecting started?

My parents—I’m one of five children—they were very community based. They would have the college kids who sold the encyclopedias in summertime start living in our house and having dinner. As a matter of fact, one year they told us that their supervisor said, “Don’t go down to that neighborhood, because you’ll want to quit. This little family is going to take you in.” I’ve spent nights in a chicken coop with Vista workers up in Princeville, Tennessee. That’s my childhood. That’s how I grew up. I think some of that made this resonate with me, and I’m always very fascinated by people’s stories.

When I heard about ACEs, it was the first time I felt I could help people with faith, encouragement, prayer, and compassion.

Collecting stories goes back to my days in ministry. I’ve often pondered how did I get picked to do this? Certainly, faith is integral in my life. When I worked in ministry, I would be sitting up in ICU holding the hand of a 70-year-old gentleman whose wife had congestive heart failure and they’ve called the family. The family lives around the world, and I’m sitting there with them that night, while he’s hearing these conversations with medical people about the hours that his wife has left to live. I see those tears falling down his cheeks, and it’s a sacred place to be there with someone.

I’ve wondered, do I like have this sign over my head – if you’re in the worst day of your life, call Becky. I’ve never forgotten a story of human suffering and human resilience. Before I knew about ACEs, it stuck to me like lint on a pair of black slacks. I felt people were such heroes. One of my dearest friends, who’s in his nineties now, when he was a little boy his father went to the doctor and never came home. His father died of tuberculosis. His mother went away sick, and he was so worried as a little boy; lo and behold, she also died of tuberculosis. He told me that he and his two sisters went to live with an aunt and an uncle. Every Sunday after church they’d get dressed up for church. They would sit in the parlor, and they noticed an unusual number of people would come by. One day it dawned on him that the aunt and uncle were trying them out to see if someone might adopt them. I’m hearing all these stories, and I don’t always know what to do with them. When I heard about ACEs, it was the first time I felt I could help people with faith, encouragement, prayer, and compassion.

With ACEs, how could we protect a child?

ACEs gave me a meaningful way, on a big scale, to raise awareness to the courage of people around us. How the smallest of kindnesses brought some comfort: sitting in intensive care or going to visit someone whose young person is suddenly in jail. ACEs has given me a way to really raise awareness of how much kindness means to people when they’re in suffering. I don’t know if I found ACEs, or ACEs found me.

We know that higher ACEs scores are associated with so many things, alcoholism, depression, health issues, employee absenteeism, job performance, and more. It’s significant on the individual level, of course, but what do you see that it does to a community?

I didn’t realize until working for police the trickledown effect of the drug epidemic. Now that we know about ACEs, it’s almost like which came first, the chicken or the egg. The drugs are not ACEs, and trauma is not an excuse for drugs and crime – but now it offers us an explanation. We know that when bad things happen to people, they have to cope. You and I have found healthy coping mechanisms where some people turn to risky behaviors at an early age: tobacco, underage drinking, drug use, cutting, and eating disorders. I saw the impact that addiction had on the community. When I was overseeing the prison program what we were doing about this was being replicating across the state.

Instead of kicking them out, we hold them more tightly, you know, and what was that going to look like over time.

As we learned about it, a restaurant owner would call me and say I appreciate the work you’re doing. I have a child that’s been in and out of rehab. The next time you all have a gathering, I want to cater that event and do it for free. I was amazed at how many people were touched in the community. Then I saw the numbers. I sat in city commission meetings, hearing local government leaders in a local county. The sheriff told me that in 2010, it cost about $650,000 to run the jail for a year. And then in 2018 or 2019, it jumped to $2.9 million! I saw government leaders talking about how to fund our hospitals, how to dedicate more floors to deal with the volume of babies being born addicted.

That was another reason I championed this message, because it provided this upstream approach, instead of trying to deal with everything through more jails. In 2014, a study done by the Pew Charitable Trust compared Tennessee to New Jersey. Tennessee is the fifth highest state for using incarceration to monitor drug crimes, while New Jersey is 45th. Yet our drug rates and drug crimes continue to grow at the same rate. The summary of that report was incarceration is not reducing drug crimes. I didn’t know anything about this. I sat in city commission meetings and heard mayors talk about this. I heard police chiefs talk about it, how costly, at $80 a day in Tennessee, to incarcerate someone for one night. You have to assume all the healthcare, you have to assume the dental, the clothing, the laundry. That’s the reason that the county jail, if you have one person incarcerated that has HIV or Hep C, the medical treatments for that are amazingly expensive.

