Doc Talk: Talking About Sexual Health with Kids… and Other Parents

Sometimes talking about sexual health with kids can seem complicated and even scary for parents… but it doesn’t have to be. Dr. Amelia shares some quick tips for parents about how to start these conversations with kids at an early age… tips that also include collaborating with other parents.

 


About Dr. Amelia ♥

Amelia Siders, Ph.D., LP, serves as the Clinical Director for TBCAC and has been working in the mental health field since 1994. She received a BA in psychology from the University of Michigan and completed her doctoral degree in Clinical Psychology at the California School of Professional Psychology, San Diego. A licensed psychologist, Dr. Amelia specializes in assessment, treatment, and advocacy for children, adolescents, and adults with emotional, behavioral, trauma, and substance use disorders. She has been trained in Trauma Focused Cognitive Behavioral Therapy and EDMR, as well as several other trauma-informed interventions including Trauma Incident Reduction. In addition to overseeing counseling and therapeutic services at TBCAC, Dr. Amelia serves as an expert in child abuse prevention and intervention and provides testimony in court cases related to areas such as child abuse disclosure rates, false allegations, statistics, trauma symptoms and even grooming and offender behaviors. Additionally, she offers consultation for prosecutorial teams on psychological assessments conducted on both clients and alleged offenders that may be used in court. She and her team of onsite therapists also help prepare both families and children for the trial process by offering support and education about ways to feel more confident and less anxious when providing testimony. Dr. Amelia became passionate about working with children and families who have been affected by abuse when completing her internship at the Center for Child Protection in San Diego, California. Dr. Amelia lives in Traverse City with her canine companion and beloved TBCAC volunteer, Jeeves.

About Jeeves ♥

Jeeves serves as a loyal volunteer sidekick to Dr. Amelia, providing sweet, loving wags to hundreds of child victims and their caregivers for the past several years. A Havanese, Jeeves has hair instead of fur which helps people visiting the Center who may have allergies. As the TBCAC mascot, Jeeves welcomes any and all opportunities to receive belly rubs and hugs!

 


Four Easy Ways to Teach Body Safety to Kids

By SUE BOLDE, Executive Director

A preschool teacher was helping one of her students button her winter coat. As the teacher threaded the buttons through small button holes, the little girl looked up at the teacher and whispered, “My daddy touches my buttons.”

“Oh, that’s nice of him,” the teacher replied as she secured the last button. “I’m glad that he helps you.”

A few months later, it was discovered that the little girl was being sexually abused by her father.  As it turns out, the girl was actually attempting to disclose the abuse to her teacher as she was buttoning her coat. Instead of knowing the proper names of her body parts, the little girl was taught to call her breasts “buttons”. So, when she shared with her teacher that “daddy touches my buttons,” the teacher had no idea the little girl was talking about being molested by her father.

Is this an isolated case? Sadly, no. Far too often parents, in an honest desire to protect their children, are hesitant to teach kids the proper names of their body parts and instead use euphemisms like “naughty”, “no-no”, “Popsicle”, “bumps” or “buttons”… and the list goes on. In fact, there was one case where a little boy was taught to call his penis an “esophagus”.

So, when children use words like these, it’s easy to see how attempted disclosures can be misunderstood. To help protect children from sexual predators, “Body Safety 101” is to teach kids the proper names of their body parts. Doing so actually empowers children to understand and appreciate their bodies… after all, each of us has these body parts and every body part has an important purpose. Teaching kids proper body part names also helps remove the shame or stigma sometimes attached to them.

There are four (4) very easy ways to begin body safety conversations with children that are simple, child-friendly and not scary at all… for you or your child.

1) Get comfortable using proper body part names yourself.

Hey, we come by it honestly… many of us were not taught proper body part names when we were young and were instead told NOT to use those words because they were “dirty” or “wrong”. Let’s dispel that myth right here and now. Practice saying these terms until you are comfortable and can share them with your child — if you treat these words as something silly or embarrassing, so will your child. So get used to saying:

  • Penis
  • Anus
  • Breasts
  • Vagina
  • Vulva

These are all proper terms and body parts each of us has… nothing to be ashamed of or embarassed about.

2) Start early!

Begin using proper body part names with your child from the time they are born! You can start as you change their diapers. There has been plenty of research demonstrating that talking to babies boosts their brain power. Babies as young as six-months begin to understand the words that are being spoken to them. So, start talking right away.

As children grow, other opportunities to use proper body part names happen on a daily basis! Take advantage of bath time or getting dressed to use proper body part names and talk about parts of their bodies that are “private” and “just for them”.

Toddlers are naturally curious and will want to know things like, “Do you have a penis, mom?” or “Does our cat have breasts?” Embrace these questions as opportunities to talk about body parts and their proper names (and functions). These don’t have to be long conversations, but rather address your child’s questions directly in short sound bites.

3) Take advantage of every-day opportunities.

Believe it or not, this is SO easy to do! You can reinforce basic body safety principles in ways that your child won’t even suspect you are teaching them protective behaviors. Here are some simple, every-day things you can do with your child:

Use a washcloth or bath mitt when bathing. Sexual predators will look for opportunities to be alone with children and seek skin-on-skin contact. By teaching kids to use a washcloth or bath mitt when bathing reinforces that these tools are used to help get clean. So, someone using their hands to help a child bathe isn’t the way to do it. If someone else helps your child bathe, you can simply ask your child afterwards, “Hey, what color was the washcloth grandpa used to help you with your bath? If your child shares that no washcloth was used, that’s a sign that you need to follow-up with grandpa to find out why.

Use toilet paper or wipes after going to the bathroom. For the same reasons as above, be sure your kids know it’s important to use something to clean themselves after going potty. It’s also a good time to reinforce that going to the bathroom is a private activity and they should respect other’s privacy when they are doing so. AND, your child should let you know if they see or are asked to watch someone else going to the bathroom. Case in point… one grooming technique used by sexual predators is to walk in on a child using the bathroom or leave a bathroom door open so a child can see the perpetrator as s/he is urinating, defecating or even masterbating. This is done in an effort to desensitize children and groom them for future sexual contact.

