Trauma & Adverse Childhood Experiences (ACEs) -- Prevention and Helping Survivors

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“Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering.” —Peter Levine

Countless Albertans suffer from the negative effects of childhood abuse and neglect, family dysfunction, bullying by peers, and community violence. They can suffer across their lifespan and may pass on the negative affects to future generations via behaviours and/or epigenetics. (Epigenetics is the science of how external stressors, such as trauma, can alter gene expression predisposing someone to disease.)

Adverse Childhood Experiences (also known as ACEs) are potentially traumatic events that occur during childhood (0-17 years). These can include experiencing violence, abuse, or neglect; witnessing violence in the home or community; having a family member attempt or die by suicide; growing up where there is in the household substance misuse or mental health problems; instability due to parental separation or household members being in jail or prison.

ACEs and childhood trauma increase the risk of: family violence, intergenerational trauma, juvenile delinquency, youth that were kicked-out or ran-away from home, addiction, cults, gangs, crime, terrorism, mass murder/serial killing, bullying, poverty, homelessness, chronic illness, mental illness, unemployment and under-employment, illiteracy and low education, racism and other forms of bigotry, self-harm, suicide, poor physical health, and early death.

To help improve the lives of those affected by violence, abusive relationships, child abuse and neglect, we, the undersigned, petition the Alberta government to implement the following seven actionable goals:

  1. Mandatory ACE (Adverse Childhood Experiences) Screening of Albertan Patients by general practitioners, family physicians, registered nurses, psychiatrists, mental health and addictions therapists. That if a patient is found to have had ACEs, that the patient is referred to the necessary supports and/or report to the authorities (if there is abuse or neglect of vulnerable persons, reporting is required by law). An example of what screening for ACEs could look like can be seen in two parts here and here.
  2. General practitioners, family physicians, registered nurses, psychiatrists, mental health and addictions therapists give all patients basic information about healthy vs. unhealthy relationships and trauma as it is as vital to the patient’s treatment plan as giving the patient information on healthy diet, exercise, sleep, and medication management. To give information about healthy vs. unhealthy relationships and trauma to the patient even if abuse or neglect isn’t suspected for the same reason they would still remind a patient that doesn’t appear overweight to eat healthily: because they are necessary practices for good health. That medical professions be taught about the warning signs of abuse or neglect, how to go about asking if there has been abuse or neglect (going beyond asking, “How are things at home?”), trauma bonding, cognitive dissonance, dissociation, denial, thought-stopping (automatic dismissal of negative remarks made about an abuser), and how the abuse or neglect appears as “normal” to the victim, or that they must have done something to deserve it, or has been told to keep quiet about it or been told a cover story (such as “I walked into a door”), or the victim doesn’t want to get their abuser into trouble. As well as to be taught about why directly telling someone that they are or were abused will backfire, and that it is best to give the patient the information about abusive relationships and trauma, then let the patient connect the dots.
  3. Elementary & High School Students are taught age-appropriate education on coercive control (a.k.a undue influence) in health class as part of the curriculum. Coercive control is exhibited in abusive relationships, dysfunctional families, gangs, cults, human trafficking, and dictatorships. Albertan students deserve to know the warning signs of these unhealthy relationships, how to seek help, and the physical and mental health effects that being in an unhealthy relationship or group has on the victim. As well as the signs of healthy relationships and groups. Stephen Hassan’s BITE Model (Behaviour, Information, Thought, and Emotional Control), his Influence Continuum and diagram of Authoritarian, Destructive Cult Structure demonstrates succinctly characteristics of abusive relationships and groups. To prevent thought-stopping, it would be best if the warning signs were taught using fictional examples or true stories where only the names of persons, places, or groups have been altered to preserve anonymity. Stories about abusive relationships (intimate partner, familial, or platonic), gangs, cults, human trafficking and dictatorships. (A suggested example would be the four fictional stories of intimate partner and platonic abusive relationships in the book Dangerous Relationships: How to Identify and Respond to the Seven Warning Signs of a Troubled Relationship by Noelle Nelson, PhD.)
  4. Teachers are taught the warning signs of abuse or neglect in students and the importance of why they should report directly to the authorities rather than speaking to anyone else or hoping that someone else has reported it. That Albertan teachers also be taught about ACEs and how they impact a student’s behaviour and ability to learn.
  5. Daycare Workers are taught the warning signs of abuse or neglect in the children that they care for, and the importance of why they should report directly to the authorities rather than speaking to anyone else or hoping that someone else has reported it.
  6. Neighbours in Albertan Communities are taught the warning signs of abuse or neglect, how to safely report incidents of family violence to the police or other authorities, the importance of why they should report directly to the authorities rather than speaking to anyone else or hoping that someone else has reported it, that family violence isn’t a “family matter”—it’s a community matter, spread awareness of Alberta’s new law known as “Clare’s Law,” and that the abused child and the family of the abused are statistically among the least likely to report the abuse and neglect of a child (see Table 3-4b). Reasons for why adult family members may remain silent and make no effort to protect the abused child after they have witnessed the abuse and/or have been told about the abuse by the child are further explored here.
  7. Children’s Services implements random auditing to ensure consistency across the province in quality of service provided, to proactively combat the leaning on physical abuse or drug use as primarily legitimate, while dismissing the warning signs of emotional injury that some workers or regions have within Children’s Services.

