Children Under Stress: Preventing ACEs and Supporting Childhood Well-Being

Time & Location

2:00 - 3:00PM ET

Our nation’s children are under stress. Every year an estimated 3 million children in the United States are exposed to shootings and millions more are living with the far-reaching effects of the COVID-19 pandemic. In addition, more than 200,000 American children are now orphans, having lost a parent or primary caregiver to the pandemic.

The number of families experiencing hardships, including unemployment, food insecurity, and housing instability, rose during the pandemic, with a disproportionate impact on Latino and Black communities. Compounding these stressors are the adverse childhood experiences (ACEs) that most children experience at least once in their lifetime, such as neglect and abuse. Trauma experienced during childhood can have a lasting impact on health and well-being. At least five of the leading causes of death are associated with ACEs. This webinar explored actionable strategies to prevent ACEs and programs to support children and break the cycle of adversity. Speakers discussed:

  • The Centers for Disease Control and Prevention’s investments in implementing ACEs prevention strategies and opportunities for cross-sector involvement
  • Evidence-based actions that can create safe, equitable, and engaging learning environments, including trauma-sensitive schools
  • Establishing community programs and partnerships to build social and emotional learning and skills


Good afternoon. I'm Catherine Santoro, Director of programming at the National Institute for Health Care Management Foundation. On behalf of ..., thank you for joining us today for this discussion on adverse childhood experiences or aces.


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Our nation's children are under stress. Every year, roughly three million children in the US are exposed to shootings.


More than 200,000 American children have lost a parent or primary caregiver due to covert 19.


Millions of children have been exposed to economic hardships during the pandemic such as food insecurity and homelessness with a disproportionate impact on Latino and black communities.


These stressors are all in addition to the aces that most children experience at least once in their lifetime, such as neglect and abuse.


We know aces can have lasting negative effects on health.


five of the 10 leading causes of death are associated with aces.


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Today we will hear from a prestigious panel of experts to learn more about actionable strategies to prevent aces and programs to support children and break the cycle of adversity.


Before we hear from them, I want to thank ..., president and CEO, Nancy Chocolate, and the Nigam team who helped to convene today's event.


You can find biographical information for our speakers along with today's agenda and copies of their slides on our website.


We also invite you to join our conversation on Twitter using the hashtag Healthy Children Bright Future.


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I am now pleased to introduce our first speaker, doctor Phyllis Nylon, the Senior Scientist for Preventing Adverse Childhood Experiences and the Office of the Director of Division of Violence Prevention, National Center for Injury, Prevention, and Control at the Centers for Disease Control and Prevention.


In this role, she co-ordinates their work relating to the prevention of aces and collaborates with both internal and external partners on advancing the field of aces prevention and response. We're so honored to have her with us today to share CDC's commitment to preventing aces.


Go ahead.


Thanks so much, Kathryn, and thank you all for having me here today. I'm going to start us off by just giving a little bit of background on aces, and then, I'm talking about work that we're doing at CDC to support the prevention of aces.


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Adverse childhood experiences, or aces, are potentially traumatic events that occur in childhood, too, from birth to age 17, including witnessing or experiencing violence, experiencing neglect.


But also included are aspects of the child's environment that under mine, their sense of safety, stability, and bonding, such as growing up in a household with substance abuse problems, mental health problems, or parental separation or incarceration.


And on the left-hand side of the screen, you'll see the traditional aces that were measured in the original CDC, Kaiser aces Study, conducted in the 19 nineties, but, at CDC, and in the field of aces. And there's a great recognition that these really didn't capture the full range of, of traumatic events that can happen to children in childhood.


So, on the right-hand side, you'll see what we're, what we're kind of, calling expanded aces, or additional aces that weren't originally measured, but certainly have the potential to be traumatic and and cause toxic stress.


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So, aces and their associated social determinants of health, things like living in under resourced or racially segregated neighborhoods, frequently moving, and experiencing food insecurity. All of these things can cause toxic stress, which really is an extended or prolonged activation of the stress response system.


Some children may face further exposure to toxic stress from historical and ongoing traumas due to systemic racism or the impacts of multi-generational poverty, resulting from limited educational and economic opportunities.


And we know now from this study on toxic stress, and the biological impacts that it has on children. That the impacts are wide ranging, disrupted neuro development, and changes in the brain. That can have direct results on disease, disability, and social problems. But also, those neuro developmental changes from experiencing toxic stress can affect things like tension, decision making, learning, and response to stress.


To increase risk of becoming involved in crime and violence, using alcohol and other drugs, and engaging in other health risk behaviors.


And all of these can have significant impacts on life potential, susceptibility to disease, illness, and mental health challenges over the lifespan in early death.


And the effects don't stop there, They can be passed on to the next generation.


