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ACEs Science & Trauma-informed Practices

…a trauma is any event or experience of sufficient force or magnitude that it overwhelms the capacity of the individual to absorb the experience and continue essentially unaffected, and which therefore results in a significant reduction or distortion of the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.1

ACEs are adverse childhood experiences that harm children’s developing brains and lead to changing how they respond to stress and damaging their immune systems so profoundly that the effects show up decades later. ACEs cause much of our burden of chronic disease, most mental illness, and are at the root of most violence.

“ACEs” comes from the CDC-Kaiser Adverse Childhood Experiences Study, a groundbreaking public health study that discovered that childhood trauma leads to the adult onset of chronic diseases, depression and other mental illness, violence and being a victim of violence, as well as financial and social problems. The ACE Study has published about 70 research papers since 1998. Hundreds of additional research papers based on the ACE Study have also been published.

The 10 ACEs the researchers measured:

— Physical, sexual and verbal abuse.
— Physical and emotional neglect.
— A family member who is:
  • depressed or diagnosed with other mental illness;
  • addicted to alcohol or another substance;
  • in prison.
— Witnessing a mother being abused.
— Losing a parent to separation, divorce, death or other reason.

Subsequent to the ACE Study, other ACE surveys have expanded the types of ACEs to include racism, gender discrimination, witnessing a sibling being abused, witnessing violence outside the home, witnessing a father being abused by a mother, being bullied by a peer or adult, involvement with the foster care system, living in a war zone, living in an unsafe neighborhood, losing a family member to deportation, etc. 

ACEs fall into three large categories:

• Adverse childhood experiences
• Adverse community experiences
• Adverse climate experiences

ACEs science refers to the research on how common adverse childhood experiences (ACEs) are, the stunning consequences when children experience childhood trauma, and what can be done to protect against ACEs.  It comprises:

1. The CDC-Kaiser Permanente ACE Study and subsequent surveys that show that most people in the U.S. have at least one ACE, and that people with four ACEs— including living with an alcoholic parent, racism, bullying, witnessing violence outside the home, physical abuse, and losing a parent to divorce — have a huge risk of adult onset of chronic health problems such as heart disease, cancer, diabetes, suicide, and alcoholism.

2. Brain science (neurobiology of toxic stress) — how toxic stress caused by ACEs damages the function and structure of kids’ developing brains.

3. Health consequences — how toxic stress caused by ACEs affects short- and long-term health, and can impact every part of the body, leading to autoimmune diseases, such as arthritis, as well as heart disease, breast cancer, lung cancer, etc.

4.  Historical and generational trauma (epigenetic consequences of toxic stress) — how toxic stress caused by ACEs can alter how our DNA functions, and how that can be passed on from generation to generation.

5. Resilience research and practice — Building on the knowledge that the brain is plastic and the body wants to heal, this part of ACEs science includes evidence-based practice, as well as practice-based evidence by people, organizations and communities that are integrating trauma-informed and resilience-building practices. This ranges from looking at how the brain of a teen with a high ACE score can be healed with cognitive behavior therapy, to how schools can integrate trauma-informed and resilience-building practices that result in an increase in students’ scores, test grades and graduation rates. 2
1. Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
2. Stevens, Jane ACEs Science 101, ACES CONNECTION, 2019

Trauma-Informed Approach

Trauma-Informed Approach
Adopting a trauma-informed approach is not accomplished through any single particular technique or checklist. It requires constant attention, caring awareness, sensitivity and quality improvement, as well as engagement with community stakeholders, will help to imbed this approach which can be augmented with organizational development and practice improvement.

A trauma-informed approach (the 4 R’s):

1. Realizes the widespread impact of trauma and understands potential paths for recovery

2. Recognizes the signs and symptoms of trauma in clients, families, staff, volunteers and others involved with the system

3. Responds by fully integrating knowledge about trauma into policies, procedures and practices

4. Resists re-traumatization 

How We Say It

How we communicate with each other and our clients is a powerful tool in avoiding re-traumatization. 

Music4Health classes are led by modeling nonviolent communication and guiding class participants to experiment with non-violent communication.   Non-violent communication expresses our thoughts non-judgmentally through observations, feelings, needs and requests for action and receives communication non-judgmentally through observations, feelings, needs and requests for action. 

Guidelines for conveying messaging in a trauma-informed manner:

• Use language that leads to agreements as opposed to rules
Convey that a safe space is a right for everyone
Include statement of affirmations that includes everyone, not just students
Focus on what you want people to accomplish or the action you want to see instead of what you do not want
Do not address verbal expressions of unmet needs, listen only for the feeling/need and respond as if this was all you heard
household abuse reports

The original ACEs that were studied by asking whether any of these events occurred prior to a persons’ 18th birthday

Early adversity has lasting impacts!

Negative Health Outcomes Odds Ratio Associated with ≥4 ACES
Coronary Heart Disease
Cancer (excluding skin)
All odds ratios from Merrick MT, Ford DC, Ports KA, et al., 2015-2017 except suicide (Hughes et al., 2017) and Alzheimer’s (Center for Youth Wellness, 2014)

Suicide rates in the United States for youth aged 10 to 19 years increased 33% from 1999-2014. The gender gap that previously existed in suicide rates is closing according to a study published in JAMA Network Open showing that starting in 2007 suicide rates for girls ages 10 to 14 began increasing by 13% annually compared to 7% for boys.

Individuals with 6 or greater ACES have a life expectancy that is 19 years shorter than individuals with none.

Why does this happen?

At the same time of the ACEs study, parallel research was being done on the brains of children that found that toxic stress damages the structure and function of a child’s developing brain. The changes in the structure of our brains results in these lasting long-term effects.

Fortunately, further research has determined that certain buffering protections can reduce the impact of stress, trauma and ACEs and the sooner these buffering protections are made and maintained, the better the health outcomes will be. Our brains are somewhat plastic and through certain practices and buffering protections we can alter the negative trajectory caused by ACEs and trauma.

The Six Buffering Protections

Six Buffering Protections
Music4Health programs are designed to prevent and protect against the toxic stress physiology created by ACEs, stress and trauma.

Educational Videos Provided to Music4Health

Stress and Resilience: How Toxic Stress Affects Us, and What We Can Do About IT
How Children and Adults Can Build Core Capabilities for Life
Executive Function: Skills for Life & Learning
The Power of Playful Learning

In Brief: The Science of Neglect

In Brief: What is resilience?

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