2021

November 18  Connecting the Dots: The Impact of Adverse Childhood Experiences on Health Disparities and Health Outcomes webinar featuring Manisha Patel, MD and Sarah Bacon, PhD (US CDC National Center for Injury Prevention and Control); Erika Lichter, PhD (Cutler Institute, University of Southern Maine); Ian Yaffe (Director, Office Population Health Equity, Maine Center for Disease Control and Prevention); Robin Matthies, MSW (Director, Public and Behavioral Health Integration, Association of State and Territorial Health Officials)

2019

September 26 Screening and panel discussion of Broken Places at the MRBN meeting at Educare in Waterville. Broken Places explores why some children are severely damaged by early adversity while others are able to thrive. By revisiting some of the abused and neglected children profiled decades ago, the documentary  dramatically illustrates how early trauma shaped their lives as adults. 

June 12  Building School Capacity Through Community Collaboration Conference, MRBN and Department of Education Meeting. Statewide Community Public Health and school staff learned about programming from MRBN, Department of Education, Me CDC Prevention Services and Maine Children’s Trust. Dr. Todd Landry, Director of OCFS introduced Dr. Ken Ginsburg, Pediatrician and author of Reaching Teens who provided a presentation on community and school resilience informed practice. In addition, MRBN members highlighted school and community coalition work that exemplifies resilience building.

May 30  Building Resilience Across the Life Span MRBN Conference at Educare. The agenda included Social Emotional Learning: Cool Calm Kids, Poverty to Resilience; Surviving to Thriving, and Grandparents as Caregivers: Realities and Resources.

March 28  MRBN Member meeting Rita Furrow, Sr. Policy Analyst, Maine Children’s Alliance provided an overview the 2019 Maine Kids Count Book. Peter Lindsay, United Way of Mid Coast Maine provided an overview of the Maine Children’s Growth Council 2019 Report to Governor and Legislature.

2016

November Maine initiates the first rollout of the Reaching Teens Tool Kit with Dr. Ken Ginsburg with 23 teams (150 cross sector-participants) representing every county in Maine for this 18-24 month implementation

October Over 70 showings of documentary “Paper Tigers” statewide including Lewiston, Waterville, at the 2016 Positive Youth Development Conference, Lincoln, Skowhegan, Maine CDC

October MRBN membership exceeds 650 individuals and organizations statewide.

October The Trauma Partnership Team is awarded funding from John T. Gorman Foundation to enter into a one-year strategic planning process focused on embedding trauma informed care, training and technical assistance statewide, cross-sector, and in the public/private sectors under the leadership of the University of New England, Graduate School of Social Work

October Dr. Ken Ginsburg returns to Maine for two, one-day Seminars: Our Kids Are Not Broken for more than 350 cross-sector participants

September MRBN celebrates attaining an outreach and engagement of more than 10,000 individuals throughout Maine since our inception through training and technical assistance efforts

September Initial screening of the film RESILIENCE with plans for April 2017 month of statewide showings and local community conversations

February 2nd MRBN Statewide Survey conducted to update relevancy, focus and priorities of MRBN http://maineaces.org/wp/courses/adverse-childhood-experiences-in-maine-iiknowledge-action-and-future-directions/

2015

December  MRBN initiates its transition to a shared leadership model with the articulation of a Strategic Plan and selection of Leadership Team designed to shepherd the work forward

November  Production of PSA, “Be There for ME” https://www.youtube.com/watch?v=8R4N7Xoz0nk

November  First Annual ACEs Conference. This was a partnership effort between MRBN, Quality Counts, the Maine AAP and received lead sponsorship by The Bingham Program. Many local presenters and featured keynote speakers: Dr. Robert Anda, Dr. Ken Ginsburg, Jane Stevens. First showing of the documentary, “Paper Tigers,” Northport

September  New Hampshire for Infant Mental Health 21st Annual Conference, “From Risk to Resilience” with Vincent J. Felitti, MD and Elizabeth Warner, Psy.D.

