Children and adolescents with a history of ACEs can overcome by identifying sources of strength that promote resilience

Children and adolescents with a history of ACEs can overcome by identifying sources of strength that promote resilience. In order to do this, practitioners must understand the effects of ACEs and the promotion of resilience in at-risk children and adolescents.

Elizabeth Occhipinti, April 2021

By age 12, one in every seven American children have been reported to child protective services on more than one occasion

Jonson-Reid et al., (2019)

Evidence-Based Practices

• Prevention:
  • The perinatal period is a critical time to intervene to avoid intergenerational trauma (Atzl et al., 2019; Chamberlain et al., 2019).
  • Low income, lack of social support, and mental health history all increase the risk of the children of foster alumni being placed into foster care (Foster et al., 2015).
  • Some methods can predict and prevent child maltreatment. S. Font et al. (2020) explain that algorithms and birth mother matching systems offer preventative solutions to intergenerational risks and preventative measures.
• Identifying the early symptoms of trauma
  • Such as: learning difficulties/delays, behavioral issues, and medical issues) to help professionals across child-facing fields become trauma-informed prevent and identify signs of trauma and abuse (Sciaraffa et al., 2018). 
  • Identifying and meeting children’s needs while maintaining their safety is an important aspect of early detection, determination and intervention (S. Font & Gershoff, 2020);
• Protective Factors
  • Faith – Religion is positively associated with higher levels of resilience (Shpeigel, 2016).
  • Education – Extra-curricular activities and positive attitudes about school promote higher levels of resilience (Shpeigel, 2016).
  • Reading  Intellectual ability assessed through an examination of reading levels increases the likelihood of higher resilience (Shpeigel, 2016).
  • Helpful people – Children who were able to identify their case-worker and someone who they live with (ie foster parent, group home staff) as being very helpful were seen to possess higher levels of resilience (Shpeigel, 2016).
  • Promote Future Orientation Relying on promotive practices in the development of resilience, Cui et al. (2020) examined children and their primary caregivers at age 4, continuing every two years until the child reached 18.
• Skills Development
  • Self-regulation
    • Promote resilience by assisting children in building skills and self-regulation
    • Educators can play an important role to assist children to build resilience by developing their self-regulation skills
    • Sciaraffa et al. (2018) indicates that educators can play an important role in promoting resilience
    • Methods:
      • Recognize a children need for help and calm and support them 
      • Create predictable schedules and reoutines
      • Model emotional self-regulation
      • validate a child’s feelings
  • Emotion identification and expression
    • Sciaraffa et al. (2018) recommend
      • Talking about feelings
      • Identify how a child responds to their own feelings
      • Help a child to use words to resolve conflicts and differences
  • Promote the skill of self-assertion (Sciaraffa et al., 2018)
    • Offer a child choices (Sciaraffa et al., 2018)
    • Allow a child to feel in control of aspects of their environment(Sciaraffa et al., 2018) 
    • Be familiar with aspects of normal childhood development which might cause children and teens to attempt to assert control (Sciaraffa et al., 2018).
    • Be mindful of our own emotions (Sciaraffa et al., 2018) and attuned to our own needs and model this to students.
  • Tangible Skills to overcome hardship and adversity
    • Gardening:
      • There is research that has been conducted on the benefits of job and skills training in youth.
      • Using garden-based service-learning helps mitigate food insecurity while educating students and strengthening community ties (Aftandilian & Dart, 2013)
•  Set goals
  • Promote positive outcomes in adolescents
    • Set goals and pathways for success
    • Examples of goals include: Completing school, getting a job, finding a safe and stable living environment (Sciaraffa et al., 2018)
• Mentoring & Treatment
  • Mentoring
    • Mentoring increases skills for at-risk and juvenile justice involved youth. 
    • Research indicates a relationship with one caring adult improves outcomes including socioeconomic disadvantage, improving the effects of exposure to family violence and dysfunction (Wesely et al., 2017).
  • Cognitive Behavioral Therapy
    • Focusing on treatment that identifies thoughts, emotions, and behavioral patterns in children at-risk.
    • Szigethy et al. (2012) support the use of cognitive-behavioral therapy (CBT) to help children and teens who have diverse needs, including symptoms of depression, anxiety, and physical ailments (ie. inflammatory bowel disease). 
    • CBT is encouraged to intervene and address dimensions of trauma, promote self-regulation skills, process trauma, and improve a sense of felt safety (Soleimanpour et al., 2017). 
    • Both trauma-informed CBT and cognitive therapy showed promising results in children who had experienced a significant trauma, having been diagnosed with Post-traumatic stress disorder (Nixon et al., 2017)
    • Practitioners and professionals should become familiar with these risks and identify children and teens who might present a higher risk, and evaluate them for traumatic experiences to develop intervention plans to increase resiliency. 
    • Leitch (2017) highlights the effectiveness of action-based skills-building to promote a neuro-scientifically supported method of responding to ACEs’ effects and building resilience. One element to the development of resilience that is often overlooked is the adverse experience itself. Interventions that allow children and adolescents to recognize their strength in overcoming adversity may promote positive outcomes.
    • Methods such as Trust-based relational intervention (TBRI), which rely on empowering, connecting, and correcting principles, have been studied primarily in the field and deemed effective, though their methods were not quite as rigours as other studies, the risks are far outweighed by the benefits of their methods (Purvis et al., 2013; Purvis et al., 2014). 
  • Family-centered programs have been shown effective interventions in working with children and adolescent youth who have experienced adverse childhood experiences (Berger and Font, 2015).
  • Horticultural Therapy which uses gardening as a basis for physical and psychological rehabilitation, vocational skills development, behavioral health-care, social development and inclusion, and overall health and wellness. This method views gardening as a means to engage participants in motivational, accessible and meaningful outdoor activities (Haller, 2021).
  • Art Therapy
    • Research provides evidence that art therapy is effective to treat adolescents with complex trauma and higher ACE scores and may create lifelong patterns of seeking therapeutic support in times of distress (Hill, 2018)
    • Art therapy seen as an effective EBP to assist children to cope and an Evidence-based practice as a primary prevention service for supporting children impacted by parental

