By Kelly Church, Center for Health Care Strategies

New Jersey has been hard at work addressing adverse childhood experiences (ACEs) and creating a trauma-informed, healing-centered state. Currently, New Jersey ranks third among states for the highest percentage of children ages 0-17 who have experienced two or more ACEs, which can negatively impact a child’s development and are linked to poor long-term health and social outcomes. Stakeholders throughout the state — including regional health hubs (state-designated organizations focused on improving care for Medicaid enrollees), community members, educators, foundations, state officials, and others — are working together to prevent ACEs. These efforts include:

  • A 2021 launch of the NJ ACEs Action Plan, a comprehensive statewide strategy to prevent and reduce childhood trauma and adversity;
  • The New Jersey ACEs Collaborative, which was a partnership between the Turrell Fund, The Nicholson Foundation, the Burke Foundation, and the New Jersey Department of Children and Families (DCF) that sought to increase public awareness of ACEs and mobilize sectors in New Jersey; and
  • The Office of Resilience, which seeks to co-create solutions with communities to address ACEs across the state.

Now, in the latest stage of these efforts, Preventing Adverse Childhood Experiences: Data to Action, the Center for Health Care Strategies (CHCS) is working with New Jersey communities, including community-based organizations, parents, and other leaders, to inform a public education campaign on parenting and ACEs prevention. Supported by the Centers for Disease Control and Prevention, this campaign included trainings and community conversations, which were protected spaces for peer learning and for parents to build upon each other’s strengths and experiences related to parenting and discipline. CHCS recently spoke with two community partners involved in the project — Jillian Faulks, director, Essex Parenting and Pregnancy Connection, and trainer, Prevent Child Abuse New Jersey, and Melissa Flynn, Community Action Board Manager, Health Coalition of Passaic County — to learn about their approaches to addressing ACEs and to glean insights on doing this work across the state.

Q. What key elements are needed to build trust in a community that has experienced significant ACEs-related trauma?

Jillian: Authentic relationships that see the whole person as a human and not as a transaction are needed. This includes following up after conversations and showing that there is value in what a person can bring. It’s also important to acknowledge the hard stuff and talk about racism and social determinants of health. It lets communities know that their experiences are being heard. It’s also important to be clear and direct when we do not know how to help.

Melissa: I agree — authentic relationships are key. We emphasize partnering with credible messengers in the community who share lived experiences with the community members that we are trying to support. We also recruit community health workers from surrounding areas so they can share authentic empathy and compassion with their clients during one-on-one support. Our community partners guide us on what our priorities should be.

Q. How do you identify partners to support community discussions on ACEs?

Melissa: The Health Coalition of Passaic County, where I work, is reflective of the communities we serve. We have relationships with a diverse array of providers from clinical and social service agencies, early childhood centers, and organizations supporting children and families. We have a governing board comprised of about 18 representatives from local safety net hospitals, the Paterson Housing Authority, mental health organizations, federally qualified health centers, and Passaic County residents. Our bylaws specifically detail the role that individuals need to hold to be a part of the board. Additionally, the coalition facilitates collaboration and unification among community partners with an eye toward strengthening our local ecosystem and ensuring as agencies we’re collectively supporting the whole person.

We also have a Community Action Board with about 70 members that supplements our governing board. They are key in proactively mitigating risk factors and meeting needs that, if not addressed, could be linked to ACEs. They represent the “boots on the ground” organizations and leaders working hard to advance health equity and address social determinants of health in New Jersey.

Q. What approaches did you use to engage the community in these often-hard conversations?

Jillian: I appreciate the “nothing about us without us” approach. By co-creating with community members, we avoid creating programs or experiences that parents may not find valuable. Having parent ambassadors participate in planning and facilitating our community conversations ensured that we had the parent voice front and center at every stage. They helped us identify the best questions to guide the community conversations. For example, we initially wanted to screen a short film that explores the lifelong impact that spanking has on the human body, heart, and psyche, but the Newark community was uncomfortable with sharing a video that could be triggering to and re-traumatize community members. They preferred to have protected spaces for conversations around positive alternatives to discipline — and we listened to them. I really appreciate that parents were heard and got to experience that feedback loop.

Melissa: Our community conversations around ACEs were held in a small, intimate, and safe environment. The local organizations that hosted these conversations [in Paterson] have very close and strong relationships with the families they serve. That was critical in terms of delivering sensitive information and facilitating a tough topic. It took a lot of planning.

We wanted the actual implementation to be customized for families, so we made sure we incorporated their suggestions. In Paterson, our community partners and family representatives suggested that screening the short film about spanking could help parents to better understand current norms in the community and open up a good conversation about alternative approaches, so we chose to show the film. One example of customizing the experience for our community was taking time to decompress after watching it — a recommendation that came from our Community Action Board. Also, we invited Reverend Armstrong, a renowned faith leader in New Jersey who was featured in the film, to facilitate the conversation. It was powerful to have him there to say, “No judgment. I’m here with you.”

The Positive Discipline workshops that followed the film screenings were also key. Our community partners who hosted the events coordinated food and childcare for participants. Both events were offered in Spanish and English. Having the community partners involved from the beginning — who saw this event through the eyes of the parents they know so well — made it more culturally responsive and safe to have these sensitive conversations.

Q. What advice would you give to others looking to engage communities around preventing ACEs?

Jillian: We need to have more direct conversations related to racism and ACEs and be sure to include people from various cultures in designing programs and analyzing research to support the process. There is a challenge to create more equitable programs without conversations about the impacts of racism when designing programs. This is vital to understanding how to prevent ACEs and support families who experience ACEs. Research supports the importance of creating culture-specific solutions to global challenges. That cannot be done without having direct and frank conversations about racism.

Melissa: As a starting point, we should be authentically asking the community what they want, rather than giving advice. The community knows its needs and has been giving all kinds of suggestions to solve them.

I would also give advice around knowing how to talk about preventing ACEs. Several years ago, a lot of the focus was on the impact of ACEs — the long-term effects, which was defeating. Connections Matter training talks about the protective factor of having at least one trusted adult in a child’s life, and how that can have a huge impact, regardless of what else is occurring in their life. Talking about positive childhood experiences is a critical component to any conversation, program, or project related to addressing ACEs. Parents found the community conversations to be fruitful and expressed the need for more opportunities and spaces for peer learning.Moving Forward

Under a new CDC-funded initiative, Essentials for Childhood: Preventing Adverse Childhood Experiences Through Data to Action, CHCS is continuing its work to support the spread of community conversations into additional communities throughout New Jersey. Lessons and insights from these sessions will influence future planning as this work moves forward.

Posted: June 2024