Action steps using ACEs and trauma-informed care: a resilience model

Abstract

This paper 1) discusses two important contributions that are shaping work with vulnerable and under-resourced populations: Kaiser Permanente’s (1998) Adverse Childhood Experiences Study (ACE) which includes the impact of adverse experiences in childhood on adult health and health behaviors and the more recent advent of what has come to be known as Trauma-Informed Care (TIC), programs which incorporate knowledge of the impact of early trauma into policies and programs. 2) Despite many positive benefits that have come from both contributions there are unintended consequences, described in the paper, that have an impact on research and program evaluation as well as social policies and programs. 3) Three key neuroscience concepts are recommended for inclusion in Trauma-Informed Care programs and practices in ways that can enrich program design and guide the development of practical, resilience-oriented interventions that can be evaluated for outcomes. 4) Finally, a resilience-oriented approach to TIC is recommended that moves from trauma information to neuroscience-based action with practical skills to build greater capacity for self-regulation and self-care in both service providers and clients. Examples from criminal justice are used.

Screening Adults With Substance Use Disorder for Adverse Childhood Experiences

“…Understanding the neurobiological changes resulting from the brain's response to a perceived threat, and the resultant sympathetic (SNS) and parasympathetic nervous system (PNS) activation, is imperative for understanding the impact of ACE on physical and mental illness (Agerwala & McCance-Katz, 2013;Leitch, 2017).…”

Developing content to promote desistance in men who have committed intimate partner violence in same-sex relationships

“…The GAM can be used as a framework to help any individual understand their pathway into IPV by enabling them to consider how their personal attributes (i.e., sex, personality and intersectional identities) may predispose them to IPV when triggered by certain situational factors. Recognising that personal attributes sometimes stem from traumatic experiences from an individual's learning history can enable practitioners to help participants explore relevant cognitive, emotional, physical, and behavioural symptoms of trauma within the context of a safe and supportive working relationship (Leitch, 2017). These values are consistent with strengthsbased desistance-orientated approaches, which aim to enable participants to form meaningful therapeutic relationships with practitioners (see Ross, et al, 2008); identify and build on strengths (McNeil, 2012); and, develop skills that allow them to lead a better life (Looman & Abracen, 2013).…”

Examining Multiple Health Behaviors

“…In this case, exposure to Adverse Childhood Experiences (ACEs) such as abuse, neglect, or other traumatic experiences that occur during the first 18 years of life may serve as the antecedent. For example, the more negative events a child experienced, such as sexual abuse, the higher the likelihood he or she will suffer from certain health and/or behavioral problems as an adult (Leitch, 2017). Behavioral problems such as poor diet, smoking, alcohol abuse, and illicit drug use may be used as coping mechanisms for past traumatic experiences.…”

“…Behavioral problems such as poor diet, smoking, alcohol abuse, and illicit drug use may be used as coping mechanisms for past traumatic experiences. However, these behaviors increase the risk for disease outcomes such as liver disease, cancer, stroke, depressive disorders, and high blood pressure (Leitch, 2017).…”