Address Adverse Childhood Experiences
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Author(s): Marci Feldman Hertz
May 1, 2020
If ever there were a time to talk about adverse childhood experiences, that time is now. The spring 2020 pandemic has brought on changes that will have a lasting impact, even once students are all back in school. Most students will likely have experienced some trauma – and staff as well.
The impact from COVID-19 is inevitable; however, a large percentage of students are dealing with a number of other adverse childhood experiences (ACEs). In a study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) in the late 1990s, more than 17,000 adult patients were surveyed and asked about their experiences as children with three types of events:
Asking similar questions of youth during their adolescence instead of adulthood had similar results. Almost 50% of youth ages 6–17 reported experiencing one ACE, and 23% reported two or more ACEs. These ACEs, in addition to having a long-term impact, also have an immediate impact. Youth with two or more ACEs are almost three times more likely than those with no ACEs to repeat a grade in school. Conversely, youth without any ACEs are nearly three times more likely to be engaged in school, compared with peers with two or more ACEs.
ACEs can also have an impact on the school environment. A study of 100,000 middle and high school students in Minnesota found that each type of ACE was significantly associated with an increase in bullying, physical fighting, dating violence, and thoughts and attempts of suicide. The same study found that for every additional ACE a student experienced, there was a 47%-56% increase in the odds of stimulant, pain reliever and tranquilizer use in the past year.
Although we know ACEs are common and detrimental, we are also learning what measures we can take to lessen the effect of these events. What can schools and school counselors do? One model currently being implemented in school districts across the country that receive funding from CDC’s Division of Adolescent and School Health (DASH), has three components:
School Counselors’ Role
School counselors are vital in the fight to help students rise above their ACEs. They can’t, of course, do it alone. Helping these students does, indeed, take a village – a village composed of caring school faculty and staff members and community agencies.
Safe and supportive school environment: One of the first things school counselors can do is work with their administrators and staff to create a warm, welcoming school environment where students feel like they belong, where they are cared about as individuals and where school and classroom rules are fair and consistently enforced. A supportive environment can help protect students from many of the negative effects of ACEs and prevent some ACEs, such as school bullying or other peer aggression, from occurring. Students who feel connected to their school are less likely to experience depression, anxiety, suicidal ideation or to engage in sexual activity according to a 2017 article in Children and Youth Services Review.
The effects of school connectedness are long-lasting. Students who feel connected to their school are, as adults, less likely to have emotional distress, suicidal ideation, physical violence victimization or perpetration, multiple sex partners, sexually transmitted diseases, prescription drug misuse or illicit-drug use, according to a 2019 Pediatrics article.
Health and mental health services: Given the prevalence of ACEs and the impact on academic and health outcomes, increased access to mental health services is critical. However, there is a tremendous gap between mental health services needed and mental health services received. Nearly 59% of adolescents ages 12–17 with a major depressive episode did not receive any type of treatment, according to a 2019 Substance Abuse and Mental Health Services Administration study. The service gap is even larger among young people of color. Hispanic and black adolescents were less likely than their white peers to receive services for mood and anxiety disorders, even when these disorders were associated with severe impairment.
Although mental health services aren’t a school’s primary function, nor is long-term therapy an appropriate duty for school counselors, for many young people schools are the only place they do receive services. In 2018, schools were the second-most frequent provider of mental health services to young people ages 12–17, followed by a general medical setting, a child welfare setting and juvenile justice setting. When schools have policies and procedures in place protecting student confidentiality, schools are often a preferred mental health provider because of increased accessibility (reduce caregiver transportation/leave from work burden) and the increased likelihood of youth-friendly providers and services.
In addition, having mental health practitioners on-site increases student, caregiver and staff contact with the providers and can play an important role in de-stigmatizing mental health services. School counselors support implementation of multitiered systems of support (MTSS) and provide Tier 1 and Tier 2 supports by providing positive social/emotional and behavioral skills and wellness for the entire school population and offering support and services to those at increased risk of mental health concerns. Additionally, school counselors can coordinate with mental health providers, either school- or community-based, to help students with mental health challenges affecting their daily functioning.
As much as school counselors do, they can’t do it alone. Partnerships with local community partners, including universities, hospitals, and local and state health departments are also instrumental. School-based health centers (SBHCs) can also be an important school-based service delivery mechanism. SBHCs increase student access to health and mental health care, especially for minority and students from a lower socioeconomic status.
Mental health education: Finally, school counselors can enhance awareness of mental health education into the school environment. Beyond stand-alone health education classes, mental health and social/emotional learning (SEL) should be central in all classes and the entire school building.
