The Benefits Of Incorporating An Adverse Childhood Experiences Lens In Social Work Practice

Summary

This webinar, presented by the Canadian Association of Social Workers, highlights the significance of integrating an Adverse Childhood Experiences (ACEs) lens within social work practice. The speakers, including professionals from Nova Scotia and ACE advocates, discuss the impact of childhood trauma on health, the role of social workers, and the need for systemic change in healthcare and social services. By understanding ACEs, social workers can improve advocacy, address trauma, and promote health equity and resilience, ultimately advocating for a more compassionate society.

Highlights

• The webinar underscores the importance of addressing adverse childhood experiences (ACEs) in social work. 🎓
• Speakers include notable social work professionals who share insights on trauma-informed care. 🌟
• ACEs understanding plays a crucial role in improving health equity and reducing stigma in health services. 🙌
• The discussion includes the need for a compassionate approach towards individuals with addictions linked to ACEs. 💪
• There’s a call for systemic change in healthcare, with social workers leading advocacy for trauma-informed policies. 🏛️

Key Takeaways

• Incorporating an ACEs lens in social work enhances understanding and advocacy for clients. 💡
• Social work has historically addressed trauma, yet ACEs provide a more structured approach to linking individual experiences to broader social issues. 🌍
• Adverse childhood experiences are prevalent and have lasting impacts, yet recognizing them opens avenues for prevention and healing. 💔
• Health professionals must be educated on ACEs to reduce stigma, particularly in addiction services. 🏥
• Promoting awareness of ACEs helps in acknowledging trauma and advocating for systemic change in social services. 🚀

Overview

The webinar begins with an introduction to the significance of incorporating an Adverse Childhood Experiences (ACEs) lens in social work practice, setting the stage for a deeper understanding of its impact on individuals and communities. The host acknowledges the historical context of social work in addressing trauma and the ongoing struggle to acknowledge and integrate ACEs into everyday practice.

The speakers, each bringing a wealth of experience and personal insight, elaborated on the effects of ACEs on physical and psychological health. They emphasized the need for systemic change within the healthcare system and the crucial role social workers play in addressing and mitigating trauma. With real-world examples, they highlight how understanding ACEs can empower social workers to advocate better for their clients.

The session concludes with a resounding call for more education, advocacy, and integration of ACEs awareness in healthcare and social work. There is a strong emphasis on collaboration across sectors to reduce stigma and improve outcomes for individuals affected by past trauma, ultimately aiming for a more equitable and compassionate society.

Chapters

• 00:00 - 01:30: Welcome and Introduction The webinar 'The Benefits of Incorporating an Adverse Childhood Experience Lens in Social Work Practice' is introduced. The speaker acknowledges the Nova Scotia College of Social Workers is located on Mi'kmaq ancestral territory, recognizing treaty rights and responsibilities.
• 01:30 - 03:00: Housekeeping and Webinar Details The chapter acknowledges the contributions and legacies of the African Nova Scotian people who have been in the region for over 400 years. It introduces Anime Kevink, a professional practice consultant with the Nova Scotia College of Social Workers. The chapter discusses a webinar conducted in collaboration with the Canadian Association of Social Workers, expressing gratitude for their annual support and recognition of National Social Work Month.
• 03:00 - 08:00: Overview of ACEs and Research The chapter titled 'Overview of ACEs and Research' begins with a mention of the 2021 theme for Social Work Month, which is 'Social Work is Essential.' It acknowledges the contributions and hard work of social workers in Nova Scotia and extends happy wishes for Social Work Month. The chapter proceeds with housekeeping details regarding a webinar presentation, emphasizing its format: a 40-minute presentation followed by a 20-minute Q&A session. It also mentions the availability of necessary details like access to the slide deck and other resources.
• 08:00 - 11:00: Introduction of Speakers The chapter 'Introduction of Speakers' informs attendees about the virtual event interface, explaining the function of turquoise widgets for accessing certificates of attendance and other logistical details. Attendees can customize their screen view by moving and resizing elements. The speaker encourages the audience to type questions during the presentation, which will be addressed during a dedicated Q&A session at the end of the talk.
• 11:00 - 30:00: Nancy Ross's Presentation on ACEs The chapter titled 'Nancy Ross's Presentation on ACEs' provides insights into the advantages of integrating an understanding of Adverse Childhood Experiences (ACEs) into social work practice. It highlights the extensive six-year endeavor to disseminate this knowledge to a broader audience. The workshop is set to deliver a concise summary of research on ACEs and demonstrate how this scientific knowledge can enable social workers to more effectively support their clients towards living genuine and fulfilling lives.
• 30:00 - 44:00: Elizabeth Perry's Personal Experience with ACEs The chapter introduces Nancy Ross, an assistant professor in the School of Social Work at Dalhousie University. With a background as a clinical therapist in mental health and addiction services, her research interests focus on the role of social work in mental health, gender-based violence, adverse childhood experiences (ACEs), and resilience. She approaches her work through a peace-building and intersectional lens, aiming to support the development of fulfilling and autonomous lives.
• 44:00 - 58:00: Kevin Duga's Clinical Use of ACEs Lens The chapter titled 'Kevin Duga's Clinical Use of ACEs Lens' explores the analysis of justice system responses to domestic violence and systemic and policy responses to adverse childhood experiences (ACEs). It introduces a short film titled 'Women of Substance,' which profiles stories of women dealing with challenges related to substance misuse. Additionally, a second film titled 'I Work for Change' is discussed, which delves into the complexities of social work and celebrates the profession. The chapter also mentions the involvement of a second speaker, Elizabeth, though further information about her is not provided in the transcript.
