Beyond ACEs, with Dr. Lisa Amaya-Jackson

Season 1Episode 11December 4, 2019

Why context matters when it comes to an individual’s adverse childhood experiences (ACEs)—and why all ACEs are not created equal.

In 1998, the Adverse Childhood Experiences (ACEs) study showed that traumatic events in childhood were common and could have lasting effects—on everything from SAT scores while we’re in school to long-term physical health issues as adults. But are all ACEs created equal? We invited Dr. Lisa Amaya-Jackson from the National Center for Child Traumatic Stress to discuss the benefits—and the limitations—of keeping score. Have we oversimplified the way in which we talk about ACEs? What’s the role of the community in developing resilience? (And why does she think “resilience” is both a beautiful word and a burden?) What do we need to know to help survivors heal?

Topics in this episode:

  • The terms used to define trauma. (1:34)
  • “All ACEs were not created equal.” (5:29)
  • How an ACE can be more potent, and the problem with oversimplification. (8:58)
  • How an ACEs assessment fits into the CAC rubric. (20:23)
  • Advice for CACs. (26:20)
  • Resilience and how communities and organizations can help kids recover. (29:43)
  • What’s coming up at the National Child Traumatic Stress Network. (40:53)


Lisa Amaya-Jackson, MD, MPH, is a child and adolescent psychiatrist; a professor in psychiatry and behavioral sciences at Duke University; and associate director of the National Center for Child Traumatic Stress

The original Adverse Childhood Experiences (ACEs) study

National Child Traumatic Stress Network

National Center for Child Traumatic Stress

Resilience: The Biology of Stress and the Science of Hope (2016 documentary)

Dr. Nadine Burke Harris, at TEDMED 2014, “How childhood trauma affects health across a lifetime

Prevent Child Abuse America

Core Curriculum on Childhood Trauma, including The 12 Core Concepts: Concepts for Understanding Traumatic Stress Responses in Children and Families

Season 1, Episode 11

[Intro music]


Teresa Huizar:
You are listening to One in Ten from National Children’s Alliance. I’m Teresa Huizar, your host. Join us as we engage in one-on-one conversations with the brightest minds in science, medicine, faith, communications, and the law. We’ll discuss the path forward to solve the greatest challenge one in 10 of our children face: child abuse.

Today’s episode is “Beyond ACEs.” In 1998, the Adverse Childhood Experiences study showed that traumatic events in childhood were common and could have lifelong effects on our health. The insights from that landmark research transformed our approach to dealing with adverse childhood experiences, or ACEs. But are all ACEs created equal?

What else do we need to know to help survivors heal? I spoke to Dr. Lisa Amaya Jackson from the National Center for Child Traumatic Stress about the benefits and the limitations of counting ACEs. Have we oversimplified the way in which we talk about the issue? What’s the role of the community in developing resilience? And what does the trauma lens help us to understand about this important issue?

[Intro music begins to fade]

[1:33] Teresa Huizar:
How did you come to this work in child traumatic stress? I mean, most people don’t grow up thinking, “The place that I want to spend my adult professional career is in child traumatic stress.” How did you come to it?

Lisa Amaya-Jackson:
Well, as a physician, as a physician in training, and then as a resident in psychiatry, I very quickly zeroed in on the aspects of medicine that dealt with the most people part of things and hearing about their experiences. And also with adults, seeing the impact of their life experiences was very significant. And I can remember having conversations about wanting to be very interested in child abuse and talking to faculty who were saying, “Well, how do you know that the experiences from abuse and what we’re seeing isn’t confounded with socioeconomic status and things like that?”

Teresa Huizar:

Lisa Amaya-Jackson:
And deciding that because abuse was very complex and muddy sometimes, I said, “I’m going to go to Los Angeles and learn about trauma that’s not just abuse.” And all trauma is muddy. And what I came to recognize was, you know, this high impact of many negative adverse childhood experiences, including and not including child maltreatment.

And as we have seen, research has born to bear what those of us who do clinical work recognizes, that what happens to you as a child can have lasting impact for the rest of your life.