The ASCA Mindsets & Behaviors include multiple standards that school counselors help students demonstrate to promote SEL, including the five core competencies central to SEL: self-awareness (recognize emotions and their influence on behavior), self-management (regulate emotions, thoughts and behaviors), social awareness (take perspective and empathize with others), relationship skills (establish and maintain healthy relationships) and responsible decision-making. Across primary and secondary students, SEL has demonstrated significant improvements in student social and emotional skills, attitudes, behavior and academic performance. Of note, for staff to be able to be effective teachers and promoters of social/emotional health, they need training and support. School counselors play a critical role in fostering social/emotional development. School counselors can bring individual and small-group activities into the classroom to model, demonstrate and coach students and staff on SEL skills. To influence the entire school climate, all staff interacting with students (teachers, administrators, school counselors, custodial staff, bus drivers, school resource officers, coaches, etc.) must receive SEL training and must have support in coping with their own ACEs. Overall, school staff should embrace teamwork and a sense of shared responsibility for all students.
Finally, while implementation may seem challenging, there are school systems that are successfully implementing these strategies. For example, the Wisconsin Department of Public Instruction combined funding from multiple federal sources to provide mental health professional development and coaching to staff and developed a statewide mental health framework integrating the MTSS approach and SEL competencies. School mental health staff were instrumental in launching a new initiative in Boston Public Schools. Staff in behavioral health services realized student and staff need was overwhelming their capacity, and they reached out for help. They partnered with Boston Children’s Hospital and University of Massachusetts – Boston to develop and implement The Comprehensive Behavioral Health Model. Seventy public schools in Boston are implementing the model, which is based on MTSS and includes an emphasis on SEL, “with the same intentionality as reading and math.”
By creating safe, supportive school environments, providing access to quality mental health services and mental health education and by forging partnerships with community partners, schools and school counselors can help prevent some ACEs from occurring in the first place and ensure that those who experience ACEs are protected and grow up to be healthy, happy and productive adults.
Marci Feldman Hertz, is a senior health scientist, Division of Adolescent and School Health, Centers for Disease Control and Prevention. Contact the author for references to this article. For resources to promote a healthy school environment, including school connectedness, visit the CDC.
The impact from COVID-19 is inevitable; however, a large percentage of students are dealing with a number of other adverse childhood experiences (ACEs). In a study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) in the late 1990s, more than 17,000 adult patients were surveyed and asked about their experiences as children with three types of events:
- Abuse (including emotional, physical or sexual abuse)
- Household challenges (including mother being treated violently, parental substance use, parental mental illness, parental separation or divorce, incarceration of a household member)
- Neglect (including emotional and physical neglect)
Asking similar questions of youth during their adolescence instead of adulthood had similar results. Almost 50% of youth ages 6–17 reported experiencing one ACE, and 23% reported two or more ACEs. These ACEs, in addition to having a long-term impact, also have an immediate impact. Youth with two or more ACEs are almost three times more likely than those with no ACEs to repeat a grade in school. Conversely, youth without any ACEs are nearly three times more likely to be engaged in school, compared with peers with two or more ACEs.
ACEs can also have an impact on the school environment. A study of 100,000 middle and high school students in Minnesota found that each type of ACE was significantly associated with an increase in bullying, physical fighting, dating violence, and thoughts and attempts of suicide. The same study found that for every additional ACE a student experienced, there was a 47%-56% increase in the odds of stimulant, pain reliever and tranquilizer use in the past year.
Although we know ACEs are common and detrimental, we are also learning what measures we can take to lessen the effect of these events. What can schools and school counselors do? One model currently being implemented in school districts across the country that receive funding from CDC’s Division of Adolescent and School Health (DASH), has three components:
- Safe and supportive school environments where students feel engaged in school and connected to important adults at school
- Health and mental health services that connect students with nonstigmatizing, confidential, accessible and youth-friendly health providers
- Health education that is scientifically accurate, developmentally appropriate and culturally inclusive and that builds knowledge and skills needed to promote healthy behaviors and avoid risks.
School Counselors’ Role
School counselors are vital in the fight to help students rise above their ACEs. They can’t, of course, do it alone. Helping these students does, indeed, take a village – a village composed of caring school faculty and staff members and community agencies.
Safe and supportive school environment: One of the first things school counselors can do is work with their administrators and staff to create a warm, welcoming school environment where students feel like they belong, where they are cared about as individuals and where school and classroom rules are fair and consistently enforced. A supportive environment can help protect students from many of the negative effects of ACEs and prevent some ACEs, such as school bullying or other peer aggression, from occurring. Students who feel connected to their school are less likely to experience depression, anxiety, suicidal ideation or to engage in sexual activity according to a 2017 article in Children and Youth Services Review.
