Moving Beyond Adverse Childhood Experiences: ACES and PACES

Adverse Childhood Experiences, or ACES, can have a profound and lasting effect on children’s health and well-being. Oklahoma is 41st in the country for Adverse Childhood Experiences, and 21 percent of children in the state have experienced two or more ACEs. In this episode, we sit down with Christine Marsh, Chief Program Officer for Child Abuse and Trauma Services, also known as CATS, at Family & Children's Services. As a licensed clinical social worker and a nationally certified expert in trauma focused cognitive behavioral therapy, Christine provides expert insights and actionable strategies you can start implementing today to foster resilience and healing for our children.

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Transcript

Chris: [00:00:00] Welcome to OK State of Mind, a podcast by Family & Children's Services based in Tulsa, Oklahoma. This podcast seeks to satisfy inquisitive minds eager to delve into the realm of mental health and overall well being. Together, we'll gain insights into the human psyche, draw inspiration from stories of resilience and hope, And unravel the science, the invisibilia that underpins our behaviors, shedding light on the whys behind our behavior and overall mental health.

Our goal is to empower, educate, and inspire you with actionable insights that you can immediately use in pursuing your own mental wellbeing.

Dee: Today we're diving into a crucial topic that impacts countless lives across Oklahoma. Adverse Childhood Experiences are what we call ACEs. Oklahoma is 41st in the country for Adverse Childhood Experiences, and 21 percent of children in the state have experienced two or more ACEs.

[00:01:00] ACEs range from abuse and neglect to household dysfunction to divorce in a household. ACEs can have a profound and lasting effect on health and well being, especially in the event of multiple experiences.

Chris: To shed light on this issue, we're joined by Christine Marsh, Chief Program Officer for Child Abuse and Trauma Services, also known as CATS, at Family & Children's Services. Christine brings over three decades of experience in working with children and families specializing in trauma informed care and interventions. As a licensed clinical social worker and a nationally certified expert in trauma focused cognitive behavioral therapy, Christine is deeply committed to addressing the impact of ACEs and supporting those affected by them.

Dee: I'm Dee Harris, your host, joined by co host Chris Posey.

Chris: Hi. Now let's explore with our guests the terrain of ACEs and highlight actionable strategies you can start implementing today to foster resilience and healing for our children. [00:02:00] Welcome Christine.

Christine: Hi, thank you. 

Dee: So glad to have you here today, especially since it's April and we're going to talk about all the things that people are interested in learning about, not only child abuse and trauma, but how to take care of your children and the well being of our community.

So I'm excited to dive into all those things. The ACES, or Adverse Childhood Experience Study, came out in the 90s, didn't it? 

Christine: Yes, it did, in the late 90s with Vincent Filetti. 

Dee: Okay, and that was kind of a big turning point. You were part of that study. initial beginning of all of the awareness around adverse childhood experience early on?

Christine: Yes, absolutely. It was really fun in the sense of it just opened up what we felt we were experiencing working with kids and families. So to have somebody come forward and say, definitively how these things tie together was very assuring to us in the work that we were [00:03:00] doing. 

Dee: So was it almost like an aha moment for you as a therapist at the time? Tell us a little bit about kind of your journey into this space and then how things were before the ACES study and after the ACES study. 

Christine: Sure. So yeah, my journey came from, you know, working in the field with child abuse and trauma from day one after I graduated from college and came to Family & Children's Services and did case management, worked in the homes with families who are at risk of losing their children to the Department of Human Services because they were abusing or neglecting them.

And a lot of times the families didn't recognize how that was happening. It may have been multi generational, might have been socioeconomic kind of burdens. So just really through that work and then moving into seeing all of the therapy and all of the people around me helping the families and getting to partner with some of those therapists and looking at the work that Family & Children's Services was doing in that [00:04:00] space.

Long ago even then our agency brought in some of the most. renowned speakers, Michael White, Yvonne Dolan, a lot of folks who just really started becoming prolific about how do you work with families? How do you work with couples? How do you work with individuals? And then children kind of fell in that group more exponentially.