I saw what the drug epidemic was doing to the community and how costly it was affecting us all with taxes to staff and build. But yet, I didn’t see anyone saying conclusively, that if we keep going this way, we’re going to eventually end it. With ACEs, how could we protect a child? When I did work in healthcare, we had 50 school districts in our healthcare footprint. What if we had 50 trauma-sensitive school districts, how many more kids would, over 10 years, 15 years, affect the health of a region? If a lot of that was mitigated in a school setting, teachers who were trained in college to deal with “willful” behavior all of a sudden were trained now to know it as survival behavior. Instead of kicking them out, we hold them more tightly, you know, and what was that going to look like over time.

It definitely impacts the community.

Continue to Part 3 of 3

Learning More about ACEs and Fostering Positive Childhood Experiences with Becky Haas: Part 1 of 3

“From overcrowded prisons, hospitals delivering staggering rates of babies whose mothers are addicted, to finding foster care shortfall solutions and public-school systems where I first heard phrases like, cradle to prison and school to prison pipeline. As a mother and grandmother, I wondered who are the children that are born with a predisposition heading them into prison?”

~ BeckyHaas.com

Becky Haas Interview with API for AP Month 2020:

Parenting with PEACE, Part 1 of 3

Trigger warning: this post contains brief mention of child abuse events in the fifth paragraph of Part 1.

API is pleased to interview Becky Haas as part of AP Month this year. Becky is an international presenter of trauma-informed care and the Adverse Childhood Experiences (ACEs) study, as well as a pioneer in successfully developing trauma-informed communities. Her seasoned presentation experience includes trips to Delaware presenting to state leadership at the invitation of their First Lady, as well as the training of multiple juvenile justice systems in both Virginia and Tennessee. She developed Trauma-Informed Policing training – now certified in two states for officer in-service credit – and has delivered it to the Oklahoma City Police Department, as well as precincts within Tennessee, North Carolina, Virginia, and West Virginia. She has worked in partnership with the Tennessee Association of Chiefs of Police (TACP) to make Trauma-Informed Policing Training available to officers statewide. Becky is a highly sought-out trainer for educators, often working directly with school superintendents. Together, they impact entire school districts on their journey to creating trauma-sensitive schools.

When I heard about trauma-informed care, I was shocked at the brave people walking around among us, that so many people are trauma survivors.

Becky has served as the Trauma-Informed Administrator for a regional healthcare system, providing training development and delivery to healthcare staff in multiple hospitals, and she was instrumental in raising awareness of Adverse Childhood Experiences (ACEs) as a social determinant to poor health and addiction within rural Appalachia. Becky serves as a consultant to the East Tennessee State University/Ballad Health Strong Brain Institute and helped to pioneer the Northeast Tennessee ACEs Connection. Becky is married to Jonathan, and their greatest joys in life are their two sons and their growing families.

Becky, ACEs – adverse childhood experiences – have brought people together from many different fields, and I would like to hear about your background and what brought you to this work.

I’m actually trained in ministry, and for 24 years I worked in the church that I still attend. I was involved with recruiting volunteers, education programs, pastoral care, and visitation. I also taught law enforcement in 33 counties of Tennessee about car seat safety for six years through a grant-funded program at East Tennessee State University.

My prayer had been that whatever kind of work I could do, that it would just be something that made a difference for people. In 2012, that landed me working for the Johnson City Police Department, where I directed an $800,000 crime reduction grant to reduce drug related and violent crime. I had no criminal justice background, but I had to bring together a community coalition to address four strategies around that grant. It ended up being 19 programs that 35 agencies did together, and we won two national awards. We won the most prestigious criminal justice award of the year in 2014, Outstanding Criminal Justice Program of the Year for the Southern region. Maybe it helped coming into this role that I had no criminal justice background, as I wasn’t focused on “the way things are always done;” instead I brought a fresh approach to looking at all the causal factors of crime and how community partners could address them. During this time, I learned the value of the collective impact of bringing all voices to the table. We had public housing, city government, libraries, and corrections – that really made an impression on me. Here, I learned about ACEs in my journey at the police department.

Between hearing the two of them 30 days apart, I felt like I’d heard the cure for cancer.

One of the pillars of the grant was to create an intervention to reduce recidivism. I’ve lived in the community since the seventies, but I had not spent much time with the prison population or the judges who worked with the first judicial district felony offenders. They wanted to create the perimeter that the program would be for high-risk, high-need felony offenders with addictions. So, working with this population for years, I hear about ACEs in the second year of that, and I hear their stories of being raped by a parent, being raped by a relative, being held in a closet, I just wondered: why was ACEs not a part of the toolkit? Why was this education not widely known? When I heard about trauma-informed care, I was shocked at the brave people walking around among us, that so many people are trauma survivors.

