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Adverse childhood experiences damaging our rural Americans

We hear it often: rural America is reeling from problems: drug addiction, slow economic growth and shorter lifespans.

That’s not the full story.

Lest we wave rural America off to a bygone era, let’s recall where our food is produced, fuel and power created, and where the goods you use on a daily basis derive. Do you remember the last time you worked hard and were proud of yourself, but nobody noticed — or worse, didn’t get paid? Welcome to rural America.

A report published a few weeks ago by NPR, the Robert Wood Johnson Foundation and Harvard University’s T.H. Chan School of Public Health notes that “rural Americans have strong ties to their local communities and value life, family, and jobs” but face a future fraught with drug abuse and troubled local economies. The report says that 49 percent of rural Americans personally know someone who has died of a drug overdose, yet still believe that such problems “can be solved within the next five years.”

That’s optimistic. It will take a generation or two of family- and community-based interventions to elevate America’s heartland. That’s primarily because of adverse childhood experiences, better known as ACEs.

ACEs are less about childhood and much more about experiences. They occur when adults abuse children in any form, when parents are incarcerated or abuse alcohol and/or drugs, when children witness violence at home, school or in their community, when parents permanently separate, or when parents fail to address their own mental health issues. ACEs are the common thread woven through stories of adult substance use, road rage, poor work performance and domestic violence. They are not new or specific to rural America.

Rural America, however, is disproportionately affected by the ramifications of ACEs and the insidious, multi-generational ACEs cycle because it has fewer services per capita than urban or suburban America, according to the 2017 Center for Behavioral Health Statistics and Quality report published by the Substance Abuse and Mental Health Services Administration.

ACEs change brains, making people more impulsive, explosive and depressed.

The science about this is robust and frighteningly real. Researchers with the CDC-Kaiser Permanente ACEs study learned that those with six or more of the 10 ACEs (physical, emotional or sexual abuse; domestic violence; parents’ alcohol or drug addiction; parental death, divorce or separation; untreated mental health diagnosis; or incarceration of a household member) are more likely to die 20 years sooner than average. In takes only four ACEs to experience physical and mental health issues.

Oh, and ACEs are costly — hence the connection between rural ACEs and economic woes. The Centers for Disease Control and Prevention estimate that $124 billion is lost per year in worker productivity, health care costs, substance abuse treatment and incarceration. ACEs are undermining our country’s ability to care for itself and eroding rural America’s economic vitality.

The 2018 National Health Survey says that 25 percent of Tennessee children are experiencing two or more ACEs. We can change this reality. ACEs are facts, not fate.

Decreasing the prevalence of ACEs through abuse prevention programs and a paradigm shift toward trauma-informed practice that recognizes and embraces the brain-based needs of victims will change the story in rural America. The University of Tennessee Institute of Agriculture Family and Consumer Science Extension Agents are responding to this call. In seven rural Tennessee counties UTIA Extension is pioneering the nation’s first emotionally intelligent afterschool program in partnership with Yale University’s Center on Emotional Intelligence. Less than six months into the program, staff are reporting a healthier environment where youth spend nearly 20 hours per week. This and similar programs alleviate ACEs and more than pay for themselves.

Thankfully, our legislators recognize this and some support ongoing interventions through the Building Strong Brains initiative. We still need to do more.

There will always be rogue cases where we try to figure out what happened, but by shifting the conversation from “What’s wrong with you?” to “What happened to you?” we can start to heal rural America.

Heather Sedges Wallace is an assistant professor and human development specialist with Family Consumer Sciences at UT Extension.

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