ACEs in Real Life Prevention and Mitigation Using the Cross-Sector Approach

Ricky is a three-year-old boy who cries inconsolably when his mother, Sasha, drops him off at day care in the morning His teachers thought his crying would stop when he became more comfortable in the classroom It did not

Ricky does not interact with his teachers and plays aggressively with his peers. Due to his violent behavior, Ricky is at risk for expulsion from his school Ricky also has a speech delay and gets very upset when the other students are loud or when his daily routine is interrupted

The family is referred to a community system to begin an intake assessment

The family has numerous challenges. Sasha reports that she is very concerned with Ricky's behavior She discusses escalating behavioral problems, including aggression like hitting, pushing, and slapping Ricky's father was recently deported and had a history of being abusive to Sasha. Sasha is recently unemployed and behind in all her bills She is experiencing grief and loss; she doesn't show much enjoyment during her interactions with Ricky Sasha also reports having endured severe physical and emotional abuse as a child.

Initially treatment revolved around stabilizing the family Through a therapeutic approach and care coordination, Sasha accesses community resources to help improve her appearance and secure a job so that she can address her basic material needs

With professional help, the family is able to gain social supports Ricky's behavior improves in his classroom and there is increased joy in Ricky's relationships with his teacher and mother

As Ricky naturally transitions to a new school, these new therapeutic relationships help to support the family At discharge, Sasha is no longer depressed The family is financially stable and there is a solid social support system in place

Cross-System Impact:

Individual: Child

Relationship: Mother, Teacher

Community Sectors:

Early Childhood Education

Law Enforcement

Healthy Beginnings System

Therapeutic Programs

Community Programs

The team worked with Sasha to strengthen her executive functioning so that she could master skills like: organizing, planning, and prioritizing time management self-regulation of affect

These are all skills Sasha needs to stabilize her financial situation and learn how to manage the family's finances

The clinician helped Sasha engage in bodybased regulation techniques to regulate affect which improved co-regulation between Sasha and Ricky

She supported Sasha's ability to self-reflect and encouraged her to use relaxation strategies when she felt overwhelmed Sasha was able to incorporate these techniques into her family dynamics

The clinician helped Sasha identify traumatic triggers and the difference between then and now She helped Sasha find words to explain Ricky's father's absence.

Through therapeutic services Sasha's emotional state shifted which directly impacted Ricky’s emotional state. Sasha’s depression diminished because her financial stress decreased

Co-regulation began to emerge and strengthen as Sasha’s depression diminished

Ricky began exhibiting pro-social behaviors.