Sunday, December 30, 2012

New Card about my Book

Here is a card I just made and ordered to hand out to people who are interested in my book:

Front:



 












 
Back:












What do you think of it?
 
 
 

Wednesday, December 26, 2012

Love Wins

Remembering Ana Grace Màrquez Greene

I am sure that all of you know about the horrible killings in Newtown CT. A 20 year old gunman shot 20 first graders and six adults in the Sandy Hook Elementary school. Prior to going there he shot his mother. Finally, he shot himself.
One of the children killed was the daughter of a Klingberg employee, Ana Grace Màrquez Greene. Her mother, Nelba Màrquez Greene, is the Director of our Family Therapy Institute. Her father, Jimmy Greene, is a jazz musician.

I spent much of the week helping our Klingberg community absorb this tragedy.
Staff and clients were deeply impacted by these deaths, Ana’s and the other 26. As an administration, we wanted to provide space for staff to discuss the events and to explore their feelings and reactions.

We transformed our former reception area into a Room of Reflection. We added soft lighting from lamps, plants, pictures and stuffed animals. We had a bulletin board. I originally thought that would be for staff messages, but instead people posted articles, poems, pictures, etc. AND copies of staff emails they felt were moving. We had a book to sign in and write a message, and a basket for cards. The newspaper article with the pictures of all 20 children was posted. All in all, it was a place where people could sit and reflect or talk with others.

We noticed that the room of reflection had a purpose far beyond its actual use. Often people looked in and said “I’m so glad you are doing this.” Whether or not they chose to hang out there, the room was a statement that we knew our staff were having deep feelings about this event, and that thinking and sharing were important and worthwhile activities.
Similarly, the discussion groups we organized had unanticipated results. We set up several times to accommodate the complex schedules of an agency like ours. During those times staff were encouraged to come to the Room of Reflection and discuss the way the killings in Newtown and our co-worker’s terrible loss were affecting them. My colleague Steve Brown joined me in facilitating the groups, and we had some ideas to get the discussions started. Not many people came, but those that did spoke thoughtfully and compassionately. They were impacted on many levels. The clients were having various reactions, and staff were creating space for them to explore their feelings. Some outpatient families had lost a child themselves, and were re-experiencing their own losses. In fact, everyone was experiencing their own losses, recent or distant. Many spoke of hugging their own children more. One father reported his child saying “Dad, will you stop hugging me!?” Concerns of personal safety were on everyone’s mind- what is our safety at Klingberg? We constantly deal with emotionally dysregulated people, are we doing enough to increase safety? People worried about the safety of their children and reported on how their children’s schools were responding. My colleague David Lawrence Hawley made the excellent point that “we are no less safe than we were last week, we are just feeling differently about it.” Our wall of denial has been pierced.

Another area of concern was ourselves as mental health providers. Could we have helped this shooter if we had treated him earlier in life? Do we know what to do? Many are not sure. Assessments that we are currently making assumed a greater importance that was scary to some. And it feels like there are so many constraints and so little we can do. People spoke of youth they had known who seemed dangerous, and how little they could get the community to respond because the youth hadn’t done anything serious yet. One therapist describes one such youth who had gone on to kill his girlfriend. So, our confidence in our interventions was shaken, and at the same time we felt the importance of what we do.
One unanticipated results of the Discussion Groups was that serious, thoughtful discussions were starting everywhere, outside the discussion group times. This may have been inevitable, but I think it helped that the administration gave permission and acknowledged how important it was to set aside time to share our reactions. As the quote that we posted in our Room of Reflection says:

“Grief wounds more deeply in solitude; tears are less bitter when mingled with other tears. “
                                                                                                     Agememnon Seneca

