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Adverse Childhood Experiences and Building Resiliency
Adverse childhood experiences (ACEs) are linked to chronic diseases in adulthood. Kellie Flock and Marielle Silk discuss ACEs and resiliency.
Featured Speakers:
Learn more about Marielle Silk, FNP
Kellie Flock, PA-C graduated from the Pennsylvania College of Technology Physician Assistant Program and specializes in General Practice.
Learn more about Kellie Flock, PA-C
Marielle Silk, FNP | Kellie Flock, PA-C
Marielle Silk, FNP, BC, came to the Outer Banks originally in 2010. She left for a few years after having her first child, and then moved back permanently in 2016. Silk has a Bachelor of Arts in psychology from Wesleyan University in Connecticut, a Bachelor of Science degree from the New York University College of Nursing and Master of Science degree in nursing from Yale University.Learn more about Marielle Silk, FNP
Kellie Flock, PA-C graduated from the Pennsylvania College of Technology Physician Assistant Program and specializes in General Practice.
Learn more about Kellie Flock, PA-C
Transcription:
Adverse Childhood Experiences and Building Resiliency
Caitlin Whyte: Research has proven that adverse childhood experiences known as ACEs have long-term impacts on our health, not only during childhood, but throughout our lives. There is a direct connection between traumatic experiences and chronic disease such as diabetes, heart failure, and cancer, but resiliency is a key to dealing with ACEs, allowing someone to deal with life's challenges and not become drained of energy and resolve. Dare County has worked with community and regional partners to provide educational events on the topic for teachers, counselors, and medical professionals. Their community partners such as CYP and Dare County Schools have developed pilot programs focused on mindfulness in the elementary and middle schools. Today we're joined by Pediatric Physician's Assistant, Kellie Flock and Family Nurse Practitioner, Marielle Silk. To talk more about ACEs and resiliency. This is Outer Banks Health. I'm your host, Caitlin Whyte. Let's start with you, Kellie, give me a brief overview of what an adverse childhood experience is?
Kellie Flock: So you could look at adverse childhood experiences as the big things or also there are smaller things, but the big ones that we are looking for and screening for are personal traumas, physical abuse, verbal abuse, sexual abuse, physical neglect or emotional neglect. We're also looking for familial traumas, addiction, domestic violence, a family member who was incarcerated. Mental illness, especially in parents and family members is huge. Divorce can be an adverse experience for sure. Abandonment by a family. So those are our kind of big ones. There are things too that we tend to not think of that certainly can, can adversely affect, especially a child, something, you know, like moving multiple times in the same year. Things like we're only Outer Banks, weather related things, hurricanes, losing a home or having flooding or an experience like that that as an adult or you know, someone who has seen those things before, we may not be as affected as a child who this is the first time they've experienced that or they experience it time and time and time again.
Host: Talk about your collaboration with these other agencies and how community resources can be used as a way to heal?
Kellie Flock: So that's a great question. We are still, I will say first and foremost we're still working on that and that's an area where we definitely need help. We need more resources to be able to adequately deal with this kind of stuff. But we do, we have started to have some agencies through some grant funding that can pick up children. So we have one organization for example called Child First through an organization called Kids First. But Child First, it's a program for kids zero to five where if we recognize this in the office or with a family or a patient, we can contact them and say, I'm worried about this kid, I'm worried about this family and I need you guys to come in. And then they are able to pick up that referral, really screen heavily, spend a lot of time at the family, and they end up working with them for at least a year, if not longer with therapists, social workers, just getting a family what they need and not just addressing what the child may be experiencing. But then also traumas within the parent because that is usually part of what is contributing if not all of what is contributing to how their child is being raised. So, that's been a really valuable resource for us as kids get older and we're seeing, you know, with adults as well, places like the center for healthy living are really helpful as well because we can target and send over referrals where they're able to dig in deeper on the subjects that we're just not able to do with the time constraints that we have sometimes.
Host: So you say this is something you're trying to grow, you know, this outreach in your community. What would you like to see as far as resources? Is there a specific group?