Keep lines of communication open. Children who have been sexually abused will often ‘test the waters’ before they disclose abuse. Many are afraid of not being believed or have been made to feel the abuse is all their fault. It is estimated that 70% of sexually abused children DO NOT disclose their abuse for at least one (1) year; another 45% won’t tell anyone about their abuse for five (5) years; and still others never tell. By encouraging and maintaining open communication with kids, you establish an environment in which disclosure would be easier should it ever be necessary. Talk with your kids. Time spent driving kids to and from school, sports or clubs provides an awesome opportunity to find out about their day (…the added bonus is that neither of you have to establish eye contact, which sometimes makes it easier for kids to share). At dinner, go around the table and have everyone share the best and worst things about their day. Bottom line: find opportunities to chat.

4) Model your own behavior.

Children really do live what they learn and will follow your lead. It’s important for you to model healthy behavior in touch, attitude and treatment of your spouse, partner or friend. Ask for permission before giving a touch so that toddlers can learn that permission must be received before touching someone or being touched by someone. And never force a child to hug or kiss someone… instead, offer options such as high-fives or hand shakes and support your child’s decision not to give kisses or hugs.

For additional tips on talking with kids about body safety and sexual abuse prevention, visit our Team Zero website.

Experiences cited in this and other articles on this website have been modified to protect the child victims.


About Sue ♥

Traverse Bay Children’s Advocacy Center Executive Director Sue Bolde has a BA in psychology from the University of California Santa Barbara and an MA in art therapy from the University of Illinois. Her professional career includes clinical work with children and teens at the University of Chicago, graduate-level instruction with students at the School of the Art Institute of Chicago, and certification as a Montessori teacher and yoga instructor. She is currently a teacher in training with Google’s Search Inside Yourself Leadership Institute as well as a Michigan ACE Initiative trainer.

About Traverse Bay Children’s Advocacy Center ♥

The nationally accredited Traverse Bay Children’s Advocacy Center brings help, hope, and healing to child victims of sexual abuse, physical abuse, and violence. Our mission is to protect children by supporting multidisciplinary investigations into alleged cases of child abuse by conducting child forensic interviews in an environment that is child-sensitive, supportive and safe. We help heal child victims and their families through our in-house therapeutic services and offer prevention education throughout the region via our Team Zero program. As the Grand Traverse regional response center for the investigation of child abuse, we collaborate with multidisciplinary teams in six counties – Antrim, Benzie, Grand Traverse, Kalkaska, Leelanau, and Wexford – in addition to the Sovereign Nation of the Grand Traverse Band of Ottawa and Chippewa Indians. More than 1,400 children have been referred to the Traverse Bay Children’s Advocacy Center since our founding in 2010.


3 Reasons Santa’s Lap May NOT Be A Good Place For Kids

By SUE BOLDE, Executive Director 

For many, the image of Santa Claus conjures up warm, happy thoughts of a jolly man in red, loaded down with gifts in a magical sleigh pulled by a talented team of reindeer, catching some serious air in the night sky. This beloved holiday figure embodies everything we adore about this time of year… a belief in good things for all.

However, there are a few aspects of the Santa holiday tradition that fly in the face of teaching body safety and proper boundaries to our kids… and the holidays offer adults a wonderful opportunity to reinforce basic rules that can help protect children from sexual abuse.

1) Let’s face it… not all kids like Santa’s lap.

Have you ever witnessed a child crying while sitting on Santa’s lap? It can happen for a variety of reasons, often stemming from a child’s fear of losing control of his or her own body for reasons that are difficult for a young mind to comprehend or accept. While photos with Santa can make for fun memories later in life, the act of forcing a child to sit on a stranger’s lap runs counter to important body safety rules that we must teach our kids.

Respecting a child’s wish to NOT make physical contact with someone — anyone — is a practice that our community must agree to follow if we are truly committed to keeping children safe. Cajoling children to pose or have physical contact with someone without their consent reinforces a social expectation that children should do as they are told, even if it violates their bodily integrity. Internalizing this expectation puts children at risk of being manipulated by predators. Keep in mind, sexual predators often take pictures or videos of their victims.

 2) Sexual predators frequently use gifts as a way to groom children.

Gift giving is a wonderful part of the holiday season. Socially, we are taught that gifts are selfless, thoughtful and virtuous expressions of love, friendship or respect. During the holidays, children receive gifts from people they know as well as from those they don’t, like Santa or distant relatives. This time of year offers a great opportunity to teach children to show all gifts that they receive to their caregivers.

Why is this so important? Sexual predators often lure children into trusting them by giving gifts that can range from candy to toys to even bigger things! Showering children with gifts and special attention is a grooming tactic to elicit comfort and investment in the predatory relationship.

Sadly, over 90% of children who are sexually abused know, love or trust their molesters. In other words, people who harm children are most often in a child’s circle of family or friends. Talking with children about gifts or special favors keeps adults mindful of what’s happening in a child’s sphere of relationships and empowers adults with the knowledge to determine if cautionary action is required. Writing thank you cards together is a perfect platform for tallying all gestures of affection.

3) Forced hugging or kissing of relatives is a bad idea.

Do you have a relative who means well but always insists on kissing or hugging your child? Are you one of those relatives yourself? It cannot be overstated that forcing children to kiss grandma or hug Uncle Buck flies in the face of body safety rules that, if followed, help keep kids safe.

Tragically, 30% of child sexual abuse incidents are committed by family members. Parents and step-parents. Uncles and aunts. Grandparents and cousins.