This slide really just demonstrates the number of different physical, mental, and behavioral health outcomes that have been related to aces, And we know that there is a dose response relationship between aces and all of these outcomes. So, the more aces a person reports having experienced in childhood, the higher likelihood it is that they will develop one of these health or opportunity problems.


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Oh, sorry, I've got behind on Sing, next slide, so I'm going to ask you to skip forward.


So, this is the slide that, that really demonstrates kind of all the different, um, health, physical health, mental health, and behavioral health outcomes.


The aces have in the dose response relationship that aces has, Sorry, I got got ahead of you to the next slide.


Now, I'll talk some about our, our surveillance efforts at CDC and that help us understand the prevalence of aces.


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So, the first and kind of most comprehensive way that we that we measure aces currently is through the Behavioral Risk Factor Surveillance System, or BRFSS. And this is an annual cross-sectional, telephone survey of health related risk behaviors, chronic health conditions and use of preventative services among Adult United States residents.


And there is a CDC sponsored aces module, which states can use to measure to measure aces and their relationship between aces and all these other health outcomes.


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So, as of 2020, all 50 states and DC have collected aces data at least once from adults since 2009. So we do have a paper hopefully coming out later this year that will give us an idea of the aces burden across all 50 states and DC.


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This is our vital signs on aces. That came out in 20 19 that was based on BRFSS data.


This was based on data from 25 states that had used the aces Module between 2015 and 2017 to estimate long term health and social outcomes in adults that contribute to leading cause of illness and death and reduced access to life opportunities.


We know from the BRFSS that aces are common, 62% of adults report at least one ace and as you can see from the top of that Vital signs Snapshot that at roughly one in six or 16% report having experienced four or more aces in childhood. And, as I said, we know that the accumulation of aces is linked to much higher risk of all of these outcomes.


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So this study that was, the vital signs was based on found that preventing aces has the potential to reduce leading causes of death such as heart disease, cancer, respiratory disease, and diabetes. And also can have that preventing aces can also have a positive impact on education and employment levels.


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But measuring aces among adults doesn't give us a good sense of what the burden or prevalence of aces is now, or any ability to monitor trends or changes over time, especially if we are implementing prevention strategies in states.


And if we want to understand the current burden of aces, prevalence, or monitor trends, we need to get a snapshot of aces from people who are still in childhood, which is where the youth risk behavior surveillance system comes in.


The wire BSS is run out of CDC's Division of Adolescent School Health.


And there's a national why RBS that produces national estimates of health risk behaviors. And then, also, there are state and local jurisdictions who administer The Wire BS.


And all that, for states in the US administer The Wire BS and many large school districts and several tribal nations also administer there's their own wire BS.


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In FY 20, CDC got its first ever appropriation.


for aces with this money and we're part of this money, we incentivize local administrators of The Wire BS to add either eight core aces questions.


So, there's really map onto those original aces questions on my first slide that were in the original study or 16 core and expanded questions to their local wire BS.


In 20 21, 21 state and local jurisdictions added either 8 or 16 CDC developed ace and positive childhood experience or PCE questions to their wire BS surveys for the first time.


And we look forward to seeing that data and, and starting to analyze it here very soon.


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This just capture, sort of what is in those two tiers of questions.


So, again, that those who did the eight questions, they map pretty closely onto those eight traditional questions.


They, we didn't ask about parental separation or divorce and emotional and physical neglect were combined into one neglect question.


Um, for Tier two, the ones who added 16 questions, they added those eight questions on aces, and then to past year, incidents, questions on emotional and physical abuse.


three of what we're calling Community ace questions, those are some of those expanded aces that were on the right-hand side of that original slide.


These questions asked about witnessing community violence, experiencing race, discrimination based on race or ethnicity and experiencing discrimination based on gender or sexual identity, and then finally, three positive childhood experiences, questions, as well.


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I don't have time to go into any of these in depth, but certainly can answer questions about them, and we have worked with the National Survey of Family Growth and the National Health Interview Survey, to add some aces questions to their survey.


The National Health Interview Survey is doing a pilot with adolescents, and said, that enables us to look at the concordance between adolescent reports of their own aces and Parent reports of those adolescents, aces. So, that's going to be exciting when we get that data in.


And then we've also been working with the National Survey of Children's Health, which already collects a lot of kind of those household challenge aces, but we are working with them to see if we can add questions on experiencing violence.


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So, preventing, sorry, I'm having some technical difficulties.


Preventing aces is a CDC priority.


Our goal is to sustain and create, create and sustain safe, stable, nurturing relationships, and environments for all children and families, and to help children reach their full health and life potential.


And that is a prime priority for the national one of the three stated priorities for the National Center for Injury Prevention and Control, where I sit.


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So CDC has produced a suite of technical packages to help states and communities take advantage of the best available evidence to prevent violence, including the many types of violence and social, economic, and other exposures in the home, and community that adversely affects children.