Throughout this process we were encouraged by occasional reports of communication with our beloved staff member, Nelba. Her strength, honesty and grace in this terrible situation inspired us all. The family began to sign all communication with the phrase: “Love wins.” So we adapted that slogan. The town also said “We are from Newtown and we choose love.” Even while wrenched with this desperate sadness, the families were reaching for the meaning of their children’s lives, and trying to bring some good from the horror.
Then on Saturday I attended Ana’s funeral. This was the most incredible event I have ever been to. Ana’s father is a jazz musician named Jimmy Greene. He plays the sax. He is very connected to the jazz community. The held the ceremony in this huge cathedral church and there were literally over a thousand people there, all races, ages and types, most dressed in purple. Prior to the ceremony the family sent out an email inviting people to wear purple and sparkles because that is what Ana loved.

The ceremony, which they called "A Celebration of Ana's Homegoing", included lots of music, jazz, choir singing, a classical string quartet, etc. The message of the powerful speakers was all positive- acknowledging the sadness and pain, but emphasizing our learning from Ana's short life and becoming more loving.

On every email and communication they have sent out they have ended with "Love wins." I now have a purple bracelet (one of those plastic bands) that says "Ana Grace: Love wins". That was the message of the ceremony. It was so incredibly inspiring.

Now, how do we go forward as the media retreat and the attention moves elsewhere? How do we do the hard work of actually creating the change that children like Ana deserve? It is clear that we must work together, that we must be inspired to fight for what is right. And our efforts will matter because LOVE WINS.

Sunday, December 16, 2012

Tragedy

The shootings in Newtown Connecticut are close to us geographically. And they have been brought even closer because one of the children shot was the daughter of one of our Klingberg employees. Nelba Marquez-Greene is the new Co-ordinator of our Family Therapy Institute, and a wonderful new addition to our staff. She and her husband, the jazz musician Jimmy Greene, lost their daughter Ana in the shooting.

I have been thinking about Newtown, Nelba and their family almost constantly, as I am sure many others have.
There have been many different clamors for many different solutions. More gun control! Easier access to mental health treatment! We wish so badly that there was a solution, something to do, a law to pass.

As a person who teaches others about treatment, I of course think of the shooter. Do we know what treatment would keep this from happening? I have read speculation that the shooter had Aspergers.  If he had received the most caring and skillful treatment possible, could we have presented this? We don’t know yet whether he ever had treatment. I do feel confident that any treatment that emphasized relationship, safety, caring and finding your voice would have had a better chance of reaching him than a  harsh, punitive approach would have.
But this is all speculation at this point. What is not speculation is the love and connection we are sending to Nelba and her family. We comfort each other by gathering and by sharing in an open hearted way. We can’t make sense of what has happened. But we can use our connection to each other to get through it and to strengthen our commitment to the work we do.

Please share your thoughts by clicking “comment”.


Sunday, December 09, 2012

Ruta Mazelis on the Experience of Self Inflicted Violence

This past week we held our annual Day of Learning and Sharing for Risking Connectionsâ trainers. My colleague Steve Brown gets credit for both the vision and the implementation of this event, which offers in-depth training on an important topic in trauma treatment. This is one of our most excellent achievements. The warmth in the room is obvious, as the community of trainers greet old friends and catch up on the latest events. This is a group of the clinical leaders in Connecticut, all of whom have attended Risking Connection training and an additional three days to become trainers. They have also attended Consult Groups and Recertifications to keep their knowledge current. They are seeped in a trauma-informed approach to their clients. They are our partners in changing the world.

This year our guest speaker was Ruta Mazelis. Ruta is a popular speaker and trainer who presents nationally on behalf of Sidran on issues surrounding self-inflicted violence, trauma, and trauma informed care. She frequently consults to SAMHSA's Center for Mental Health Services on topics related to trauma, including trauma-informed care, co-occurring disorders, re-traumatization in systems of care, self-injury, and criminal-justice involved survivors. She provided extensive technical assistance to the SAMHSA Women, Co-occurring Disorders and Violence Study, served as a program manager for the National Center for Trauma Informed Care, and is currently on the board of the National Trauma Consortium. Ms. Mazelis, herself a trauma survivor, has worked as a substance abuse and mental health care provider in inpatient and outpatient settings. She is the editor of The Cutting Edge newsletter which she founded in 1990, and edits the web site, healingselfinjury.org, and she has published numerous books.