Instead of making your child hug or kiss a family member, step in and say, “We are teaching Emma about body safety and personal boundaries, so we respect her when she does not want to be touched by others, no matter how innocent… but I’ll take that hug!” (Then give your relative a big hug.) Another option would be to encourage kids to give high-fives instead of hugs.

Kids can even high-five Santa if they feel comfortable doing so. ♥

The best way to help others understand safety expectations is to model the behavior you hope to see. Ask every child, including your own, for permission before giving a hug or high five. Ask your spouse or partner permission before showing them affection, especially when in front of children.

Holiday Tips for Caregivers

In addition to supporting your child in his or her decision to respect body boundaries, here are a few more tips for caregivers to help keep kids safe during the holidays:

  1. Take a moment to remind your child about body safety rules. This can be done in a very child-friendly, non-scary and simple way. For tips on how to have these talks with your child, learn more at Team Zero.
  2. When going to parties at places unfamiliar to your child, walk around with your child and identify the rooms that are okay to go in, as well as other areas they should avoid.
  3. Make an agreement with your child that s/he will check-in periodically with you during the party or holiday event you are attending.
  4. If cocktails are served at the event, please keep yourself in check. If your senses are obstructed, that can present an open door to a sexual predator to gain ready access to your child… again, sexual predators are indeed among us. The sad fact is, they hide in plain sight and are often people most of us think “would never do that to a child.”

The greatest gift we can give ourselves and our children is a commitment to keeping them safe. When we agree to protect our children above all else — even when it means opting out of long-held customs and traditions — then we will be creating a world within which all children may flourish.


About Sue ♥

Traverse Bay Children’s Advocacy Center Executive Director Sue Bolde has a BA in psychology from the University of California Santa Barbara and an MA in art therapy from the University of Illinois. Her professional career includes clinical work with children and teens at the University of Chicago, graduate-level instruction with students at the School of the Art Institute of Chicago, and certification as a Montessori teacher and yoga instructor. She is currently a teacher in training with Google’s Search Inside Yourself Leadership Institute as well as a Michigan ACE Initiative trainer.

About Traverse Bay Children’s Advocacy Center ♥

The nationally accredited Traverse Bay Children’s Advocacy Center brings help, hope, and healing to child victims of sexual abuse, physical abuse, and violence. Our mission is to protect children by supporting multidisciplinary investigations into alleged cases of child abuse by conducting child forensic interviews in an environment that is child-sensitive, supportive and safe. We help heal child victims and their families through our in-house therapeutic services and offer prevention education throughout the region via our Team Zero program. As the Grand Traverse regional response center for the investigation of child abuse, we collaborate with multidisciplinary teams in six counties – Antrim, Benzie, Grand Traverse, Kalkaska, Leelanau, and Wexford – in addition to the Sovereign Nation of the Grand Traverse Band of Ottawa and Chippewa Indians. More than 1,400 children have been referred to the Traverse Bay Children’s Advocacy Center since our founding in 2010.


The ACE Study

ACEs has become a buzzword in social services, public health, education, juvenile justice, mental health, pediatrics, criminal justice and even business. But what is this study and why is it so important? The article below gives the backstory to the CDC’s Adverse Childhood Experiences Study as well as the significance of what could be the largest public health discovery of our time.

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The Adverse Childhood Experiences Study
by Jane Ellen Stevens
First published on October 3, 2012, www.acestoohigh.com

The ACE Study – probably the most important public health study you never heard of – had its origins in an obesity clinic on a quiet street in San Diego.

It was 1985, and Dr. Vincent Felitti was mystified. The physician, chief of Kaiser Permanente’s revolutionary Department of Preventive Medicine in San Diego, CA, couldn’t figure out why, each year for the last five years, more than half of the people in his obesity clinic dropped out. Although people who wanted to shed as little as 30 pounds could participate, the clinic was designed for people who were 100 to 600 pounds overweight.

Felitti cut an imposing, yet dashing, figure. Tall, straight-backed, not a silver hair out of place, penetrating eyes, he was a doctor whom patients trusted implicitly, spoke of reverentially and rarely called by his first name. The preventive medicine department he created had become an international beacon for efficient and compassionate care. Every year, more than 50,000 people were screened for diseases that tests and machines could pick up before symptoms appeared. It was the largest medical evaluation site in the world. It was reducing health care costs before reducing health care costs was cool.

But the 50-percent dropout rate in the obesity clinic that Felitti started in 1980 was driving him crazy. A cursory review of all the dropouts’ records astonished him — they’d all been losing weight when they left the program, not gaining. That made no sense whatsoever. Why would people who were 300 pounds overweight lose 100 pounds, and then drop out when they were on a roll?

The situation “was ruining my attempts to build a successful program,” he recalls, and in typical Type-A fashion, he was determined to find out why.

The mystery turned into a 25-year quest involving researchers from the Centers for Disease Control and Prevention and more than 17,000 members of Kaiser Permanente’s San Diego care program. It would reveal that adverse experiences in childhood were very common, even in the white middle-class, and that these experiences are linked to every major chronic illness and social problem that the United States grapples with – and spends billions of dollars on.

But in 1985, all that Felitti knew was that the obesity clinic had a serious problem. He decided to dig deep into the dropouts’ medical records. This revealed a couple of surprises: All the dropouts had been born at a normal weight. They didn’t gain weight slowly over several years.

“I had assumed that people who were 400, 500, 600 pounds would be getting heavier and heavier year after year. In 2,000 people, I did not see it once,” says Felitti. When they gained weight, it was abrupt and then they stabilized. If they lost weight, they regained all of it or more over a very short time.

But this knowledge brought him no closer to solving the mystery. So, he decided to do face-to-face interviews with a couple hundred of the dropouts. He used a standard set of questions for everyone. For weeks, nothing unusual came of the inquiries. No revelations. No clues.