• 58:00 - 61:00: Questions and Closing Remarks This chapter focuses on Elizabeth's discovery of ACES (Adverse Childhood Experiences) and its impact on her self-awareness and advocacy. Elizabeth was influenced by Perry, the founder of ACES Canada, who aims to promote awareness, prevention, and healing of ACES. Elizabeth, recognizing ACES as a crucial element in her personal development, now dedicates her efforts to integrating this understanding into various sectors through advocacy and education. The chapter also highlights the importance of spreading knowledge about ACES across different fields.

The Benefits Of Incorporating An Adverse Childhood Experiences Lens In Social Work Practice Transcription

• 00:00 - 00:30 welcome everyone and thank you for joining us i have the honor of of bringing to you the webinar called the benefits of incorporating an adverse childhood experience the lens in the social work practice before i begin i want to acknowledge the nova scotia college of social workers is in migrate the ancestral and unseated territory of the migma we are all treating people in magma with treaty rights and responsibilities
• 00:30 - 01:00 and we acknowledge the history's contributions and legacies of the african nova scotian people and communities who have been here for over four hundred years my name is anime kevink professional practice consultant with the nova scotia uh college of social workers today's webinar is in collaboration with uh the canadian association of social workers who we really want to extend our appreciation and and acknowledgement to for their annual support and recognition of national social work month
• 01:00 - 01:30 the 2021 theme for social work a month this year is um social work is essential and from all our colleagues far to all our colleagues far and wide we in nova scotia wish you a happy no no happy social work month now for some host keeping details of course this um webinar presentation will be approximately 40 minutes followed by a 20-minute period of questions and answers that i will moderate please note that all the details you need like how to access the slide deck other resources how to get your
• 01:30 - 02:00 certificate of attendance and other housekeeping information it's all found at the bottom of your screen all those turquoise widgets can be accessed by clicking the icons at the bottom of your window you can also resize and move around any of your elements that you see on your screen to customize your own viewing experience during the presentation i encourage you to type in your questions at any time and i will be asking them at the end of the presentation during the question and answer period we have the opportunity today to hear
• 02:00 - 02:30 about the benefits of incorporating an adverse childhood experience lens in social work practice we're really grateful for that it's been as the speakers were just consulting this morning it's been a six year process to bring this to so many viewers so we're really grateful that you're here the workshop will present a brief overview of the research related to adverse childhood experiences or otherwise known as ace and how this science can better equip equip social workers to assist clients to lead authentic
• 02:30 - 03:00 fulfilling and autonomous lives our first speaker is nancy ross nancy ross is an assistant professor in the school of social work at dalhousie university her previous work as a clinical therapist in mental health and addiction services informs her research interests which include a focus on the role of social work and mental health gender-based violence adverse child experiences and resilience she applies a peace-building and intersectional lens
• 03:00 - 03:30 to the analysis of justice of justice system responses to domestic violence and systemic and policy responses to adverse childhood experiences she has produced a short film titled women of substance that profiled stories of women meeting challenges of mis of substance misuse and co-produced a second film titled i work for change which explored the complexity of social work while celebrating the profession the second speaker is named elizabeth
• 03:30 - 04:00 perry who was the founder of aces canada an organization with the mission to advance aces awareness prevention and healing when elizabeth learned about aces later in life she realized they were advocate they were the missing piece in her self-understanding since then she's been advocating for the incorporation of this knowledge into our collective consciousness by spreading the word reaching out across sectors including
• 04:00 - 04:30 internationally hosting multiple online communities of collaborators all contributing to the global movement elizabeth uses her lived experience to contextualize her passion for sharing the knowledge of aces she also provides training and consulting in aces and trauma-informed organizations we're glad to have her with us kevin duga who is a master's of social work candidate in the dalhousie university school of social work
• 04:30 - 05:00 is our third speaker he also has a master's in educational psychology from mike mcgill university prior to his initial graduate studies kevin worked at a res as a research laboratory manager at emory university in atlanta georgia he has worked as a research coordinator with dr rentz nancy ross over the last three or more years kevin currently works full-time as a healthcare social worker in the halifax infirmary within the rehabilitation and supportive care portfolio
• 05:00 - 05:30 and word has it that he also has a wonderful hobby of playing the bagpipes with that i'm honored to pass on to you our incredible presenters and i offer you nancy ross to take it away thank you very much for that introduction um so i'm going to try to navigate us here on the slides so everyone has probably seen okay let me see so i just want to introduce um our agenda here
• 05:30 - 06:00 um and i'm gonna bring that up for me myself okay so what we're hoping to do uh today in a very short period of time is provide an overview of adverse childhood experiences and then we're going to have a first voice reflection noting the benefits of of aces knowledge and then kevin is going to speak to the relevance of aces to addiction to mental health settings and in his own work practicing social work in healthcare
• 06:00 - 06:30 so i'm going to start now uh with the the uh a brief overview and okay i'm going to try to bring this up so let's see if someone can help me bring this first slide up uh the one following the agenda that would be really helpful
• 06:30 - 07:00 and while um we're bringing that slide up it would be um [Music] slide three if someone could help uh bring that up for me i will just talk a little bit about um the importance of um incorporating incorporating an ace framework within um social work practice so i'd like to begin by acknowledging
• 07:00 - 07:30 that since the origin of the profession of social work we've been addressing the impacts of adverse childhood experiences and working with individuals families and communities who have experienced trauma so hall house in chicago founded by dane adams one of the founders of the profession of social work began to provide community services to new immigrants women and children and families in need as early as 1899
