ACEs and Elsewhere

Impact Pyramid of ACEs

About a decade ago I edited a training manual for Save the Children, the organization that recognized in 1919, a century ago, that every child deserves a chance. It emphasizes these words: every last child.


The manual Save the Children trusted me to edit would aid child care workers in conducting activities with children in refugee camps to support cognitive development and foster emotional resiliency, Gargantuan tasks under such dire circumstances. I got the task because I'd experienced first-hand the trauma of young children separated from parents. For five years I'd been the psychiatric social worker for the nursery at Los Angeles' locked facility for abused and neglected children awaiting placement by the juvenile court.

The sole clinician working on Sunday, I'd responded to the needs of the entire institution, so also dealt with the anxiety and anguish of bewildered K-12 age children, as well as my nursery infants and toddlers.

So when I think about children worldwide who face crisis because of war, natural disaster or family breakup, no matter what the circumstances, I remember those children I worked with in the early '80s. I can still see their faces contorted by fear and rage. I remember those wrinkled brows, twisted lips.

Right now Save the Children works with refugee camps in Syria, South Sudan, Uganda, Burundi, Tanzania, Lebanon, Bangladesh, Egypt, Ethiopia, Kenya and Myanmar. And in rural America, beginning in the 1930s in Appalachia. Here's a plea from its website:
Right now, Save the Children remains gravely concerned about the well-being of children in the custody of the U.S. government after crossing our southern border. We know from our nearly 100 years of service that family separation and detention can cause severe, long-lasting trauma, which ultimately results in the loss of childhood.
For nearly 100 years, Save the Children has put the rights of every child at the very center of our mission. We’ve now heard these children’s cries and we must raise our own voices to protect their best interests. Because every child deserves safety and a chance at a future.
Tell Congress to reunite families and ensure unnecessary family separation never happens again.


I share this concern. I'm particularly concerned about ACEs, the adverse childhood experiences that impact healthy development. These ACEs effects can last an entire lifetime.

• Physical abuse
• Sexual abuse
• Emotional abuse
• Physical neglect
• Emotional neglect
• Intimate partner violence
• Mother treated violently
• Substance misuse within household
• Household mental illness
• Parental separation or divorce
• Incarcerated household member

For more information about ACEs:
https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences
 
To learn more about what you can do to help Save the Children:
https://www.savethechildren.org/us/about-us/why-save-the-children

When I worked at MacLaren I learned some important lessons about nurture and separation trauma. When places that shelter children apart from families are equated with "summer camps," I shudder. Here's my personal experience at MacLaren, 1978 to 1983.

Elsewhere

 I hung up the phone and stared at a poster on the wall beside my desk. The receptionist at the visiting center had called to let me know that a mother had appeared for her court-ordered monitored visit. For the past three years I'd been the psychiatric social worker for the nursery at the Los Angeles County residential institution that housed children awaiting placement by the juvenile court. Not often a sunny job.

 I could already anticipate how the visit would go. The visitor would be angry. We had her child in our locked building. It wouldn't matter to her that the two-year-old had been removed from his home because he’d been left alone for hours and neighbors had called to police to report hearing his cries. No. All that would matter is that mother and child were separated. We had him. She didn’t.

The nursery aide who would escort the toddler to the visiting room would treat both me and the visitor to hostile glares. Most of the nursery staff resented visiting days. The children cried when their parents left, leaving them behind. I'd conducted training on bonding and attachment, and explained that though these children might be too young to remember events, they would forever remember feelings. Nonetheless the staff still believed in "out of sight, out of mind."

"It would be better if the parents didn't come at all," they said. "Besides, they don't deserve to see their kids."

And, yes, the toddler himself after the visit would squall and kick and flail at me with tiny fists all the way back to the nursery. I could understand why the attendants held me responsible for provoking the tantrums.

"I hate you, I hate you," those children old enough to talk often screeched when their visits ended, as I returned them to the nursery where they’d turn their rage and frustration on the hapless attendants and nurses.

On Sundays, when I conducted these visits, I forced myself to become a jumbo sponge to soak up everybody's ire, taking care not to ooze any out myself. That would be unprofessional behavior for a psychiatric social worker.

The three earlier visits I’d monitored so far, that late November day, had been particularly unpleasant. With Thanksgiving fast approaching, parents had fixed me with sullen eyes, dropping references to having little to be thankful for.

I had trained myself to hold my tongue. Many of these parents were in sad need of parenting themselves, some so woefully uninformed about the stages of early childhood development that they expected a two-year-old to follow instant and sometimes complicated commands.

Usually the poster by my desk brightened my spirits, with its sunflower motif and splashes of bright lettering in yellows and reds. A local artist had been engaged to design it for MacLaren's annual Sunflower Day, a summer Sunday when actors, artists and musicians visited to entertain and mingle with the two hundred and fifty or so children in temporary residence. Today, though, even the poster's glowing gold and shimmering scarlet hues failed to cheer me. Instead I held on to a vision of a sodden gray sponge as I trudged towards the visiting center.

