Integrating ACEs increases hope for healing at One Hope United in Illinois

Tammy Ambre (l) and Keri Bechelli of One Hope United

One Hope United attempts to lead those affected by childhood trauma down a Healing Path.

That’s the name of a three-year-old program that has brought a different approach to helping people with adverse childhood experiences (ACEs). The program operates out of One Hope United’s office in Gurnee, IL, north of Chicago, and three others in the metropolitan area.

“It’s specifically trauma-based treatment, rooted in evidence-based practices,” says Jill Novacek, director of programs for the four Illinois offices of One Hope United. The organization works to ensure safe, loving environments for children by educating and empowering them and their parents—or, if need be, foster parents. The program serves children from three through 18 years old. Most have a complex set of ACEs. ACEs refers to the CDC-Kaiser Permanente Adverse Childhood Experiences Survey, which found a direct link between childhood adversity and the adult onset of chronic disease, mental illness, violence and being a victim of violence, among a host of other consequences.

“We’re helping people understand it’s not just a kid doing bad things, but a kid who has experienced scary things,” she says.

The bottom-line results: a 91 percent improvement during fiscal year 2015 in scores on the Child Adolescent Needs and Strengths (CANS) evaluation tool for those in Healing Path for at least six months, on the heels of an 85 percent improvement across all programs during fiscal year 2014 (One Hope started measuring Healing Path separately for the first time in 2015).

These numbers reflect steady progress. Using different evaluation tools, in 2013, all clients achieved at least 75 percent of their treatment plan goals at discharge, while 50 percent showed overall improvement in their wellbeing. In 2012, 66 percent of clients achieved at least 75 percent of treatment plan goals, and 33 percent showed overall improved well-being. In 2011, the numbers were 75 percent and 20 percent, respectively.

One Hope United had begun trauma-informed training before the NCSTN grant, about five or six years ago, when child psychiatrist Bruce Perry was invited in to conduct trainings, says Tammy Ambre, a licensed clinical social worker who counsels patients in the Gurnee office. The approach of integrating ACEs, prompted by requirements under contracts with the Illinois Department of Children and Family Services to integrate trauma-informed practices has worked better for patients and therapists, she says.

“It gives us more common language and understanding about the impact of trauma over the lifespan,” she says.

The ACE Study measured 10 types of childhood adversity, those that occurred before the age of 18. They are physical, verbal and sexual abuse; physical and emotional neglect; a family member with mental illness, or has been incarcerated or is abusing alcohol or other drugs; witnessing a mother being abused; losing a parent to divorce, separation or death.

Of the 17,000 mostly white, college-educated people with jobs and great health insurance who participated in the study, 64 percent had an ACE score of 1 or more; 12 percent had an ACE score of 4 or more. The researchers found that the higher a person’s ACE score, the greater the risk of chronic disease, mental illness, violence and being a victim of violence. For example, compared with someone who has an ACE score of zero, a person with an ACE score of 4 is 12 times more likely to attempt suicide, seven times more likely to become an alcoholic, and twice as likely to have heart disease, according to the data.

When they have their first meeting with a child, Healing Path counselors use a modified version of the traditional 10-question ACE survey. Their list includes: abuse, neglect, accidents or injuries, loss of a loved one, abandonment, homelessness, domestic violence, peer and community violence, natural or man-made disasters, substance abuse, serious illness, terrorism or war zone trauma. The traumas from the original ACE Study that are not included are losing a parent to separation or divorce, living with a household member who is depressed or has other mental illness, and having a household member who is incarcerated.

Therapists spend at least four sessions gathering information from the children about their trauma symptoms, such as behavior changes, anxiety, inability to focus, academic problems, depression, nightmares, physical complaints and problems maintaining relationships. They also ask parents about similar stresses in their own lives that could be contributing to a child’s traumatization.

Novacek says One Hope United asks questions about ACEs in an “interview format, more of an open conversation” as opposed to simply going down a checklist.

“Once we’re done with the assessment,” she says, “we talk about the ACEs they have discussed with us. ‘Let’s talk a little about that….how do you define that?’ Clients will share physical abuse from their childhood, but they’re not typically going to say, ‘physical abuse.’ ”

Once they understand the client’s story, she adds, “we’re having that conversation of, ‘Here are your experiences, this is what we call it, this is how we see it impacting people’s lives in general, here’s how I see it impacting you in particular.’ That informs our treatment plan and what we want to work on when we’re together.”

They do not educate clients about the ACE Study until clients have told their own stories and begun to build a relationship of trust with their therapist. They don’t explain ACEs to young children who would not have the capacity to understand, says Ambre.

Healing Path uses the evidence-based Attachment, Self-Regulation & Competency (ARC) framework developed by Kristine Kinniburgh and Margaret Blaustein, a primary component of which is helping parents rebuild attachment with their children, Bechelli says.

