Cecil J. Picard Center for Child Development & Lifelong Learning, March 2020
The landmark Adverse Childhood Experiences (ACE) study, co-sponsored by the Centers for Disease Control and the Kaiser Permanente Managed Care Consortium in San Diego, CA (Felitti et al., 1998) demonstrated that cumulative adversity in childhood is associated with significant long-term consequences for adult health and well-being. The “ACE Study” findings have been replicated in numerous studies and the research has underscored the urgent need to accelerate focus on preventing all types of early adverse experiences, as well as developing interventions that mitigate effects, especially for young children already exposed.
Using a broad, cross-sector online survey that reached over 900 professionals and included interviews with 20 key informants from across service sectors, the A View from the Field: Awareness, Activities and Approaches for Addressing ACEs (AAA for ACEs) study sought to assess the penetration of ACE education, advocacy, and trauma-informed approaches in Louisiana. The study addressed three specific questions:
1. What is the saturation of ACEs education and awareness in Louisiana?
ACE education and information has reached every region of the state. Respondents were representative of the racial/ethnic mix of Louisiana citizens, and professional disciplines represented a wide range of child and family service professionals including direct service providers, home visitors, supervisors and consultants, administrators, community advocates, educators, and researchers. Across disciplines, respondents perceived ACE education as highly valued, relevant, and beneficial to service recipients, staff, programs, and communities. However, slightly more than half of the respondents indicated they had only basic, introductory knowledge and/or did not know how to apply the knowledge; slightly less than half reported having a good grasp of information and were beginning or regularly applying the content. There was consistent recognition of the need for more ACE education for both the public and for professionals throughout the state.
2. What are the trauma-informed prevention and intervention activities in Louisiana, including research and advocacy?
Direct service providers described a wide range of clinical trauma-related services and activities, with screening and referral most frequently endorsed, but many of the identified approaches were not specifically evidence-based to address the impact of trauma. Notably, few of the mental health respondents indicated they were fully trained, confident, or actively using specific, trauma-focused, evidence-based therapies for young children. Nevertheless, there is great interest among all direct service providers to deepen and expand knowledge and skills for addressing ACEs and trauma.
The vast majority of administrators, program managers, and agency directors reported their programs engage in a variety of ACE and trauma-related services, including direct services, advocacy, education for professionals, community education, research and program evaluation, and spiritual support. Similar to direct service providers, administrators believed that ACE-related knowledge has a positive impact on their agency or program activities, but often felt they did not have enough knowledge of “what to do” and/or lacked the resources to implement activities.
Similarly, the majority of advocacy and community development professionals indicated that their communities were at least somewhat interested or already had ACE-related activities underway, and they perceived a number of potential benefits to community knowledge of ACEs. However, they too indicated that lack of resources, lack of clarity about what to do, as well as other issues with higher priorities as barriers to more active community uptake of ACE knowledge.
We did not reach a large number of university or medical school faculty, likely a limitation of the sampling approach of the survey. While those who responded believed incorporating ACE information into curricula was important, the low response rate also suggests that penetration of ACE education in undergraduate and graduate programs may be limited. In addition, few of these respondents indicated they were involved with ACE-related research.
3. What are gaps, needs, and priorities for ACE education and prevention and intervention activities? Although the survey reached a wide range of professionals, few represented law enforcement, business, and faith-based communities. This likely reflects the recruitment process, but also suggests gaps in groups who may benefit from and be interested in ACE-related education.
Barriers to providing ACE education, services, and activities were not surprising: insufficient funding, insufficient referral resources, and insufficient expertise in evidence-based, trauma-informed services. Respondents expressed the need for tools, materials, and strategies for providing education to professionals as well as families and communities. Additionally, respondents identified the need for better awareness of how communities are incorporating ACE-related activities, access to or development of community data regarding trauma and ACEs, and web-based resources for statewide ACE-related services and activities.
The three most frequently endorsed top priorities for ACE education and interventions included trauma-informed approaches in schools, education for providers/professionals, and prevention services (such as home visiting). Specific trauma-informed approaches were identified as needed in every child-serving system, as well as the need to address basics such as housing, food, and health care. Additional priorities included trauma-informed health care services, improved inter-agency collaboration and communication, and better research on ACEs/trauma in Louisiana.
In addition to the needs and priorities identified in the survey, key informants identified the need for policies and procedures at the program and system levels that recognize the effects of trauma and do not undo trauma-informed treatment efforts (for example, it was noted that the “zero tolerance” policies implemented in many schools not only ignore understanding of the individual child, but can replicate traumatic experiences in some cases). The importance of adequately supporting professionals who work in systems of high trauma-exposure was noted. The transmission of ACE information needs to consider the social and community contexts, and the importance of including the voices of parents and those directly affected by trauma in ACE education and activities were emphasized. The perennial challenge of ensuring long-term planning and commitment to the needs of children and families also were high priorities of the key informants.
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