Teresa Huizar:
So, Lisa, you know, you’ve already used some terms, and I think while most of our audience will be familiar with them, I just want to define them a little bit for people who are not. There are a lot of terms floating around childhood traumatic stress: toxic stress, ACEs or adverse childhood experiences, those kinds of things. What’s important to know about those terms?

Lisa Amaya-Jackson:
Well, I think, you know, there’s been a lot of history around the term trauma, which is experiences that someone has had that have been certainly out—we had initially hoped were outside the realm of human experience and were often considered life-threatening. But now what we’re finding is they’re not outside the realm of usual human experience. But this recognition, there’s been a lot of study around traumatic life events. And then with the landmark study that came out in 1998 by Felitti and Anda, et al., who introduced the term ACEs and adverse childhood experiences, this recognition that there are, you know—and they listed 10 as part of their study that were around basically child maltreatment experiences and household dysfunction.

But what I like to think of the ACEs as is very specific to the Felitti ACEs that were in that study we’re talking about: Physical abuse. Sexual abuse. Neglect. Domestic violence. Household dysfunction. Where there’s been violence in the home. An incarcerated parent, separation from a caregiver. Divorce is included. And there’s a number, you know, that people are very familiar around ACEs.

But I think important in this language, is that what someone may be referring to as an adverse experience and they’re talking about an ACE may be one thing. Someone talking about trauma may be different. And not only does it impact us in prevention work, in treatment work, it also impacts policymakers who say, “OK, you’ve been talking about trauma all this time, but now you’ve been talking about ACEs. Are we talking about something totally different?” So I think language matters and we have to be very conscientious when we’re using it and what we mean.

[5:29] Teresa Huizar:
It seems like one of the—part of the importance of the original ACEs study was that, maybe for one of the first times, it really illuminated this issue that childhood abuse and other experiences can have a lifelong impact. And so while I think many people sort of thought about that, or knew people that they saw as deeply affected by these things, I think that it may have had a lot of value initially because it sort of brought to bear a specific research question. And even though there are, you know, some issues with the research itself and who was in the population that was studying, those kinds of things, it’s still, I think, contributed to our understanding of those.

When you think about what has flowed from that though, what do you worry about in terms of the way that understanding of ACEs, understanding of the study, could be misapplied, or misunderstood, or misinterpreted in some way?

Lisa Amaya-Jackson:
You know, that’s a really great question. I’d like to go back to the positive aspects that you mentioned, that how ACEs opens the door. Even though there’d been years and years of study in some of this regard, you know, the ability to talk about ACEs without maybe a stigmatizing way of thinking about it or talking about in terms of risk and these lists of things that have happened to you instead of actually something that maybe connotates impact. Which again, I’ll get to in a minute, how important that is. You know, that was really amazing. And then for them to actually think about this, as you said, life term impact that was not just mental health but physical health, opened the doors in pediatric practices, in medical practices, in ways that had never been open before. It felt like people were willing to talk about it.

And then the other thing that for many years people have been trying to have people recognize is, whether you’re someone in the CAC or whether you’re a clinician or whether you’re someone doing prevention, is that these experiences are cumulative in their impact. And that many times they go hand in hand. And that a child who comes in with sexual abuse, you need to be thinking about the fact that they may have other traumas as well, other adverse experiences as well.

The flip side to that now is that now people are saying things like, you know, the score is what matters, and that the individual things have less impact.

And that concerns me. I’ve actually had people come and quote this fact based on having seen the resiliency film, and while you know, this idea of an “ACE effect,” a cumulative effect, a dose effect of multiple traumas that, you know, Dr. Burke Harris in her TED Talk has really brought home to bear for us. The flip side that, you know, people’s experience are more than the score. That individual items matter. I kind of use the term all ACEs were not created equal.

You know, I think when you look at it from the perspective of meaning making, from the perspective of where developmental impact could have been affected, individual adverse experiences need to be understood at the individual level.