Ruta immediately sensed the skill and knowledge in the room, and realized that she did not have to teach this audience the basics about trauma. Instead, she used her personal experience to instruct us about the realities of being a trauma survivor who relies on self-inflicted violence to deal with unbearable pain.
I hope to write more about this training in a later blog. In this post I would like to convey some points that Ruta emphasized: The first is that self injury is not a distinct and uniquely horrible or dangerous symptom. It is just one more way people have found to deal with the unbearable pain that has been part of their lives. She emphasized that we all self harm, and that for all of us it is a method of coping with pain. It is adaptive, as are addiction, aggression, eating disorders, smoking, running away, sleeping all the time. It is actually not the most dangerous thing that many trauma survivors do. The long term harm to the body is considerably less than say alcoholism. Or smoking. It is not illegal, it can be kept hidden, and it does not hurt others. Ruta told us that she has learned from her newsletter that self-inflicted violence is part of the lives of people of all ages, sexes, socio-economic groups, professions, and statuses. She has known many treatment professionals who use this technique to manage their lives.

I was once again struck by the ways that the pressure to achieve change can so often interfere with change. Self harm is adaptive. The trauma survivor will stop doing it when they no longer need it. Therefore, if we immediately jump to methods to eliminate the self harm we are not respecting the survivor’s experience. If we start talking about replacement behaviors (writing on one’s self with red pen), it may seem naïve or insensitive to the client. If writing with red pen would accomplish what I need, I would have done that long ago. It may seem disrespectful: I am not interested in how you came to do this or what it means, I just want you to stop. Ruta said repeatedly that most trauma survivors stop self inflicted violence when they work on the trauma, are no longer in desperate pain, and do not need it any more.
This is such a hard stance to maintain with all the pressures surrounding us, both from our colleagues, from those outside our agencies who monitor our performance, sometimes from the client’s family, and certainly from inside ourselves. It is extraordinarily difficult to stay with such a painful symptom.

So all we have to do is work on the trauma. What exactly does that mean? And particularly what does it mean for those of our children (most) who are far from being ready to talk about the events in their lives? As Ruta presented it, it does not just mean teaching coping skills. It means interacting with the child at every possible moment from the understanding that their behavior comes from fear, shame and despair and is adaptive. If a treater expresses that conviction repeatedly the client may gradually question their own self blame. It means creating a safe enough space that the client can relax, play and sleep. It means engaging in rhythmic rewarding activities with engaged adults to begin rebuilding the brain and reshaping early templates of relationships. Most of all it means love and compassion, for the client, ourselves and each other.
So that’s all we have to do. And gradually the self inflicted violence will fade, along with the other extreme symptoms, as the client moves forward to a life worth living.

Ruta was intense, real, passionate, and at times uncomfortable. Just what we all need to counteract all the push towards shorter, more practical, symptom reduction quick fixes. Thank you Ruta for a reminder of the profound depth of the work we do.

Sunday, November 25, 2012

Thankful this Thanksgiving

I guess I could follow the theme of the weekend by listing some of the work-related things I am thankful for this Thanksgiving:

1.       My book- I’m so happy and proud of this accomplishment and thankful for all the people that helped me realize it.

2.       All the smart, interesting, thoughtful caring people I have met through my training and consulting.

3.       The people I have come to know who really think about this work, develop new ideas, and strive to change the world. These include Steve Brown, Laurie Pearlman, Sandy Bloom, Kay Saakvitne, Martha Holden, Sarah Yanosi, and many others. It’s great to bounce ideas off of each other and thus come up with even better thoughts.

