The Other ACE: Adverse Community Environments

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By Andrea Meyer Stinson

It’s difficult to even approach the topic of resilience while people are trying to meet basic needs during a crisis. However, it’s also the most crucial time to have this conversation.

The coronavirus pandemic, for instance, has exposed the need to address trauma and adverse childhood experiences (ACEs), along with inequalities that lead to adverse community environments. Families need to feel supported and safe in their communities to be able to raise resilient children. We can’t expect individual children to become resilient on their own. That’s not a reasonable expectation. We also can’t expect parents and caregivers to help build resilience in their children if they are surrounded by toxic stress and lack of support resources for parenting.

We need a paradigm shift in our communities. It is essential that we acknowledge the pair of ACEs: adverse childhood experiences and adverse community environments. The work of Wendy Ellis at George Washington University has brought attention to the interaction between adversity in families and communities. She has suggested that in order to address trauma on the individual and family levels, we also need to identify adverse community environments. Trauma and family adversity can occur in all families; however, for families that live in adverse communities, there are inequities that further the damage and make it difficult to recover or build resilience. All sectors and stakeholders, including leaders and policymakers, need to come together to change the way we think about each other and talk to each other in order to encourage understanding, empathy, and respect.

Trauma and ACEs are steeped in inequities that come from hundreds of years of racial and economic inequalities across our country. Historical racism and income inequities are still harming our communities, which lead to adverse environments that don’t support families. The result is that the children in those families grow up with trauma-related experiences—and then are expected to behave and be compliant at school, home, and in the community.

When you discipline a child by asking, “What’s wrong with you? Why did you do that?” you shame that child. That’s a significantly different message than, “What happened to you?” which takes the shame out of the equation and shifts the conversation to a place where the child feels like there’s hope and possibility to change. Saying, “What’s wrong with you?” implies something is inherently bad about the person. With both children and adults, acknowledging and identifying possible trauma experiences and how they’re influential is a missing element in many settings like schools and social service agencies.

There have been extensive attempts to fix the problems of misbehaving children and adults—implementing “no tolerance” policies at schools, cracking down on violent crime, increasing arrests, reducing blight—but those solutions don’t get to the root cause of why people sometimes act the way they act. We need to address the underlying issue, which is toxic stress and trauma experiences rooted in adverse community environments.

For school-age children, we focus a lot on attendance and making sure kids arrive to school on time. That’s necessary but fails to account for the many kids who don’t get to school because of trauma or toxic family environments. Rather than focus on strict attendance policies, we should encourage children and families by asking about the difficulties they face and empathizing with the possible barriers families are experiencing.

Creating a community environment for families that is safe, nurturing, and caring doesn’t require a high level of income necessarily. But we do need to provide families with resources such as parenting support, safe and affordable housing, good schools, adequate jobs, access to food, and access to mental and physical health care. When children grow up in the same environment as their parents with the same community challenges, it’s hard to prevent those children from having the same adverse and toxic experiences.

To tackle this issue, we need to take a two-generational approach. We can’t just intervene at the child level or just at the parent level—we have to intervene at the family level, or else the cycle can continue. With a two-generational approach, we can stop those cycles of violence, poverty, abuse, and neglect within families; but this will only happen if we also address the larger inequalities that make it difficult for families to avoid toxic stress generated from their environment.

The science of ACEs is clear: prevention and early intervention works. However, we don’t always invest in this kind of work in our communities. We often use “band aid” solutions that don’t address the underlying issues. We need policies in place that support families early and often. We need to come together and build connections to establish resilience.

I would love to see more trauma-aware teachers and health care providers in our communities. We want every adult a child interacts with to have a trauma-informed perspective and be able to ask questions early on to see if needs are being met. We would like to see everybody speaking the same language and providing early intervention and prevention. We must offer the right resources and support when a need is identified.

Walla Walla, a small community in Washington state, has become trauma informed in a substantial way. Residents there have seen the suicide and teen pregnancy rates dropping, school attendance improving, and other drastic changes. In 15 or 20 years, I would love for our communities in middle Georgia to have similar changes and improvements.

I know that every community is unique and may have different challenges. I also know that if we don’t address racial and economic inequalities, things are not going to change and toxic stress will continue to lead to increased ACEs. Everybody has to commit to that shift in thinking, language, and understanding.

Stan Sonu at Emory University School of Medicine talks about “systemic empathy,” or the desire to feel understood and valued at all levels of human interaction with services. No matter who you are or how much money you make or what color your skin is, that’s a basic human need—and it’s one we all need to work on in order to enact systemic change.

Andrea Meyer Stinson serves as interim program director of the Master of Family Therapy Program and associate professor of psychiatry and behavioral sciences/pediatrics at Mercer University School of Medicine. She received her Ph.D. from Florida State University and her M.S. from Purdue University. She specializes in working with children and adolescents with emotional and behavioral challenges. Her current clinical focus is the integration of mental health services in primary care settings, in order to provide accessible and quality behavioral health services to underserved and rural populations. She is also interested in maternal child health interventions in order to address maternal mental health issues and improve parent child relationships.

Stinson and Jill Vanderhoek, executive director of Bibb Community Partnership, established Resilient Middle Georgia, a coalition that aims to foster community resilience and integrate trauma awareness in Central Georgia. Read “Empowering and Connecting Middle Georgia Communities” to learn more.