We, we, the first five on the left-hand side of the screen, are the original technical packages, and then we went through all of those and created a preventing adverse childhood experiences resource tool based on all the strategies that are evidenced based to prevent aces, as well.


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This is a quick snapshot of the strategies to prevent aces, which I'm going to quickly run through now.


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Strengthening economic supports for Families is a multi generation strategy that addresses the needs of parents and children so that both can succeed and achieve lifelong health and well-being.


The two approaches under this strategy are strengthening household and financial security and family friendly work policies.


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Changing social norms that accept or allow indifference to violence and adversity is really important in the prevention of aces.


Approaches under this strategy include public education campaigns, legislative approaches to reduce harsh physical punishment, bystander approaches, and efforts to mobilize men and boys as allies in prevention.


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The next strategy focuses on ensuring a strong start for children and paving the way for them to reach their full life. Potential.


Approaches under this strategy include: early childhood home visitation, high quality childcare and preschool enrichment programs with family engagement.


And all of these strategies can both have evidence base for both preventing aces and for mitigating the consequences of aces.


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Teaching skills to help parents and youth handle stress manage emotions, foster healthy relationships, and tackle everyday challenges of life is an important part of a comprehensive approach to prevent aces.


Approaches under this strategy include social emotional learning programs, safe dating and healthy relationship skill programs for young people, and parenting skills and family relationship approaches.


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The next strategy is about connecting youth to caring adults and productive afterschool activities.


These connections are important for both preventing aces and for buffering against the impact of aces among youth who have already experienced them.


And approaches under this strategy include mentoring programs like Big Brothers, Big Sisters, and afterschool programs.


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This last strategy focuses on timely access to intervention and effective care, support, and treatment for children and families in which aces have already occurred To help mitigate the health and behavioral consequences of aces, Strengthen children's resilience, and break the cycle of adversity.


Approaches under this strategy include enhanced primary care in which children and families are connected with referrals and resources by their health care providers, Victim centered services for children and adults, survivors of intimate partner violence, including shelter, housing, support, crisis intervention, legal intervention, and other resources.


Also, treatment to lessen the harms of violence exposures for children.


Then also treatment to prevent problem behavior and reduce risk for later violet's among adolescents who are demonstrating risky behaviors already.


And then the last approach under this strategy is family centered substance use treatment programs.


These are programs which simultaneously treat the parental substance use problems while addressing the needs of their children with this Aces exposure.


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So this is a slide on our Preventing Adverse Childhood Experiences Data to Action, Programmatic Effort. As I said, an FY 20, we got our first appropriation for aces and this was funded after that out of that appropriation.


These grantees are entering their third year and they are tasked with building and enhancing an aces surveillance infrastructure so some way to collect aces data within their strength within their state, um, to implement aces prevention strategies.


So, choosing a primary prevention strategy among the strategies that I just went through and then conducting foundational activities to really support a Data to action framework.


So, using the data that they collected, goal one, to inform and hone their prevention strategies among goal two.


I also wanted to mention programmatically, we can go to the next slide, our Essentials for Childhood, programmatic endeavor.


And these grantees are tasked with the goals that are here on this slide, and they use the, the strategies that are captured in the Preventing Child Abuse and Neglect Technical Package, which are very, very similar to the, to the strategies that I just went through, that are in the Preventing aces package.


So, these are two ways that, that CDC is providing support to states in order to try to really get these evidence based strategies out into the community and support prevention of aces.


And I know I'm over time before I wrap up.


I also just wanted to point out, and this is the next slide, that our veto violence website has five different trainings for adverse childhood experiences.


The first one that you see at the top is an overview and public health approach to aces. It's for people of all professions and education levels and, and audiences.


And then each of the four on the bottom or profession, specific aces trainings. So, the ones for mental health providers and pediatric care providers. The two in the middle have been on our website for several years. And we're really excited about the bottom left is the at the training for educators.


And that was just released in July and is out in time for the new school year, and then coming this fall is a profession specific aces training for faith leaders. And I'm sorry for going over time. I will stop there. On the next slide is just my final slide, and I'll turn it back over to Kathryn now.


Thank you so much for your leadership and CDC's leadership on preventing aces. Our next speaker is doctor David Osher, Vice President, an Institute Fellow at the American Institutes for Research. His work focuses on school climate and the conditions for learning and social and emotional learning, and we're so grateful to have David on our panel today to share his research on creative, creating safe, supportive learning environments.


Thank you very, very much, Catherine, and also thank you very, very much fill us, as well, after, I think you really set the stage very, very well for what we're talking about, and the CDC has and continues to do extraordinarily important work in this area. Next slide, please.


My work with others over the past half decade is really focused on ongoing interactions between what's happening within individuals and between individuals in environments and how that both contributes to both thriving. On the one hand, including well-being. And on the other hand, how it also contributes to ill being.


