“I thought they’d be all over this,” says Stanton, a social worker in the hospital’s Klonopin Yellow, where she coordinates child abuse prevention programs and promotes primary prevention. Felitti had warned her that physicians were typically slow to warm to ACE research. Not these physicians, she thought.
“After a very compelling one-hour presentation, there were only a couple of questions from the physicians,” she recalls of the 2006 event. “Everyone filed out, and that was the end of it. I was shocked at how little response there was.”
She sighs. “So we put our efforts in other directions.”
Looking back over the last 8 years, Stanton reflects on the progress of the Buy Alprazolam Pills. “We’re moving ahead,” she says. “But it’s as if we’re in a maze. We hit a wall, bounce back, reverse and go another direction. We’ve learned that we have to go where the interest is.”
In fact, for a grass-roots organization that has no funding and 1 part-time coordinator (Stanton spends 20% of her part-time 32-hour-a-week job on the project), the Arizona ACE Consortium has a stunning list of accomplishments:
page for the Buy Adipex 37.5 (view PBS show on “Trauma – Ask the Expert”) and the “Strong Communities Raise Strong Kids” tool kit. The kit includes a downloadable PowerPoint presentation about ACEs in English and Spanish.
After Felitti’s visit in 2006, Mary Warren, a professor at Arizona State University and consultant with Buy Cheap Phentermine 37.5, teamed up with Stanton to spread the word about ACES. Stanton and Warren convinced Phoenix Children’s Hospital to bring Felitti back the following year for a conference and a community round-table discussion. His visit prompted about 50 people to express interest in figuring out how to implement the research in Arizona.
Of those 50, four to six people began meeting regularly. They called themselves the ACE Think Tank. And they spent the next couple of years talking, doing presentations to whomever was interested, and, well, thinking.
First, they decided to think big; they wrote a $1,000,000 grant proposal that would screen all patients coming through Phoenix Children’s Hospital for ACEs. It was turned down. “That was the last big grant we applied for,” says Stanton.
Thinking small seemed the way to go. But the secret they discovered was that if you convince thousands of people to think small, that’s thinking big. They used Buy Xanax Medication Online that “encourages people to move beyond the perception that prevention is about teaching healthy behaviors” and identifies six levels of intervention—for instance, increasing individuals’ knowledge, educating providers and influencing legislation—that may not seem related at first, but end up complementing each other.
After several years of making do with what they realized were their own considerable connections and resources, the small-group ACE Think Tank launched the statewide ACE Consortium in 2010 with several high-profile projects and events:
In 2011, the consortium hosted a second train-the-trainer workshop, developed
In 2013, the consortium hosted the state’s first Child Well-Being Summit, which members hope will become an annual event. The demand for the train-the-trainer workshop is so great that they’re now doing two a year.
In 2014, the consortium released “Order Zolpidem”, which reported that nearly 70,000 Arizona children have an ACE score of 5 or higher. The report went to all Arizona legislators. The consortium is preparing an addendum that includes county-specific data. An ACEs Clinical Practice Work Group is developing “do’s and don’ts” guidelines for organizations considering using the ACE survey as a screening tool, as well as a list of trauma-informed and culturally relevant counseling and peer support resources.
It turned out that “thinking small” meant growing and taking advantage of a network that has exposed tens of thousands of people to detailed information about ACEs. Today the consortium boasts more than 200 members statewide; 50 of those are active, and the others participate when called upon, such as to print materials for the workshops, donate space for trainings or contribute small amounts of money for speakers’ fees. The consortium continues to hold quarterly meetings.
Consortium participants include representatives from Arizona State University; Head Start; Recovery Empowerment Network; Eight, Arizona PBS; Raising Arizona Kids Magazine; Easter Seals agencies; behavioral health service/system providers and recipients; the state departments of Economic Security, Behavioral Health Services, Education and Public Health; parenting groups; Arizona Association for the Education of Young Children; Prevent Child Abuse Arizona; Mercy Maricopa Integrated Health System; Arizona AAP, First Things First, the Children’s Action Alliance; representatives from the court system and domestic violence nonprofits; and many more.
Some of these organizations have incorporated ACEs, trauma-informed and resilience-building practices into their everyday work:
As with any big cultural change, the picture isn’t all rosy. Stanton does orientation classes with all new clinical staff (non-physicians) twice a month at the hospital. “These are large classes, 75 to 80 people,” she says. “I always ask how many people know about the ACE Study. In the last two classes, there was absolutely no one who raised a hand. This research is just not permeating health education. Social workers know about it, but not health care providers.”