• 07:30 - 08:00 many of whom had prior experiences of trauma so the the profession i believe intuitively considers what has happened to individuals as opposed to what is wrong with them from the beginning and the emphasis on the social and recognition of the cumulative impact of lived experience influenced by social and cultural factors distinguishes the profession of social work today
• 08:00 - 08:30 so this is uh lauded as uh currently as a hallmark of trauma-informed approaches and speaks to the importance of a critical and or social justice approach to social work practice so i believe the benefits of incorporating an average childhood experience lens is that it assists social workers to practice in a manner that is aligned
• 08:30 - 09:00 with our profession that rests on the belief that what has happened to you matters from this acknowledgement it also provides a way to link individual experience to family and community and opens the door to prevention work so in other words acknowledging and reflecting on the experiences and prevalences of adverse childhood experiences should lead to the recognition that they are a public health emergency and link personal experience to public
• 09:00 - 09:30 and political advocacy so aces originate in our hearts and stress stressed social context and are expressed in our relationships they are all preventable so the next few slides will provide a brief overview of the ace of a studies so on my screen i can't um it's not um showing up but i'm hoping that you are now looking at a slide that um features
• 09:30 - 10:00 uh the cover of the book the deepest well um i'm hoping you can see that okay so the adverse childhood experiences study explored the relationship between what has happened to a person during childhood and subsequent physical and psychosocial health issues in adulthood so the ace study began as a longitudinal health study in california in 1998 and since then more than 3 000 studies have been conducted around the globe including canada which makes connections
• 10:00 - 10:30 between experiences of childhood adversity and health challenges across the lifespan these studies demonstrate that adverse childhood experiences are common and that even one can have serious implications on your physical and mental health and that the more you experience the higher your risk of developing physical and mental health challenges so dr neen dr nadine burkharis the surgeon general of california refers to the pervasiveness of aces as i've just noted as a public health emergency
• 10:30 - 11:00 so she appears in a ted talk titled how childhood trauma affects health across a lifetime and authored a book about healing the long term term effects of childhood adversity so i highly recommend that ted talk so the original aces measured measures included physical abuse as you
• 11:00 - 11:30 can see here on the slide uh physical abuse sexual abuse emotional abuse physical neglect emotional neglect exposure to domestic violence household substance abuse household mental illness parental separation or divorce incarcerated household member so since 1998 these this list has remained the same with additional studies um adding additional aces to become more representative of diverse experiences so for example the philadelphia ace
• 11:30 - 12:00 project expanded the list of aces to include five additional items such as witnessing violence other than a mother being abused experiencing discrimination based on race or ethnicity feeling unsafe in your neighborhood or not trusting your neighbors bullying and having ever lived in foster care so we have included more information in the handouts that recognize more experiences that can be described
• 12:00 - 12:30 as aces so this slide um indicates that uh clearly having a critical lens around average childhood experiences recognizes that structural cultural roots that form adverse community environments can limit access to resources uh and the social determinants of health and a sense of belonging and this is especially true for african
• 12:30 - 13:00 canadians indigenous newcomers persons with disabilities and members of the lgbtq plus communities and people they often experience more childhood adverse experiences so our team conducted an ace study at the lunenberg family medical practice in nova scotia and this was a pilot study and you can
• 13:00 - 13:30 see here that we were able to interview by survey 226 people and from the from the people that completed the survey in this medical health uh study we found that aces were very high so as you can see here in the results 73 percent expressed reporting one adverse childhood experience and 31 percent report experiencing four or more adverse
• 13:30 - 14:00 childhood experiences okay so i think are my slides um so i just want to um say a little bit about a global systemic review and a meta meta analysis of the effect of multiple adverse childhood experiences on our physical health and mental
• 14:00 - 14:30 well-being found that individuals who have experienced at least four or more aces were more than twice as likely to be current smokers or heavy drinkers almost six times as likely to drink problematically about four times more likely to experience anxiety and depression eight times more likely to be a victim and or perpetrator of violence 30 more times to attempt more likely to attempt suicide and 46 more times likely to
• 14:30 - 15:00 become an iv drug user than those who had no adverse childhood experiences so working with individuals who have experienced substance abuse mental health challenges and prior and current experiences of violence is central to social work practice the more recent adverse childhood experiences research validates the widespread prevalence of trauma and the urgent need to intervene to provide both treatment and advocate prevention of all forms of
• 15:00 - 15:30 abuse and violence so significantly used and others indicate that the outcomes most strongly associated with multiple aces including interpersonal violence mental illness and substance use pose adverse childhood experiences risks for the next generation so these aces can be can cause disruptions in parental
• 15:30 - 16:00 ability to provide safe stable and nurturing family relationships and pose risk for trauma and chronic and toxic stress for children so ubel points out points to the need for healing from collective trauma as a global responsibility to stop vicious cycles of recurring collective trauma by ultimately integrating and reducing its effects on our global culture social workers grapple with these large
• 16:00 - 16:30 concepts recognizing that social injustice and histories of trauma have collective impacts that ripple out across generations and impact individuals families and communities so people often find the average child who experiences research very helpful it helps them to make sense of their experiences and as as my colleague elizabeth perry
• 16:30 - 17:00 will share for those who have experienced many aces it helps make sense of their lives to understand the way one responds to adversity and to realize that they are okay so research conducted uh by bethel at all john hopkins university indicate that evidence from assessment of aces in
• 17:00 - 17:30 adults suggests people do not object to it and find dialogue about aces empowering with some even seeing failure to inquire about aces as denying their occurrence and effect the report titled repositioning social work practice in mental health in nova scotia provided a critique of biomedical practices within mental health services influenced by neoliberalism that too often leave out the social and what has happened to people our social context is what frames our