Kellie Flock: I think it's availability. So we're in a very rural area. So availability of specialties in general is tough. We live on a sliver of land in the middle of the ocean, so we don't have a ton. But even in bigger areas, mental health care is lacking hugely. So you know, for a child who is struggling, we may be able to find them a counselor. But finding a psychiatrist, you know, we have six to nine month waiting lists for urgent problems just because there's sheer, the sheer numbers, there's not enough people to tackle this. And the amount of kids and families that are affected are astronomical. So there's a disparity between just the amount of people able to take care of them because it takes a lot of time, you know, so you could have a good number of specialists available, but if they have to spend a couple hours with each family, that limits the amount of people that they can see. So we just need more people in general that are willing and want to go into these specialties and take on this kind of, these kinds of issues.
Marielle Silk: Can I add in something there? When working with adults also at the Center for Healthy Living, we come across a lot of adults who have experienced phases or adverse childhood experiences as a child, and the same thing, we want to plug them into the right resources. We can plug them in with social workers, with therapists, but there are not enough psychologists and psychiatrists to address these issues in this area.
Host: And now, Marielle you've mentioned that part of your title is a lifestyle medicine specialist. Tell us a bit more about this work, what it means and how it's used to help people with ACEs?
Marielle Silk: So we work with a lot of adults and a lot of times when we're working with adults on their chronic medical issues, we uncover that they've experienced ACEs as a child. We know that in the research that advert experiencing early life trauma and neglect and other adverse experiences increases in adults, risk of medical and psychological issues such as alcoholism, drug abuse, depression, poor physical health, tobacco use, obesity, and anxiety. When we're working with adults on, you know, on different topics like weight loss, improving their heart health, improving their diabetes or reducing joint pain. A lot of times we uncover that they've experienced ACEs and they may not have gone through the proper professional help to help them cope with those. So we'll plug them back in to work with the therapist and hopefully kind of move past that so it's no longer a barrier to them achieving their optimal health.
We also have started seeing pediatrics and adolescents, and we work with them on lifestyle changes as well and part of that is fostering resiliency and improving their coping skills. So learning how to eat a healthy diet and get proper sleep and physical activity and stress management, that while of course that can't erase any of the ACEs they may have experienced, it can hopefully lower the impact that it has on their physical and mental health. We also, in research, it's known that toxic stress experienced in pregnancy can negatively impact the genetics passed on to the fetus and field development. So we know that pregnant women really need that support to help build resiliency, lower their stress levels and just have a healthy lifestyle so that any stress that they're experiencing isn't going to negatively impact their baby. Yeah, it's interest, there is a study that they did where they looked at infants born to women with four or more ACEs and those infants were two to five times more likely to have poor physical and emotional development by the age of 18 months which is pretty striking and sobering.
Host: I've heard resiliency come up a lot in this conversation. What are we talking about when we talk about resiliency in this situation?
Marielle Silk: I think just helping them have the some positive coping skills early on, so turning towards healthy mechanisms to deal with stress like meditation, mindfulness, exercise, you know, community as positive social experiences so that they can help negate any stress that they're experiencing rather than when it's not addressed and they aren't taught positive coping skills. Then we see, you know, earlier lessons then later on negative coping skills coming out. Alcoholism, tobacco use, overeating, even suicide or self harm. So it's teaching them at a young age the positive coping skills that they can turn to throughout their life when they experience something adverse.
Kellie Flock: Yeah, I can add to that. You know, I think there's a balance as well, so, so we're kind of stuck in this place parenting wise too right now with this generation where we're really trying to teach mindfulness and give all these positive experiences that we've kind of moved to, everybody gets a trophy situation and you know, our parents would say and grandparents would say, you don't always get a trophy and you need to, you know, suck it up and learn that maybe you play better next time. And parents nowadays are, are scared of that. There's a balance, you know, of course we want kids to have experiences where they're happy and they feel supported and that's such a huge part of their development. But there's also having positive experiences where they learn that this didn't feel great. This was stress and this is how I deal with it. And so that's a really tough, I wish I had a better answer to how to teach that to parents. I'm learning it, and I'm sure you probably are as well myself. It's a tough place to be in, but there's, there's a middle ground that you have to find.