Further reading and statistics explaining the need for this petition...

In 2013, a telephone survey conducted in Alberta on the prevalence of ACEs found that of the participants, 1/3 reported 1-2 ACEs, 1/5 reported 3 or more ACEs. This is comparable to the CDC-Kaiser ACE Study that found “ACEs are common across all populations. Almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs.”

The more ACEs a person has, the more dramatically the chances increase of developing diseases, poor mental health, and risky behaviours. According to the Collaborative Global ACE Analysis with WHO, compared to their peers that have no ACEs, those with 4 or more ACEs have a statistically increased risk:

  • 1.2x physical inactivity 
  • 1.4x obesity
  • 2.1x heart disease
  • 2.2x smoke
  • 2.2x poor self-rated health
  • 2.3x cancer
  • 2.8x heavy alcohol use
  • 2.8x liver/digestive disease
  • 3.0x respiratory disease
  • 3.6x multiple sexual partners
  • 3.7x early sexual initiation
  • 3.7x anxiety
  • 4.2x teenage pregnancy
  • 4.4x low life satisfaction
  • 4.4x depression
  • 5.6x illicit drug use
  • 5.8x problem alcohol use
  • 5.9x STIs
  • 7.5x victimization
  • 8.1x violence perpetration
  • 10.2x problem drug use
  • 30.1x suicide attempt

The CDC also adds that compared to their peers that have no ACEs, those with 4 or more ACEs have a statistically increased risk:

  • 1.6x diabetes
  • 1.6x broken a bone
  • 2.4x stroke
  • 5.5x missed 14 or more days of work in a given month due to mental illness
  • shorter lifespan by 20 years

ACEs have a significant impact on crime and recidivism. A study on Adverse Childhood Experiences and Adult Criminality concluded, “On the basis of a review of the literature and current findings, criminal behaviour can be added to the host of negative outcomes associated with scores on the ACE Questionnaire. Childhood adversity is associated with adult criminality. We suggest that to decrease criminal recidivism, treatment interventions must focus on the effects of early life experiences.”

“One of the most significant and recurring findings in the literature is that SVCs [Serious, Violent, Chronic Juvenile Offenders] are disproportionately victims of trauma, abuse, neglect, and maltreatment during childhood, as compared to the less severe or non-offending juvenile population. Specifically, new research shows that 90% of juvenile offenders in the United States experience some sort of traumatic event in childhood, and up to 30% of justice-involved American youth actually meet the criteria for post-traumatic stress disorder due to trauma experienced during childhood.” Trauma Changes Everything: Examining the Relationship Between Adverse Childhood Experiences and Serious, Violent and Chronic Juvenile Offenders

Trauma and ACEs are also connected to homelessness. According to a study on ACEs and adult homelessness, “Adverse childhood experiences are powerful risk factors for adult homelessness.” “Lack of care from a parent during childhood sharply increased the likelihood of subsequent homelessness, as did physical abuse...The risk of subsequent homelessness among individuals who experienced both lack of care and either type of abuse [physical or sexual] was dramatically increased compared with subjects reporting neither of these adversities.”

According to a Public Health Theses on Adolescent Homelessness, “Homeless adolescents are more likely to have been abused than housed adolescents. Abused youth are more likely to run away, or to be asked or forced to leave their homes by their caregivers. Forty-nine percent of adolescents reported running away for the first time due to violence at home, physical abuse, and/or sexual abuse.” Another paper on ACEs and Homeless youth found that of the homeless or previously homeless youth that they surveyed, the mean ACE score was 4.15.

Trauma and ACEs are connected to addiction. This is not only reflected in the statistics from the ACE studies by the CDC and WHO, but is a connection that various addictions therapists have noticed in their practice. Dr. Gabor Maté, a family physician, addictions expert that has struggled with addiction himself, has said in a BBC interview, “My mantra on addiction is not why the addiction, but why the pain? If you want to look at what causes addiction, you have to look at what is the benefit of addiction. What did it do for you? People will say, typically, it gave me pain relief, relief from stress, it gave me a sense of connection, a sense of belonging, the addiction met some essential human need that otherwise wasn’t being met in that person’s life...We’re not looking at it’s real nature, as a response to human suffering. Because we’re not really helping people work through and resolve their traumas. So we keep saying ‘What’s wrong with you?’ instead of asking, ‘What happened to you?’”

