California PACEs Connection initiatives spark new connections in regional meeting

Among PACEs Connection initiatives around the country, it’s well known that our social network is something like a bustling, giant town square where people share ideas, resources and any number of conversations about how to prevent childhood adversity and promote positive childhood experiences.

On May 14, PACEs Connection assembled a virtual town square gathering of PACEs initiatives in California, where we have 58 initiatives sparking action all across the state. Speakers at the gathering, which was sponsored by Genentech, hailed from central and northern California counties, including Butte, Placer, Solano, Sonoma, Humboldt, Sacramento, and Fresno. They were each asked to identify a problem in their community that they had wanted to tackle, solutions they developed to address the problem and creative partnerships they formed along the way.

Shaunda Cruz of the Sacramento County Probation Department talked about the pervasive trauma among justice-involved youth and what the department has done to address it. Alison Murphy from the Placer County Office of Education talked about how they’re handling students’ mental health needs and how they have included an equity and trauma lens into the training they offer to schools and districts.

There were 45 participants. Some 37 attendees also met in smaller groups where a cross-fertilization of ideas ensued, and we’re sharing it all with you, our larger community. PACEs Connection staff involved in planning or participating in the event included: Donielle Prince, Jenna Quinn, Natalie Audage, Lara Kain, Gail Kennedy, Jane Stevens, Elizabeth Prewitt, Rafael Maravilla, and me, Laurie Udesky.

To start things off, Jane Stevens, PACEs Connection’s founder and publisher, talked about our name change from ACEs (adverse childhood experiences) Connection to PACEs, positive and adverse childhood experiences. Why the shift? Resilience, as many of our members know, is one of the five parts of ACEs science, explained Stevens.

“But we realized that ‘resilience’ wasn’t capturing everything we wanted to address,” she said.

The springboard for the change was emerging research developed in 2019 by Dr. Christina Bethell, a professor in the Bloomberg School of Public Health at Johns Hopkins University, along with some of her peers. It described seven positive childhood experiences (PCEs) that can make a huge difference in someone’s life.

In a nutshell, the research showed:

A high ACE score doesn’t mean you’re doomed. (You may have enough positive childhood experiences to counter the effects.)
A low ACE score doesn’t mean you’re in the clear. (If you also don’t have PCEs, you may suffer worse effects than if you had a high ACE score.)

“It all boils down to your experiences and your physiology that’s happening in your brain and body as you’re growing up,” said Stevens.

To be able to heal as individuals, organizations and systems, you have to be able to acknowledge and deal with adversity. Doing so, said Stevens, paves the way for flourishing.

Stevens also talked about PACEs Connection’s latest effort, our Cooperative of Communities. It now includes five initiatives, with another nine being onboarded. INSERT COOP SLIDE. See the attached handout detailing coop benefits below, and watch this video about PACEs Connection’s Cooperative of Communities.)

Trauma-informed care at the forefront

Following Stevens’ overview, Shaunda Cruz, chief deputy of the Sacramento County Probation Department, discussed how her department has made mitigating childhood adversity and its effects the focus of their work. The underlying problem that needed to be tackled full on was crystal clear, she said: “90% of our system-involved youth—those that are on probation or in detention—have experienced trauma or traumatic events.”

That sobering statistic has guided Cruz in her work. Her go-to roadmap was one provided by the National Child Traumatic Stress Network for implementing trauma-informed practices in the probation department and beyond.

Every new employee, she said, is trained in trauma. But the work around changing systems doesn’t happen in a vacuum. It involves building partnerships in the community. For Sacramento probation, beginning in 2014 that meant working with the county Board of Supervisors and learning about PACEs science in a cross-sector collaborative provided through the Resilient Sacramento PACEs initiative. And for collaboration between probation and community-based organizations to work, she said, it requires thinking outside the box.

“it's really about sharing resources and being transparent, and letting down your guard and being vulnerable. We challenge anyone that wants to work with our youth and families to have that trauma-informed lens. We build our contracts around (the requirement) that it can't be an afterthought; it has to be something you bring to the forefront.”

Cruz described two different examples of how the department has changed the environment in its detention facility to help the young people there. At around the time that legislation in California was introduced to end the practice of isolating young people in their cells in detention facilities, the Sacramento County Probation Department developed an area where young people who were on the verge of an emotional meltdown could go to decompress. In that room, known as the Multi-Sensory-De-escalation Room, youth could select from a range of calming music and sensory tools, like squeeze balls. A staff member interacts with the teen “to build on their strengths and determine their triggers. And it really helps the youth with their internal regulation,” said Cruz.

In 2017, the facility began assessing each young person who entered detention for trauma, using the Child and Adolescent Trauma screening tool, which included questions about abuse. Those with especially high scores were housed in a trauma unit, where they could participate in classes to learn how to recognize their own trauma triggers and the roots of their trauma, and how to identify and manage their triggers. The curriculum and classes were offered by a team from the University of California at Davis’ Child Adolescent and Abuse Resource and Evaluation Diagnostic Treatment Center. Additionally, said Cruz, “We could actually create treatment plans and ways to work with the youth and build supports around them. (To read about the trauma-informed work at the facility, see this story. )

Cruz, who oversees the department’s juvenile field and placement services, says that if you want to shift the system’s culture, you must:

Regularly focus on the question “What happened to you?” instead of “What’s wrong with you?”
Build relationships with youth and at every level between probation and community organizations that serve youth.
Highlight the voices of the family and young people. They’re the experts.
Build cross-sector collaborations. In Sacramento County, she said, they brought in Kros Learning Group to teach a train-the-trainer model of trauma-informed practices. Now 41 trainers are embedded in different organizations throughout the county.

