AN URGENT CALL TO ACTION

Anna, Age Eight was designed to serve as a catalyst for community dialogue and action. We have included very brief excerpts from each chapter, followed by questions to explore and serve as a way for people who have read the book to discuss their reactions, opinions, insights, likes and dislikes. Group members could discuss a chapter or the entire book at work, home or community settings.

For those book club members working within government, non-profits or foundations, the book provides practical steps toward addressing the epidemic of childhood trauma and maltreatment. For those readers who don't work in the public sector, the book can serve as a catalyst for community engagement. We wish your book club an insightful sharing of ideas as you consider our questions.

Anna,
Age Eight

Questions seeking answers

From the Introduction

Throughout Anna, Age Eight, we’ll tell you the story of eight-year-old Anna, and her deeply troubled mother, Cassandra. Anna is a fictional case informed by our experiences working with several state’s child welfare departments. The details have been significantly altered to protect her real identity. Anna was the catalyst that inspired our writing. Her story was literally the tipping point for us, the event that sealed our commitment to producing this work.

Think back for just a moment to reflect on your childhood and how parts of it may have mirrored the story of Anna. You may not relate at all to any of her circumstances, but that actually puts you in a minority.


Chapter 1
Comfortably Numb

When this trauma inflicted on children rises to the level of a fatality, especially one almost tailor-made for TV, we are all collectively mortified. We express horror and outrage, and there is much moaning and gnashing of teeth. But like an unstable isotope, that energy seems to have a half-life of only a day or two. By next week, it’s just a light hum in the background. Until the next fatality, when the process begins again, because there is no clear way to stop it.

We want to stop it, of course, but where do we even begin? Where do we start to tackle this multi-generational, multi-faceted issue of childhood safety, and its aftereffects that roll on through time?

Questions

How numb are we to news about childhood trauma and fatalities?

What can we do to reduce the numbing influence of the mass media on all our screens?

Who is doing any work related to advocating for the safety and health of children and families in your community?


Chapter 2
An epidemic we prefer not to see

The aftershocks of this trauma spread like a virus, resetting human social relations for the worse as they go. We all face adversity in childhood, and we tend to think whatever we faced was normal, but many of these experiences we dismiss at our peril. The emotional costs are high, especially when put them on a high-interest, long-term payment plan known as "not dealing with it."

Questions

How are ACEs (adverse childhood experiences) like a virus? How are they different?

Why are some people able to shrug off childhood adversity as "no big deal" while others are somewhat traumatized by it?

What are the financial costs of childhood trauma that you can see in your everyday life?


Chapter 3
Software, eggshells, and minefields

We're huge fans of the ACE survey, and we wish we could administer it to every student in every grade in every school in the country every year, as well as to parents and anybody thinking about becoming one. We enjoy daydreaming about what a treasure trove of useful, life-saving data that would provide, but alas, the politics make it impractical. Still, various people and organizations have already administered the survey at reasonably large scales – like with groups of patients in clinical settings. A few states have surveyed a representative sample of the general population over the phone.

Questions

What do you think of the ACEs survey?

Had you taken it before?

Do you think it would be useful to have all late elementary, middle, and high school students take the ACEs survey? Why or why not?

How useful are ACEs scores from middle school students versus a random sample of adults across your state?


Chapter 4
Our inheritance of horrors

Breaking down problems into root causes is a great way to increase your odds of solving them. What we all need to be thinking about is which of these root causes could be tackled in our own city.

Questions

How is brainstorming root causes for bad coffee in an office different from brainstorming the root causes of ACEs?

If a root cause of ACEs is untreated mental health challenges, what data and research tell a story of the availability of your county’s mental health services? (For both children and parents.)

How do you think community norms are related to how parents can treat their children?

What do you think are the root causes of childhood trauma in your community?


Chapter 5
An infant, a motel room, and a pile of needles

Our modest proposal is this: Within the child welfare department, build an in-house unit of a few staffers that is dedicated to a process called continuous quality improvement (CQI). Their mandate would be to use data to identify problems and solutions. They would be engaged in the four-step process of assessing, planning, acting and evaluating progress toward measurable and meaningful results. Their jobs, quite simply, would be to help everyone else do their jobs better, and to enlist elected officials and the general public in that cause.

Questions

What do you know about your local child welfare office?

Where can you easily access data on local maltreatment?

