What is ACEs and Why Should You Care?

Journey mapping from one of Susan Jones’ recent trauma informed workshops.

Journey mapping from one of Susan Jones’ recent trauma informed workshops.

Here’s Part 2 with longtime friend, collaborator and HEP practitioner Susan Jones, founder and principal of Creative Behavior Systems. You can check out Part 1 here.

It’s a great overview of Adverse Childhood Experiences, a research study-turned-movement that encourages us all to measure, understand and heal from our childhood.We all carry trauma in various ways and at various levels; trauma is a scary because we all naturally connect to it. We’re human. What’s now understood through studies like ACEs is that adults can heal their brains and bodies many years after trauma has occurred. It’s not like you hit your 20’s and just hope for the best (I had a conversation recently with an old friend who admitted this fear that’s how it goes…30 years later).

Susan’s mission in her work and in her life: to help people of all ages (not just the kids) begin a path to healing themselves, their families, their workplaces…it’s all connected.

HEP: Hi Sus! First question: we’re hearing more and more about Trauma-Informed these days. What is Trauma-Informed and how do you approach teaching it to others?

SJ: A lot of people don’t know what’s Trauma-Informed or where it came from, so let me start with the ACEs study. The ACEs study was back in the mid-90’s; ACEs stands for Adverse Childhood Experiences. Dr. [Vincent] Felitti and Dr. [Robert] Anda had pretty good ideas in their experiences as physicians that adverse experiences in childhood had very direct correlations to very specific health outcomes. So, they did a study of over 17,000 participants, and made the distinct correlations between pretty specific and common health outcomes that they and others were seeing. These outcomes were and are very prevalent, they were able to directly connect prevalent outcomes to adverse situations in childhood, such as abuse and neglect.

The ACEs assessment is now online. Anybody can do it. There are 10 questions that are in the 10 different categories from the study. And for each question that you can answer a “Yes” to, you get an ACEs score of one. So, an ACEs score of 10 would mean that you had significant abuse and trauma in your childhood and an ACEs score of one or two is a much lower level.

That’s the pretty simple overview of the ACEs study. What it uncovered was that two thirds of the population has an ACE score, so the prevalence of trauma across the world is incredibly common.

HEP: Has the ACEs study been used outside of the US, so there’s enough data from other parts of the globe that this isn’t just an “American Problem”?

SJ: Yeah, absolutely. Jane Stevens, the author of the ACEs study, started her first website to raise awareness of the prevalence of traumatic experiences. It’s called ACEs Too High, and it has a little bit more of a journalistic approach, but she also started ACEs Connection, another web resource which is like a community building and resource sharing platform. It helps raise awareness of Trauma-Informed practices that are predominantly county-based in the United States, but it’s also connected people all over the world now.

HEP: Talk a little bit about how you learned about ACEs and how you became involved with the Sacramento County Chapter.

SJ: Several years ago, my daughters’ friend was dropped at our house by her mom. I was sitting on the front porch, and so we met and talked. She asked me what I did for a living, and I explained I worked as a behavior specialist in schools. That I was particularly focused in setting up systems of engagement and positive behavior and restorative practices, and really just teaching the connection and relationships and creating trust in environments. How I believed this is going to increase academic engagement for students in classrooms and create more of a feeling of community for students in schools. She looked at me and said, “Oh! You teach Trauma Informed.” I had no idea what she was talking about.

She brought me in to the very first county-based ACEs Connection group, which Jane Stevens was a part of in Yolo County, California [note: Davis is a city in Yolo County, it’s where Susan and I grew up]. That’s where I started. But because I did the majority of my work with schools in Sacramento County, I helped create the first ACEs Connection group in Sacramento County, now Resilient Sacramento. It is a functioning, wonderful group of individuals who are all very interested in teaching Trauma-Informed practices and raising awareness to all of the arenas of trauma in Sacramento County.

There’s Resilient Sacramento and then the one in Yolo County is Resilient Yolo, because being Trauma-Informed is all about teaching resiliency.