If you’d like to learn about my personal reasons for starting this petition, the reason why medical, mental health, and addictions therapists need to go beyond asking “How are things at home?,” why one should report abuse or neglect directly to the authorities rather than speaking to anyone else or hoping that someone else has reported it, why I think that basic education about abuse disseminated to a large population with mixed or unknown beliefs or life experiences would be most effective if as much of the material as possible used either fictionalized or omitted names, or a certain amount of anonymity such as using only first names, and more, you can read that here.

If you’d like to learn more about trauma, abusive relationships, and ACEs may I recommend watching:

  • How childhood trauma affects health across a lifetime | Nadine Burke Harris (16m.) TED Talk
  • The difference between healthy and unhealthy love | Katie Hood (13m.) TED Talk
  • Step Inside The Circle | Compassion Prison Project (7m.) Prison Inmates and ACEs
  • Steven Hassan: The BITE model (5m.) How would you know if you’re in a cult or under undue influence?
  • Multi-Level Marketing and Self-Help Cult Groups: Learn the Warning Signs (3m.) Not all cults are religious or political, they can also include pyramid schemes and awareness training groups.
  • Slavery & Human Trafficking Prevention (4m.) Human traffickers also use undue influence to manipulate their victims.
  • Us & Them (2015) (1h. 22m.) Homelessness, child abuse and neglect, family violence, trauma, addiction, depression, low self-esteem, poor health, early death, intergenerational trauma. Follows the lives of four chronically homeless adults in Vancouver.
  • We Were Children (2012) (1h. 28m.) Canadian Residential School System, child abuse and neglect, sexual abuse, addiction, low self-esteem, depression, suicidality, early death, intergenerational trauma. Two residential school survivors tell their story of being separated from their family, community, and culture to endure various forms of abuse and neglect. The affects that the residential school has had on their lives, the lives of fellow survivors (many died an early death due to addiction, poor health, or suicide), and the lives of their children.
  • Paper Tigers (2015) (1h. 42m.) High School students, low self-esteem, aggressive or withdrawn, addiction, truancy, bullying, family violence, dysfunction, intergenerational trauma, child abuse and neglect. After teachers and students learn about ACEs and the school implements a trauma-informed model of education with in-school suspensions, the students’ behaviour, attendance, grades, and rates of high school graduation improve.
  • Bad Behaviour (2003) (50m.) Parenting documentary, intergenerational trauma, dysfunction, child abuse and emotional neglect, family violence. Warwick Dyer, working only with the parents and never the child, trains the parents in parenting. An aggressive and overly defiant child transforms after the parents have transformed their behaviours.
  • Cracked Up: The Darrell Hammond Story (2018) (1h. 37m.) Child abuse and emotional neglect, family violence, intergenerational trauma, dysfunction, depression, self-harm, suicidality, addiction, low self-esteem, decades of misdiagnoses by mental health professionals.
  • Trophy Kids (2013) (1h. 47m.) Child abuse and emotional neglect, dysfunction, family violence, addiction. When winning is the only thing that matters, at any cost. Parents that treat their child not as an individual to be unconditionally loved, but as a trophy to boost the parent’s ego and status.
  • A Stone In Our Heart (2019) (1h.) Child abuse and emotional neglect, incest, dysfunction, family violence, trauma, addiction. The abusive stepfather deceased, an adult daughter goes hiking with her mother. The mother has denial about how her enabling actions affected her daughter and an emotional disconnection to her daughter’s suffering. The daughter is in search of answers and is hoping that the hike might bring healing.
  • Just, Melvin: Just Evil (2000) (1h. 15m.) Child abuse, physical and emotional neglect, incest, family violence, murder, addiction, intergenerational trauma, dysfunction, homelessness, low self-esteem, suicidality. Filmed by the grandson of Melvin Just, the documentary covers three generations of family violence and its aftermath.

Books about trauma, abusive relationships, and ACEs:

  • Dangerous Relationships: How to Identify and Respond to the Seven Warning Signs of a Troubled Relationship by Noelle Nelson, PhD
  • Freedom of Mind: Helping Loved Ones Leave Controlling People, Cults and Beliefs by Steven Hassan
  • No Safe Place: The Legacy of Family Violence by Christina Crawford
  • Complex PTSD: From Surviving to Thriving by Pete Walker
  • Start Here: A Crash Course in Understanding, Navigating, and Healing from Narcissistic Abuse by Dana Morningstar
  • Fuel: What Makes the Narcissist Function? by HG Tudor
  • Pipelines: The Narcissist’s Fuel Matrix by HG Tudor
  • Children of Trauma: Rediscovering Your Discarded Self by Jane Middleton-Moz
  • The Holocaust Lessons: On Compassionate Parenting and Child Corporal Punishment by David A. Cooperson
  • Genograms: Assessment and Intervention (Third Edition) by Monica McGodrick, Randy Gerson, & Sueli Petry
  • The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma by Bessell Van Der Kolk, MD
  • When The Body Says No: The Cost of Hidden Stress by Gabor Maté, MD

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