When a youth starts any program or service at Adelphoi, one thing we know for certain is that youth has experienced trauma, whether he or she arrives as an infant or a teenager. This was true when I started working at Adelphoi 37 years ago, and is still true today. The difference between then and now is we presently have a better grasp of the significant impact of trauma on children and young people in general. Our understanding of how trauma impacts a child’s psychological development drives the manner in which we deliver services to kids and families throughout our system of care.
So what is trauma?
Bessel Van der Kolk, M.D., a leading author, professor and trauma expert defines trauma as an experience in which a person’s internal resources (emotional state, coping skills) and external resources (family, spiritual, community supports) are inadequate to cope with an external threat. This definition takes into consideration that it is not only the experience that defines something as traumatizing, but also the person’s individual ability to cope that determines whether or not an experience is traumatic. A person experiences something as “traumatic” when both their internal AND their external resources fail to adequately protect their central nervous system from being overwhelmed by a significant event. We know that what is traumatic for one person may not be for another and that different people may react very differently to the same situation.
Understanding the Impact of Trauma
We also know that trauma substantially impacts brain development. Exposure to trauma in early childhood has long lasting effects because it alters the course of the child’s normal development and can change the structure of the brain. Human brains do most of their development after birth, making us vulnerable to the effects of early disruptions and traumatic experiences. As a child grows, the brain becomes more and more hardwired and less elastic. By age 10, a child’s value system is already in place. If a child has experienced abuse or neglect, their value system will have been influenced by those incidents. There is an adage that says “Neurons that fire together, wire together.” Once the brain is hardwired to react a certain way in response to stress, those patterns often become a type of “survival” response. When a child is exposed to chronic stress or continued crisis, the brain is flooded with stress hormones, creating a state of chronic hyper arousal, a change in the central nervous system that the child cannot control.Ultimately, trauma impacts brain development in a way that permanently affects cognition, emotion and behavior.
One of the most significant studies that contribute to our understanding of the impact of childhood trauma is the Adverse Childhood Experiences study (ACEs). The ACES study was conducted in the 1990s by Drs. Felitti and Anda as a collaboration between Kaiser Permanente and the Centers for Disease Control. These researchers looked at the relationship between adverse childhood experiences and later health outcomes in adults. What they found was some very disturbing data that points to the fact that traumatic experiences in childhood are strongly correlated with poor physical, mental and social health outcomes in adulthood. It also demonstrated how pervasive early childhood adversity and exposure to trauma is in our society. In a survey of over 1,800 adults, researchers discovered that 2/3 of the survey participants reported some type of exposure to adversity in early childhood. Of those reporting adverse experiences in childhood, one in four reported two or more adverse childhood experiences while one in 16 reported four or more. If one was to extrapolate these findings to the general population, the numbers suggest that the majority of the population is exposed to some type of childhood adversity.
The reason that these findings are so important is that it links poor health outcomes with increased exposure to adversity. What the ACEs researchers found was a correlation between childhood adversity and multiple health-related problems: smoking, drinking, IV drug use, depression, attempted suicide, STDs, teen pregnancy, and later in life, heart disease, lung disease, liver disease and many others. The higher the ACEs score, the more likely someone was to experience a health-related problem. They also found that an ACEs score of 6 or higher correlated with death at an earlier age.
Understanding the overall impact of trauma on one’s health is critical in leveraging a holistic approach to care and treatment. These outcomes reinforce the fact that the earlier we can intervene and implement interventions to address the trauma, the more likely that we will have a positive impact for the kids we work with. Knowing that our youth have experienced significant and/or complex trauma also allows us to avoid re-traumatization. Our counselors and therapists at Adelphoi are hyper-aware of the need to provide an environment of safety at all times, and are trained on how to use reflective listening and empathy whether in a counseling session or working a child through a crisis. Some fundamental questions in our sessions with youth are “What’s happened?” or “Help me to understand…..” To this end, we help youth create treatment plans and goals that show them how to cope with and manage their emotions when they feel out of control. We create therapeutic communities where youth can openly communicate their emotions and practice newly found coping skills whether at home with their families, in education environments, or in group home settings.
It’s important to acknowledge that understanding the impact of trauma is useful not only in our professional work, but can also serve to help others struggling to navigate the current pandemic. As we all endeavor to adjust to a new normal, it’s important to use what we know to help each other through these challenging times. When you see someone struggling or in need, ask them “What’s happening?” and be prepared to listen. Remember that in 2021, all of us can benefit from a little bit of genuine concern and understanding.
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