Photo: Kate Samp for Strategies for Children

Worcester, Mass., wants to do more for its children by offering trauma-informed care.

The city’s goal is to look at what scientists call ACES — adverse childhood experiences — and understand their impact on children and how these impacts can cause health problems once children are grown.

“We had been thinking about the vulnerability of our populations in Worcester,” Kim Davenport says of work that was going on around the city. Davenport is the managing director for Birth to 3rd Grade Alignment at Edward Street Child Services.

Among the city entities that were thinking about children was Worcester Hears, a local coalition focused on bringing together “advances in brain science, child development, and best practices to address childhood adversity” to help public school students. (Worcester Hears unites the Worcester Public Schools, The Health Foundation of Central Massachusetts, the Worcester Education Collaborative, and other organizations.)

The YWCA Central Massachusetts was also thinking about vulnerable children, and it invited Dr. Heather Forkey of UMass Medical School to speak at a breakfast event that Davenport and other local partners attended.

“She actually put science to some of the long-term implications of children witnessing or experiencing issues of trauma,” Davenport says about Dr. Forkey.

Forkey talked about ACES, highlighting a major, long-term Kaiser Permanente study, “one of the largest investigations of childhood abuse and neglect and later-life health and well-being,” according to the Centers for Disease Control and Prevention. Forkey gave a speech on childhood trauma in 2015.

What are ACES? The federal Substance Abuse and Mental Health Services Administration says that ACES include:

physical abuse

sexual abuse

emotional abuse

physical neglect

emotional neglect

intimate partner violence

mother treated violently

substance misuse within household

household mental illness

parental separation or divorce

incarcerated household member

As the Worcester Telegram and Gazette reported last year:

“Until recently, health care professionals and educators would look at an unruly or seemingly unteachable child as the problem, said Dr. Heather C. Forkey.”

“ ‘We would’ve asked the question, “what’s wrong with them?” ’ said Dr. Forkey, chief of the Division of Child Protection at UMass Memorial Medical Center. ‘It turns out, we were asking the wrong question.’ ”

“The right question, which she said has a lead to a ‘revolution’ in pediatric care and education, is not what’s wrong with those kids, but what happened to them that made them that way. Many of them, researchers have discovered over the past two decades, suffered trauma that not only negatively affected their emotional well-being, but also worsened their mental health, their physical health – and even altered their DNA.”

The impact of ACES can last for years. Children who endure a high number of ACES are more likely as adults to suffer from diabetes and heart attacks, the National Institutes of Health reports. In addition, “poor mental health and poor stress-related coping behaviors, such as smoking, obesity, and lack of exercise were more prevalent among adults who experienced ACEs…”

“If the danger is always there,” Davenport explains, “where can a child go?”

As grim as this scientific understanding is, the good news is that interventions can help, according to Dr. Nadine Burke Harris, a national ACES expert who spoke last year at Worcester Technical High School.

Burke Harris has also given a TED talk on ACES.

A key strategy for addressing ACES is to assess families’ needs and provide appropriates services — such as mental health support and parenting skills classes — so that children and parents can develop resilience.

“We knew we had to get this information to our community partners,” Davenport says.

In early education settings this means recognizing that even very young children face severe adverse experiences. To help them, early educators have to create safe environments. It’s also important, Davenport says, to think about helping children make successful transitions throughout their day. That might mean spending longer blocks of times on activities or using soft music to signal that it’s clean-up time or giving children jobs that help with transitions so that they are part of the process.

“It’s raising awareness of the social/emotional climate in a classroom.”

Davenport says that Worcester’s Rainbow Childhood Development Center is using art therapy techniques to work with children. The center also created an activity where children and parents participate in creating a mural. It’s a chance “to play and have a wonderful art experience… so that families can just come and be with their children… It’s the offline LinkedIn model that helps families connect with each other.”

What makes Worcester’s approach so promising is the broad-based community involvement, the conviction that everyone can help children recover from ACES.

“I’m thrilled that so many people are learning about the science and the solutions,” Davenport says. “It went from a hopeless lens to a more hopeful lens. And it allows adults from across settings — whether they are engaged in health care, in education in business leadership or philanthropy — to understand that there are things that can be done.”