[8:58] Teresa Huizar:
Well, you’re bringing up a really interesting point, Lisa. I think that, you know, it is true that I think in the general public especially, but even in our own work, we hear a lot about the cumulative impact. You know, have you had five ACEs? Have you had six ACEs? Have you had four ACEs? And I think part of that was around getting to the point that people really understood that many children were experiencing lots of adversity in their lives and not just from one direction. But I think it is equally important to understand the point you’re making about not all ACEs being equal.

Can you talk about that? About what’s important to understand about individual ACEs and their individual impact on people?

Lisa Amaya-Jackson:
Sure. So as we know, some of it is going to be relevant to a child’s stage of development. And so on the one hand, while we have learned that certain ACEs and certain traumas will impact a child and then into their adulthood around mental health, around their physical health, and recognizing that the more they have, you have this dose effect of potentially more severity and more complexity around, you know, major causes of morbidity. Heart disease, lung disease, sexually transmitted diseases, suicidality, and other things, that when you go straight from a score to long-term impact, you miss an opportunity for what I would term, and other researchers term, intervening variables.

And I hate that term because it sounds so academic, but this idea that these multitude of experiences and the individual experiences have lots of things that take place in the middle that are important to pay attention to because they can have areas of intervention. So then when you think about the individual ACEs themselves, or an individual trauma—

So we’re talking about ACEs. Let’s say we’re talking about sexual abuse. Well, the research is coming to bear that some ACEs more potent than others. And sexual abuse is one of those. And we have seen in a research article that Frank Putnam et al. did in 2013, where sexual abuse for women was one of the most potent ACEs interacting with other ACEs. And poverty in males was one of the most potent ACEs. And we’re seeing that. We’re now doing some studies here in the National Center looking at our core data set. And we’re in the middle of analyses, but we’re bringing to bear sexual abuse again as one of these very important, very potent ACEs.

The other thing relevant to that is that these ACEs and other traumas can interact with each other in ways that one plus one equals three. So you have sexual abuse and you have domestic violence, and you have more than an additive effect. You have this—what we call synergistic effect—such that sexual abuse alone, what do I say, domestic violence alone, added together would have a certain amount of likelihood to have a high impact perhaps on psychopathology. But when you put them together, it’s even higher than you would expect individually added together. So this recognition that we have to look at these individually.

I think the other thing that I’ll bring to bear, because we’re talking about children again, is development. And how very important it is to recognize that some things happen at different ages. So for example, sexual abuse may be more likely to happen in adolescence, or sexual assault in adolescence. On the other hand, we know neglect is most likely to occur in very early childhood, and as a result, it’s also going to have very significant effects because, you know, it’s there in the very beginning.

So I think, you know, these things recognized for both this idea of cumulative risk, but also the importance of not losing the fact that some experiences have to be dealt with at the individual level. And not just because they’re more potent, but because they are coming into the clinical world often with the need for treatment. And you don’t treat a score, you treat, you know, the individual experience and its impact.

And if I can go on from there, I’ll say there are things—for example, when we’re talking about these intervening variables, some of it may be, you know, symptomatology. You know, you have an adverse experience, and you’re having post-traumatic stress disorder. Or you’re having depression or having behavioral problems. You target those and you treat those and hopefully you’ll be able to alleviate or reduce your risk for future problems down the road. But it may not be symptoms. It may be disrupted caregiving systems. It may be social stigma. It may be risky behavior. All of those are things that we know how to target and we can do something about.

And I think sometimes that gets lost in our ACE conversations. Not intentionally, but by accident.

[14:45] Teresa Huizar:
So Lisa, sort of unpacking the issue of potency for a minute, for those who might not be familiar with that term in the context of ACEs or thinking about that. When you’re talking about a particular ACE being particularly potent, do you mean that the impact is outsize or something else?

Lisa Amaya-Jackson:
What was the last thing you said? Do I mean it—

Teresa Huizar:
That the impact is more dramatic or outsize or something else?

Lisa Amaya-Jackson:
Yes. So we can be termed in, can be used in two ways. I’d say that it’s more dramatic and more impactful than say others. Again, taking into consideration a child’s age, their gender, their background. Those things may be attributable.

