172 – Adverse Childhood Experiences and Building Resilience
Dr. Sandra Morgan and Dave Stachowiak discuss the effects adverse childhood experiences can have on a person’s entire life. They also share tools that can be used to measure the impact these experiences can have and also the factors that influence a person’s resilience.
- Childhood experiences are predictors of future health.
- People self-medicate for their anxiety, depression, and fear in different ways.
- Depending on a child’s ACE score, it can be predicted that they will have a life of up to 20 years shorter.
- Drug addicted parents usually love their children, but their addictions steal away the relationship with their children.
- Remember the connection between prevention of adverse childhood experiences and the reduction in the risk of being sexually trafficked.
- ACE Quiz
- Adverse Childhood Experiences
- Resilience Questionaire
- 169: Dr. Jodi Quas: Communicating with Child Victims of Trauma
- TEDMED talk: How childhood trauma affects health across a lifetime
- Ensure Justice Conference Videos
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Dave: [00:00:00] You’re listening to the Ending Human Trafficking podcast. This is episode number 172, Adverse Childhood Experiences and Building Resilience.
Production Credits: [00:00:10] Produced by Innovate Learning, maximizing human potential.
Dave: [00:00:30] Welcome to the Ending Human Trafficking podcast. My name is Dave Stachowiak.
Sandie: [00:00:35] And my name is Sandie Morgan.
Dave: [00:00:38] And this is the show where we empower you to study the issues, be a voice, and make a difference in ending human trafficking. Sandie, today we’re going to take a look at a model that came out of a study from a number of years ago and you have an assessment under my nose as well that I have a feeling I might be taking here shortly.
Sandie: [00:00:59] Well, there was a study that began with the Center for Disease Control and Kaiser. And it’s called the ACE Study, adverse childhood experience, and the concept was that we have childhood experiences that are predictors of our future health, including mental health, behavioral health, everything. And even how opportunity works in our life. And so, we want to look at this as a predictor of how we better serve the most vulnerable for becoming victims of human trafficking or how that experience actually informs how we support victims and intervene on their behalf.
Sandie: [00:01:48] And so the first thing we’re going to do is look at the actual survey tool that’s used, and it’s called an ACE quiz. I’ve used it in my classes for years, especially when I first started teaching family violence because if you understand how that child, who is involved in a situation beyond their control, how that impacts their future then you can better create strategies for prevention and early intervention.
Sandie: [00:02:18] And so I’ve printed this quiz. It’s only 10 questions, and you will have a link for you to download it. But Dave I want you to take this, while I read the questions so everybody understands the direction that we’re going with this. You take the quiz and then we’ll ask you what your score is.
Dave: [00:02:39] Ok I’m ready.
Sandie: [00:02:40] The first question, did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you, or act in a way that made you afraid that you might be physically hurt? So, you answer yes or you answer no. And if it’s a yes, it’s one point. The next question, did a parent or other adult in your household often or very often push, grab, slap, or throw something at you, or ever hit you so hard that you had marks or were injured? Did an adult or person at least five years older than you touch or fondle you, or have you touch their body in a sexual way or attempt to have oral, anal, or vaginal intercourse? Answer yes or no. Number four, did you often or very often feel that no one in your family loved you, or thought you were important or special, or your family didn’t look out for each other and feel close to each other or support each other?
[00:03:43] And number five did you often or very often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? Or your parents were too drunk or high to take care of you or take you to the doctor? Number six, was a biological parent ever lost to you through divorce, abandonment, or other reasons? Number seven, was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her? Or sometimes often or very often kicked, bitten, hit with a fist, or hit with something hard, or ever repeatedly hit over at least a few minutes, or threatened with a gun or a knife? Number eight, did you live with anyone who was a problem drinker, or alcoholic, or who used street drugs? Number nine, was a household member depressed, or mentally ill, or did a household member attempt suicide? And the last question, did a household member go to prison, no or yes? So now you add up your yes answers and that is your ACE score.
Dave: [00:04:54] And my score thankfully is 0.
Sandie: [00:04:58] I give this every year, and the majority of my students in my classes are from 0 to 2. And then there are probably about 20 percent who are the four or five. And then there’s about 5 percent that are six or more. And I remember the first time a young student scored eight and we took our break and she was immediately right in front of me, “Am I going to be OK?”. And I learned that day, don’t give the resilience quiz after the break, give it before the break because there is a corresponding quiz on resilience. And so, the idea that this is a determining quiz. This is all of these bad things will happen to you is not true. When we figure out how to build resilience back in and we have to start from that perspective.
