Growing up with trauma inextricably linked to racism in southern Illinois, working as a state employee in Minnesota, training folks about adverse childhood experiences (ACEs) and diversity and equity in several states—these are just a few of the life experiences Dave Ellis brings to the work he is now doing as executive director of the New Jersey Office of Resilience.

Seven months ago Ellis took the job to head the Office of Resilience with the assurance that there would be a deep and meaningful focus on community involvement. The process now underway, said Ellis, requires a culture shift to community empowerment where the people who are most directly impacted determine their outcomes, rather than the government defining needs.

Ellis shared the Zoom stage for the Feb. 4^th launch of the New Jersey ACES Statewide Action Plan with NJ Gov. Phil Murphy, First Lady Tammy Snyder Murphy, Lt. Governor Sheila Oliver, and the Department of Children and Families Commissioner Christine Norbut Beyer.

At the launch, Murphy said that hard work will be needed to break the cycle of trauma, including the trauma caused by centuries of systemic racism and discrimination. “This interagency statewide plan is integral to tackling childhood trauma before it manifests into negative health outcomes,” he said.

The ACEs plan “serves as a blueprint for action to make New Jersey a leader in tackling adverse childhood experiences," he continued. "It seeks to empower New Jerseyans in our communities to equip everyone — not some — with the tools to support resiliency and to ultimately prevent adverse childhood experiences from impacting our families. Only by working together will we stop the cycle of abusive toxic stress and ensure healthy, safe lives for every New Jersey mom, dad, baby, child and family.”

First Lady Murphy’s remarks described how ACEs work relates to an initiative she’s led, Nurture NJ, that aims to make New Jersey “the safest most equitable place in the nation to deliver and raise a baby.” She said ACEs-related health effects can impact pregnancy and result in problems related to newborns’ birth weight, shorter gestational age and higher risks, developmental challenges and socio-emotional problems.

“If we fixate exclusively on the nine months of pregnancy to prioritize a woman's health, we've missed the mark and put another entire generation at risk,” said Murphy. “But if we can help a little girl or a little boy heal from trauma today, then we're helping them become better mothers and fathers tomorrow. If we can help young adult men and women cope with the trauma of their childhood, we can stop the cycle of toxic stress in its tracks.”

Commissioner Beyer talked about how ACEs impact people from all socioeconomic groups, races, type of neighborhood, different cultures. “We also know that systemic barriers, economic disenfranchisement, and institutionalized racism can and do contribute to the increased likelihood for adversity in children in New Jersey,” she said. She noted that the COVID 19 pandemic is an adverse childhood event on its own, causing social isolation and stress, and mental health challenges such as anxiety.

Beyer emphasized the importance of community involvement.  “The plan advocates for community voice and community leadership utilizing a boots-on-the-ground approach to propel New Jersey forward and engaging individuals with lived experience as partners in this work,” she said. She urged New Jerseyans to become involved in the work and invited the viewers to join the learning community on ACEs Connection, the NJ Resilience Coalition.

Lt. Governor Sheila Oliver said there are significant numbers of children in New Jersey who are traumatized by ACEs and if there is no intervention, they will carry the negative impacts into adulthood.  She highlighted the plight of children whose families are moving four, five, and six times because there is no stable housing.

NJ ACEs Statewide Action Plan

The action plan was funded by the New Jersey ACEs Collaborative, an alliance created in 2018 by the NJ Department of Children and Families and three foundations — The Burke Foundation, The Nicholson Foundation and the Turrell Fund. According to the report, the plan “seeks to identify and implement promising strategies to address the negative effects of ACEs.” Beginning in 2019, the Center for Health Care Strategies facilitated the statewide process to develop the action plan.

In 2019, the Collaborative released a foundational report, Adverse Childhood Experiences: Opportunities to Prevent, Protect Against, and Heal from the Effects of ACEs in New Jersey, that detailed the challenges in New Jersey and identified areas of opportunity. The new action plan builds on the years of work documented in the 2019 report and reflects  the awakening that unfolded with the racial reckoning galvanized by the death of George Floyd as well as the impact of the COVID pandemic. This context is touchingly referenced by the report’s “In Memoriam” to Colette Lamothe-Galette, described as a public health champion, who died of COVID in April 2020.