July Positive Youth Development Institute with Dr. Ken Ginsburg, Biddeford

May In partnership between MRBN, the Maine AAP and Quality Counts, Dr. Andy Garner provides a series of conversations focusing on epigenetics and the role of ACEs in brain development, child “readiness” for school and success in later life

May In partnership with Quality Counts, Dr. Ann Dorney and Sue Mackey Andrews provided a webinar focused on ACEs awareness and value throughout Maine and in pediatric practices which was attended by more than 800 people

2014

Multiple dates Donna Beegle presented to expand knowledge considering poverty as an outcome of ACEs. Waterville, Lewiston-Auburn, Machias

February Dr. Ken Ginsburg multiple presentations sponsored by national AAP. Included meeting with MRBN members and multiple clinical and community audiences in Waterville, Augusta, and Bangor

2013

The Maine Trauma Partnership is formed (MRBN, THRIVE, Maine Behavioral Healthcare, Community Caring Collaborative)

October “Poverty Summit” with Donna Beegle, Orono, Blue Hill, Dover Foxcroft

October Brunswick symposium with Pat Leavitt; Donna Beegle poverty summits in Dover Foxcroft, Orono, Blue Hill

July  The Community Caring Collaborative, “Poverty Institute,” 3-day training with Donna Beegle, Machias

May  Maine team invited to the first National Summit on ACEs, Philadelphia, PA

April  Dr. Felitti presents to MAPA, meets with MRBN for a Saturday Institute on ACEs research

April  Resiliency conference with Steve Burkowitz, Chris Trout

2012

July  The Community Caring Collaborative, “Breaking the Barriers of Poverty,” 3-day summer training conference with Donna Beegle, Machias

Maine Resilience Building Network is formed

2011

May United Way of Mid Coast Maine Annual Meeting with Bowdoin College professor Craig McEwen and Rockefeller University neuroscientist Bruce McEwen speaking on “Early Childhood Experiences: What’s at Stake for our Community’s Health and Education” 

Development of the Maine Early Childhood Investment Group, headed by Steve Rowe, focused on CEO membership

April  Bangor Rotary-Early Childhood Investment and Toxic Stress presentation

2010

December  Maine ACEs Study initiated by the Health Accountability Team of the Maine Children’s Growth Council

December  York County Business Leader Summit with United Way and Community College

October York County Community Conversation (outgrowth of Governor’s Summit on Early Childhood)

September Educare opens, Waterville Maine

May “Why do you Hurt Me” York County Child Abuse Prevention Council

April Hancock County Business Leader’s Summit

Dr. Felitti interviewed on Maine Things Considered public radio program

Dr. Felitti visits Maine, presents at: Maine Medical Center-Portland, Summer Institute in Washington County with Community Caring Collaborative, Maine Development Foundation, Maine Children’s Growth Council, Maine Medical Association, Eastern Maine Medical Center-Bangor

2009

Child Abuse Action Network conference with Neil Boris focusing on ACEs as a common pathway to parental domestic violence, substance abuse, and mental illness; and attachment difficulty

November York County Community Conversation on Early Childhood

October Regional Economic Summit on Early Childhood (Bangor, ME)

October Regional Economic Summit on Early Childhood (Augusta, ME)

September Regional Economic Summit on Early Childhood (Portland, ME)

September Regional Economic Summit on Early Childhood (Bath, ME)

Business Leader’s Summit- Ellsworth, ME

2008

Business Leader’s Summit-Brewer, ME

Maine Development Foundation Annual Meeting: Investing in our Most Precious Assets, speaker: Jack Shonkoff

Business leader roundtable four meetings

Maine Children’s Growth Council (in statute) has first meeting. Transition from the Children’s Task Force into the Growth Council

2007

Governor’s Economic Summit on Early Childhood

Child Abuse Action Network conference with focus on resilience and family protective factors with Irwin Sandler and Laurie McCubbin

Governor’s Summit on Cardiovascular Health with Dr. Felitti

Community Counseling Center community practice center grant within National Child Traumatic Stress Network

THRIVE: Trauma Informed System of Care grant

2006

Child Abuse Action Network conference on Child Impairment with Frank Putnam and a community panel

Healthy Start focus on parental ACEs and HEARTS (Health Experiences And Relationships That Support) and child resilience

Maine Chapter American Academy of Pediatrics Community Forum with Dr. Felitti (ACEs), Dr. Blum, (Protective Factors), Dr. Werner (Resilience)

2005

Prior to 2005 in Maine, there were a number of conferences focused on children’s risk and resilience, including those hosted by the Maine Association for Infant Mental Health, Maine Child Abuse Action Network, Spurwink, etc.