And the framing I'm going to give here comes from that. There are resources on the second page of the resources about the science of learning development and the synthesis that we've done that will provide the scientific basis for this work. That is not just done by me, but with a whole set of other people as well.


I think the key here is that individuals can thrive on language, of course dynamically, inter-dependent, individual and collective ecosystems.


And thriving in well-being Are not just individual collectives, then not just objectively things that we can measure. They're also subjected.


They're not just in any one domain, they occur across all life, those means, and those domains co act, and they're in all parts of every child, and every adults likes spaces.


And in those spaces, the experiences people have, the relationships they have between and among each other and environments, shape how adults and children interact and develop.


And this also shapes what we know about what contributes to resilience, or it'll be when a parent or a teacher is under stress.


They're less likely to be able to support a child who's under stress or who has experienced trauma than the opposite.


And it's very important to understand that when we think about intervention because the child is an important target.


But cheer, he's not the only target.


What also affects things is both among children and adults, the inter-related, cognitive, emotional, and cognitive capacities that people have an effect themselves and cognitive capacity, for example, is not your your basic intelligence level.


It's, it's, you bandwidth, can you do something, or can you not do something when you're working three jobs. It's much harder. When you're having more kids than you can handle, it's much harder.


Um, these capacities are affected by the conditions around people, we can help adults, we can help young people succeed and thrive and be resilient or the opposite.


Or they can be undermined And relationships, as I said, between people, the process of meaning making that they make individually and collectively, the effects of stress drive growth and development, which can be a good thing, or a bad thing. And when it's toxic straights, it's going to be a bad thing.


And the historical context matters.


The issues of expanded aces always existed. It's just the fact that the initial Kaiser Permanente ... database tended to be very, very middle-class and didn't pick up what we know has existed.


We now know it, and it's very, very real. And the current social conflicts, as well, heightened these issues. Next slide, please.


You may want to look at this document is Elite Lead After, which he is here because of the fact that I want you to think about just this model for a second. And instead, it's that's Dinette Diamond.


The dynamism is important and while this talks about how we can build success, think about reversing it.


It's also how we can create, you'll be, and as cast stated, a cascade of negative co actions and interactions and outcomes. Next slide, please.


We now know and the science of learning develop and syntheses that I and others have done really further establish it that aces are not destiny.


You know, when I adopted my children and who had experienced a bunch of aces, the people I was working with really tried to say to me at best which you could do this prosthetics.


this this 30 years ago, we now know that we can do a lot better than prosthetics.


We now know a great deal about the promise of neuroplasticity and what we also know what I know from other work that I do and other people do about the profound human capacity to learn.


Now, we also know there's a profound capacity to learn good things. There's also profound capacity to learn silly things.


The deep brain can heal and grow, people can learn to change.


Resilience, personal growth, and even thriving, are possible for everybody, but we have to create the safe and supportive environments to, to enable it to happen. We have to create, adapt, and support adaptable, caring, relationships between adults and peers, siblings.


We have to build around young people and adults, ecological assets.


And when we do this, we can create those three components thriving that you can read about if you look at that report. The floor's thriving, which is incredibly important, is well-being.


But thriving also includes a sense of ground doneness knowing where you are in time and place, feeling that you're connected to other people and a sense of individual and collective agency, that I can do something about it.


You all know the word S, and then blank happens, agencies about the fact that that might be happening, but I can do something about it, and we can do something about it. And that becomes really important when we think later on about trauma related interventions. Next slide, please.


I'm Catherine laid it out, you know, in terms of the variety of aces. I just want to point out again that these things really will connect very deeply and all sorts of different ways. You can look at the slide is some of the point.


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We can think about the conditions that perpetuate adversity and trauma.


And remember, that downward dynamic that I suggested, as well, um, you know, trauma, toxic, stress, complex stress, multiple and cascading traumas.


I'm not, you know, not just an individuals but connection between them.


You know, a traditional ace is having a parent who's been arrested ticket bet that ASE within the context of historical racism and institutionalized racism and the experience of black people with mass incarceration and understanding when a policeman comes in an arrest, a black person, more than a white person. That's not just an ace coming in. It's multiple different things that can co act.


There's also the possibility institutions, do them all the time of ..., does negative learning. People always learn.


Um, and there's the amplification, if it'll be.


And this happens by reversing air for all the good things I talked about before, by creating a threatening an unsupportive environments by using harmful interventions and building ecological risks and using harsh punitive uncaring, unsupportive approaches, or when we interact with other people.


Um, and I think Kathryn really talked about the extent to which, um, aces really affects young people in the long, short and long run. I will just say that, in addition, it affects issues of hope, it can affect your sense of connection and efficacy in the world. Next slide.


This comes from my colleagues at the Center for the Developing Child, who are part of the size of Learning Development Alliance.


