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The two biggest myths about ACEs science are:

MYTH #1 - That it's just about the 10 ACEs in the ACE Study- the CDC-Kaiser Permanente Adverse Childhood Experiences Study. It's about sooooo much more than that.
MYTH #2 - And that it's just about ACEs...adverse childhood experiences.
These two myths are intertwined. The ACE Study issued the first of its 70+ publications in 1998, and for many people it was the lightning bolt, the grand "aha" moment, the unexpected doorway into a blazing new understanding of the link between childhood adversity and the adult onset of chronic disease, mental illness, violence and being a victim of violence, among many other surprising consequences. Most people don't realize that the original ACE questionnaires had more than 100 questions, and explored many aspects of a person's family history. To make things easier to grasp, one of the people working with Drs. Robert Anda and Vincent Felitti, the co-principal investigators, came up with the suggestion for a shortened version, and the 10 ACEs and the ACE score were born. By the way, Anda and Felitti recognized that there were many other ACEs than those they chose to look at - including racism, bullying, a father being abused, and community violence - but they settled on those ten because they were identified as common in a pilot study of about 300 people; several of the adverse experiences - such as sexual abuse and physical abuse - had been individually well studied.

Since the original ACE Study was done, there have been many other surveys and studies, and many of those have expanded the types of ACEs. Based on the other parts of ACEs science, we now know that any experience that results in toxic stress can be regarded as an ACE. So, we put together this infographic to show the three realms of ACEs:

This infographic expands the types of experiences in the original ACE Study and combines them with the "Pair of ACEs" described by Wendy Ellis, director of Building Community Resilience Collaborative and Networks, and adverse experiences from climate crises, which are sure to increase over the next several decades. The truth of the matter is that the experiences listed in the three areas in the infographic can all cause harm to children's brains and bodies. How they recover - or cope - depends on the supports provided them after the experience.

There's no doubt that the ACE Study is an easy door to go through to begin to explore the mind-bending, world-changing knowledge of ACEs science, but there was so much more going on before, during and after the ACE Study was first published. The story of that evolution is for another time. For this post, it's important to grok that around 2012, give or take a couple of years, among leaders of the ACEs movement, ACEs science jelled into what it is today - an interlocking matrix of five areas of complementary research:

The ACE Study and subsequent ACE surveys that show how many people experience ACEs, at what levels, and the consequences (epidemiology).

How toxic stress from ACEs damages children's developing brains (neurobiology or brain science).

How toxic stress from ACEs affects our short- and long-term health.

How we pass ACEs from generation to generation through our genes (epigenetics).

And how resilience research shows that our brains are plastic and our bodies can heal through implementing protective factors and resilience-building practices based on ACEs science.

The other 10 myths:

MYTH #3 - The ACE Study findings are just about figuring out your ACE score. It's more complicated. And eye-opening.

1. ACEs are surprisingly common - 64% of the 17,000 in the ACE Study had one of the 10 ACEs; 12 percent had four or more.

2. There's an unmistakable link between ACEs and adult onset of chronic disease, mental illness, violence, being a victim of violence, and so much more, including more broken bones (from thrill sports).

3. The more types of childhood adversity, the direr the consequences. An ACE score of 4 increases the risk of alcoholism by 700%, attempted suicide by 1,200%; it doubles heart disease and lung cancer rates.

4. ACEs contribute to most of our health problems, including chronic disease, financial and social health issues.

5. One type of ACE is no more damaging than another. An ACE score of 4 that includes divorce, physical abuse, a family member depressed or in prison has the same statistical outcome as four other types of ACEs. This is why focusing on preventing just one type of trauma (stopping sexual abuse) and/or coping mechanism (stopping smoking) won't ever eliminate that trauma or coping mechanism.

MYTH #4 - If you have ACEs, you're doomed. If you have no ACEs, you're fine. The brain is plastic. The body wants to heal. No matter who has ACEs - kids or adults - it's not too late to heal. Understanding ACEs science is the first step, because that leads to understanding that you weren't born bad, you had no control over your childhood, the way you coped was appropriate because you weren't given healthy alternatives, and you can heal. Recent research shows that if you have protective factors in your childhood along with ACEs, you do much better than people who have ACEs and no protective factors. And here's something interesting: if you have no or low ACEs, that doesn't mean life is a bed of roses. Without protective factors, you do worse than someone with ACEs and protective factors. Those protective factors are crucial to health and well-being.

