Looking for Advice: Resiliency Focus in an ACE conversation

Great question and focus, Katie. I don't know if this is helpful or not, but in some of the critical incident management and residual effect conversations and readings I do, it's clear that we have survived and often our child-that-we-were developed ingenuous solutions that can be pointed out, validated, reinforced. (Often ACEs don't carry with them this realization, many times quite the opposite, so it's a hopeful, helpful perspective to discuss.)  The next thing I'd add is that open-ended questions that allow them to talk about the solutions they found and how they view themselves are helpful departure points for this resilience conversation you want to have.  Last but not least, finding out what helps them stretch their current window/threshold of tolerance, and co-investigating strategies for that in advance of the next activation, all lead down the road to resilience.  Hope that helps in some way for the good work you're doing.

Hi Katie!  

I commend you for considering the use of the ACES tool.  I imagine Nadine Burke's center (Center for Youth Wellness) or Kaiser Permeante (in San Diego) could best answer your question as both of these places have used the ACES quiz as a screening/prognostic tool.   

As one caveat, I think it's important for people to recognize that the tool can be triggering for many.  In my personal opinion, the tool should be used in the context of high psychological safety - with a person that is trained to listen and has an established relationship with the patient. 

We are a culture uncomfortable with people's hurt and suffering.  As a result, we like to "rose color" glass (a Brene' Brown saying) a lot of very painful life experience.  That can cause damage.  It's like "rose coloring" a cancer diagnosis.  We need to make room for people to feel what they feel, to say what they need to say in the moment, react how they need to react - and to be psychologically held.  Otherwise, we can cause harm.  Again, just to say it one more time, our own discomfort and what we do to avoid it can cause harm to others.  

Again, I commend you for wanting to use the tool.  I think it's a powerful conversation starter and awareness builder.  You may just want to ask yourself, "Why?"  and "Can we do this with great care and provide high quality response for the person?"

Best of luck...

We recently attended a training that focused on resiliency. I was struck by the power of a simple exercise the trainer used.  They talked about ACES (enough so that the audience could quickly figure out what # they had) and then had the group look at the attached Resiliency graphic and circle those components that applied to them. Then they asked the group to discuss what it felt like to do that exercise and what they thought about as a result.  The table discussions were fascinating.  People then shared (publicly!) how through this simple exercise they realized where/why/how they had survived/thrived... how they themselves (or helping others) could identify additional ways to find/nurture resiliency.  

I don't know how it would work in a 1on1 setting but I'd be very curious.  This is a great question you've posted and I'm following.

Thanks for that - trying to figure out how to print it, will add to great resources.  Thank you.

Thanks for sharing the resiliency graphic.

Dr. Felitti found that JUST asking about ACES and listening to people decreased their use of services and improved their sense of well being.  The impactful questions were framed as: It shows on your survey that you experienced xxx, how has that impacted your life.

I think curiosity is such an important part of any conversation.  Compassion too, but not "I feel sorry for you"...

Jody

Katie [and ACEsConnection members/readers]:

While there are an assortment of both ACE screening tools and Resiliency measures, I'm partial to the World Health Organization's [WHO] "WHO ACE International Questionaire"--because of it's availability in over 100 languages, and seemingly more comprehensive list of 'ACEs'. There are probably quite a number of Resilience 'measuring tools': last time I checked my own scores, I had an ACE score of 6, but a Resilience score of 10--although I don't immediately recall which Resilience scoring tool I used. Perhaps all participants in this discussion can identify their preference and or rationale for their choice, especially when some 'scoring tools' are intended for adults, and some are worded [and have a 'readability'] intended for children.

Hey, Bob -- We have a link to the WHO ACE questionnaire, but I can't find a link to it in other languages. Do you have a link to the WHO ACE survey in other languages besides English?

Katie:

I LOVE this conversation. I am glad you are asking and inquiring and opening up this discussion for the benefit of all of us. My personal view is biased and I'll say that up front. I have an ACE of 8 and was furious when I learned about the ACE study in my mid-40s. It wasn't the ACEs info. I found hard but the fact that it hadn't been shared with me earlier in my healing, parenting and as part of my general healthcare. 

What is positive and resiliency focused can mean very different things to different people. For many, learning about the heavy and hard facts of ACEs is validating and affirming.