Sandie: [00:05:58] So we use the ACE quiz because it has a lot of validation. Later research now continues and it is more and more understood as a tool to use to be able to build prevention and early intervention strategies for kids that will have better outcomes and will build their resilience because the antidote to the adverse is the practices that build resilience.
Sandie: [00:06:28] So now we’re going to look at a diagram that shows the pyramid and we’ll have that in our show notes as well. And basically, the foundation of a pyramid, if you can imagine this as you’re listening, is if you have a high number of adverse childhood experiences, then all of these other things will compound your future expectations. And so next, if you have a high adverse childhood experience score you’re going to also have disrupted neurodevelopment. And we’ve talked about trauma-informed communication, trauma-informed care because if a young person, so this is your ACE score is built on your childhood under the age of 18 for practical research parameters. And so, if you had these experiences then there would be this sort of expectation that your disrupted neurodevelopment would then impact the next rung on the ladder, social, emotional, and cognitive impairment.
Sandie: [00:07:43] And we see things when students come to school after having had a terrible fight in their home, and maybe the parents coming to physical blows, and maybe the police are called in. And in a previous episode, we talked about the Handle with Care intervention that would recognize that these kids are traumatized by that. And the next day when they go to school they may not have had breakfast, they may have no lunch money with them, they may not even have their books available, they didn’t get a bath, they didn’t do their homework, and so that impacts the normal patterns of cognitive development.
Sandie: [00:08:28] So if you understand that might happen, you can begin programs, like Handle with Care, that intervene to start building resilience. Right at that moment, that’s going to change the outcome for that kid when they become an adult. But if that doesn’t happen we go to the next rung of self-medication, and people self-medicate their anxiety, their depression, their fear in different ways. Some resort to really poor habits like cigarette smoking, others begin to use even prescription drugs that are going to impact and possibly become an addiction. Or They’ll turn to socially acceptable self-medicating, socially drinking, going out with workers and not just having one beer but having a lot of beers. And so, we see the cycle that may have actually contributed to their adverse childhood experience. And we talked about this on a previous podcast, we’ll put the link in there, of drug endangered children now become parents, and their children are drug endangered children. So, this is not just something that happens in a linear or this pyramid model, but it becomes cyclic as well. And part of our goal by understanding this is to figure out ways to intervene and break that cycle after developing those health risk behaviors. And some people self-medicate with food. You put some salt and vinegar potato chips in front of me and when I was going to school, that was my calm me down, I can keep writing for another hour.
Dave: [00:10:21] It’s probably in a slightly different category. But if we’re going there are Haagen-Dazs ice cream would be it.
Sandie: [00:10:25] Haagen-Dazs, that’s right.
Dave: [00:10:27] There’s some in the freezer right now, Sandie.
Sandie: [00:10:28] Oh, let’s pause the tape. Seriously, these are self-medicating behaviors. And if you do it every year, you know you start getting it in December, here’s the best diet to lose that extra few pounds. This becomes a bad health practice of up and down in weight gain and weight loss. And how is that connected to the foundation of adverse childhood experiences and behaviors that you developed that became habits as a way to self-medicate and calm yourself? And that results in the diseases, the disability, the social problems, and a life expectancy that is significantly lower than your peers.
Dave: [00:11:20] Oh, interesting. What are their statistics on what the differences in life expectancy?
Sandie: [00:11:27] Yes there are. And they change from time to time but in some studies, the life expectancy depending on the severity of your scores can be correlated with a loss of 20 years. So, it’s not like, oh if you quit this, you’re going to get six more months. But if you can intervene on this, it’s a huge change in the quality of life. It’s a huge change in your ability to be a contributor to our society instead of a drain on resources. And I think that’s really an important aspect.
Sandie: [00:12:08] When you look at resilience, and this is where we meet the intersection between our focus on Ending Human Trafficking and my passion to intervene early to do prevention with at-risk youth who could become victims of commercial sexual exploitation. And people have this idea that prevention is going to be printing up a little card that has the hotline number on it and seven red flags and handing it to you and you’re a 15-year-old kid, and this is how we’re going to keep you from becoming a sex trafficking victim. Tell me how you, when you were 15 years old, and I know you were very advanced for your age, Dave, but when your parents told you not to do something that was your response usually?
Dave: [00:12:58] You know the defensiveness in all of the things that teenagers normally do I’m sure.
Sandie: [00:13:03] Well the literature shows us that these kids actually do become very defensive and they don’t process what the adults in their lives warned them about. They actually are already, and we all do this, we’re listening to somebody but we’re planning what we’re going to say. And so, we’re resisting. And for a young person, their resistance comes across as you don’t trust me, so we accuse you, or that’s not going to happen to me, that I’m really strong I can do this.
