LACONIA — Officer Eric Adams, the Laconia Police Department’s prevention, enforcement and treatment coordinator, walks into situations that are impossible to forget – including drug overdoses, domestic violence and sexual assault.

Perhaps his most pivotal role is to connect children to the support they need to weather these disturbing experiences and prevent the trauma from derailing their lives.

“We’re not trying to take your kids away,” Adams tells parents when he asks them to sign a release that enables him to link their children to support at school and in the community.

“This is to help your family dynamics and your situation,” he says. “Everybody needs help sometimes.”

At a time when adverse childhood experiences are under a microscope because of the damage they inflict on young and adult lives, Adams is a point person for early change. As a patrol officer he responds to traffic accidents, burglaries, substance abuse and family violence that children witness or are victims of - crises that seed toxic levels of anxiety and stress that can cause lifelong physical, emotional and learning difficulties if the trauma simmers untreated.

Adams is a key member of Laconia’s ACERT – which stands for Adverse Childhood Experience Response Team – a program launched in September 2019 because of alarming local data on violence and its far-reaching impact on young lives. It’s patterned after a system started in Manchester and its value is clear: The early identification and referral network gets kids useful and appropriate services faster – timely assistance they might otherwise not receive.

For a child, a traumatic experience “without advocacy or intervention is like a brain injury,” said Lara Quiroga, director of Strategic Initiatives for Children at Amoskeag Health in Manchester, who designed the program with Manchester police and the YWCA. Now in its fourth year, Manchester’s ACERT has resulted in over 1,200 referrals. ACERT is now in place in Concord and is poised to begin in Claremont and Somersworth. Some North Country communities are considering it – along with the states of Washington, Oregon, Florida, Massachusetts and Pennsylvania, and a 17-person delegation from Wales came to study how it works, Quiroga said.

Since its inception in Laconia, the local ACERT program has netted 14 referrals for at-risk children and families who might have been missed by school teachers and counselors, primary care providers and mental health professionals, including staff at the New Hampshire Division of Child, Youth & Family Services.

“It’s hard if you have ACES (adverse childhood experiences) in your world, and can’t seem to move out of that pattern,” said Erin Pettengill, vice president of the Famly Resource Center of Central New Hampshire, and co-founder of  Laconia’s ACERT. “We support families to develop resiliency and tools they need to move past the situation, and move forward.”

A two-year study released in 2019 found that 23.4 percent of New Hampshire children have been impacted by a traumatic event, said Deputy Chief John Thomas, ACERT coordinator at the Concord Police Department. Throughout much of New Hampshire, including Manchester and Concord, domestic violence-related calls outnumber others that law enforcement departments receive, including those related to substance abuse.

Trauma puzzle

But domestic violence is only one jigsaw piece of an elusive trauma puzzle. Adverse experiences include many issues with enduring effects, such as divorce, having a parent or family member in jail, alcoholism or substance abuse at home, watching or experiencing a sexual assault, death or long-term illness or disability of a primary caregiver, homelessness, poverty, food and financial insecurity, and any form of physical or emotional abuse or neglect.

The ability of children to cope can vary, but the danger of the trauma remains. ACES “create toxic stress in the brain that can lead to physical, emotional and developmental delays, especially when there’s no caring adult in their life,” said Kerri Lowe, coordinator for Laconia’s ACERT.

The experiences don’t have to be external crises or major catastrophes. “If there’s an LGBTQ youth who has no empathy at home, it’s kind of an abuse. Or if they live with a caretaker who denigrates them,” said Paula Clearwater, a child and family service coordinator at Lakes Region Mental Health Center. The center treats many children with anxiety, depression, and trauma-related problems, including PTSD, which may play out as nightmares, an inability to learn and symptoms that might be mistaken for ADHD, she said.

The sheltering at home mandated by the COVID-19 crisis and closure of schools has raised the incidence of family violence and trauma in many communities, while reducing the ability of schools and medical providers to spot youngsters in trouble.  During that time, reports to DCYF of domestic violence rose, but reports of child abuse declined.

In Laconia, when responding to a call where there are young people, Adams often kneels and tries to put himself in the position of a child.

“Having your home broken into, or having something stolen from your home or car, a child may think it’s scary and doesn’t necessarily talk about it. They many think, “There was someone bad who came and stole. What if they break into our house and take me?’”

“You can kind of tell when they’ve been exposed to many domestic violence incidents,” Adams said. “They’re more frozen or angry or they’re really clinging to one parent.  Sometimes you have to ask the child if they saw anything. That can be traumatizing in itself.”

More common

Child and family counselors say ACES seem more common in today’s school population because of the opioid epidemic and factors such as family breakups, joblessness, a lack of consistent adult support or supervision, and bullying, labeling or exclusion on social media at younger ages. Unaddressed ACES can surface as anger, risk-taking, lack of impulse control, aggression toward others, depression, anxiety, self-isolation, chronic sleeplessness, lack of ability to focus, and compromised learning and memory, according to mental health experts.

“This generation now in K through 12 has a lot more ACES with the things running through our society, and they’re experiencing more things early on in their lives,” said Samantha Raticik, a guidance counselor at Winnisquam Regional High School. “We have a lot of students come into the building who have experienced one or more traumas.  It’s really clear that they’ve had adverse childhood experiences that they’re experiencing in their teenage years.”

At Franklin High School, “We have a huge trauma population,” said Desiree Smith, a guidance counselor. “The economy comes into play with that. We also have a lot of drug addiction. Some families have all those factors.”