HEP: So the ACEs Connection website is really like a platform that different organizations, whether it’s a school or folks in the criminal justice system, or just somebody who is new to understanding ACEs, can go and not only learn about what it’s about, but meet others who are doing this work. Correct?

SJ: Correct. And there are different arenas. There’s Trauma-Informed and building resiliency, it’s all just about how people interact and connect with each other. This teaching can be done anywhere and in any arena, in any organization, school, classroom, medical field, the office, hospitals…any place where there are people.

HEP: And this isn’t just about working with kids, Adults can actually learn a lot from this and potentially get on a path of healing of some kind, is that right?

SJ: Correct. Actually part of the raising of awareness of being Trauma-Informed, first and foremost is having a really significant understanding that this isn’t about “them” or “those people”.

Being Trauma-Informed is having a significant awareness of, what is our own bias, reactivity, our triggers? All of that is based on our own personal life experiences and how it comes out in communication and behavior. I believe that that’s the first step in truly being what is considered Trauma Informed.

There’s a significant teaching of the ACEs study and what trauma does to our neurology and physiology, but I think a lot of people think that that is in fact being Trauma-Informed without taking it the next step, which is how are we connecting? How are we creating those emotionally safe environments? How are we reacting and responding, and are we even aware of our own level of reactivity?

HEP: So if you’re talking about, for example, in a business, a corporate setting, it’s the taking into account how employees, including leadership teams support one another or don’t support one another. And from there, really, that’s where stress and dysfunctional behavior happens, because people aren’t really understanding how to help each other.

SJ: Absolutely. I think so many people may be even not even aware of the way that they react to…whatever it is that’s happening in front of them is directly connected to their own life experience.

What I mean by life experience is, were they raised with abuse or neglect or were they raised with even something, a low level, traumatic experience, such as shame. Shame and blame are alive and well in this world right now and a significant amount of people react and respond based on their belief that they are not just not valued or don’t have that sense of belonging to whatever system or group or connections that they have in their lives. Behaviorally they react and respond and it becomes about them instead of reacting and responding to what is actually happening in front of them. So, we’re adding layers and layers of dysfunctional communication based on our internal experiences of our individual lives.

HEP: Ostensibly then, you could have somebody who comes from a very privileged background, who was a really great student, who excelled in college, who ended up becoming a CEO of a very successful company, but could still be holding, could still have a very high ACE score.

SJ: Absolutely. Behaviorally, one of the things that…well, I’m going to touch on the opposite first, just to have a better understanding of what I’m about to say next, which is, a lot of people will immediately think that if you live in chaotic situations as a child, if you’re poor or if there’s neglect or abuse, you’re going to act out in certain ways, and that’s in fact true.

So there’s functions of behavior and a lot of times that we see, especially in school settings, because that’s where I’ve been in the last 20 years, is adults will quickly say, “Well, that child is just trying to get attention”. And in a way that allows the adults to wash their hands of the situation and blame the child for the behavior, without actually diving in and looking at what is influencing the behavior. Most of the time when you have your neurology and physiology escalated, and you are used to living in a chaotic environment, and then you come into a situation that is very nurturing, supportive, caring, there’s clear expectations, everyone is working as a whole in one direction and that makes you feel, literally, like a fish out of water.

So, what are you going to do? You’re not going to gain attention, you’re going to actually disrupt that environment, because then the environment matches what the feelings are internally, which is chaos and a feeling of out of control. So control is a function of behavior that is often viewed in correlation with trauma.

Now we can go to the higher functioning, the more seemingly on the outside, families and children and successes are exuberant, but often times, you’re correct, that sense of needing to be a perfectionist or things absolutely being in a very specific order, is in fact having that external need for control, because what’s happening on the inside is so out of control, so chaotic.

So, yes, a very long answer to say yes.

HEP: One thing that comes to mind as well is social determinants of health. It’s a term I read and hear more about more and I hear about more. When we refer to social determinants of health, how is that connected to something like ACEs?

SJ: I think the first thing that comes to my mind is I’m really frustrated with the healthcare system. In my life, in my 52 years, the healthcare system, I have watched from myself to my children, to my parents, care is often individual systems being cared for, without actually looking at the whole.

