Adverse Childhood Experiences (ACEs) has impacted social services in recent years. Groundbreaking research has opened our eyes to underlying factors that impact the lives of youth and adults alike. It is a health epidemic that requires a call to action. But, what do we do with the research? What are the practical application measures? How do we provide equitable services? What are the best methods for reaching, helping, and working with children experiencing trauma?

In presentations, I discuss the practical applications I have used over the last ten years in urban education from elementary to high school. Now, the research has caught up with the successes I have found in my office and work with adolescents. For example, to move from the emotional part of the brain (amygdala) to the thinking part of the brain (prefrontal cortex), it takes 90 seconds to reset. When you look around the room and find facts (i.e., the wall is gray, the vase is white, the chair is blue, etc.), the brain will slowly move from processing emotion to thinking. Your body will relax thus leaving you in control of your emotions versus emotions controlling you. Strategies like this work for children and adults. It is just one of the various practical applications that will be taught, practiced, and adapted for immediate personal and professional use. To provide equitable services, we must meet children where they are with an understanding of the underlying adversities they have experienced.

Counselors regularly experience and assist clients in crisis. These clients impact the counselor due to the level of trauma that can remain after the crisis is handled (Dupre et al., 2014). It can be a positive or negative outcome for the counselor. The positive outcome can be vicarious resilience or posttraumatic growth (Dupre et al., 2014). The negative outcomes can include the “counselor’s personal and professional development, increasing the risk for difficult countertransference reactions, empathic strain, burnout, and compassion fatigue” (Dupre et al., 2014, p. 83-84).

As social services workers, we must practice what we preach through self-care and putting our oxygen mask on first before helping others. While these practical applications can be utilized for others, we should practice and use them in our own lives to ensure personal wellness.

To learn more about ACEs and practical strategies, join me at the Indiana Youth Institute’s College and Career Conference on June 5 and 6 in Indianapolis. Register here: http://bit.ly/IYICollegeAndCareer

About Sherri Barrow

Sherri is the Future Center Coordinator at Shortridge High School in Indianapolis. You can connect with her on Twitter @MrsBarrowIPS or on LinkedIn.

References

Dupre, M., Echterling, L. G., Meixner, C., Anderson, R., & Kielty, M. (2014). Supervision Experiences of Professional Counselors Providing Crisis Counseling. Counselor Education & Supervision, 53(2), 82–96. https://doi-org.library.capella.edu/10.1002/j.1556-6978.2014.00050.x

Additional Resources

Welcome. How May I Serve You?

By Tami Silverman, President & CEO, Indiana Youth Institute

An increasing number of our children and youth have mental health disorders, encountering challenges with school, within their peer groups, and at home. Unfortunately, most of them are not getting the care they need. Signs of mental health disorder may be difficult to recognize, and unfortunately mental health disorders continue to be stigmatized. These, combined with a lack of access to services for many, create substantive barriers to care. More must be done to combat widely-held myths, connect children with treatment, supports, and services, and work to build strong support networks for all our young people.

A February 2019 study in JAMA Pediatrics estimated that 7.7 million American children, one in every 6 children, have at least one mental health disorder. According to the Centers for Disease Control (CDC), ADHD, behavior problems, anxiety and depression are the most commonly diagnosed mental disorders in children, and some of these conditions, such as anxiety and depression, commonly occur together. The JAMA Pediatrics study also showed that roughly half of children do not receive any kind of treatment from a mental health professional.

Last year, 11.6% of Hoosier children received treatment or counseling from a mental health professional, a significant number, and yet still only a portion of Indiana children in need. The National Survey of Children’s Health indicates that 5.2% of Indiana children have ever been diagnosed with depression, and 11.0% have been diagnosed with anxiety. We know that accessibility remains an issue in Indiana. Among our neighboring states, Indiana has the lowest ratio of mental health providers available to serve the population, approximately 1 per every 700 people, and nearly 60% of the state’s population lives in designated mental health professional shortage areas.