• 17:30 - 18:00 lived experience and it's inseparable from our mental wellness so to change life narratives and restore individual adversity and trauma we need uh societal change that transforms the culture and structures to create a society where all can flourish so social workers need to partner with education health justice community services etc to collectively advocate for a more just increased inclusive and caring society that promotes wellness and supports families
• 18:00 - 18:30 i've included a slide that looks at the what i think are some of the relevance of including an adverse childhood experience lens in social work practice so one it it's empowers and validates social work practice i think many uh people that we interviewed uh in nova scotia about their experiences of working in mental health and addiction services found that
• 18:30 - 19:00 they were very limited in terms of how often they could uh explore past experiences of childhood trauma and yet the uh prevalence of it was there in almost every person that they worked with so i think then it could empower and validate social workers pairing ace questionnaires with resilience measures helps identify those most in need of supports and interventions reclaiming the social and health care including mental health and addiction
• 19:00 - 19:30 services also helps introduce complementary interventions to reduce medical and pharmaceutical responses it can help individuals restore adversity and trauma it can validate their coping it can introduce a decolonial and anti-oppressive lens and it can politicize the personal and then i wanted to include one further slide
• 19:30 - 20:00 that looks at an example of a group program developed by the embrace model in alberta and some of you may be familiar with that and i just wanted to highlight that the focus of each of this six week group program is something that i believe social workers could implement in their practice that could be uh very helpful and i just want to point you in that direction so basically
• 20:00 - 20:30 they have developed a six six week program that is a cycle educational program that uh looks at introducing uh clients to knowledge about aces so their first week of the six week program looks at aces and you and then the second week recognizes the ways that imp that trauma and average childhood experiences impact your physical self and your body so looking so they titled that second week taking care of your body the third week is looking at um more
• 20:30 - 21:00 maybe of a cognitive behavioral therapy approach and looking at taking care of my thoughts and that's fourth looking at emotions uh the fifth taking care of my relationships and the six is taking care of my past and living a valued life so why this is a very short program of six weeks i have seen initial results that indicate that it has been very helpful uh in helping people who have experienced uh multi aces to in their lives so i just wanted
• 21:00 - 21:30 to introduce you to that as there are more and more uh work being done to explore possible interventions and i'm also aware that there's an adverse childhood experiences recovery workbook so there is more work done now in terms of recognizing impact of aces and how we as social workers can be helpful and intervening in our practice and so now i'm going to hand hand us over to elizabeth perry
• 21:30 - 22:00 thank you so much nancy welcome everybody it's so exciting to see so many people interested in this topic i've been working on getting the word out for over six years now and it's so exciting to see that we're getting some momentum and people interested more on a personal as well as a professional level so thank you so much for joining us what i wanted to do today was just share with you the benefits that i experienced
• 22:00 - 22:30 in my own life as a result of understanding about um about the aces research so i'll just contextualize it a little bit but i'm also want to acknowled i also want to acknowledge that obviously i'm a white woman and i'm of a certain age so i do not represent everybody's perspective but i do represent a perspective that i hope you'll understand is actually relevant to this particular
• 22:30 - 23:00 topic so one of the things that um so in nine i'll just start with the story here so in 2014 i was concurrently reading bessel vander clark's book the body keeps the score at the same time i was going through some really you know uh strenuous personal problems and so i was seeing my my therapist again on a very regular basis and he just happened one day when we were talking about things to mention
• 23:00 - 23:30 well you know you might want to look at the ace study so i had actually just read that chapter and the body keeps the score and i thought it was just the same old stuff that i'd ever heard before but since my therapist pointed it out to me i went back and i re-read that chapter and then i started researching it to the nth degree i needed to know what this was all about and when i did the ace questionnaire
• 23:30 - 24:00 which is not an official the the 10 questions is not the official questionnaire it's a questionnaire that one of the co-principal investigators dr robert ander put together to use when he was going out speaking primarily to social workers actually about his research and trying to get people on board so he put all of the um the original questions into a very short uh 10 question self-reflective survey
• 24:00 - 24:30 and that's what is available in a lot of contexts now and people are concerned about that not being an official screening tool and being used for that sort of thing so we need to be careful how we're using that but it's really great for self-reflection and when i did that i discovered that i had a seven so looking at myself i'm white i'm you know in my senior years and um grew up in a you know
• 24:30 - 25:00 relatively middle class you know not always that way uh community and i am not your typical person who would be considered to have a high ace score and yet the point about the original lace study that i think is often not emphasized enough is that that original population was white middle class people so we need to
• 25:00 - 25:30 look at that and talk and and realize that that particular research is not primarily for people from sort of the non-dominant um sectors of society right it starts with us and i've learned a lot from resma mannequin the writer of my grandmother's hands and he
• 25:30 - 26:00 actually helps us understand that white on white violence is what contributed to white on bipod violence you know that we have been perpetuating for over 500 years in this particular territory at the very least and around the globe so it wasn't anybody from any other communities that caused my trauma it was white people and in and surprisingly it was white women
• 26:00 - 26:30 that um that caused a lot of my trauma so we need to be able to look at this and look at it with what i call radical self-honesty that we are um you know it is us right it is us it is not other it is us and the benefit of that is that when i found about it for me it was this huge relief
• 26:30 - 27:00 that i wasn't fatally flawed i had a lot of difficult experiences and relational relational experiences in my adulthood and my family looked at me and they kept saying like why do you have such problems and then when i found out about aces i started to be able to look at that and say well you know what i didn't grow up in the same family conditions that my other siblings particularly my oldest
