Easing your way into changing your organization to include practices and policies based on PACEs science

Last week I posted “The trouble with trauma (-informed), the aggravation of ACEs (screening): We're trying to fit both into traditional frameworks and it isn't working.” This post goes one step farther to describe the first easy steps that all organizations can use, no matter what the sector, to wrap their minds around integrating healing practices and policies based on PACEs science.

In the comments section, Rebecca Bryan asked, “What is a reliable tool to assess organizational ACEs? Does a survey exist that includes household, community and climate ACEs that is validated and reliable?” And Craig McEwen commented that I’d “underplayed the vital importance of promoting policies that support families, reduce toxic stress and lower the likelihood of childhood adversity.”

To answer the first of Rebecca’s questions, organizational ACEs are the staff’s ACEs plus ACEs in the organization’s history.

As emphasized in last week’s post, to assess your organization’s ACEs and PCEs, educate people about PACEs science first. Then:

…have staff members complete an anonymous PACEs survey together (in person or live webinar) by using instant polling software such as PollEverywhere. The individual PACE scores are compiled in real time so that everyone can see the organization’s collective burden of ACEs and the collective strength of its PCEs instantly. Make sure to include the range of ACEs and PCEs (1-2, 3, 4+) to get a handle on how much the organization needs shoring up.

These steps are included in our Milestones Tracker. The tracker is a good starting point to assess your organization and particularly your community’s progress in integrating policies and practices based on PACEs science. Less an assessment tool and more of a checklist or roadmap, it identifies the general steps that any organization can use to determine if it’s on the right track, whether a school, police department, business, healthcare facility, or social services agency.

We chose the 14 milestones based on an extensive literature review of evidence-based self-assessments by organizations. These milestones are common to most, if not all, organizations across sectors. Some milestones are very simple. Others represent many changes an organization needs to implement. This tracker does not evaluate how well an organization is doing at each milestone, but if the organization completes all milestones, it’s likely that meaningful change is occurring.

Although we created the Milestones Tracker so that members of a community PACEs initiative could eyeball the overall progress of their participating organizations on an interactive map (we offer this as part of the tools and services of the PACEs Connection Cooperative of Communities), the following 14 milestones can be used by any organization. This includes volunteer, advocacy, neighborhood association, parent association, small business, health clinic, faith-based, recreation, arts, school, school board—any group of people that organize around a goal or mission and who want to measure their progress in integrating PACEs science into their work.

The Milestones

1. PACEs science presentation to a volunteer or staff member of an organization—Somebody hears a presentation somewhere and is the catalyst to bring information about PACEs science to the organization.
2. PACEs science presentation to ALL organization staff and/or members—All employees and/or members participate in a presentation about PACEs science.
   
   
3. Leadership commits to integrating PACEs science—Your organization’s decision-maker(s) or the organization by consensus—whichever works best for your organization—publicly announces to staff members the intention to integrate practices and policies based on PACEs science, approves a committee to lead the effort and provides appropriate resources. Committee members join PACEs Connection.
   
   
4. Organization members or staff complete ACE & PCE (positive childhood experiences) surveys—Each person anonymously completes an ACE survey (one that includes other questions, such as racism, bullying, involvement with foster care system, etc., that reflect the experiences of staff members) to determine their own ACEs and positive childhood experiences. (We recommend that racism is included because all people in the U.S. are affected in one way or another.) This is best completed in an in-person or virtual meeting so that the entire staff can see the organization’s ACEs burden and foundation of resilience. Anyone who takes these surveys is provided the opportunity to talk with a peer support specialist, social worker, or someone designated inside or outside the organization by leadership. Employees should not provide their scores to the organization they work for. Depending on the size of the organization, this process can be done by department.
   
   
5. Human resources department integrates healing-centered (trauma-informed) practices & policies based on PACEs science—These include such functions as membership, hiring, termination, leave, supervision, etc., as applicable. It’s very important to make sure that anyone hired, including new leadership, is well versed in PACEs science, its practices and policies.
   
   
6. Your organization participates in a local PACEs initiative—Representatives of your organization attend local PACEs initiative meetings, participate in workgroups or have signed an MOU with the PACEs initiative. If no PACEs initiative exists, work with organizations from other sectors to create one.
   
   
7. People served by your organization are educated about PACEs science—This includes patients, students, prisoners, customers, community members, parents, activists, advocates….whomever the organization serves. They have a right to know the most powerful determinant of their...and their children’s...health, safety and productivity.
   