MYTH #5 - Screening should be done everywhere. Not necessarily. When you want to know the burden of ACEs and the promise of protective factors in a community, a school, an organization - and it's extremely useful to know what the ACEs burden is, as well as the level of protective factors - an anonymous ACE and resilience survey is enough. But in healthcare an individual's score is useful for treating and following patients. In both circumstances an ACE questionnaire should never be done without explaining ACEs science. Some people don't think ACEs screening should become common, and often say, "What if insurance companies start screening for ACEs to determine insurance rates?" Well, we're hoping to build enough of a movement so that insurance companies would have to look at the ACEs in their own organization first, before using it in a nefarious manner.

MYTH #6 - Physical and sexual abuse are the worst ACEs. The brain can't distinguish between different types of ACEs - once the experience goes into the brain, it's toxic stress. The ACE Study showed that it doesn't matter what the types of ACEs are. An ACE score of 4 that includes divorce, physical abuse, an incarcerated family member and a depressed family member has the same statistical outcome as an ACE score of 4 that includes living with an alcoholic, verbal abuse, emotional neglect and physical neglect. "We studied a whole range of outcomes - emotional, social, financial, biomedical, etc. If someone had an ACE score of 2 or 4 or 7, it didn't matter how you made the ACE score up. It didn't matter. That was unexpected and a surprise," says Felitti.

MYTH #7 -You don't need to learn about ACEs science if you're becoming trauma-informed. We know organizations that skipped over the ACE Study, included a little bit of brain science, and went right to implementing a trauma-informed approach. But that approach is not going to get an organization to be as successful as it could be if it integrated ACEs science.

MYTH #8 -You can't ask someone about ACEs because you'll traumatize them. When the ACE Study was going through the design and approval process, the institutional review board that decided if the study could be done turned it down at first because they thought that people would have what is known in layperson's terms a "nervous breakdown" if they were asked the questions. To receive approval for the study, a person on the research staff was required to wear a pager 24-7 for the dozens, perhaps hundreds of people the review board thought would be needing emergency care. Not one person called this hotline. However, although anyone can do the 10-question ACE survey online - it's in lots of places (e.g., NPR, here) - it's NOT a good idea to introduce ACEs science in a staff meeting by requiring everyone to take the survey first. The trauma-informed approach is to educate people about ACEs science, make time for questions and discussion, then do the survey anonymously. And always have someone there available to talk with people who have their lives suddenly altered by the knowledge and want to talk about how it's affecting them. It happens. Some therapists have been reluctant to ask their patients about ACEs. But what better place to address ACEs than with a therapist?

MYTH #9 - For physicians to start asking about ACEs, they need to have a therapist on staff. When Felitti realized the power of the ACE survey, he integrated it into the Health Appraisal Center at Kaiser Permanente in San Diego. Over the next few years, more than 440,000 patients who came through the center took the survey. He didn't have a therapist on staff. For a while, a therapist had a temporary office in his clinic, and the nurse-practitioners called on him when necessary. It turns out that just the act of listening and acknowledging can make a difference - in the only study that's been done on this, of 125,000 people who went through his center, there was a 35% drop in doctor visits and an 11% in visits to emergency rooms.

Felitti wrote:
It turned out that asking, listening, and accepting are a powerful form of doing that appears to provide great relief to patients. A common interchange was for the examiner to remark, "I see on the questionnaire that ...... (your father killed himself / you were raped / you were frequently beaten as a kid). Can you tell me how that has affected you later in your life?" It took patients only a minute or two to describe how their childhood trauma affected them later in life. Their responses were to the point and usually helpful to understand what might be done.
MYTH #10 - There's no difference in being trauma-informed or ACEs-science informed. Being ACEs-science informed is the bedrock, the foundation of becoming trauma-informed. You need both. ACEs science is the WHAT and WHY. Trauma-informed is the HOW. If we do only the how, becoming trauma-informed risks becoming a fad, especially if implementing trauma-informed practices without ACEs science shows only slight improvement.