4.       The concept of vicarious transformation.

5.       My new friend at the UConn School of Social Work Megan Berthold whose courageous work with torture survivors has taught her a lot about surviving with dignity.

6.       The opportunity to teach at the School of Social Work- I’m going to teach a real credit course this semester!

7.       My wonderful supportive workplace, Klingberg Family Centers, with all its good humored and hard working people. We are developing new ways to provide excellence in trauma informed care.

8.       Our relationship with the publisher/owner of Risking Connection, Sidran Institute, Esther Giller and Elizabeth Power.

9.       Our work with our Risking Connection trainers. I am very proud of what we do to improve treatment excellence through our consultation groups. Our Day of Learning and Sharing with Ruta Mazelis looks to be another excellent event.

10.   Our new webinars offering training and consultation to our distant trainers.

11.   The fact that both Risking Connection and the Restorative Approach have just been accepted for inclusion on an Evidence Based List, the California Evidence Based Clearing House for Child Welfare.

12.   A new research project we have just been commissioned to do in the Yukon Territory in Canada.

13.   Our working on adapting Risking Connection to native Hawaiian values with Child and Family Service and Partners in Development in Hawaii.

14.    The marvelous people who are directly responsible for the Traumatic Stress Institute of Klingberg Family Centers: Steve Brown, Marci Marciniec, and our newly hired associate, Michelle Kenefick.

Happy Thanksgiving!

 

Sunday, November 18, 2012

What Difference Do Templates Make?

I have been trying to figure out ways to convey to people the importance of a person’s basic templates about other people. These templates are formed early in life, before the baby has language. All of our expectations and actions are based on these templates. We see them as the way the world is, not as our ideas or opinions. The reason I feel it is so important to highlight these templates is that I have come to believe that our most important task as treaters is to change these templates from “people can’t be trusted and they hurt you” to “some people are trustworthy and can be a source of joy and help.” If we understand that, it changes how we approach treatment.

I devised the following exercise to demonstrate the effect of templates. To use this for training, I would divide the group into smaller groups. Give each group a pair of scenarios. Instruct them to consider what each youth is feeling, and what they are likely to do next. What might be the difference between the ways that the two youth would react? When they are done, each group should choose a member to portray the youth. This person should read the scenario then continue with “I am feeling… What I plane to do about this is… “Hopefully what will come out is that kids who have had good experiences with people are more likely to ask for help and hide problems without getting into trouble. Kids who have had bad early experiences with adults are more likely to think that they have to handle the problem themselves and more likely to use violence and threats, because those are the only solutions they know.
Here are the scenarios:

My name is Daquan. I am 15, and my life hasn’t been that great so far. DCF took me out of my family when I was five, and I have been moving around a lot since then. I live in a foster home, and DCF gave me this scholarship to send me to camp. One of my bunk mates, Seth,  is bigger than me and he has been threatening me, demanding to wear my clothes,  and saying he is going to beat me up. I don’t know what to do..

My name is Darrell. I am 15, and I live with my mom and dad and little brother, Joey. We mostly get along pretty well. My school gave me this scholarship to send me to camp. One of my bunk mates, Seth, is bigger than me and he has been threatening me, demanding to wear my clothes, and saying he is going to beat me up. I don’t know what to do..
My name is Bianca. I am sixteen years old. I live in a group home. I’ve always hated school and I don’t do well there. I especially don’t understand math and this year algebra makes no sense at all to me. Yesterday the teacher called on me and I had no idea of the answer. I mumbled something and left for the bathroom. I don’t know what to do.

My name is Estelle. I am sixteen years old. I live with my mom and dad and three sisters. We all love each other except sometimes my sisters drive me crazy. I’ve always hated school and I don’t do well there. I especially don’t understand math and this year algebra makes no sense at all to me. Yesterday the teacher called on me and I had no idea of the answer. I mumbled something and left for the bathroom. I don’t know what to do.
My name is Kyle. I have just moved into a foster home- I don’t even know how many I have been in since I was taken from my family when I was six. Last night I was at a party at a friend’s house. There was a lot of drinking and some kids were doing drugs. The noise and rowdiness kind of got out of hand and next thing I knew the police were called. I didn’t know what to do.

