‘We all have our stories, but nobody talks about them’

No one gets to choose their parents or where they grow up. We are simply dealt a hand of cards, says Assistant Professor Dawn Bounds.

This summer, Bounds will help adolescents and their caregivers learn to cope with those cards through her study, Garnering Resilience in Traumatized Youth and Families (GRIT). The study is funded by the Office of Inclusive Excellence and has recently garnered support from the 2021 Athalie R. Clarke Achievement Award for Nursing Research. 

After the Chicago transplant came to California, she learned of the state surgeon general’s push for universal screening of adverse childhood experiences (ACEs). 

Adverse childhood experiences are events such as divorce, neglect or abuse, that occur before one turns 18. They can have profound consequences on one’s health and future. Screening for them is important, Bounds says.

“It’s a big and wonderful movement,” she acknowledges. But there’s a problem: There just aren’t enough mental health care providers wto go around. As a result, providers simply don’t ask about ACEs.

“If you don’t have mental health referrals, you don’t talk about it. That’s problematic.”

Why ACEs screening is important

A number of events can be considered ACEs, not just abuse and neglect.

“We think about abuse and neglect being problematic, but there are other challenges, such as substance use by a parent, that make the household environment problematic for the child’s development,” Bounds says.

Those challenges include:

• Witnessing violence at home or in the community
• Living with someone with substance abuse or mental health problems 
• Instability because of divorce, separation or imprisonment

While ACEs are incredibly common — 61% of adults report experiencing at least one, according to the Centers for Disease Control (CDC) — they can have devastating consequences.

The more ACEs one reports, the greater the risk of in adulthood: 

• Chronic health problems, including heart and lung disease and cancer
• Mental illness, such as anxiety and depression
• Substance use
• Negative impacts on education, job opportunities and earning potential

“There is a connection researchers have made to ACES being connected to our health and the future,” she says.

Consequences of childhood ACEs

There are also health conditions that have been connected in childhood. 

Children with four or more ACEs are at greater risk for developing: 

• Asthma
• Allergies
• Headaches
• Obesity
• Depression
• Attention deficit/hyperactivity disorder (ADHD)
• Teen pregnancy

Bounds notes that there is a dose-dependent relationship. “The more ACEs you have, the riskier things become in terms of your health.”

Early screening for ACES helps one understand how toxic stress may also need to be addressed for certain conditions.

Building a protective buffer

Since Bounds and her research team can’t prevent ACEs in adolescents, her intervention centers on what she calls “buffering” — building up elements of an adolescent’s life that protects them from toxic stress associated with the impact of adverse experiences.

This, in turn, fosters a resilience that enables them to cope in the future.

“The biggest buffer for young people is having a supportive adult in their life, having somebody that nurtures them and is invested in their development.”

That’s why caregiver participation in the study will be so important. 

“Instead of pointing the finger at the caregiver, why not give the caregiver the intervention as well?” she asks. 

“They probably had ACEs when they were younger. So, let’s try to put them on a different trajectory for their own health too.”

Nursing students turned health coaches

To deliver the intervention to 20 adolescent/caregiver pairs in the study, Bounds recruited nursing and public health sciences students and trained them as health coaches. Read Student health coaches inspired to empower ›

Students with specific attributes were encouraged to apply, particularly those from minoritized communities, first-generation students and those from single-parent homes. Those populations often report higher ACEs, Bounds says.

“These wonderful students reached out to me who could relate. They had stories about why they wanted to work with this population,” Bounds says. 

“It’s common. We all have our stories, but nobody talks about them.”

Promoting healthy habits

As health coaches, the students will guide and facilitate the study’s participants through developing healthy habits based on the Surgeon General’s Stress Busters.

Surgeon General of California’s Stress Busters.

Bounds wants her students to walk the talk first. Mental health care, as Bounds sees it, is not just medications and therapy but more so learning how to self-regulate. Self-regulation are self-care practices that include the stress busters listed above. It is not just about recommended self-care, which is typically what we do in healthcare, but about creating a space for practice and mastery of self-care skills.

“I’m always asking them, ‘What are you doing for self-care?’ Because they’re going to coach these youth and families into doing that.”

The coaches will also instruct the adolescent/caregiver pairs on understanding their health data using biofeedback to promote a positive psychological state.

Hopes for expansion

Bounds is applying for federal funding so she can expand the study to 320 adolescent/caregiver pairs.

Through a partnership with the American Academy of Pediatrics Orange County, Bounds aims for the intervention to close the gap between adolescents needing mental health care and them getting it.

“Let’s not just say ACES is a sentence to chronic disease and early death and say, ‘oh, well.’ There’s a lot we can actually do about it.”