MYTH #11 - Since ACEs only happen during childhood, we only have to focus all our resources on kids and we'll solve our problems. Research shows that parents pass their ACEs on to kids, so you have to involve parents. If parents address their ACEs, learn about ACEs science, and get help, they get healthier, and, as a result, their kids get healthier. What causes ACEs? Toxic stress. And since toxic stress appears in the community and the environment, parents won't get as healthy as their kids need them to be until the organizations and systems they work for and interact with, the communities they live in, and the nations they're part of stop traumatizing already traumatized people, and start healing. The early ACEs science pioneers have shown that we can solve our most intractable problems, but we won't solve our most intractable problems unless all organizations, systems in all sectors, all communities and nations integrate trauma-informed practices based on ACEs science.

MYTH #12 - We need to address ACEs only in poor people of color who live in urban areas, because they're the demographic with the highest burden of ACEs. This just further exacerbates the them-us culture we're all living in now, and is remarkably short-sighted. ACEs are everywhere, in all demographics. And people with ACEs in power - which in the United States are mostly white men who come from middle-class and upper middle-class backgrounds - can and do act out their ACEs by abusing people individually and by the policies that they create, either in the organizations they lead or the positions they hold in public service. You can find many examples of leaders in the business, faith-based, healthcare, entertainment, political and other arenas who have done so, and are doing so, due to their own ACEs. So it's just as important to educate kids and their parents in Palo Alto High School in Palo Alto, CA., about ACEs science as it is kids and their parents in McClymonds High School in Oakland, CA.

ACEs are everywhere, but, generally speaking the people with the least burden of ACEs are those who have the most power, because they have the most resources. Those with the greatest burden of ACEs are those with the least power and the fewest resources, no matter what country you're talking about. Traditionally, the people in power create a social structure that keeps those without the power as powerless as possible by instituting racism, sexism, classism, etc.

The promise of ACEs science is that we humans finally understand that these "isms" harm everyone - the powerful and the powerless - and that it's better for everyone to institutionalize sharing. Yeah, I know - much easier said than done. But now we have - and are accumulating more - scientific evidence, and, just like the increasing evidence for climate disruption, that genie won't be put back in the bottle.

_______________
Gail Kennedy of our ACEs Connection team came up with the idea for the 3 realms of ACEs while talking with Elaine Miller-Karas of the Trauma Resource Institute and Bob Doppelt of the Resource Innovation Group. She brought in the rest of our ACEs Connection team to come up with the approach and content, and handed it over to graphic designer Mindy Atwood to make it look gorgeous. Thank you all for creating this very useful infographic! A two-sided PDF is attached: infographic on one side, facts about ACEs on the other. For more information about ACEs science, go to ACEs Science 101.

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The two biggest myths about ACEs science are: MYTH #1 - That it's just about the 10 ACEs in the ACE Study - the CDC-Kaiser Permanente Adverse Childhood Experiences Study . It's about sooooo much more than that. MYTH #2 - And that it's just about ACEs...adverse childhood experiences.

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Updated 3/27/2018 LD

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Download the Practical Strategies Flyer for Teachers (PDF 320kb)

View full-featured PowerPoint presentations with The PowerPoint™ Viewer (verions 97 and later)

Modules are best viewed using the Adobe Acrobat Reader.

Scripted Stories for Social Situations
Scripted Stories for Social Situations help children understand social interactions, situations, expectations, social cues, the script of unfamiliar activities, and/or social rules. As the title implies, they are brief descriptive stories that provide information regarding a social situation. When children are given information that helps them understand the expectations of a situation, their problem behavior within that situation is reduced or minimized.

Scripted Stories for Social Situations Tip Sheet
(1 pg) HTML | PDF

I go to Preschool (on the bus)
(14 pg) HTML | PPT

I go to Preschool (in the car)(14 pg) HTML | PPT

What Do We Do In Circle?
(10 pg) HTML | PPT

I Can Be a Super Friend
(18 pg) HTML | PPT

I Can Stay Safe
(15 pg ) HTML | PPT

I Can Use My Words(15 pg) HTML | PPT

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Positive Attention Data Sheet
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Book List -Using Books to Support Social Emotional Development

Children's Book List
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Book Nook

These easy-to-use guides were created especially for teachers/caregivers and parents to provide hands-on ways to embed social emotional skill building activities into everyday routines. Each book nook is comprised of ideas and activities designed around popular children's books such as Big Al, Hands are Not for Hitting, On Monday When it Rained and My Many Colored Days. Examples of suggested activities include using rhymes to talk about being friends, making emotion masks to help children identify and talk about different feelings, playing games around what to do with hands instead of hitting and fun music and movement activities to express emotions.