 So then got my master's degree, worked in child welfare for a little bit, came back recognized that need for That community and that collaboration between mental health and child abuse and child welfare and just our systems, the school systems, everybody who were working with these families to understand how this impacted that, nuclear family.

Christine: So in the 80s, Family and Children's Services started a sexual abuse treatment program. Oh. Yeah. And it was the first of its kind really in northeast Oklahoma and that's when sexual abuse became more known about with children. [00:05:00] And again, the agency really took that on and so I came into that program because at the time that was the only therapy program that truly addressed trauma and it was specific to sexual abuse, but what we found was sexual abuse didn't happen alone. A lot of times it went along with neglect, or it went with a parent with substance abuse, or it went with physical abuse, or siblings were traumatized by the sexual abuse of another sibling even though it might not have happened to them. So we started seeing that it was really hard to only work with a child with sexual abuse and their caregiver and not treat All the family members as well.

And so we had to, to look around and try to figure out what to do about that. And, and who wants to come to a sexual abuse treatment program if you don't have sexual abuse? 

Dee: I was going to say, I mean, the stigma piece of that, I'm sure. 

Christine: So talk about a not trauma informed program name in [00:06:00] itself, you know, nobody wants to, to put a reminder card or a brochure on your refrigerator that says family sexual abuse treatment program.

That's where I go. Right. But that's what we were called in part because we wanted people in the community to know that's what our specialty was. 

Dee: Because it was so cutting edge. 

Christine: It was so cutting edge. And it was so not talked about that I believe the thought was we're going to talk about it and we're going to put it out there and we're going to put it under title and you're going to know where to come and we're going to say all these words that are shameful and fearful and hurtful that people are afraid of and normalize it.

Chris: All right, so in light of these things, what sort of community response did you see? How did they respond to what you guys were doing? 

Christine: I think because it was put out there in a way of we're here to help and we're going to have services for people that have not been able to outwardly have these services.

Maybe it was done [00:07:00] privately. And again, at this time mental health was still pretty much a stigma. So if you had to go and find services for divorce or depression you maybe weren't necessarily talking about it. So marital counseling was acceptable to go to maybe, but some of the other individual counseling was still not really acceptable so to imagine that you were also going for a sexual abuse situation.

And oftentimes back in the 80s was when we were still having adults going in for the first time reporting sexual abuse that they had experienced as a child. So it gave them a place and again, that. response was, Wow, there is a place to go. People are going to start talking about it. And we did have people come and be very thankful that we were there and, and could reassure that we specialized in this and, and we could talk about it and we wouldn't make things worse.

Because that was the other big [00:08:00] assumption at that time was if you talk about it, it'll get worse. 

Dee: Yeah. I mean, it's an interesting thing. It's like the same thing with suicide. We had a conversation recently with Copes about, You know, a lot of people still believe if you talk about it, then they want to do it more when really it's more about, being heard .

 I can actually talk about this and maybe work through it all of those kinds of things. As you're saying this, it makes me think about second generational trauma, like an incarceration. Children of incarcerated parents are more likely to be incarcerated themselves.

Is that a similar situation with the child abuse and sexual abuse as an adult? 

Christine: Yes, you're right on it. So many generational. Experiences happen that have that adverse childhood experience and, and in sexual abuse especially there is a unique dynamic of how people understand sexual abuse.

A different sometimes than physical abuse and neglect even in the secrecy. that is assumed [00:09:00] there and or promoted the threats that may come with it. And some of the assumptions that the false thoughts people can have about it. And so oftentimes even today we'll have parents coming in. We have a, a special group for parents to come and learn how to keep their children from being sexually abused or exposed to sexual abuse again.

And every parent hands down will say, I wish I had had this. had happened, although we know preventatively, it would have been less likely for people to come. Probably 80 percent to 90 percent of the attendees have had their own past sexual abuse experience. They say, I never wanted this to happen to my child.