Identifying mental health issues may be less obvious than physical ailments, such as broken bones, asthma, or diabetes. Occasional bouts with emotional distress, anxiety, stress, and depression are normal experiences for all children and youth. It can be difficult to distinguish between behaviors and emotions that are related to typical child development, and those that require extra attention and concern.

The national nonprofit Child Mind Institute describes seven myths about childhood mental illness that need to be debunked. These include recognizing that childhood mental illness is not caused by personal weakness or poor parenting. Children and youth cannot overcome mental health problems through willpower, nor will they grow out of their disorder. Instead, understanding that most psychiatric disorders begin before age fourteen provides additional incentive to screen and intervene during childhood. Children who receive early interventions and treatment have a good chance of managing or overcoming their symptoms.

How do you know when a child’s behavior is cause for concern? You should always seek immediate help for a child or teen who harms themselves or others or talks about wanting to do so. While short term stress, anxiety or depression can be developmentally appropriate, the National Institute of Health (NIH) advises that you should also seek help if a child’s behavior or emotional difficulties last more than a few weeks and are causing problems at school, at home or with their friends. Young children may exhibit symptoms such as intense worry or fear, frequent tantrums, complaints about frequent stomach or headaches with no known medical cause, and a lack of interest in playing with other children. Symptoms in teenagers include a loss of interest in previously enjoyable activities, spending increasing amounts of time alone or avoiding social activities, sleeping too little or too much, and engaging in risky, destructive or self-harming behaviors. The NIH recommends talking with your child’s teacher and consulting your pediatrician, asking either for a recommendation to a mental health professional who has specific experience in dealing with children, when and if possible.

Caring adults and a strong support network, including family members, teachers, coaches and mentors, can serve as protective factors for mental health. Indiana’s Family and Social Services Administration Division of Mental Health and Addiction manages our state’s Systems of Care, a model framework used to coordinate services and supports. Schools throughout the state continue to expand their services and expertise, understanding the importance of prevention, intervention, positive development, and communication to families.

While many agree that progress has been made regarding how mental health is viewed, stigma and negative connotations still keep far too many children from getting critical care and support. It is important to understand and work to reduce the barriers of stigma and access to mental health care. It is equally, if not more important, to understand that, for most youth, childhood mental disorders are episodic rather than permanent. Just as with physical illnesses, keys include ensuring children in need can receive appropriate screening and treatment. We would not ignore a child’s physical ailment, and it is time that we consistently take the same approach to their mental health.

(Tami Silverman is the President & CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI. IYI’s mission is to improve the lives of all Indiana children by strengthening and connecting the people, organizations, and communities that are focused on kids and youth.)

Hoosier youth are the hidden victims of the opioid epidemic. The statewide crisis has a negative impact on child well-being, families and communities. Hoosiers are more likely to die from a drug overdose than car crashes and gun homicides combined. In 2017, Indiana’s rate of fatal overdoses was 25.7 per 100,000. This is significantly above the national average of 22.4, ranking Indiana’s overdose death rate as the 15th highest in the nation.

  • In 2017, 1,138 Hoosiers died from an opioid overdose, a rate of 17.1 deaths per 100,000 Indiana residents.
  • In 2016, opioid overdose deaths were most common among white (89.8%), followed by black (8.9%) and all other Hoosiers (1.3%).
  • 83 out of the 92 Indiana counties had at least one non-fatal emergency department visit involving any opioid in 2017.

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Indiana ranks 48th for child abuse and neglect which puts children’s safety at risk and impacts future well-being across a lifetime.

Reporting

The Indiana Child Abuse and Neglect Hotline serves as the central reporting center for child maltreatment allegations.

  • The total number of calls made to the Indiana Child Abuse an dNeglect Hotline in 2018 was 203,602, an increase of 30.6% since 2012.
  • In 2018, the Indiana Child Abuse and Neglect Hotline handled 242,994 reports; this has increased by 36.9% since 2012.
  • Every adult in the state of Indiana is a mandatory reporter of child abuse and neglect. Any adult who has reason to believe that a child has been abused or neglected is required to call the Department of Child Services: 1-800-800-5556.

