Adverse Childhood Experiences: What Students and Health Professionals Need to Know

183 Pages·2019·8.073 MB·English

by  Roberta Waite, Ruth Ann Ryan

ADVERSE CHILDHOOD EXPERIENCES
This guide provides healthcare students and professionals with a foundational background on
adverse childhood experiences (ACEs) – traumatic early life experiences, which can have a
profound impact on health in later life.
ACEs can include being a victim of abuse, neglect or exposure to risk in the home or
community. How healthcare students and professionals learn to recognize, react and respond
to persons affected by trauma will lay the foundation for their relationships with patients.
This book intentionally uses micro-to-macro lenses accompanied by a structural competency
framework to elucidate health implications across the lifespan. It explores the nature of
adversity and its effects on the physical, emotional, cognitive and social health of individuals,
communities and society. The book, written by two experienced psychiatric nurses, will
equip healthcare students and professionals with an understanding for critical change in
practice and offer action steps designed to assist them with prevention and intervention
approaches and steps to help build resilience.
This book will be core reading for healthcare students within mental health, pediatric and
primary care nursing courses. It will also be of interest to students and professionals in the
social work, psychology and public health fields who are exploring resilience and trauma-
informed practices.
Roberta Waite is a Professor at Drexel University, College of Nursing and Health Profes-
sionsandAssistantDeanofAcademicandCommunityIntegrationattheStephenandSandra
Sheller Eleventh Street Family Health Services of Drexel University.
Ruth Ann Ryan is a Board Certified Clinical Nurse Specialist and a Psychoeducation
Training Specialist with the Healing Hurt People Program in the Center for Non-Violence
and Social Justice at Drexel University College of Medicine. She is co-founder of the Sanc-
tuary Model and was the Clinical Director of the program for 20 years.

ADVERSE CHILDHOOD
EXPERIENCES
What Students and Health Professionals
Need to Know
Roberta Waite and Ruth Ann Ryan
Firstpublished2020
byRoutledge
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CONTENTS
List of illustrations vii
About the authors ix
PARTI
Knowledge development about ACEs 1
1 Introduction: Repression to spoken truth – Opening up 3
2 Making the connection: The ACE study 6
3 Toxic stress, adversity, and trauma 14
PARTII
Understanding ACEs from a life course health development
perspective 25
4 The body keeps the score: Epigenetics 27
5 Early brain development: Childhood trauma and adversity 34
6 Developmental psychology: Implications of ACEs 41
7 Community and structural determinants: Implications of ACEs 53
vi Contents
PARTIII
Reducing ACEs 61
8 Socioecological model: Individual and family influences 63
9 Socioecological model: Context and cultural influences 74
PARTIV
ACE intervention: A social-ecological approach 85
10 Early identification and trauma-informed approaches 87
11 Community and societal trauma-informed interventions 105
PARTV
Conclusion 131
12 Moving forward 133
Appendix1: Integrating ACE education into the curriculum of health professionals 142
References 152
Index 170
ILLUSTRATIONS
Figures
2.1 The ACE Pyramid (CDC, 2016) 11
3.1 Types of Stress 16
3.2 Adversity Diagram 17
3.3 Types of Trauma 19
8.1 Resilience: Prevention through Protection Factors 72
9.1 Examples of Exosystemic Protective Factors that Promote Resilience 77
9.2 Examples of Macrosystemic Protective Factors that Promote Resilience 81
9.3 Distal Systems 82
10.1 Benefits of Utilizing Trauma-Informed Principles (Bloom, 2016;
Gilliver, 2016) 90
10.2 Continuum: Trauma-Informed Through Trauma-Specific 93
11.1 Signs and Symptoms of Vicarious Trauma 117
11.2 Coping and Transforming Vicarious Trauma (Jacksonville University,
2018) 117
Tables
2.1 Conventional ACE Percentages and Philadelphia ACE Percentages 13
8.1 Other Programs that Support Prevention and Promote Healthy
Development of Individuals 70
10.1 Explanation of SAMSHA Trauma-Informed Principles (SAMHSA:
Project Aware, 2014) 89
10.2 Resource Table: Examples of Additional Trauma-Informed Schools 102
11.1 California Policy Strategies to Address Childhood Trauma (Merck,
2018) 108
viii Listofillustrations
11.2 Representative Agencies in Philadelphia That Have Moved from
Knowledge to Action (Philadelphia CeaseFire, 2014; Trauma
Informed Philanthropy, 2016) 111
Boxes
6.1 Case illustration: 5-year-old 45
9.1 Case illustration: Elijah, 22-year-old 83
11.1 Case illustration: Healthcare Center 118
ABOUT THE AUTHORS
Roberta Waite, EdD, PMHCNS, ANEF, FAAN is a Professor at Drexel University,
College of Nursing and Health Professions and Assistant Dean of Academic and Community
Integration at the Stephen and Sandra Sheller Eleventh Street Family Health Services of
Drexel University. As an advanced practice psychiatric nurse, her scholarship and research
centers on behavioral health concerns, specifically adult ADHD, psychological trauma, and
depression and their effects on health outcomes as well as promoting systemic prevention/
earlyinterventionefforts.Dr.Waite’seducationalresearchfocusesonleadershipdevelopment
of students in the health professions and public health while concurrently fostering critical
consciousness using a social justice lens.
Ruth Ann Ryan, MSN, CS is a Board Certified Clinical Nurse Specialist and a Psychoe-
ducation Training Specialist with the Healing Hurt People Program in the Center for Non-
ViolenceandSocialJusticeatDrexelUniversityCollegeofMedicine.Sheisco-founderofthe
Sanctuary Model and was the Clinical Director of the program for 20 years. She and her col-
leagues developed the S.E.L.F. Model of trauma recovery, which has been implemented in
programs for children, adolescents and adults in many national and international locations.
RuthAnnhas30yearsofexperienceinthetraumafieldasapsychotherapistandorganizational
consultantontraumainformedprinciplesandpractices.Sheco-authoredagroupmanualtitled,
S.E.L.F.: A Trauma-Informed Psychoeducational Group Curriculum and has been training on this
model in educational settings and clinical programs throughout the United States.