A trendy subject these days is the discussion of “toxic stress” and “resiliency” through the study of “ACEs,” or Adverse Childhood Experiences. Twenty years after a groundbreaking study by Drs. Vincent Felitti and Robert Anda established this connection, most communities are grappling with what to do with the now-accepted fact that the awful things that happen to us in our childhood can cause disease and early death.
In New Hanover County, a group of us has aggressively taken on this project. The New Hanover County Resiliency Task Force has more than 200 members from just about every segment of the community, including schools, health providers, law enforcement, the courts, state and local government, social services, nonprofits, churches, nursing homes and even the county library.
The movement is catching on. And make no mistake. This is not some “touchy-feely” psycho-study designed to get us in touch with our feelings.
Toxic stress may be the most important discussion in public health at the moment. The lousy things children and even adults go through actually change us physiologically. They alter cell structure and hamper the brain’s ability to develop. The outcomes are predictable. And as Dr. Anda, a researcher with the Centers for Disease Control, famously says, what is predictable is preventable. Which is what our Task Force is intent on doing.
ACEs are 10 common “adverse” events from childhood, including parents’ divorce or incarceration, neglect, isolation, abuse (emotional, physical and sexual), and domestic violence, substance abuse or depression in the home. The point of the screening is not to reveal which ACEs apply to you, but to give a number.
Two-thirds of the population have at least one “ACE.” Fifteen percent of women and 9 percent of men have four or more, which means this group has three times the level of heart or lung disease, and is twice as likely to have liver disease. They are 4½ times as likely to be depressed and 14 times as likely to attempt suicide. They are four times as likely to be sexually active at age 15.
Those with six ACEs can expect to die 20 years earlier than those with none. You know people in your everyday life with six or more ACEs.
Is Wilmington somehow exempt from this? Absolutely not. ACEs occur in all demographics and income groups, but tend to cluster where poverty does. Talk to any school teacher at a high poverty elementary school about the difficulty of teaching addition to students who have seen their mother get beaten by her boyfriend that morning or have seen dead bodies in their front yard. For too many of our children, this is part of their childhood.
Perhaps our defining moment in toxic stress occurred in August last year at the Houston Moore housing project. As 200 or so elementary and middle school students attended a “Back to School” picnic, a drive-by murder took place a few hundred yards away.
Tim Markley, our schools superintendent, wrote a blog in which he recalled saying that at first it sounded like firecrackers. A young student looked up at him.
“It’s never firecrackers here,” she said.
And that is a childhood reality our Task Force is trying to address. The goal is to instill “resilience” across our community, to help children and adults buffer these bad experiences and move forward with a healthy life.
We have received grant funding to begin training the community on the Community Resiliency Model. Thirty trainers were qualified during a recent week-long “train the trainer” session, and we hope to train more in the future.
The idea is to get children, parents, co-workers, church members or whomever is struggling to cope to recognize that the question is not “What’s wrong with you?” but “What has happened to you?” The Community Resiliency Model encourages six concrete skills such as one to literally “ground” oneself - focusing attention downward to help move into the “Resiliency Zone.” Again, the program is based on science geared toward engaging the correct part of the brain – away from the fight or flight part to the more rational, executive functioning part of the brain.
As we start this program in the schools, the goal is to have this become part of every school teachers’ interaction with their students. But, as Dr. Markley encouraged us before we started, we have to address the teachers’ own resilience first. Their stress comes from two directions – their own childhood experiences and the secondary stress of seeing what their students are going through.
In the future, we hope to create a community where everyone speaks the same language regarding toxic stress and can adopt common coping methods, and to provide havens within our key infrastructures. We are thrilled, for example, that the court system and law enforcement are drawn to this effort, as the potential for more positive interactions to respond to abnormal behavior is limitless.
Imagine a school with high levels of toxic stress that becomes a “resiliency focus” school where every adult is trained to address this. That is one of our goals going forward. We have to eliminate barriers to learning. We envision improved end-of-grade testing, less suspensions, less absenteeism, higher graduation, and more economic opportunity as adults. Building resiliency throughout our society will be a tide that rises all boats.
Finally, it’s not enough to simply coach children on becoming resilient to the bad things that happen. We cannot merely assume these things are a given. The other side of ACEs is “Adverse Community Environments,” where we address underlying stresses like poverty, homelessness, and racism. The Resiliency Task Force may not be able to directly attack all of these, but we can certainly work alongside other community efforts that are.
This was brought home to us during the storm recovery, when another well-meaning group handed out water to a neighborhood that had been devastated by Florence. “We don’t need another water bottle,” one survivor said. “We need a home.”
The storm, in an odd way, can be an opportunity in this regard. We recognize more than ever that we can collectively address some real issues that were problems before the storm. Resilience is a fantastic skill to have, but even better would be to reduce the need for it.
If you are interested in becoming part of the New Hanover County Resiliency Task Force and one of its five subcommittees, please email Mebane Boyd, the Task Force’s executive director, at [email protected].
Scott Whisnant is Administrator of Community Engagement of New Hanover Regional Medical Center and chair of the New Hanover Resiliency Task Force