Metropolitan Family Services Addresses ACEs Across Metropolitan Chicago

Katharine Bensinger founded a program called Parenting Fundamentals at an agency called Community Counseling Centers of Chicago nearly two decades ago. The program had been providing parenting education classes to low-income people for almost a decade when Bensinger attended a speech by Dr. Robert Anda, co-principle investigator of the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study.

“I flipped out,” she says. “It was putting a construct to what I already knew, which was that abuse affects children and young adults emotionally and physically. … When I heard about this research, it was a gift, a tool to help people. Because it was research-based, it had credibility.”

Part of why it resonated with Bensinger was that, despite growing up surrounded by affluence in Chicago’s northern lakefront suburbs, she had seen friends who experienced ACEs manifest those experiences through conditions like obesity, anorexia, alcoholism and child abuse.

“I’ve lived it from childhood to adulthood,” she says. And knowing that the ACE Study participants were 17,000 middle-class, mostly white, college-educated Kaiser Permanente members who all had jobs and great health care, she said, “imagine low-income people.”

Equipped with this new knowledge, she created an eight-page booklet for clients and staff of Community Counseling Centers of Chicago that discussed the study, the ACE pyramid that shows the emotional and physical toll ACEs can take, how to find your ACE score, and what your ACE score means.

In the spring of 2015, Bensinger took the content of that booklet and imported it — along with the rest of her Parenting Fundamentals curriculum and staff – over to a much larger, multifaceted agency called Metropolitan Family Services.

“It’s really a perfect fit,” Bensinger says. “We focus primarily on prevention. We are about strengthening families and empowering families.” And Parenting Fundamentals is about combatting trauma and ACEs, which Metropolitan Family Services has been spreading throughout its geographic reach and services for the past five years.

Metropolitan Family Services serves about 68,000 people a year through four types of services — emotional wellness, economic stability, education support and legal aid — in nine locations in Chicago and its suburbs.

The agency provides prenatal home visiting, senior services, counseling and crisis services, after-school programs, post-secondary engagement, job readiness and job placement, and legal services that include domestic violence, poverty law, and “wraparound crime-victim services,” says Vikki Rompala, director of quality and outcomes.

Parenting Fundamentals
One of Parenting Fundamentals’ six educators, Robert Augustin, graduated from the program 12 years ago. He took the course as a result of a court order after his divorce 12 years ago. Then he became a volunteer, a contract worker, a part-time employee and is now full-time.

“He’s the kind I want to replicate because they [former students] obviously know the reality,” Bensinger says. “The first thing he says is, ‘I was sitting where you are before I was sitting here.’ The parents drink it up.”

Augustin recalls that his son, now 22, was 10 years old when he took the Parenting Fundamentals class. At that time Augustin recalls, there were handouts and resource materials that touched on ACEs, but not nearly in the same depth.

Parenting Fundamentals has evolved a great deal, he says. “Especially when we talk about childhood experiences, and talking about our own children, it gives parents the ability to think about what happened to them and how it affects what they’re doing.

The parenting education programs help parents help their own children. “Even small, young children show effects from trauma when they’re exposed to it early and often,” says Bensinger. As such, the workshops “talk about how trauma affects their kids–and how parents are the first responders.”

Maria Andrino, an educator who has been with the program for 15 years, has thought a lot about her own childhood in Guatemala and her abusive father.

“When I had children, I always said I didn’t want to do the same thing,” she says. Parenting Fundamentals “opens their eyes, and they learn a completely different way to raise children. It breaks the cycle of abuse.”

Each year, the program serves 425 parents and more than 800 children in seven dedicated locations as well as child care centers and partner schools; all are in low-income, high-risk, multicultural communities. Since 1996, it has served more than 7,000 parents and 21,000 children. While there is not currently a waiting list, Bensinger says, “Our classes do fill up.”

Parenting Classes
The parenting classes use an ACEs manual [PFACEsManual] that talks about the types of ACEs, the risks they entail and other facts to remember. It contains a checklist for parents to total up their ACE score, discusses what that score means and provides resources. It contains the PARENTS slogan — seven essential practices for positive parenting: Patience, Awareness, Role modeling, Esteem, Nurturing, Timely & consistent, Self-Care.

“They talk about what are ACEs, and they go around the room and [parents] say how many ACEs they have,” Bensinger says. “It’s too traumatic to say [openly] what the ACEs are. And they ask the class, ‘Why does this matter?’ Hopefully they get the answer, ‘So that we can heal our ACEs, and so we don’t pass our ACEs on to our children.’ ”

The educators emphasize that the parents are not to blame for their problems. “You were given a set of ACEs by your circumstances,” she tells them. “You can heal them and not pass them on.” Those who wish to talk openly about their ACEs are invited to stay after class and/or are given referrals to private counseling services.

