Adverse Childhood Experiences (ACEs) with Guest Renee Hettich

Serena: Hey Everyone, I’m Serena.

Tina: And I’m Tina and we are the Mental Health Mamas.

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Serena: Welcome to No Need to Explain, we are so glad you’re here.

Tina: First, as always, a quick disclaimer.

Serena: We come to you NOT as mental health professionals or experts in the field, but rather as the parents of kids who struggle with their emotional health.

Tina: If you or someone you love is experiencing a mental health crisis, please seek professional support. You’ll find a variety of resources in our show notes and on our website, NoNeedToExplainPodcast.com.

Serena: If you listened to last week’s episode, you heard our guest, Renee Hettich, talk about her lived experience as a parent. So now that you’ve gotten to know her as an Expert by Experience, we wanted to invite her back to share some of her knowledge around adversity, trauma and toxic stress. Renee has worked in the field of adoption and foster care since 2004 as an adoption social worker and program director supporting families adopting domestically and internationally. She is currently a director at the Adoptive and Foster Family Coalition of New York or AFFCNY for short and is a Licensed Master Social Worker. Renee, thank you so much for coming back to share this really important information with our listeners.

Renee: Thanks so much for inviting me to talk about such an important topic.

Tina: Yeah, super important. So it was a number of years ago that I learned about ACEs or Adverse Childhood Experiences and since learning about this information, I’ve tried to share it with as many people as possible. It really is something that affects ALL of us either directly or indirectly and as you’ll learn, it’s a direct effect for most of us.

Serena: Yes, absolutely. And while the information on ACEs is becoming more mainstream with more people talking about it and sharing the information with others, I think there are still many people who don’t know about this topic or the far reaching implications. So let’s start there. Renee, we wonder if you would share about the original ACEs study with our listeners?

Renee: Sure, be happy to. So over twenty-two years ago now, in 1998, there were two physicians - one from the CDC (Anda) and one from Kaiser Permanente (Felitti) conducted a study where they looked at over 17,000 adults and they looked at the adult’s long-term health and social outcomes and the adult’s early childhood experiences. What they found was that there was a link between childhood adversity and negative adult health and social outcomes. And what they identified initially was ten adversities that were experienced by a child prior to their 18th birthday, that then was linked to long-term health outcomes and social outcomes. And those original ten adversities were physical, emotional, and sexual abuse; physical and emotional neglect; and then household dysfunction including mental illness of a family member, incarceration of a relative, domestic violence in the house, substance abuse by a parent and divorce. And what the findings were, were that number one, adversity was common. 61% of all adults have at least one adversity in their life. And then 1 in 6 adults have 4 or more of those adversities earlier listed. Note that the adverse childhood experiences study was also known as the ACE study so if you hear Tina or Serena or I talk about ACEs, ACEs stands for Adverse Childhood Experiences.

Tina: Yeah, thanks for that. And, you know, it’s true, and this kind of struck me, that the subjects, the people in the study were mostly white, middle class people with health insurance, right? So we’re not talking about a marginalized portion of adults, of our population, right? We’re talking about these Californians who were mostly white, middle-class people with health insurance. So, I’m curious if you can tell us more about what we know about the long-term effects of ACEs. We know that having ACEs affects your physical, mental and behavioral health and that the higher your number, the worse it gets. So tell us a little about what that looks like.

Renee: I’d be happy to. So before I do that, let me just comment on what you just talked about and the fact that the original sample of the 17,000 individuals was overwhelmingly middle class, suburban, caucasian adults. Since that time, over the 22 years this study has been replicated in many different communities including diverse communities and the results were the same, right, across all different types of populations. Were there additional adversities in some minority populations in terms of racism and oppression? Yes. But overall the same result was found and what was found was the more adversity, the more impact it had on the person’s life. And there was what we call a dose-response relationship. The more adversity that you have, the more ACEs that you had, the more yeses you had to those 10 things, the greater risk you had for physical and mental and social negative outcomes. And what we actually found was once a person has four or more, so they say yes to four or more of those adversities of childhood, we now know that those individuals are at higher risk. Twice as likely, for example, to have health conditions of heart disease, obesity, diabetes, cancer, COPD, emphysema, and liver disease. The major issues of long-term. Individuals who have an ACE score of four or more are almost five times as likely to have depression, they’re twelve times as likely to make an attempt on their lives. And then socially they’re twice as likely to smoke, five times more likely to use drugs, seven times more likely to be an alcoholic. They’re at higher risk for being violent. And for our youth, that is kids who have four or more ACEs are 32 times more likely to have learning and behavioral difficulties. So that link between that early childhood adversity and physical health, mental health, social health and educational outcomes is strongly linked.

