Not Every Trauma Comes with a Bandage, Cast, or Crutches - Unseen Injuries that Alter Lives
Stanley G. Falk: A Therapeutic Day School in Western NY
There is a relationship that I have been wanting to write about for quite some time. It began in 1996 and has continued for nearly 30 years; shortly after becoming a Special Education Teacher at the Stanley G. Falk School in Buffalo, NY, I was asked if I’d consider becoming a trainer of Therapeutic Crisis Intervention (TCI). This program has been administered by Cornell University in Ithaca, New York, dating back to the early 1980s. The first go around of this program focused on a methodology for decreasing injuries to staff who worked in and young people who lived in various residential care facilities in New York State.
At the age of 23, I and one of my colleagues named Tim Lasky went to the Cornell campus, where we spent five days and nights learning the ins and outs of training in this innovative program from two experts – who I will never forget. Greg Wise, a former United States Marine, was so memorable in his presentation of the content that I occasionally cite the very instruction he provided me so many years ago. The program he instructed was so effective that although it was developed for residential care facilities – it was being used in an increasing number of K – 12 special education schools.
The TCI program is what we in the business call “Trauma Informed.” This is a topic that I am planning on writing about in successive pieces, so I am going to provide information on several TCI-related topics that are very important in schools… sports fields…gyms…dance studios… playgrounds…and even more importantly, in homes. The topic of “Trauma” has become increasingly known in schools, with professional development opportunities all around us. Those of us concerned about trauma were horrified by what the COVID-19 Pandemic was doing to children and young adults – while it was happening.
After years of conducting professional development on this topic, I have found that adults can best understand trauma's effects on children when they come to understand its effects on adults who experienced it when they were children – many before anyone knew what trauma was. The best way to do this is by informing caregivers about the ACES study.
The Adverse Childhood Experiences (ACES) study is a seminal research project that has fundamentally shaped our understanding of the long-term effects of childhood trauma. Conducted by the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego, the study involved over 17,000 participants who underwent comprehensive physical exams and provided detailed information about their childhood experiences. The ACEs study, first conducted in the late 1990s, illuminated the strong, graded relationship between exposure to abuse or household dysfunction during childhood and multiple risk factors for several leading causes of death in adults.
The ACEs study was groundbreaking because it demonstrated the profound, lifelong effects of adverse childhood experiences on mental and physical health. The study found that the more ACEs a person experienced, the greater their risk for health problems later in life, including alcoholism, drug abuse, depression, suicide attempt, heart disease, cancer, stroke, diabetes, skeletal fractures, and liver disease. Moreover, individuals with high ACE scores were more likely to engage in risky behaviors, suffer from poor academic performance, and experience social, emotional, and cognitive impairments.
This Image Appropriately Captures the Impact of Adverse Childhood Experiences on the Lives of Those Involved in the Study - We Learned So Much From This!
The implications of the ACEs study are far-reaching, as it emphasizes the necessity of preventing and addressing childhood trauma to improve adult health. Based on the analysis, researchers developed a 10-item questionnaire now widely used to assess an individual's ACE score. Here are the ten questions:
Warning: Sensitive Material Below
Did a parent or other adult in the household often or very often... Swear at you, insult you, put you down, or humiliate you? Or Act in a way that made you afraid you might be physically hurt?
Did a parent or other adult in the household often or very often... Push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured?
Did an adult or person at least five (5) years older than you ever... Touch or fondle you, or have you touch their body in a sexual way? Or Attempt or have oral, anal, or vaginal intercourse with you?
Did you often or very often feel that... No one in your family loved you or thought you were important or special. Or did your family not look out for each other, feel close to each other, or support each other?
Did you often or very often feel that... You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? Or were your parents too drunk or high to care for you or take you to the doctor if you needed it?
Were your parents ever separated or divorced?
Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? Or sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? Or ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
Was a household member depressed or mentally ill, or did a household member attempt suicide?
Did a household member go to prison?
Each "Yes" answer to these questions is counted as one ACE. More ACEs can indicate a higher risk of health and social problems later in life, with increasing significance for those who experienced more than four (4) ACEs. For instance, those with five (5) or more ACEs in this study approached 100% in their likelihood to have been prescribed an anti-depressant or anti-anxiety medication at some point in their lives.
It is vital to know that ACEs are not destiny, and resilience factors can help to mitigate their effects.
More to come on this.