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By Tami Silverman, President & CEO, Indiana Youth Institute 

“When I was a child…” We all have likely said this, wrapping ourselves in nostalgia about what we perceived as a carefree, easier time. In many ways, to have been a child decades ago was less complicated. While today’s students have access to technology, information, and opportunities like never before, they also have unprecedented levels of stress, anxiety and depression. High-stakes testing, hyper-competitive sports and activities, and ever-present social media all add to the developmental stressors of growing up and finding where you fit in. We also better understand the compounding nature of childhood traumas, such as living in an environment exposed to substance use disorder, child abuse or maltreatment, neighborhood violence and poverty.  

Increasingly, educators are asked to identify and address behavioral health needs of large numbers of students. The Indiana Department of Education’s (IDOE) new Indiana Social-Emotional Competencies (Competencies) address the social and emotional needs of students in grades Pre-K through 12. IDOE’s Competencies start with five core standards: self-awareness, social awareness, self-management, relationship skills, and responsible decision-making, and add to that sensory integration and the mindset. This program is designed to advance student social and emotional development and has been proven effective in promoting academic achievement, reducing conduct problems, improving prosocial behavior, and reducing emotional distress. This is a positive development, as data related to the social and emotional well-being of many of Indiana’s students indicates concerning unmet needs. 

Distressingly, in Indiana, suicide is the 2nd leading cause of death for youth ages 15-24 and the 4th leading cause of death for youth ages 5-14. Research shows 1 in 5 Indiana high school students – which translates to approximately 200,000 of our children – seriously considered attempting suicide in the past year, and data from the past several years shows that percentage continues to rise. Indiana ranks 2nd out of 34 states measured in the percentage of students who made a suicide plan, and 3rd out of 37 states measured in the percentage of students who seriously considered attempting suicide. Experts and teens list several reasons for these trends, including insufficient access to mental health screening, poor access to mental health services, and resistance to seeking care.  

School suspensions and expulsions are commonly used to discipline students for disruptive behavior. However, many disciplinary techniques negatively impact student achievement, increase students’ risk of dropping out and increases the likelihood of involvement with the criminal justice system. Furthermore, in Indiana, black students are disproportionately subject to this type of intervention. Black students are 2.3 times more likely to receive in-school suspension, 4 times more likely to receive out-of-school suspension, and 2.2 times more likely to be expelled than their white peers. Students engaged in social and emotional learning programs routinely report increases in their optimism, improved social behavior, better self-control and decreased aggression. There also is evidence that equity focused interventions, such as social and emotional learning programs, along with alternatives to suspension, help reduce the discipline gap, mitigate the above negative impacts, keep students in school and improve overall school climate.  

It is encouraging to see that school climate, and school safety, has been a focus of the current legislative session, including strong support for funding programs that increase access to mental health services. Students who feel unsafe at school are more likely to miss days of class, and students who witness school violence are more likely to experience physical and mental health problems. In 2018, 25.9% of Hoosier high school students did not feel safe at school. Black high school students (33.4%) feel less safe at school, than their Hispanic (29.2%) and white peers (24.5%). Students who identify as lesbian, gay, or bisexual are 2.6 times more likely to miss school because they felt unsafe at school or on their way to or from school in the past month, than their heterosexual peers.  

IDOE’s investment in addressing the social and emotional, as well as academic, needs of our students will likely pay dividends for years to come. Studies show that on average, every dollar invested in such programs yields $11 in savings from juvenile justice crime, higher lifetime earnings and increased mental and physical health. It is also clear that social and emotional learning programs are even more effective when schools partner with afterschool and community programs and families. Indiana Youth Institute is honored to partner with IDOE to support the rollout of their Social and Emotional Competencies. The intersection of social and emotional well-being, school safety, and student success is clear, and we all benefit when all Indiana students are prepared to succeed.  

(Tami Silverman is the President & CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI. IYI’s mission is to improve the lives of all Indiana children by strengthening and connecting the people, organizations, and communities that are focused on kids and youth.) 