Free Spirit Publishing, Inc. 2000 Hands Are Not for Hitting by Martine Agassi

(5 pages) PDF

Mouse was Mad by Linda Urban
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When I am by Gladys Rosa-Mendoz
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Teaching Social Emotional Skills

"You Got It!"
Teaching Social and Emotional Skills
Lise Fox and Rochelle Harper Lentini

Super Friend Award
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Emotion Faces
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en español: Caras de sentimientos ( HTML)

Feeling Chart: English
(4 pages) PDF
en español: Feeling Chart: English-Spanish ( PDF)

Feeling Chart: Flowers(1 page) PDF
en español: Paquete de soluciones ( PDF)

Feelings Sign-in Chart: English
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Feelings Faces Cube: English
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The Turtle Technique
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Problem-Solving Steps
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Solution Kit Cue Cards
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The following are from Tools for Developing Behavior Support Plans the Module Archive. These are Modules from 2003. The Archive has Spanish and HTML versions available. For the most current modules, see: Training Modules.

Observation Cards
Home Observation Card PDF
Functional Assessment Interview Form -Young Child PDF

en español
Tarjetas de observación PDF Formulario de Entrevista de Evaluación Funcional-Niño pequeño PDF

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CSEFEL: Center on the Social and Emotional Foundations for Early Learning

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The National Center for Effective Mental Health Consultation (CEMHC) addresses the needs of Early Head Start/Head Start (E/HS) staff and families for practical guidance on effective ways to promote young childrenís social and emotional development and reduce challenging behaviors.

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Ages zero to three are the most important for lifelong mental health and well-being.

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I wrote this article for Breaking Barriers a couple of years ago in order to put in one place all of the studies that I have reviewed and used for the background work on trauma and the compelling need to address mental health disorders early.

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The Pyramid Model for Supporting Social Emotional Competence in Infants and Young Children. We have developed extensive, user-friendly training materials, videos, and print resources which are available directly from this website to help early care, health and education providers implement this model.

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CSEFEL: Center on the Social and Emotional Foundations for Early Learning

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The National Center for Effective Mental Health Consultation (CEMHC) addresses the needs of Early Head Start/Head Start (E/HS) staff and families for practical guidance on effective ways to promote young childrenís social and emotional development and reduce challenging behaviors.

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When Students Are Traumatized, Teachers Are Too 

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When Students Are Traumatized, Teachers Are Too 

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Alysia Ferguson Garcia remembers the day two years ago that ended in her making a call to Child Protective Services. One of her students walked into drama class with what Garcia thought of as a "bad attitude" and refused to participate in a script reading.

"I don't care if you've had a bad day," Garcia remembers saying in frustration. "You still have to do some work."

In the middle of class, the student offered an explanation for her behavior: Her mom's boyfriend had been sexually abusing her. After the shock passed, the incident provided an opportunity for the class-and Garcia-to provide the student with comfort, and to cry.

When Garcia first started teaching, she wasn't expecting the stories her students would share of physical and sexual abuse, hunger, violence, and suicide. The stories seemed to haunt her all the way home, she says, recalling nightmares and sleepless nights spent worrying about her students. They also dredged up deep-seated memories of her own experiences with abuse.

"When you're learning to be a teacher, you think it's just about lesson plans, curriculum, and seating charts," said Garcia. "I was blindsided by the emotional aspect of teaching-I didn't know how to handle it. I was hurt by my students' pain, and it was hard for me to leave that behind when I went home."

The Real Costs of Trauma

Data shows that more than half of all U.S. children have experienced some kind of trauma in the form of abuse, neglect, violence, or challenging household circumstances-and 35 percent of children have experienced more than one type of traumatic event, according to the Centers for Disease Control and Prevention (CDC). These adverse childhood experiences (ACEs) can have impacts that extend far beyond childhood, including higher risks for alcoholism, liver disease, suicide, and other health problems later in life.

Trauma in children often manifests outwardly, affecting kids' relationships and interactions. In schools, the signs of trauma may be seen in a student acting out in class, or they could be more subtle-like failure to make eye contact or repeatedly tapping a foot. (To learn more about how trauma impacts students, read " Brains in Pain Cannot Learn! ")

For teachers, who are directly exposed to a large number of young people with trauma in their work, a secondary type of trauma, known as vicarious trauma, is a big risk. Sometimes called the "cost of caring," vicarious trauma can result from "hearing [people's] trauma stories and becom[ing] witnesses to the pain, fear, and terror that trauma survivors have endured," according to the American Counseling Association.