The turning point in Felitti’s quest came by accident. The physician was running through yet another series of questions with yet another obesity program patient: How much did you weigh when you were born? How much did you weigh when you started first grade? How much did you weigh when you entered high school? How old were you when you became sexually active? How old were you when you married?

“I misspoke,” he recalls, probably out of discomfort in asking about when she became sexually active – although physicians are given plenty of training in examining body parts without hesitation, they’re given little support in talking about what patients do with some of those body parts. “Instead of asking, “How old were you when you were first sexually active,” I asked, “How much did you weigh when you were first sexually active?’ The patient, a woman, answered, ‘Forty pounds.’”

He didn’t understand what he was hearing. He misspoke the question again. She gave the same answer, burst into tears and added, “It was when I was four years old, with my father.”

He suddenly realized what he had asked.

“I remembered thinking, ‘This is only the second incest case I’ve had in 23 years of practice’,” Felitti recalls. “I didn’t know what to do with the information. About 10 days later, I ran into the same thing. It was very disturbing. Every other person was providing information about childhood sexual abuse. I thought, ‘This can’t be true. People would know if that were true. Someone would have told me in medical school.’ ”

Worried that he was injecting some unconscious bias into the questioning, he asked five of his colleagues to interview the next 100 patients in the weight program. “They turned up the same things,” he says.

Of the 286 people whom Felitti and his colleagues interviewed, most had been sexually abused as children. As startling as this was, it turned out to be less significant than another piece of the puzzle that dropped into place during an interview with a woman who had been raped when she was 23 years old. In the year after the attack, she told Felitti that she’d gained 105 pounds.

“As she was thanking me for asking the question,” says Felitti, “she looks down at the carpet, and mutters, ‘Overweight is overlooked, and that’s the way I need to be.’”

During that encounter, a realization struck Felitti. It’s a significant detail that many physicians, psychologists, public health experts and policymakers haven’t yet grasped: The obese people that Felitti was interviewing were 100, 200, 300, 400 overweight, but they didn’t see their weight as a problem. To them, eating was a fix, a solution. (There’s a reason an IV drug user calls a dose a “fix”.)

One way it was a solution is that it made them feel better. Eating soothed their anxiety, fear, anger or depression – it worked like alcohol or tobacco or methamphetamines. Not eating increased their anxiety, depression, and fear to levels that were intolerable.

The other way it helped was that, for many people, just being obese solved a problem. In the case of the woman who’d been raped, she felt as if she were invisible to men. In the case of a man who’d been beaten up when he was a skinny kid, being fat kept him safe, because when he gained a lot of weight, nobody bothered him. In the case of another woman — whose father told her while he was raping her when she was 7 years old that the only reason he wasn’t doing the same to her 9-year-old sister was because she was fat — being obese protected her. Losing weight increased their anxiety, depression, and fear to levels that were intolerable.

For some people, both motivations were in play.

Felitti didn’t know this at the time, but this was the more important result — the mind-shift, the new meme that would begin spreading far beyond a weight clinic in San Diego. It would provide more understanding about the lives of hundreds of millions of people around the world who use biochemical coping methods – such as alcohol, marijuana, food, sex, tobacco, violence, work, methamphetamines, thrill sports – to escape intense fear, anxiety, depression, anger.

Public health experts, social service workers, educators, therapists and policy makers commonly regard addiction as a problem. Some, however, are beginning to grasp that turning to drugs is a normal response to serious childhood trauma, and that telling people who smoke or overeat or overwork that these are bad for them and that they should stop doesn’t register when those approaches provide a temporary, but gratifying solution.

Ella Herman was one of the people who participated in the obesity clinic, but had dropped out because any weight she lost, she regained. Herman owned a successful childcare center in San Diego. Herman said she was sexually abused by two uncles and a school bus driver; the first time occurred when she was four years old. She married a man who abused her repeatedly and tried to kill her. With the help of her family, she fled with her children to San Diego, where she later remarried.

“I imagine I’ve lost 100 pounds about six times,” she recalled. “And gained it back.” Every time she lost weight and a man commented on her beauty, she became terrified and began eating. But she never understood the connection until she attended a meeting at which Felitti talked about what he’d learned from patients. At this time, Herman was just over five feet tall and weighed nearly 300 pounds. “He had a room full of people,” she said. “The more he talked the more I cried, because he was touching every aspect of my life. Somebody in the world understands, I thought.”

Herman later sent a letter to Felitti. “I want to thank you for caring enough about people to read all those charts and finding out what happens to all of us who are molested, raped and abused in childhood,” she wrote. “… I suffered for years. The pain became so great I was thinking of jumping off the San Diego Bay Bridge…. How many people may have taken their life because they had no program to turn to? How many lives can be saved by this program?”

What do you do when you’ve got something important to tell the world, but the world thinks it’s stupid?

So, if you were Vincent Felitti, whom would you pick as your first audience to reveal your stunning findings? A group relatively informed about obesity that would greet the new information with extreme interest, praise and applause? Natch. So, in 1990, Felitti flew to Atlanta to give a speech to the members – many of them psychologists and psychiatrists — of the North American Association for the Study of Obesity. The audience listened quietly and politely. When he finished, one of the experts stood up and blasted him. “He told me I was naïve to believe my patients, that it was commonly understood by those more familiar with such matters that these patient statements were fabrications to provide a cover explanation for failed lives!”

At dinner, Dr. David Williamson, an epidemiologist from the U.S. Centers for Disease Control and Prevention, sat next to the perplexed Felitti. Williamson was intrigued. He leaned over and “told me that people could always find fault with a study of a couple of hundred people,” says Felitti, “but not if there were thousands, and from a general population, not a subset like an obesity program. I turned to him and said, ‘That’s not a problem.’ ”

Williamson invited Felitti to meet with a small group of researchers at the Centers for Disease Control. Dr. Robert Anda, a medical epidemiologist was among them. If Felitti is the model for a TV show featuring a wise and stately chief physician who sits straight, stands straight, and keeps his personal feelings in check, Anda would be the dashing, young, brilliant researcher who wears his tie askew, slumps in chairs, laughs easily, loves to joke around, and puts his heart on his sleeve for all to see.

