Background
Adverse childhood experiences, or ACEs, are defined as negative experiences that occur in childhood and affect children’s mental and physical health throughout their life (Felitti et al., 1998). While ACEs are prevalent among American youth, youth in Alachua County, FL experiences a disproportionate amount of ACEs (CDC, 2022b). In a study done by the Florida Department of Children and Families, researchers found that 69.2% of Alachua high school students had experienced at least one ACE, compared to 67.9% of Florida high school students overall (Florida DCF, 2020). Furthermore, the study found that 1 in 5 Alachua County high school students had experienced 4 or more ACEs, while the national average is 1 in 6 (CDC, 2022b). Consequently, most programs and interventions target the children who are being affected by these experiences to increase their resilience and provide them with stable environments outside of their homes. However, this intervention will utilize community health workers (CHWs) to target the parents of children experiencing ACEs to help improve their home environments and help parents build their capabilities to properly care for their children.
Studies have found a positive association between parental exposure to ACEs and child exposure to ACEs (Ports et al., 2021). Furthermore, parental exposure to ACEs has been found to increase child behavioral issues as children of parents who have experienced 4 or more ACEs have a 4.2 higher odds of being diagnosed with an emotional disturbance and 2.1 higher odds of hyperactivity (Schickedanz et al., 2018). Therefore, it is equally important to address parental ACEs and needs as child ACEs to ensure the health and well-being of the child.
Program Summary
This intervention is partnered with Pace Center for Girls, a nonprofit that provides both education and counseling to girls who have experienced significant trauma and cannot thrive at a traditional school. Through this grant 10 community health workers (CHWs) will be employed and paired with the families that attend this school to provide targeted education and counseling to the parents of these girls. The CHWs will meet with parents in their homes and develop individual care plans for the parents that involve getting them appropriate treatment for any possible mental or physical health challenges as a result of ACEs the parents experienced, connecting them to community resources such as support groups or childcare, and providing education to them on ACEs and how to prevent them. The goal of this intervention is to increase parental capacity and educate them about the effect ACEs have had on their children to better familial relations and help prevent ACEs in the future.
Trauma-Informed Principles
This program will be implementing SAMHSA’s 6 key principles of a trauma-informed approach to secure its success (SAMHSA, 2014). Firstly, this program will focus on the principle of safety by having CHWs visit the parents and families in their homes, where they feel safe and comfortable, rather than in a clinical environment. This will allow for trust to be built, which is the next principle. Trust is key to the success of this program as parents must be able to trust their counselors and CHWs to feel comfortable enough to adhere to their services and recommendations. This trust will be built through being transparent with parents about the aims and procedures of this program, as well as through consistent and genuine meetings with their culturally and trauma-informed CHWs. Peer support will also be utilized by providing parents with resources for support groups where they can share their stories and also hear from other parents who may have lived similar situations and are now trying to do better for themselves and their families. Collaboration and mutuality are also essential to this intervention as parents must feel that they are part of this process and not being told what to do. To accomplish this, CHWs must make it clear that there is no power differential between themselves and parents, but rather they are equals in this process to help themselves and their children. Empowerment, voice, and choice will also be utilized as parents will be guiding this process, letting their CHWs know what resources they truly need to be successful in their parenting and allowing parents to choose which resources to use. Finally, cultural and historical issues will be addressed as programmers will treat participants in a culturally and historically sensitive way, acknowledging that some families may be wary of staff and their intentions, but ensuring that they work to build trust with these families so they feel included and in control.
Levels of the Social Ecological Model
This project will address both the individual and relationship levels of the social-ecological model (SEM) as described by the CDC’s SEM (CDC, 2022a). This project will address the individual level as parents will be receiving individual counseling to help address their ACEs and begin healing their past traumas. Furthermore, CHWs will also be providing parents with a thorough education on ACEs and their effects on their children, as well as connecting them with resources that can increase their parental capacities. The program will also address the relationship level of the SEM as each of these three individual aspects of the program will ideally influence how parents interact with their children. The goal is that if parents are educated about ACEs and their detrimental effects, counseled and assisted in their healing, and given resources to help them care for their children, then positive relationships amongst these families will flourish and the incidence of ACEs will be reduced. These levels of the SEM were chosen in this specific instance as the organization this project is partnered with, Pace Center for Girls, already has strong relationships with the families they serve and thus it would be most effective to work with these families directly. Additionally, program leaders already know that these families are deeply affected by ACEs and could benefit from direct assistance to help reduce their incidence in the future.
Public Health Framework
This program will be comprised of both primary and tertiary cross-sector prevention strategies targeting ACEs (Feuer-Edwards et al., 2016). The primary prevention strategies will encompass the education and resource connection aspects of the intervention. Educating parents on ACEs and their effects will allow parents to evaluate and improve their parenting styles in order to prevent ACEs in the future. Furthermore, connecting parents to resources will improve their parental capabilities and ideally prevent the incidence of ACEs caused by parental struggles and lack of capacity. The tertiary prevention strategies will encompass parental counseling for their ACEs. Many parents who have experienced ACEs become part of a vicious cycle where they expose their children to ACEs due to a belief that those experiences are a normal part of life (Ports et al., 2021). However, many of these parents have severe trauma as a result of their own ACEs (Ports et al., 2021). These traumas must be treated properly to help begin to heal those wounds within parents and stop exposure to similar traumas for their children (Kiser et al., 2020). To accomplish all this, this intervention will employ cross-sector strategies as resources relating to mental health, health care, child welfare, early childhood, and education must be utilized to make this program successful.
References
CDC. (2022a, January 18). The social-ecological model: A framework for prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/violencepr...ecologicalmodel.html
CDC. (2022b, April 6). Fast Facts: Preventing adverse childhood experiences [Governmental]. Centers for Disease Control and Prevention. https://www.cdc.gov/violencepr...n/aces/fastfact.html
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. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
Feuer-Edwards, A., O’Brien, C., & O’Connor, S. (2016). Trauma-informed philanthropy, Volume One. ScatterGood. https://www.scattergoodfoundat...anthropy-volume-one/
Florida DCF. (2020). 2020 Florida youth substance abuse survey- Alachua County report. Florida Department of Children and Families. https://www.myflfamilies.com/s...-reports/Alachua.pdf
Kiser, L. J., Miller, A. B., Mooney, M. A., Vivrette, R., & Davis, S. R. (2020). Integrating parents with trauma histories into child trauma treatment: Establishing core components. Practice Innovations, 5, 65–80. https://doi.org/10.1037/pri0000109
Pace Center for Girls. (2022). Our approach. Pace Center for Girls. https://www.pacecenter.org/about/our-approach
Ports, K. A., Tang, S., Treves-Kagan, S., & Rostad, W. (2021). Breaking the cycle of Adverse Childhood Experiences (ACEs): Economic position moderates the relationship between mother and child ACE scores among Black and Hispanic families. Children and Youth Services Review, 127, 106067. https://doi.org/10.1016/j.childyouth.2021.106067
SAMHSA. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. SAMHSA’s Trauma and Justice Strategic Initiative. https://ncsacw.acf.hhs.gov/use...es/SAMHSA_Trauma.pdf
Schickedanz, A., Halfon, N., Sastry, N., & Chung, P. J. (2018). Parents’ adverse childhood experiences and their children’s behavioral health problems. Pediatrics, 142(2), e20180023. https://doi.org/10.1542/peds.2018-0023
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