And it really just reflect some of the things that Catherine talked about. I will not elaborate now, So we can go to the next slide.


And this slide also reflects the fact that we don't want to just be thinking about the individual, even though the individual is key. We have to think about those relationships, and we have to think about how those nested in communities.


And workplaces, including the inter co action between those different parts of a person's ecology. Then the effects of large social policy. And we've seen all of those play out in the last two years, in terms of covered, in terms of the racial conflict and so forth, and how it occurs within segregated communities and how it's experience differently with different levels of adversity. Next slide, please.


The key message here, besides focusing on adults, as well as on young people, is that support is the key facilitator of healing of growth and change.


And so that the happen, adults as well as peers and civil siblings, need the support so that they can attune to each other, and to it, troubling child, or tribal child, to provide emotional support and buffa stress to be culturally humble.


And competent and responsive and learn from others and listen, be empathic.


To support people's social cognitive and oceans and emotional development to provide both instrumental support, but also, provide relational support that is even as key, if not more key.


And, as I said before, stress fear and cognitive overlap, overload and a lack of empathy undermine the ability to provide support. We know the teachers or policemen who actually may know about implicit bias, are less likely to be able to handle that when they're under stress and under high levels of bandwidth bandwidth challenge. And then they go back to a default system that involves implicit biases, and there were, and that traditional tools that they learned to handle. Next slide, please.


No washes schools and other service settings address trauma because they want to realize their goals unless they're able to.


I mean, I won't talk about it here, but I think there really is a reason not just in terms of the needs of young people and families, but also the needs of the institutions to really collaborate and co-ordinate and create a trauma sensitive trauma informed system. Next slide, please.


And what I want to say to you is that we both want to create, trauma, is sensitive, places that include the ability to provide trauma, informed, more intensive interventions.


And we also wanted to make sure that those approaches are equity centered and centered on healing, and centered on creating the conditions in the long run.


And not just the short run, where people are more able to thrive and more able to prevent the fact the causes of ill being.


And if you look at some of the references in there, on the right side, and I particularly would refer you to the really important work by showing general, Jim Wright, who's at the University of California San Francisco, um, on his approach to dealing with community trauma, which I think is extraordinarily important and suggestive. Next slide, please.


I talked about trauma sensitivity and trauma informed, and this is for schools, as an example, because I do a lot of work in schools, but I also do, and my colleagues, doing a lot of work in other agencies, just to know that what we need to be doing, is to really not just focus on those people, who we know have been traumatized, We can't ignore that in any way.


We also have to know that both the people who we may not have seeing or screen for trauma may actually have experienced it, but also, they do things or don't do things that will affect other people in the environment.


Um, next slide, please.


Let me just talk for a second about the difference between a traditional environment and a trauma sensitive environment.


On the one hand, traditional environments, which are much less aware of the implications of trauma and how it affects behavior of children. And adults tend to be judgemental rather than asking, trying to figure out what's going on for the young person. And what can we do?


The focus is on fixing individuals', rather than creating a supportive environment that can help individuals heal, and also prevent what's happening.


A focus often in institutions and settings ends up being on management, on power, or an obedience rather and through control rather than power through collaboration through people's ability to manage their own emotions.


Traditional environments tend to be more reactive and punitive, good trauma sensitive environments are proactive and restorative.


Traditional trauma, environments are often siloed and they see children that exposure to trauma is being just isolated, whereas trauma sensitive environments, a much more integrated, and traditional environments, tend to be more deficit oriented, trauma sensitive environments, more strength based. Next slide.


Let me just say that a key element is not just educating your staff on its effects, and providing physically emotionally and identity, safe environments, but also eliminating the harmful ... things that are often done. Corporal punishment, restraint, suspension, disproportionate surveillance and harshest responses, Implicit and explicit bias, racial and cultural neutrality, School hardening policies that affect all children who have really experienced trauma and are dealing with it, but particularly minorities and marginalized children.


Next slide, please. And I'm going to now ended, because I'm at my end, just know that safety is not just physical, and it's also emotional psychological, and involves identity, among other things. Next slide.


I've talked about this. So let's go to the next slide right now.


And I won't, I just want you to know that what we really want, is also, not just to think about, I would suggest trauma sensitivity, but really transform, using transformative approaches, That, in the way in which we help people heal, we build individual and collective agency on the right, that's on there. It's in blue.


And then we do things that really builds the way in which people can, individually, collectively, both deal with things that have happened to them, but also prevent it from happening to them in others later on, which, in its own right, ends up being healing.


And let me go to the next slide.


And just to end this, I just want to say, and I'm just taking two very important, Kim chemicals that relate to our HPA system. one is oxytocin, As you know, it's something that really binds us. The other is cortisol. It's one of the stress hormones.


What we really want is to create environments, whether it's in families or schools or agencies, whether it's among peers or adults, the flowing of oxytocin which bounds but also is healing and actually helps people learn better.