To me, the danger or silence is far worse than the danger of not having enough of a positive focus, though many share that same worry so I know it's a real barrier for people. I haven't heard those with high ACEs complaining that talking about ACEs is too hard or negative though. 

I think of it as validation even when there's not something to do. For example,   if  I have terrible symptoms related to vertigo but don't know what vertigo is, having a friend or medical professional say, "Sounds like vertigo" can be a relief. I know it's something with a name, something real, something others have and do have and something I can figure out how to weather if not cure.

That can reduce fear by a lot and that's positive. Plus, what  we learn about ACEs can be immediately actionable in terms of what we do as parents even if though it can't change the past. It can help us parent differently and to re-parent ourselves. If we understand how much good health can come from low ACEs that can be powerful and positively motivating. I went to a symposium at McLean Hospital last month and learned that the some residents now speak with a trauma survivor as part of their residency and training. This is done to help residents ask questions and consider how talking about trauma is for them, as residents, as well as to the people they are working with. This is done because so many people who have mental health issues also have experienced trauma. This is a new thing and has not always been done. It sounds like a great program to me.

I love that residents who often have fears about if or when or how to bring stuff up related to trauma, get to be in conversation with a trauma survivor who isn't a patient about their concerns, feelings, fears and to talk it through.

I think we need way more of those kinds of shared learnings and conversations.

 I'm not responding only to your question but the many questions related that have been asked and discussed in our community. We could have a whole book/handbook on how/why/when and where to share about ACEs in ways that have and have not worked well for others. There's so much already here and in past discussions, posts and threads. It's great to keep sharing.

Cissy

Hi Katie,

We also discuss resilience in any of our conversations or trainings, to help emphasize what strengths we have, how to add to our "toolbox", and the importance of understanding resilience as a developmental process, through the life span, and that resilience must be modeled, promoted, taught, lived... We emphasize the many ways to increase our understanding of both individual and also community resilience, both are important! Our materials help support this message of hope, help, healing. Best wishes on your journey!

Hello Katie,

When we did ACE screens(as part of an overall health history and as part of a public health family acuity tool) with families in Spokane, we used our ACEs flyer as a tool in talking about ACEs and how they can impact health throughout the life span. We also used it in talking about resiliency in guiding the questions around how the person has been able to make it through their experiences. Talked about how your score does not define you, but does impact you. So, this was a time of not blaming or shaming, but of meeting families where they are and really reinforcing the positives seen and a time of hearing their story.  (there are always positives to build on and families shared that this conversation validated their experience).  

Melissa Charbonneau

Nicely done and addressed, Melissa.  Thank you.

When we talk about ACEs science, Katie, we include trauma-informed and resilience-building practices as the fifth part of five parts. The other four parts are the the original ACE Study and subsequent surveys that add more types of ACEs (epidemiology); how toxic stress from ACEs affects the brain, especially children's developing brains; how toxic stress from ACEs affects short- and long-term health; and how toxic stress from ACEs can be passed from generation to generation (historical trauma) through changes in how genes function.

All these parts work together to tell the entire story of this new understanding of why we respond the way we do to adverse experiences in our lives, and how our traditional approach of using blame, shame and punishment to change people's behavior doesn't work. What does is understanding, nurturing and helping people heal themselves. Our goal is to institutionalize that approach in all of our organizations and systems.

Thanks so much for the Promising Futures; Promoting Resiliency Handout--we are doing a program next week and will use it in conjunction with asking participants ACE scores, anonymously and optionally. I have worked in a family medicine practice that used the Spokane Health ACE and Resiliency Two sided handout. Patients seemed to find it beneficial--sometimes tied together with doing an ACE score and other times just starting a conversation about these issues.  

Ellen, I am so glad that you are finding the handout helpful. The handout has been translated into Spanish along with another tool that we use. If that would be helpful, here are the documents:

11x17 1-2-3 Care Poster:
English/Spanish versions attached (Network Manager, 12/5/2017)

ACEs Original:
Post by Jane Stevens on Spanish ACEs Flier: https://www.pacesconnection.com/...tress-and-resilience Flier also attached to comment.  Link to post with Parent Handout in English: https://www.pacesconnection.com/...tress-and-resilience. 3 versions of fliers attached to the comment. (Network Manager, 12/5/2017)

ACEs Version 1:
http://teams/sites/Admin/commu...20rev%2012-04-15.pdf

 Jane Stevens did develop some alternate graphics from our original flyer, with National resources. You will find that information in the attachment that I will include with this post. I love to hear how the word continues to spread and how people are sharing the information!