Marielle Silk: Yeah, we talk about that with adults too, about kind of leaning into some of the negative experiences that are part of life and not necessarily just trying to make everything seem all happy and positive and that you just need to have the skills and same thing with children to, you know, realize that the hard things in life, they're going to happen. And then you kind of let yourself feel that and then you move on and you know, hopefully grow from it.
Kellie Flock: Yeah. We talk about that a lot with teenagers. And again, when we're talking about ACEs, we are talking about bad stress. We're talking about toxic stress, but there is good stress as well. And so helping, especially I see this more in older kids and teenagers, but helping them to figure out what's good stress and what's bad stress and then recognizing in those really young kids and the parents, you know, what's their reaction to good and bad stress because that will help shape how their kids react to things as well. The one thing that I would say is, you know, going back to having availability of resources, I hate that kind of healthcare is in this place, but there's a financial and a cost association with all of this and I think a lot of why we don't have the resources we need drives back to being able to support and fund, and that kind of thing. But we need to look at the financial costs of this pattern that's happening.
And we know that not only are there immediate costs for when children go through abusive situations or neglectful situations, but then there's these secondary longer term costs, special education, juvenile delinquency, criminal justice system, healthcare, long-term mental and physical, and just lost productivity, that we need to start thinking about. And so if somebody could get a better handle on that, cause that would be amazing because I think that we need to fix the system a little bit to make this work better.
Marielle Silk: I agree. We need to invest in our children and especially the zero to five age and support, you know, childcare support, working parents, all of that so that the, we can stop these adverse events from happening and leading to, you know, increase costs throughout their life, physically, mentally, and financially. But in talking about, you know, just the effects on society. James Heckman, who's a professor at the University of Chicago and won the Nobel Prize, so he's a smart guy. He has a quote that says, early nurturing learning experiences and physical health from ages zero to five greatly impact the success or failure in a society. And I think that puts it in a nutshell, exactly what we're talking about.
Kellie Flock: And the other quote was a quote from Pam Dayo, it's children need at least one person in their life who thinks the sun rises and sets on them. Someone who delights in their existence and loves them unconditionally.
Host: Well, thank you so much for your time, Kellie and Marielle. You can call (252) 449-5978 to make an appointment with Marielle Silk at the Center for Healthy Living. That's (252) 449-5978. To make an appointment with Kellie Flock, you can call (252) 255-5321, that's (252) 255-5321. If you enjoy this episode, you can find more like it in our podcast library and be sure to share this episode on all your social channels. This is Outer Banks Health. I'm Caitlin Whyte. Thanks for joining us.
Adverse Childhood Experiences and Building Resiliency
Caitlin Whyte: Research has proven that adverse childhood experiences known as ACEs have long-term impacts on our health, not only during childhood, but throughout our lives. There is a direct connection between traumatic experiences and chronic disease such as diabetes, heart failure, and cancer, but resiliency is a key to dealing with ACEs, allowing someone to deal with life's challenges and not become drained of energy and resolve. Dare County has worked with community and regional partners to provide educational events on the topic for teachers, counselors, and medical professionals. Their community partners such as CYP and Dare County Schools have developed pilot programs focused on mindfulness in the elementary and middle schools. Today we're joined by Pediatric Physician's Assistant, Kellie Flock and Family Nurse Practitioner, Marielle Silk. To talk more about ACEs and resiliency. This is Outer Banks Health. I'm your host, Caitlin Whyte. Let's start with you, Kellie, give me a brief overview of what an adverse childhood experience is?
Kellie Flock: So you could look at adverse childhood experiences as the big things or also there are smaller things, but the big ones that we are looking for and screening for are personal traumas, physical abuse, verbal abuse, sexual abuse, physical neglect or emotional neglect. We're also looking for familial traumas, addiction, domestic violence, a family member who was incarcerated. Mental illness, especially in parents and family members is huge. Divorce can be an adverse experience for sure. Abandonment by a family. So those are our kind of big ones. There are things too that we tend to not think of that certainly can, can adversely affect, especially a child, something, you know, like moving multiple times in the same year. Things like we're only Outer Banks, weather related things, hurricanes, losing a home or having flooding or an experience like that that as an adult or you know, someone who has seen those things before, we may not be as affected as a child who this is the first time they've experienced that or they experience it time and time and time again.