I don't know how this happened to my child. In talking with them, we can kind of help them see how some of what happened to them did play out then again with their child and how they weren't able to protect or recognize. 

Chris: Christine, can you spell out what ACES means for anyone who may not be familiar with that term?

Christine: Sure. So ACES are the [00:10:00] adverse childhood experiences that all of us can have growing up and there are A number of these experiences that can then cause additional patterns of behaviors from us. So an adverse childhood experience could be having a parent who's incarcerated. It could be having an adult family member in your household who has mental health issues.

It could be somebody in your household having substance abuse. It could be somebody who experiences violence in their home or in their community. So there's a number of these things that happen to us or that we're exposed to in our childhood that then impacts us developmentally. So depending on where we are in that experience, if we're six years old, we're you can look at how your DNA can actually be changed from the trauma that you've experienced.

So even in utero, if there is [00:11:00] an infant who is exposed to domestic violence in utero, we can now finally see that that DNA of that child could actually be changed. So we know that substances obviously can impact a child in utero, but so can stress. and domestic violence and what that caregiver is exposed to that then goes to that infant.

 And, and you can see metabolic changes. And so if we as children experience different things that then alter our DNA, alter the way we process information maybe have to stay in a hypervigilant state of mind, our brain functions differently. You don't have room to necessarily acquire some of the other information that, that your brain would would absorb in if it weren't in a hyper sense of, of state of mind and more of a survival mode, so to speak.

So you can imagine running from a bear. You're not also [00:12:00] going to pull a book and start reading it while you're running away from a bear. So it's kind of similar to that. So depending on where and what age and what's going on in your life, when these things happen to you, that's kind of where you could potentially have. changes and how you develop moving forward. 

Chris: So, lining out the different things that contribute to an adverse childhood experience , it seems that probably quite a few people have had an adverse child experience in his or her life. How many experiences does it take before it begins to be a critical problem? Obviously from the first one, it's an issue, but I would imagine that, over time, as they continue to experience these, it would be tougher and tougher to come back from them. Have you looked at that the number of experiences that a person has and how that impacts him or her?

Christine: Absolutely, you hit the nail right on the head asking that question. So yes, we have looked at the number of experiences [00:13:00] individuals can have that then may equate to long term lifelong Issues that can can start impacting you in your health not just your emotional well being but in your overall well being. Again, development outcomes and maybe even an early end of life.

So it's common, unfortunately, for, yes, like you said, for people to have had an adverse childhood experience. One of the experiences is having parents separated or divorced.

Dee: And Oklahoma has a high rate of that

Christine: Yeah, yeah. So many of us, you know, if we all took the ACES test right now, you know, we're going to score quite high.

I personally am a four. Yeah. And so, for the state of Oklahoma, you know, we rank 41st in the nation in terms of where our folks are with having two or more experiences of adverse childhood experiences. So, they are common. And what starts to happening, you know, to your point is one [00:14:00] traumatic event, can definitely have the same impact as multiple, but when you have multiple traumatic events, you start looking at what we would call a complex trauma situation versus maybe a single trauma situation.

So if somebody experiences a tornado versus someone who experiences five tornadoes, you know, maybe you're going to start seeing that piling on impact and then also trying to look at, again, what were those developmental ages that all those happened in? Because we know As people develop, there are critical periods of development where other things are supposed to be happening and you're supposed to be grabbing in and bringing in.

Dee: Can your DNA change during those periods as well?

Christine: Yes, because we're continuing to develop. So you know, between the ages of, zero when you're conceived to three is when your brain is just rapidly, rapidly, rapidly growing. But we know that our brain doesn't stop growing until about 25, [00:15:00] 26, 27 ish.

So, yes, you will continue to have those things. We used to say years ago that the age that something has happened to you, you need to look back at that and find out when did this happen to you? What were things like before that? What were things like after that? Because oftentimes we can work with caregiver or a child and we can kind of see, yeah, that's where that was a turning point.