Child Abuse Action Network conference with Dr. Felitti, with InterDepartmental Response Panel

Children’s Cabinet adds ACEs as one of top three priority areas

January American Academy of Pediatrics Forum, FutureSearch methodology

2003

December Early Childhood Task Force becomes part of the Children’s Cabinet, chaired by Maine’s First Lady, Karen Baldacci

Grant from the federal Maternal Child Health Bureau

2002

Mid-Maine Child Trauma Network community practice center within National Child Traumatic Stress Network

Vincent Felitti published article: “The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead”

2000

Trauma Conference, Augusta

1998

ACE Study published

1997

Early Childhood Task Force Forums

1996

Kmihqitahasultipon (We Remember) SAMHSA grant, Passamaquoddy Tribal Health Care

In a time of limited resources and growing needs, policy makers need to understand the causes of our deepest social issues and invest resources appropriately. Understanding the role of childhood trauma and the social costs that trauma creates in health care, drug and alcohol abuse, poverty, lost productivity, incarceration, and special education will drive informed social policy. Supporting programs that build resilience will reduce costs in treatment, education, criminal justice, and create a stronger society.

How can policy be informed by the ACE study?

The Adverse Childhood Experiences (ACE) Study can brings cohesion and synergy to policy work with its findings that illustrate how the cumulative stress of ACEs can be a powerful determinate of the public’s health and a strongest common driver of mental, physical and behavioral health costs. Through the prevention and promotion of awareness of ACEs policy makers can help create informed policy that gets to the heart of the issues that create many health problems and in doing so be more effective with public dollars.

How much do ACE-related outcomes cost, and what return on investment can be expected for preventive interventions?

Maine spends over 3.5 billion dollars a year on outcomes relevant to ACEs, not counting lost work productivity (absent, not fully productive, etc.). It is estimated that over $500 million in expenses is attributable to those having 4 or more ACEs and that if even ¼ of those experiencing the above outcomes could resolve their impairment (to ‘not bothered’), the state could save $124 million annually.

Understanding the life history of the people you serve, no matter what services you provide will help your services be more effective. Asking about their personal experiences with adversity will build your relationships and understanding your own experiences will help build your empathy and ability to respond. Knowing how those experiences have an impact, and the variety of responses, will frame the services you provide to truly meet peoples’ needs.

Four Ways the ACEs Findings Make A Difference

1. Provides a better understanding of why children and families make the choices they do and why they react a certain way
2. Helps to inform services/practices
3. Promotes/reinforces strength based approach
4. Problem behaviors recognized as ways of coping

How can we build resilience to mitigate the effects of ACEs?

• It is important to build the capabilities of caregivers and strengthen the communities that together will form the environment of relationships that are essential to children's lifelong learning, health and behavior.
• Provide safe, nurturing relationships
• Understand coping strategies
• Identify and reinforcing child and family strengths
• What has helped the individual to “not be bothered” by their experience?
• Enhance knowledge (parenting skills)
• Identify and access supports - Informal and natural; who do they go to in times of need?
• Provide Evidence Based Programs/treatments or promising practices (age and developmental appropriate)
• Identify ACEs and provide protective/promotive family and community experiences and enhance resilience before the child develops impairment (e.g. to maintain child feeling safe, lovable, capable, meaningful; to make sense out of the adversity and how to cope; to enable parent availability to support the child, etc.).
• Identify ACEs and impairment and provide intervention for impairment, before it leads to unhealthy coping or negative outcomes. Screening for cumulative risk across categories (not just the major identified adversity) is important for developing a trauma-informed intervention plan. Trauma-focused cognitive- behavioral therapies for individuals or groups are available to treat impairment, PTSD, depression, loss, internalizing and externalizing behavior problems, etc.
• Take a trauma-informed approach to dealing with unhealthy coping strategies and illness, such as assessing for trauma which may have led to impairment which the unhealthy strategies are being used to cope with or which exacerbate illness.
• Check out the ACEsConnection website, an online network where you’ll find articles, blog posts, opportunities to connect with professionals from around the world. They’ve published a Roadmap to Resilience that features best practices from around the country. Maine was involved in building this Roadmap!
  

Most people who are exposed to trauma or adversity do not develop negative outcomes, hence it will be important for the field to better understand what protects them and what tips a person from being resilient to being impaired (and what can assist them in reversing this). However, as the ACE studies are based on a count of adverse experience categories, rather than on how many categories still bother the individual, further research asking questions both about what was experienced and what still bothers a person is recommended to clarify this.

The following table presents three stress response systems available to humans. Each may be adaptive in the short run, however, chronic activation of the first two may lead to negative health outcomes in the long run.

• “Fight or Flight” is the most commonly understood. The sympathetic autonomic system prepares to mobilize for action (increasing respiration, heart rate, blood pressure; releasing of adrenalin and insulin; suppressing inflammation and immune response).
  