Host: Talk about your collaboration with these other agencies and how community resources can be used as a way to heal?
Kellie Flock: So that's a great question. We are still, I will say first and foremost we're still working on that and that's an area where we definitely need help. We need more resources to be able to adequately deal with this kind of stuff. But we do, we have started to have some agencies through some grant funding that can pick up children. So we have one organization for example called Child First through an organization called Kids First. But Child First, it's a program for kids zero to five where if we recognize this in the office or with a family or a patient, we can contact them and say, I'm worried about this kid, I'm worried about this family and I need you guys to come in. And then they are able to pick up that referral, really screen heavily, spend a lot of time at the family, and they end up working with them for at least a year, if not longer with therapists, social workers, just getting a family what they need and not just addressing what the child may be experiencing. But then also traumas within the parent because that is usually part of what is contributing if not all of what is contributing to how their child is being raised. So, that's been a really valuable resource for us as kids get older and we're seeing, you know, with adults as well, places like the center for healthy living are really helpful as well because we can target and send over referrals where they're able to dig in deeper on the subjects that we're just not able to do with the time constraints that we have sometimes.
Host: So you say this is something you're trying to grow, you know, this outreach in your community. What would you like to see as far as resources? Is there a specific group?
Kellie Flock: I think it's availability. So we're in a very rural area. So availability of specialties in general is tough. We live on a sliver of land in the middle of the ocean, so we don't have a ton. But even in bigger areas, mental health care is lacking hugely. So you know, for a child who is struggling, we may be able to find them a counselor. But finding a psychiatrist, you know, we have six to nine month waiting lists for urgent problems just because there's sheer, the sheer numbers, there's not enough people to tackle this. And the amount of kids and families that are affected are astronomical. So there's a disparity between just the amount of people able to take care of them because it takes a lot of time, you know, so you could have a good number of specialists available, but if they have to spend a couple hours with each family, that limits the amount of people that they can see. So we just need more people in general that are willing and want to go into these specialties and take on this kind of, these kinds of issues.
Marielle Silk: Can I add in something there? When working with adults also at the Center for Healthy Living, we come across a lot of adults who have experienced phases or adverse childhood experiences as a child, and the same thing, we want to plug them into the right resources. We can plug them in with social workers, with therapists, but there are not enough psychologists and psychiatrists to address these issues in this area.
Host: And now, Marielle you've mentioned that part of your title is a lifestyle medicine specialist. Tell us a bit more about this work, what it means and how it's used to help people with ACEs?
Marielle Silk: So we work with a lot of adults and a lot of times when we're working with adults on their chronic medical issues, we uncover that they've experienced ACEs as a child. We know that in the research that advert experiencing early life trauma and neglect and other adverse experiences increases in adults, risk of medical and psychological issues such as alcoholism, drug abuse, depression, poor physical health, tobacco use, obesity, and anxiety. When we're working with adults on, you know, on different topics like weight loss, improving their heart health, improving their diabetes or reducing joint pain. A lot of times we uncover that they've experienced ACEs and they may not have gone through the proper professional help to help them cope with those. So we'll plug them back in to work with the therapist and hopefully kind of move past that so it's no longer a barrier to them achieving their optimal health.
We also have started seeing pediatrics and adolescents, and we work with them on lifestyle changes as well and part of that is fostering resiliency and improving their coping skills. So learning how to eat a healthy diet and get proper sleep and physical activity and stress management, that while of course that can't erase any of the ACEs they may have experienced, it can hopefully lower the impact that it has on their physical and mental health. We also, in research, it's known that toxic stress experienced in pregnancy can negatively impact the genetics passed on to the fetus and field development. So we know that pregnant women really need that support to help build resiliency, lower their stress levels and just have a healthy lifestyle so that any stress that they're experiencing isn't going to negatively impact their baby. Yeah, it's interest, there is a study that they did where they looked at infants born to women with four or more ACEs and those infants were two to five times more likely to have poor physical and emotional development by the age of 18 months which is pretty striking and sobering.
