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.
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
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Children thrive when they are surrounded by stable, consistent and meaningful relationships with caring adults.
Research shows that a quality mentoring relationship can have a resoundingly positive impact on young people’s lives. Youth with quality mentoring experience better educational, vocational and psychosocial outcomes than their unmentored peers. For all its benefits, unfortunately, one in three young people will grow up without ever having a positive mentor.
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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
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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Childhood obesity presents a critical and widespread issue for Indiana children.
One in three Hoosier children ages 10-17 are overweight or obese (33.9%). While childhood obesity presents a concern nationally, this issue is especially relevant in Indiana. Hoosier children are 14.9% more likely to be obese than their peers nationwide. This ranks Indiana as the 9th highest rate of childhood overweight and obesity. In comparison to all neighboring states, Indiana has the highest rate.
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As parents, caring adults and community leaders, we must create the conditions for healthy kids to thrive. This means recognizing and addressing the dangers children face when they live in unhealthy environments, reducing health-harming behaviors like smoking and substance use by children and around children, and building communities that make it easier for kids and families to make healthy choices about food and physical activity.
Unfortunately, Indiana comes in 35th for overall children’s health in the U.S. Recognizing this, a new statewide collaboration, the Alliance for a Healthier Indiana, is bringing together business and community leaders to address the health of our citizens. The Indiana Youth Institute is joining this important effort to support building a healthier state from the child up.
Growing up in an environment with trauma and abuse creates lasting negative effects on children’s health, including slowing a child’s social and cognitive growth, raising their likelihood for obesity, tobacco and drug use, and inflicting long term consequences to their health and life opportunities. By understanding the co-occurrence and impact of these Adverse Childhood Experiences (ACEs)*, we are better able to create positive interventions and conditions for change.
If we can reduce child and adult smoking rates, we can have a significant effect on Hoosier health. Indiana ranks 41st in the nation for the percentage of smokers, and an estimated 95 percent of adult smokers start smoking before age 21. More than 4,100 Hoosiers under age 18 become new daily smokers each year. In 2017, nine percent of Indiana high school students smoked cigarettes in the past month, and 14.9 percent of Indiana high school students used electronic vapor products. This is especially concerning, as teens who use e-cigarettes are more likely to subsequently take up cigarette smoking.
Governor Holcomb has challenged Indiana to lower its infant mortality rate, as Hoosier kids infants are 24 percent more likely to die before their first birthday than the national average. Smoking is a significant contributor to problems arising during pregnancy and in the child’s development and health. Almost 1 out of every 7 pregnant women in Indiana smokes during pregnancy, a rate that is 68 percent higher than the national average. Smoking while pregnant is associated with a higher risk of miscarriage, low birthweight, premature birth, some birth defects and Sudden Infant Death Syndrome (SIDS).
Our state’s struggle with opioid use disorder is also taking a tremendous toll on our babies and children. Newborns exposed to opioids in utero have a 60-80 percent likelihood of suffering from Neonatal Abstinence Syndrome, a condition which impacts the child’s long-term growth, behaviors, language abilities, cognitive development, and academic achievement. Last year, Indiana had one of the nation’s greatest percentage increases in the number of children being placed in foster care. The Indiana Department of Child Services reported a sizable increase in the number of substantiated cases of abuse or neglect, with over half of the removals due to parental substance abuse.
Parental overdoses have both an immediate as well as a cumulative impact on children in the home. Children double their likelihood of developing addictive disorders when they come from homes where one or more adults abuse alcohol or drugs. While we do not yet know precisely how many Indiana children are living with adults struggling with opioid use disorder, we do know that these children are suffering and that immediate interventions are needed.
The prevalence of substance use disorder has captured recent headlines, but Indiana’s struggle with obesity is a longstanding problem that we have yet to effectively address. Indiana is the 10th worst state for adult obesity rates, and 1 in 3 Indiana youth ages 10-17 are overweight or obese. According to Julie Burns, CEO of Jump IN for Healthy Kids, in central Indiana the obesity/overweight rate is 25 percent higher than the national average, and three times higher than the goal of 15 percent. Burns stresses the importance of focusing on young children, as habits around food and physical activity are developed by age 5.