"Being a teacher is a stressful enough job, but teachers are now responsible for a lot more things than just providing education," says LeAnn Keck, a manager at Trauma Smart, an organization that partners with schools and early childhood programs to help children and the adults in their lives navigate trauma. "It seems like teachers have in some ways become case workers. They get to know about their students' lives and the needs of their families, and with that can come secondary trauma."

When you're learning to be a teacher, you think it's just about lesson plans, curriculum, and seating charts. I was blindsided by the emotional aspect of teaching-I didn't know how to handle it.

Vicarious trauma affects teachers' brains in much the same way that it affects their students': The brain emits a fear response, releasing excessive cortisol and adrenaline that can increase heart rate, blood pressure, and respiration, and release a flood of emotions. This biological response can manifest in mental and physical symptoms such as anger and headaches, or workplace behaviors like missing meetings, lateness, or avoiding certain students, say experts.

Yet many teachers are never explicitly taught how to help students who have experienced trauma, let alone address the toll it takes on their own health and personal lives. We reached out to trauma-informed experts and educators around the country to get their recommendations for in-the-moment coping strategies and preventative measures to help teachers process vicarious trauma. We share their tips below.

Talking it Out

Garcia, now a teacher of eight years, says she's found that confiding in others-either a therapist, her boyfriend, or colleagues-helps her process students' trauma and her own emotions.

Connecting with colleagues to talk through and process experiences can be invaluable for teachers coping with secondary trauma, according to Micere Keels, an associate professor at the University of Chicago and founder of the TREP Project, a trauma-informed curriculum for urban teachers.

"Reducing professional isolation is critical," said Keels. "It allows educators to see that others are struggling with the same issues, prevents the feeling that one's struggles are due to incompetence, and makes one aware of alternative strategies for working with students exhibiting challenging behavior."

It doesn't serve anybody to pretend that we're teacher-bots with no emotions, which I think sometimes teachers feel like they have to be.

Finding a wellness-accountability buddy-a peer who agrees to support and keep you accountable to your wellness goals-or using a professional learning community as a space to check in with other teachers are also ways to get that support, offers Alex Shevrin, a former school leader and teacher at Centerpoint School, a trauma-informed high school in Vermont that institutes school-wide practices aimed at addressing students' underlying emotional needs.

At Centerpoint, time for a monthly wellness group-where teachers, administrators, and social workers support each other on their personal wellness goals like exercising and creating work-life balance-is built into the professional development schedule. Staff also use in-service time to focus on taking care of their health together, by hiking, biking, going to the gym, or even learning to knit.

"If I had one wish for every school in the country, it would be that they made time for teachers to really sit down and talk about how they're feeling in the work," said Shevrin. "It doesn't serve anybody to pretend that we're teacher-bots with no emotions, which I think sometimes teachers feel like they have to be."

Building Coping Strategies

Students affected by trauma can have combative personalities and learn which buttons to press to upset you in class, says Garcia. When a student acts out in class, Garcia takes a few deep breaths, drinks coffee, or goes to a different part of the classroom to help another student.

"If I get upset, it never goes anywhere," Garcia said. "When you try to have a battle in class, you automatically lose as the teacher."

That's a good approach, says Keck, who suggests developing proactive coping strategies to address stressful situations in advance. A strategy may be counting to five, visualizing a calming place, or responding with an opposite action-like talking to a student quietly when you want to yell. Waiting until you're actually in a stressful situation means you're likely to overreact or to say or do something unhelpful.

Keck also recommends mapping out your school day and taking note of the times of day you feel most stressed, and then integrating scheduled coping strategies into your daily routine. If you feel stressed when students start to lose focus midday, for example, guide your students in a quick group stretch and some deep breathing to shift energy before getting back to work.

"Look at your schedule. If you see a stressful pattern, don't wait for it to happen. Don't wait to feel overwhelmed and stressed," urges Keck.

The important part is customizing the strategy to meet your needs.

Garcia applies this strategy when she's at home. She knows that after she puts her daughter to sleep, the worry for her students creeps in-so she makes sure to take time for things she enjoys, like watching movies and playing video games.