For many of us, it is easy to see how our childhood experiences influence our adult choices, behaviors, and preferences. Perhaps you like basketball because all the kids on your street played together after school. Or you learned to cook by helping a beloved grandparent make special family meals. Years spent in a scouting program can create a lasting love of exploration. Examples of positive experiences are endless and unique to each of us.

In the same way, stressful or traumatic childhood events also have lasting impact. The importance of Adverse Childhood Experiences, or “ACEs”, was first discovered 20 years ago as a result of a large-scale research study led by Kaiser Permanente and the Centers for Disease Control and Prevention. The resulting ACEs screening tool established a way to gauge the cumulative effect of different types of childhood abuse, neglect or stressful events.

While adverse childhood experiences are very common, as the number of ACEs experienced by a child increase, so does that child’s risk for chronic disease as an adult. Unfortunately, as documented in the Indiana Youth Institute’s September data brief, Hoosier youth have a higher prevalence than their peers nationally in eight of out nine ACEs as measured by the National Survey of Children’s Health.

The good news is that the earlier we can identify a child’s ACEs score, the sooner we can connect them to services to prevent, reverse, or heal the effects. Both physicians and educators are building systems to screen and respond to ACEs.

In many cases, positive childhood experiences can mitigate the stressful or traumatic events. All children need adults that support, trust and love them. Caring adults, whether parents, grandparents, teachers, coaches or mentors, are key to helping children build long-term resilience.

Find more information about ACEs from the following resources:
Indiana Youth Institute ACEs Data Brief
Substance Abuse and Mental Health Services Administration
American Academy of Pediatrics

sad boy

The cumulative effect of Adverse Childhood Experiences (ACEs) has a lifelong impact on children. As the number of ACEs increases, there is a greater likelihood of negative wellbeing outcomes such as obesity, depression, and other chronic conditions throughout life.

What are ACEs? Adverse childhood experiences are stressful or traumatic events occurring in childhood and are used to assess the long-term impact of abuse and household dysfunction on later-life health.

  • Nearly half (47.3%) of Hoosier children have experienced one or more ACEs.
  • Indiana has a higher prevalence of children experiencing at least one ACE (47.3%) than half of our neighboring states: Illinois (39.7%), Michigan (46.2%), Ohio (49.5%), and Kentucky (53.1%).
  • Hoosier youth have a higher prevalence than their peers nationally in eight of out nine ACEs as measured by the National Survey of Children’s Health.

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Our kids are going back to school and many of us are thinking about backpacks, school supplies and physicals. With bus schedules, class schedules and afterschool activities, our kids can easily get stressed about the beginning of a new school year. For some children, especially teens, this stress and anxiety exists at a dangerous level.

In Indiana suicide is the 2nd leading cause of death for youth ages 15-24 and the 4th leading cause of death for youth ages 5-14. Experts and teens list several reasons for the increase, including insufficient mental health screening, poor access to mental health services and resistance to seeking care. Suicide ideation and attempt rates are also found to be higher during the school year than in the summer.

Sadly, Hoosier youth are significantly more likely to consider or attempt suicide than their peers nationally, and Indiana faces significant disparities in youth suicide among vulnerable groups.

  • 1 in 5 Indiana high school students seriously considered attempting suicide in the past year. The percentage of students who seriously considered suicide increased from 18.0% in 2005 to 19.8% in 2015.
  • Indiana ranks 2nd out of 34 states in the percentage of students who made a suicide plan and ranks 3rd out of 37 states in the percentage of students who seriously considered attempting suicide.
  • Among our neighboring states, Indiana has the highest percentage of students who seriously considered attempting suicide and the highest percentage of students who made a suicide plan.

For more data on Youth Suicide in Indiana, read IYI’s Data Brief.

Based on these pressing needs, the Indiana General Assembly has passed youth suicide prevention legislation in the past two sessions. Effective June 30, 2018, all teachers and educators for students in grades 5-12 are required to participate in at least two hours of youth suicide awareness and prevention training every three years.

For details about the required training, school responses and effective interventions, go to the Indiana Department of Education’s website.

Hoosier youth are significantly more likely to consider or attempt suicide than their peers nationally. Indiana faces significant disparities in youth suicide among vulnerable groups.