Healthy kids grow up with greater chances to be healthy adults, and are more likely to become productive and successful citizens. Far too many Hoosier children face the issues caused by ACEs, smoking, opioid use, obesity and are lost due to infant mortality. We support and applaud the efforts of the Alliance for a Healthier Indiana. Local events to improve Hoosier health are taking place across the state, and we encourage everyone to find a way to contribute by going to www.healthierindiana.org. By collectively dedicating ourselves to these efforts, and by taking a multi-generational approach, we hope to increase the health and success of all Indiana residents.
The scene from Marjory Stoneman Douglas High School in Parkland, Florida is one we have seen far too often: terrified students fleeing a school, parents frantically searching for their children, law enforcement swarming a campus. While our immediate concern is for those directly involved in these tragedies, instinctively we also wonder if our own children are safe. Safety is the top school-related concern of parents, above academic performance, student services, facilities or educator quality. Parents must have an accurate understanding of the safety plans in place in our schools. We also must work to ensure that students, and their families, feel that their schools are safe.
School administrators are keenly aware of the need to protect students, with the range of threats including not only active shooters but also weather and natural disasters, noncustodial parent abductions, and everyday issues like bullying and fighting. Although mass school shootings understandably garner intense media coverage, all threats to school safety are cause for concern. Research shows that any instance of crime or violence at school not only affects the students directly involved but can also negatively impact bystanders, the larger school environment and the community.
The good news is that Indiana is leading the nation in school security and safety planning. Indiana is one of only two states with a school safety specialist law, and is the only state in which the program is fully implemented. Every public school corporation in Indiana is required to have a certified school safety specialist, and 88% of districts have two or more specialists.
David Woodward has worked at the Indiana Department of Education (IDOE) for over 20 years and is architect of the state’s School Safety Academy. Started in 1999, the Academy’s five-day basic training covers national and state best practices on topics such as cyberbullying, digital threats, active shooters, safe and effective drills, student suicide and school entrance security. Each district specialist must also complete two additional days of training annually and are tasked with starting the multi-step process of updating and implementing their district’s safety plan. As Woodward notes, “The threats to our schools are always changing, so our response always needs to be updated.”
Although our state is proactive in addressing the safety needs of schools, challenges remain. Fear at school can contribute to an unhealthy school climate and lead to negative student behavior. 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 health problems, social and emotional difficulties, and poor academic performance. According to the National Survey of Children’s Health, 78.1 percent of Indiana parents say they “definitely agree” that their child is safe at school. This is compared to the Healthy People 2020 initiative’s goal that 95 percent of parents will consider their children to be safe at school. We all have a role to play in creating and sustaining a climate of safety through our schools.
At the leadership and policy level, more can be done to increase both the actual and perceived levels of safety. In late February, State Superintendent of Public Instruction Dr. Jennifer McCormick called on the General Assembly and our Congressional Delegation to pass additional school safety policies. Her two main requests were increased resources for mental and behavioral wellbeing, and ensuring that our private and charter schools all have the same requirements to keep our schools and students safe. Late in the legislative session, Governor Holcomb requested a $5 million increase in the state’s school safety grant fund, but the bill died in the final minutes of this year’s session. The May special session will be a time to finalize additional school safety actions and funding.
At the community level, effective communication is critical. Although schools understandably cannot publish their specific safety plans, they can and should talk with parents and community members about the steps they are taking to ensure students are safe. Experts suggest directly calling your school principal with safety concerns, noting that many people erroneously first call local law enforcement. Student voice is also important in shaping and maintaining a safe school environment. Ask your school how they are supporting student engagement in their safety planning. Finally, do not underestimate the impact these national traumas have on our students’ sense of safety.