Kimbly Wade, substance misuse and suicide prevention manager at the Partnership for Public Health in Laconia, likens the stress of accumulated ACES to a child constantly dodging vehicles while crossing the street, and having to do that multiple times each day or week.

“As these ACES mount, these children never get to build their resiliency because they’re always on alert,” bracing for the next crisis. “They have a long-term sense of being scared and living in a fearful place,” Wade said. “The more events – the greater it’s changing developing minds and bodies.”

“As people perceive a threat in the environment, fear triggers a survival response that affects emotional reactivity,” said Clearwater at LRMHC. If the fear is never acknowledged or mitigated, “the human being never settles. They’re over-ready, hyper-vigilant, looking for what will crash over my head next. It creates physical and mental health problems. They can’t rest or sleep.”

Long-term impacts

According to a large population study by the Centers for Disease Control and Prevention and the Kaiser Foundation, unrecognized and untreated ACES can persist into adulthood, increasing one’s likelihood of developing of mental illness, chronic diseases such as diabetes, heart disease, obesity and stroke, substance misuse, lower educational and career achievement, incarceration and even early death.

New Hampshire’s statistics mirror many national findings, said Paulette Valliere, a data analyst for the NH Department of Health and Human Services.  A 2016 survey of over 5,000 New Hampshire adults over age 18 showed striking differences between the sexes: males more often reported no adverse childhood experiences, and were much less likely than females to report high numbers of ACES – a difference that may be tied to their reluctance to report, or actual experience.

Those with less education – fewer than 12 years of schooling – more frequently reported higher numbers of ACES. Those with college and graduate degrees were more likely to report having none.

People with the lowest incomes – less than $15,000 annually – more frequently reported higher numbers of ACES, and as income levels rose, the numbers of ACES declined. Unemployed people typically reported more ACES than people with jobs. Those who rated their health as poor to fair typically declared higher totals than those who considered their health good to excellent.

What also surprised Valliere was a significant correlation between ACES and adult asthma – a relationship not well understood. Out of the survey, 53.7 percent of NH residents without asthma reported zero ACES, while only 36.2 with asthma reported zero ACES. The survey also found that 17 percent of people with asthma reported a high score (four to seven ACES), nearly twice the percentage (8.8) of people without the respiratory condition.

There are no scientifically proven links. But absence of self-care, parental care, or access to food, safe and dependable housing and medical treatment are well known to affect children’s health – and ongoing poor health as a child can impact wellness as an adult.

Connections are key

Research shows that a caring, nurturing and listening grownup  – whether a parent, teacher, coach or club leader – and a positive community - even one online - can reduce ACES’ lingering effects.

“Just finding a community they’re connected to, some positive community where they feel they have a support system and people that they can count on” can make a difference, Raticik said. “It’s important to make positive connections with an adult when home is not strong.”

“It’s hard to be a typically-developing child in a house where parents aren’t helping,” said Laurie Belanger, a student assistance counselor at Gilford High School. “Brains change in childhood when there’s trauma and violence in the home. Our work is helping them learn to cope in a healthy way and not repeat the pattern.”

Belanger holds support groups for teens who need practice with social skills, and for those whose parents struggle with drug and alcohol abuse.

“Kids can talk about how they cope,” Belanger said.  On top of the pressures of peers and academics, “a real dilemma has been social media and the ability to say things and see things they’re not emotionally ready for” – which adds another dimension of stress.

Erica Ungarelli ,of the Bureau for Children’s Behavioral Health at the NH Department of Health and Human Services, said New Hampshire schools, community service and mental health agencies are targeting ACES by concentrating on early detection and intervention so children can resolve their ACES before fallout from trauma becomes a pattern. Early childhood programs focus on increasing a child’s social connections and strengthening the parent-child bond, which includes a parent’s ability to response to an infant’s needs. Nurses make home visits to check up on babies and first-time mothers, and strive to identify and mitigate ACES in infancy. Having caring, close friends can help counteract the ACES in older children, and so can supportive community services such as boys and girls clubs, Ungarelli said.

Although child abuse and neglect cut across all demographics and income levels, poorer families and people in rural areas generally have less access to treatment and fewer services for trauma, she said. The goal is to develop programs specific to the local population – not a one-size-fits-all response.

While it’s impossible to determine whether the frequency of ACES is changing, “our response to them is definitely increasing,” Ungarelli said. “It’s never too late to receive treatment. You can always help build resiliency and resolve reaction to trauma.  Hopefully over time we can see a decrease from where we are now.”

Now, when Laconia police respond to situations where children are present – homes where mental illness, substance misuse or overdoses or domestic violence are evident – parents are asked to sign a release for ACERT, the Adverse Childhood Experience Response Team.  If they decline, Officer Adams returns a day or two later to answer questions and allay their fears when anxiety over the recent crisis has passed, and parents are no longer in fight or flight and can think clearly about helping their young ones.

Concord Police Deputy Chief Thomas said visiting families later to get signatures has bumped ACERT’s parent agreement rate to 90 percent. One mother who’d been involved with the legal system wrote a thank you note to police, grateful for their concern and for bringing a toy and teddy bear for her son and daughter, Thomas said.

Lowe, the coordinator for ACERT in Laconia, is frank about the importance of getting families to agree and follow through. “The kids that aren’t going to be that resilient were not connected with resources following those experiences,” she said.

•••

The Sunshine Project is underwritten by grants from the Endowment for Health, New Hampshire’s largest health foundation, and the New Hampshire Charitable Foundation.

Roberta Baker can be reached by email at Roberta@laconiadailysun.com

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