   
8. People that your organization serves receive ACE & PCE (positive childhood experiences) surveys—This means that clients/ students/ customers/ patients/ prisoners/advocates/, in other words anyone whom the organization serves, have completed ACE and PCE surveys for themselves. It does not necessarily mean that they have provided that information to the organization that gave it to them; it may be for their own knowledge. It depends on the organization. For example, it’s appropriate for a physician to know the ACE and PCE score of a patient; it’s not necessary for a school to know the ACE score of a student. However, it would be useful for a school to know the ACE burden and PCE foundation of its student body, and gather student ACE scores anonymously. Anyone who takes an ACE survey should be educated about PACEs science, and provided the opportunity to talk with a peer support specialist or social worker.
   
   
9. Your organization implements trauma-informed procedures or practices based on PACEs science for people served by the organization—Your organization or association has applied a PACEs-science lens to all practices for clients, students, patients, prisoners, customers. In other words, these practices and policies are for anyone whom the organization serves, and are developed with the input of the people it serves.
   
   
10. Your organization evaluates policies and practices—On an ongoing basis, your organization evaluates changes it has implemented, includes staff members and people it serves in that evaluation, and makes improvements.
11. The physical environment of your organization creates safe, quiet and healing places—Your organization or association finds good examples of the healing-centered/trauma-informed physical environments of other organizations, and makes changes in the physical environment. This includes waiting areas, work areas, recreation areas, with considerations that include but aren’t limited to lighting, fresh air, safety, noise, and privacy.
    
    
12. Diversity—Your organization evaluates the diversity of the staff AND develops a plan to address its findings AND put a system in place for continuous evaluation.
    
    
13. Equity—Your organization evaluates its practices, structures, and policies for areas of inequity; AND takes steps to ensure that specific solutions and remedies are employed; AND puts a system in place for continuous evaluation.
    
    
14. Inclusion—Your organization evaluates its practices, structures, and policies to ensure and emphasize that all are welcomed, respected, supported, and valued; AND takes steps to ensure that specific solutions and remedies are employed; AND puts a system in place for continuous evaluation.
    
    

The next step is to use a self-assessment tool to take a deep dive into every milestone (except the first, because that’s fairly serendipitous) so that you can begin to develop a plan to make changes as your organization progresses down the path of integrating healing policies and practices based on PACEs science. For self-assessment tools for organizations in specific sectors—including child-abuse prevention agencies, child/youth/adult/family serving organizations, domestic violence services, healthcare agencies—check out the Self-Assessment Tools in PACEs Connection’s Resource Center. We will be adding tools as we hear about them. If you have good examples, contact Rafael Maravilla (rmaravilla@pacesconnection) so he can add them to the Resource Center. Please note that these tools might not include our recommendations to have the staff anonymously assess their own ACEs and PCEs, or educate the people they serve about them. We think every organization needs to do so.

Also in last week’s post, Craig McEwen noted that “the vital importance of promoting policies that support families, reduce toxic stress and lower the likelihood of childhood adversity” was underplayed. He cited policies such as “universal, high-quality childcare; making the child tax credit permanent; family leave; higher minimum wage; affordable housing… are among the many policies that can support families and reduce stress.”

We definitely need all the policies mentioned above and more. But to successfully make lasting changes requires two shifts in our current approach: Organizations need to integrate policies and practices based on PACEs science for their own staff and, following that, the people they serve so that they can establish a solid fad-proof foundation from which to change. By doing that, they’ll be able to move out of the constraints, the boxes, the silos they operate in now to create new more adaptable structures and policies to solve our most intractable problems.

One example of this is how people in the district attorney’s office, law enforcement, social services, and healthcare—all trained in PACEs science—came together to drastically reduce the opioid epidemic in Plymouth County, Massachusetts. Briefly, this is how it works: Within 24 to 48 hours after a person recovers from an opioid overdose, a social worker or police officer trained in social work visits and offers to take them to a rehab facility right then and there. And then says, “How about I treat you to dinner on the way?”

Opioid deaths in the county dropped 26 percent, while in the surrounding counties, death rates increased 84%. Since they first started this approach, it’s become more complex, has incorporated healing-centered and trauma-informed ways to help people who have the most troubles, and has moved aggressively into integrating prevention practices. Understanding PACEs science has given them the knowledge to develop these new practices. I’ll be posting a detailed article about their work on January 4.