My name is Tommy. I live with my grandmother and I love her very much. She has always raised me to know right from wrong. Last night I was at a party at a friend’s house. There was a lot of drinking and some kids were doing drugs. The noise and rowdiness kind of got out of hand and next thing I knew the police were called. I didn’t know what to do.
My name is Sarah. I lived with my mom until I was 12, and she had some serious problems. I am 18 now. I lived in a shelter and then some foster homes. I got pregnant last year and now have my wonderful baby Melissa. But some nights she cries and cries and just won’t sleep. I don’t know what to do.

My name is Rebecca. I am 18 now. I lived with my mom until I got pregnant last year. Mom was upset, but she and my Aunt Susie stood by me. Now have my wonderful baby Melissa. But some nights she cries and cries and just won’t sleep. I don’t know what to do.
My name is John. I grew up with a lot of violence, and my Dad is in jail now for killing someone. My mom just seems to bring home these angry guys. I am 18 now, I’m sharing an apartment with two friends and I have a job. I still get some help from the state. One of my roommates is driving me crazy. He is a real slob and leaves his stuff everywhere, never cleans up after a meal. I have complained to him but he has not changed. I don’t know what to do.

My name is Rick. I grew up with my mom and dad and brother. I am 18 now, I’m sharing an apartment with two friends and I have a job. My mom makes me food and sometimes still does my laundry. One of my roommates is driving me crazy. He is a real slob and leaves his stuff everywhere, never cleans up after a meal. I have complained to him but he has not changed. I don’t know what to do.
Please click on “comment” and let me know what you think about this approach. Especially if you try it with your staff, PLEASE write me and tell me how it goes.

Just think what our lives would be like if we thought our most important task was to teach our clients that people can be associated with pleasure,

 

 

Sunday, November 11, 2012

Who Are These Big People?

When a baby is very small, before she has language, she is already investigating the world in which she lives and coming to conclusions about what kind of place it is. Most importantly, she is learning about the people around her. Who are these big people? How do they treat me? When one of them comes over to me, do I generally feel better or worse?

 In good enough parenting, the presence of a person is usually associated with pleasure. I am hungry, someone comes and feeds me and I experience pleasure. I cry, someone rocks and soothes me.I am wet, someone changes me. The baby gradually discovers that she can do things to affect these people: she cries, they come; she smiles, they smile; and she enjoys many other positive interactions. Since the baby has no language at this point, she cannot create a narrative of these experiences. Instead the are stored deep in her body as a template, a pattern, a set of assumptions about how the world is. As the child grows older, she does not understand this view of the world to be an opinion based on her experience; she feels it as the truth about how the world is. These truths of course influence how she acts in the world.

If a baby is neglected or abused before she has language, she too forms a template about how the world is. She too knows the truth about other people: no matter what you do they don't come; if they do come they are often harsh and angry ;they don't undertsand what I need; sometimes they hurt me; they often seem upset that I need anything. This baby too grows up with deep unexamined assumptions about the nature of the world; this girl too acts based on those assumptions.

A person does act differently based on what they know about the world around them. Imagine that you have just started a new job that you are very excited about. On the third day you get an email from the CEO of the company asking you to meet with him the next day. You are scared and surprised, and you wonder what this is about, so you ask a co-worker. The co-worker says, "oh, don't worry, he meets with all new employees. He is a great guy, he loves to help new people and make sure they have the resouurcves to learn and develop in the company". How would this infludence your subsequent preparatione for the meeting? How would it influence how you act in the meeting?