And we want to minimize the level of cortisol that really when it's ever it's at a high level is highly problematic. I said, the following slides have a bunch of resources. I thank you very, very much. I'm happy to be available to you and I pass it back to Kathryn.


Thank you so much, David, and I'm excited to turn it over to our next set of speakers, who will be sharing some on the ground efforts, incorporating some of the concepts we've been talking about today. And we'll hear first from the Blue Cross Blue Shield of Michigan Foundation, and I will turn it over to Myra to start.


Yes, thank you so much, Kathryn. And, since 19 80, the Blue Cross Blue Shield of Michigan Foundation, we have been committed to providing financial resources for corporations, hospitals, universities, and community based organizations to address health and health care needs. And included in that is adverse childhood experiences, and the state of Michigan, we ranked 20th in the percentage of young people reporting to, or more aces, and 6 of 10 of our young people have at least one ace.


Now, specifically for the state of Michigan, we found that 72% of young people with four or more aces reported feeling sad or hopeless. and that's compared to 17% of children with no aces. And then, when we look at suicide risk, 46% of youth with four or more aces, considered suicide. And then 21% of youth with four or more aces, attempted suicide. And then in addition to that, we see our risk behaviors. And so 63% of the young people with four or more aces are reported not using a condom during intercourse.


And that is compared to 39% with fewer than four aces, and if we can go to the next slide.


So we have some amazing programs that are addressing aces on the ground. and six, since 20 20, we have awarded 25 grants. one of which you've heard of at a previous webinar and that is The Trails. The Transforming Research into Action to Improve the lives of students. That was recently provided with a $50 million state appropriations from the State of Michigan to expand its program from the Detroit Public School System and to bring that program statewide. Another program that we have is the Washtenaw Area Council for Children and this is teaching young people at the age of three about body agency. And then in addition to that, we have a program with the Ruth Ellis Center, which is helping to assist LGBTQ plus young people that are experiencing housing insecurity.


And today we have two amazing, innovative programs that we're so glad are able to come and speak to you, because this is really such an important thing to show the, on the ground approach. So we've heard a lot of the, the theoretical, and now it's time for us to hear about what's going on on the ground. And so the first that I'll introduce is a community university partnerships and community university partnerships. They are so unique.


They bring the combination of the research and then also the on the ground knowledge. And the second is a nationwide program. And this has been able to be replicated here in the state of Michigan. And previously, it's been done and racial and ethnic, diverse settings and then also in rural, urban and suburban communities. And first, I will turn it over to Leanne Al Amin and also Rapidly schur's need. And Lisa is a professor at Wayne State University. And Leann is the founder and executive director of the institute.


Thank you, Mark.


Good evening, ladies and gentlemen. My name is Liana ..., so happy to be here.


I am the Founder and Executive Director of the main Institute.


And the main institute is a Community Development re-entry corporation that was established in 20 15 to address issues that impact at ratio, as well as we turn its citizens in different areas in which they have found themselves to be faced with many barriers due to environment at home life and so forth.


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The main Institute provides transitional housing, my skills, peer-to-peer mentoring, education, health and wellness, skilled trades, construction, training for returning citizens at issue. We also provide health and wellness and financial literacy.


We use a holistic approach to recognize individuals who come to our program aberration for a dive back into the community who have been impacted by violence, mass, incarceration, and other entities distress them from being successful in the community.


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You've aged 16 to 24.


Predominantly African American families was our focus in this particular project, All of you participants are raised in low resource households.


Part of our recruiting strategy was to focus on Flinching or psi, one of the most hardest hit areas and not in the city of Flint is Genesee County. That has also been impacted by the Flint water crisis and a slew of other things from violence and mass incarceration. I won't go too much into the statistics. I will let my colleague, doctor ..., kind of address that aspect.


Go further.


Next slide, please.


So, directional.


The lives of justice involved individuals often characterized characterized by poor social ties, discrimination, health problems, and food insecurities.


Justice involved often turns to community re-entry programs for support after re-entry, re-entry programs mostly focused on employment and housing.


Can we introduce supported health and wellness programs into community re-entry programs with our focus with this particular program?


Next slide, please.


Program structure.


So, resilient workshops is one of the things, the tools that we utilize, individuals.


Grouping them as small groups, addressing the mental health.


First, a training, given them exposed to those resources, connecting them with mentors and other community systems. The purpose of the project for us was to really engage the young folks ages, mostly 16.4, and so forth.


Um, that was, um, antlers came from the north side to be really teach them how to be more resilient and to combat a lot of the social determinants that they're coming up against, Those who are connected to light.


Educational institution, workforce, health and services, and things of the search who have been impacted by are scales of violence and mass incarceration, was a main focus of the program.