Anda began his career as a physician, but became intrigued with epidemiology and public health. When he met Felitti, he had been studying how depression and feelings of hopelessness affect coronary heart disease. He noticed that depression and hopelessness weren’t random. “I became interested in going deeper, because I thought that there must be something beneath the behaviors that were generating them,” says Anda.

Kaiser Permanente in San Diego was a perfect place to do a mega-study. More than 50,000 members came through the department each year, for a comprehensive medical evaluation. Every person who came through the Department of Preventive Medicine filled out a detailed biopsychosocial (biomedical, psychological, social) medical questionnaire prior to undergoing a complete physical examination and extensive laboratory tests. It would be easy to add another set of questions. In two waves, Felitti and Anda asked 26,000 people who came through the department “if they would be interested in helping us understand how childhood events might affect adult health,” says Felitti. Of those, 17,421 agreed.

Before they added the new trauma-oriented questions, Anda spent a year pouring through the research literature to learn about childhood trauma, and focused on the eight major types that patients had mentioned so often in Felitti’s original study and whose individual consequences had been studied by other researchers. These eight included three types of abuse — sexual, verbal and physical. And five types of family dysfunction — a parent who’s mentally ill or alcoholic, a mother who’s a domestic violence victim, a family member who’s been incarcerated, a loss of a parent through divorce or abandonment. He later added emotional and physical neglect, for a total of 10 types of adverse childhood experiences, or ACEs.

The initial surveys began in 1995 and continued through 1997, with the participants followed subsequently for more than fifteen years. “Everything we’ve published comes from that baseline survey of 17,421 people,” says Anda, as well as what was learned by following those people for so long.

When the first results of the survey were due to come in, Anda was at home in Atlanta. Late in the evening, he logged into his computer to look at the findings. He was stunned. “I wept,” he says. “I saw how much people had suffered and I wept.”

This was the first time that researchers had looked at the effects of several types of trauma, rather than the consequences of just one. What the data revealed was mind-boggling.

The first shocker: There was a direct link between childhood trauma and adult onset of chronic disease, as well as mental illness, doing time in prison, and work issues, such as absenteeism.

The second shocker: About two-thirds of the adults in the study had experienced one or more types of adverse childhood experiences. Of those, 87 percent had experienced 2 or more types. This showed that people who had an alcoholic father, for example, were likely to have also experienced physical abuse or verbal abuse. In other words, ACEs usually didn’t happen in isolation.

The third shocker: More adverse childhood experiences resulted in a higher risk of medical, mental and social problems as an adult.

To explain this, Anda and Felitti developed a scoring system for ACEs. Each type of adverse childhood experience counted as one point. If a person had none of the events in her or his background, the ACE score was zero. If someone was verbally abused thousands of times during his or her childhood, but no other types of childhood trauma occurred, this counted as one point in the ACE score. If a person experienced verbal abuse, lived with a mentally ill mother and an alcoholic father, his ACE score was three.

Things start getting serious around an ACE score of 4. Compared with people with zero ACEs, those with four categories of ACEs had a 240 percent greater risk of hepatitis, were 390 percent more likely to have chronic obstructive pulmonary disease (emphysema or chronic bronchitis), and a 240 percent higher risk of a sexually-transmitted disease.

They were twice as likely to be smokers, 12 times more likely to have attempted suicide, seven times more likely to be alcoholic, and 10 times more likely to have injected street drugs.

People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, more auto-immune diseases, and more work absences.

“Some of the increases are enormous and are of a size that you rarely ever see in health studies or epidemiological studies. It changed my thinking dramatically,” says Anda.

Two in nine people had an ACE score of 3 or more, and one in eight had an ACE score of 4 or more. This means that every physician probably sees several high ACE score patients every day, notes Felitti. “Typically, they are the most difficult, though the underpinnings will rarely be recognized.”

The kicker was this: The ACE Study participants were average Americans. Seventy-five percent were white, 11 percent Latino, 7.5 percent Asian and Pacific Islander, and 5 percent were black. They were middle-class, middle-aged, 36 percent had attended college and 40 percent had college degrees or higher. Since they were members of Kaiser Permanente, they all had jobs and great health care. Their average age was 57.

As Anda has said: “It’s not just ‘them’. It’s us.”

Changing the landscape of understanding human development

In the last 14 years, Anda, Felitti and other CDC researchers have published more than 60 papers in prestigious peer-reviewed journals, including the Journal of the American Medical Association and the American Journal of Preventive Medicine. Other researchers have referenced their work more than 1,500 times. Anda and Felitti have flown around the U.S., Canada and Europe to give hundreds of speeches.

Their inquiry “changed the landscape,” says Dr. Frank Putnam, director of the Mayerson Center for Safe and Healthy Children at Cincinnati Children’s Hospital Medical Center and professor at the University of Cincinnati Department of Pediatrics. “It changed the landscape because of the pervasiveness of ACEs in the huge number of public health problems, expensive public health problems — depression, substance abuse, STDs, cancer, heart disease, chronic lung disease, diabetes.”

The ACE Study became even more significant with the publication of parallel research that provided the link between why something that happened to you when you were a kid could land you in the hospital at age 50. The stress of severe and chronic childhood trauma – such as being regularly hit, constantly belittled and berated, watching your father often hit your mother – releases hormones that physically damage a child’s developing brain.

Flight, fight or freeze hormones work really well to help us accelerate when we’re being chased by a vicious dog with big teeth, fight when we’re cornered, or turn to stone and stop breathing to escape detection by a predator. But they become toxic when they’re turned on for too long.