• Policy and Collaboration
  • Policy changes
    • Creating strategies for early intervention and detection (Font) 
    • Providing access to health and education services (Font)
    • Minimum standards for foster homes including limiting the capacity of children in placement in foster homes (Font 2020)
    • Regardless of placement type, homes must meet standards of health and safety (font) 
    • Timely programs to permanency (font) using smart strategies and statistics to identity which children are more likely to reunity and placement with foster-only families
    • Concurrent planning prioritizing biological families must ensure safety measures are in place  (font 2020) 
    • Using data reduced bias and ethical concerns but also identifies probablities  (font 2020) 
    • Marking identified surrender and open adoption pathways clear to reduce stigma of parents wishing to make an adoption plan
    • Measuring child well being (font 2020) 
  • Collaboration and protective communities
    • Build a protective community of care around children, specifically in vulnerable groups and areas. 
    • Schools, medical professionals, members of the community need to become trauma-informed and able to identify risk factors and be empowered to take actions to help (Sciaraffa et al., 2018).
    • Know the people in your community and have a plan to address children and families at risk and what role each plays in this collaboration
    • Collaborative committee of people who are committed to the safety and resiliency of children including parents, teachers, social workers, case workers, law enforcement, first responders, physicians and more.
• Examine intergenerational foster care involvement
  • There are cycles of re-entry and intergenerational involvement in foster care (Foster et al., 2015; Mertz & Andersen, 2017). 
  • These patterns result in child protective services involvement (S. Font et al., 2020). 
  • The effects of trauma occurring over time and the transmission of attachment styles from parent to child raise concerns (Bernier et al., 2015; Chamberlain et al., 2019; Groh & Narayan, 2019; John et al., 2019; Kelly, 2017; Mertz & Andersen, 2017). 
  • Fusco (2015) observed risk factors among first and second generations of child welfare involved mothers:
    • Several factors impacted those mothers’ participation in social services supports, and engagement. 
    • Poverty, substance abuse, and mental health among 2nd generation mothers resulted in less engagement to receive support services;
    • 42% of the participants in this research indicated their own history of child abuse (Fusco, 2015). 
• Promote Permanency
  1. Some of this is common sense. I want you to imagine what it might be like to go through the experiences children have (loss of home, uncertainty, abuse, lack of trust)
  2. Children thrive in safe, nurturing, and permanent homes. 
  3. Shpiegel (2016) encourages the promotion of long-term placements in adolescents in foster care to increase resilience. 
  4. Alder (2020) explains in a recent article that regardless of the cause of a child entering foster care, a lack of permanency and frequent moves, can have a lasting effect and cause long-term harm to a child’s healthy development. 
  5. Studies also show a link between the lack of permanency and the educational and economic attainment into early adulthood (S. A. Font et al., 2018). 
  6. We must minimize the number of placements and promote permanency and prioritize the right of a child to live in a safe and stable environment.
• Promote Healthy Attachment
  • Attachment is a building block to healthy development. 
  • There are documented effects of trauma occurring over time and the importance of healthy attachment in healthy development.  The transmission of attachment styles from parent to child raise concerns for the intergenerational perpetuation of abuse and attachment issues (Bernier et al., 2015; Chamberlain et al., 2019; Groh & Narayan, 2019; John et al., 2019; Kelly, 2017; Mertz & Andersen, 2017; Purvis et al., 2014; Sciaraffa et al., 2018; Zolkoski & Bullock, 2012). 
  • There is an ongoing lack of stability and health attachment observed in children in foster care (S. Font & Gershoff, 2020). 
  • Attachment forms through things like quality time, routines, and responsive parents that promote healthy connections with their children. 
  • Teachers, child care workers, and caregivers can help children to form a healthy attachment and promote a sense of belonging (Sciaraffa et al., 2018).
    • Methods of promoting attachment are highlighted in the work of Purvis et al., (2014)
      • Empowering, Connecting, and correcting principles of TBRI can be used by parents, caregivers, teachers, and professionals who work with children. 
      • Examples include: such as warm voice, healthy touch, giving and receiving care, meeting physical needs, reducing fear, promoting felt safety, scripts, rituals that promote consistency and stability in a child’s life.
  • Children with a history of maltreatment can have a secure attachment (Cohen, 2006). 
  • Have a renewed focus on promoting healthy attachment with caregivers may help develop resilience following childhood maltreatment. 
• Learn from other groups at-risk
  • Easterbrooks suggests a “strong sense of belonging” with a “shared mission and values” as contributing to the development of resilience in military youth (Easterbrooks et al., 2013, p. 99). 
  • Easterbrooks (2013) et al. discussed the ability to develop relationships with children and other families experiencing similar hardships, peer-to-peer supports, and formal and informal social connections as being sources of strength in the lives of military youth.
  • Interestingly, when compared to non-military children, minority military youth outperformed their peers on the SATs (Easterbrooks et al., 2013). 
  • Groups that might typically be at a higher risk benefit from the consistency, commonalities, and community associated with the military despite the difficulties and hardships noted. 
  • Social connections (formal and informal), groups, projects, and recreational activities also might represent a mitigating factor. Easterbrooks et al. (2013) explain that after enduring the war with Afganistan and the traumatic experiences of 911, the promotion of social supports in military youth’s lives to help them continue to thrive despite significant hardship.
  • Populations with similar experiences, such as military youth who demonstrated high resiliency levels when examined by Easterbrooks et al. (2013), could also inform practices relating to foster youth. These two groups share hardships (i.e., fear of or actual loss of a parent, frequent moves, changing friends, moving schools, parental stress) and demographics (racially and ethnically diverse groups. This has often been an issue that researchers identify as a challenge. Addressing racial disparities in foster care is often a concerning issue. Yet, in this case, it allows researchers to compare the groups to identify any relationships that exist and variables that promoted the development of resilience.
• Strengthening Families
  • Strengthen and support biological families
    • Routines and rituals
      • Barton et al.’s (2019) longitudinal research of adolescents found consistent routines improved health outcomes, finding predictable family environments might be an essential factor in healthy development, specifically in minority families.
  • Strengthening and Supporting Licensed Foster Parents
    • Recent research indicates that foster parents themselves also often have had ACEs (Adkins et al., 2020)
    • It is common to believe that placement in foster care is harmful and not justified  (S. Font & Gershoff, 2020). 
    • Shpiegal (2016) explains that the quality of a relationship with a foster parent increases resilience.
    • Foster families represent relatively low risks than biological relatives, extended relatives, and their parents’ unmarried partners.  (National Child Abuse and Neglect Data System (NCANDS), 2019). 
    • Foster parents can promote healthy attachment in the children in their care. 
    • Non-relative foster parents can promote resilience. We must identify foster parents as a resource and a source of support in the lives of survivors of child abuse and neglect. 
    • Foster parents must adhere to strict rules and regulations, background checks, and various other licensing requirements that biological and kinship placements do not. These standards offer stability, safety, and the removal from imminent harm. 
    • Foster parents in NJ are also resourced with a team, a nurse, adequate funding and more
    • Teach foster parents and caregivers trauma-informed skills to use when working with children-at-risk.