The path forward for New Jersey to become a trauma-informed/healing centered state is detailed in the report and includes five core strategies “to reduce—and ultimately prevent—ACEs in NJ”:

CORE STRATEGY 1 Achieve Trauma-Informed and Healing-Centered State Designation

• NJ Office of Resilience (OOR) to establish the New Jersey Trauma-Informed Care Technical Assistance Center (NJ TIC TAC), to coordinate state efforts to prevent, treat, and heal from ACEs and inform state policies and budgets related to ACEs; and
• OOR to develop a Trauma-Informed Care Readiness assessment for non-governmental organizations and state agencies interested in earning a trauma-informed designation. The assessment will determine organizational readiness and staff knowledge about trauma-informed/healing-centered care and ACEs in order to determine required level of technical assistance.

CORE STRATEGY 2 Conduct an ACEs Public Awareness and Mobilization Campaign

• OOR to survey NJ residents to determine priority populations for strategic communications campaign; and
• OOR to maintain NJ Resiliency Coalition web space, a virtual learning community for ongoing stakeholder education and collaboration between trauma-informed/ healing-centered organizations across the state.

CORE STRATEGY 3 Maintain Community-Driven Policy and Funding Priorities

• OOR to conduct a review of ACEs prevention and healing services throughout NJ’s 21 counties and subsequently develop a needs assessment; and
• OOR to encourage public and private partners to increase the number and quality of trauma-informed/healing-centered programs available to individuals most impacted by ACEs.

CORE STRATEGY 4 Provide Cross-Sector ACEs Training

In concert with organizations across the state providing ACEs training, OOR to offer evidence-based ACEs training programs for community members and a variety of child- and family-facing sectors to improve literacy in ACEs and understanding of the impact of trauma;

OOR to prioritize ACEs training for community members, including resources for parents, community, educators, law enforcement officers, and primary health and mental health providers; and

OOR to work with stakeholders and community members to identify the next most appropriate population(s) for ACEs training, building on existing statewide efforts and resources.

CORE STRATEGY 5 Promote Trauma-Informed/Healing-Centered Services and Supports

NJ to promote use of a multi-generational, trauma-informed/healing-centered approach to prevent ACEs and foster resilience through early childhood, single-point of entry programs; and

OOR to conduct surveys of nonprofit organizations, human services, and early childhood service providers regarding utilization of services; to oversee surveys to gauge the community’s perception of and relationships with provider; and to measure outcomes through data sharing with DCF, the New Jersey Departments of Education, Health, and Human Services, and managed care entities.

Exactly how the recommendations will be implemented and resourced is unfolding. To date, Ellis has been able to access resources primarily from the Department of Children and Families, including technology, staff resources, and research. Commissioner Beyer and Ellis serve as co-chairs of an intra-agency panel representing the Governor’s office, the office of the First Lady, and nine state agencies. The group reviewed the plan to make sure it made sense from each department’s perspective. Ellis suggested there may be value in something along the lines of a “trauma-impact statement,” similar to a fiscal impact note, as proposals are being formulated or evaluated whether it is legislation, regulations, or organizational policy.

Ellis acknowledged that some new resources will be needed — for the Trauma-Informed Care Technical Assistance Center (NJ TIC TAC), for example. But as the report concludes: “This plan represents the state’s commitment to re-orienting systems toward prevention, for better outcomes, at a lower cost and with reduced trauma. We have reason to believe this is possible, as similar work has been done in communities across Washington State.” The report’s appendix includes an overview of other state initiatives that informed the New Jersey plan.

Seeds of the potential transformation in New Jersey

When Ellis heard Dr. Vincent Felitti talk about ACEs seven or eight years ago, he realized for the first time that he “wasn’t crazy.” He was hearing things that happened to him and that shaped who is he is today—“in a way that didn't bring shame and blame into the conversation that allows me to do this work,” said Ellis at the launch.

Ellis dove into ACEs science, becoming one of the first ACEs Interface Master Trainers learning from its founders Rob Anda (also the co-investigator with Felitti of the ACE Study) and Laura Porter. He was invited to New Jersey to do ACEs training for the New Jersey Education Association, reaching educators who Ellis says have profound influence on the students they teach and armed with this information, can make such a difference in the lives of children. The focus on trauma by the NJ Education Association started when staff member Amanda Adams heard a presentation by Ellis.

For those involved in a state’s efforts to be trauma-informed, Ellis says to expect the process to be messy and to be patient. It takes time to build trust and to listen —especially to the stories of the people — for community work to yield positive outcomes.