According to the Center for Disease Control and Prevention (CDC), it’s estimated that roughly one in five children have a diagnosable mental health condition. It’s also estimated that one in six adults have experienced at least four of what are known as adverse childhood experiences or ACEs. ACEs increase the risk of experiencing mental health issues.
For those of us who work in child-facing professions, understanding the nuances of ACEs is critical to providing the support these children need, and that begins with understanding what they are, how the impact of ACEs manifests itself and what we can do to help.
Read on to learn more about ACEs and how you can leverage resources to mitigate the effects.
What are Adverse Childhood Experiences?
The term adverse childhood experiences originated from a seminal study back in the late 1990s. The study was a collaboration between the CDC and Kaiser Permanente and looked at 17,000 adults who were experiencing health issues. The questions the participants were asked focused on their childhood and their answers were grouped into three categories — abuse, neglect, and family dysfunction.
What the study found was that there was a strong connection between the number of ACEs and the increased risk of both mental and physical health issues. Using the data they gathered, they identified ten types of adversity across these three categories — all of which were correlated to poor life outcomes.
It was this study, coupled with further research, that uncovered the neuroscience related to ACEs. The science shows a clear line between adversity, toxic stress, and mental health conditions that manifest in children and continue into adulthood.
What they noticed during the original study was the higher number of adverse childhood experiences someone had, the greater their health risks were. Whether it was physical health issues like cancer and lung diseases or mental health issues such as depression, anxiety or post-traumatic stress disorder, each ACE increased their risk factors in a stepwise fashion. The higher the number of ACEs the higher the level of risk.
The Effects of Adverse Childhood Experiences
When we look at measuring adverse childhood experiences, there are ten specific ones that are measured. For each event a client experiences, they are given a score of one on the ACE scale, leaving them with a final score ranging from zero to ten.
The ten experiences are:
- Verbal abuse
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Divorce or separation
- Physical abuse of a parent
- Alcohol or drug abuse by a parent
- Mental illness of a parent
- Incarceration of a parent
While it’s easy to assume that some of these experiences are more impactful than others, it’s important to note that in fact, not one event is likely to be more predictive of risk than the other. The issue isn’t the adversity, but instead how adversity can effect the developing brain. The toxic stress response created by repeated exposure to adversity is what can increase overall health risk factors.
Knowing that a child is exposed to ACEs, understanding the toxic stress response, and realizing the potential outcomes are all critical pieces of information that lead us toward a better understanding of what safeguards and buffers need to be put in place to mitigate risk. It opens the door to helping children move towards a more positive trajectory with the right support systems in place.
The toxic stress response of ACEs is different for each child, however some common ways they manifest include:
- Learning and behavior problems
- Difficulty with self-regulation
- Irritability
- Sleep issues
- Chronic physical ailments such as headaches or stomach issues
Building Resiliency for Adverse Childhood Experiences
When working with children who’ve had adverse childhood experiences, the good news is that with intervention, the risks can be lowered. A key facet of intervention includes helping the children we work with build resiliency.
Let’s take a look at four categories of help that mitigate risk and build resilience. The “Help that Helps” framework outlined below is from the ACE Interface Master Trainer Program. At Western Youth Services (WYS) we have completed this training and find this framework to be beneficial for helping our clients build resilience through relationships:
Social Connection
- This step stresses the importance of staying connected to others. All children need at least one stable, dependable, caring adult who believes in them.
Receiving practical help
- This step focuses on receiving practical help like help with homework, or day to day activities. It also includes being taught how to identify emotions and how to pause and press the RESET button.
Social Reciprocity
- This step is all about reciprocal support of others, creating a community of people that help each other to make life easier through shared responsibilities, such as carpools, and other communal activities.
Social Bridging
- This step is about having access to professional help and learning to reach out when needed. Reducing stigma, finding the resources available in your area or helping someone in your reciprocal community find the help they need.
Leveraging ACEs Resources
The number one factor for mitigating the effects of adverse childhood experience for children is having at least one stable, dependable adult who believes in them. But the other categories of help are important as well. That’s why understanding what resources are available to you and your community and knowing how you can help is key to intervention.
Here at WYS, we’ve recently launched the RESET Toolbox, which is a collection of no-cost trainings and resources designed to help children build resilience and to provide resources for adults with children in their care to help them do so. The RESET Toolbox is funded by the Orange County Health Care Agency and everything is available at no-cost for residents of Orange County. We are so thankful that they made this very special resource possible.
In early 2020, the California Surgeon General and DHCS launched the ACEs Aware Initiative. This initiative focuses on providing reimbursement for Medi-Cal providers for conducting ACE screenings on children and adults under the age of 65. Plus, it’s designed to ensure providers not only have the appropriate tools, training and resources to include ACEs screening in their assessment process, but the training and resources to know how to incorporate the knowledge of ACEs and toxic stress response into their patient care plans.
The CDC also offers a variety of information, tools and resources for those looking to learn more about ACEs and how they can be an advocate for the children they work with.
Be an Advocate for Those Dealing with ACEs
While exposure to adverse childhood experiences can have a profound effect on overall physical and mental health, an intervention can make a significant difference on the short and long-term outcomes.
By understanding what ACEs are and how we can mitigate their effects, we can provide those we work with the tools and resources they need to have a brighter future.
Do you work in a child-facing profession and are looking for additional support regarding ACEs?
WYS focuses on advancing awareness, cultivating success, and strengthening communities through integrated mental health services for children, youth, and families. We would love to hear from you and see how we might be able to help.
As always, we are here to help!
Lorry Leigh Belhumeur, Ph.D.
Chief Executive Officer
Western Youth Services
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