Youth Suicide Deaths:

  • In 2016, 57 Hoosier youth ages 19 and younger died by suicide. This represents an increase from 55 deaths in 2015 and 52 deaths in 2014.
  • Suicide is the 2nd leading cause of death for youth ages 15-24 and the 4th leading cause of death for youth ages 5-14.
  • 39% of Indiana’s youth suicide deaths are concentrated in 5 counties: Lake, Marion, Allen, Hendricks, and Porter.
  • 59 of Indiana’s 92 counties had zero youth suicide deaths in 2016.

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A sophomore struggling academically thrives after being guided to a drafting course available at his school. Fifth graders throughout a district learn the connection between school and work through an annual BizTown event. And 21st Century Scholars attend an afterschool seminar where they get hands-on training in the Scholar Success Program. These are just some examples of school counselors helping students thrive. Yet many Indiana students are at a critical disadvantage—there is not enough counseling time to reach every student who needs it.

The Center for Education Statistics ranked Indiana 42nd in the nation for having one counselor for every 541 students in 2013. The American School Counselor Association (ASCA) recommends a 250:1 student-to-counselor ratio. But Indiana Department of Education (IDOE) data shows that for every 619 students, Indiana has just one licensed counselor.

This is not only a problem on the state level. Ratios vary greatly from county to county. The IDOE data shows Washington County has the lowest student-to-licensed counselor ratio in the state, with one licensed counselor for every 351 public or charter school students. Crawford County has the highest county ratio at 1,606:1. However, several districts around the state, especially charter schools, have no licensed counselors on staff.

ASCA identifies three essential areas where counselors can support student success: academic performance, college and career preparation and social/emotional development. Many schools report success with their academic counseling efforts, which can cover traditional counseling activities such as course selection or study skills, but the highest need lies in the areas of college and career preparation and social/emotional issues.

For example, school counselors assist students with family issues such as divorce and deaths of loved ones, managing emotions, resolving conflict, and learning interpersonal skills. Counselors help students with bullying, drug abuse and mental health issues in an era when nearly one in five Indiana high schools students have considered suicide — tied for the third highest rate in a national survey.

Dr. Michele Moore, superintendent for the Metropolitan School District of Martinsville, says the number of students needing assistance with social/emotional issues continues to increase. Her district’s eight licensed counselors are “putting out brush fires that have to be immediately taken care of.” In recent years, counselors have seen more students dealing with parents who are incarcerated or addicted to heroin/opioids. It is easy to understand how student achievement and success can be sidetracked by these complicated issues. School counselors are uniquely trained and qualified to help students cope with these situations.

School counselors know that student academic and social/emotional well-being are interconnected and critical to long-term achievement. Counselors play a key role in career development, helping students at every education level understand the link between school and work opportunities, while also guiding students toward college and career transitions.

The Indiana Department of Workforce Development reports that Indiana will need to fill one million jobs by 2025. Mark Friedmeyer, president of the Indiana School Counselors Association, says counselors need to start the career readiness process at the elementary and middle school levels. “If they wait until they get to high school to learn about that then that may be too late,” he says.

A comprehensive counseling approach provides adequate time for counselors to address all three critical areas with all of the students they serve. Recognizing the increasingly complex challenges schools and students face, a groundbreaking new effort from Lilly Endowment Inc. will address the academic, college and career, and social-emotional needs of students. Through grants to public school districts and charter schools, the Endowment’s new five-year, $30 million initiative will help schools better meet students’ needs for comprehensive school counseling.

This grant is both an exceptional opportunity and a sizeable challenge. That’s why the Indiana Youth Institute was asked to assist school districts with the planning, implementation, evaluation and sustainability of their initiatives. Information on available services can be found at www.iyi.org/counselinginitiati… and by calling 855-244-7175. Once again, we are reminded that student well-being and achievement is a shared responsibility of schools, families and the community.

(Tami Silverman is the president and CEO of the Indiana Youth Institute. To provide feedback on the column, she may be reached at iyi@iyi.org or on Twitter at @Tami_IYI)