This was determined by a group of neuroscientists and pediatricians, including neuroscientist Martin Teicher and pediatrician Jack Shonkoff, both at Harvard University, neuroscientist Bruce McEwen at Rockefeller University, and child psychiatrist Bruce Perry at the Child Trauma Academy.

As San Francisco pediatrician Nadine Burke Harris recently explained to host Ira Glass on the radio program, “This American Life”, if you’re in a forest and see a bear, a very efficient fight or flight system instantly floods your body with adrenaline and cortisol and shuts off the thinking portion of your brain that would stop to consider other options. This is very helpful if you’re in a forest and you need to run from a bear. “The problem is when that bear comes home from the bar every night,” she said.

If a bear threatens a child every single day, his emergency response system is activated over and over and over again. He’s always ready to fight or flee from the bear, but the part of his brain – the prefrontal cortex – that’s called upon to diagram a sentence or do math becomes stunted, because, in our brains, emergencies – such as fleeing bears – take precedence over doing math.

For Harris’ patients who had four or more categories of adverse childhood experiences “their odds of having learning or behavior problems in school were 32 times as high as kids who had no adverse childhood experiences,” she told Glass.

Together, the two discoveries – the ACE epidemiology and the brain research — reveal a story too compelling to ignore:

Children with toxic stress live much of their lives in fight, flight or fright (freeze) mode. They respond to the world as a place of constant danger. With their brains overloaded with stress hormones and unable to function appropriately, they can’t focus on learning. They fall behind in school or fail to develop healthy relationships with peers or create problems with teachers and principals because they are unable to trust adults. Some kids do all three. With despair, guilt and frustration pecking away at their psyches, they often find solace in food, alcohol, tobacco, methamphetamines, inappropriate sex, high-risk sports, and/or work and over-achievement. They don’t regard these coping methods as problems. Consciously or unconsciously, they use them as solutions to escape from depression, anxiety, anger, fear and shame.

What all this means, says Anda is that we need to prevent adverse childhood experiences and, at the same time, change our systems – educational, criminal justice, healthcare, mental health, public health, workplace – so that we don’t further traumatize someone who’s already traumatized. You can’t do one or the other and hope to make any progress.

“Dr. Putnam is right — ACEs changed the landscape,” Anda says. “Or perhaps the many publications from the ACE Study opened our eyes to see the truth of the landscape. ACEs create a “chronic public health disaster” that until recently has been hidden by our limited vision. Now we see that the biologic impacts of ACEs transcend the traditional boundaries of our siloed health and human service systems. Children affected by ACEs appear in all human service systems throughout the lifespan — childhood, adolescence, and adulthood — as clients with behavioral, learning, social, criminal, and chronic health problems.”

But our society has tended to treat the abuse, maltreatment, violence and chaotic experiences of our children as an oddity instead of commonplace, as the ACE Study revealed, notes Anda. And our society believes that these experiences are adequately dealt with by emergency response systems such as child protective services, criminal justice, foster care, and alternative schools. “These services are needed and are worthy of support — but they are a dressing on a greater wound,” he says.

“A hard look at the public health disaster calls for the both the prevention and treatment ACEs,” he continues. “This will require integration of educational, criminal justice, healthcare, mental health, public health, and corporate systems that involves sharing of knowledge and resources that will replace traditional fragmented approaches to burden of adverse childhood experiences in our society.”

As Williamson, the epidemiologist who introduced Felitti and Anda, and also worked on the ACE Study, says: “It’s not just a social worker’s problem. It’s not just a psychologist’s problem. It’s not just a pediatrician’s problem. It’s not just a juvenile court judge’s problem.” In other words, this is everybody’s problem.

According to a CDC study released earlier this year, just one year of confirmed cases of child maltreatment costs $124 billion over the lifetime of the traumatized children. The researchers based their calculations on only confirmed cases of physical, sexual and verbal abuse and neglect, which child maltreatment experts say is a small percentage of what actually occurs.

The breakdown per child is:

  • $32,648 in childhood health care costs
  • $10,530 in adult medical costs
  • $144,360 in productivity losses
  • $7,728 in child welfare costs
  • $6,747 in criminal justice costs
  • $7,999 in special education costs

You’d think the overwhelming amount of money spent on the fallout of adverse childhood experiences would have inspired the medical community, the public health community and federal, state and local governments to integrate this knowledge and fund programs that have been proven to prevent ACEs. But adoption of concepts from the ACE Study and the brain research has been remarkably slow and uneven.

On the federal level, the Substance Abuse and Mental Health Services Administration(SAMHSA) – probably the largest federal agency you never heard of – launched the National Child Traumatic Stress Network in 2001, and the National Center for Trauma-Informed Care (NCTIC) in 2005. Much of the work focused on stress from individual traumatic events, or individual types of child abuse; only recently has there been a focus on dysfunctional families or changing systems that engage those families to become trauma-informed, i.e., not further traumatizing already traumatized people, as so many of our systems do.

Until the last 10 months, the medical community practically ignored the ACE Study. Just last December, the American Academy of Pediatrics issued a policy statement recommended that its members look for toxic stress in their patients. Except with local exceptions, the public health community has not embraced it. In fact, the CDC — the one agency you might think would use its own research to reorganize how it approaches prevention of alcohol, obesity, sexually transmitted diseases and smoking — has whittled down funding for the ACE Study to practically nothing, and nobody’s working on it full time.

However, on a local and state level, there’s been considerably more action. Washington was the first state to embrace the ACE Study and the research on children’s developing brains, when its Family Policy Council distributed the information through a statewide network of 42 communities. Over the last three years, 18 states have done their own ACE surveys, with results similar to the CDC study.

Some cities have set up ACE task forces. Trauma-informed practices are popping up around the U.S., Canada, and countries in Europe, Asia, and Central and South America in schools, prisons, mental clinics and hospitals, a few pediatric practices, crisis nurseries, local public health departments, homeless shelters, at least one hospital emergency room, substance-abuse clinics, child welfare services, youth services, domestic violence shelters, rehab centers for seniors, residential treatment centers for girls and boys, and courtrooms.