While many teachers say they don't have time for self-care, experts insist that it's necessary to develop long-term self-care practices-and stick to them-to build up your overall well-being and resilience. These self-care activities could be going for a walk, reading, watching a movie, practicing mindfulness, or talking with a friend-whatever invigorates you.
©Shutterstock.com/Dudarev Mikhail
Establishing Coming Home Rituals

It can be hard to leave work at work, but to address vicarious trauma, teachers need to create clear boundaries between work and home life. Part of that can be developing a ritual or routine that signifies the end of a work day, either before you head home, on the way home, or at home.

"For me, sometimes it's just as simple as turning off my work phone before I go into my house," Shevrin says. "I hear the sound of my phone turning off and then I know that I'm home."

After an emotionally difficult day, many teachers will write about their experiences before they leave, or sit down with a colleague to help process it, Keck told us.

Others organize their desk or create a to-do list for the next workday so they can let go of worry before heading home. While driving home, teachers listen to audiobooks, call a friend, or sit in silence to decompress. A ritual could even be as simple as changing clothes or taking a bath once you get home.

For Garcia, it's about putting her daughter's needs first and making the most of the time she has with her.

"It's very easy to get overwhelmed and let the job consume you. But teaching is about balance," she said. "When I come home, I try to just focus on my kid so she gets as much of me as she can. It's not always easy, but I've learned to put my life and my daughter's life first."

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When Students Are Traumatized, Teachers Are Too

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Trauma in students' lives takes an emotional and physical toll on teachers as well. Experts weigh in on the best ways to cope.

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How Trauma-Informed Teaching Builds A Sense of Safety And Care

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How Trauma-Informed Teaching Builds A Sense of Safety And Care

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Change the First Five Years and You Change Everything 

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Change the First Five Years and You Change Everything 

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Change the First Five Years and You Change Everything

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If we invest in programs that promote learning beginning at birth, the statistics will change, the stories will change, the future will change.

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Treating Childhood Trauma

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/ CBS News

In 1850, a Catholic orphanage called St. Aemilian was founded in Milwaukee, Wisconsin to take in children whose parents had died in a cholera epidemic. 168 Years later, that same organization -- now known as "SaintA" -- is still finding shelter for thousands of children who need it, often kids who have deep trauma in their young lives, and helps those kids with a revolutionary approach that's spreading across the country.

No longer a residential orphanage, SaintA primarily places orphaned, abandoned, neglected and abused children in foster homes, and then coordinates their care. On any given day, it's looking after some 2,000 children, almost all of whom are part of a 21st century epidemic of childhood trauma.

Alisha Fox: I got diagnosed with post-traumatic stress disorder when I was 15.

Milwaukee resident Alisha Fox was given that PTSD diagnosis seven years ago, months after she somehow found the courage to tell her grandmother - and then the police - of the terrible trauma she had been enduring.

Alisha Fox: For ten years, when I was four to 14. I'd been sexually abused and raped by my father.

Alisha's father and mother split up even before she was born. Her dad eventually got custody because her mom had a drug problem, and he then hid his crimes from everyone for a decade.

Alisha Fox: So during that whole time, I wasn't a person. You know? I wasn't anything. I wasn't even my own property. I didn't own myself. Somebody else did.

Oprah Winfrey: I can tell by the way you can speak about it, when you can say, "This thing happened to me from four to 14," that now there's been a clearing for you.

Alisha Fox: Right. Most people think that, you know, "Oh, she's damaged," or like, "Oh, she's not gonna be okay," but at the end of the day I think that I'm a survivor.

Oprah Winfrey: And every time you tell it, it makes you a little stronger.

Alisha Fox: Absolutely.

Alisha's survival was not a sure thing. Her father went to prison for his crimes against his daughter; she went to live with her maternal grandmother and aunt, Bonnie and Michelle Hahn.

Oprah Winfrey: What did you think the first time you heard her described as suffering from PTSD?

Bonnie Hahn: I didn't understand it because PTSD was for the veterans coming home from the war. That was what I thought it was. I had no idea.

Tim Grove: At the time, she was acutely suicidal.

Tim Grove is clinical director at SaintA, and he took responsibility for Alisha's care.

Tim Grove: We might not be able to ever prevent the stuff that happens to kids. But we are fully in charge of how we respond when we see it.

