The Problem: A Costly Epidemic of Childhood Trauma Across New Mexico and the entire nation, our children endure adverse childhood experiences (ACEs), trauma and social adversity. This is a costly public health crisis impacting families, schools, campuses, workplaces and local economies.
ANSWERS TO YOUR QUESTIONS
What’s the magnitude of trauma impacting us?
“We are the product of our childhoods. The health and creativity of a community is renewed each generation through its children. The family, community, or society that understands and values its children thrives; the society that does not is destined to fail.”
—Bruce Perry, MD, PhD, author of The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook — What Traumatized Children Can Teach Us About Loss, Love, and Healing (with Maia Szalavitz)
“This is the thing that’s so powerful about the adverse childhood experiences study—it really revealed this connection between childhood adversity and health problems.”
—Nadine Burke Harris, MD, author of The Deepest Well: Healing the Long-Term Effects of Childhood Adversity
“Reading a book about childhood trauma is, in many ways, like waking up from a bad dream. The fog that once obscured this tragic corner of life slowly clears, and the more you learn, the more you see children at risk all over the place, facing adversity and trauma, as you go about your everyday life.”
—Anna, Age Eight authors, Katherine Ortega Courtney, PhD and Dominic Cappello
Trauma is so pervasive in our society that it takes a rather comprehensive survey just to delineate the types of traumatic events children are experiencing. The adverse childhood experience (ACEs) survey, first published in 1998 as part of the ACEs Study by Doctors Felitti and Anda, asks a person what form of adversity he or she experienced as a child. It’s a checklist of potentially traumatic events with varying degrees of severity. In the book guiding the Anna, Age Eight Institute, Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment, we leave the language of academics behind in order to describe most of these experiences as “terrible, horrible, no-good and very bad.” The truth is that ACEs have led to an epidemic of childhood trauma and untreated adult trauma with costly emotional, physical and financial consequences. Our families, schools, campuses, workplaces and local economies may be diminished by ACEs and the trauma and substance misuse associated with it.
What does the ACEs survey reveal about us?
A large percentage of the population has endured various forms of ACEs in the form of abuse, neglect and living with adults misusing substances, inflicting domestic violence, experiencing mental health challenges, involved in a divorce or engaged in activities leading to incarceration.
With a quick online search, one can learn how the ACEs survey is being used with adults, teens and children locally and across the nation. Some communities use the results as a call to action, advocating that local governments fund trauma-informed behavioral health care in school and community settings, along with vital services shown to strengthen families. On the other end of the spectrum are government leaders who think that adversity is character-building and if people are traumatized, then they should fix themselves without community support. Whether brought up in a school board meeting, a community center or a state’s legislative committee, ACEs are a public health crisis that brings up many strong opinions.
The ACEs survey is finding its way into popular culture – there’s even an app with the ten question survey that young people are finding on their own.
The ACEs survey that follows may bring up many memories and questions. Depending on a person’s score and form of ACEs, it may also bring up feelings of sadness, fear, anger, confusion and trauma. We recommend that people have access to a friend, family member, mentor, colleague or counselor to discuss the results with. We strongly recommend that all community and education organizations do a thoughtful assessment of their capacity to provide behavioral health care, before administering the ACEs survey.
ADVERSE CHILDHOOD EXPERIENCE SURVEY
ONE: Did a parent or other adult in the 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?
TWO: 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?
THREE: Did an adult or person at least five years older than you ever touch or fondle you or have you touch their body in a sexual way? Or attempt, or actually have, oral, anal or vaginal intercourse with you?
FOUR: Did you often or very often feel that no one in your family loved you or thought you were important or special, or that your family didn’t look out for each other, feel close to each other or support each other?
FIVE: Did you often or very often feel that you didn’t have enough to eat, had to wear dirty clothes or 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 if you needed to go?
SIX: Did you live with anyone who was a problem drinker or alcoholic? Or who used street drugs?
SEVEN: Was your parent or stepparent often or very often pushed, grabbed, slapped or hit by a thrown object? Or sometimes, often, or very often, kicked, bitten, hit with a fist or hit with something hard? Or ever repeatedly hit for at least a few minutes or threatened with a gun or knife?
EIGHT: Was a household member depressed or mentally ill? Or did a household member attempt suicide?
NINE: Were your parents separated or divorced?
TEN: Did a household member go to prison?
Review the interactive Adverse Childhood Experiences survey below to understand what it can reveal to people of all ages. The ACEs survey is not provided here to serve as a diagnostic tool. It is provided to promote awareness of ACEs and encourage dialogue about the impact of adversity and potential trauma.