Oh the other hand, imagine that when you ask your co-worker about the meeting she says: "Oh my God, I'm sorry to hear that. The CEO here is a total idiot. He's always yelling at us for something. When a new person is hired he always tried to intimidate them into performing well. He has to establish that he's the boss and tell you what will happen if you do anything wrong." How would this infludence your subsequent preparatione for the meeting? How would it influence how you act in the meeting?

We act differently towards people based on our unexamined, unarticulated assumptions about them.

Luckily, even though these templates are formed early and stored deep in the lower part of the brain, they can be changed. Our central job in treatment is to change the child's assumptions about people from: people are mean. You can't trust them and they hurt you. Best to stay away from them and take care of everything your self. to: people can be nice. Some are trustworthy and will gladly help you. Some will love you. Connections with others will make your life better and easier.

So how do we do that? We think about all the qualities we wish the child expected in other people. Then we ourselves exemplify those qualities. And we create positive, pleasurable, fun interactions for the child with adults. We include many pleasurable activites that involve physical activity, rythym, movement, art, music, dance, etc. this will open the lower brain so that more change is possible.And we have to continue doing these things over and over again for a long time. The brain can change, but it takes many repetitions especially to change early templates stored in the lower brain.

So, that's pretty amazing. It turns out that behavior will change not primarily because it is punished, but primarily because the child's view of the world and other people gradually changes. As she begins to feel safer and to associate adults with pleasure she will no longer need to utilize extreme behaviors to push people away. Therefore, all people in treatment programs must emphasize having fun with the kids and making sure than most of their interactions are pleasureful. Sounds like a fun job to me!

Sunday, October 21, 2012

The Restorative Approach Training

I have been working very hard on completely revising my Restorative Approach one day training. It now follows the order of my book (Trauma Informed Care- The Restorative Approach www,nearipress.org). The exercises consist mainly of scenarios. The training includes many useful tools. I strongly urge anyone who is interested in the approach to attend my day long training at Klingberg on the 29th, even if you have attended a previous one. Besides, everyone who attends that training will get a copy of my book! If you can’t do that, I hope to see you at a training in the future. As you can see I am very excited about this new presentation. 

Here is the outline:

I.              The trauma framework, a useful road map to understanding both the effects of trauma and how people can heal.

II.            The Treatment Model

a)                  Overview
b)                 Use of Brain Science
c)                  Day-to-day Operation (Attunement exercise)
d)                 Common concerns

III.           Case examples demonstrating the daily workings of a trauma-informed treatment program. Handout: Scenarios

a)                  Defining and discussing behavior: Cassidy, Sarita and Dahlia
b)                 Managing challenges: Marcus, LaTasha, Juan, Young Love, Jesse, Taking Responsibility
c)                  Holding our values during hard times: Kathy, Katrina, Aaron, Trevor and Mario

IV.          Responding when children hurt others.

a)                  Theory of change
b)                 Rewards and punishments
c)                  Joquim Plays Basketball
d)                 Exercise: Becoming More Like You (Handout)
e)                  The Restorative Task, a response that incorporates opportunities for healing and for making amends. Handout: Formulation and the Restorative Task
f)                   Exercise: Formulation Jeffrey and Alexandra
g)                  Exercise: Restorative Task: Jeffrey and Alexandra
h)                 Taking Responsibility
i)                     When the program feels like a war zone  (Handout)

V.           The role of the clinician in trauma-informed care

a)                  Characteristics of clinicians who will succeed in this system
b)                 Necessary training
c)                  The clinician and the team
d)                 Treatment planning
e)                  Supervision and Support

VI.          Trauma-informed care and families.

a)                  Parents as trauma survivors. Exercise: Laura
b)                  Need to feel safe and to build trust. Exercises: Jaquanda, the Johnson family
c)                  Recognize and honor their strengths
d)                 Family fun and joy.
e)                  Psycho-education
f)                   RA at home