And now ACEs and trauma-informed care are a part of many programs, largely because of your work. ACEs is being addressed in schools, hospitals, foster care, businesses, and of course law enforcement. What other audiences have you been working with and advising?

Before I told anyone what I was learning at the police department, I’d gone to two national conferences, and at one, Dr. [Vincent] Felitti spoke (Principal researcher of the ACEs study). Then I went to another, a probation conference in Florida where I heard Dr. Joan Gillece, who at the time was the Director of the National Center for Trauma Informed Care Substance Abuse and Mental Health Services Administration. Between hearing the two of them 30 days apart, I felt like I’d heard the cure for cancer.

“What if I came back and didn’t tell my town?,” it struck me, as I almost felt now that I’d be held responsible if I didn’t. My first step was creating a huge binder, putting 35 tabs in it representing all the agencies who were helping me do crime prevention – the library, healthcare, housing authority, faith community, judges, etc. I then researched mostly using the global online learning collaborative, ACEs Connection, to see if there were meaningful applications for using a trauma lens in all those settings. I honestly didn’t know what I was going to find. I thought maybe it would apply to a few – but at the end, I could not close the notebook! When I found a program that was making a difference and having good outcomes, I printed it off, put it in the notebook. After a few months of research, every single tab — juvenile justice, schools — every single tab had an application for using a trauma-informed lens. So that convinced me that there was a need to bring this approach into every kind of service. Then I went over to East Tennessee State University (ETSU), and presented my findings to some department chairs to see who might help me educate the community. In 2014, the Substance Abuse and Mental Health Service Administration (SAMHSA) at the U.S. Department of Health and Human Services had published a concept paper that recommended reducing the effects of childhood trauma in a public health approach by way of community education of the cross sectors of professionals.

From that meeting at ETSU, Dr. Andi Clements emerged to help me. We never asked anyone if we could train them, but one by one, the group of partners I already had around the table every month for my policing program began to want training. In less than three years, we trained over 4,000 professionals while it wasn’t even in our job description nor did we have any funding to do it. I would get in the office at 6:00 in the morning to keep my 19 police programs running so that no one would ever feel that I took away from my job to do that.

In 2017, we wrote the National Center for Trauma Informed Care to ask if we could host a webinar in 2018 of all the cities that have been doing this kind of work. We wanted to learn from them. In response they said, “We don’t know of a city that has trained such a diverse group of professionals about trauma informed care in one community.” That was the first time we knew something special had happened in Johnson City. So, in 2018 we were asked to host a forum and tell our story. Attending the forum were two governors’ wives, people from 20 states, and leaders from SAMHSA. After hearing our story, they told us we had created a model that other cities should follow for how to create a trauma-informed community.

There’s a responsibility by the people who hear about it to do something with it.

In 2019 Dr. Clements and I wrote a toolkit, funded by the Tennessee Building Strong Brains Grant, on Building a Trauma Informed System of Care for the Tennessee Department of Children’s Services. In the summer, we received notification that an article on the toolkit we had submitted to Johns Hopkins was accepted to be published in their journal, Community Progress in Community Health, Research, Education, and Action in December. The toolkit has also been recommended in Growing Resilient Communities 2.1, through the global online collaborative ACEs Connection. It provides step-by-step information on how to advocate, educate, and collaborate to create a trauma-informed community.

The message you’re bringing communities, that you recognize as effective, is to advocate, collaborate, and educate. Can you describe how you want communities to advocate, educate and collaborate?

You take these three actions to raise awareness about the ACEs Study and how to build resilient communities. The SAMHSA course, which we’ve used to train thousands, describes a trauma-informed organization or community as those who:

Realize the widespread impact of trauma and understand the potential paths of recovery.
Recognize the signs and symptoms of trauma in clients, families, staff, and others involved in the system.
Respond by fully integrating knowledge about trauma into policies, procedures, and practices.
and seeks actively to Resist Re-traumatization. ~SAMHSA

There’s a responsibility by the people who hear about it to do something with it. In the SAMHSA training, there are six pillars: Safety, Trustworthiness & Transparency, Peer support, Collaboration & Mutuality, Empowerment & Choice, and Cultural, Historical & Gender issues. Dr. Clements and I framed it up as an inventory instead of just facts: Is your program safe? Do people feel safe there? Do they feel you’re trustworthy?