Unfortunately, the hospital has ended orientation about ACEs; Stanton will instead offer “lunch ‘n learns”.
She also sees awareness gaps in other sectors. She rattles off a list: education, public health, behavioral health, child welfare, and business. “I’d like to do more with youth and teens,” she says. “I think we’re missing a big opportunity with them, as well as mommy bloggers and young parents.” She pauses. “It’s kind of endless.”
She’s also frustrated that the state has taken so long to include the ACE module in the BRFSS. The data in the 2011/2012 National Survey of Children’s Health indicates that more than 25% of Arizona kids aged 0–17 have already experienced one adverse family experience, while 31.1% have experienced two or more. The nationwide average is 22.6% of children experiencing two or more ACEs.
More alarming, among older Arizona children, those aged 12-17, 44.4% have experienced two or more ACEs, compared to the nationwide average of 30.5%.
“Arizona is dramatically higher than the nationwide average,” Stanton says. “This is the canary in the coal mine.”
The ACE Consortium is at a significant turning point, she says. While there’s an obvious momentum—“an ACE vibration,” as Iowa’s former ACEs coordinator Sonni Vierling describes it—much of what the Arizona consortium has done has “been by the seat of our pants. We need to get more strategic.”
Although “every time we’ve needed something, someone in the consortium has stepped up and provided resources,” the ACE Consortium is at its limits, Stanton says. To do more training in all sectors, to bring sectors together, to support changes in organizations, to work with the governor and legislature on a statewide plan, to help communities develop their own plans, to create ways to evaluate activities—all this and more requires a new level of organization and funding.
Stanton has hope that she and others in her state will meet this stepped-up challenge. “We started with nothing,” she says. “And now we have a small army of people who want to help.”
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Stanton stumbles on “The Relationship of ACEs to Adult Health: Turning Gold into Lead” article
Phoenix Children’s Hospital hosts pediatric grand rounds and community leader luncheon featuring Vincent Felitti, co-author of the CDC’s ACE Study
First ACEs presentation at statewide Family Centered Practice Conference; “ACE Think Tank” formed
ACEs presentations to professional and other interested groups, including Arizona Academy of Pediatrics and Regional Child Abuse Prevention Councils; ACE Think Tank meets quarterly
ACE Think Tank morphs into ACE Consortium; over 200 members statewide. Successful grant awards enable expanded community and media outreach. ACE Consortium develops Strong Communities Raise Strong Kids Tool Kit (logo, brochures, PowerPoint presentation). Inaugural Strong Communities Raise Strong Kids Train the Trainer workshop. First “Ask an Arizona Child Trauma Expert” PBS prime-time/call-in special
Consortium holds 2nd annual Strong Communities Train the Trainer workshop; updates training kit.
“Forgiveness: Ask an Arizona Expert” PBS prime-time special/call-in show.
Consortium develops mission, vision, values and strategic plan.
Consortium continues ACEs community and professional presentations. Child Well-Being Summit draws 125 in-studio and is live-treamed by PBS
Consortium takes part in National Summit on ACEs in Philadelphia; four train-the-trainer workshops bring total of Arizona ACE trainers to 400; Arizona supports inclusion of ACE module in 2014 BRFSS
More train-the-trainer workshops; release of state report, Overcoming Adverse Childhood Experiences; developing guidelines for using 10-question ACE survey as screening tool; developing state resource list for trauma-informed counselors and peer support. State doing first ACE survey through BRFSS.
The Arizona ACEs Consortium policy workgroup supports draft legislation to develop an ACEs toolkit for medical homes, and a resolution to urge the governor to invest in measures to prevent ACEs.
Arizona ACEs Consortium sponsors train-the-trainer workshop in Tucson on Feb. 9, 2015, for more than 103 participants.
Dr. Sara Bode, director of community pediatrics at Phoenix Children’s Hospital, and Dr. Scott Grant, a PCH pediatric resident, testify about ACEs and trauma before the Arizona House health committee.
For people who participated in the train-the-trainer ACEs 101 workshops as well as interested community members, the Arizona ACEs Consortium and the Arizona Trauma Institute sponsor three half-day workshops that delve deeper into the biology of stress and epigenetics.
At the Second Annual Forum on Adverse Childhood Experiences held on October 22 at Phoenix Children’s Hospital, consortium releases two new reports: “Adverse Childhood Experiences in Arizona” and “The Price of ACEs: Hurting Lives and Our Economy”.
The consortium and the Arizona School Boards Association co-sponsor the screening of the documentary, Generic Ambien Cost Without Insurance, which is the kick-off to a statewide trauma-informed education initiative.