Holding all the Aces not always a winning hand

Renée and Reggie once had good jobs until a bike accident on Middle Road left them with severe injuries and unable to work. Unable to qualify for financial assistance, the couple relied on family members, friends and the community to help to pay their basic living expenses while they recovered. However, the recovery period was longer than expected and both Renée and Reggie quickly felt trapped, with no way out, as they slid into debt.

The stress of job loss and pain fractured their relationship. The impact from the accident stretched beyond their physical injuries and their own lives to those of their children. The time Reggie and Renée would usually spend with their children is now consumed by arguing. Unable to afford school fees or the cost of meals, their children have had to switch schools, and now attend the public school that provides a free-meal programme. Although the children are still a priority and have access to their basic needs, the change in family circumstances may be felt in many ways for decades to come.

Beaver is an 18-year-old young man imprisoned at Westgate Correctional Facility. His incarceration followed an attempted gang retaliation; he was avenging the attempted shooting of his friend, the most consistent family he has known. Born to a drug-addicted mother, Beaver bounced around in foster homes before being placed in residential care at the age of 13. Beaver’s foster parents struggled to help him manage his rageful behaviour, especially as he got older. As an adult, he is living out the consequences of his childhood trauma.

Jordan is a seven-year-old girl who lives in a two-bedroom apartment in a neighbourhood close to town, along with her mother, grandmother and three siblings. They all have to share a tiny apartment with only one bathroom. When Jordan was 5, she watched as her father was arrested by the police and taken away in handcuffs in the middle of the night. Jordan hasn’t seen him since. Jordan often watched and listened to her mother and father fight, and now she watches and listens to her mother and granny argue. Granny also has a drinking problem, which is no longer hidden from the children. As a result, Jordan is shy, quiet and withdrawn. She falls under the radar at school because the only giveaway to her stressful home life is her unkempt appearance. If long-term supports are not put in place quickly, the outcome for Jordan’s future could be bleak.

Each of the mentioned cases describes the experiences of adversity within families: parents who have had trauma as a result of an injury, parents with substance-abuse problems, and parents who are physically and emotionally neglectful.

Parents and children alike are affected by these circumstances, with the greatest ripples lasting well into the children’s early adulthood. Those with adversity in their childhood, and who did not have the support needed to change their life course, are more likely to carry the effects of adversity into their own adult families. Even with intervention, those same children, as adults, may still carry the burdens of their childhood stress.

Whether the issue is perpetuating the cycle of negativity or struggling with behaviours that lead to otherwise preventable chronic disease, there is an opportunity for change. This opportunity is one that is rooted in understanding the results of research done in the community, and then to provide for the exact needs of every individual. The Bermuda Adverse Childhood Experiences study was instituted to foster this evidence-based approach.

The Bermuda Adverse Childhood Experiences, or Bermuda Aces study, is based on validated questions sourced from the World Health Organisation and the US Centres for Disease Control and Prevention. The United States-based Aces study is the most advanced longitudinal US research to date, which links childhood adversity to many types of negative health and social outcomes in adulthood, including anxiety, depression, substance abuse and other common chronic health conditions. With components conducted semiannually across the nation, this groundbreaking study cuts across all demographic lines and links the experiences of children to subsequent adult risk across many dimensions.

The effect of Aces research in the US has been so monumental and cross-cutting that countries throughout the world are adapting and using the validated questions of the Aces study. The results of such studies are country-specific and community-driven, and rely on adverse childhood experience surveys that will provide the practical data needed to associate childhood experiences with higher risks of disease as adults. This type of data also serves to inform the economic case for, and development of, appropriate interventions early in life.

In many countries, including Bermuda, there is limited research on childhood abuse and neglect, as well as the absence of relevant longitudinal studies. As a result, by initiating a Bermuda-specific study, our findings will be of great value in advocating for increased investments to reduce childhood adversities, implement individualised therapies, and create national policy that can be improved by an informed study. Without this research, gaps will be difficult to bridge and Bermuda will continue to miss out on knowing its very own best practices.

There is a growing interest in understanding the frequency of Aces, globally as well as in Bermuda, and how to better prevent or respond to them. We ask that you join us by completing the Bermuda Aces survey and, thus, add to the body of international research while also helping to improve our present knowledge regarding assessment, early intervention and prevention of Aces in Bermuda.

Our findings can also be of great value in advocating for increased investments by the Government to reduce childhood adversities and to inform the design and implementation of Bermuda-specific programmes that can reduce and ultimately eliminate the consequence of Aces in our community.

Family Centre, along with the Bermuda Health Council, has prepared the WHO’s Adverse Childhood Experiences questionnaire for use in Bermuda. The questionnaire can be found at https://goo.gl/forms/EhbFRq0W3e2EtZQD3, where you can read more about the questionnaire itself and participate. You can also access the survey on Family Centre’s website at this link: https://www.tfc.bm/acessurvey/. We ask that you complete the confidential questionnaire and send this link out to others who may wish to participate.

Stephanie Guthman, PhD, is the Director of Specialised Training and Assessment at Family Centre

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Published Apr 6, 2019 at 8:00 am (Updated Apr 5, 2019 at 10:38 pm)

Holding all the Aces not always a winning hand

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