Reflecting on the results
Much is written on what an ACEs score can tell an individual. Currently, there are more than 1,000 books on childhood trauma listed on Amazon, most having a self-help/behavioral health care lens.
Unsurprisingly, the levels of adverse childhood experiences like those listed above can predict to a degree all kinds of risky behavior later on in life. If too many ACEs are experienced during childhood, pretty soon the risk of suicide, alcoholism, illicit drug use, prescription drug misuse, smoking, severe obesity, depression, risky sexual behaviors and sexually transmitted diseases go through the roof. Untreated trauma caused by ACEs may diminish one’s capacity to learn, acquire and hold down a job, have healthy intimate relationships, and be a successful parent.
In Anna Age Eight, we focus on what the ACEs scores tell us about the city and county we live in, and more importantly, local government’s commitment to the safety of children. We write about the ten vital services needed to prevent ACEs, services that could be put in place in every community if the elected leaders made trauma-free and thriving childhoods a priority. We provide a blueprint for our mayors, city councilors, county commissioners, school board members and state lawmakers to create a seamless local system of safety and trauma-informed care for 100% of our families.
Rather than being viewed as a private family problem to address, ACEs is a public health crisis that impacts all aspects of life, as well as the public and private sectors.
How do ACEs, trauma and social adversity impact students?
The truth is this, our public and private schools are ground zero for the epidemic of childhood trauma. Yet if you review school policy, you wouldn’t know it. Within an epidemic of student trauma, you will see school district policies on bullying, but barely a word about ACEs or trauma.
For a variety of reasons, schools have done an incredible job of ignoring the relationship between learning and trauma. It’s not that educators don’t wish to help all their students, it’s just that this is an overwhelming and complex challenge. Meanwhile, third-grade student Jamie is far more concerned about what awaits her at home than doing her math homework.
This is a problem that must be addressed as some classrooms have up to 75 percent of students going home nightly to various forms of abuse and neglect. Each school could keep a school-based wellness center, with behavioral health care providers busy all day treating students and their family members for trauma related to ACEs.
It is important to acknowledge that until a few decades ago, most educators accepted that a school’s role was limited to teaching reading, writing, math and a bit of US history. As community and family structures have broken down, and families are expected to fix themselves without support, teachers have faced a tsunami of deeply troubled and traumatized students along with their parents.
The community schools movement arose out of the reality of students arriving at school without any fundamental social skills, and with many students simply left to parent themselves as their own parents became lost in a haze of substance misuse and untreated trauma.
Until each school is empowered to tackle ACEs, trauma and social adversity in the classroom, many students will be marginalized as they fail to keep up with academics and fall through the cracks.
ACEs, Trauma and our Children
ACEs impact many of our children. Instead of growing up with joy they endure emotional trauma year after year. Most ACEs fly under the radar of child welfare and schools. Click above to learn their stories.*
ACEs and Traumatized Students
Instead of learning and socializing at school, in some classrooms a third to three-quarters of students may have three or more ACEs. They may be marginalized at school, perceived by teachers as being disengaged or acting out. Students may worry more about what adversity awaits them at home instead of doing math homework. Click above to learn their stories.*
How do trauma and adversity impact campuses?
Untreated trauma due to ACEs can impact students on campus. Trauma can lead to substance misuse and emotional health challenges that impact academic achievement and graduation rates. Some students with ACEs may also have the additional burden of enduring social adversity in the form of lacking access to survival services. Most institutions of higher learning, as of this writing, have yet to shine a spotlight on the epidemic of childhood trauma leading to student trauma, placing it front and center for all members of higher education. Academics fully understand that trauma, untreated in children, becomes a problem as those young students arrive at universities. In some colleges, the majority of students won’t graduate, often due to trauma, the result of adverse childhood experiences combined with social adversity.
We are awash in data, research and multi-million dollar special community projects controlled by higher education. Yet, there is no organized mobilizing process to engage our colleges and universities in addressing the impact of ACEs on the student body, faculty and staff.
Untreated Trauma on Campus
Students arrive to college or university with untreated trauma due to ACEs. Lack of academic achievement and low graduation rates can be the result of untreated trauma and the lack of accessible behavioral health care on campus. Click above to learn their stories.*
How do trauma and adversity impact the workforce?
When people hear childhood trauma, they think about kids, families and maybe child protective services. Our job is to work with every elected leader and business leader in our county to connect the dots among 1) trauma in families 2) a failing school experience 3) a lack of job readiness 4) a less-than-thriving workforce 5) a local economic engine that sputters without productive workers and 6) the lack of an entrepreneurial spirit, which can start up innovative zones in city centers where new local businesses are born.