But the other thing, for example, in this one study I mentioned earlier where they looked at sexual abuse, it was potent in that interacted very significantly with other ACEs, such as domestic violence, as I mentioned, crime victimization, poverty, parental mental illness, loss of a parent. In a way that it did something when interacting with that other to have higher impact, in this case, specific to psychopathology.

In men it was different. So that’s another thing. It’s that, you know, what may be the case of high impact by an adversity in one population, in this case gender, might be different in another.

[16:24] Teresa Huizar:
It sounds like one of the issues here is that, in an attempt to try to explain to the general public the lifelong effects that can come from these sort of traumatic events or adverse childhood experiences, maybe we’ve oversimplified the way we’ve talked about this to such a degree that we’re really not explaining as well as we could these differences you’re talking about.

Whether it’s the way in which the particular adverse childhood experience interacts with the child’s developmental phase, or what it is in and of itself, or how that interacts with other experiences that they may be having that may have these potentially lifelong impacts.

I think one of the things that I worry a little bit about because there’s—you know, of course in the Children’s Advocacy Center world, we’re very concerned with the adverse childhood experiences or the traumas that kids have experienced. And we work with kids who’ve been traumatized daily. But one of the things about ACE scores, because there was kind of a wave there for a while, the idea that every child should be scored for their number of ACEs.

And, you know, I don’t know how you feel about that, but one of the things that I worried a little bit about with that is, to a certain extent, your ACE score as a child is an immutable fact. I mean, once something has happened to you, it’s happened. There’s no erasing it, there’s no undoing it. And so I just wonder about how we translate that into something that, when we’re talking to clients, when we’re talking to family, when we’re talking to the general public, it doesn’t sound as though they should just throw up their hands and go, “Well, it’s a crying shame that that happened to that kiddo, but you know, they’re never going to get better from that.”

How do we sort of instill this hopefulness into the conversation that, you know, kids can respond to treatment? That folks’ lives can improve with appropriate treatment?

Lisa Amaya-Jackson:
You know, point very well taken. I think particularly when we’re talking about children, you know, that opens the door for so much opportunity to intervene. And for us to understand what are the tools that allow us to intervene the best way allows us to all feel more empowered, also, when we’re talking to the child.

So when we can basically use tools that say, “OK, yes, we know these things have happened to you. But that’s not it. Then the other thing we need to know is some measure of distress.” And I think that’s another key element we can’t forget, is that it’s not just what happened. It’s not just the score. But what is the measure of distress? What is the impact this is having on the child? And when you understand what that is, it may be related to an internal sense of distress. They may be having trauma. They may be having nightmares. We know how to treat that. They may be having problems with behavior. We know how to work with parents to help them to deal with that.

They may be having suicidality. They may be having a sense of hopelessness. They may be having other things where the systems are all trying their hardest to work together, to work on behalf of the child and the parent, need to work together so that we are bringing to bear the things that we know that will help.

Because we know we’re—I mean, we’re in a wonderful, wonderful time where, while these things are happening, and maybe they seem to be happening at more of a prevalence, maybe there’s a landscape of where our health system’s at that we’re struggling. But at the same time, it doesn’t discount the fact that we know what to do. We know what to do for this.

So it’s not just that this happened to them, but that we want to understand how it’s impacting them so that we can intervene at the right level.

[20:23] Teresa Huizar:
When you think about the kinds of interventions that would happen at a Children’s Advocacy Center and in concert with their mental health, so you know, the importance of conducting a trauma screening and, you know, later trauma assessment for those kids who are going to be recommended on to therapy, those kinds of things. How does this whole ACEs assessment fit into that rubric?

I think that that’s one of the things that CACs are trying to figure out is: Do they need to do anything with the sort of—you know, there’s a push in the medical community, for example, to really look at screening for ACEs. And I think CACs are kind of on the fence about: Well, you know, we’re already doing some trauma screening and those kinds of things. We’re really doing evidence-based assessment now.

So where does this fit into that? Is there some additive benefit or is it really something that, given, if someone’s getting a good screen, if someone’s getting a good assessment, you wouldn’t expect to also see.