Does your state or local child welfare office have a robust quality and planning department with the capacity to promote a framework and process like continuous quality improvement?

Do people who work on the prevention of ACEs see themselves differently from those who work in child welfare preventing maltreatment? If so, how?


Chapter 6
Trauma's fuel tank

Let's make this easy: We believe that America can take a big and fairly simple bite out of this problem by installing behavioral health services in schools, and streamlining the process by which kids and their family members get in to use them. This sort of school-based operation would go a long way toward removing the practical and psychological barriers to behavioral healthcare. This system would also reduce the logistical burden of parents, who often don't have the resources to make the health care happen in the first place. In a nation as wealthy, creative and technologically advanced as ours, we have no legitimate excuse for not ensuring the mental health care of every child and adult.

Questions

What are the challenges to providing mental health care to children and families?

What are the benefits of having behavioral health care based in a school setting?

What are attitudes about accessing "talk therapy" in all your communities? Is there any stigma discussing trauma-related problem with a counselor?

How can we better promote the benefits of mental health care and treating ACEs?


Chapter 7
Because this is America

Feel whatever you want about (struggling mom) Deirdre, then work like hell to build a country in which all zip codes are a great, or at least tolerable, place to grow up, so that 20 years from now, (young son) Ethan isn't in this exact same place.

Questions

What are the benefits of home visitation for parents your community and county?

What are the benefits of early childhood programs? What are the challenges to accessing such programs?

What are the benefits of having youth mentors? What are the strategies used to recruit mentors?

How can organizations that serve families become data-driven, cross-sector and adopt a systematic approach to preventing childhood trauma?

Which groups are tackling on the long-term work of creating access to safe housing, medical/dental care, transport, job training and high performing schools?


Chapter 8
There's an app for that (maybe)

We can imagine a long list of fascinating ways that technology — both the kind we have now and the kind that they say is just around the corner — could potentially help our kids avoid and recover more efficiently from ACEs.

  • Artificially intelligent coaches/therapists
  • Mapping and visualization
  • Institutional tracking software
  • Attitude adjustment: Though they can come off as arrogant little know-it-alls, what with their incessant talk of disruption and the internet of things, we do, as a general rule, like how the tech industry thinks.

Questions

What would be the benefits of an app or site that published information about family-centric services in your area?

What are the benefits of creating an online environment that would tell us if the needs of our most vulnerable families were being met?

How can you access data and research related to ACEs and maltreatment?

How do you start or strengthen an organization to ensure that we address risk factors in our most vulnerable communities?


Chapter 9
Get the Data and Make a Plan

In the shadows of Santa Fe's beautiful churches, under those stunning mountainous panoramas, random acts of evil take place daily, and by the thousands. Within smelling distance of the city's great restaurants, there are low profile cases of neglect and abuse.

We've discussed many problems in this book: Entrenched bureaucracy, lack of commitment to data-informed planning and action, an apathetic public that parachutes into the conversation only when major disaster strikes and then only long enough to label a few people monsters.

Questions

What do you need to strengthen ACEs prevention work and resiliency promotion work?

How data-driven, cross-sector and systemic is the current ACEs prevention work? How do we strengthen it?

What can we do to ensure that each state has dedicated staff positions and the resources to implement the data-driven prevention of childhood trauma and maltreatment?

How can you train people in continuous quality improvement at your place of work?

What can you do about the lack of urgency for addressing childhood trauma and maltreatment?

Why will some people and agencies fear using data?


Chapter 10
Experience being courageous preferred, but not essential

We believe that if a measly quarter of the readers of this book responded to our calls to action we would soon see two major disruptions to business as usual. Only one thing prevents this from happening: Us.

Questions

Why would it take courage to work on ACEs prevention?

What other large social problems required courage and risk to solve?

What is one social problem you see as solved that can serve as a model for addressing ACEs?

What is your role in ending the epidemic of childhood trauma and maltreatment?


GETTING YOUR QUESTIONS ANSWERED

For more information about Anna, Age Eight and the Data Leaders for Child Welfare and Resilience Leaders for Public Health programs it's based on, please see Anna, Age Eight Book Page or the contact the authors Dominic Cappello in Seattle at dom@safetyandsuccess.org or Katherine Ortega Courtney, PhD in Santa Fe at kcourtney@santafecf.org.


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