Research links adverse childhood experiences, known as ACEs, such as abuse, neglect or experiencing or witnessing violence, to health and well-being challenges in adulthood. But in her research, Dr. Christina Bethell, director of the Child and Adolescent Health Measurement Initiative at the Johns Hopkins Bloomberg School of Public Health, found that many people who experienced ACEs also had positive experiences as children that made a difference in adulthood.
Here, Dr. Bethell discusses the importance of focusing on positive and healing experiences for individuals, families and communities. She explains how to establish family routines that promote well-being even when families are under stress and how parents can set the agenda to get help their families may need.
Q. The ACEs research could make people feel like they are set up to fail because of their childhood experiences. Your research focuses on positive experiences. Why is that important?
A. The presence of adverse childhood experiences (ACEs) is an indicator of risk. But by only focusing on ACEs, we identify people as “at risk” who may not be. All of us know people who have had a lot of adversity and are thriving. That’s because the presence of certain positive factors supports healthy development. By looking at the positive experiences necessary for healthy development, we get a more accurate picture.
For example, having a caring adult in your life is a positive experience. It is very important that children feel safe and feel that they can communicate their feelings and needs — that someone is attuning to them when they are having a hard time. That is the factor that has the greatest impact for buffering the negative impacts of adverse experiences. My research found that when this need was met in childhood, the odds were 72% less that people had depression or poor mental health as adults, even after adjusting for ACEs. Those with more positive childhood experiences (PCEs) were 3.5 times more likely to have the social and emotional support they needed as adults.
The specific positive childhood experiences that we studied were family resilience, talking with each other about problems as a family, identifying and celebrating strengths and making a resilience plan that expects people to have difficult times. This means that you make a plan, saying: “What are we going to do when mom is struggling? How are we going to support the child?” Expect everyone to be part of this family resilience plan and make a plan tailored for what each person needs and wants when they are having a hard time.
Q: The Coronavirus pandemic has been stressful and has disrupted children’s day-to-day activities. What advice do you have for parents during the pandemic?
A. First, recognize that this is a stressful time and that there are opportunities to use it to build resilience and connection. Connection is the foundation of healthy child development and well being and health across life. When a child feels they have someone they can talk to and who supports them when things are hard, it helps them throughout the rest of their life. Spending time being together physically is not the same as creating a sense of belonging and connection. It requires putting down the phone and making intentional space to be together to see what arises that needs to be shared. Giving voice to what is hard and not blaming ourselves for what is happening, seeing the larger context — that is a type of resilience that can help families stay connected and children stay in an empowered relationship to what is happening.
It is also important to find something to be hopeful about in difficult times. You can celebrate your longing for peace and well being, recognizing that it is threatened right now and that is hard, but that you have a positive instinct for having a peaceful and secure life. If we stay connected to that longing, we are likely to see opportunities and reach out for help. The last part of family resilience is reaching out for help from family and community. Being vulnerable is a strength and an act of courage but in our society we often pathologize it. We try to be independent but we need each other in healthy ways.
Q: What does the research about ACEs and your research about PCEs mean for schools and communities?
A. We need to proactively promote the positive for everyone regardless of whether we know they have experienced ACEs. This should be a cultural norm.
Schools should be about promoting health and positive relationships. When a child has opportunities at school to participate and get feedback to help them improve, they will look for more positive opportunities and develop a sense that the world can be a safe and supportive place. Without that, a child may not notice opportunities or trust that that is true.
Our study showed the importance of children feeling belonging in their school, community or church — that they enjoy participating in activities that give a sense of being part of a community. People who had those experiences as children were 70% less likely to experience depression as an adult. Just as adverse experiences stick with us, so do the positive. Creating a positive cultural norm in a community is a process. One of the first parts is coming together to see what opportunities and risks are there.
Q. How can community belonging heal and protect families from the negative impacts of ACEs, including racism and the pandemic?
A. Communities can come together in a structured way with intention to tell the stories of what is being experienced, build on the resources they have, lobby to get more support if needed and be active in their destiny. Many communities are doing this. There are a lot of natural convening places like churches and supermarkets with a community feel where businesses and services come together, raise hope, provide support and resources, and acknowledge that it is difficult but we can find new solutions so that we can flourish even after the pandemic.
In terms of racism, it is important to create space for telling stories and sticking with the healing process. Trauma gets stuck and shows up again — often as if it just happened yesterday — in the nervous system and culture because it has been so oppressed, in our bodies, systems, and societal groups. I’m going to look to people who have experienced racism directly to dictate the specifics of how to address racism, but it is important to come together, download what has been stuck, take time to listen and make space to share stories within a small set of rules — that this is about healing.
We need to become an anti-racist society. There is a huge role for any community to be engaged in this issue that is at the root of our well being as a nation. In the World Happiness Report, the US is low on the continuum. One key factor studied was whether you feel you are in a society that is on your side and cares about all people. That is not an experience many people have here and we need to address it.
Q. Why is it important for health care providers, schools and other systems and services to listen to parents’ priorities?
A. We have systems and services that say they are for families, but they have a “guilty until proven innocent” approach. Health care providers and the child welfare system and schools need to view parents as doing the best they can and work with parents in an empowering and supportive way.
Families should set the agenda for what help they need and their whole context should be taken into account. The most important thing for a parent might be food or to be able to safely go on walks in their neighborhood with their child. Too often, we don’t ask — and when we do, we don’t listen. Systems and services don’t meet the needs that are most important to the family, then view them as “non-compliant” and blame them for not following through. We need to put mechanisms in place at the community, systems and provider level so that families set the agenda.
Young children are supposed to have lots of well visits with pediatricians to promote healthy development. These visits could be an opportunity to support a family early on. There is low attendance at well visits, especially amongst families that are most vulnerable, because families don’t find the visits valuable. Well visits should be about supporting family well-being and encouraging parents to say, “This is my context and these are my priorities”, so that every encounter is anchored in the family’s priorities. We don’t do that now, but we need to embed that kind of model into services.
When we evaluate programs, we need to ask about the experiences of parents and children. Do they trust the services? Do they feel respected? Do they feel their needs are met? Families should feel services are about them — not to “fix” or change them, but to help them follow their positive aspirations.
I was born in the 60s in Los Angeles in a low-income area. I loved my mom and just thought she was sick. I didn’t know she was drunk and high and I was protective. Nobody was interested in helping my mom until things got bad. They would just wait until something bad happened to me or my sister to take us away or to court. Getting involved only when things go awry is backwards.
People want to grow and be healthy and love. When things are hard, it can beat us down. We need to address the safety of the child, but we also need to help the family and help them heal. In my experience, no one was interested in helping our family.
Q. In an article about your research, you discuss a neighbor, Ms. Racoon, who was a caring adult in your life when you were a child. How did she make a difference for you?
A. Knowing there was one place I could go where someone would be kind felt like it saved my life. Looking back, it gave me a sense that I mattered to someone — that there are kind people in the world and there is someone who supports me. One person in a child’s life can make a difference. Ms. Racoon got other neighbors involved in caring for me, she may have talked to teachers — I don’t even know what she did — but other people started getting involved. It’s absolutely critical to have that support.