Lisa Amaya-Jackson:
Again, great question. I see—you know, what I love about the ACEs movement is this attention to understanding what has happened in people’s lives and trying in some way to quantify it.

The things that I think have to be done, let’s talk at the child level: One, is that when you’re doing a good trauma assessment, you’re looking at children’s adversity, those things that go hand in hand. Some of those ACEs are traumas, right?

Teresa Huizar:

Lisa Amaya-Jackson:
Child maltreatment.

Teresa Huizar:

Lisa Amaya-Jackson:
They’re both in both languages, but you may have the fact that they’ve been exposed to community violence. There may have been a shooting. They may have been through hurricane. They may have had a horrific loss, the death of a family member. And what’s even worse? What if that death happened in front of their eyes?

Those things have to be taken into consideration, and those things aren’t listed on the ACEs screeners.

So, and making sure, you know, ACEs and trauma screening can be done very … you know, to do one isn’t meaning you’re not doing the other. ACEs can be folded into that. And I think this idea that thinking about it is really important. That’s for children.

The other thing we have to be cognizant of is, once you’ve done any kind of screening or any kind of asking about ACEs or a score, you know, the expectation that something has to be done has to be taken into consideration. Especially with children.

When they tell a caregiver of some type that something has happened to them, there is an expectation that the caregiver knows best and will do something about it. And so I think that that vulnerability for a child that once they’ve given this, you have to do something with this information. And that may mean reporting, that may mean getting them into a clinic. That may be following and monitoring. You know, that’s really important.

The other piece to it is, using these to talk to the parents. Talking to the parents about what they’ve had. So the ACEs screening that I think has done a magnitude of progress in the mental health world is, and in pediatric and prevention is, for these parents to be being asked about their experiences.

Teresa Huizar:
Mm-hmm. Mm-hmm.

Lisa Amaya-Jackson:
Sometimes for the first time. And for them to be able to say, you know, they have a score, for them, says, “Oh my gosh, all these things have happened to me, and somebody is actually listening to it.” And when someone asks that and then empowers the parent to feel some validation for what they have survived and what they’ve dealt with. And that they as a parent have experienced something that may impact the way they parent. Is of such critical importance, I can’t overstate that.

And when it’s a pediatrician asking it, when it’s a mental health provider, when it’s anybody even, you know, at a DSS level, asking that parent and kind of talking to them at that level, I think is really, really important. The impact that that these experiences have on their parenting and what they’ve been able to do as a parent, I can’t understate as being a very important way to engage a parent.

[24:50] Teresa Huizar:
I think you’re bringing up a really important and interesting idea around family engagement, which is I think sometimes Children’s Advocacy Centers can struggle with getting parents to fully understand the benefits of mental health intervention for their kiddo.

And so, you know, we find in our own research that the most common reason that there may not be follow-through on a referral to mental health or completing mental health, it’s just the parent’s underlying belief that the child doesn’t need it.

And we’ve started to try to unpack that a little bit. Like, why is it that the parent may not believe that their child needs that? Well, there are a lot of reasons that that could be the case, but one of them may really relate—or we find it often relates—to their own prior experience themselves. And they’re sort of often having untreated trauma of their own, their own sense of they went through horrible things and they’re “fine”—I’m putting that in quotation marks—and so, you know, somehow the child is going to cope in the same way.

So it’s an interesting thing that it can be a vehicle for these discussions and really validating for a parent that, you know, they have themselves been through and, in many cases, overcome a great deal of adversity. And yet that can still very much impact their parenting and very much impact their kids today.

Lisa Amaya-Jackson:
So true. Well, very well said.

Teresa Huizar:
So what do you think, you know, as these conversations unfold, if you had some specific advice for Children’s Advocacy Centers and you know, how they go about not only talking to parents about this, but how they really talk to the general public.

You know, they’re out giving a presentation and, as you know, although we would like to believe that every single person already knows that, you know, child abuse can have a terrible lifelong impact if it’s untreated. And yet we also know there are fundamentally effective treatments for these things. How do you—how do you go about talking about those things, and how do you advise them to go about talking about this in a way that provides accurate information and is still hopeful?