To a multiple strategy, we were able to increase your awareness of the impact that it's repeated by exposure of trauma and violence, and what that does to their health and overall well-being.


Next slide.


I'm gonna let my colleague kind of speak to more of the outcomes, and go back more into the data. But I would like to add, also, that one way we were able to, again, to the far as on the program implementation side, was utilizing the health and well.


This program that we were able to create, which has like a nutritionist who teaches healthy diet, eating and eating habits and tools and things in which has a great impact, on how they think, and how they behave, especially those who have been no noise and come from these environments that's impacted by violence, mass incarceration, and things a search. Also, mentor ship is a big part of the program. Gaining young folks trust is critical before you can implement any kind of program. It's hard if you don't gain their trust. So, we focus a lot on mentorship, exercising. These are little simple things that we found to be very effective when you're trying to carve impact of what we will have the opportunity to see about what ace is. The soo young folks in these communities and so forth, other traumas and things that can have become barriers to their success.


Hi, everyone. I'm doctor Steen. And I'm working with Leon and the Maiden to Implement Health and Wellness Program.


Among returning citizens that participate in Made Institute program.


And a lot of the work that we're doing is really focused on developing and implementing a physical activity and nutrition program that caters to the specific needs of retirement.


We are working in this program in partnership with Michigan State University Extension, which provides nutrition education, will have a partner that does urban farming education as well, and a lot of what we're really focused on at this point is the feasibility and acceptability of implementing this kind of broken down among return.


And so, with that in mind, we have a few implementation outcome. First, we're very much interested in reach. Are we able to recruit and retain returning citizen in our programming that are representative of the broader population of attorney in the Greater Flint area?


Second, we're interested in fidelity. Are we able to deliver the program as intended? And, if not, what type of modification are necessary in order to effectively deliver the design?


And then finally, as an outcome, we're looking at, is the program acceptable to returning?


Is it the program that people are interested in continuing to participate in time?


And what can we do in order to improve the acceptability of the program?


So, these are just some of the outcomes that we're focused on in our partnership with the meeting.


Next slide.


Thank you so much, and now we're here from Latish Latisha Williams, who is a program director at Friends of Children Detroit.


OK, thank you so much.


Today I'm going to share the Friends of the Children two gen Approach impacting generational change in Communities across the states. How I work with our children affects the effects Aces in all of the information that has come for thus far in this in today's discussion. Next slide, please.


OK, now we were good, stay there!


Now, Go back.


Yes, thank you. We helped to make to break generational cycle of poverty, enrolling children between the ages of 4 and 6 and mentoring them through 12 plus years. In our program, no matter what.


We accomplish this, by applying a program model, which outlines a theoretical background of how our organization connects the daily work of our friends.


Our model identifies five strategies, anchoring program services, and outcomes.


We experienced success by teaching nine core assets, through intermediate outcomes of school success, pro social development, improved health, making good choices and plans and skills for the future.


As our mentees grow and excel in these intermediate outcomes over this 12 plus year, timespan, they experience the long term goals and outcomes of high school graduation avoiding the juvenile justice system, avoiding teen parenting, enrollment, employment, and enlistment.


Next slide, please.


Aces directly touches our work as our children must have two or more aces to enter in our program.


Many of our mentees come into our program with high risk factors, child high risk factors, and environmental risk factors as high as 8 to 10 at such a young age.


We experience and see aces in our work through life stressors and critical incidents. Life stresses are those environmental or individual circumstances with a negative impact on our daily functions and then our critical incidents which are incidents that occur in a youth's life that puts them at serious risk and harm. Next slide, please.


Our goal is to support children with the highest risk factors and the lowest protective factors.


We employ full-time salary, professional mentors, who we call friends, we make long-term commitments, and we stay with them, no matter what.


We continuously assess, evaluate to improve our work. Each dollar, as some of our outcomes, each dollar invested in our youth, return $7 to the community.


90% of our youth go on to enroll in post-secondary education, serve our country, or enter the workforce.


83% of our friends, youth earn a high school diploma or GED, while 50% of their parents did not have the necessary support to graduate high school, 93% of our friends youth remain free from juvenile justice system.


While 60, 63% of the parents have been impacted by the criminal justice system.


And 98% of our friends, youth wait for parent weight to parent until after their teen years, while 85% of their parents started parenting during their teen years. Significant outcomes that we can look to four X, our success, and how friends of the children is making an impact in the 25 locations that we currently serve. Next slide, please.


So, part of our program strength is in our 2 general 2 generational approach, that we call two gen. That impacts changes across generations, Not only for the youth before their families.


By empowering them to move beyond poverty, foster care, the criminal justice involvement, and move toward health, well-being, and community. And some of the, many of the instances and examples that have already been provided through other panelists today speak to how we create healthy environments in our home with our children, among our families and within our communities.


Next slide please.