Tina: Yeah, that’s pretty stunning, I have to say. I guess not surprising when you think about it but I guess part of what surprised me was not the behavioral aspect of it, but the physical health. I mean, to be, you know, that much more likely of having a heart condition. Yeah, really just...it was, as I said, super surprising to me when we learned about it.

Serena: Right. And I’m just gonna reiterate the point that this is all of us, right? That this is not a select few but the implications for our entire population and I can also imagine anybody listening right now who hasn’t heard of this before is now wanting to check their ACE score, right? To understand what this means for them. So I guess before we go any further...is there a place, Renee, where you would recommend somebody might go to learn about their ACE score?

Renee: Yeah, there’s a number of resources that you can go to. You know, ACEs Too High is a website that you could, you know, look at those ACEs questions and find your score. ACEs Connection is also another website. And of course, the Center for Disease Control, right? This is a national public health emergency and you have resources at that website to help you determine your own ACE score as well as your child’s ACE score. So those are some of the places that you can go.

Serena: OK, great. Thanks. So let’s focus in on trauma for a moment and there are two things that I have on my mind that I’d like to address. And the first one is the idea that people tend to throw around the word “trauma” or “traumatized” in situations where it may not actually be true.

Tina: Yeah, so I want to take a second here and acknowledge a little bit of hard is hard, right? There may be something that happens in your life that’s really difficult for you or your family. It’s really upsetting and like I said, difficult. I’m really trying to make a distinction here, as is Serena and Renee as well, about trauma as it relates to, you know, just kind of the over use of the word trauma and how we’re gonna define it today as it relates to this study. So while you might be upset by something that happens in your life, getting caught in the rain without an umbrella or your washing machine breaking down, not having a refrigerator. Those are hard things. I am not discounting them but it’s not “trauma”. You’ve not been “traumatized”. So Renee, can you tell us a bit more about what trauma actually looks like?

Renee: Yeah. So I’m really actually going to talk about two things. One is the definition of trauma but also something called toxic stress. So trauma is a psychiatric or behavioral state that results from a severe mental or emotional stress or physical injury. Very commonly linked to, you know, war veterans, car accidents, threats on your life, domestic violence, those types of things. The ten adverse childhood experiences can be considered trauma, right? Being physically abused, experiencing domestic violence, right? And then there’s something called toxic stress. So toxic stress creates this similar change in the mind and the body as does trauma. And toxic stress results from strong, frequent, or prolonged activation of the body’s stress response systems. When we are in a constant level of high stress, that creates a change in how our body and our mind respond. The difference between traumatizing or toxic stress versus manageable stress is having a buffering adult. That is the key. Having the protection of a supportive adult is the difference between a traumatizing and toxic episode and a manageable stress situation.

So for example, in my own case, right, I have an ACE. I have one ACE and that is I lost a brother to cancer when he was at the age of 10 and I was at the age of 13. Very potentially traumatizing, very stressful, but I had the two most amazing parents on the planet who were able to buffer my stress, right, and able to help me move through that stressful space in my life without traumatizing me. Versus...so that was me, right? That was a buffering adult. Verses two of my children who soon after birth were abandoned by their birth family, had this tremendous loss of their birth mother and their birth father, and had no one to buffer that stress. They were placed in an orphanage, there was no one there to help reduce their stress response so that event of loss created trauma and toxic stress for that child. So the difference is really that buffering adult.

Serena: So, I just want to ask quickly. Toxic stress. Can you give a few examples of that so people understand what that might look like in...for a child.

Renee: Right. Again, for a child it’s when there’s a stressful event or traumatic event that does not have a buffering adult, right? So for our kids, if you look at the adverse childhood experiences questionnaire or those categories, those are the events in the child’s life that can create the long-term impact on stress and trauma for the child. So for the child who’s experiencing abuse and neglect in the home that doesn’t have an outside buffer. And if you look at childhood adversity overall, it’s about trauma within a relationship. It’s about toxic stress within a relationship typically between a child and a parent where that’s supposed to be nurturing, loving, supportive and it becomes toxic and it becomes harmful and it becomes scary for the child. And with nobody there to help the child through that it becomes toxic and traumatizing. When there is, you know, loss of parent, physical abuse, neglect, substance abuse, etc.