• • If fight, flight, or action are needed this can be adaptive. If prolonged, this can contribute to cardio-vascular problems, insulin elevation and resistance, autoimmune disorders, It may affect sleep, hyperarousal, anxiety, depression, and motivate unhealthy coping.
    
• “Freeze” is a backup strategy, if fight/flight is not successful or available (e.g. for weaker ages, gender, or situations). The body immobilizes, may feel numb, or may dissociate.
  
• • In the short run this may be adaptive, but if too intense (shock) or chronic (helpless) this can also be costly for the body or motivate unhealthy coping.
    
• Social Engagement (or “Friend”) is recently receiving attention. It involves the parasympathetic autonomic system and is associated with health maintenance and using social communication and problem-solving to deal with stress.
• • This system can dampen ‘fight or flight’ and inhibit ‘freeze’, decreasing their negative effects. It can contribute to resilient functioning and health maintenance.
    

How can you help your child deal with stress?

Neurological Impacts of Stress

Within pregnancy and the early years after birth, the brain structures and connections for dealing with stress are built in part by physical development and partly through practice—we “use it or lose it”—and what we use depends on our environment. Children exposed to adversity are likely to practice fight/flight/freeze reactions and build brains that are ‘on alert’ for danger, quick to react behaviorally and emotionally, and less likely to think ahead about choices and consequences or engage socially in problem-solving. The brain chemicals that prepare for stress response in the short run (e.g. cortisol) can be toxic over the long run, interfering with development of brain regions. Traumatic stress may overwhelm memory systems for danger and safety, making it difficult to learn from experience, failing to isolate past from present experience (flashbacks), etc.

What it may look like in children: Children may be impulsive, aggressive or defensive, anxious, reactive, seem hyperactive, and have difficulty focusing in the classroom. Heightened arousal may make it difficult for them to get enough sleep, resulting in sleep deprivation symptoms. Readiness for social competence may be weak. They may seek to manage their arousal level, painful sensory memories, etc. with self-medication (nicotine, alcohol, illicit drugs, cutting, etc.)

Biological Impacts of Stress

Chronic activation of the fight/flight system (being “bothered”) may result in chronic obstructive pulmonary disorder, coronary artery disease, insulin-related problems (diabetes), autoimmune disorders, cancer, etc. Research estimates that chronic or cumulative stress may shorten one’s lifespan by nearly twenty years.

What it may look like in children: Children may have difficulty regulating mood and behavior, be irritable or aggressive, be anxious or withdrawn, show growth delay, experience sleep difficulty and deprivation, have difficulty managing social interaction, have difficulty with attention control, etc.—which may interfere with attachment, social competence, and academic achievement that could otherwise serve as protective factors and support resilience development. This may lead to inappropriate or excessive psychiatric medication or to self- medication with substance use.

Psychological Impacts of Stress

How we see and think about ourselves and the world includes expectations about safety, confidence, self- esteem, and meaningfulness. ACEs can undermine or overwhelm these expectations, leaving us feeling chronically unsafe, hopeless, helpless, shamed, etc. Thoughts may focus on life being unfair, meaningless, and unforgivable. When these expectations about self and others continue into adulthood, the stress responses at the neurological, biological, and social levels are perpetuated. The relationship between ACEs and alcohol, nicotine, and substance abuse indicates that dependence is not just the result of biological exposure to an addictive substance. Reorganizing incorrect thoughts and expectations may reduce stress and the promotion of resilience expectations may protect against stress.

What it may look like in children: Children may wrongly conclude from ACEs that they are at fault or that the scope or longevity of problems will be catastrophic, and feel ashamed, anxious, helpless, depressed, angry, etc. They may learn to avoid situations that upset them, interrupting social competence development or derailing maturation. Even as they do gain greater competence, they may fail to update these expectations and, as a result, may carry them into adulthood. Before developing language, infants and toddlers may experience and remember trauma non-verbally. They may develop a self-image or sense of competence consistent with fight/flight/freeze coping which could be self-fulfilling and interfere with prosocial personality development. Children may develop dissociative responses (e.g. shifting between different roles or personalities) that are protective, but which complicate social interaction, learning and maturing. In relation to parents who struggle with their own trauma histories, children may develop disorganized or insecure attachments.