And so, I'll close with just a snapshot from our summer camp. that was a couple of Saturdays ago, where we, couple of kids jumped in the Snapshot with us to take a picture with the ice cream truck. I think that was their second visit back. second or third visit back that day. And a fantastic time we had engaging our community and our families as a whole.


And I'll close with this, because it was best said by our national team, Our work has ripple effects on their siblings, peers, neighborhoods, and their children to help break the cycle of generational poverty. Thank you today.


Thank you all so much. And I'm going to ask our panelists to come off mute and back on video. We have a few minutes for Q&A.


We had a lot of questions on resources, and we will post links on our website, and there's a lot of links contained in the slides also that are on our website. So I wanted to start, We had a lot of questions coming and about how to involve educate parents on aces. You know, one question was, you know, how many parents know what what aces are?


If any of our speakers could share some of their recommendations on effective prevention messaging, without caregivers feeling blamed, especially, you know, if these are parents that experienced aces themselves. May I ask actually that the grantees start out with that because they do a lot of work on the ground that involves both the young people and then also the parents.


We honor Latasha OK, sure B the question, when an announcer.


How to involve educate parents on aces?


Yeah, definitely. I think some ways that we like to utilize is going back to meeting people where they are. You have to be involved.


Whether you have to go to the household, the schools be out in the community, Engaging with them, showing your face, and then once you build a report with them in a comfortable with you, then you can slowly began to inform them of aces and the impact that it has on our young folks, and even adults.


Also, I think, is, you have to have a collaborative effort, is not necessarily 1.


1 idea, or suggestion is gonna fit each and every individual, it takes community partners and so forth, as a way of arm to engage them, is what we like to utilize, We found to be very effective.


I would just like to add one thing to that, and thank you, Lee-anne, I think that is very thorough. Is to also create opportunities for them to get involved.


So, meeting them where they are, could include forming advisory board, so they now know that their voices matter. And we're not creating programs or strategies, or what outcomes that we think they should have, necessarily without an isolation, from what is actually happening in the home, or the trauma that they may have experienced in life. So, advisory boards, volunteer opportunities, inviting them into our community, and into our direct work.


OK, and, Katherine, if I can add and I'm in full agreement with what we teach here in Leon said, that, and this comes from about 45 years of working in communities, that.


David, osha research you've been looking at in the last 20 years is that I think that it, it is also really enabling people to see that, as I said in my slide here, I didn't know it 30 years ago, that aces not just destiny, even though we weren't talking about aces. That.


Because, I think parents are often bombarded with information that they may need to know, But it's only negative information, and they can create self fulfilling prophecies.


But I think, as well, the more you can help people understand the social context as well, that this is not just about you.


This takes place within a setting. And what we want to do is work with you to enable you and us to be able to do things, to really help heal and help your student, your children survive and thrive.


But also to deal with these things.


It's not, it's not about you, but it is about your ability to heal and come together. And we're with you as Leon, and let you, she said.


Just a tip for that, bad predictions.




Go ahead.


Go ahead.


I was just going to say, and real quickly, that, that we really can emphasize that everyone has a role to play in preventing aces. And then, a big part of preventing aces is the entire community supporting families, and that by supporting families, we can, we can do a lot to prevent aces.


So it kind of like moves it away from there, the onus, all being on the responsibility of the parents.




I was gonna say something very similar.


one of the things that we've been doing in Flint is educating the broader community about aces, such service providers, people who work with youth and families, know what they are, and then, you can then pass that knowledge on the other.


In addition, we've been working quite a bit with human service providers, unbinding programming to mitigate the negative aspect.


So, working with a broader community and not necessarily focusing on individual families has really been our approach.


If I can add one further thing, it's one of the ways you can enable and collaborate with families is also help them learn and understanding how they can in their interaction with institutions, like schools, what they should want to expect, and what they should worry about.


So that they just are not in a situation where they don't feel they can do something and they can help define what's the level of scripting they need help with and so forth.


Well, thank you so much. We are out of time. But want to thank our excellent panel of speakers for being with us and sharing all this valuable information, research perspectives, and thank you to our audience for joining and being engaged.


We will try to follow up on some of your questions and hope that you access the resources and a recording this event. And your feedback is important to us. Please take a moment to complete a brief survey that will open on your screen after the event, and you can also access ... other resources, including a recent infographic on aces. So, thank you all, again, so much for being with us today.




Phyllis Holditch Niolon, PhD

Centers for Disease Control and Prevention

David Osher, PhD, MA

American Institutes for Research

Audrey Harvey, MPH, CPH

Blue Cross Blue Shield of Michigan Foundation

Myra M. Tetteh, PhD, MPP

Blue Cross Blue Shield of Michigan Foundation

Leon El-Alamin

M.A.D.E. Institute

Rodlescia Sneed, PhD, MPH

Wayne State University

Letitia Williams

Friends of Children-Detroit


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