That was a turning point. And if you look at Bruce Perry and some of the other developmental doctors who look at development and trauma, you can look at really critical periods where things have happened and you can see where the growth started going a different direction. So it's kind of like a tree that struck by lightning, right?

You know, you're struck by lightning and the tree doesn't maybe die, but it's going to maybe lose this branch over here and start growing off in some other way. Right. And, and that's how our brain is. And we're going to keep developing in some capacity. It just might have holes in it. It may, you know , [00:16:00] miss some foundational steps that we just kind of have to skip.

And if we don't go back and get those then we're kind of running. Without everything that, that we need to, or, we might not understand some of how we cope with information. 

Chris: So we've talked about the number of incidents in a person's life. What about the intensity level, for lack of a better word, of the adverse childhood experience? Divorce may be in one range and physical abuse may be in a different section of that continuum Have you looked into that sort of thing, the intensity of the experience? 

Christine: Yes. Yes And so I love that you brought that up. So one of the things that we have learned over time Through lots of research and in one that happened shortly after ACES came out You know, we hit 9 11 and the National Child Traumatic Stress Network was created in 2000.

So, the government put it together through SAMHSA and [00:17:00] that was boring because we recognized the impact of trauma, so kind of what you're speaking to is how the intensity of something makes you feel that your life is in danger or the life of someone else that know and love and have a relationship with is in danger to the point where you could lose your control of your body or you feel like your life is at stake or someone else's is.

And that is considered more of that traumatic experiences versus gosh, negative things keep happening to me and I have to keep figuring out how to cope. The drama on top of that then, That intensity even if it's not just a one time event, but it is a kind of what I mentioned earlier, an ongoing kind of complex, it continues to happen. You continue to be exposed to things. So, for example, we'd be living in a violent neighborhood where you're constantly exposed.

Dee: It's a constant fight and flight. And I know that there's a bunch of new science around the effect on the brain when you're constantly in that state. 

Christine: [00:18:00] Correct. Absolutely. And you don't have time to pause and think in the same way maybe or your body almost starts becoming acclimated to that level of chemicals in your system, kind of having you in that fight or flight or freeze or flock depending on what your system does and your normal state becomes that.

And, and so oftentimes when we're working with children they come in and if somebody says calm down or relax, or let's, let's do some calming breathing, they may not even know how that feels. Kind of like folks who have ADHD, you know, they may not know what it feels like. And so it's hard to tell somebody relax when they have no idea how to relax.

Dee: I'm curious, I'm just going to fast forward to the 80s. We started this program, sexual abuse that kind of morphed into what's now child abuse trauma services. Right? 

Christine: Right. We renamed as, as we got into NCTSN, right around then, we thought, we're working with way more than sexual abuse. [00:19:00] And, we need to start looking at all of it.

Dee: So, breaking down the stigma and the approachability? Because, like you said, you have four ACES. I'm sure I have two or more. I mean, I've, I've had trauma, but it hasn't probably been to the degree that I've not been able to function. So what does that look like for a parent and a child when they come into the program? I know it depends on the situation, but generally speaking. 

Christine: Yeah, generally, we get all their information, but the first thing we start with is really doing a lot of education around what they might have, why they're feeling how they are or their experiences or what has happened to them and, how that may be changing things for them.

, and asking those questions about is this accurate, and really explaining a lot of the psychoeducation around it. Because a lot of times we all feel like, There's something just wrong with me, there's something wrong with me, or there's nothing wrong with me, but everyone tells me there's something wrong [00:20:00] with me, and I don't know, and I don't see it, and I don't understand it.

And so, oftentimes, that's what we can help the family with, is, yeah, this is what we're seeing, you know, this is what we're hearing, and this does make sense, and we get to really help them put those pieces in place, and, and help them try to see that and understand it. And it is very difficult because society as a whole doesn't necessarily support that.