• 27:00 - 27:30 siblings uh grew up in there was no you know sort of support i didn't have that one supportive adult um that actually helped me navigate my social and emotional uh understanding that i did have one that you know sort of gave me a purpose in life and welcomed me to be able to contribute to you know her family activities and things but it didn't um help me sort of understand the troubles that i was having
• 27:30 - 28:00 with my own you know my own family right so it didn't help me process those uh relational uh nuances and things right so there was a whole bunch of issues that i experienced in my early life that until i actually heard about the ace study i just assumed as nancy had mentioned earlier you know social work has always been working on these issues and even when i've um you know worked at
• 28:00 - 28:30 us started working with my my therapist initially you know we acknowledge that you know early life experiences can be um uh you know an issue in our adult lives but until i'd heard the aces research and saw the actual categories of experience outlined and described and realized that you know out of those 10 categories that were deeply researched i actually fit in seven of them
• 28:30 - 29:00 and that was a real eye-opener for me so going forward what i do want to just emphasize is that everybody doesn't agree with the aces research everybody doesn't like using the aces questionnaire there's a huge concern about that being deterministic right i don't promote it as deterministic i found out about it when i was oh must win well a number you know a few years ago so i must have been in my early 50s
• 29:00 - 29:30 and um so i was able to look at it from a self-reflective looking at the past situation younger people may be a bit more concerned about it being deterministic and that those are things that we need to be very sensitive with when we're communicating with our with our clients and our colleagues and even with ourselves but the ultimate goal of aces is that we need to change our relationships
• 29:30 - 30:00 we need to be more more compassionate compassionate towards ourselves compassionate towards each other and also we need to we need to dismantle this colonial culture that we have um existed in and that you know in a lot of ways continues to be perpetuated i my original my my first career was in early childhood education and when i first found out about
• 30:00 - 30:30 early childhood you know child development and what was required for you know nurturing healthy development in uh you know young children i thought oh well that's okay i know i didn't have an optimal childhood so i can just you know fill in the gaps for myself but that even wasn't enough for me i had lots of bad experiences in relationships after that and it's only since i found out about aces and the specificity of them
• 30:30 - 31:00 and and also now we've included as a handout hot off the press 25 additional experiences that can be toxically stressful that we just found in that newly uh published recovery workbook adverse childhood experiences recovery workbook published by um glenn chiraldi who's done a number of
• 31:00 - 31:30 different workbooks and great resources over the years and so even just looking at that and seeing that you know there's a whole bunch of other experiences that can uh you know contribute to our view of ourselves others our relationship to the world and even in our even to the planet right so there's a a number of things that that are beneficial to understanding about the aces uh
• 31:30 - 32:00 i um i highly recommend that we you know sort of look at ourselves go cautiously and um and start to prior start to to flip our priorities in our society to sort of make all of our decisions in our policy and our practice to actually put the children and the needs of the children that we are helping to nurture um to develop to be authentic um you know sort of fully actualized human
• 32:00 - 32:30 beings that we're supporting those children in that development instead of sort of imposing on them the lessons that we have learned along the way which you know are in a lot of ways just a perpetuation of the uh the old way of thinking so i'm all about let's prioritize the kids let's meet needs and also meet the needs of the people who are continuing to be affected by
• 32:30 - 33:00 the experiences that they had in their early lives without necessarily knowing about it so there's a few ideas here cautions on using aces questionnaires i hope you've had a look at those while i've been talking and i will pass it over to kevin and see how he uses aces in his clinical work so thank you very much for attending
• 33:00 - 33:30 okay thanks so much nancy and elizabeth welcome to everyone viewing across the nation so i am just going to speak a little bit uh about um you know how i see the aces research unfolding in my daily work and and how um i feel i have truly benefited in my ability to you know effectively
• 33:30 - 34:00 advocate and support patients i work with you know with having this knowledge of aces so i guess i'll just start by uh saying that back here in halifax i work i've been working a few years now as a healthcare social worker in acute care um in at the halifax infirmary so the halifax infirmary is one of the primary uh acute care hospitals uh here in nova scotia based in halifax
• 34:00 - 34:30 and specifically i do work with the the cardiology team so i'm one of the main social workers who works among various inpatient uh social work inpatient units in cardiology such as cardiovascular surgery and the uh and the uh intensive care unit and uh so i truly love my work here um and and the halifax infirmary
• 34:30 - 35:00 is the uh the the cardiology hub of atlantic canada so we truly from from a cardiovascular perspective we truly do treat um the the most ill patients uh east of montreal in terms of cardiology so i wanted to talk about a population of patients that i work with quite regularly and that would be iv drug users we
• 35:00 - 35:30 often have and as pointed out in the uh the study that nancy spoke of by hughes uh and all in 2017 um i think this is an excellent example that kind of highlights the importance of knowing aces among our patients because as they found individuals who had experienced four or more aces were 46 times more likely to be an iv drug user um so
• 35:30 - 36:00 you know this is a particularly vulnerable population that certainly uh needs to be advocated for so and and in the literature they're um one of the biggest issues that this population has um in terms of being admitted to cardiology service is infective endocarditis um so you know for those unfamiliar uh infective endocarditis is an inflammation of the heart
• 36:00 - 36:30 it's caused by a bacterial or fungal infection of the heart valves or the inner lining of the heart and if it's not treated quickly it can lead to life-threatening complications so when bacteria and cell debris accumulate inside the heart clumps can break loose they can form uh blood clots and travel through throughout the bloodstream to other organs and these blood clots can cause serious complications uh such as heart damage uh stroke
• 36:30 - 37:00 pulmonary embolism seizures uh kidney damaged uh paralysis and organ abscesses and uh and infective endocarditis um it's well established in the literature that that infective endocarditis is a notorious complication of iv drug use it mostly affects the valves the tricuspid valve is the most common but certainly the the mitral and the