Lisa Amaya-Jackson:
Oh, what a big question. You know, I feel like when we’re talking about child adversity and trauma, that it’s really important for people to recognize how frequent it is. You know, how much it happens. How it can have both immediate and long-term consequences. And how it can truly disrupt normal development.

And so that when we are thinking about it, we have to have a recognition that ACEs are important in the language. That, you know, it is cumulative and that some of these things that are very household, you know, child maltreatment and some of these household dysfunction, you know, let’s pay attention to that. Because this study has emphasized that what happens in the home and some of these things have this high impact.

But don’t forget other things like violence. Like disaster. Like loss. That often can occur individually and can co-occur. And to recognize that it’s not all about the score. I feel like all the good that has come out of the ACEs, one of the things that I feel like is important in that cumulative risk is something that many of us suspend our life trying to emphasize and don’t forget.

But now I’m feeling like we also have to say, but it’s not the whole story, and so it’s not just the score. The score is very important, but for someone to actually say the score is what is important and the individual items are not, is wrong. So I think that’s a very important to thing to say. And that in all of this, context is everything in that, when it happens to a child, what’s their understanding? What’s their level of development? And the aspect of meaning making and how important that is to the individual child within the family. And how to make connections kind of from self to community is another layer of opportunity.

I don’t want to go on and on because I’m not quite sure where I’m going hit the, you know, where I hit the exact pulse of this.

But I feel like in terms of thinking about trauma and thinking about adversity and recognizing that you have to have a lens towards that in our experiences of working with families is very important. And I’m so appreciative of that message.

[29:45] Teresa Huizar:
Yeah. And I feel like we’re going to have to continue working at this somewhat because, one of the things I was interested in over the last week or so, there’s a story about, the SATs had interestingly enough started using—and I, you know, it’s interesting, I don’t know exactly what the formula was—but that sort of an adversity score, which they added.

And it was interesting in that the individuals themselves couldn’t see this. It was based on things like, your neighborhood, your socioeconomic level, the school you were from, a whole variety of sort of larger macro issues. And they were assigning individuals a score, and schools that kids were applying to could see that score.

Well, over the last week or so, they backed off from that, sort of articulating something somewhat similar to what you were saying, which is what they were trying to do was provide context to colleges to know that the person standing in front of them, the score wasn’t all that could be said about them and their experience, right? Not just their adversity score, but their actual SAT score. But at the same time, at the end of the day, they had gotten really brow-beaten around this issue of assigning a specific one number that was supposed to calculate somebody’s adversity. So they withdrew from that. And now it sounds like they’re going forward where they’re providing that contextual information, but without a score.

And when I first heard this story in the media, I thought, “Well, this is interesting.” Because, first of all, you can see that they’ve been influenced in some way, whether it’s by the ACEs study or this general sense that things in your community and environment can greatly impact your educational experience and is important to be interpreted in your scores.

And at the same time, you could also see the resistance to this idea that a person can be encapsulated in one score. That their adversity can be encapsulated in one score. And it sounds like this is sort of an analogous thing, even in the child abuse world, intervention world, is that we have to realize that people are more than the sum of the terrible experiences that have happened to them. And while it’s important to talk about those things, its not the only factors that are important to talk about with kids.

The other thing that I’m wondering about here is the role of resilience in all of this. So not, you know, individual resilience. Yes. But also what can communities do, what can organizations do to help kids who have been through difficult things recover.

So we know mental health is critically important of course. But beyond that, are there things that can help kids in the face of these adversities be more resilient?

Lisa Amaya-Jackson:
You know, what a nice question.

I feel like, with children who’ve experienced, you know, difficult—had a lot of difficult experiences in trauma. That one is this recognition that, you know, trauma is complex. And there are many moments to these events. And there are many secondary consequences to that, reminders, ways that they react, ways that they recover. And that so much of that is impacted by their community, their family, the social contract, so to speak.