Dave: [00:13:37] I see that. I remember being that way myself, of course. And I see that even in our young kids, we have six-year-old and 4-year-old, and you know already I see those things come up. It’s always really fascinating to me reading some of the parenting articles that have the importance of being really concise. Like when you say something like that, of not going on and on where your kids are you know if not literally in their minds rolling their eyes.
Sandie: [00:14:02] And tuning you out.
Dave: [00:14:03] Yes, I read some really great article awhile back, I wish I could remember what it was. But it was just the importance of being really concise and clear and then being done and moving on to the next thing.
Sandie: [00:14:13] That’s a good tip. If you look at the resilience quiz.
Dave: [00:14:17] Oh there’s another one, alright.
[00:14:17] Yes. You take a look at that and read through a couple of those for our listeners.
Dave: [00:14:23] OK. For question 1, I believe my mother loved me when I was little. Question 2, I believe my father loved me when I was little. Number 3, when I was little other people helped my mother and father take care of me, and they seemed to love me. Number 4, I’ve heard that when I was an infant someone in my family enjoyed playing with me and I enjoyed it too. I would say all of those are true for me. And there’s a Likert scale here of definitely true, probably true, not sure, not true, probably not true, and definitely not true.
Sandie: [00:14:51] So if I’m in a community where I know there’s a lot of at-risk kids, I want to create an opportunity, not just to touch the life of that child but to bring the parents and create an atmosphere where they can play with their kids safely, where their kids know they love them. One of the experiences that I’ve had since I started working with drug-addicted parents is they absolutely love their children. That is not the issue. The addiction is the real issue and it steals a relationship.
Sandie: [00:15:34] But that child, because the adult doesn’t have the capacity to actually create that opportunity on their own because of the addiction, that child will grow up thinking, “well he never played with me,” so there you go. So, I believe that there are ways that we can start building resilience by actually working with the addicted parent or with the parent that is a perpetrator of domestic violence, to create opportunities that support the parent relationship. And there you can go through on your own, we’ll put the resilience document on there as well because there are other factors in here that begin to show how the external community can be part of reassuring and supporting a child.
Dave: [00:16:30] I had not seen these before, Sandie. So, it’s really interesting to not only read through these questions but also the research that’s based around this and the indicators we can see as far as how this really affects our lives and our quality of life like you said earlier.
Sandie: [00:16:48] One of my favorite TED Talks is a TEDMED talk, and it’s a pediatrician from Northern California and her name is Nadine Burke Harris. She absolutely does a brilliant job of showing the impact on health for adverse childhood experiences. And then she uses this illustration. We go across the world to communities where we understand that diarrhea and the malnutrition of children are related to bad water and we don’t just go and start treating diarrhea and warning people not to drink that water. We’ve developed incredible programs to dig wells to create filter systems for people in remote villages. So, they have access to clean water.
Sandie: [00:17:46] So we should be using exactly the same kind of thought process for preventing adverse childhood experiences. It’s doing this. So instead of seeing kids or 100 kids a day, we should be actually thinking about how do we go back to stop this. And one of the things I learned at Ensure Justice, which by the way go to our website and look up the latest Ensure Justice links and my team told me the other day the videos are all available now.
Dave: [00:18:22] Oh wow.
Sandie: [00:18:23] And there are some powerful things for you to learn about the link between substance abuse and human trafficking. So, the idea, one of the workshop speakers and trainers from an OB/GYN in an obstetrics hospital, where babies are born and they already have an ACE score of 4 out of 10 at birth. Because when you look at this diagram, that we have in our show notes, the diagram covers the timeline from conception to death. So, the things that happen in the womb actually are part of the research. And the research continues to grow and hospitals and research institutions continue to work with the CDC to build this. And it hasn’t changed, it’s actually become more focused and clearer that this is something we have to pay attention to.
Sandie: [00:19:32] So the nurses for labor and delivery, as well as post-delivery, began a program to follow those babies not just from the day they were born for the first month of life but for as long as it takes to support the parents. And they integrate these resiliency skills of parenting like creating safe places to play and integrating an opportunity for the dads to be there. Because most of the time those relationships, because of the drugs, have been broken. And the child doesn’t have a relationship with the father and I think that was the second question.
Dave: [00:20:17] Yeah, indeed.