• 37:00 - 37:30 aortic valves can be involved as well and it's mssa which is the most common uh micro microbial agents that um is involved in infective endocarditis so you know certainly it's you know it's it can be an incredibly difficult thing to advocate for working within such a dominant medical model and in my experience
• 37:30 - 38:00 um you know a lot of these patients who are admitted to the to the cardiology services they undergo a lot of discrimination and stigma because people generally don't understand you know the link between early childhood trauma and iv drug use and you know in in my experience it whenever we have an iv drug user with substance use disorders admitted to
• 38:00 - 38:30 the hospital i can guarantee without question that when we dig back into their childhood they were um exposed to an enormous amount of adversity so so i use this um you know i use the ace lens to help educate whether it's surgeons physicians nurse practitioners to try and advocate for healthy quality
• 38:30 - 39:00 oftentimes we'll have examples when you know certain surgeons or or health clinicians will will actually refuse to provide in some cases life-saving treatment to someone who is an iv drug user and because they just you know they discriminate and they really have so much stigma towards these patients
• 39:00 - 39:30 they say well you know why would we waste our resources and money to help support a person who's choosing to use iv drugs so in my work i used ace lens to really advocate to educate and really to fight for health equality because when often when you create this awareness and educate other
• 39:30 - 40:00 members of the health team about trauma then you know as a whole our multi-disciplinary teams have a better understanding of how we need to indeed support this incredibly vulnerable population so i use the ace lens to to advocate and i use it to educate um in our multi-disciplinary teams here in
• 40:00 - 40:30 cardiology uh use it as to provide educational opportunities to others on our team such as the nursing staff and and really promoting the lens of ace to be able to more effectively um support these patients when they're in the hospital and of course um you know this this type of example is relevant to other areas of primary health such as other areas of acute care and also we
• 40:30 - 41:00 know the long-standing links to mental health outcomes as well but i did think this was a a good example to highlight in terms of the daily work that i do here at the halifax infirmary and how the ace lens really helps me to to adequately advocate and support patients that i work with
• 41:00 - 41:30 okay so um so just a few other examples here about uh you know having the conversation about aces and how the research helps me to to be a better advocate in my social work practice um so in in addition to working on my inpatient units i also do work with the um advanced heart failure and the heart transplant clinics here at the halifax infirmary so again this is a this is a
• 41:30 - 42:00 multidisciplinary team and committee um working to cover all of atlantic canada so anyone in atlanta canada who's going through some sort of heart failure and would benefit from a heart transplant it's the team here in halifax that that works with these individuals and and and does screening to to determine um if individuals are appropriate candidates to receive a new heart
• 42:00 - 42:30 so again um you know within this within this really dominant medical model team um a lot of the things that we the the committee screens for is um changing lifestyle behaviors so really being strict in terms of making sure that patients can be abstinent from alcohol cigarettes any other type of
• 42:30 - 43:00 recreational drug use do using a heart-healthy diet exercise so they're very strict in terms of when they look at these candidates and oftentimes um you know again the the having an ace lens really helps to better understand certain patient profiles um and and a discussion of basis helps you know these individuals to become empowered
• 43:00 - 43:30 and realize that you know that their behavior that they they shouldn't be blaming themselves if they are engaging in in drug use because because most often as i said these individuals have had extreme aces so it really benefits the perspectives on those on the collaborative team and it helps to educate health practitioners of various stripes about
• 43:30 - 44:00 a science and it assists with reducing discrimination and increasing health equality um so just as one example i i a number of months ago i did a psychosocial assessment for a young man in uh in uh in atlanta canada and i had to speak to um you know whether i thought that this young man would be a good candidate to receive a new heart
• 44:00 - 44:30 so i did take an opportunity and through my psycho-social assessment to really get to know individuals i don't necessarily use the ace you know survey formally but i do ask these individuals about their childhood about whether they've experienced any traumas and then i also try to integrate the ace lens and the ace history with
• 44:30 - 45:00 resilience factors so in this young individual it was amazing that despite having experienced tremendous childhood adversity and not having any family support he nonetheless was able to to be empowered to become empowered by learning about early childhood trauma
• 45:00 - 45:30 and being able to reflect on that and to use other avenues to build his resilience and to really um you know increase his behaviors to make him a good candidate for a transplant so certainly um without the social work lens and the trauma lens within this collaborative multi-disciplinary team you know i don't think uh any others would be able to look at that history
• 45:30 - 46:00 look at his resilience factors and to speak very confidently in terms of you know that this individual is incredibly deserving of a new heart and so it does allow me to advocate and and you know provide perspectives to others on the teams so and again this is something that applies to other transplant areas as well so it helps to you know by
• 46:00 - 46:30 by integrating the ace lens it truly helps these patients to not only feel less stigmatized less discriminated against but also to to become empowered um and i think i think that's mainly what i was going to cover in terms of uh you know presenting uh the the some of the work that i do in
• 46:30 - 47:00 healthcare and how the the ace lens and the ace research i believe truly allows me to to become a more compassionate um an understanding social worker and it allows me to to better advocate for for the patients on my floors so i think maybe i'll hand it back over to uh to nancy ross to to make just a couple of final remarks to close the presentation and move on to questions
• 47:00 - 47:30 i think what we were hoping to do is to engage with some questions but uh in terms of final remarks i would like to say that uh it's as for social workers uh i we recognize that most of the people that we work with have experienced adverse childhood experiences i think it's something that is central to our profession but it's not one that is um often
• 47:30 - 48:00 specified and we know that the average childhood experience is science per se has been initiated within a medical profession but i think it's really important for social workers to recognize that the intervention and prevention of adverse childhood experiences is social it uh average childhood experiences occur within relationships within the broader social context that we all live in and also i
