Looking at Adverse Childhood Experiences Through a Trauma-Informed Lens

Looking at Adverse Childhood Experiences Through a Trauma-Informed Lens


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What Most of Us Already Know About Trauma

It’s not surprising to most of us that traumatic experiences during childhood can have long-term impacts on our lives as adults.  The more we learn about the far-reaching consequences of mental health challenges like Post-Traumatic Stress Disorder (PTSD), anxiety, depression, attachment disorders, and other life changing diagnoses that can be caused by traumatic events, the more we understand the need to address and treat trauma victims with respect and regard for their past experiences.  This approach is called Trauma Informed Care.


But what many of us don’t know about trauma is that its impact on childhood is quantifiable in far more impactful ways as traumatized children reach adulthood.  Beyond the challenging and varied types of mental health diagnoses that traumatic events can cause for their victims, studies on Adverse Childhood Experiences (ACEs) have demonstrated that trauma correlates with an increased risk of physical health comorbidities like cancer, heart disease, diabetes, stroke, obesity, and COPD in adulthood.

Adverse Childhood Experiences and How They Impact Us Throughout Our Lives

What is an Adverse Childhood Experience, and how are they measured? An Adverse Childhood Experience (ACE) is a type of stressful traumatic experience that occurs during childhood. ACEs can include abuse, neglect, witnessing domestic or other kinds of violence, living with a family member that suffers from a substance abuse problem, living with someone struggling with mental illness, experiencing the separation or divorce of parents or parental figures, or having an incarcerated parent or family member.  The more ACEs a child experiences is directly related to an increased risk for physical and mental health challenges as they grow older.


But why measure ACEs? ACE scoring became prevalent in the mid 1990s when a landmark study conducted by the Center for Disease Control revealed that 12.5% of individuals who experienced 4 or more ACEs before their 18th birthday had a 390% increased risk of COPD, a 240% increased risk of hepatitis, a 460% increased risk of depression, and a shocking 1,220% increased risk of suicide.  Even for individuals reporting just 2 ACEs, the increased risk for adult alcoholism is more than double that of the control group. (https://www.cdc.gov/violenceprevention/acestudy/index.html).

So What Can We do About It?

So what does this mean for our community and what can we do about it?  In Baltimore City, the prevalence of ACEs is well above the national average with more than 30% of children reporting two or more Adverse Childhood Experiences (vs. 22% nationwide).  In a city where the leading causes of death are cancer and heart disease, and where life expectancies vary more than 20 years from one neighborhood to the next, it is critical to look at how ACEs impact overall well-being.  Here is where our agency comes in: we provide a holistic Intervention to our community’s residents through a trauma informed lens.

Trauma Informed Care (TIC) in the human service field that assumes that an individual is more likely than not to have a history of trauma. Trauma Informed Care recognizes the presence of trauma symptoms and acknowledges the role that trauma may play in an individual’s life.  Critical elements involved in providing TIC consider the widespread impact of trauma and understand potential paths for recovery; recognize signs and symptoms of trauma in clients, families, staff, and others involved in the system; respond by fully integrating knowledge about trauma into policies, procedures, and practices; and seek to actively resist re-traumatization (https://socialwork.buffalo.edu/content/dam/socialwork/social-research/ITTIC/TIC-whitepaper.pdf).

The Successful Family Permanency Model and Trauma Informed Care

In 2015, FamilyWorks Together launched the Successful Family Permanency Model, a 36-hour, 6-week intensive training for mental health workers in Baltimore City designed to provide clinicians, administrators, and organizational directors with a tool-kit to approach caring for their clients through a trauma-informed lens.  Participants gain a range of understanding surrounding the prevalence of childhood trauma in Baltimore City; the short and long-term effects of childhood trauma on children and adults, including substance abuse disorders, depression and anxiety, self-harm and suicide, as well as PTSD and more; cultural differences in how families respond to trauma, providing professionals with a more complex understanding of how trauma impacts families; the risk factors for vicarious trauma and burn-out in staff and professional providers; and best practices for implementing  a trauma-informed model that utilizes valid assessments that guide planning for treatment and intentional organizational approaches to trauma.  Attendees come from a diverse care background. Last year participants included staff from homeless intervention efforts, substance abuse treatment clinics, domestic violence shelters, AIDS/HIV assistance programs, low-income housing associations, hunger relief services, women’s shelters, were trained to approach clients using trauma-informed methods.


We believe that providing practitioners in Baltimore with the tools to address trauma is an essential key to addressing the morbid impacts of Adverse Childhood Experiences as our population grows.  The cyclical nature of many ACEs (abuse, neglect, poverty, substance abuse, etc) demands that we recognize that intervening in the underlying causes of these challenges is paramount in treatment planning.  The foundation of Trauma Informed Care is to first provide a safe environment for clients and caregivers, based on a collaborative and trusting therapeutic relationship.  The result is increased resilience and empowerment where skill-building can take place and where triggers and re-traumatization can be controlled.  Providing these crucial therapeutics skills to practitioners in Baltimore is one of FamilyWorks Together’s most important and meaningful ongoing missions as we move into the second half of 2017.


Learn more about ACEs and TIC here:


Got Your ACE Score?

Institute for Families: The Philadelphia Urban ACE Study

Substance Abuse and Mental Health Services Administration: Trauma-Informed Approach and Trauma-Specific Interventions

The National Council: Trauma-Informed Care

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