“The overwhelming majority of the feedback is positive,” says Augustin. “‘I didn’t know that because this happened to me, it affects what I’m doing now.’ It gets them to stop and think.”

Home Visits and More
In addition to the parenting education classes, the Parenting Fundamentals program offers home visits, case management and a children’s art group, all to promote the social and emotional development of children, to prevent child abuse, to strengthen families and to improve school readiness and achievement, she says.

Staff members provide additional support to parents over the phone or in the home, Augustin says.

“They have to understand the whole thing about abuse and neglect,” he says. “Parents want to talk about it, but not necessarily in a classroom setting. We go over what the ACEs lead to — like heart disease, drug abuse, multiple sex partners.”

But they make clear that people with ACEs are not necessarily doomed to such purgatory, Augustin says. “One of the things I tell the parents is, ‘We’re not saying that if this has happened to you, then it is 100 percent guaranteed you will abuse drugs,’ ” he says. “ ’But the chances are greater. So now that you’re aware, why would you continue [taking drugs or other harmful behaviors?’ ”

Among those helped has been parent Veronica Prieto, who has taken classes through Parenting Fundamentals since 2004, who says her original motivation was that her then-16-year-old daughter was suffering from depression and resisting attending school. She says the classes have helped her to better understand her other children, grandchildren and “everyday people” she encounters.

“I can understand my children’s feelings and communicate much better with them,” Prieto says. Even outside her family, “I teach Catechism in church, and I can understand the children’s feelings and communicate much better with them. Through the years, I have learned a lot. I want my children to have a better relationship with my grandchildren and break the cycle of abuse.”

To help them absorb the combined weight of such experiences among all of the parents they teach, the team of parenting educators meets weekly to talk about their self-care and participate periodically in the Metropolitan Family Services trainings on secondary trauma and how to avoid burnout and stress from their work, Bensinger says. “Taking your vacation is critical in this work,” she says. “That recharging period is so critical.”

Evaluation
Metropolitan Family Services conducted an evaluation of the 356 parents graduating from the Parenting Fundamentals program in 2014-15; 194 received home visits and 175 were referred to specialized outside agencies.

Participants overall said they had learned valuable new skills and techniques, better understood themselves and had developed improved communication and trust with their children. They described improved behavior, stronger communication, and better academic achievements among their children.

In the aggregate, participants showed an average of 10.6 percent improvement in their parenting skills, in areas like non-violent discipline, empathy toward children’s needs and positive parenting techniques. They made an average of 12.9 percent improvement in the area of child maltreatment, encompassing expectations, empathy, use of corporal punishment, role responsibilities, and children’s power and independence. And they made a 3.4 percent improvement in parent involvement in education, support for studies at home, and supervision.

Recommendations for the program included making greater outreach to fathers and other males, taking a more focused approach in assessing parent needs, working to attain resources to implement a support group for program graduates, and ensuring that effective referrals are provided to parents for serious risk factors covered within the ACEs framework.

Safe from the Start.
While trauma- and ACEs-informed programming and training may not yet have taken hold equally and completely in every corner of the agency, for the past five years Metropolitan Family Services has endeavored to spread this knowledge base and practice across its geographic locations and services, Rompala says. This includes:

• Annual training for service providers that addresses the universal impact of traumatic events, how those who have experienced trauma may present themselves, and how vicarious trauma can affect staff and their provision of services. This training includes a review of the original CDC-Kaiser Permanente ACE Study, its results and what they imply for service provision and resilience-building among clients.
• Specific training for staff members that address, for example, how to structure after-school programs so that children know the agency is trauma-informed. For example, kids who act out are not labeled as “problems” or kicked out of the programs; instead, staff members know how to handle those kids and link them with appropriate services.
• At the high school level, restructuring of behavioral management to ask adolescents how staff members can “be helpful in helping you regulate, or help you take care of yourself,” Rompala says. “And to be more deliberate in creating a safe structure with predictability.” That means “structured psychotherapy” based on clinical trauma interventions from the National Child Traumatic Stress Network.
• In early childhood programs that include a parent education program, staff training to understand trauma and its impact — including the intergenerational nature of trauma. They learn about the impact of trauma on the brain and how to address the trauma stories families bring to them through techniques like meditation practices to help young children regulate themselves. These are built into the schedule at certain times of the day, based on the recognition that “kids and families are exposed to violence on a regular basis, which may make it harder for them to participate and learn in our settings,” Rompala says.

The Safe from the Start program, with four locations in Chicago, three in the suburbs and three in downstate Illinois, receives funding from the Illinois Criminal Justice Information Authority to provide intensive trauma-based counseling services for children ages 5 and under who have been exposed to violence, and their families.

The program, which serves 24 families and about 34 children each year, is also charged with providing education and community awareness around prevention of domestic or sexual violence, says Te’Aira Malone, program supervisor. “We’re helping community members to recognize signs of child abuse and how to appropriately respond,” she says.