Hi Katie! I love that you asked that question. Speaking from my own personal experiences with trauma,(now an ACE's survivor transformed to thriver) and my professional experience working with women who have a great deal of ACE's in their past and interviewing women who shared their childhood experiences; here is what I know...

* we all want to know that we are heard, seen and that we matter

* the most effective tools we have are A.L.L. that we need: Ask..Listen...Learn. 

* hurt, yet stable, people will talk when in a safe and trusting environment. Asking an open ended question, such as "talk to me about trust?" opens the door for a release of secrets and shame that often have never been spoken. 

* I encouraged people to write their version of their story out - all of it, every last bit of fear, hurt, anger and powerlessness. I tell them once it's out, we work on learning how to perceive their Story as a Gift and not a Curse. The 2nd step in healing is getting the survivor out of that "victim" mentality. You do this by challenging their perceived powerlessness by allowing them to see a choice always exists - it may not be a great choice, but nonetheless if we have choice, we have power. And by it's definition a victim has neither choice or power. THIS IS A CRUCIAL piece of moving beyond the story of their past.

* In my 25 yrs of having Conversations that Matter with women this is what I have discovered about resiliency...

 1. For some people, like myself, it's innate. I don't know why I never gave in but I didn't - I still don't

 2.  I always thought that "daddy issues" were at the root of a lot of women emotional baggage. What I have discovered is quite the opposite. If a women's mother has her "back" and is always there for her, the woman seems to do better in life. When a mother chooses a man over the daughter, not so much.

3.  The other critical piece to resiliency is having at least one adult who is consistently there with encouragement. One adult who believes in the child and tells them that - this doesn't have to be a family member. As an adult, empowering support is needed. ACE's survivors are often lacking in basic life skills and need support in this area.

Hope this helps! 

Feel free to contact me if I can be of further assistance. Info@LesliePetersRN.com and/or 610-506-8298.

With gratitude, Leslie

Hi everyone. Katie, thank you for asking the question and PLEASE let us know how plans go towards integrating ACEs into your program.  Please share your experiences with the community!

And thanks everyone for your comments, suggestions, experiences. I am so grateful for the open sharing that we see here in this community.  It makes me so hopeful for the progress we together will be able to make to raise awareness about ACEs and support each other and our communities to figure out what to do with that newfound awareness.

I'm seconding that motion - very grateful to have this community - I have very few like it, and so am very appreciative.  

I wanted to add my voice to Katie's post and say that I wholeheartedly agree on those principles she's invoking, nurturing, creating.

I'm adding this:   Many times the telling/writing/opening up the story or secret  they've been carrying is overwhelming and carries with it the frightening prospect of being too overwhelming, so...they've learned  'not to go there.'  Just the thought of opening this up can be too scary.  When they finally do open and 'go there' with us, I ALWAYS use Tapping or one of the EP protocols (in my own Emotional First-Aid collection) to keep them 're-telling' -- not 'reliving' the event.  In my experience  I've found this is a very safe way to proceed, maintain a good handle on the pacing while carefully calibrating their intensities, and starts building first-hand 'evidence' for the client -- that they CAN begin safely deconstructing their stories, one small activated aspect at a time, without the discomfort they feared.    

Hope this is helpful!

Cheers and kudos to all the fine people doing wonderful work on this. : )

Christine Cissy White posted:

Katie:

I LOVE this conversation. I am glad you are asking and inquiring and opening up this discussion for the benefit of all of us. My personal view is biased and I'll say that up front. I have an ACE of 8 and was furious when I learned about the ACE study in my mid-40s. It wasn't the ACEs info. I found hard but the fact that it hadn't been shared with me earlier in my healing, parenting and as part of my general healthcare. 

What is positive and resiliency focused can mean very different things to different people. For many, learning about the heavy and hard facts of ACEs is validating and affirming.