It's more of that. Pull yourself up by your bootstraps. Hey, bad things can happen and you just move on and yeah, what's wrong with you? I'm weak if I can't manage it or don't understand it or it's not working for me or I'm tired all the time. So the other thing we know about the ACES is the side effects of having this stuff happen to you is, you know, you might, start smoking or using substances or having risky sexual behaviors or You may not have good health outcomes And so you might not feel like going in exercising or having physical [00:21:00] activity like you've had a long day We can all imagine, you know, I'm going home. No, I'm not going for the walk. I'm going for the couch in the TV remote So that plays out in a very same way, but a little more extreme. And so you turn to these other things or your self care is isolating, staying put, not doing the things that you need to do to take care of yourself. So that's where the ACES starts impacting people longterm and it ends up becoming a health issue.

So we have obesity, we have diabetes, we have substance abuse, we have addictions, we have sexual promiscuity, you may have then unplanned births, you may then also have you know, diseases and other things start happening to you in, in isolation in there as well. So that's where it can play out into having heart attacks or heart disease from the smoking or cancers or whatnot.

And so that's where they talk about how ACES can lead to [00:22:00] actual early death. 

Dee: Right. 

Christine: And statistically they do tie in. If you have four or more, you would statistically die 20 years earlier than somebody who doesn't. 

Dee: Yeah. And it goes back also to mental health is health. 

Christine: Exactly. 

Dee: And breaking the stigma around that and realizing that You know, this is another symptom of a larger problem that you need to address.

Christine: Right. If you are, you know, I don't want to overuse the word depressed, but if you don't feel like you have enough energy. Because all this stuff is weighing on you and you don't have anybody to help you understand it or talk about it or see it or even get what it is that makes you feel this way. Then you're not inclined to do these other things and so mental health and physical health are one.

 We have one body. We are all one and it's all mixed up in there. And that's what I loved about Philetti is he was a doctor, a health doctor who decided to start asking patients about what's happened to you. [00:23:00] And when they started endorsing all these things, he started recognizing, wow, you know, a lot of these folks who are ill or on multiple medications to manage things maybe don't even need to be on those medications to manage those things.

If they could go and get counseling and talk to somebody to understand a lot of it, and then they can start managing it differently. And, you know, that's what we really try to help families understand is you don't have to feel this way.

Dee: So what I'm hearing is that it feels very depressing. So you have ACES they're prevalent You have somebody, a parent dies. You have a parent who might use substances, very common things. So, how do kids overcome this? 

Christine: I'm so glad you asked that because it's very much like once we understand things better, then we know how to address it. And that's what's exciting about it. Where, you know, we could get excited about Felitti saying this, [00:24:00] instead of saying, holy mackerel, we're all doomed.

Dee: Yeah.

Christine: You know, it's, oh, yeah, that, now I get it. So he kind of gave us a little bit of a recipe we get to work with, which is what's so cool about it.

 And we, can help the families look at it that way and look at caregivers that way and help caregivers understand then what do kids need to overcome this? The number one thing that kids need to overcome a traumatic experience specifically is a safe, stable, supportive caregiver. So it's not magic but it's not simple either because a lot of times when kids have had These ACE experiences, their caregivers are in there with them, right?

And so, they have their own stuff that they're dealing with. And so, when they come in, you know, and they say, Help my child, Oftentimes, they don't want to talk about their stuff and we say, Hey, come on in here. So we may be vicariously working with a caregiver by helping the child and that's really fun and [00:25:00] exciting too because we get to see that caregiver change and, and be that supportive person they want to be for their kids.

So definitely engaging the caregivers, not letting them sit in the waiting room, you know, not letting them sit out in the car, run to the grocery store, those kinds of things, but, you know, getting them in there. And really helping kids learn how to express their emotions, to let them know they're not alone, that these are behaviors that are typical and feelings that are normal.

And again, , kids usually get it way before the adults do. 

Dee: Yeah. 

Christine: Which is kind of fun is that the kids are.

Dee: Kids are smart

Christine: They're smart and they like, Being able to have even a therapist being able to talk to them or a teacher or coach, whoever it is, that safe, stable, supportive caregiver can be many different adult roles in their life.