Serena: OK. So the second piece around trauma that I wanted to mention was a bit of a lightbulb moment for me when I was learning about the ACEs. And I think we’ve probably all experienced meeting someone who has faced adversity, things you couldn’t even imagine, right, and yet they seem to be ok. And then there are people who seem to be profoundly affected by an event. And you’ve touched on this a little bit in terms of the having a buffer for that. But then I guess what I’ve come to understand is that two people can face the exact same adversity. So there’s the event, right, like a natural disaster, and have completely different responses. One person may be traumatized and the other person might be fine depending on a whole bunch of different factors. So first I just want to verify that that’s accurate and maybe you can speak a bit to what’s behind those different outcomes.

Renee: Yeah, that’s absolutely true. The same event could have a different impact on the child short-term and long-term. The factors that are intertwined are so complex that I’ll only touch on a little bit of it. I’ve already touched on the most important and that is a buffering adult. A relationship with an adult who can manage or help manage the stress response of the child. But in addition to that there are other factors. Some of them are internal to the child. Some of our kids have this grit, this ability to overcome, right, resilience internal to who they are. So I have a young man in my home right now that, you know, he is probably the most resilient young man I’ve ever met and a lot of it is who he is and the fact that he does have that grit and that determination and he has goals and he has a vision of where he wants to go. So some of it is part of who that child is as a person.

And then there’s the external factors like the support he gets from an adult, right? Having that caring relationship, you know, whether it’s in his family of origin or whether it’s in a new family. Whether it’s a kinship, foster, adoption family. So those things are important.

Other things that are protective, right, so there’s a lot of resiliency research out there and what most of the resiliency research points to is five or six, what they call, protective factors. Things that help our children become resilient and overcome the trauma, overcome the toxic stress. And here’s what they’re saying. First know what I just said, right, that social and emotional competence of the child, their own positivity, their own capacity to regulate themselves, their ability to communicate, their ability to have goals and to have grit, that’s one of those factors.

Three of those factors are related to the parental relationship that the child has, whether that parental relationship is with their families of origin or that’s with a foster parent, an adoptive parent, a kinship parent, a teacher, a social worker, a therapist, whoever that parent is. And what research has shown is that there’s three major factors for that relationship between a child and a parent to build resilience.

The first is parental resilience. The capacity of the parent to be resilient, to overcome their own histories, to overcome the challenges and stresses within their family unit to be able to bounce back and be strong and be grounded and be regulated as a parent. So the focus for many of the things that we do at the coalition, the Adoptive and Foster Family Coalition, is building on our parent’s resilience.

The second thing in terms of the parental relationship is the importance of parental nurturing and developing a secure attachment between the caregiver and the child.

And the last thing that they found is parents who have a real good grasp of child development and basic parenting techniques, the child and the parent make a connection and do better together. That builds resilience for the child. So, you know, one of the protective factors is based on the child’s own social/emotional capacity, the second are the three factors for parenting.

The last two really talk about community. And one is about having for the family unit social connections. Having those friends, family members, neighbors who can provide support. If the parent is having a really hard time, right, and is stressed and it’s becoming toxic, they need to reach out and get the support they need from that circle of influence. Those people who can support them.

And the second factor outside of the family unit is community supports. Not only do we need to provide for the basic needs of families, right, food, clothing, shelter, healthcare. But we also need to provide supports around items that provide stress whether it’s domestic violence intervention, mental health treatments, substance abuse treatment. The community needs to rally around because it really does take a village of buffering adults to help out children become resilient.

Tina: Yeah, so this is such incredibly hopeful information we’ve actually talked about this on the podcast before. One person can make all the difference. And it sounds like the more community we have, the better, right? So our episode is called, “Be the One” if you want to look back. So, just like you Renee, we support parents with our other hat, our Family Navigator hat and we’ve been sharing this information pretty widely. And I’ll just come back to myself, right? It was important for me to understand that no one chooses these adversities. They often are things that happen to children before they’re 18, so they don’t choose them, right? That tends to remove some judgment of one another and even for ourselves. And that’s what we’ve found in our support of parents sharing this. And knowing the prevalence allows us to be certainly more gentle with one another. So it can bring guilty feelings to parents, I’m not sure if you’ve experienced that with some of your families but certainly when you know better, you can do better. It’s not all bad news. Since so many of us are walking around with ACEs, what can we do? How can we overcome our ACE history?