Ask many business owners and you can see how ACEs and untreated trauma in the workforce already leads to employees missing work, showing up unprepared to function and contributes to an overall lack of qualified people to hire.
Untreated Trauma in the Workplace
Trauma, a result of ACEs, can impact an employee’s work performance and behaviors. Substance misuse and mental health challenges may result from untreated trauma and impact workforce productivity..*
Why is trauma an economic development issue?
Local economies can become as traumatized and dysfunctional as its children and families. In our work, we often visit cities that appear like ghost towns, where the jobs are few, businesses constantly fail and entrepreneurship is almost unheard of.
Millions of dollars are spent on the aftermath of trauma. If we leave aside the emotional costs for a moment and just focus on what the business community holds dear — money — we have a list of costs associated with the status quo where many of our kids live in unsafe households run by struggling parents.
The economic and educational consequences of ACEs and childhood trauma impact not only families but also schools, prisons, the workforce and every level of government.
The more ACEs endured by an individual, the more likely one is to have emotional, educational and physical challenges. All of these challenges have financial implications for taxpayers who pay for services that address the consequences of trauma.
While the ACEs survey assesses the experiences of an individual, we know that these “individuals” make up our families and communities. Moreover, children are not the only ones who suffer; the effects of ACEs ripple out and impact many others. Equally important to note: untreated childhood trauma can become untreated adult trauma.
The following issues related to ACEs form a starting point for a much broader dialogue within city, county and school board leadership about the costs associated with childhood trauma.
Toxic Stress: Apart from or in addition to ACEs, many children in our communities are experiencing toxic stress. Even without an adverse event or abuse taking place in the home, children are experiencing higher levels of performance expectation and anxiety than they have in the past. The lifelong costs of toxic stress experienced during childhood are enormous and can manifest as adverse effects on learning, behavior and health.
ACEs and Mental Illness: There is a correlation between ACEs and mental health challenges, which can impact school achievement and future employment. While many factors influence mental health and the diagnosis of mental illnesses, including biological factors and genetics, there are specific challenges to mental wellness that are the direct result of ACEs, including PTSD, anxiety and depression.
Child Welfare System: ACEs can result in the involvement of child welfare services and their partners in law enforcement and the judicial system, which result in increased trauma when it leads to out of home placement or incarceration, all of which results in substantial costs to communities and taxpayers. ACEs also contribute to Juvenile Justice involvement, incurring further costs and perpetuating cycles of incarceration and trauma.
School Dropout and Underemployment: ACEs can impact students’ capacity to learn, leading to poor academic achievement and high rates of drop-out. Individuals who are unable to graduate from high school are less likely to have access to job opportunities and experience a higher lifetime poverty rate than those with high school and college degrees. Individuals who are unable to establish income during their years of peak performance will be unable to pay into the long-term systems of care and support for later in life, including social security and retirement. Cycles of poverty and generational economic stress contribute to the increasing cost of care for impoverished seniors. While there is no direct link between dropping out and criminality, incarceration rates were 63 times higher for dropouts between the ages of 16 and 25 than among college graduates.
Substance Misuse: Those with higher ACEs scores are at risk for substance misuse, leading to injury and illness and the associated costs related to DWI, hospitalization and substance overdose death. Substance misuse and addiction costs states hundreds of millions of dollars every year. Not to mention the impact of lost lives and livelihoods, and the family’s ability to be economically self-sufficient.
Impact on Employers: ACEs can lead to various forms of social challenges and substance use that cost employers nationally an estimated billions of dollars. The largest indirect cost comes in the form of absenteeism and presenteeism (working while sick).
Trauma has flown under the radar of business leaders and chambers of commerce. There has been no organized local process to bring together leaders from the public and private sector to join efforts to reduce all forms of childhood trauma and the associated financial burden placed on taxpayers and businesses.
What’s the data-driven solution?
Childhood trauma has a very long and complex history, incurring high emotional and financial costs across all socio-economic levels. There are a host of important questions to consider as we build the infrastructure to end childhood trauma. The data-driven prevention strategies are detailed in the books Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment and 100% Community: Ensuring trauma-free and thriving children, students and families by Katherine Ortega Courtney, PhD and Dominic Cappello. Visit BOOK to learn more.
Consider the following action step as a starting point: Start a dialogue about trauma with your family, friends, neighbors, colleagues and elected leaders.
- The good news is that ACEs, trauma and social adversity are predictable and preventable. Visit SOLUTION to learn about our groundbreaking strategy.
- To see our progress in New Mexico and learn how one champion can start a local initiative, visit COUNTIES.
- For more information on the ACEs survey, research, prevention strategies, and school, campus and workplace policies on ACEs, please visit CONTACT.