New normal still has to deal in Aces
Growing up in a home with physical abuse, emotional neglect, mental illness and substance misuse are some examples of Adverse Childhood Experiences, and are among those considered in the original Aces study by Felitti et al (1998).
However, it is important to consider Aces that were not reported in that study, such as bullying, discrimination, racial trauma, losing a parent, poverty, unstable housing, family separation — and the list goes on. We can now add the Covid-19 pandemic as another of the identified Aces.
Millions of lives have been affected in unprecedented ways by the novel coronavirus, which halted much of our movements by the end of March. In many parts of the world today, they are still grappling with continuing uncertainty — our daily routines have been interrupted, and we don't quite know what is to come, or how to navigate through life as businesses and public places are beginning to start up again.
A string of disappointments — no football games, no graduation ceremonies, no hanging out with friends or parties, no Saturday favourite activities, no Cup Match — were added to the stress of sheltering in place.
As the pandemic continues to rage, people of colour, blacks and African-Americans in communities around the world have been and continue to be disproportionately impacted by more deaths from Covid-19 than their white counterparts — in part because of underlying health conditions, limited access to quality healthcare and disproportionate representation in frontline jobs.
Adding to this profound emotional toll was yet another highly publicised death that is, seemingly, the result of underlying and ongoing racism. Research suggests that racism has harmful, mental and physical effects that can result from a person experiencing it directly or vicariously — such as someone watching a video of George Floyd's suffering during his arrest (Williams, Metzger et al, 2018).
The reality is that inequalities in stress and adverse social and environmental conditions do exist. Higher Aces exposure has been reported by individuals who identify as black, Hispanic or multiracial; individuals who have less than a high school education; and those who are unemployed, unable to work, or have low income. (National Academies of Sciences, Engineering & Medicine, 2017)
Covid-19 and ongoing racial traumas will almost certainly take an emotional toll on children, adolescents and their families in an exceptional way. For those who have had prior Aces-related traumas, these times can be particularly distressing and could result in an increased risk of struggling during and after the present crisis.
These circumstances bring crucial questions to light for the Bermuda community to consider: how will these events impact the lives, deaths and futures of our children? Will we see an increase in the number of established and newly added Aces in children now that the shelter-in-place order has ended?
What will life be like in our “new normal”? What services will we need to ramp up or be delivered differently from how we did before Covid-19? How do we connect support from care providers to individuals and families who experience an exacerbation of pre-existing Aces because of these events and in addition to Covid-19 potentially being recognised as an Ace?
In this pandemic, there is a looming reality that children face: they and their families and friends are at risk when it comes to Covid-19. That knowledge alone is stressful. By building resiliency into children by talking to them about their fears, how to cope with those fears, and the fact that it is OK to have these emotions, children will have tools that could last them a lifetime.
Family Centre and other organisations have discovered that interventions with parents and school professionals, and education regarding awareness of and treatment for Aces, can help families and school systems to create safe, stable, and nurturing relationships and environments that assist to build resilience in children and families.
Perhaps we have more questions than answers. However, using primary prevention as a model, we can support children and families in their mental health and social needs before they begin to feel the withdrawal, anxiety, hopelessness and depression that can accompany communal traumatic experiences, making all the difference in the world.
• Stephanie Guthman, PhD, is the former Director of Specialised Training and Assessment at Family Centre
To learn more about Adverse Childhood Experiences, go to Family Centre's website at www.tfc.bm or call 441-232-1116