“If your kid is traumatized, you are also affected,” she says. “You’re treating them hand-in-hand as a family.”

When parents are unavailable for whatever reason—which can include death, substance abuse problems, abuse or neglect in the home that’s led to foster placement, or their own unresolved trauma—the agency turns to extended family, or perhaps a daycare provider or school social worker or teacher with whom the affected child connects well, says Ambre.

“Sometimes, we are that caregiver ‘container’ until we find one” in the child’s life, she says.

In working with caregivers, One Hope United therapists attempt to bring the adults up to speed on how to understand their child’s emotions, so they can better relate to the traumatized youth.

The success of the Healing Path Program, for which the National Childhood Traumatic Stress Network has provided $400,000 annually for four years, has prompted other counseling programs in the Gurnee office of One Hope United to infuse similarly trauma-informed practices based on ACEs research into their programming. These other programs deal respectively with foster care youth, adolescents with sexual behavior issues, and prevention and early intervention for youngsters three years old and under.

The parent education varies slightly by program. For example, those whose youth are in the sexual behavior program need an answer to the question, “How do I deal with the fact that everyone is calling my kid a monster?” Ambre says. Whether for the sexual behavior program or others, these groups are “pivotal” to helping kids moving forward. After the formal groups end, parents tend to meet with each other in the community to continue their mutual support of one another, she says.

Individual and group therapy explore potential intergenerational trauma that’s so common among families whose children are exhibiting symptoms.

“It’s interesting how many families draw that parallel themselves,” Ambre says. “It takes them awhile to get there, but in exploring their history, people are more honest than we expected.”

“I never wanted this for my child. This is how I grew up,” adds Bechelli, summarizing a common reaction.

Intergenerational issues can be quite delicate, Novacek notes.

“Sometimes, after you have a relationship with a family and can unfold their story, you can address the anxiety they experience on a daily basis,” she says. “Sometimes youth may not have ACEs of their own but have anxiety due to the environment they’re living in [with parents or caregivers who do]. Sometimes you have to find those pieces of evidence to help the family see, ‘OK, we’ve talked about these things, this is how we see it fitting together.’ ”

“As an organization, we have been engaged in efforts to become more trauma-informed, wanting to make sure we’re understanding the ACEs of all of our clients [and their families]” Novacek says. Headquartered in St. Charles, the Illinois offices have a total of 256 clients in all its programs, not including family members, who are referred through any number of avenues—state DCFS; county health, probation and juvenile justice agencies; child advocacy and other community organizations; schools and sometimes families.

“ACEs are important to have an understanding about what their life experiences have been,” says Novacek. “It shapes who they are today.”

The Healing Path program offers individual and family therapy that includes parents or caregivers, as well as an eight-week group psycho-education program for parents. They offer all services in the home, office or other community locations in English or Spanish at no cost to clients; this is covered by the NCTSN grant.

One Hope United has been building partnerships with area schools to provide therapy for students. This can include individual therapy sessions with students who would have difficulty traveling to their office, psycho-education with groups of students, and teacher training around managing the symptoms of ACEs.

“A lot of times, it’s best to go to schools because these are community centers,” says Keri Bechelli, one of three Healing Path counselors.

Although ACEs are not formally integrated into the workplace, therapists at One Hope United are strongly encouraged to become aware of their own adverse childhood experiences and how that might affect them, as well as the second-hand stress that comes from dealing with such children and families, Bechelli says.

Because the organization is well aware of the effects of secondary trauma, they have set up an employee assistance program, they host retreats twice a year that combine work-related sessions and fun activities to build rapport, they hold monthly team meetings to discuss common challenges, and weekly meetings with supervisors, she says. And supervisors proactively encourage therapists to take their sick leave and vacation time so they can get a break from the intensity.

“We have to take care of each other. We have to vent,” Bechelli says. “We have to talk about strategy: ‘What are you doing to take care of yourself?’ ”

By design, so they can be supportive of one another, all the therapists share a large open office, Ambre says.

“You’re aware of what’s going on with your team,” she says. “It can be distracting but it’s very supportive. You get off a stressful phone call, and the room responds.”

That “fishbowl” environment can be reassuring since the therapists are typically familiar with one another’s cases and can check in about “not just how the kid is doing, but how are you doing?” she says.

“It’s unique to have that immediacy,” Bechelli adds. “Even if it’s just to vent.”

“We know that if you have your own ACEs, you have a higher risk level,” she says. By providing self-care support for staff, the organization can make sure that the experiences of clients aren’t “stealing into [counselors’] dreams and impacting their lives.”

Written By Ed Finkel

Integrating ACEs increases hope for healing at One Hope United in Illinois was originally published @ Ed Finkel – ACEs Too High and has been syndicated with permission.