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Using the Strength-Based
Approach to Engage
Families in Conversations
about ACEs
Kathy Rogers, MSW
FSS Recruitment and Training Director
Tennessee Voices for Children
Mira Hanna, LMSW
Quality Assurance Manager
Prevent Child Abuse Tennessee
Who’s in the Room?
Learning Objectives
1. Participants will understand the ACEs Questionnaire and how to
administer the Questionnaire with families
2. Participants will understand how to support resilience in the presence
of ACEs
3. Participants will understand the importance of support for staff who
administer the ACEs Questionnaire
About Adverse
Childhood Experiences
Background and Significance
Educational
Achievement
Economic
Productivity
Responsible
Citizenship
Lifelong
Health
Healthy Child Development
Successful Parenting of Next Generation
Brain Architecture
The early years of life matter because early experiences affect the
architecture of the maturing brain. As it emerges, the quality of that
architecture establishes either a sturdy or a fragile foundation for all of the
development and behavior that follows – and getting things right the first
time is easier than trying to fix them later
Serve & Return Interactions
Build Brains and Skills
Young children naturally reach out for interaction through
babbling, facial expressions, and gestures, and adults
respond in kind
These “serve and return" interactions are essential for the
development of healthy brain circuits
Therefore, systems that support the quality of relationships in
early care settings, communities, and homes also support the
development of sturdy brain architecture
Toxic Stress Derails Healthy
Brain Development
Adverse Childhood
Experiences
Source: Robert Wood Johnson Foundation
The Impact of ACEs
Source: Centers for Disease Control and Prevention
ACEs are the LEADING
determinants of the
health and social and
economic wellbeing of
our nation - The Centers for Disease Control and Prevention
47.9
19.6
11.3
7.3 5.0 4.0
2.9 1.6
0.5 0.0
10.0
20.0
30.0
40.0
50.0
60.0
0 1 2 3 4 5 6 7 8
Perc
en
t, %
Number of Adverse Childhood Events
Prevalence of Adverse Childhood Experiences in Tennessee, 2014
Source: Tennessee Behavioral Risk Factor Surveillance System (BRFSS), 2012.
61% had at least 1 ACE
24% had 3 or more ACEs
(that’s 1 in 4)
ACEs in Tennessee
Using ACE Research in
Practice
Adapting to Agency and Program Needs
ACE Research in Action
In home services with youth
and adolescents
In home services with
caregivers of infants
Best Practices for
Administering the ACEs
Questionnaire
Adapted from NEAR@Home Toolkit
Engaging Families in
Conversation
Benefits to Home Visitor/Family Support Specialist and family
Dangers of avoidance
Engaging Families in
Conversation
Preparation
Administration
Follow-Up
Must be an intentional process from beginning to end
Preparation
Plan for ACE discussion to take up majority of visit
Gives this important topic the time it deserves
Consider safety and privacy of parent during conversation
Communicates importance of subject; build trust
Home Visitor/Family Support Specialist should be calm and fully present
People with history of trauma will be sensitive to a distracted Home Visitor/Family Support Specialist
Balance visits during the day
Avoids stress overload which might lead to inappropriate responses to family during ACE discussion
Prepare parent to discuss personal, sensitive information
Trauma-sensitive approach; Shows respect
Strategy Benefit
Administration
Set the context through sharing information about impact of early life experiences
Information is empowering and sets the stage for buffering some of the experiences
Share scientific findings on stress and brain development
Empowers family with information and increases understanding
Listen and respond in a trauma informed manner
Honors the life story and provides hope for child’s future
Accept information shared Provides support for self care and encourages reflection, future sharing
Share role of all of us to keep children safe
Family understands mandated reporting
Strategy Benefit
Follow-Up
Follow up contact planned in near future
Provides support and honors/respects the courage of sharing
Provide encouragement Restores HOPE
Recognize what can be done about ACEs
Lays foundation for increased resilience
Reinforce accomplishments Bolsters belief that I “CAN” do things well
Strategy Benefit
ACEs are Not Destiny
The Power of Resilience
What is Resilience?
Resiliency is a journey and a developmental process. Resilience is
the opposite of stress and mitigates negative outcomes. It requires
continuous balance and ability to spontaneously respond to the
dynamics of life. We bounce forward by developing the skills,
characteristics and attributes that are necessary to adapt to the
environment as it changes and as it challenges us
It is the capacity to absorb disturbance and re-organize while
undergoing change. It is the ability to meet challenges, survive and
do well despite adversity
Remember when positive experiences outweigh negative
experiences we are more likely to achieve positive outcomes
Fostering Resilience
Source: The Harvard Center on the Developing Child
Fostering Resilience through
Development of Capabilities
Support the development of emotional regulation
Promotes understanding of self, connection to people and environment
Support attachment and belonging
Promotes positive relationships with people and creation of a nurturing environment
Support a safe environment Decreases the events creating toxic stress
Support the development of self-efficacy AND choices
Promotes understanding that my action has an influence on what happens to me
Strategy Benefit
Strategies that Address
Needs of Children and their
Families
Resiliency is a journey and a developmental process. Resilience is the
opposite of stress and mitigates negative outcomes. It requires
continuous balance and ability to spontaneously respond to the
dynamics of life. We bounce forward by developing the skills,
characteristics and attributes that are necessary to adapt to the
environment as it changes and as it challenges us.
It is the capacity to absorb disturbance and re-organize while
undergoing change. It is the ability to meet challenges, survive and do
well despite adversity.
Source: Centers for Disease Control and Prevention
Support for Staff
Avoiding Burnout
The Role of Reflective
Supervision
Supervisors are in a prime position to support home visitors to:
Successfully use ACE research with families
Practice ethically and within the scope of service
Develop and refine skills to listen and respond appropriately
to parent’s concerns
Model self-regulation and reflective capacity to parents
Debrief, troubleshoot, and process emotions in order to
mitigate effects of secondary trauma and avoid burnout
The Role of Reflective
Supervision
Reflective Case
Conferencing is an
excellent opportunity to
further explore the
effects of ACEs on the
lives of families served
and on the Home
Visitors/Family Support
Specialists providing the
service
Questions?