And so I think anything that we can do so that they don’t feel all alone. So that things that are enhancing their ability to make more of themselves. to interact with those, you know, the Big Brothers program, the connections, the inter, you know, being able to participate in activities that engage them in developmental things that they should be doing. Playing with their peers, learning give and take, playing in sports, being part, having caring adults be involved with them. Having food, having nutrition, feeling safe, being in a place where if their environment is not safe, they can be in a place where it is.

And, you know, I’ve heard Prevent Child Abuse talk about connections matter. They really do matter. So I think those kinds of things, I think recognizing that we need to have a trauma-informed lens so that when we know these things have happened and we see behavior that we would consider inappropriate and problematic, that we don’t zero in on the behavior and think, “This is, you know, a budding conduct disorder or sociopath.” But maybe this behavior comes from a trigger to a past experience that is making the child act in a certain way that, if we wear our trauma lens, we can recognize. And instead of want to punish or suspend, we can put our arm around and, you know, recognize they seem maybe a little out of control. And maybe I’ll take their hand and I’ll hold them and I’ll do something to kind of help them regulate because they’re emotionally kind of distressed by what’s happened to them in their past that’s been triggered.

I think that kind of awareness and, you know, you kind of put your finger right on the pulse, which we’re all struggling with this because there’s no one right answer. And the more we try to simplify it so that people get the message, we are then faced with the counter of: Well simple doesn’t work.

And we have to realize that, you know, you can’t put it all in a score. You can’t put it all in a screening tool. You can’t put it just in an impact of distress measure alone. All of these things have to work synergistically. I’ll bring that word back. You know, to have the impact. I feel like resiliency is both a beautiful word but it is a burden to us in that, you know, we know children are remarkably resilient. But we also know it can be up to a certain point.

And I think when we talk about the term resiliency, where we’re looking for how do we have a strength-based approach to some of these things that have happened to our children and our families. Never, never forget that. You know, it’s like you said, it’s the negative things that happened, but it’s those positive things about them and in their life that we can magnify.

But we also have to be careful that we don’t judge someone by, you know, “how resilient are you?” in any way that will discount what has happened to them in a way that kind of glosses over that and doesn’t give credence.

When we say things like, even I’ve heard people use the term resiliency score

Teresa Huizar:
Oh, dear.

Lisa Amaya-Jackson:
—that that makes me anxious, you know, makes me very anxious. Because they need the validation of what happened to them. But they need a strength-based approach. And they need that sense of caring community, that says, “We care, and we don’t care just about your mental health. We care about your physical health. We care about your education. We care about you socially. And we care about you as a person and an individual.”

[36:57] Teresa Huizar:
Well, and it seems to me, you know, because I really take your point about making sure that that term resiliency doesn’t get misused and applied in a way so that people feel like they’re responsible to be resilient. You know what I mean? That somehow, if they’re not suitably resilient, there must be something wrong with them. And I think it’s important for us to really be careful in the way we talk about that with the public.

But to me it seems like, really, many of the factors that we couch as resiliency are really community and family health matters more than anything.

Do you know what I mean? It’s not so much, often, about the person, him- or herself, it’s that person being strengthened through whether they have good family support. Or there are some caring adults that may even not be family, a neighbor, a person from their church, a person from, you know, some other Boy Scouts or Girl Scouts, or a mentor, or something that has this outsized positive impact and lets someone think that there is a positive future for them, even though they’re suffering right now.

And I think that, in many ways, resiliency is about the resiliency of the community as much as it is about anyone’s independent internal response to something. Because I think when we unpack resiliency and we start looking at what the factors are that build it, aren’t they really the same? They, they’re sort of the converse of adverse childhood experiences, right?

Instead of family dysfunction, it’s family functioning. It’s not having community violence. It’s, you know, having a school you can go to where you’re not worried that you’re going to be stabbed or shot or some other horrible thing. And so I just wonder, when we’re talking about these childhood traumatic experiences and we’re talking about ACEs, how much of it, we’re really also needing to be aware that we’re responsible as a community to provide a community experience to kids that minimize those experiences to begin with.