Now the work I’m doing is to bring this message to groups on a national level. Most recently, I’ve trained all the childcare leadership in the state of Mississippi and in Tennessee. I’m working with the Tennessee Association of Chiefs of Police to create a professionally recorded video training of my Trauma-Informed Policing training that will be made available to all members of law enforcement statewide.

I turned the pyramid upside down to explain the concept of resilience and hope. At the upper level, we infuse the community with empathy and understanding.

My hope is that by telling people what trauma is, and about its universal prevalence, we can create an environment that helps trauma survivors heal.

In understanding ACEs, the top of the coin is trauma and childhood household dysfunction, but on the bottom of the coin is resiliency. We’ve learned that resiliency can happen in the community. Resiliency can happen through a Boys and Girls Club, for example.

As communities learn about ACEs, I feel by using a trauma-informed lens to provide services, we could mitigate the effects of trauma, maybe by 50%. In the ACEs pyramid that came out of the original ACEs study, the base is childhood adversity, all the way to the top which is early death. In the training I deliver, I turn the pyramid upside down to explain the concept of resilience and hope. At the upper level, we infuse the community with empathy and understanding. The shop clerk who is very rude? Don’t take it personally. They may just have been served divorce papers, or failed a class at the university that they were barely affording anyway.

Then the middle layer is much more social work, much more navigating because many tasks we need to do in life are hard. But if your life is overwhelmed with trauma, you’re likely not going to do those things, because it’s too hard. It’s too complicated. The middle part of the model is more what I call “warm hand holding.” The bottom part is clinical interventions which are important, but not always essential.

I’ve heard story after story of people who healed, were helped, and were set on a good path by interacting with the upper and middle levels of the funnel. One recent story that I heard on the CBS news earlier this year, before COVID, is a favorite for illustrating the upper level. It’s about a bus driver in Utah, who loved driving the school bus. In this particular school year, she had a little girl getting on her bus, 11 years old, who she just struck up a friendship with. One thing she noticed about the little girl was how she always had her hair braided. A few months into the school year, one day, the little girl not on the bus. This expanded into a whole week missing. The next week on Monday, the bus driver was relieved to see the little girl back on the bus, but she noticed her hair was messed up and not braided. The driver reasoned to herself the little girl must have overslept. However, the next day the little girl got on the bus but again for several days her hair was not braided. Finally, the fourth day, the bus driver said to the little girl, “I sure miss those braids.” And the little girl said to her, “Last week, my mommy died and my daddy doesn’t know how to braid hair.” This touched the bus driver so much that after she dropped the children off at school, she went to Walmart to buy a clean hairbrush and a bag of bows. Every day after that, she began to brush and braid the little girl’s hair before she got off the bus and went into school. The teachers noticed that this single act brought that child in with a smile again, adding a little bit of a spark to her step.

It was so remarkable. They said something to the principal, who said something to the superintendent, and that story was on their local news. It made the national CBS news. That’s the top of the funnel of hope. In similar fashion, after training we now have librarians who realize youth coming in have not had anything to eat so they keep a snack drawer along with hygiene products. A local high school started a program called, “Suds for Buds” after students were trained about ACEs. They realized some of their classmates did not have access to these products at home so now they can clean up at school.

Can you see how this message is helping communities work the top and the middle part of the funnel to reduce the effects of adverse childhood experiences? There is a wonderful pilot program locally that is working to improve workforce sustainability by providing a navigator to the human resource departments of a couple of very large companies. As part of the employee benefits, they can access the navigator to find resources for things like paying their rent or purchasing a new set of tires without any blaming or shaming. This enables employees to stay on the job instead of struggling and quitting – actions which only contribute to a domino effect of complications.

Continue to Part 2 of 3

Editor’s pick: How your childhood shaped your adult personality

Parenting is largely undervalued in our society. So much discussion among politicians and policymakers centers on public education, gender equality, and poverty alleviation. These are all important areas, but parent support is glaringly missing from the list…

When I refer to parent support, I mean research-backed parenting education for all parents, regardless of income class or at-risk group.

Relatively few parents seek out parenting classes when they’re not court-ordered. Many parents do pick up a parenting book from time to time, or seek out support from Facebook groups, or search for specific parenting questions on the Internet. But there is much to be considered whenever any parent solicits advice in how to raise their child. Most parents don’t feel they have the time do the homework necessary to make sure their references are up-to-date, accurate, and aligned with their family values and personal parenting goals.