Making mental health care accessible

Placer County, like Sacramento, saw a huge underlying problem in their community. But they were not sure how to solve it.

“We knew that mental health needs were increasing. We knew that suicide rates in some districts were increasing. But we didn’t know how to create centers that were accessible for students,” said Alison Murphy, a mental health coordinator with Placer County Office of Education’s Prevention & Support Services..

The solution? Establish health centers on campuses and staff them with mental health specialists.

To date, 10 wellness centers are located on different school sites. Each is staffed with a licensed therapist and a staff person, called a “family and youth liaison,” who checks in with families if students are missing from school to help them get back to the classroom.

While a more traditional approach to unexplained absences may be shame and blame, Murphy shared an example of how the liaisons use a different approach.

“Rather than getting a punitive phone call right away saying ‘Hey, your kid isn’t coming to school,’ our liaisons are able to call and just see what’s going on, and see if there are any barriers that we can help problem-solve.”

Among barriers that students were experiencing were access to the internet and Chromebooks. Murphy said the Placer County Office of Education filled in to help. “We brought district Chromebooks and hotspots to students’ homes,” she said.

The county also learned from students that transportation was a challenge last year. “We did try to organize walking groups to school, but we couldn’t organize carpools, because of COVID,” Murphy said.

While the impetus for establishing the wellness centers was to provide mental health access to all students, Murphy said that they also tracked demographic data to see who was being referred for services. If data showed, for example, that a particular teacher was sending a disproportionate number of black and brown students for referrals, “We’ve sometimes found that our work is to push into a classroom and help that teacher shift some things in the environment or look for strengths [in students] in a different way so that students aren’t just being siloed out to us as a problem that needs to be fixed.”

In those interactions, says Murphy, her team also makes sure that teachers don’t feel singled out. Her team might ask, for instance, why the teacher thought the referral was necessary. “Any time a student is referred, we make it a practice to observe the student in the classroom—this takes away the fear that a teacher is in trouble or being criticized.”

Besides the work done by staff in the wellness centers, the PCOE has provided 233 schools in Placer County and other parts of California with trauma- and equity-informed Positive Behavioral Interventions and Supports training. Part of this is reframing how to respond to disruptive behavior in children.

“When children are not able to meet defined behavior expectations, what are equitable responses?” said Kerri Fulton, another PCOE coordinator. “That means getting all the adults on board [to decide] what does minor defiance look like? What does major defiance look like? And then moving away from a punitive response to building skills. What does that child need to be safe, respectful, responsible at school?”

Fulton says that while the PBIS training went well, schools were coming back and saying they needed more trauma-responsive training. Now “they’re looking at their data and their experiences and they’re realizing we can get better at this,” she said.

For example, a foundational maxim of PBS is “Be safe, Be kind. Be respectful,” which is typically displayed around schools on banners and posters. As part of the new training, schools began to dissect what those words really mean. They were asking, said Fulton, “Does be safe, be kind, be respectful, really work for all of our students and families in our school community? Where are their potential areas where it doesn't quite fit? It kind of was imposed upon our students.”

In revamping the PBIS training, the PCOE learned:

To work effectively on equity, use disaggregated, trusted data.
If you say you don’t have a problem, look harder.
Schools should send a team, not just one person to trainings and coaching.
An ongoing, multi-year commitment is needed to achieve true systems change.

A problem and a solution

Leaders of several other initiatives from around California highlighted a problem they encountered and how they solved it. Here are more details.

Lourdes Valdez is a pediatrician and hospitalist in Butte County, which has the highest per capita ACE score of all of California’s 58 counties (76.5% of the population have one or more ACEs.) Its residents have suffered displacement from wildfires and flooding from the Oroville dam. There’s a high incidence of fentanyl-related overdoses and a spike in adolescent suicide attempts and completions (20 attempts or completions in 2018; 60 in 2020), yet families were having to navigate siloed systems to get help. One solution: First 5 of Butte County, which serves families of children through the age of 5, established a local affiliate of the national organization Help Me Grow, which coordinates access to community services for families with young children.

Jen Mager from Humboldt County First 5 said their problem was that with a third of the county having ACEs scores of 4 or more, more awareness and funding were needed. Through advocacy and training across agencies around protective factors, First 5 and its partners convinced the county Board of Supervisors to allocate money from the general fund to support activities focused on young children and their families.

Lisa Eckhoff, with the Solano County Office of Education, is part of the PACEs Connection initiative Resilient Solano, a cross-sector group that formed in 2015. The group, which includes First 5, the Department of Public Health, social service and mental health agencies, had the shared vision of preventing and mitigating ACEs. The first order of business was raising awareness among residents. To get the word out, they:

Delivered 23 ACEs presentations to more than 450 people.
Held 15 community screenings to 1,000 people of the film “Resilience: The Biology of Stress and the Science of Hope”
Sponsored a billboard campaign with messages such as “One person is all it takes to help a child. Are you that one?”
Conducted an ad campaign on the music app Pandora

(To learn more, read this story about their initiative.)

During the last hour of the meeting, participants were assigned to small groups where they were asked to consider:

What is a problem they’d like to solve? How can PACEs Connection help them? What are their next steps?

Here are the takeaways from the small group gatherings: