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Beginnings Guides Blog

Home visiting strategies to prevent and reduce harm from ACEs.

Emily was about eight months old the day her mother Julie dropped her off
at my house along with a pile of baby paraphernalia and a playpen.  Emily
was staying with me while her mom took a week-long road trip with friends. 
Emily arrived clean, nicely dressed and well fed; and she looked shriveled and
grey like a tiny old woman. She was silent as her mother handed her off to me.
“She won’t be any trouble,” her mother said. “You can just leave her in the playpen."

Over the course of our week together, I folded Emily into the usual activities and
daily routines that my two-year old daughter and I had established. We played and
sang and went to the park and the grocery store. Emily sat in a high chair at the
table with us for meals. We read stories at bedtime. We did not use the playpen. 

In that week I witnessed what seemed to be a miracle. Emily bloomed.  Almost as I
watched, her cheeks became rosy and soft. Her eyes sparkled. She giggled.  She made
new sounds everyday and glowed when we made those sounds back to her. When her
mother returned, tears sprang to her eyes. She said, “I never knew she could be so

Emily had been neglected. That was her ACE – Adverse Childhood Experience.
(See previous blog). The absence of interaction and non-response to her cries had
already taught her to lay silent in her playpen knowing that she cannot count on
those she loves. Her brain was adapting to the constant stress of being alone by
shutting down. The effects of one week in a stimulating environment were nothing
short of remarkable, a dramatic demonstration of both the devastating power of
ACEs and the possibility for preventing them or reducing their harm.

Home visitors can prevent ACE’s starting in pregnancy by asking reflective questions
that focus the mother’s thinking on how she was mothered and how she wants to mother
her child. Use the Beginnings Pregnancy Guide content to engage the mother in reflective
conversation about her childhood experience and how she wants her child’s experience to
be similar or different.  These conversations help her understand the impact of her life
experiences and reframe her thoughts about “what’s wrong with me” to “what happened
to me?” Make your trusting, durable relationship with her a model for the mother–child
relationship she is already establishing.  

Each booklet in the Beginnings Pregnancy Guide includes a feature on the baby’s growth and
development. You can use this content to help a pregnant mother visualize the physical and
emotional life of her baby during pregnancy so that the mother-infant bond and the
motivation to parent effectively is already established at birth. Encourage interaction,
like talking and singing to the baby, before birth to establish the practice interaction in
everyday activities. 

Throughout both the Beginnings Pregnancy Guide and the Parents Guide you will find content
to help parents reduce stress in their lives and so reduce the impacts of their ACEs , which may
be affecting their health and well –being as well as their parenting practices. The prospect of
having a baby can be a powerful motivator to increase knowledge, improve diet and exercise,
stop smoking and learn to utilize healthcare services starting with prenatal care. By supporting
mothers’ development of parenting skills, social support, and access to resources, home visitors
promote safety, predictability and resilience and so reduce the harm of the parents’ ACEs and
prevent ACEs for the child.

Here is an instrument  you can use to determine your own ACE score. These events in your life
are important.  How have they affected you? You also can use the questions to generate a
reflective conversation with a mother about her childhood experiences and their impacts. 
Testing has shown the questions do not spur trauma or need for professional help. 

For more info: www.acestudy.org/

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