MCH Student:
Claire Cunningham
Date of Defense:
April 20, 2018
Abstract:
Introduction
In my work at Saint Joseph’s Home for Children (SJHC) I addressed childhood trauma and adverse childhood experiences as a clinical intern. Experiencing adversity in childhood is, unfortunately, incredibly prevalent. Per the groundbreaking ACES study done by Kaiser Permanente in 1998, about 26% of the population experiences at least one “adverse experience” in childhood.1 This study, the first of its kind, defined “adverse childhood experiences (ACES).” The definition, which is still used in research and practice today, describes a traumatic childhood experience that can be recalled in adulthood and includes any experience of abuse, neglect, domestic violence, parental incarceration, parental separation or divorce, household substance abuse, and/or household mental illness occurring within the first 18 years of life.1 The study found a significant dose-response relationship between ACES and health outcomes/quality of life, with four experiences of adversity leading to the greatest likelihood of poor physical and mental health, low quality of life, and premature death.1 The study found that about 12.5% of individuals experience at least four ACES in childhood.1 Minnesota specific data collected in 2011 indicated that about 55% of Minnesotans report experiencing at least one “ACE” in childhood.2 This high prevalence is alarming and imperative from a public health perspective. The experience of adversity in childhood is linked to nearly every measure of poor health and increased risk for disease across the lifespan including, higher rates of substance abuse, smoking, asthma, cancer, obesity, mental illness, and diabetes as well as overall poorer self-rated health and premature death.1,2,3
Children admitted to Saint Joe’s residential treatment program have experienced high levels of adversity and trauma in their childhood and meet criteria for significant mental health diagnoses as a result of these experiences. Most commonly young people at SJHC meet criteria for Post-Traumatic Stress Disorder, Reactive Attachment Disorder, Attention-Deficit Hyperactivity Disorder, Major Depressive Disorder, and Generalized Anxiety Disorder. These diagnoses, and the underlying experiences which have contributed to their occurrence, place children on a trajectory for poor health outcomes, poor health related behaviors in adulthood, higher rates of disease and chronic conditions, higher rates of mental illness in adulthood, poorer quality of life indicators, and premature death. SJHC functions as a form of tertiary prevention in treating mental illness, addressing trauma and adversity, and moving young people towards healthier outcomes across their lifespans.
Experience
As a dual degree student with the School of Social Work, my field experience took place over the course of an academic year and required 600 hours of internship. In my time at SJHC I worked in the residential treatment program in King Hall, which serves youth ages 6-11 with serious mental health diagnoses. I was responsible for conducting weekly individual and family therapy for two assigned clients. Additionally, I conducted bi-weekly group therapy for ten children. Beyond therapeutic responsibilities, I conducted quarterly care team meetings with my assigned clients’ care teams, conducted intake assessments and diagnostic assessments, and engaged in weekly team meetings with a multidisciplinary staff.
The learning objectives associated with this experience primarily focused on developing clinical skills as well as advocacy skills for the mental health needs of young children exposed to adversity and trauma and their families. Additionally, it was a goal to understand and situate SJHC as a multidisciplinary organization in the context of the field of children’s mental health and health services, which focused on researching children’s mental health related policy and understanding the role that SJHC plays in relation to these policies and programs within Minnesota. All goals related to this experience were completed by the end of the 600-hour timeframe.
Organization
Saint Joseph’s Home for Children is a large non-profit organization run by Catholic Charities of Minnesota. SJHC runs four programs that serve young people and families throughout Minnesota: Central Intake for Child Protection in Hennepin County, Emergency shelter for Hennepin County children, Residential Treatment for children across Minnesota with significant mental health diagnoses, and Day Treatment for Hennepin County children with mental health diagnoses who have been unsuccessful in a normative school setting. Each program is designed to serve young people and families significantly impacted by trauma and move them towards healing and long term success in the community. SJHC functions as a tertiary prevention program that mitigates the effects of childhood trauma and ACES and works to prevent the long term poor health and wellbeing outcomes typically associated with ACES through mental health treatment and family focused work.
In my work as an intern I worked directly with children and families to counteract trauma and move children and families towards more successful, healthy, and thriving lifestyles in their communities. The work that I did with King Hall as a clinical intern fits directly with the mission and vision of Saint Joe’s by serving young people and helping kids and their families move towards healthy, bright, strong futures.
Lessons Learned
This experience provided me with a wealth of learning experiences and lessons. In addition to gaining clinical skills and a foundational understanding of the children’s mental health system in Minnesota, I was able to more deeply understand and appreciate ACES and childhood trauma through both a social work and public health lens. I came to understand ACES a complicated and multifaceted issue requiring integrated and multidisciplinary intervention both in terms of prevention and treatment. I was able to experience firsthand the imperative role that relationships and early attachment play in the occurrence of ACES as well as in the healing of trauma and the sustainability of healing in communities. I learned that the general society has a fairly limited understanding of trauma and ACES and that there is much work yet to be done around ACES and trauma education for the public. Overall, I gained a deeper appreciation of ACES as both a public health and clinical issue, in need of targeted and innovative intervention.
Recommendations
While Saint Joseph’s Home for Children, and other organizations engaging with childhood trauma are doing important work, there is still much to be done around ACES and trauma in Minnesota. Given the complicated and multifaceted nature of ACES and trauma, increased collaboration across agencies and organizations is imperative, both within the children’s mental health system and across other disciplines such as healthcare systems, and education systems. With this multidisciplinary approach, there is a great need for increased education around ACES at the community level in order to increase public awareness and provide the broader community with a more trauma informed lens. There is also a strong need across agencies to continue producing evaluative materials and publications that highlight effective interventions in the prevention and treatment of childhood trauma in order to deepen our current collective evidence base.
SJHC specifically could consider increasing their focus on the prevention of ACES and trauma, possibly through collaboration with community partners and other resources. SJHC should continue targeted efforts to reduce barriers to engaged treatment for families, which often includes the cost of treatment as well as transportation to and from family sessions.
Conclusion
Through my 600-hour yearlong internship experience at SJHC I was able to engage with childhood trauma and ACES, work to mitigate the long-term effects of ACES interpersonally with young people and integrate my social work and public health perspectives as a dual degree student.
References
1 Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine,14(4), 245-258. doi:10.1016/s0749-3797(98)00017-8
2 Adverse Childhood Experiences in Minnesota. (2013). Minnesota Department of Health. Retrieved from http://www.health.state.mn.us/divs/chs/brfss/ACE_ExecutiveSummary.pdf
3 Brown, D., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J., Giles, W., (2009) Adverse Childhood Experiences and the Risk of Premature Mortality, American Journal of Preventive Medicine, Volume 37, Issue 5, 2009, Pages 389-396, ISSN 0749-3797, https://doi.org/10.1016/j.amepre.2009.06.021.