I glanced out the window at the darkening clouds, and realized that by the time my shift ended and I headed home, it would probably be raining. I dreaded driving the oil-slick Los Angeles freeways in the autumn.

No sunshine for me today, I thought.

I reminded myself again that only three elements needed to converge to create a situation that could lead to child abuse or neglect: a child, a parent with poor coping skills, and stress. Many of the parents I saw were ignorant of the most basic child-care routines. Many suffered from untreated character disorders or alcohol or drug addictions. Most were so deprived in their own childhoods that they had no alternative to repeating their own parents' pattern of poor care.

What was evident, though, was that most of them indeed loved their children. Some cared enough that they'd even enter treatment programs or ditch an abusive partner, so they could rehabilitate themselves and eventually make a home again for the child. In my Parent Outreach project, I offered such resources to the visiting parents.

To my surprise, the visiting mother's face was wreathed in smiles. It had been a few weeks since she'd visited. I'd tried to reach her, but her phone had been disconnected.

"Guess what?" Her smile illuminated the little room. "I've been released from the recovery center and I've got a job! I've got a gift for Tommy." She held up one of the new plush Care Bears. This one, bright yellow, was Funshine Bear. I well knew the stars of the new Care Bear television series, sitting on the nursery floor, and watching the cartoons with the kids. Funshine Bear had a tummy symbol with a smiling sun. He was famous for always trying to help someone, being able to use his symbol to light up the darkest night or shine a beacon for all to see.

Kind of like me, I thought, the first time I noticed him. I'd wondered who lit up Funshine's dark days. Could he turn his beacon toward himself? The aide who brought Tommy to the visiting room was new on the job. Her eyes twinkled when she spotted the bear. "Oh, look, Tommy," she said, a pleasant lilt to her voice.

Tommy squealed, grabbed Funshine Bear, and hugged him close. He clambered up on his mother's lap and answered her questions as best he could.

"We walked to MacDonald's yesterday. I ate ice cream!"

I waited for the mom to begin a rant about how she didn’t allow her kid to eat sugar. Instead she smiled at her son, hugged him, and then smiled at me.

"The nurses decided it would be a good day for an outing since the sun was out in the afternoon and the restaurant is only a block away," I explained. The Saturday nursery staff often liked to get a little exercise and fresh air, and would stroll to the nearby fast food place, pushing the younger children in buggies and strollers.

Besides, they remembered that most of the children were familiar with MacDonald’s, and that any familiar experience helped them with the trauma they suffered being separated from their families.

This visit even ended in an exceptional way. Tommy didn't even cry when his mother kissed him goodbye. She'd promised to come again soon, and confided to me that she thought the court would release him to her soon. Her probation worker was ready to vouch for her.

“Congratulations,” I said. “I hope the hearing goes well for you.”

Tommy didn’t even scream when she left.

A couple of years earlier, still new on the job, I’d complained to my consulting psychiatrist that sometimes I felt unappreciated – by staff, by the children, by the parents.

"Honey," he'd said, "in this line of work you've got to get your loving elsewhere. You've got to get it from yourself. Appreciate yourself!"

At that time, I vowed to not a let a working day go by without doing three kind things: one for a staff member or parent, one for a child, and one for myself. I found I felt more in control if I had definite goals for my days that otherwise could spin into chaos.

This Sunday when I returned for my last evening report in the nursery I made a special effort to single out the aide who had been so cheerful in bringing Tommy for his visit.

"You made it so easy for him to leave," I praised her. "Letting him take the bear back with him to his crib was a really great idea!"

I spent several minutes before my shift ended rocking one of the four-year-old girls. She'd fallen in the playground earlier and bruised her forehead. She’d had a bad day.

“When will Mommy be here?” she’d implored, eyes shiny with unshed tears.

They never showed up. This wasn’t an isolated case, where parents failed to appear. Sometimes cars would break down. Sometimes buses ran late. Sometimes they got drunk or high again, and forgot their appointments.

"I love you," the little girl whispered in my ear as I tucked her into her youth bed. I gave her a final hug.

Then I climbed into my car and turned on my windshield wipers, anticipating what kind thing I'd do for myself that day. I usually saved me for last, enjoying the anticipation.

"A Christmas Story" had just been released. It played in a theater close to my home. I decided to get an early jump on the holidays and see it. Then I'd treat myself to a hot bubble bath and a mug of cocoa before bed.

Perhaps tomorrow would be sunnier. Sunshine already was breaking through in my heart. I remembered my grandmother’s old mantra that even on a cloudy day the sun is shining somewhere.

 ********

MacLaren Hall closed in 2003. http://articles.latimes.com/2003/mar/11/local/me-mac11