• Final Thoughts
  • Common sense strategies could prevent child abuse and neglect by identifying parents with prior confirmed abuse and neglect histories S. Font et al. (2020). 
  • Sadly, it is judges and lawyers, not psychologists, who most often determine the fate of America’s abused children. 
  • Child-facing agencies, practitioners, and scientists must invest in training and trauma-informed interventions focusing on building resilience and promoting permanency to prioritize children and adolescents’ best outcomes.  
  • Childhood is a short and sweet time, rich in developmental possibilities. 
  • If being a minority increases the risk of ACEs (Barnett et al. (2020) and the likelihood of higher resilience (Shpiegel, 2016), the research gathered about minorities and resilience could also inform and be generalized to foster youth and at-risk juvenile populations.
  • Adverse experiences are occurring too often and re-occurring in future generations. 
  • If we only prioritize biological families and extended relatives without determining stability and safety, the foster care system could in itself be perpetuating abuse and neglect in the lives of children and adolescents 
  • The low risks of abuse perpetrated by foster parents raise concern for the national foster care system’s negative sentiments directed at foster parents and a renewed concern for supporting biological families while keeping children safe.
  • The importance of a permanent, stable, and safe environment as a foundation for children and adolescents to grow and flourish cannot be more strongly overstated.
  • Children and adolescents can become resilient and overcome ACEs by relying on sources of strength including stable and nurturing homes, healthy and attached relationships, education, future orientation, and a community of support.
  • By identifying the factors that help children and teens thrive, the predicted outcomes would be diminished, giving rise to newfound strengths and skills so that children and adolescents with a history of adverse childhood experiences

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