Renee: Right. That’s a great question and you know resiliency is everything. And children and adults are incredibly resilient. You know, as I have parented children from adverse histories for the last 25 years, I think the greatest experience as a foster, adoptive and kinship family is to watch my children be resilient and be in awe of that. I mean, it’s absolutely incredible to watch, for example, my daughter who is now a college student, on the college track team, come to me at 10 months old unable to hold her head up, roll over, interact in any way to this amazing young person is miraculous. And I see that over and over and over in my house, to watch these young people become resilient. We talked about some of the protective factors earlier, about how do we, number one, prevent, but how do we intervene. There’s other things that really help our kids become resilient that are centered around them. So you know there’s other strategies that we can use as the adult to support the resilience. One of them is to help them develop life skills. I’ll never forget my two teenagers who could care less about how to cook dinner. We still sat in the kitchen together as a group and we learned how to or I taught them how to make spaghetti. Developing those life skills...how to do your own laundry. Those things are important to resiliency. The other thing that I think is always interesting is purposeful contributions. Having your child contribute to the wellness of the community through volunteerism, through activism. All my children are involved in the Black Lives Matter movement, the Anti-Asian Hate movement. Many of them are volunteering at different activities. But that purposeful contribution improves their capacity to be resilient. Having high expectations of themselves and us having high expectations. “I know you can achieve”. One of the young persons in my house was not confident in his capacity to be successful in college and I just encouraged him and he’s incredibly successful because we have the high expectations. Certainly healing therapies. Of course, reach out to your mental health therapists in your community who have this knowledge base. And then the other things that I think are interesting that are so important to resiliency is providing four major things for our kids. One of them is respect. Respect who they are, respect their history. The second is to provide stability. Give them that stable base where they can jump off and be ready to tackle the world. The other one is predictability. And it’s so interesting. After one of my children who was in kinship care with me after his first year here I asked him what the year was like. You know and I expected him to say we went to an amusement park, we went swimming...I thought he was gonna do the typical teenage things. You know, I got my driver’s permit. But no. Instead what he said to me was three things that are exactly what I’m talking about here. He said for the first time in my life, my life was predictable. I knew what was gonna happen first, second, and third. Every morning I knew what was gonna happen when I woke up. He had that predictability. The second thing we talked about, which we haven’t got to, but I’ll just illustrate it through his description, is that he was for the first time heard. That somebody listened and validated him. And the third thing was fascinating because we talk about this a lot in therapeutic parenting and for the first time he felt safe. He knew that he was in a place that he was not going to be harmed. Those are all so important to helping our children be resilient and as you can see, all of those things are about a relationship with that one caring adult.

Tina: Mmhm. Exactly. Yeah.

Serena: Yeah. Yeah. So I will just acknowledge that we mentioned some resources before and I know that for people hearing about the ACEs for the first time, it can be a bit unsettling and it can also be really validating to sort of understand yourself better and the people around you. So we will make sure that we list a variety of resources with our episode so that people can explore it further. So before we kind of wrap things up today, Renee, I wonder if there are...are there any things that we didn’t ask you that you’d like to put out there or anything you’d like to add to our conversation?

Renee: Yeah, I think what you just said was interesting because for those of you who this is new to can be overwhelming, right, but it can also be affirming and validating and give you the tools to now be resilient. And I think the message, my hope is acknowledging your past and understanding it’s impact will then allow you to move forward and be resilient and find the one that you can connect with to support you. And then in terms of resources, Serena, that you mentioned, I mentioned a couple of them already but know that the ACEs too high and the ACEs Connection websites are great resources to learn more. Certainly the Center on Disease Control’s website on ACEs is important. And then nationally there is a National Child Traumatic Stress Network and they are the leader in the nation around ACEs and the prevention and the intervention and resiliency so I really encourage you to do that. In the state of New York there’s two major initiatives. One is The New York State Trauma Informed Network. Search for that on the web. And the other is the University of Buffalo, School of Social Work has an Institute on Trauma and Trauma-Informed Care that really is leading, not only the state, but the nation in trauma-responsive care.

Tina: Awesome. Yeah. Great resources. Thanks for sharing them. They will be in the show notes. And Renee, thank you so much for spending time with us today to share this super-important information with our listeners. We are grateful to you for all of your work you are doing professionally to support families and of course all that you do with your own people.

Renee: Thank you so much for having me.

Tina: So podcast friends, we are, as always grateful for all of you listening and supporting us. You can help us out by visiting Apple podcasts, leaving us a review, subscribing and please, share this information widely with others.

Serena: And this is your gentle reminder to take good care of yourself while you are also taking care of your people.

Tina: Thanks so much for listening!

Serena: Bye!

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