Background
Adverse childhood events (ACEs) are traumatic events that occur before the age of 18 that significantly affect the child’s physical, mental and emotional well-being. Some examples of ACEs include physical, sexual and emotional abuse, neglect, and parental incarceration. ACEs are linked to chronic health problems, mental illness and substance use problems in adulthood and can also negatively impact education, job opportunities and earning potential in adulthood (Centers for Disease Control and Prevention, 2020a; Felliti et al., 1998).
ACEs represent a preventable public health issue (CDC, 2019). The number and severity of ACEs can be reduced through prevention while intervention efforts can be used to mediate the long-term impact of ACEs on individuals and communities. There is a growing body of literature to support that building resiliency among children who have experienced ACEs can act as a protective factor against the negative long-term impacts of ACEs on individuals and communities (Bethel et al., 2017; CDC, 2021; Cohrdes & Mauz, 2020; Ortiz & Sibinga, 2017).
Trauma-Informed Principles Utilized in this Grant
SAMSHA’s trauma informed principles will serve as guide for this program (SAMSHA, 2014). The most important aspect of being trauma informed is preventing the re-traumatization of the participants. To that end, one of the goals of this program aims to change the culture of how negative behaviors in the classroom are addressed. By adopting a trauma informed approach, it is hoped the root cause of the negative behaviors can be addressed through a variety of strategies and approaches including self-calming techniques, stress management and relaxation skills versus the typical punitive responses towards them.
Psychological safety is emphasized through trauma staff education and ensuring that interpersonal interactions with the students and families promote a sense of emotional safety. Trustworthiness and transparency are built between staff, children and family members through good communication between the school district and those receiving services. This includes seeking input from the staff, children and families on how to improve the program.
Recognizing the importance of peer support in the recovery process, parent peer support groups will be offered monthly as part of the family engagement section of the program. The principle of collaboration and mutuality will be appreciated through sharing of power with staff, children and families recognizing that everyone is able to contribute to the program to make it successful. Families will be encouraged to choose topics/skills they would like to learn more about and offer other programming input. It is hoped that as the program develops that parents can become involved in a more formal role if they choose.
Cultural, historical and gender issues will be embraced by providing all education in a culturally competent manner free from cultural stereotypes and biases. Additionally, traditional cultural connections will be fostered through community partners when applicable.
Levels of the Social Ecological Model
The CDC’s four-level social ecological model (SEM) will be used as the framework to demonstrate the various levels where the program will have impact (CDC, 2022). This project aims to bring multilevel interventions to combat the effects of ACEs to the individual, relationship and community levels. It has been well established that multi-level interventions have the highest likelihood of being successful, especially when looking at reducing at risk behaviors (CDC, 2022). This project will impact the individual level by helping children develop their social emotional skills, coping skills, and problem-solving skills through various activities that are known to enhance resiliency and protective factors. The project engages the relationship domain by providing education on ACEs to families regarding the impact of ACEs on the family. The program also engages parents to learn skills that will ultimately improve their own emotional regulation, improving the child-parent relationship. The skills learned can also be applied to interactions within the entire family. If parents choose to participate in peer support groups that will also help build interpersonal relationships. Community level engagement will occur through educating the school staff and educators about ACEs and the importance of preventing and mitigating the negative consequences of ACEs. These efforts will also help to move the district to adopting a trauma-informed approach in dealing with student behavior issues, discipline policies, learning environments, and staff-student, staff-parent interactions. While the societal level will not be directly addressed by this project, it is hoped that with the success of this program more focus can be placed on this level in future.
Public Health Framework
This project recognizes that a collaborative public health framework will have the most impact on the prevention and mitigation of long term consequences from ACEs in the community. A public health framework promotes building partnerships across multiple sectors so that lasting and impactful results beyond what only a single sector approach would allow (CDC, 2020b). This program has aspects of primary, secondary and tertiary prevention levels throughout its curriculum. Primary prevention strategies are designed to prevent ACEs from ever occurring (CDC, 1992). By raising awareness and educating parents/caregivers about ACEs, along with efforts to enhance parenting skills, primary prevention can be realized. Secondary prevention strategies are aimed at preventing further harm and trauma after someone has experienced an ACE (CDC, 1992). This program introduces children to age appropriate coping skills and resiliency building activities which have been shown to be protective factors in children who have experienced adversity. Another secondary prevention strategy this program offers is the principles of trauma informed care are being introduced into the school culture to support children and their families. Lastly, tertiary prevention efforts include interventions to treat and reduce long term consequences of ACEs (CDC, 1992). Again, building resiliency has been shown to mitigate the long term negative sequelae of ACEs. Because ACEs and toxic stress tend to be intergenerational, secondary or tertiary prevention in one generation is primary prevention for the next – a very powerful intervention (Office of the California Surgeon General, n.d). This program hopes to break the intergenerational cycle of ACEs.
References
Bethell, C. D., Carle, A., Hudziak, J., Gombojav, N., Powers, K., Wade, R., & Braveman, P. (2017). Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice. Academic Pediatrics, 17(7), S51–S69. https://doi.org/10.1016/j.acap.2017.04.161
Centers for Disease Control and Prevention. (1992, March 27). A Framework for Assessing the Effectiveness of Disease and Injury Prevention. www.cdc.gov. https://www.cdc.gov/mmwr/previ...mwrhtml/00016403.htm
Centers for Disease Control and Prevention. (2019, November 5). Adverse childhood experiences (ACEs) - vital signs. Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/aces/index.html
Centers for Disease Control and Prevention. (2020a). Adverse childhood experiences (ACEs). www.cdc.gov. https://www.cdc.gov/violenceprevention/aces/
Centers for Disease Control and Prevention. (2020b). CDC - Original Essential Public Health Services Framework - OSTLTS. Www.cdc.gov. https://www.cdc.gov/publicheal...lhealthservices.html
Centers for Disease Control and Prevention. (2021, January 5). Risk and protective factors |violence Prevention|injury center|CDC. www.cdc.gov. https://www.cdc.gov/violencepr...otectivefactors.html
Centers for Disease Control and Prevention. (2022, January 18). The social-ecological model: a framework for prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/violencepr...ecologicalmodel.html
Cohrdes, C., & Mauz, E. (2020). Self-efficacy and emotional stability buffer negative effects of adverse childhood experiences on young adult health-related quality of life. Journal of Adolescent Health, 67(1). https://doi.org/10.1016/j.jadohealth.2020.01.005
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72, 141–149. https://doi.org/10.1016/j.childyouth.2016.10.021
Office of the California Surgeon General. (n.d.). ACEs and toxic stress | OSG. Retrieved February 28, 2022, from https://osg.ca.gov/aces-and-toxic-stress/
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach prepared by SAMHSA’s trauma and justice strategic initiative. https://store.samhsa.gov/sites.../priv/sma14-4884.pdf
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