"That very same sensitivity that makes you able to learn language just like that as a little infant makes you highly vulnerable to chaos, threat, inconsistency, unpredictability, violence"

For Alisha, like every child who comes to SaintA now -- they responded with an approach called "trauma-informed care," which focuses on a person's experiences before trying to correct their behavior, whether it be juvenile delinquency, poor performance in school, or out-of-control anger.

Oprah Winfrey: It comes down to the question of not, "What's wrong with you? What's wrong with that kid? Why is he behaving like that," to, "What happened to you," which is a very different question.

Tim Grove: It's so subtle and yet so profound in terms of how kids experience an adult that approaches them from that angle. They--feel safe.

Alisha Fox: I felt that somebody understood. That they knew where I was coming from. That it wasn't just another person just tryin' to talk to me to calm me down for that moment. That they had done their homework and that they really wanted to help.

Oprah Winfrey: You felt seen?

Alisha Fox: I felt seen. Felt heard.

A crucial element of trauma-informed care is something called the "ACE test." ACE stands for adverse childhood experiences.

Tim Grove: Ten questions primarily taking a lens and looking at sort of the family home and saying to adults looking back at their childhood, "Were you physically abused? Were you neglected? Did someone go to prison?" Ten questions categorizing adversity that kids face.

Alisha Fox: I did a ACE test for them, and I scored a nine out of ten.

For anyone, a high score on the ACE test is a powerful predictor of physical and mental problems down the road. According to the Centers for Disease Control, it makes you five times as likely to be depressed and can cut your overall life expectancy by as much as twenty years.

The CDC says this isn't theory, it's scientific fact, backed up by hundreds of published studies. And, the CDC says, one out of every eight children suffers enough trauma to cause lasting damage.

Dr. Bruce Perry: If you have developmental trauma, the truth is you're going to be at risk for almost any kind of physical health, mental health, social health problem that you can think of.

Dr. Bruce Perry may be the world's leading expert on childhood trauma. He has treated thousands of children, and been called on for decades to treat kids traumatized in high-profile events including the Columbine and Sandy Hook school shootings. He's a psychiatrist, and also has a Ph.D. in neuroscience.

Dr. Bruce Perry: That very same sensitivity that makes you able to learn language just like that as a little infant makes you highly vulnerable to chaos, threat, inconsistency, unpredictability--

Oprah Winfrey: Violence.

Dr. Bruce Perry: --violence. And so children are much more sensitive to developmental trauma than adults.

Oprah Winfrey: So if you're a child who's raised in a nurturing and well-cared-for environment, you're more likely to have a well-wired brain?

Dr. Bruce Perry: Correct.

Oprah Winfrey: And if you're a child who's raised in an environment of chaos, of uncertainty, of violence, of neglect, you are being wired?

Dr. Bruce Perry: Differently.

Oprah Winfrey: Differently.

Dr. Bruce Perry: And-- and typically in a way that makes you more vulnerable.

Kids that grow up like that have much higher rates of risk for mental health problems, much higher rates of risk for doing poorly in school.

Oprah Winfrey: For just functioning in the world.

Dr. Bruce Perry: Exactly.

Bruce Perry travels the world teaching the techniques of trauma-informed care to therapists, educators, social workers and foster care agencies. It's crucial, he tells them, to understand what has happened to traumatized children before trying to "fix" their behavior.

Dr. Bruce Perry: "You need other tools in your toolkit."

Tim Grove heard Perry speak at a conference 10 years ago, and almost immediately began incorporating the Perry approach at SaintA.

"Really it boils down to something pretty simple. And it's relationships."

Tim Grove: We started to train our staff. And what our staff came back to us and said was they said, "We're starting to get this and we're seein' some remarkable things happen, but you gotta work on that teacher. You gotta work on that cop who just came and screwed everything up." And we said, "Okay."And 10 years later, 50,000 people have gone through our curriculum and been--

Oprah Winfrey: Wow.

Tim Grove: --trained by us.

Among those trainees, all the teachers at a "trauma-sensitive" charter school operated by SaintA.

SaintA now works with the Milwaukee Police Department's trauma response unit, and with judges in the city's childrens court.

What the judge now knows is to ask a child "what happened to you?" Before asking "what's wrong with you?" SaintA repeats that mantra to any Milwaukee organization that will listen.

Belinda Pittman-McGee: I got involved with SaintA's and the director over there, Tim Grove, and he says, "Belinda, you've been doing this all along. There just never was a name attached to it."

