Iowans Thrive Blog
Featuring stories, research, and news on Iowa's movement to respond to ACEs
Around any table discussing children and family issues in Ottumwa, Pat McReynolds and Cheryll Jones are likely present, leading or participating, and often grounding the conversation in the Adverse Childhood Experiences (ACEs) research.
Hearing about The ACE Study from Dr. Robert Anda with the CDC a decade ago was the spark they and several stakeholders needed to unify their community around prevention and family support efforts. They especially connected with the idea that the challenges they saw with kids and families could stem from past traumas and that interventions needed to start early in a child’s life, with support for parents and children.
Since that spark, they have worked to spread knowledge about ACEs and related topics and build champions for change—all without a formal coalition. Knowledge about ACEs is now being infused into social service agencies, the education system, health care, the community college, and even city government.
“When we’re at the table, if you don’t know about ACEs, you’re going to learn it,” says Cheryll, a nurse practitioner with the University of Iowa’s Child Health Specialty Clinic.
Mayor Tom Lazio, who has had a career in child and family welfare, agrees that he sees knowledge of ACEs being infused in the community. He’s even presented on ACEs to his staff in city government.
- Tom Lazio, mayor, Ottumwa
A new approach to early childhood
When Pat first met with Ottumwa superintendent Nicole Kooiker, her goal was to share the ACE Study findings and establish a positive relationship with the public school system. A meeting planned for one hour quickly turned into nearly three hours as Nicole made the connection between the findings and the importance of early childhood and parent engagement efforts.
In 2018, the school district opened the Pickwick Early Childhood Center for three- and four-year-olds, combining the head start program with the school’s preschool program. With 20 classrooms, the school district thought the school would be half-full in the first year, but enrollment quickly reached capacity at more than 360 students.
The school's principal is focused on early childhood education and is committed to integrating parents and community into the system. The early childhood center provides wrap-around child care outside of classroom instruction, so students can attend from 6 a.m. until 6 p.m. Mahaska Wapello Early Childhood Iowa helps fund transportation, and parent groups and community meetings are held in the space.
“Collaboration has really brought a sense of community for the early childhood world together,” says Pat. “Our goal is that parents start being involved with their kids early on and that continues throughout their public-school education.”
Knowledge of ACEs is being infused across all early childhood and parent support programs as well.
For example, Parent Cafés bring parents together to talk about protective factors and to learn from each other and build connections. Up to 26 parents attend each session and parents say they feel empowered to speak, respected, and reassured that they are not alone.
Often, I hear feedback from parents that they did not realize the impact these Protective Factors (and ACEs) have on their children. They are learning that it is okay to accept help, to even ask for it. The ACEs research is opening the door to conversations about things that have been kept secret for generations. Silence is a breeding ground for guilt and shame. Because of ACEs research we are able to talk about building resilience.
- Jill Lane, BASEC family support assistant with Great Prairie Area Education Agency (AEA)
Joan Garrett, Behavioral Alliance Supporting Early Childhood (BASEC) coordinator with the AEA, says Parent Cafés are just one way the ACEs knowledge is being infused into early childhood. Her organization also works with child care providers to understand the needs that drive children’s behaviors and how to respond in the classroom, as well as build on families’ strengths and values to support their kids.
“Physical and emotional safety, trusting relationships, healthy environments and culture are at the forefront of care,” says Joan. “Our goal is to build resiliency from birth forward.”
Infusing ACEs in health care
Pediatric health care providers are often the first to see a child as parents bring them to well child check ups starting shortly after birth. Cheryll Jones sees this as the opportunity to identify family stress and needs that can put children at risk for ACEs and connect those families to support.
Her clinic sees children who have been referred by health care providers, community providers, or parents because of concerns about developmental delays, mental health issues, or other problems.
Staff have been trained on ACEs, and the office asks parents questions related to ACEs as part of the health history intake form. Frequently Cheryll sees families with ACE risk factors, including domestic violence, substance use, mental health challenges, and suicide attempts. In addition to referring children to services, such as early intervention, speech therapy, or behavioral health therapists, she spends time talking with parents about services they might benefit from.
- Cheryll Jones, nurse practitioner
The clinic will offer parents information on how they can create healthy environments for their children. A family navigator will then work with parents to access services and supports in the community. This step of connecting families to services is crucial with screenings, says Cheryll.
“I was taught years ago that if you don’t have anything to offer when you get done with a screening, don’t do it,” she says. “You don’t have to deal with it yourself, but you have to know the resources to get families connected to.”
The biggest challenge she finds is referring patients to mental health or behavioral health therapists, especially to work with young children, which she attributes, in part, to a workforce shortage.
Part of Cheryll’s role is to be in the community and connecting with other sectors to create a system of care for children and families. She is chairing the Children’s Mental Health Advisory in south-central Iowa to address some of those challenges, with Pat as her vice chair. In particular, the group is emphasizing that children’s mental health needs are different than adults and that an understanding of ACEs and the impact of trauma needs to be infused in the work.
Spirit of Collaboration
Several years ago, Cheryll, Pat, and other stakeholders agreed to combine all coalition meetings related to child welfare and family support together into one day, so that those on the child abuse prevention council, for example, are also meeting on topics related to the community partners for protecting children. Once a month about 25 partners gather for most of the day, breaking down silos in their fields.
“There’s been so many leaders and contributors to this movement,” says Cheryll. “It’s incredible because one person can’t do this. We have an awesome village.”
One of the groups focuses on providing quarterly community trainings around ACEs, resilience, and related topics. While initial trainings focused on ACEs and trauma-informed care, recent trainings have talked about race and poverty, implicit bias, and having courageous conversations.
This focus on equity and inclusion has been especially important, says Pat, with data that shows higher rates of ACEs among specific populations and as Ottumwa’s population demographics rapidly change. At the pork packing plant, workers now represent 35 countries, and that's growing.
There’s really an influx and that’s been a big challenge for school district and businesses. When you walk down the street in Ottumwa you see such mixed cultures. The trainings are an opportunity to learn with an open mindset.
- Pat McReynolds
Over time, these conversations and trainings have spread into other areas. Pat notes how one coalition member’s husband who works in human resources at a local business became interested in the courageous conversations training they were offering. Another has engaged the pastor at their church. Tom has had conversations with his daughter, who is a teacher.
A December legislative forum focused on health, mental health, and related topics also includes a short presentation related to trauma and brain science to state and federal elected leaders. Representatives now reach out to Pat And Cheryll to learn what’s happening.
"They are coming to us instead of us going to them,” says Pat.
As the community looks toward the future of this work, Pat and Cheryll hope they will receive a grant that will help them formalize into a plan how all of these efforts work together to build resiliency.
“We have a long way to go, but I think there’s some exciting things happening in a collaborative way, and I really believe that’s the only way,” says Cheryll. “You can do what you do in your practice, but it’s only affecting the kids that you see. If we can do it as a community and get these concepts out there, in the long run, it’s going to make the most difference.”
Without ACEs, Pat says, “We wouldn’t be where we are today at all. There might have been pockets of things happening, but the knowledge of the impact of ACEs and the science of prevention is so key and fundamental to changing rural Iowa mindsets and opportunities for growth.”
Learn more about ACEs and how you can lead efforts in your workplace or community.