But with only one clinician in her location on the far southeast side of Chicago, they struggle to meet the demand, Malone says. “Other agencies are doing similar work but not with a younger population,” she says. “Unfortunately, not a lot of programs specialize in counseling services for younger children, especially ages 0 to 5. There are extremely long waiting lists [currently 11-12 families with sometimes multiple kids per family], and a lot of times, our families need services yesterday.”

Safe from the Start uses the Life Stressor Checklist Assessment [LifeStressorChecklist], developed by the National Center for Post Traumatic Stress Disorder. It lists some of the questions from the ACE Study, Malone says. “It captures pretty much questions about life events that were stressful,” she says. “For example, have you ever been in a serious disaster? When did it happen? Did your parents separate or divorce?”

Although they don’t usually reference the ACE Study, Malone says, they cover it when providing parents with psychoeducation about intergenerational trauma and how it can impact their children physically and emotionally. They delve into the study “if the parent seems a little more willing to understand certain research and how it has an affect,” she says. “We do definitely try to use that within treatment, plus during the assessment phase.”

This information gives clinicians within Safe from the Start valuable insights. “They get a pulse for some of the things we may want to be mindful of because they may resurface,” she says. “We’re dealing with young kids. They’re not going to say, ‘This is a trauma trigger for me, mom.’ You’d be surprised the amount of times we get families saying — even when you ask them, ‘Have you had any trauma in your life?’ — ‘No.’ ”

One parent, for example had been sexually abused as a child by a relative. “She didn’t report that was traumatic for her,” Malone says. “It was kind of like, ‘Things happen.’ But then her kid was sexually abused by her boyfriend. … Her family didn’t talk about what happened to her, but we’re helping her appreciate how she can be a support system for her kid and not try to avoid it.” And they’re helping this mother to identify warning signs of potential abusers and preventative steps we can take, “so that this type of experience doesn’t affect her family again.”

This is the type of situation where they might not delve into the ACE Study on the spot because “with a client like that, we’re pretty much trying to help them sit in the room while we discuss the trauma itself, which is pretty difficult,” Malone adds. “But eventually, as the treatment goes along, we help the client understand that it’s not an isolated issue, and how it can impact their kids.”

Community Schools Program
Metropolitan Family Services’ Community Schools Program provides after-school programming in 26 elementary, middle and high schools, and works with parents to boost parenting skills and raise awareness of trauma and its effects.

The afterschool programs, which serve between 100 and 500 students, provide a range of offerings like dance, martial arts, photography, magic workshops, and academic enrichment focusing on students who need it the most. These are paired with wraparound services for families; for example, at Wendell Smith Elementary School, a parent engagement center provides computers for their use when job hunting.

“One of the biggest needs I see, most of our parents need parenting skills,” says Carlos Smith, resource coordinator at the school, which has a behavioral support team comprising school administration, psychologist, nurse, and parents. “Probably about 30 percent of our parents are between the ages of 19 and 23. They have not gotten those skills necessary for them to have been great parents, and our students are lacking in social skills.”

This is the approach taken at all Community Schools, says Kelsey Pierce, program supervisor who oversees six schools. “We’re trying to provide, knowing the school situation and family situations as best we can, wraparound services like parenting skills,” she says. “We’re definitely making sure we’re providing a safe space, warm and welcoming, training our staff to make sure that we’re continuing to meet those needs.”

Behavioral support teams delve into ACEs as part of their relationship-building with students, Pierce says. “We do a lot of referrals, internal and external, for students who need additional supports,” she says, “for students who have the higher ACE scores.” The scores are determined over a period of time through conversations, not through a survey.

Metropolitan Family Services provide school staff and a few parents with “Trauma 101” training, which covers the ACE Study, Pierce says. “It’s definitely part of our everyday conversations.”

“It was a great training for me and my staff,” Smith says. “One of the biggest things I took from the training was the importance of relationship-building.”

The training includes vicarious trauma – as well as exploring one’s own ACEs — among staff, Pierce says. “We talk a lot about self-care, as well as your own personal experiences,” she says.

Smith had just spoken with his staff at Wendell Smith Elementary about the importance of self-care. “You have to recognize when you need to take a break,” he says. “They need to know when the team needs to stop what they’re doing, reassess the situation and decide who’s best fitted at the moment to provide services to the students. That’s something we stress, and it’s needed because of the job we do.”

Metropolitan Family Services clearly understands that addressing trauma and ACEs is not just a Trauma 101 class, Rompala says. “It’s about taking a close look at policies and practices, and even job descriptions of staff involved. It’s about hiring at least some people who already have trauma-informed training, making policies and handbooks specific to say we are a trauma-informed service provider,” she says.

Written By Ed Finkel

Metropolitan Family Services addresses ACEs across metropolitan Chicago was originally published @ Ed Finkel – ACEs Too High and has been syndicated with permission.