And I do know now there are a lot more medical doctors, physicians that are looking at the whole system. The brain is such a significant component of our entire, our physiology and neurology and especially connected to trauma. The ACEs study showed the correlation, a very specific health outcome, which are treated by looking at the smaller arenas, the areas of whatever it might be. I’m struggling with the medical field because I’m by far not a doctor.

But you can imagine, you go and you’re having one symptom and your physician treats the one symptom, where the research has actually come out and shown that if that doctor says to you, “So, how are you? What’s happening in your life?” And actually connects with you for just a few seconds or minutes, your immune system increases.

Social connectedness along with the social determinants of health is so integrated and I don’t think we are … I don’t even think that we’re in the beginning phases of understanding how incredibly important all of this systems work is. I’ve always said that I do systems work predominantly in communication and how to address behavior and again predominantly in schools for the last 20 years, but working with many organizations now outside of schools, it’s given me the awareness that it’s all the same everywhere. We can’t continue to look at one piece. We have to continue to look at the whole, in the entirety, and that’s really overwhelming.

HEP: Getting back to ACEs then, are medical schools starting to teach it? Is this something that is becoming more of a mandatory teaching in the health field?

SJ: Raising awareness, it’s actually shocking to me. I was driving last week and I was listening to the radio and I was listening to an interview of a very public figure about an event that is happening in our nation right now, and I was shocked, I almost … It was difficult to continue to drive because of my excitement, because I heard a mediator interrupt… I’m not quite sure if I’m using the correct language, but it seems like some sort of prosecutor, somebody who was questioning. Anyway, somebody interrupted the interview that was being broadcast on the radio while I was driving and said, “We need to remember that our questions are to be in a Trauma-Informed manner. I literally just about crashed my car! I was blown away that I’ve heard that in this top of the news moment, and was just elated, because there are so many people that have been in the ditches and running and working so hard for so many years, Dr. Nadine Burke Harris, is one of them.

I highly recommend anyone who wants a good 20 minutes, very informative “aha” moment of all of this Trauma-Informed and ACEs study work, to watch Dr. Nadine Burke Harris’s TED Talk. It’s been out for a few years now and it is just an excellent way to get a better understanding of how her compassion and her philosophy from being a pediatrician, and how she has hit significant brick walls that her organization, Center for Youth Wellness, has done some amazing work and even her work going into the legislative arena of bringing Trauma-Informed practices as something that is mandatory, and again in all arenas.

What I have been watching and following lately, is a lot of the legislation has not been passed because the language is just written in too broad of a manner. Unfortunately, the people who are very compassionate behind the Trauma-Informed movement, are writing it in a very broad manner probably purposefully because it really is for everybody. But understanding the political movements and how things have to occur, it’s coming, but it’s not quite here yet.

HEP: Is Trauma-Informed a component or an outcome of the ACEs study? Can you talk, again, a little bit more about that relationship between Trauma-Informed and the ACEs study?

SJ: As I started at the very beginning, the way that I see Trauma Informed is literally looking at our own individual life experiences and how it has driven our, how we react and respond to any situation, and of course staying away from unsafe situations. I’m not talking about being in an unsafe situation and you need to respond in a Trauma-Informed manner. That’s not what I’m saying.

I’m saying that our reactivity, our responses, being Trauma-Informed is being able to understand that another person’s behavior or whatever is happening in front of you might be triggering your own potential life experiences. Trauma related or not, we are not aware of what the individual’s behavior is really connected to, unless of course we know that person well, like they’re somebody who’s in our inner circle.

The majority of people in the world are very reactive and I think it’s very much connected to the fact that the ACEs study has shown the prevalence of traumatizing situations in life and we need to be aware of not adding those additional layers to the communicative dysfunctions, which come out behaviorally, because literally, we’re triggered. I should also say that the Trauma-Informed world is focused on building resilience and the only way that you can build resilience in another individual or yourself is to be able to stop. And as my sweet friend Kate says, “Stop and take a look in the mirror at what it is and how it is” that you’re responding. Once you have that awareness of how it’s connected to your neurology and physiology, then you have a much better understanding of what could be happening right in front of you with another.