In these dozens of organizations, the results of the new approach are nothing less than astounding: the most hopeless of lives turned around, parents speaking “ACEs” and determined not to pass on their high ACEs to their children, and a significant reduction in costs of health care, social services and criminal justice.


The Michigan ACE Initiative

The Michigan Association of Health Plans Foundation (MHAP) believes that key interventions to address Adverse Childhood Experiences (ACEs) will come from the community – the parents, teachers, social workers, community health workers and beyond who frequently work with kids and make an impact on their lives.

The statewide initiative is largely funded by a $451,000 grant from the Michigan Health Endowment Fund, which supports childhood health programs. The purpose is to build awareness of ACEs and their impact on health and well-being later in life.

Being able to recognize signs of ACEs before it is too late can change a child’s life. ACEs include abuse and neglect, experience with domestic violence, substance abuse, mental illness and stress. These experiences can lead to negative health outcomes in adult life.

“This is truly a core public health issue if ever there was one,” said Richard Murdock, former executive director of the Michigan Association of Health Plans who is overseeing the grant efforts this year.

So far, the Michigan ACE Initiative has trained 24 individuals from northern Michigan to be Master Trainers. The goal for these Master Trainers is to educate the community to better identify signs of ACEs in children and to help create community-based interventions.

Master Trainers for the Grand Traverse Region include:

  • Betsy Hardy, Program Coordinator, Healthy Futures, Munson Healthcare
  • Denise Busley, Co-founder, Grand Traverse Pie Company
  • Mary Gruman, Licensed Professional Counselor, Birchbark Counseling
  • Mary Manner, Great Start Coordinator, Venture North Funding & Development
  • Sue Bolde, Executive Director, Traverse Bay Children’s Advocacy Center

Murdock noted that Michigan doctors who serve impoverished Medicaid patients are now expected to look for signs of toxic stress in younger patients. Effective Feb. 1, they are being instructed to actively screen those under 21 for traumatic risk factors and, if needed, refer them to a mental health professional.

“That part is already funded under Medicaid. So, we don’t have to go to the Legislature and ask for money,” Murdock said.

Underscoring what’s at stake, a report by the Michigan Department of Community Health for 2011-12 found that young people in Michigan are exposed to more childhood trauma than the national average. According to a state fact sheet, 28.5 percent of children up to age 17 in Michigan in 2011-2012 had two or more ACE factors, compared with the U.S. average of 22.6 percent. More than 40 percent of Michigan children in poverty had two or more risk factors.

For more information about the Michigan ACE Initiative in the Grand Traverse Region, please contact the Traverse Bay Children’s Advocacy Center at sbolde@traversebaycac.org.

 


The Impacts of Trauma

Childhood trauma impacts emotional regulation and can leave us oscillating between anger and numbness (hyper- and hypo-arousal). But what are the other symptoms of trauma? This infographic created by Echo Parenting & Education and shared by Louise Goldbold looks at some of the other ways childhood trauma can leave its mark.

Loss of safety: The world becomes a place where anything can happen.

Loss of danger cues: How do you know what is dangerous when someone you trust hurts you and this is then your ‘normal?’

Loss of trust: This is especially true if the abuser is a family member or a close family friend.

Shame: Huge, overwhelming, debilitating shame. As a child, even getting an exercise wrong at school can trigger the shame. The child may grow into an adult who cannot bear to be in the wrong because it is such a trigger.

Loss of intimacy: For survivors of sexual abuse, sexual relationships can either become something to avoid or are entered into for approval (since the child learns that sex is a way to get the attention they crave) and the person may be labeled ‘promiscuous.’

Dissociation: Often, to cope with what is happening to the body during the abuse, the child will dissociate (disconnect the consciousness from what is happening). Later, this becomes a coping strategy that is used whenever the survivor feels overwhelmed.  

Loss of physical connection to body: Survivors of sexual and physical abuse often have a hard time being in their body. At some level, they consider that their body let them down and so turn the volume down on physical sensations. For example, survivors may go for a long time before they realize they need to use the bathroom. This disconnection from the body makes some therapies known to aid trauma recovery, such as yoga, harder for these survivors. Trauma-informed yoga avoids some of the potential triggers and helps participants get back in touch with their bodies.

Loss of sense of self: One of the roles of the primary caregiver is to help us discover our identity by reflecting who we are back at us. If the abuser was a parent or caregiver, then that sense of self is not well developed and can leave us feeling phony or fake.

Loss of self-worth: Trauma survivors, especially survivors of sexual abuse, can swing between feeling special, with grandiose beliefs about themselves, and feeling dirty and ‘bad.’ Trauma survivors are special – they have a PhD in survival – but this self-aggrandizement is an elaborate defense against the unbearable feeling of being an outcast and unworthy of love.

Re-enactment: Recreating the childhood dynamic expecting the same result but hoping for a different one, such as anticipating and even provoking your partner’s ‘betrayal’ but wanting badly for it to be different this time, and thus resolve your childhood dilemma. This strategy is doomed to failure because the need is in the past and cannot be resolved. Also, you are setting up the other person because you are always waiting for the other shoe to drop and will interpret anything as confirmation that you have been betrayed once more.


NCVRW 2017 Virtual Art Show at TBCAC

At the Traverse Bay Children’s Advocacy Center, we are excited for our plans for National Crime Victims’ Rights Week!

National Crime Victims’ Rights Week (NCVRW), is April 2nd–8th and this year’s theme is “Strength. Resilience. Justice.” NCVRW is celebrated throughout the country and is a week in which we are reminded of the strength and courage victims have. We are reminded to meet victims where they are, listen to what their needs are and understand how we might be able to help them in recovery and through justice. It is important that we are all aware that crime victims have rights and that we, as a community, come together to show our support to each victim where they are at. Victims of crime are all in different places in their healing process and cannot all be treated the same. This week also reminds us to keep fighting for victims everyday, as they are fighting a lifetime of pain and suffering.

