Imagine you’re walking in the forest and you see a bear,” said Nadine Burke-Harris, a Canadian-American pediatrician, during a 2014 TEDMed talk. “Your heart starts to pound, your pupils dilate, your airways open up, and you are ready to either fight that bear or run from it. And that is wonderful if you’re in a forest and there’s a bear. But what happens when the bear comes home every night, and this system is activated over and over and over again?”
Burke-Harris, known for linking adverse childhood experiences (ACEs) and toxic stress with harmful health effects later in life, uses this bear analogy to explain how ACEs affect children and continue to distress them into adulthood. Whether the “bear” is living with a parent with mental illness or substance abuse issues, suffering through physical or emotional abuse or not knowing day-to-day where one’s next meal will come from, Burke-Harris says this reoccurring physical response to stress goes from being adaptive or life-saving, to maladaptive or health-damaging.
The term ACEs originated in a 1995 study conducted by the Centers for Disease Control and Prevention and the Kaiser Permanente health care organization in California. According to the Center on the Developing Child at Harvard University, dozens of studies using the original ACEs data show, first, ACEs are quite common, even among a middle-class population, with more than two-thirds of the population experiencing one ACE. Second, there is a powerful, persistent correlation between the number of ACEs experienced and a greater chance of poor outcomes later in life, including increased risk of heart disease, diabetes, obesity, depression, substance abuse, poor academic achievement, time out of work and early death.
What does this mean for Berea College students? “Given the population Berea was founded to serve—primarily students from Appalachia with limited financial resources—the College can expect to serve a population of students with a plethora of ACEs,” said Sue Reimondo, director of Counseling Services. “ACEs are common regardless of socio-economic status or educational attainment within the family, but the literature suggests that the chronic stresses of poverty increase the potential for ACEs and the emotional scarring that accompanies such experiences.”
Counselor Tricia Isenstein said she was astonished when she came to Berea and learned the extent of trauma many students have faced. Isenstein spent years working with domestic violence victims in shelters, and much of her work and continuing education have centered on trauma treatment.
“What our students have experienced feels higher than with those I worked with in the shelters,” Isenstein said. “It is unbelievable what students have survived. It speaks to the resilience of our students. Often, we are the first person they tell about some of the most horrific things you could imagine.”
Students are asked to fill out an ACEs questionnaire when they first come to Counseling Services. An ACE score of just two can put students at risk for health issues, and every additional point increases their chance of an autoimmune disease, according to an article published in Psychosomatic Medicine: Journal of Behavioral Medicine.
“A lot of students present with adjustment issues, much of which is rooted in traumatic experiences,” said Counselor Joel Wilson. “Not being emotionally supported at home or living in a toxic environment makes it difficult to adjust to being a first-year student in college. They come into [counseling] to start talking about anxiety, but the more they talk, we realize how at-risk they are. What they thought was just a stomach or back ache is actually rooted in this trauma.”
What can be done?
Dr. Robert Block, the former president of the American Academy of Pediatrics, referred to ACEs as “the single greatest unaddressed public health threat facing our nation today.” The scope and scale of the problem seems so large that it can feel overwhelming to think about how to approach it. But what ACE scores don’t account for are the positive experiences in early life that can help build resilience and protect a child from the effects of trauma.
“Some students have identified a safe person in their life, like a high school teacher or counselor,” Isenstein explained. “It amazes me what teachers and high school counselors have done for our students—driven eight hours and put them up overnight to get to their College interview, housed them, bought them clothes and shoes. Before they came to Berea, they either had someone like that or not, but it makes a huge difference if they did.”
Positive relationships that build trust and rapport and engaging in psychoeducation, which gives individuals a stronger base of knowledge for knowing ways to cope and thrive, can empower trauma survivors and act as a catalyst to their natural resilience. It may also mitigate the long-term effects of early trauma, psychologists say.
“It is not enough to say ‘You’re so resilient,’” said Counselor Julie LeBrun. “That means nothing to someone in pain. It is about helping them understand themselves and the ability and skills they already have used to get where they are now. They can build on that strength. Being resilient is looking back and saying, ‘I did this and this to get here, now how can I go forward?’”
Recommendations from the College’s Task Force on Trauma and Resilience included increasing campus awareness of trauma, ACEs and resilience. The work of responding to students’ past traumas and increasing their resilience to persist through challenges is complex and multifaceted, and the task force report only begins that very important conversation.
“However, we believe that with a commitment from the community, Berea College can truly transform the experiences of these students and provide them the kind of support they need to be successful,” task force members stated in the report’s recommendations.
The task force made several recommendations regarding increasing campus awareness of trauma, ACEs and resilience. One recommendation is to create an online resilience module for incoming students. The website would act as a toolkit to support students with issues related to college stress, burnout, homesickness, decisions about drugs and alcohol, and other topics. This recommendation was realized this past summer with the creation of the Student Resilience Project and its website, resilient.berea.edu. The Student Resilience Project is a web-based, research-informed toolkit developed to encourage students’ wellness by helping them learn to manage stress in healthy ways and increase their sense of belonging. The website features videos; skill-building activities; resources and information, including podcasts by campus experts. The website was made available to students in fall 2020.
Another recommendation, creating a visual campaign to increase awareness, encourages placing posters throughout campus defining ACEs and their link to common health issues. The task force believes raising the campus community’s awareness about ACEs will provide much-needed background information to those interested in meeting the needs of students who struggle with these issues.
A third recommendation would invite nationally recognized leaders with expertise in the areas of trauma and resilience to campus as part of the convocation series or for other special events. Though the current pandemic has postponed the implementation of this recommendation, the task force believes bringing some of the top researchers, speakers and activists to teach the most current research and share best practices about intervention will inspire the Berea College community to develop strategies to become more resilient.
For Isenstein, the goal of these and the other task force recommendations would eventually lead to Berea being
a trauma-informed campus where all students feel safe, welcomed and supported, and where addressing trauma’s impact on learning on a campus-wide basis is an intrinsic facet of its educational mission.
“Resilience is a message of hope,” said Debbie Alleyne, a child welfare specialist at the Center for Resilient Children at Devereux Advanced Behavioral Health in Villanova, Pa. “It is important for everyone to know that no matter their experience, there is always hope for a positive outcome. Risk does not define destiny.”