Research tells us that almost half of us will experience a traumatic event such as a loss of a loved one, a serious injury, witnessing a violent crime, domestic violence, abuse or neglect at some point in our lives. When we experience a traumatic event before age 17, it is called an Adverse Childhood Experience, or ACE.

Though these experiences can happen to anyone, they occur more often and have greater consequences for children. And they can have both an immediate and a long-lasting impact. In fact, children who are exposed to toxis stress over an extended period of time can experience a physiological impact that can negatively impact their brain development and affect their health and well-being for the rest of their lives.

But ACEs aren’t destiny, and not everyone who experiences toxic stress is doomed. Though children are particularly vulnerable to trauma, they are also incredibly resilient, and have the capacity to bounce back from even the most horrific experiences. But to realize these gains, children need to be in homes, schools and other safe environments that support their development and ability to thrive.

Routine screening for ACEs offers the opportunity to detect children at high risk of toxic stress early and provide prompt intervention to mitigate its effects.

The Center for Youth Wellness determined Detroit’s readiness for adopting ACE screening and ACEs-related public education efforts in a study, “Creating Healthier Futures for Children in Detroit,” released at an event at The Kresge Foundation in late February.

While nearly half of all children nationwide have at least one ACE, data shows that 77,000 children in Detroit – about 40 percent of children in the city – have two or more ACEs. According to the Children’s Trauma Assessment Center, “more than 70% of children seen by community mental health officials in Wayne County have experienced at least three potentially traumatic events that could change how they think and learn.”

Through this study, conducted in partnership with Kresge, CYW sought to find out if it was feasible to implement ACE screening within pediatric primary care in Detroit, who would be the most likely partners in this type of effort, and what is the most effective way to educate the community about ACEs in concert with a screening program.

“There is a growing movement in Detroit focused on improving outcomes for young children,” said Phyllis Meadows, senior fellow in Kresge’s Health Program. “This is an opportunity to strengthen the way we work together and discuss how we can build a comprehensive, community-based approach to mitigate the effects of ACEs and toxic stress so children and families can reach their full potential.”

After reviewing literature, interviewing professionals at public sector, health care and community-based organizations, and conducting surveys and focus groups with parents and caregivers in Detroit, there was consensus that screening children and adults for ACEs is important and needed in Detroit, said Jim Hickman, chief executive officer at the Center for Youth Wellness.

To make it a reality, respondents said that there is a need for multi-sector collaboration among the education, health, social services, and juvenile justice systems, as well as public-private partnership.

At the local level, the study indicates that public sector agencies and community-based organizations appear to be independently developing services to address childhood adversity, though there are a few champions representing medical providers, mental/behavioral health providers, research, academia and philanthropy that are beginning to coordinate with each other, noted Molly Peterson, program manager at the Center for Youth Wellness.

“A lot of people are trying to help, but they are often in a lot of different places and silos,” Peterson said.

For example, Authority Health, Detroit Life is Valuable Everyday (DLIVE) and Wayne Children’s Access Program’s Pediatric Residency Learning Collaborative are either currently implementing ACE screening or will be doing so soon, either directly as part of their medical practices or in partnership with others.

In addition, the Michigan Association of Health Plans Foundation received funding from the Michigan Health Endowment Fund for the Michigan ACE Initiative, which works to increase statewide awareness of ACEs and recommend the development of appropriate interventions and state policies. The Michigan ACE Initiative has partnered with the Michigan Primary Care Association to provide training on ACEs to Michigan’s Federally Qualified Health Centers.

Though there is growing momentum around screening, respondents expressed concerns about the availability of providers, provider time, provider awareness of services available, lack of data and lack of patient trust in providers.

Infrastructure to support ACE screening needs to include mechanisms that make it easier for families to navigate the system and access existing services.

“Screening is the starting point on a pathway to healing for families. So how can we work with partners that families trust to engage people in authentic ways and build a better system to get them what they need?” Hickman asked.

Given that Detroit, Wayne County, and Michigan have several champions already seeking ways to address childhood adversity, CYW identified several areas in which continued or enhanced support could advance efforts already in motion:

Study recommendations include:

• Convene a cross-sector collaborative focused on addressing ACEs in Detroit.
• Work with state-level stakeholders to ensure Detroit-level data is made available and to help evaluate the screening policy.
• Support collection and sharing of city and regional data that includes information about ACEs, social/essential needs and associated outcomes across the lifespan, emphasizing the need to include data on children.
• Improve linkages between services, including building and enhancing existing systems for care coordination across city/district/county lines and between public and community-based organizations
• Ensure identification, evaluation, and dissemination of findings of a pilot or demonstration project to identify locally effective models and best practices for screening and intervention, help identify barriers/opportunities, and create broader buy-in to scale impactful solutions.
• Enhance provider training to include practical skills relevant to their specific interactions with children and families, working with community-based organizations and existing ACEs trainers to inform and deliver training.
• Continue efforts in public education around ACEs and toxic stress directly with caregivers, community members, and professionals working with families.

“Yes, screening is feasible in Detroit. But it means working together to make sure that children can lead happy, successful and productive lives,” Peterson said.

As for next steps, in addition to sharing findings with the community, CYW will provide training on ACEs science and screening to residents in five residency programs in Wayne Children’s Healthcare Access Program’s Pediatric Residency Program. CYW will also connect Kresge with ACEs Connection, an organization that has expertise in supporting cross-sector community-level efforts focused on addressing ACEs and building resilience.

To read the full study and its findings, click here.