• 48:00 - 48:30 think when we think about uh neoliberalism and the ways the multitude of ways that in that neoliberalism puts an emphasis on our own individual efforts and our own individual responsibilities uh in some ways it it it contributes to ignoring the social context so as social workers i think we're always resisting that notion and moving to more collective notions of what a society can be and i think if we look at
• 48:30 - 49:00 afrocentric and indigenous perspectives they offer us some ideas and examples of ways in which our society can become less individualistic and more caring with a focus on the overall well-being of gender of our communities and a focus on on the generations to come so as kevin pointed out and as um as we've been we've been making points to say is that not all individuals who
• 49:00 - 49:30 experience childhood adversity suffer all the negative impacts so people who have believe they can get support in the communities who have access to resources who have people they believe that care about them they do better and they have more resilience so in the words of uh barry brazelton families need families parents need to be parents need to be parented grandparents aunts
• 49:30 - 50:00 and uncles are necessary so adverse childhood experiences and trauma don't happen in isolation and the consequences of ignoring them is detrimental to all of us so it is a societal responsibility to reduce aces so we are all implicated so i believe the benefits of incorporating an adult an adverse childhood experience lens in social work is to strengthen and renew the call to create a society where
• 50:00 - 50:30 child abuse and neglect does not exist and one where we can all flourish so with that i would like to open uh it up to questions for all three of us thank you very much for attending this presentation thank you all so much i it feels like that you've generated so much activity in the chat room it's hard for me to pick out who i'm going to be able to talk to talk about first thank you so much it's very exciting um
• 50:30 - 51:00 my first question comes from um when the first question i have here is is related to someone who's talking about reading and currently reading a book called when the body says no and i'm wondering she's saying um or is asking if when we found the client's early childhood trauma or past history of trauma which could lead them to serious disease what should we do how can we heal it
• 51:00 - 51:30 so i don't know who wants to take that question well i guess i'll start because yeah i'll start because um it uh first of all validate that it's not your fault right it's um it's not a life sentence it can be mitigated right and now's the time to be able to
• 51:30 - 52:00 start so some of the best practices that are helping with uh processing that sort of thing are uh the somatic practices so somatic experiencing sensory motorcycle therapy um any of the work that resma manikin offers is fabulous and also in gabor mate who wrote that book also offers a compassionate inquiry
• 52:00 - 52:30 course that he helps to support people in sort of understanding themselves and and processing their own but the other thing is is you know you don't want to go in and dig stuff out and process that sort of thing you have to be able to make sure that there's some stability first before you start looking at the deeper issues and i'll pass over to uh both nancy and kevin who are actual clinicians uh for their input
• 52:30 - 53:00 well if i understand the correct the question correctly i think it's about uh how do you respond when you start to recognize some effects of trauma and when the body says no so i think it's to recognize that healing is a process it's not a one-time event as elizabeth was talking about so the first it begins with acknowledging that that
• 53:00 - 53:30 there is a need to uh heal and something to address so as as elizabeth said to be compassionate to seek out supports to to pace oneself and to try to develop practices that help you feel safe as you go on that journey excellent someone has um
• 53:30 - 54:00 okay some i'll just chime in here uh andrea has added the compassionate inquiry has been transformational to her practice as a social worker so that's so that's what we're about learning to be sensitive aware and move forward i wanted to add um there was somebody who asked for the resource slide to be returned to the to the front uh front and center on the screen is that the one that i'm looking at now
• 54:00 - 54:30 references or resources i'll see if the person and then further to that um there was a question about is the adverse childhood experiences international questionnaire located on the who website or is uh your aces based off off of that they're wondering does that make sense to you the yes um so the world health organization does
• 54:30 - 55:00 have a standardized questionnaire adverse childhood experiences questionnaire that they um use that they recommend using internationally um some people in different localized contexts don't always find it uh relevant all of the aces so some people adapt it but the ten original aces have remained but people have been um there are a number of different um questions that have been added uh that are uh validated in in
• 55:00 - 55:30 in some research so i get i guess it you can tailor the adverse childhood experiences somewhat to the context that you're in but also recognizing that the list of what constitutes adversity is growing as our as as we as the resource that we've added uh shows i'll just add that in that resource that we added uh the um extended aces questions from
• 55:30 - 56:00 chiraldi i also put a link in there to a blog that i posted um that has a list of all of various uh aces questionnaires including the um the one from the who and also and a link to a video and an uh a published article by robert and explaining that ten questionnaire that you know sort of that ten point
• 56:00 - 56:30 questionnaire that he had put together and giving us better context to the uh to its non-research quality but you know why he actually put it together so it gives you can follow the link in that handout and that will get you to re um aces questionnaires and resilience questionnaires okay thank you anything more that you'd like to add kevin
• 56:30 - 57:00 um no i think i'm open for now okay uh were there any questions further questions i'm gonna check here but um lots of people are saying thank you for this interesting and important conversation about giving us so much information actually thank you profusely i was wondering if between the three of you there were some questions that you had of each other um that actually speak to the takeaway
• 57:00 - 57:30 you want from the audience of which there have been upwards of 400 people here so what are what are your best hopes for when they walk away from this webinar and have all this wealth of information for you and the aces that lies ahead in terms of work and research well for me i feel that average childhood experiences as i said earlier originated within a
• 57:30 - 58:00 medical profession and i think we as social workers need to claim it uh and maybe reclaim it and to recognize as i said earlier that they occur in a social context and in relationships and that they're all preventable and that this is the essence i think of much of our social work thank you so much i'm true and yeah i would just say for the work that i do