To me, the danger or silence is far worse than the danger of not having enough of a positive focus, though many share that same worry so I know it's a real barrier for people. I haven't heard those with high ACEs complaining that talking about ACEs is too hard or negative though. 

I think of it as validation even when there's not something to do. For example,   if  I have terrible symptoms related to vertigo but don't know what vertigo is, having a friend or medical professional say, "Sounds like vertigo" can be a relief. I know it's something with a name, something real, something others have and do have and something I can figure out how to weather if not cure.

That can reduce fear by a lot and that's positive. Plus, what  we learn about ACEs can be immediately actionable in terms of what we do as parents even if though it can't change the past. It can help us parent differently and to re-parent ourselves. If we understand how much good health can come from low ACEs that can be powerful and positively motivating. I went to a symposium at McLean Hospital last month and learned that the some residents now speak with a trauma survivor as part of their residency and training. This is done to help residents ask questions and consider how talking about trauma is for them, as residents, as well as to the people they are working with. This is done because so many people who have mental health issues also have experienced trauma. This is a new thing and has not always been done. It sounds like a great program to me.

I love that residents who often have fears about if or when or how to bring stuff up related to trauma, get to be in conversation with a trauma survivor who isn't a patient about their concerns, feelings, fears and to talk it through.

I think we need way more of those kinds of shared learnings and conversations.

 I'm not responding only to your question but the many questions related that have been asked and discussed in our community. We could have a whole book/handbook on how/why/when and where to share about ACEs in ways that have and have not worked well for others. There's so much already here and in past discussions, posts and threads. It's great to keep sharing.

Cissy

Cissy - can you share your handbook?

Reading through all the comments feels like a birth of an on-going virtual learning community on Katie's topic. Thank you for your question and initiating our conversation. Everyone's collective shared learning on what works well, what to be mindful of, creating safe/brace spaces, trust-building, as early adopters on the front line integrating ACEs Science is inspirational. 

There are such impactful resources and healing strategies shared in this post, concurring with your suggestion Cissy of creating a handbook, we could capture these nuggets and hyperlink to those individuals/organizations.

Wondering if any members know of professors at colleges/universities who are in need of project-based outcomes for their students' internships for Spring, 2018?

Hello friends,

I have developed a small group activity to facilitate/introduce conversations about the NEAR sciences (neuroscience, epigenetices, ACEs, & resiliency). I am an ACEInterface certified speaker in WA State and I love how adaptive and flexible the curriculum is to facilitate powerful conversations. I also believe that having stories/metaphors are powerful and important for communicating the science, so I adapted the "Tipping the Scales" game from the Harvard Center on the Developing Child website to be an interactive group activity. 

NEAR Teeter-Totter Activity - video; vimeo link

For some reason your link didn't work. Could you try again?

Sorry about that, not sure why the link doesn't work. Here it is...

Vimeo link: vimeo.com/252719982

Kody - that's awesome!

Thanks, I hope it is useful. Feel free to reach out if you have questions about the activity. 

Jane Stevens posted:

Hey, Bob -- We have a link to the WHO ACE questionnaire, but I can't find a link to it in other languages. Do you have a link to the WHO ACE survey in other languages besides English?

Jane, I was just on the WHO website tonight, and I had to 'Search' for it, as it, and the link to both the ACE IQ, and 'User's Guide' were no longer where I'd found them on the lower right quadrant of their main webpage. A copy of a report on the ACE-IQ, which I printed from the website, didn't come with their web address on the bottom left line of the page. It reported on the 'Field Testing', between May 2009 and March 2011, of the draft ACE-IQ having been tested in China, the former Yugoslav Republic of Macedonia, Phillipines, Thailand, Saudi Arabia, South Africa, and Vietnam. I do recall David Finkelhor's 'cautionary article'-last year  having the web addresses of documents he cited in his article in his references, but I don't recall him differentiating between the WHO and CDC versions of the ACE questionaires. I'll try to get back to this later.

Thanks, Bob!

Hi Jane, I've spent 15 yrs working in the homes of low income women. If I can be of assistance please let me know! 6105068298.

ALL you need to know...

Ask, Listen, Learn 😄 with honesty, authenticity, vulnerability, interest. Just be real. 

Oops, sorry..meant Katie

Also, the NEAR@Home toolkit for home visitors has some fabulous scripts for conversations that include resilience & ACEs.