Dee: What about benevolent adults that are like teachers or counselors or neighbors? 

Christine: Absolutely. And that's, that's what's so critical about it [00:26:00] is even as a parent, if you feel like, oh my gosh, I can't do everything and be everything. neighbors, aunts, uncles. It takes that village and that community. Definitely teachers, coaches, ministers.

You know, a boss. You know, maybe, maybe a youth works someplace and has a strong connection to their their boss or their, their supervisor. So lots of really great opportunities. Poverty, you know, throws in another barrier for us.

Dee: And another Oklahoma problem, unfortunately. 

Christine: Yeah, huge, right? So you know, when folks are isolated, when they don't have transportation or access to get places.

So You know, online schools are fantastic for certain folks, but sometimes that really perpetuates the isolation. And then poverty, you know, we also see where oftentimes the environment that they're living in is maybe not always safe on a regular basis. And then we also see the health [00:27:00] differences in terms of food. Availability in a consistent way. So poverty definitely exacerbates the situation. So when kiddos with poverty have adverse childhood experiences, then it takes more of that community effort to really focus on that family and try to get them the supports that are needed. And that's absolutely not to say The children in poverty all have ACES because that's absolutely not true.

And there are amazing families that, work through poverty and do wonderful loving nurturing things. So, but yeah, you know, kids can overcome ACES by certainly being in social systems, getting therapy understanding how to express themselves and absolutely can work to address what's, happened to them.

Dee: So are there other things that individuals can do to protect and encourage children to get better? 

Christine: Yes, absolutely. So, [00:28:00] we actually have the protective and compensatory experiences, which is a mouthful, but

Dee: PACES, that's PACES.

Christine: PACES, yeah. So, what we can do as caregivers is and again, it's kind of a giant parenting class but sometimes our parenting skills get a little simple, because it's hard to always think as a parent when you're just a person, too.

And again, you have your own experiences and whatnot. So, our parenting practices are not always pristine but they don't have to be. You don't have to be the perfect parent But one of the things that we do know that is really impactful is parenting with discipline versus punishment, having a more nurturing parenting style.

And that's one of the things we see when we work with families. Parents don't want to change their parenting style. If you had a kiddo who's had some of these experiences you, you possibly going to need to parent differently because otherwise they may not come through things as healthy as they can.

So you know, [00:29:00] making sure that kids are in a social group attending school if they have a best friend or if they can see how to have a healthy relationship. It's really critical and it seems simple, again, but, it's a lifelong skill , to play sports, to be able to get along with other people, to be able to have a job when they grow up, to be able to navigate systems, and that is not something that always comes naturally for folks.

Dee: Yeah, I love the fact that those are all things that we identify as healthy relationships and things we can do for kids. I like that it's labeled PACES,because it, you know, because you go, Oh, ACES, that happens all over. And it's like, Well, this is something really proactive that I feel like I can do and identify and go, Oh, those are really approachable things that almost anyone can do , I think you need more of that in your life.

Christine: Right. And that's what we really look at. If there are families who come in and they don't have a lot of PACES, we really work with them on how do you, how do you build these, you know, how do you put them in your community, how do [00:30:00] you access these kinds of things for you as a caregiver, as well as for your kids and it can be really new But it's very obtainable again, poverty can throw us for a little bit of a curveball to figure out how to creatively do it at times, so a clean, safe home with enough food, you know, that can be a stretch sometimes but just that need to again share where resources are and what they can do to make that work and it might mean helping people learn how to cook you know, with certain foods that they can afford. And you know, we all can benefit from that too. 

Dee: So when COVID hit, I know kids were more isolated and we started that partnership with some of our community partners that you work really closely with to start a program called Look Out, Reach Out. You know, if somebody identifies behaviors within children that just don't seem right, how can people help something that they're observing that might not be getting the attention it needs?