Media Analysis Guidelines for Parents

It’s important that we all learn how to read between the lines on any media report about parenting, so we can make informed decisions on how to raise our children. Attachment Parenting International (API) created these guidelines to help parents to be able to better discern appropriate resources amid the clutter of information that bombards us everyday:

What’s fact or fiction in parenting news?

Get the most out of a scientific study

Trusted resources

API supports parents in raising their children in a way that meets all of their needs for healthy development, not only physically but also socioemotionally. Growing up without a close, warm, trusting, and sensitively responsive attachment to the parent can have serious, lifelong consequences for a child. These children grow into adults who then struggle with raising their own children in a way that is warm and loving. In many ways, we could view this as a mental health crisis.

Not only that, but research also demonstrates that certain childhood events can alter our biological stress responses, translating into physical health problems not only in the affected individual but in his or her DNA with the possibility of being passed down the family tree through epigenetics. From this perspective, the lack of consistent parenting education available and promoted to all parents is a public health crisis on many levels.

Attachment Matters

API explores the effects of insecure childhood attachment on adults in-depth in our latest ebook, Attachment Matters. Receive your copy of this ebook with a donation of $25 or more to API.

To get a better feel for the specific effects of parenting that is not in line with research, this API Editor’s Pick highlights the Psych Central post, “Unloved in Childhood: 10 Common Effects on Your Adult Self” by Peg Streep, a parenting book author from New York City, USA. It’s important to note that while this post refers specifically to mothers and daughters, the effects of a son feeling unloved is much the same. These 10 effects include:

Insecure attachment
Undeveloped emotional intelligence
Impaired sense of self
Lack of trust
Difficulties with boundaries
Tendency toward toxic friends and partners
Fear of failure
Feelings of isolation
Extreme sensitivity
Inner conflict.

What I particularly like about this post is how it draws attention to the fact that the problem is not so much how well the parent perceives he or she loves the child, but rather, what’s important to that child’s development is the sense of love from the child’s perspective. It’s all about how the child perceives he or she is loved her by the parent. That’s an important distinction.

The author has so much to impart on this subject, so be sure to read the entire post, but here’s a quote I found especially enlightening:

“Because the culture stubbornly believes that all mothers are loving and that mothering is instinctual, the unloved daughter mistakenly believes she’s the only child on the planet to find herself in this predicament. As a result, she feels isolated and afraid, and is likely to continue to self-isolate because of her deep shame. She’s not likely to tell anyone. More than anything, she wants to belong to the tribe — those girls who hug their moms and laugh with them.” ~ Peg Streep, Psych Central

Parents, I urge you to be the parent whose children — no matter their age — finds it easy to laugh with you and who feels completely comfortable in seeking out a hug with you anytime. Don’t be afraid to be warm toward your child, don’t be afraid to offer comfort to your child night and day, don’t be afraid to use positive discipline rather than spanking or timeout, and don’t be afraid to be different from your friends and family. Seek out your free parenting support from a local API Support Group or the API Warmline.

Raising kids with grit…and an interview with Jane Stevens of ACEs Too High

Attachment Parenting International (API) is directly involved in building resilience in communities across the nation and around the world through its local API Support Groups and accredited API Leaders by supporting secure parent-child attachments.

It cannot be emphasized enough how important secure attachments are. To be sure, resilience is something we all want for our children — actually, resilience is something all children need.

This scientific-sounding term, “resilience,” may seem really abstract and difficult to define. Perhaps you’ve heard of resilience by its other names. Synonyms include: grit, hardiness, toughness, adaptability, rebound, perseverance, tenacity.

In the most basic definition, resilience is the capacity to recover quickly from difficulties. I like to think of it as emotional toughness.

It’s the ability to rebound from frustrations and disappointments, to not get lost in life’s inevitable valleys between the high points, to persevere — all the while staying true to oneself, remaining passionate about life and never giving up hope.

Secure parent-child attachments and resilience-building go hand-in-hand. Positive discipline, coupled with warmth and nurturing, makes for an ideal child-raising atmosphere.

There is no need to expose our children to harsh situations with the misguided intention to raise them with grit. True grit — resilience — is not a mean-spirited or emotionally avoidant individual who has grown up building walls around his or her vulnerability. True grit is the ability to feel all emotions and to know how to manage healthy responses to those emotions, no matter the situation, without feeling a need to avoid or destructively act-out his or her strong emotions.