VII.         The Restorative Approach and Foster Care

a)                  Training
b)                 Special Needs of Relative Foster Parents (Handout)
c)                  Defining Behavior
d)                 Not Giving Up
e)                  Handling Problem Behaviors Handout: Exercise:  Joseph Visits his Bio Mom, the Contingent Life, Handout: Behavior Management in Foster Care
f)                   VT

VIII.       Agency support for trauma-informed care.

a)                  Leadership Exercise: Problems in the Treatment Team
b)                 Structure
c)                  Culture Exercise: Boundary Questions
d)                 Physical plant

IX.           Staff development.

a)                  Hiring
b)                 Training
c)                  Supervision
d)                  Promotion
e)                  Skill building
f)                   Staff turnover
g)                  Attention to vicarious traumatization

X.           Sustaining the change

a)                  Forces pushing towards a punitive approach
b)                 Predicting and addressing challenges
c)                  Measuring and celebrating progress
d)                 Celebrating success will help sustain the transformation
 

Sunday, October 14, 2012

The Book Everyone is Talking About

I just finished the book How Children Succeed: Grit, Curiosity and the Hidden Power of Character by Paul Tough, Houghton Mifflin Harcourt, Boston New York 2012. This book has received a lot of media attention. For example, was reviewed in the NY Times Book Review (http://www.nytimes.com/2012/08/26/books/review/how-children-succeed-by-paul-tough.html?pagewanted=all&_r=0 )  Paul Tough was also featured on This American Life. (http://www.thisamericanlife.org/radio-archives/episode/474/back-to-school ).

To give an overview of the book I’ll quote the New York Times: “This book challenges the belief that success today depends primarily on cognitive skills — the kind of intelligence that gets measured on I.Q. tests, including the abilities to recognize letters and words, to calculate, to detect patterns — and that the best way to develop these skills is to practice them as much as possible, beginning as early as possible. In his new book, “How Children Succeed,” Tough sets out to replace this assumption with what might be called the character hypothesis: the notion that noncognitive skills, like persistence, self-control, curiosity, conscientiousness, grit and self-confidence, are more crucial than sheer brainpower to achieving success….” These skills can actually be taught, but a significant factor is that “Character is created by encountering and overcoming failure.”
However, I’d like to concentrate on the ways that this message interacts with our work. In his attempt to discover what factors actually contribute to adult success, Tough first describes the ACES study, and give an excellent concise report of the correlations discovered in that study between childhood traumatic events and later psychological and medical problems. Interestingly Tough reports that even when only the subjects who didn’t smoke, were not overweight and did not use drugs were examined, there was still a high direct correlation between the number of ACEs and the incidence of heart disease. Tough explains the biochemistry that produces this result through the stress response. He makes the connection between traumatic events, stress and poverty. So, this underscores our growing understanding how early childhood traumatic events change children’s biology and affect the rest of their lives.

Then Tough reports on the science of attachment, which shows beyond a doubt that attachment with a caring adult predicts future success. In fact, Tough states later that attachment can overcome the stress of traumatic events (connection is the antidote to trauma). He specifically describes how the chemistry of attachment counteracts the chemistry of stress.
Tough moves on to the central point of his book, which is the importance of teaching the executive functioning skills, which he names character. As mentioned above, these are persistence, self-control, curiosity, conscientiousness, grit and self-confidence. I think this fits in with our teaching by underscoring the importance of specifically teaching skills; through curriculums, experiences, and through modeling and demonstrating. He gives many specific ideas for doing so (one of which is playing chess). An interesting point is that children learn partly from experiencing and triumphing over failure. Affluent kids, he postulates, don’t go through enough failure or demand for hard work because everything is set up for them to succeed. Poor kids, on the other hand, don’t get enough help triumphing over failure and seeing it as temporary and not because of a character failure.

I would have liked more exploration of how these various factors interact with each other. Maybe that’s the next book. But it is great that this book is getting so much attention, and publicizing the ACEs study and the importance of attachment. I highly recommend it.