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PACEs in Nursing

What Do We Do? What Do We Do Now?

 

People’s response to the great chasms of structural inequities glaringly laid bare by the COVID-19 pandemic have been further inflamed by the murder of George Floyd and deaths of other African Americans in recent weeks. The acute emergency of the pandemic has eased, but the violence inflicted on racial minorities and now those who are protesting the inequities in our society has compounded the outrage. 

Right after the pandemic began running riot across the US, I often heard people ask: When will we get back to normal? We at ACEs Connection don’t want to get back to normal. For most people in this country, “normal” wasn’t such a great way to live. Our goal is to create a better normal. Never before has the science of ACEs, which includes addressing racism and intergenerational trauma, been more relevant in the search for solutions to heal our country. And never have solutions been so achievable.

Our approach has always been to educate, nurture, nudge, encourage, and support our more than 44,000 members and the more than 300 ACEs initiatives in cities, counties, regions and states as they integrate practices and policies based the science of adverse childhood experiences. Now, as the pandemic wreaks havoc across our nation and African-Americans, Latinx, Native Americans and their white allies take to the streets yet again to demand social, economic and health justice that’s long overdue, ACEs initiatives in communities across the country are expressing a tremendous desire to accelerate their efforts to add to the progress we’ve made over the last eight years, and to clarify our commitment to racial justice and equality as we figure out how to create systems that serve all of us, not just some of us.

Since mid-March, we have held two or three “Better Normal” community conversations every week on ACEs Connection. Each conversation brings together two dozen to 100 people who discuss topics such as K-12 education, family violence, racial health disparities, and self-regulation practices for communities. They identify practices to put into place immediately and those that can change systems and communities. These discussions have prompted us to respond with plans to accelerate our work, including practices to put into place immediately, and those that take more time to change systems and communities forever. We are: 

  • Increasing the number of communities with ACEs initiatives to 1,000 by the end of 2022, and 5,000 by the end of 2025, which is close to a national tipping point (there are 34,000 cities and counties in the U.S.), with half of those participating in the ACEs Connection Cooperative of Communities, which provides advanced tools and guidelines;
  • Working with the many U.S. states that have recently announced state ACEs initiatives or plan to do so soon, initially to use federal COVID-19 funding to help state agencies address their own trauma as they adapt to a different world, and to help states coordinate with ACEs initiatives in counties and cities through ACEs Connection to build coalitions supported by solution-oriented data;
  • Finding and reporting on the new wave of ACEs science pioneers who are developing new cross-sector approaches to solve their most difficult challenges (inadequate and insufficient housing, stark inequities in education and healthcare, gross inequities in income, etc.), so that the most advanced ACEs initiatives can adapt them to their own communities. 


Many issues are best addressed at the federal level, others at the state level. State-wide coalitions support such policy changes as universal basic income, living wages, paid parental leave, universal health care, reparations, all schools funded and equipped with enough computers, playgrounds, teachers, etc. — all with practices and policies equity-based through an ACEs-science lens. Cities and counties use practices and policies based on ACEs science to solve what have been their most intractable problems — such as family violence, which most communities spend up to 50% of their operating budget responding to — so they can begin shifting taxpayer money to building resilience in communities. 

Although many individual organizations have integrated ACEs science to produce eye-popping results, the potential of sectors working together shows the true and remarkable promise of a better normal:

  • Over the last few years, we know that patients and physicians can successfully manage addiction to opioids and other substances so that 100% of patients are no longer addicted and can hold down jobs. The next step — already in practice in Plymouth County, MA — combines law enforcement, rehab centers, and healthcare in a joint cross-sector program that has resulted in a 26% drop in opioid deaths v. an 84% increase in deaths in surrounding counties.
  • We have evidence that batterer intervention programs that integrate ACEs science reduce recidivism from 30–60% to just 1%. Safe Babies Courts show that one year after participating 99% of the children suffer no further abuse. Taking this a step further is at least one ACEs initiative that is integrating ACEs science-informed batterer intervention, victim services, child welfare, schools, law enforcement, courts and juvenile justice to take a whole-family approach to practically eliminate violence and other troubles in families.
  • Thousands of schools – including those in Antioch, CASuisun City, CA, San Francisco, CASpokane, WASan Diego, CA, and Walla Walla, WA — have integrated trauma-informed practices. Suspensions and expulsions have dropped while grades and graduation rates increase. Taking this a giant step further, a stunning project in Atlanta, GA, provides a community and economic model that successfully combines for-profit trauma-informed low-income housing; health clinics that improve services for families; trauma-informed schools; after-school programs in the housing project; and local vegetable gardens. Residents are more empowered and self-reliant, kids become healthier and do better in school, schools become more successful, communities become more resilient and stable, and landlords make more money because they create a healthy environment so that everyone thrives. It flips the current system from using blame, shame and punishment to building understanding, nurturing and healing into the walls.


To continue to accelerate the use of this knowledge, it is imperative that we continue to report on data-driven successes, to add tools and guidelines requested by communities across the U.S., and to provide guidance to communities making substantial progress in integrating practices based on ACEs science in organizations, institutions, and systems. In these times of social networks and with this knowledge, we finally have the opportunity to change things fast and for the better.

Now, to continue what is truly the first paradigm shift in how we create systems that address the deep-seated inequities that have brought about the suffering finding expression in this Spring of protest and in the violence of hundreds of years of frustration spilling over into the streets of hundreds of American cities, it is imperative that ACEs Connection continue its work and for us and our communities to become more directive and committed. And we are ready to do so.

And the only way to do so effectively is to make sure we do this together, with everyone at the table, and to make sure to bring the table to those who’ve been burned for too many generations, to ask their forgiveness and for one more chance to serve. We will create safe places where we’re willing to listen to each other and work out our aspirations, differences, and mistakes with good humor, love, trust and patience. Using this new knowledge of ACEs science isn’t easy, but it’s already been proven to be not only possible, but also can provide a healthy and inclusive way forward. There aren’t blueprints for what we’re doing. But, as we’ve always said, the only way to proceed is to build the ship as we’re sailing it. What else are we to do?

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