Christine: You know, there are so many different times [00:31:00] that that happens, and , it's easier to kind of look away and assume people are having a bad day. But when you, see something and you have that ability to reach out, which is what I loved about the Look Out Reach Out is you don't have to take on the whole situation , but even offering a kind word or, or what we would say, maybe an intervention of saying, wow, it looks like it's been a big day, you know, for everyone. And again, kind of normalize those things. You see a child and a caregiver in a grocery store and you know, they're not getting along and there's a lot of fussing or whatnot. Even being able to go by and distract, you know, or say, Hey, I really like your shoes or just...

Dee: That's kind of a PACE in a way.

Christine: It is. It really is. It's another benevolent kind of person, you know, stepping in there and and it's having a healthy boundary and it's just being another human, you know, interacting in their life. If there are those situations where you do think something's going on beyond just that moment.

Yeah. And you see, maybe the [00:32:00] person or a pattern, you know, those, things need to be reported. And the Department of Human Services. of Oklahoma has the ability to screen and assess situations to see if somebody does report child abuse or neglect suspicions to them. That's all you have to have. And the wonderful thing on the flip side of what DHS can do besides remove kids is they can put lots of services in the home to work with families.

Dee: Yeah, I don't think a lot of people realize because there's a lot of fear around reporting. I don't know that everyone understands that it's not just, call and the kid's removed from the home situation.

Christine: Right? You know, really, that's the last thing that Oklahoma human services wants to do is to remove a child because as a community who provides these services, we recognize the removal of a child can be more traumatic than the The experiences they're having, so we understand that and I think that's the other beauty of where we are today versus 20 years ago that we do recognize that could be [00:33:00] worse. So we have worked and states are working to look at what can we do instead of removal. 

Dee: I learned about SafeCare when I first started at Family and Children's. I did not know about it before and it's just such a remarkable program with a curriculum that works. So, I'd love for you to talk about that.

Christine: It's so wonderful. So, and some of these services that people might not know, the only way to get to some of the services some of our families can get are through a referral, which is kind of wonderful. Not right. Maybe.

Dee: So who can refer? 

Christine: So, DHS can refer. There are some programs that are just paid for DHS, so Oklahoma Human Services, Child Welfare. One of them is to SafeCare. We have a SafeCare just through Child Welfare. We have a SafeCare that's available in the program. 

Dee: Explain what SafeCare is. 

Christine: Yeah, so SafeCare is a model that came about really to address kids who've had neglect situations. And It's awesome because it works with the caregiver and the children in the home and [00:34:00] looks at how do you have those positive, healthy, nurturing relationships that we talked about because it goes back into education and teaching parents how to parent without punishment and how to use discipline.

It provides parents the ability to understand the importance of having a safe environment, having health. as a critical factor. So even a pediatric appointment, are those being attended to? Dentist appointments, are those being attended to? Do you need access to those things? So it has a broad scope of four domains of health, safety, wellness, and then the parenting components.

And so they actually walk caregivers through Showing competency in all of those components.

Dee: So they come into the home and help.

Christine: They come into the home. We use a curriculum and the parents show their competencies in the curriculum. And a lot of it is [00:35:00] parenting in a way without having to have a lot of screaming and fussing and cussing. pulling and yanking and all those kinds of things. So even if you have a child who's more aggressive, SafeCare can address that because it can teach you how to parent in a way that provides structure, routine consistency, fair rules. But also the ability for the child to make choices and to have a say in some things.

And we all know what worked as a parent three weeks ago may not work tomorrow. And what works on a five year old doesn't work on a ten year old. So, it has a developmental different parenting strategies in there, which are wonderful. And then we augment safe care with managing child behavior and healthy relationships.

So again, it goes back to how do you communicate, how do you manage a child with aggressive or negative behaviors without getting into where you're wrestling them around or spanking and doing all those things that's more physical and you can as a parent lose control because we get upset. So how do you manage that? How do you manage yourself? [00:36:00] How do you manage them? So it's been phenomenal we've done studies across the state of Oklahoma showing the, the recidivism rates back to Oklahoma Human Services have gone down for families who have had this intervention and it's not just for families and child welfare, it's for anyone.