We will be hosting a Virtual Art Show April 2nd-8th displaying artwork created by victims while they are at our Center for a forensic interview, counseling or ongoing supports.

At the TBCAC, therapists often use art with their clients to help them express feelings and ideas that may be hard to articulate with words. Art expression is a powerful way to safely contain, and create separation from, the terrifying experience of trauma without relying on verbal language to share one’s story. We asked some of the children and adolescents who come through our doors to contribute a piece of their art drawing for our show to be on display for the week. They were encouraged to express feelings they had about themselves, others in their lives, and activities that make them feel safe and strong. Pride and excitement were seen on their faces as they handed over their creations. Resilience exists within every child. It is built and supported by caregivers, therapists, and community members who encourage that light to shine brighter every day.

Since 2010, the Traverse Bay Children’s Advocacy Center has reached over 1,200 children, 300 during last year alone. The TBCAC works with six counties in our region, each with its own particular team of organizations and resources working to help crime victims. We take pride in our teamwork and know that together, we are creating communities to provide the Strength, Resilience, and Justice that NCVRW embodies.

CLICK HERE to view our NCVRW Virtual Art Show on Facebook.


Doc Talk: Talking About Sexual Health with Kids… and Other Parents

Sometimes talking about sexual health with kids can seem complicated and even scary for parents… but it doesn’t have to be. Dr. Amelia shares some quick tips for parents about how to start these conversations with kids at an early age… tips that also include collaborating with other parents.

 


About Dr. Amelia ♥

Amelia Siders, Ph.D., LP, serves as the Clinical Director for TBCAC and has been working in the mental health field since 1994. She received a BA in psychology from the University of Michigan and completed her doctoral degree in Clinical Psychology at the California School of Professional Psychology, San Diego. A licensed psychologist, Dr. Siders specializes in assessment, treatment, and advocacy for children, adolescents, and adults with emotional, behavioral, trauma, and substance use disorders. She has been trained in Trauma Focused Cognitive Behavioral Therapy and Trauma Incident Reduction, as well as several other trauma-informed interventions including EDMR. Dr. Siders became passionate about working with children and families who have been affected by abuse when completing her internship at the Center for Child Protection in San Diego, California. Amelia lives in Traverse City with her canine companion and beloved TBCAC volunteer, Jeeves.

About Jeeves ♥

Jeeves serves as a loyal volunteer sidekick to Dr. Amelia, providing sweet, loving wags to hundreds of child victims and their caregivers for the past several years. A Havanese, Jeeves has hair instead of fur which helps people visiting the Center who may have allergies. As the TBCAC mascot, Jeeves welcomes any and all opportunities to receive belly rubs and hugs!

 


Shedding Light on Sex Trafficking

Screen Shot 2016-05-16 at 10.39.14 AMShedding Light on Sex Trafficking

A new publication has been released from the UCLA Luskin School of Public Affairs’ Luskin Center for Innovation entitled “Shedding Light on Sex Trafficking: Research, Data and Technologies with the Greatest Impact.”

The value of the report lies not in the novelty of its content but rather in the way it can be used to help communities organize their efforts to combat human trafficking, with resources for technology to assist in those efforts.

According to the report, childhood sexual abuse is the most commonly identified antecedent to commercial sexual exploitation and sexual victimization. Between 70 percent and 90 percent of child sexual exploitation cases have a history of child sexual abuse, physical abuse, neglect, and/or trauma. Furthermore, in their lifetime these children are 28 times more likely to be detained on “prostitution charges” than their non-sexually abused counterparts.

Child Advocacy Centers (CACs) have an important role to play as we interview children to assess for high-risk and/or current commercial sexual exploitation. CACs are also a critical part of the healing and recovery process for these victims, as with any other victims of child abuse. The report specifically points to the CAC model as the best practice for provision of services.

“Currently, there is no standard of care for human trafficked survivors. Children’s Advocacy Centers (CAC) serve as a model of how service providers can mitigate re-traumatization for child abuse victims. Developed in the 1980s, CACs have positively transformed services for and treatment of child victims of suspected maltreatment (e.g. sexual abuse) through a centralized and comprehensive approach.”

Click here for a complete version of the report.


TBCAC Local Council: Request for Safe Sleep Proposals

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As a recipient of grant dollars from the Michigan Children’s Trust Fund, the Traverse Bay Children’s Advocacy Center and its local council must commit to raising awareness and providing support around the issue of safe sleep in Grand Traverse, Kalkaska, and Leelanau counties. In accordance with this requirement, the Local Council for this region is requesting proposals from nonprofit organizations that wish to purchase and distribute safe sleep materials in their area as well as educate community members about safe sleep practices.

The purpose of this project is to grant safe sleep funds to nonprofit organizations with the capacity to carry out safe sleep education and distribution of resources to infant caregivers within Grand Traverse, Kalkaska, and Leelanau counties. Successful proposals should include plans for purchasing materials (i.e. safe sleep sacks, pack and plays, etc), as well as delivering face to face education to those receiving materials.

Nonprofit organizations serving Grand Traverse, Kalkaska, or Leelanau counties that provide safe sleep programming to infant caregivers may apply for these funds. Proof of 501(c)(3) status must be included with proposals. Proposals are to be submitted by Friday, March 11th at 5pm. Please review the full 2016 Safe Sleep RFP for more details. For questions regarding the process, or to submit a proposal, contact Hannah Rodriguez at hrodriguez@traversebaycac.org or at (231) 929-4250. Thank you for your support in spreading Safe Sleep awareness throughout our region and please feel free to share within your networks!

2016 Safe Sleep RFP