API helps parents learn how to develop this true grit within their children. API is a resilience-building resource, funded entirely by donations, yet offered free to all parents no matter their income class, life circumstance or location. Evidence-based parenting — like the approach advocated through API — is one of several areas of community-based resilience-building practices.

Jane Stevens, founder of ACEs Too High and the ACEs Connection Network, elaborates on resilience and its opposite — trauma — in this API interview.

API: ACEs are integral to understanding resilience. ACEs basically outline the childhood environments that are more likely to predispose people to grow up without developing a high level of resilience. Jane, what are ACEs?

JANE: ACEs are Adverse Childhood Experiences.

ACEs usually refers to the 10 types of childhood adversity that were measured in the U.S. Centers for Disease Control and Prevention’s Adverse Childhood Experiences (ACE) Study: physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, a family member who’s an alcoholic or addicted to other drugs, a family member diagnosed with a mental illness, witnessing a mother being abused, a family member in prison, and loss of a parent through separation or divorce.

That doesn’t mean that there are no other types of childhood trauma. There are, of course: living in a war zone, witnessing a sibling being abused, witnessing violence outside the home, and others. It’s just that in the ACE Study, only 10 were measured.

API: Thank you, Jane, for providing this quiz for readers to learn their own ACE score (as well as their own Resilience score).

JANE: Many people who learn about the ACE Study and who calculate their own ACE score say they’re relieved, especially if they have a high ACE score. They say that their life finally makes sense.

They also understand that they’re not bad. They coped as best they could under dire circumstances. And knowing that they’re not bad people opens the opportunity for them to change their lives. It’s quite empowering information.

API: Looking at your website, we can see that higher ACE scores are associated with adult alcoholism, chronic depression, perpetrating domestic violence, smoking, being raped, suicide attempts, teen sex and pregnancy, employee absenteeism and job performance. From your website:

“At the same time that the ACE Study was being done, parallel research on kids’ brains found that toxic stress physically damages a child’s developing brain. …

When children are overloaded with stress hormones, they’re in flight, fright or freeze mode. They can’t learn in school. They often have difficulty trusting adults or developing healthy relationships with peers (i.e., they become loners). To relieve their anxiety, depression, guilt, shame and/or inability to focus, they turn to easily available biochemical solutions like Marijuana, if your son us medicated check out this online dispensary canada for a great variety of strains for medical use.

Using drugs or overeating or engaging in risky behavior leads to consequences as a direct result of this behavior. For example, smoking can lead to COPD (chronic obstructive pulmonary disease) or lung cancer. Overeating can lead to obesity and diabetes. In addition, there is increasing research that shows that severe and chronic stress leads to bodily systems producing an inflammatory response that leads to disease.”

This is significant on an individual level, so what does this do to a community?

JANE: Communities whose residents have high ACE scores and few resilience factors are difficult places to live.

Essentially, the community is in a state of constant and chronic traumatic stress. This means that it’s difficult for people to thrive, or to raise children who will thrive.

API: What are your hopes in helping people learn more about ACEs, their own ACE and Resilience scores, and creating a network of resilience-building groups?

JANE: Once people learn about the consequences of ACEs, the effects of toxic stress and that trauma-informed practices and building resilience can create healthy individuals, families, communities and systems, they can never look at a homeless person without seeing an abused child.

They can never look at a young man in juvenile detention without wondering why the schools he attended did not intervene in his journey from the classroom to prison.

They can never look at communities without wondering if they are implementing trauma-informed and resilience-building practices. And if they are not, they begin asking: “How can we start?”

API: It’s wonderful that people like Jane Stevens are working to raise awareness of ACEs and the effect of traumatic childhood stress. In addition, through her ACEs Connection Network, she is working to guide connections between trauma-informed and resilience-building groups to help individuals with high ACE scores find pathways to healing. This is much needed.

API works at the issue of trauma and resilience from another angle — prevention. It’s clear that the key to positively impacting a community is to first address the family, to get to the heart of the matter — the parent-child attachment relationship — in order to both prevent high ACE scores and to help our children develop resilience.

On Jane’s website, she writes about how resilience fits in with ACEs:

“Fortunately, brains and lives are somewhat plastic. The appropriate integration of resilience factors born out of ACE concepts — such as asking for help, developing trusting relationships, forming a positive attitude, listening to feelings — can help people improve their lives.”

This is exactly how children are raised in evidence-based parenting approaches, such as is advocated by API.

Read the entire API interview with Jane Stevens in The Attached Family‘s online “Nurturing Peace” issue.