Dee: Oh, so anyone can refer to SafeCare. Yeah, I think we have a referral form on our website if anyone's interested. 

Christine: Yeah, we do. And we provide it actually in Tulsa County and in the surrounding. So all around Tulsa, we have availability and it is, it is neat. They, we do go to the home and so. 

Dee: What a luxury. I mean, having just somebody there to, I mean, when I was at early parenting, you go, I don't know what I'm doing.

Christine: Right.

Dee: In so many cases and you just kind of are figuring it out, but to have like, Kind of a, a little tutor in a way. 

Christine: That's right. We can come to your home and, and see, because a lot of times that's what parents would say, I tried it and it didn't work. You know, I tried it and it doesn't work for my child. And what is better than having somebody who [00:37:00] understands parenting coming to your home and getting to work with you and your child in your home, in that environment, and get to see it played out and say, man, you're right. This is tough, but we're going to work through it and let's make it work for you.

Chris: It sounds like there's a lot of positive going on in this space, a lot of reason for optimism, but what gives you hope in light of all that we've discussed today? 

Christine: Yeah, so hope in itself is an amazing gift that, that we have and that we do try to bring to the families that we work with. And we can do that because of things like Safe Care and what we call evidence based practices. So, again, what science has shown us and how to work with kids. Yes, we use play therapy working with children and families. Play is a language that kids use whether it's art or, you know, writing. We go through the pathways that kids and families are giving us and that's what's so exciting.

These evidence based practices have given us tools to [00:38:00] that we can see have positive outcomes with families and children. And it's not, you know. where therapy might have been, you know, 20, 30 years ago where, yes, therapy helped a bit. We kind of had a couple of tools in our toolbox. Now, you know, we're doing 10 different evidence based practices in our program. When I came on board, there was one, you know. 

Dee: So you can really individualize the treatment models. 

Christine: Yes, from zero to, you know, 18 plus. So, you know, when I came in, we didn't know what to do with a two year old. What, are we going to do when they're pre verbal or, we're not real sure what they're saying.

And so, that's what we've learned over the years, is how to have those interventions and then how to communicate that back to the caregiver so it can be, with, with them and their children. So the hope is definitely there. The work is hard. Absolutely. You know, we don't like seeing and hearing the things that people suffer with, but more than anything, we like getting to say, yeah we [00:39:00] understand how to help. We may not have walked in your shoes to see what you've gone through, but. We've got all these tools here to help you get through it. If you're willing to, come and work or we can do telehealth, there's just so many different ways we can access people now. And I think the community and like you'd mentioned earlier, Dee, some of our partners in the field, we are more on the same page now than we were at one point where only some of us might have had some interventions.

The state of Oklahoma has really tried to work to have one of the best interventions for children is trained now through the Department of Mental Health for a lot of the providers in our state versus us having to acquire it on our own only. When I started in this agency, we acquired everything on our own.

We brought in the trainers or we sent people to trainers or whatnot and that's, changed over the years. It's still not perfect by any means, but we [00:40:00] recognize the importance of having evidence based practices and using those tools. So it's very hopeful. 

Dee: That is hopeful. And my hope for this conversation today is that People realize this isn't, it doesn't have to be this scary topic, that there are things that we all go through as humans and there's ways to combat what's happened and move forward in a better, brighter way.

Christine: Absolutely. In, in talking with others and being with others that have that information can be, You know, what can really change it and, and help put perspective in place. So you know, I think that's what's so exciting. Seeing kids change and seeing caregivers change whether it's in family or individual or group therapy models is just, it's so motivating.

And, and you know that, we can help them get through this component. So when and if they do have another experience, right? That might happen because life is life. They have a lot of those skills then with them that they [00:41:00] can carry forward and they can recognize. Oh, yeah, you know been here I can do this. I know what I'm thinking. I know why I'm feeling this way. And they're better equipped to manage it. 

Dee: Great. Chris, Christine, thank you so much. It was fun chatting with everybody today. 

Christine: Thank you. It's been great. 

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