Sandie: [00:20:17] And so the building in all of our programs an awareness of how we can correct by integrating resilience. That’s my goal in doing this particular podcast. So, when we look at the DOJ continuum of sexual abuse, sexual exploitation, and commercial sexual exploitation. And again, that diagram is in our show notes today too. That continuum is, well you know I teach the commercial sexual exploitation class. I teach one in person from our traditional undergrad program, but I also teach it online. And my traditional undergrad students are required to have a binder where they begin to keep their expert research knowledge, notes from class, we have special speakers, but I ask them to bring a binder that has one of those sleeves for the cover. And we put this particular continuum, it was funded by research out of Department of Justice and had participants from victim service delivery nonprofits from across the nation, five different regions, and this continuum starts with the abuse and takes us across to the final commercial sexual exploitation. And right at the beginning, you see that this diagram shows child abuse. And so, we already understand that that’s the beginning of the path for the majority of our commercially sexually exploited children. So then using this ACE tool is a way to identify a child that might be much more vulnerable than the next child. They look like they live in the same neighborhood. They look like everything is the same but the Adverse Childhood Experience quiz will help us identify the level of vulnerability.
Dave: [00:22:30] You utilize these in your classes, Sandie, and of course for the purpose of discussion and education around the assessments themselves and of the complexity of these issues. In practice, where would be the places that this would be given and how is that done logistically?
Sandie: [00:22:48] Well, I think that a lot of school counselors, teachers, child welfare case managers this is a quiz that can help them assess the level of vulnerability and kind of direction where on that resilience chart we need to be focusing our efforts. And this doesn’t have to be a quiz I print out and hand to you. That’s what I did for you, Dave because you’re not a child, right? But I can do this quiz verbally with a child, and get a pretty good idea of where they fit on this pyramid.
Dave: [00:23:30] And I’m guessing that especially with like the resilience questions here, that a child wouldn’t even necessarily know that they’re being assessed as just you know that there’s some conversation here about “oh tell me about your mom and your dad”.
Sandie: [00:23:42] That’s right, yes. And then when you look at the continuum and you begin to see how the abuse creates problems with low self-esteem. And when the child reaches an age, and you’ve heard us tell this story so many times of how runaways are recruited. So, they’ve endured all of this and then they reach an age 11, 12, 13, 14, who knows, where they stand up they wake up one morning and they’re like, “I don’t have to take this anymore. I’m all grown up. I can leave.” And they may pack a bag or they may have already been removed from their home for their own safety but they don’t want to live in a group home. They don’t want to live in a foster placement. So, they run away and because it’s not just the running away but the runaway part of their story is very connected to the abuse.
Sandie: [00:24:49] Now it’s becoming a practice in our schools to assess and to do prevention. So, in our schools, as we’re assessing possibilities, risk factors and we’re integrating mandated prevention curricula, part of the understanding has to be built on the idea that every child in front of you is not the same. Every child has a history of different experiences and some of the children in front of you have a very high ACE score, and they need to know that we’re going to be there to help build resilience. We aren’t going to deny this happened to them. We aren’t going to try to alleviate their anxiety because they know something’s not right by saying, “Oh it’s OK, it’s going to be OK. Don’t worry I’m right here with you.” No, we have to be intentionally developing resilience.
Sandie: [00:25:55] I know our time is just about up. So, we’re going to have to do a podcast at a later date that is totally focused on resilience. But at this point I want us to consider the connection between prevention of adverse childhood experiences and reducing the risk of being sexually trafficked. That’s a way we can use this research to gain more credibility in our schools and help them with finding their role in ending human trafficking from a prevention perspective.
Dave: [00:26:39] We’ve talked a lot about prevention on the show, Sandie, and of course one of the things we always try to be mindful of is bringing in these resources to you in the easiest possible way. And so, we have worked tirelessly on our team, and particularly Andrew, our editor, to get these resources up and to the show notes for you. So, we certainly would encourage you to visit the website at endinghumantrafficking.org. That is a wonderful resource to be able to track down the assessments you’ve heard today, the reports, the research, the links. But also on every episode, almost always we’ve mentioned a few of these resources, and we’ve got quite a library going, Sandie, over the last seven, almost eight years now of producing shows. So, check that out at endinghumantrafficking.org. If you have a question for us, maybe today’s episode is bringing up some questions for you around this topic, send us an e-mail feedback at endinghumantrafficking.org. That is a great way to reach out to us and to let us know how we can be of service to you. And if you’re on the website endinghumantrafficking.org join our newsletters as well, you can keep up to date on where Sandie is in the world and what she’s up to. And Sandie I’ll see you again in two weeks.
Sandie: [00:28:00] Thanks, Dave.
Dave: [00:28:01] Take care, everyone.