Adverse childhood experiences (ACEs) — such as abuse, neglect, family dysfunction, exposure to violence, and being subjected to prejudice and racism — can negatively impact a child’s developing brain and body, as well as long-term health and social outcomes. In New Jersey, over 40 percent of children are estimated to have experienced at least one ACE, and 18 percent are estimated to have experienced multiple ACEs. Given the prevalence of ACEs and their impact on the life course, New Jersey is coordinating a statewide strategy to prevent and help children and families heal from early adversity and trauma. With support from the NJ ACEs Collaborative, the Center for Health Care Strategies (CHCS) is convening New Jersey-based cross-sector stakeholders to inform an ACEs action plan for the state.
Dave Ellis, the newly appointed executive director of the NJ Office of Resilience, is working to help communities lead the state’s ACEs action plan with support from the NJ Department of Children and Families (DCF) and others. CHCS recently spoke with Dave to better understand his vision for addressing ACEs in New Jersey.
Q: People who work on addressing ACEs often note the “aha” moment that occurs when they first learn about the impact of early childhood adversity on lifelong health and behavior. Can you describe that moment for you?
You get to that “aha” moment when parents and people who do this work begin to understand that intervention at an adult level is prevention of ACEs at the child level.
A: I had the opportunity to talk with Vincent Felitti, MD, one of the co-principal investigators of the original CDC-Kaiser ACE Study, after a chance encounter in a session he was leading about the implications of trauma at a conference about eight years ago. During that session, Dr. Felitti sounded like he was talking exactly about my life, and that was the first time I realized I wasn’t crazy. I found the answer for what I believed was true: that what happens in your early life shapes the life you have now and how you respond to certain events. That was my “aha” moment. Although, there’s also a second “aha” moment when you ask yourself, “If that’s what happened to me, and I’m raising my kids the same way, what am I doing to them?” You get to that “aha” moment when parents and people who do this work begin to understand that intervention at an adult level is prevention of ACEs at the child level.
Q: How has understanding the science of ACEs impacted your thinking on how we can collectively improve health and well-being?
A: The original ACEs study illuminated the root causes of toxic stress. We’re good at diagnosing — in fact, that’s what we do all the time. In Minnesota, where I worked as a state employee for over 20 years, we tried to legislate our way out of smoking — we raised the cost of cigarettes; we changed where you can smoke; we talked about the impact of secondhand smoke. We wanted to scare people, but did we stop to ask why people smoke? The reality is, the chemicals in cigarettes reduce stress — so smokers are self-medicating, and people do drugs for that very reason. When you hurt enough, you will do something about it. These are our biggest health issues, and we need to deal with the root causes of them. If we can inject a little bit more listening, a little bit more compassion, a little bit more desire to actually talk about root causes, then we can actually begin to impact some of this work — which is what the science of ACEs does.
Q: You’ve shared that you believe that we are actually experiencing three pandemics — COVID-19, racial trauma, and ACEs. Tell us more about your thinking here, and how this informs the work that you are leading in New Jersey?
A: We look at the COVID-19 pandemic, racism, and ACEs as individual issues, but they’re intertwined. We don’t recognize racial injustices and ACEs as the true epidemics that they are. We can talk about the impact of COVID-19, while simultaneously addressing questions about racial health equity and racism being raised across the country regarding the killings of African American men and women.
Every day that I wake up, I may or may not get COVID-19, but I’m going to be Black and male for the rest of my life — people are going to see those aspects of me first. Over 200,000 people have died from COVID-19 in this country, but when I think about deaths caused by ACEs, we might be talking about millions of people. You can’t live in this country and not be exposed to trauma because we are founded on it.
Q: You are a huge proponent for letting the community guide the work to address ACEs. How are you centering the voice of the community, particularly the voice of communities that are often marginalized, while advancing a statewide strategy for addressing ACEs?
I don’t want them to guide it, I want them at the forefront — the true answers lie within the community.
A: I don’t want them to guide it, I want them at the forefront — the true answers lie within the community. So many people write grants, come back to the community to create a program, then leave once the funding runs out. This has been the history in communities for as long as I can remember. What message does that send to the community when you step away because there’s no more funding? I did not come to New Jersey with a plan; I came here with a process to get to a plan. That process starts with engaging those who are most impacted by ACEs, and that requires us to leave our offices and engage the communities we’re working with. This community-led effort is also supported by the public-private partnership among funders from the NJ ACEs Collaborative (The Burke Foundation, The Nicholson Foundation, and Turrell Fund) and DCF, who created a one-of-a-kind office within the Commissioner’s executive team. This partnership acts as a liaison across the state’s public, private, and philanthropic sectors to increase public awareness of ACEs.
Q: At a high-level, what’s your vision for addressing ACEs in New Jersey over the next two years?
A: It’s a process, but it is in part about discovering the good things already happening in New Jersey that people don’t know about. The key elements of that process include: gathering information about current efforts in addressing ACEs in the state; meeting with community-based organizations to let them lead our work; expanding leadership to include communities directly impacted by ACEs into the design process; collecting data on the project so people can engage with it; and letting community members know that an online community is now available for them to share their opinions on the ongoing work. Luckily, there are a number of teams that are investing in training community members to lead presentations on ACEs across the state.
Through this process, we hope to make a significant change in the state. Our goals for the statewide plan are to: (1) help children and families in New Jersey to reach their full potential by growing and developing in relationships that are safe, healthy, and protective; (2) reduce ACE scores in future generations; (3) resource programs and services based on what we learn rather than if we succeed or fail; and (4) look at solutions based on community input that address root causes rather than symptoms.
Q: What will your role be in operationalizing New Jersey’s statewide action plan on ACEs?
A: My role is to give people in New Jersey the tools to lead these efforts and to show them they can do it themselves. I don’t believe that my role should be to stay here and continually take money to do this work because it parallels that cyclical nature of funding. Nobody knows the state of New Jersey better than the people in the state of New Jersey.
Q: Do you have any early advice for other states looking to advance their efforts to address ACEs?
Different parts of a community need to be involved because they have a vested interest. If we don’t recognize existing programs, we’re going to lose them and the people who do the work.
A: First, I want people to know that this is heart work — it’s consent-based and readiness-driven. Know that you can’t do this alone — different parts of a community, including local businesses, philanthropic organizations, faith-based organizations, and medical and research communities — need to be involved because they all have a vested interest in this. There are a lot of effective, evidence-based programs out there, and the community knows they work because that’s where they go when they need help. If we don’t recognize and value these existing programs, we’re going to lose them and the people who are doing the work.