The horrific mass shooting in Florida has once again heightened our concerns for school safety. Indiana has proactively taken steps to ensure our schools have updated safety plans in place and yet even the best plans are not guarantees. All Hoosier parents and families should have a clear understanding of what is going on at the state and local levels, especially inside their individual schools. Students are understandably and admirably stepping up to not only regain their sense of safety but also to call for increased action. But as community leaders, parents and citizens, it is our shared responsibility to provide safe learning environments for all of our educators, administrators and, most importantly, our students.
The news offers daily reminders of the complex challenges our communities, state and country face in the opioid crisis. Governor Eric Holcomb made attacking the drug epidemic a pillar of his inaugural policy agenda. Indiana University has announced its Grand Challenge to respond to the addictions crisis, committing $50 million to finding solutions. Indiana’s social service, emergency service, criminal justice, health care, and public health providers are working to respond to the relentless array of ongoing, interconnected needs arising from the crisis. Collaborations among local, state and federal agencies are developing new cross-cutting partnerships and interventions. At the Indiana Youth Institute, we are concentrating on identifying and addressing the short- and long-term consequences of the opioid crisis on Hoosier children.
For the past three years the number of children in Indiana’s foster care system has increased steadily. Experts, including Mary Beth Bonaventura, director of the Indiana Department of Child services, agree these increases are directly linked to the opioid problem.
“We have more children in care than we’ve ever had in history, nationwide and in Indiana, Bonventura said. “With all cases counted, (we have) close to 29,000 kids in care in some way shape or form.”
In 2016, 52 percent of children DCS removed from a home were removed due to parental substance abuse. When substance abuse is included as a secondary cause, that rate rises to nearly 80 percent.
Who cares for the kids caught in this crisis? In Whitley County, 2 percent of children live with foster parents, and 6.2 percent of children live with their grandparents. Bonaventura states in Indiana nearly 51 percent of all DCS foster care placements are with relatives. A September 2017 Pew Charitable Trusts study shows parents of adult children who either struggle with substance use disorder, or have died from an overdose, are raising an increasing number of their grandchildren.
Child placements with relatives, also called kinship care, can be a formal placement from the state or an informal arrangement between the parents and the relative caregivers. In fact, the Pew research estimates that for every foster child formally placed with a relative as a primary caregiver, there are 20 more in informal kinship arrangements. Tina Cloer, president and CEO of Children’s Bureau, Inc., says “I get calls all the time from people all over the city and state who have now inherited their nieces and nephews, their grandchildren, their friends’ kids, because they’re struggling with addiction.”
About 39 percent of grandparents caring for grandchildren are older than 60, 21 percent live below the poverty line and 26 percent have a disability. Like all children in care, children in kinship care have been found to lack adequate access to primary care, immunization, vision, hearing and dental care services. Despite these challenges, the American Academy of Pediatrics stresses the benefits of kinship care, including increased stability and well-being, reduced trauma, and an increased likelihood that siblings will stay together.
We can help grandparents and family members caring for these young victims of our state’s addiction crisis. Kinship care is often unexpected and unplanned. Many families are unaware of available help. For instance, grandparents and families who become licensed foster families can access services and financial supports. Organizations such as Grandfamilies.org provide valuable information on applicable laws and resources. Cloer works with many faith-based and community groups that are reaching out to grandparents caring for their grandchildren with basic needs items such as diapers, formula and clothing. As employers, we can offer flexible schedules for those suddenly faced with caring for these children. Schools and youth organizations also need to be sensitive to kinship care arrangements.
Any comprehensive solution to Indiana’s opioid crisis must include the impacted children and family members. Most child welfare experts agree that an increased focus on the impacts on the youngest victims is warranted. While we look for policy and systems change at the state level, at the local level we can immediately step in to help families providing kinship care. Actions taken now can help prevent this crisis from lasting into the next generation.
For more information on the impact of opioids on children, see IYI’s Issue Brief on the opioid epidemic’s impact on Hoosierchildren.
Tami Silverman is the president and CEO of the Indiana Youth Institute. She may be reached at firstname.lastname@example.org or on Twitter at @Tami_IYI. IYI’s mission is to promote the healthy development of Indiana children and youth by serving the people, institutions and communities that impact their well-being.
Download data on children in foster families and children living with grandparents.