Social Impacts of Stress

Children who experience adversity or victimization are more likely to encounter social environments that can multiply stressful interactions. Their fight/flight/freeze stress responses are likely to be misinterpreted by others in social settings as misbehavior rather than as attempts to cope; such that they encounter discipline rather than support. They may fail to develop social competence that could protect them from further trauma. Their families may be affected by the ACEs in ways that interfere with their ability to protect and promote resilience in children.

What it may look like in children: Children with ACEs may be picked on or may emerge as bullies. Although discipline may be ineffective in managing stress responses, they may experience multiple encounters with punishment before being excluded from academic or social settings. Children may be separated from families, placed in foster care, and though physically safe may feel psychologically unsafe and have difficulty regaining a sense of well-being and permanence; contributing to a chronic stress response. They may experience multiple caregivers across foster or kinship care. They may seek out inappropriate company, become exposed to substance abuse or illegal activity, etc. Families and community settings may struggle to deal with their extra- ordinary needs, associated with ACE exposure.

Healthy, strong family relationships are foundational to young people's growth, learning and well-being. These relationships build strong social and emotional strengths that kids use throughout their lives. 

Understanding healthy brain development, supporting a teen's ability to cope with stress, supporting effective parent and adult communication, and building resilient teens all support moving teens toward healthy young adulthood. 

A framework of five protective factors that promote optimal development and strong families includes:

1. Parental Resilience
2. Social Connection
3. Knowledge of Parenting and Child Development
4. Concrete Supports in Time of Need
5. Social and Emotional Competence of Children

How Parents Can Build Resilience

1. Begin with yourself!
   • Take care of your own emotional & physical health
   • Develop healthy coping devices (regular exercise, reading, listening to music, etc.)
   • Seek out healthy family/friends for support
   • Use community supports (counseling, substance abuse treatment, self-help programs, faith based groups, etc.
2.  Make connections
   • Good relationships with family, friends or others are important. Accepting help and support from people who care about you and will listen to you strengthens resilience.
   • Get active in civic groups, faith-based organizations or other local groups for social support.
   • Assisting others in their time of need can benefit you as much as them.
3. Take control
   • Look for your own inner strengths.
   • Have a healthy, positive view of yourself.
4. Set goals
   • Set goals and take steps to move toward them.
5.  Expect the unexpected
   • Avoid seeing crises as insurmountable problems. You can’t change the fact that stressful events happen, but you can change how you interpret and respond to these events.
   • Accept change as a part of living.

Additional Resources

• Keep Connected
• Center for Parent & Teen Communication
• Young Parents Learning (YouTube)
• American Academy of Pediatrics

In the Adverse Childhood Experiences (ACEs) Study, the Kaiser-Permanente (KP) Health Maintenance Organization (HMO) and the US Centers for Disease Control and Prevention (CDCP) collaborated in surveying over 17,000 HMO members about their experience of a variety of adversities as 0-18 year olds and their subsequent health histories.

They found a strong relationship between the number of ten categories of adversities experienced ((physical abuse, emotional abuse, sexual abuse, physical and emotional neglect and experience of parental domestic violence, substance abuse, incarceration, mental illness, and separation/ bereavement) and risk of a variety of negative behavior and health outcomes, including “the leading causes of morbidity, mortality and disability in the USA: cardiovascular disease, chronic lung disease, chronic liver disease, depression and other forms of mental illness, obesity, smoking and alcohol and drug abuse.”

Initially eight, and then ten, categories of adversity were included in the study because of their high prevalence in the KP weight reduction program: five directed toward children (physical abuse, emotional abuse, sexual abuse, and, later, physical neglect, emotional neglect) and five household issues (domestic violence to mother, separation, substance abuse, incarceration, significant psychiatric illness).

Although other risk factors such as poverty, political and cultural trauma, etc. also affect illness and wellness, they were not analyzed in the ACE Study of KP members. The number of adversity categories experienced in childhood significantly predicted negative health and behavior outcomes, but it did not appear to matter much which categories were involved. The number of experiences within categories was not counted. 

Inside the ACE Score Strengths Limitations and Misapplications with Dr. Robert Anda

Dr. Robert Anda, Co-Principal Investigator and designer of the ACE Study, explains strengths and limitations of the ACE Score. He explains why the growing popular movement to use the ACE Score for screening patients, assigning risk, and making clinical decisions for individual patients is a misapplication of the ACE Study findings. 

Watch video: https://youtu.be/Kfx5vOHFfxs

 

Other resources:

https://www.ajpmonline.org/article/S0749-3797%2820%2930058-1/fulltext

https://www.aceinterface.com/