Lisa Amaya-Jackson:
Absolutely. Absolutely. And I’m appreciative, you know, of so much of our attention to the early childhood experience and the recognition of the importance of attachment of caregivers who are trying their best to be attuned to what a child needs. And who maybe, with help from professionals to know that you’re, you know, you’re not spoiling the child by, you know, looking into their eyes and paying close attention to them and mimicking their movements and having a sense so that when some things happen, this parent can be, you know, that buffer, that hand-holder through the experience.

On the flip side, to remember, you know, once you’re past early childhood not to forget the school age and adolescent who continues to, you know, have to struggle with—you know, we have some hard, hard times where, you know, navigating our world isn’t the easiest. And kids and teenagers are facing an interface with social media. Trying to be independent. Trying to, quote, “Be resilient.” They have baggage, perhaps.

And I feel like, just one message I want to make is: I am so in favor of early childhood. I’m so pleased to see that. But let’s not forget the school-aged child and the adolescent needing some help.

[40:27] Teresa Huizar:
You know, it’s interesting because while this conversation has really been, you know, around the issue of adverse childhood experiences and traumatic experiences that children have, it’s also really also been around kindness and compassion.

You know, viewing with empathy and with compassion not only the experiences that kids and adolescents have, but also that their parents have, and helping, you know, walk through this together. I’m wondering what, for you, whether it’s around this topic or some other things that you’re working on at the National Center, what’s sort of exciting or innovative in your world in terms of practice or research right now?

What do you think we ought to be paying more attention to, or eagerly awaiting word of, or just being attuned to?

Lisa Amaya-Jackson:
Hmm. What a nice question. I feel, you know, always within the NCTSN is helping people to kind of tease apart—I love your word unpacking—of understanding of all of these things.

So that whether it’s understanding kind of core concepts of trauma, and we have a core curriculum that tries to explain the core concepts of childhood trauma. The complexity of the trauma experience. The trauma-informed organizational assessment we’re working on so that we can share with different types of organizations, you know, ability to self-assess and get assistance on what are the areas of being trauma informed that they can work on.

You know, for us really kind of coming together around this language of what do we mean by ACEs and what do we mean by trauma, and how do we look at these synergies so that we can help people to understand. We are literally, I’m going into my next meeting to kind of talk about, you know, what are the synergies and what are some of the cumulative things that we’re seeing in our core data set that reflects in the real-life experiences of children in clinics, you know, more recently than say the ACE study from 1998, right? That was an adult retrospective study. So that makes me really excited.

I’m really excited about kind of thinking about what’s going on in our field and where does the trauma lens help us to understand? Whether it’s how children learn. Whether it’s how a pediatrician can best reach a child and a family. Whether it’s the mental health piece. You know, a true understanding of kind of where the rubber meets the road in terms of really valuing and understanding the experiences of children.

I think part of the issue is recognizing that when we hear and understand about what a child experiences, we are very privileged. And we are needing to recognize, you know, that what those experiences are shape a child.

It could be a thought that was accompanying the experience that they never forget for the rest of their life. It could be a look on a parent’s face as they’re being torn away from their hand, you know, out of their arms, that will haunt them the rest of their life. And our understanding at that level, you know, that sophistication, to me is very exciting.

I can relay that in a way, again, with the compassion, but with more than a number. It’s not just the score, it’s the experience.

You know, those things I think are, are really, really important. And people resonate to those. It helps them understand.

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Teresa Huizar:
Well, Lisa, I just so appreciate the work of the National Center and the National Child Traumatic Stress Network. You all have been a wonderful partner to us and to Children’s Advocacy Centers for, well, since your existence and certainly continuing on now. So I can’t wait to have further conversation with you about these things as they come into being.

And I know you have to rush off to a meeting to further discuss this, but we really appreciate the conversation and look forward to talking to you again.

Lisa Amaya-Jackson:
Thank you so much. This was a true pleasure.

[44:38] Teresa Huizar:
Thanks, Lisa. Bye-bye.


Teresa Huizar:
Thank you for listening to One in Ten. We hope you’ll tune in for our next episode. For more information about National Children’s Alliance and the work of Children’s Advocacy Centers, visit our website at

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