According to the Centers for Disease Control and Prevention, adverse childhood experiences (ACEs) "can have a tremendous impact on future violence, victimization, and perpetration, and lifelong health and opportunity." Adolescents and adults who have experienced four or more ACEs as children are at higher risk for chronic health problems, mental illness, and substance use disorders (SUDs) as well as less success in school, on the job, and in earning potential.

In Michigan, a statewide focus on ACES has resulted in the Michigan ACE Initiative (MI ACE). Partners from across the state are working to raise awareness of the impact of ACEs, prevent ACEs, and foster resilience among children who have experienced them. ACEs include being a victim of violence, abuse, or neglect; witnessing violence; having a family member who attempts or dies by suicide; or being separated from a parent. ACEs also take place when a child’s environment doesn’t feel safe or stable — for example, having parents with SUDs or mental health problems, food insecurity, or lack of housing. When children endure bullying or discrimination, they also experience ACEs.

The more ACEs a child encounters, the more likely they are to experience negative outcomes as an adult. 63% of Michigan high school students report having experienced one or more ACE; 15% report having experienced four or more.

While the Michigan Public Health Institute (MPHI) serves as MI ACE's backbone, the initiative reflects a cross-sector collaboration of more than 200 partners across Michigan.

"We like to use the phrase, ‘Everyone has a role.’ And really, we work hard to access all different sectors and communities, all across Michigan," says Dr. Kelsey Sala-Hamrick, MPHI's MI ACE project director. "We're always looking for more individuals and organizations who would like to partner with us."

Partnering to raise awareness

Those partners include the Michigan Department of Health and Human Services, local health departments, schools, communities, providers, universities, justice system representatives, and child welfare agencies. One of Sala-Hamrick’s tasks was to raise awareness about MI ACE after the Michigan Association of Health Plans Foundation launched it in 2016.

"The goal at that time was to raise awareness of ACEs using a train-the-trainer model — master trainers, other trainers with the coalition, and community champions," Sala-Hamrick says. "We have hundreds of trainers across the state now. They do training on what ACEs are and really start laying the foundations for communities to think about ways in which they want to use this information to leverage their own strengths and resources in their communities."
Dr. Kelsey Sala-Hamrick is the Michigan Public Health Institute's MI ACE project director.
In addition, feedback from those partners was integrated into the 2023 Michigan ACEs State Action Plan. This plan aligns efforts to "prevent potential traumatic or adverse experiences, dismantle intergenerational trauma, and transform environments by leveraging community and organizational strengths to create resilient, inclusive, and prosperous environments where children, youth, and families can thrive."

As part of the action plan, four work groups have been tasked with thinking about how to implement the Action Plan objectives around prevention, data gathering, policy and advocacy, and training and education.

"The State Action Plan is a really great way to show where we're going," Sala-Hamrick says. "Part of that is awareness. The idea behind awareness is that we achieve a critical mass of people who understand what ACEs are and their impact, then leverage that enthusiasm and knowledge to take those next steps. So many people are passionate about doing this work."

Measuring and tracking ACEs

In June 2022, the MPHI Center for Strategic Health Partnerships launched the statewide MI ACE Data Dashboard to measure and track ACEs in Michigan.
Mathew Edick.
"Focusing on prevention can dramatically reduce the negative impact of ACEs and ensure that children live happy, healthy, productive lives," says Dr. Mathew J. Edick, director of the MPHI Center for Strategic Health Partnerships and principal investigator for the project. "Ensuring that communities have access to ACEs data means they will be able to develop and implement prevention strategies that build upon the needs and strengths of their communities."

Displayed in a format that is accessible to the general public and easy to navigate, the dashboard displays ACE-related data that enables schools and community-based organizations to tailor prevention strategies to the needs of their communities.

"We were asking the question, ‘Okay, so great. Everybody knows what ACEs are. But now what?’ We were implementing some primary ACE prevention strategies. And we are building infrastructure to collect data about ACEs, more specifically — data was being collected directly from youth," Edick says. "We built a beautiful dashboard."

Using data compiled by the Michigan Youth Risk Behavior Survey (YRBS), the MI ACE dashboard relays the scope and nature of ACEs in a community, identifies populations with the highest needs, and shares evidence-based strategies to prevent ACEs.

"I'm a PhD scientist in genetics. I know lots about data, numbers, and statistics. But if you hand me that spreadsheet from the YRBS, I don't know what to do with that," Edick says. "If I hand it to my mom or if I gave it to a committee or a parent at a school, what does it mean? We put data on this dashboard, so that if you're a community leader, you can look at those numbers and do something with them."

Not all children who experience ACEs develop problems. Many live healthy, happy, and productive lives. These kids have that resilience that allows them to bounce back. Some build resilience at home. While their family may have struggles, the children still feel loved, supported, and valued. Others find that support at school, in treatment, or at community organizations. Resilience helps kids overcome trauma and adversity.

"ACEs can be prevented. And when they're not prevented, there are many ways that the potential harmful effects of experiencing ACEs can be mitigated through positive experiences and resilience building," Edick says. "By addressing this in children, we're intervening in a space that can have lifelong career- and quality-of-life-improving impacts for these children."

Professor James Henry is the co-founder and director of the Southwest Michigan Children's Trauma Assessment Center at Western Michigan University. After decades of treating children impacted by ACEs, Henry is truly excited about the work that MI ACE has done to engage multiple communities across Michigan and empower schools, health systems, and courts to change paradigms, recognize true causes of behavior issues, and compassionately help children and youth rather than dismiss or punish them.

"We really need to become a witness of their experience, how challenging it is, so they realize they're not alone," Henry says. "One of my favorite moments is telling parents, ‘You are the most important resource for a child because you have that opportunity every day to build that relationship with that child.’ You don't have to have a degree in psychology or social work or medicine to have that connection that makes that child feel heard and that makes them believe that they're lovable."
 
Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Kelsey Sala-Hamrick photos by Nick Hagen. All other photos courtesy of the subjects.