The effects of school connectedness are long-lasting. Students who feel connected to their school are, as adults, less likely to have emotional distress, suicidal ideation, physical violence victimization or perpetration, multiple sex partners, sexually transmitted diseases, prescription drug misuse or illicit-drug use, according to a 2019 Pediatrics article.
Health and mental health services: Given the prevalence of ACEs and the impact on academic and health outcomes, increased access to mental health services is critical. However, there is a tremendous gap between mental health services needed and mental health services received. Nearly 59% of adolescents ages 12–17 with a major depressive episode did not receive any type of treatment, according to a 2019 Substance Abuse and Mental Health Services Administration study. The service gap is even larger among young people of color. Hispanic and black adolescents were less likely than their white peers to receive services for mood and anxiety disorders, even when these disorders were associated with severe impairment.
Although mental health services aren’t a school’s primary function, nor is long-term therapy an appropriate duty for school counselors, for many young people schools are the only place they do receive services. In 2018, schools were the second-most frequent provider of mental health services to young people ages 12–17, followed by a general medical setting, a child welfare setting and juvenile justice setting. When schools have policies and procedures in place protecting student confidentiality, schools are often a preferred mental health provider because of increased accessibility (reduce caregiver transportation/leave from work burden) and the increased likelihood of youth-friendly providers and services.
In addition, having mental health practitioners on-site increases student, caregiver and staff contact with the providers and can play an important role in de-stigmatizing mental health services. School counselors support implementation of multitiered systems of support (MTSS) and provide Tier 1 and Tier 2 supports by providing positive social/emotional and behavioral skills and wellness for the entire school population and offering support and services to those at increased risk of mental health concerns. Additionally, school counselors can coordinate with mental health providers, either school- or community-based, to help students with mental health challenges affecting their daily functioning.
As much as school counselors do, they can’t do it alone. Partnerships with local community partners, including universities, hospitals, and local and state health departments are also instrumental. School-based health centers (SBHCs) can also be an important school-based service delivery mechanism. SBHCs increase student access to health and mental health care, especially for minority and students from a lower socioeconomic status.
Mental health education: Finally, school counselors can enhance awareness of mental health education into the school environment. Beyond stand-alone health education classes, mental health and social/emotional learning (SEL) should be central in all classes and the entire school building.
The ASCA Mindsets & Behaviors include multiple standards that school counselors help students demonstrate to promote SEL, including the five core competencies central to SEL: self-awareness (recognize emotions and their influence on behavior), self-management (regulate emotions, thoughts and behaviors), social awareness (take perspective and empathize with others), relationship skills (establish and maintain healthy relationships) and responsible decision-making. Across primary and secondary students, SEL has demonstrated significant improvements in student social and emotional skills, attitudes, behavior and academic performance. Of note, for staff to be able to be effective teachers and promoters of social/emotional health, they need training and support. School counselors play a critical role in fostering social/emotional development. School counselors can bring individual and small-group activities into the classroom to model, demonstrate and coach students and staff on SEL skills. To influence the entire school climate, all staff interacting with students (teachers, administrators, school counselors, custodial staff, bus drivers, school resource officers, coaches, etc.) must receive SEL training and must have support in coping with their own ACEs. Overall, school staff should embrace teamwork and a sense of shared responsibility for all students.
Finally, while implementation may seem challenging, there are school systems that are successfully implementing these strategies. For example, the Wisconsin Department of Public Instruction combined funding from multiple federal sources to provide mental health professional development and coaching to staff and developed a statewide mental health framework integrating the MTSS approach and SEL competencies. School mental health staff were instrumental in launching a new initiative in Boston Public Schools. Staff in behavioral health services realized student and staff need was overwhelming their capacity, and they reached out for help. They partnered with Boston Children’s Hospital and University of Massachusetts – Boston to develop and implement The Comprehensive Behavioral Health Model. Seventy public schools in Boston are implementing the model, which is based on MTSS and includes an emphasis on SEL, “with the same intentionality as reading and math.”
By creating safe, supportive school environments, providing access to quality mental health services and mental health education and by forging partnerships with community partners, schools and school counselors can help prevent some ACEs from occurring in the first place and ensure that those who experience ACEs are protected and grow up to be healthy, happy and productive adults.
Marci Feldman Hertz, is a senior health scientist, Division of Adolescent and School Health, Centers for Disease Control and Prevention. Contact the author for references to this article. For resources to promote a healthy school environment, including school connectedness, visit the CDC.