• 58:00 - 58:30 sorry go kevin no i i guess just uh just in within the work that i do uh you know just reiterate that um for me as a as a fairly um new social worker and clinician i find that this research um has been incredibly valuable for me in terms of being able to be a true advocate for the patients that i
• 58:30 - 59:00 work with so in terms of moving forward you know i think there's a lot of research left to be done particularly reflecting more on the the handout that we've provided and and and this enormous list of aces that are you know that begged us to to reflect on and to investigate more um one of the biggest ways it helps my practice is is by having the conversation um and
• 59:00 - 59:30 trying to help my clients to externalize some of their problems and to remove self-blame i think um having the discussion about aces and and removing that blame and providing people with that light bulb moment truly allows them to to move in a direction where they are more empowered in their personal lives so that's uh that's that's the biggest impact that i see
• 59:30 - 60:00 and and uh i'll pass it on to you elizabeth i was just going to say get yourself educated right but there's a plethora of information and resources out there the one that is probably the best in canada would be the brain story certification out of alberta family wellness initiative so you can find them online i believe somebody may have even attached a link if they haven't it's
• 60:00 - 60:30 actually it one of the resources that we posted so the brain story certification program is available and social work uh programs should incorporate that into their curriculum as a requirement people who are providing social work through organizations everyone should be certified to in the brain story as part of their uh onboarding for their new uh roles if
• 60:30 - 61:00 that's possible and also there's a a toolkit that the alberta family wellness initiative has put together that is um a set of videos that we can use to help inform the wider public about the required circumstances that we need in order to uh support the developing brains of children right so all of those are great to offer and share with parents
• 61:00 - 61:30 obviously not from an imposition but from a you know a collaborative nurturing you know scaffolding perspective that you know we're all doing this together and i definitely reiterate and emphasize nancy's point that this is a social issue right that was the key thing that came out of bessel vander cook's chapter on aces in the body keeps the score this is the number one public health issue we're not dealing with
• 61:30 - 62:00 right and we need to get um under it and we need to get behind it and we need to transform it thank you elizabeth um i have another question at the moment which is perhaps in the same vein asking how can we promote an ace lens in the health care system when the social worker in particular is asking in relation to the local healthcare system doesn't seem to have much empathy for people with addictions and she knows or we've just learned of course that addictions are very related
• 62:00 - 62:30 to ace so the question of course is how do we promote it and that's good that's one of our advocacy questions too isn't it does someone want to take that in the next 30 seconds i'm just going to reiterate again the brain story covers off all that so if everybody gets educated in the brain story even in the health care system right they cover off that connection between aces and addiction
• 62:30 - 63:00 um having worked in addictions having worked in addictions for uh 20 years uh i've that has sort of uh been the source of my uh inspiration just to get behind and into the average childhood experiences literature because i see this the connections so clearly so i think uh maybe in terms of educating yourself further uh getting more um colleagues to discuss it uh and maybe if you have team meetings and
• 63:00 - 63:30 different ways of highlighting the the relevance of it i know within addiction services across the country right now it seems that they are influenced a lot by restriction constraint and kind of a neoliberal agenda where it sort of uh puts up an individual emphasis on people but i think we need to resist that as social workers and so to find allies that you can work with that share the same passion for it excellent thank you nancy i have one
• 63:30 - 64:00 last question um we are running a bit over time um if you need to leave so be it uh we'll just answer this last question and then wrap up the question has to do with different perspectives that are going around about giving the ace survey to clients to fill out some social workers feel it can be traumatic for people and others seem to think it's very beneficial in ways as have been presented today it can take away that feeling of it's not it's my fault
• 64:00 - 64:30 but do you recommend clients fill it out directly or that maybe the social worker should ask when it's feeling safe for the client and appropriate to do so themselves nancy maybe some of the reasons yeah sure um some of the research by uh christina christina bethel uh she's at the johns hopkins university and she's done a lot of work around adverse childhood experiences within communities and she suggests that people find it
• 64:30 - 65:00 very validating to be asked about that their their childhood experiences and i know also nadine burkaris who i mentioned earlier she does have a practice of asking her patients to fill out these questionnaires in the waiting room and she doesn't necessarily talk about a score but she talks about the impacts of adverse childhood experiences and uses it as a way to engage in conversation and to help people think about what is trauma because trauma is such a broad word so i think the adverse
• 65:00 - 65:30 childhood experiences can break that down a little bit to explore what is the nature of trauma so i think in general people have found that that those worries about it being traumatic uh to patients or clients or service users um has not been has not been born out in practice in fact people have found it helpful and i found that people don't like to be shut down in terms of talking about those experiences which often has been an experience they may have encountered great wonderful thank you so much thank
• 65:30 - 66:00 you for the great questions everyone i just want to give a quick reminder that all the resources but within this presentation will be available to you afterwards in the handout widget i will add the slide package as well for you to take the questions have been floating around can we share this information and i suspect i answered appropriately by saying please do we want people to get comfortable understood understanding and aware that we have much more to do in terms of our social
• 66:00 - 66:30 work practice and being as agents of change with people who come to talk with us and at a community level so with that i would like to say thank you again to each of you nancy elizabeth and kevin it's been a stellar webinar and it'll be on on-site for people to watch later on again uh within 24 hours so please keep your eyes open for that or share it as you will and uh and i'll be
• 66:30 - 67:00 signing off for tonight happy social work month to everyone thanks again bye now thank you thank you take care