April is memorialized as Child Abuse Awareness Month annually. In Tulsa, we have a lot of experience with child abuse, but most of us hear of it only after the tragic death of a child by a caregiver, sometimes related, sometimes not. Some 2,700 kids report some kind of abuse or neglect annually in Tulsa County.
There is growing awareness of the high incidents of Adverse Childhood Experiences scores among our population and how high scores contribute to continued violence and abuse as adults. ACE is a survey of 10 questions generally given to an older child or more often an adult where each negative experience counts as 1 point.
Oklahoma is one of three states with the highest ACE scores for children age 0-5 (National Survey of Children’s Health, 2016). For our adult population, unmitigated high ACE scores continue the cycle of violence as victims or abusers and is one of the leading indicators of community “unhealthiness.” For example, those with an ACE score of four or more experience 400% to 1,200% higher risk for alcoholism, drug abuse, depression and suicide when compared with a score of zero.
At the Family Safety Center, we have had the opportunity over the past 2½ years to explore how ACE and other traumatic events impact and contribute to multiple kinds of adult trauma over the life span as part of a National Demonstration Project funded by the Department of Justice, Office for Victims of Crime. The DOJ released a massive study in 2013 named “Vision 21” that has essentially changed how DOJ views trauma and its effects on crime victims and the perpetuation of violent crime. Based on the recommendations of this report, the Family Safety Center joined five other cities and the Alliance for HOPE International in this competitive project to develop and implement an across-the-lifespan tool to assess “polyvictimization,” or multiple types of trauma, the attendant symptomology and provide appropriate treatment options.
According to David Finkelhor, Ph.D., director of the Crimes Against Children Research Center, University of New Hampshire, polyvictimization can refer to the experience of “sexual abuse, physical abuse, bullying and exposure to family violence, not just multiple episodes of the same kind of victimization.”
As part of the demonstration project, our six sites, the Alliance and research partner University of Oklahoma-Tulsa HOPE Center reviewed more than 130 assessment tools used by professionals across the mental health and service provider spectrum and the ACE test. In the end, the assessment tool developed and now under implementation includes the 10 ACE questions and 16 other events (26 total) and 18 symptoms such as nightmares, sleeplessness and anxiety.
Family Safety Center navigators, who are licensed professional counselors and master’s in social work professionals, deliver the questions in a conversation, allowing us to measure events that occurred as children that continued into adulthood, new events and those occurring to the victim in the past year, as well as attendant symptoms. We don’t just ask about the specific event that brought them to us for service today, but what has happened in the past: community trauma, racism, homelessness, substance abuse, loss of family — things that most surveys don’t ask.
The premise is that multiple types of trauma add complicated layers to the symptoms experienced by our survivors and impact lives more negatively than multiple events of a single type. That compounded trauma and those symptoms are much more complicated to identify and treat. And usually our survivors are totally unaware of the impact of these different types of abuse or neglect on their lives.
So far, our data of traumatic events (about 50 completed assessments) shows us this: Among children, clients experienced an average 6 of 26 possible traumatic events. The highest was 16. Among adults, the average was 12, and the high was 24. In the last year, the average was 8 and the high was 18. Our clients tell us, “No one has ever asked me about what happened before this,” and, “Now I understand better how come I’m here today.” We are able to provide additional psychoeducation about the effects of multiple trauma in a lifetime, and hand clients off to mental health and other counseling services to begin the healing process.
This also means we are identifying additional services our clients need, such as housing, mental health, addiction and substance abuse issues.
Family Safety Center and our partner agencies are leading the country in the development of cutting edge best practices for trauma informed identification and ultimately treatment options for victims of violence and neglect. Together we can and will break the cycle of violence that has insinuated itself in Oklahoma culture for too long. Together we can generate hope and provide a pathway to assure no child experiences violence or neglect in the future.
Suzann Stewart is executive director of the Family Safety Center and a member of the Tulsa World Community Advisory Board. Opinion pieces from Community Advisory Board members appear in this space