Host: I've heard resiliency come up a lot in this conversation. What are we talking about when we talk about resiliency in this situation?
Marielle Silk: I think just helping them have the some positive coping skills early on, so turning towards healthy mechanisms to deal with stress like meditation, mindfulness, exercise, you know, community as positive social experiences so that they can help negate any stress that they're experiencing rather than when it's not addressed and they aren't taught positive coping skills. Then we see, you know, earlier lessons then later on negative coping skills coming out. Alcoholism, tobacco use, overeating, even suicide or self harm. So it's teaching them at a young age the positive coping skills that they can turn to throughout their life when they experience something adverse.
Kellie Flock: Yeah, I can add to that. You know, I think there's a balance as well, so, so we're kind of stuck in this place parenting wise too right now with this generation where we're really trying to teach mindfulness and give all these positive experiences that we've kind of moved to, everybody gets a trophy situation and you know, our parents would say and grandparents would say, you don't always get a trophy and you need to, you know, suck it up and learn that maybe you play better next time. And parents nowadays are, are scared of that. There's a balance, you know, of course we want kids to have experiences where they're happy and they feel supported and that's such a huge part of their development. But there's also having positive experiences where they learn that this didn't feel great. This was stress and this is how I deal with it. And so that's a really tough, I wish I had a better answer to how to teach that to parents. I'm learning it, and I'm sure you probably are as well myself. It's a tough place to be in, but there's, there's a middle ground that you have to find.
Marielle Silk: Yeah, we talk about that with adults too, about kind of leaning into some of the negative experiences that are part of life and not necessarily just trying to make everything seem all happy and positive and that you just need to have the skills and same thing with children to, you know, realize that the hard things in life, they're going to happen. And then you kind of let yourself feel that and then you move on and you know, hopefully grow from it.
Kellie Flock: Yeah. We talk about that a lot with teenagers. And again, when we're talking about ACEs, we are talking about bad stress. We're talking about toxic stress, but there is good stress as well. And so helping, especially I see this more in older kids and teenagers, but helping them to figure out what's good stress and what's bad stress and then recognizing in those really young kids and the parents, you know, what's their reaction to good and bad stress because that will help shape how their kids react to things as well. The one thing that I would say is, you know, going back to having availability of resources, I hate that kind of healthcare is in this place, but there's a financial and a cost association with all of this and I think a lot of why we don't have the resources we need drives back to being able to support and fund, and that kind of thing. But we need to look at the financial costs of this pattern that's happening.
And we know that not only are there immediate costs for when children go through abusive situations or neglectful situations, but then there's these secondary longer term costs, special education, juvenile delinquency, criminal justice system, healthcare, long-term mental and physical, and just lost productivity, that we need to start thinking about. And so if somebody could get a better handle on that, cause that would be amazing because I think that we need to fix the system a little bit to make this work better.
Marielle Silk: I agree. We need to invest in our children and especially the zero to five age and support, you know, childcare support, working parents, all of that so that the, we can stop these adverse events from happening and leading to, you know, increase costs throughout their life, physically, mentally, and financially. But in talking about, you know, just the effects on society. James Heckman, who's a professor at the University of Chicago and won the Nobel Prize, so he's a smart guy. He has a quote that says, early nurturing learning experiences and physical health from ages zero to five greatly impact the success or failure in a society. And I think that puts it in a nutshell, exactly what we're talking about.
Kellie Flock: And the other quote was a quote from Pam Dayo, it's children need at least one person in their life who thinks the sun rises and sets on them. Someone who delights in their existence and loves them unconditionally.
Host: Well, thank you so much for your time, Kellie and Marielle. You can call (252) 449-5978 to make an appointment with Marielle Silk at the Center for Healthy Living. That's (252) 449-5978. To make an appointment with Kellie Flock, you can call (252) 255-5321, that's (252) 255-5321. If you enjoy this episode, you can find more like it in our podcast library and be sure to share this episode on all your social channels. This is Outer Banks Health. I'm Caitlin Whyte. Thanks for joining us.