For the last 23 years, Belinda Pittman-McGee has been running the Nia Imani Family Center.

Oprah Winfrey: I notice the chores board. So there's order and responsibility.

Providing transitional housing for homeless women and their children. The chaos of homelessness is itself a traumatic experience.

Belinda Pittman-McGee: I couldn't help anyone if I didn't go back and learn about what happened to them. What they didn't know was to understand, "Why am I the way that I am?"

Oprah Winfrey: "Why can't I control my impulses? Why am I so aggressive?"

Belinda Pittman-McGee: That's right.

Oprah Winfrey: "Why does the first thing that happens, somebody irritates me and I blow up--"

Belinda Pittman-McGee: That's right. I blow up, I wanna fight.

Oprah Winfrey: "I wanna fight." Yeah, Yeah. So you help them put the pieces together--

Belinda Pittman-McGee: Put it together.

Oprah Winfrey: --for their stories?

Belinda Pittman-McGee: That's right.

Oprah Winfrey: To understand why I am this way.

Belinda understands trauma because she has lived through trauma. More than 30 years ago, she fled an abusive marriage with her three children.

Belinda Pittman-McGee: I got the children and we left.

She and her children walked to a shelter for abused women.

Belinda Pittman-McGee: The first week I was there, we were all outside, kinda go-- gonna go about our day and I heard a mother says, "Okay, I'll see you back at home tonight." I thought, "Home? She callin' the shelter home." That blew me away.

Belinda Pittman-McGee: I used to sit around a table just like this, just like this. So, I know life can be better if that's what we truly want.

Nia Imani's residents gather in the building's basement almost every evening for group learning and discussion facilitated by staff members who've been through training with SaintA.

Their children are looked after in an adjacent room, and Belinda shuttles between nurturing the children and nurturing their moms.

Belinda Pittman-McGee: And this is our baby in the family, right? This is our baby in the family. And she's-- we're gonna help her. We're gonna-- she's gonna learn from all of our experiences

There is a lot of pain in this room. Most of the women are on public assistance, and Belinda says that 90 percent of the men who fathered their children are incarcerated.

Beinda Pittman-McGee: How long he been incarcerated?

Woman at Discussion: Well, he get out next year. And he like, "Y'all there, come back." Like, I don't wanna go back. Like, it's the first time in my life, like, I feel like I'm doin' somethin' and I'm doin' it because I wanna do it. And I'm happy with that.

Belinda Pittman-McGee: You are. You are. And you know what? You're gonna work that out, too. You're gonna work it out.

They'll work it out, she says, by first understanding their own trauma and then, in her words, "re-scripting" their lives...and the lives of their children.

Oprah Winfrey: You know, people talk about this cycle of poverty, the cycle of joblessness, homelessness, incarceration. Can those problems be solved without addressing trauma?

Belinda Pittman-McGee: No.

We first learned of the trauma-informed care happening in Milwaukee from a series in the local newspaper, the Journal Sentinel. It was titled "A Time to Heal," and there's a lot that needs to be healedin Milwaukee; it's one of the poorest cities in the nation. And something else drew us to Milwaukee: it's the city where I grew up.

Oprah Winfrey: It's not lost on me the irony of being back in the same city, Milwaukee, where I grew up on welfare, poor. A lot of negative experiences. Sexual abuse and all of that. What's the difference between a really bad childhood and being able to overcome that and a traumatic childhood and someone not being able to overcome that?

Dr. Bruce Perry: Really it boils down to something pretty simple. And it's relationships.

Oprah Winfrey: And a lot of people can say, "Oh, I went through that. I went through that. I was, you know, physically abused, sexually abused. And I made it. I pulled myself up by the bootstraps." What you're saying is at some point in your life there was a relationship, or a helping hand, or some kind of healing process that helped you to get where you are.

Dr. Bruce Perry: Absolutely. Somebody helped you pull up those boots.

For the women at Nia Imani, that "somebody" is Belinda Pittman-McGee. For Alisha Fox, who's now in college, it's SaintA, her aunt, and her grandmother.

Alisha Fox: I think the way that I got through it is knowing that my family, my grandma's side of the family, was always gonna be there for me, no matter what. Through my darkest times they were there. So I thought, "If they could be there through my darkest times, then they're definitely gonna be there for the great times."
Produced by Rome Hartman. Associate producer, Sara Kuzmarov.
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