The state of Adverse Childhood Experiences scores in Oklahoma - MetroFamily Magazine
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The state of Adverse Childhood Experiences scores in Oklahoma

By Oklahoma Department of Mental Health and Substance Abuse Services

by Erin Page

Reading Time: 5 minutes 

By age 17, nearly one in five Oklahoma children has experienced traumatic events in their lives, also known as Adverse Childhood Experiences (ACEs). As reported by the United Health Foundation, the statistics make Oklahoma the ninth-highest state for ACEs in kids.

ACEs include abuse, neglect or household dysfunction — for example, a caregiver with substance use disorder, an incarcerated relative or a parent with a mental health condition. They can also include the death of a parent, divorce, poverty or being treated unfairly due to race or ethnicity.

One in six adults in the United States has experienced four or more ACEs, and people with six or more ACEs die nearly 20 years earlier, on average, than those without ACEs, according to the Oklahoma State Department of Health. That’s because as the number of ACEs increases, so does the risk for negative health outcomes, not just in childhood, but throughout an individual’s life. ACEs can lead to depression, anxiety, suicide, poor maternal health, infectious disease, alcohol and drug abuse, as well as more limited opportunities in education, income and occupation. In fact, at least five of the top 10 leading causes of death, like cancer and diabetes, are associated with and more prevalent in those with more ACEs.

Now for the good news: ACEs can be prevented. And when ACEs do occur, the effects can be mitigated.

“ACEs continue to be a concern for Oklahoma — we continue to see high rates for our population in general,” reports Audra Haney, senior manager for infant and early childhood mental health with the Oklahoma Department of Mental Health & Substance Abuse Services. “What is encouraging is how much awareness is building in the general community around the importance of early intervention and prevention efforts at a community level.”

Preventing ACEs at home

The best way for parents to prevent ACEs, or promote healing if an ACE occurs, is to prioritize a strong relationship with their children. Key areas of focus for positive relationships between parents and children include encouraging communication, asking for children’s input, providing emotional guidance and regulation strategies, setting fair rules and limitations and employing discipline over punishment.

“One of the most positive things is that the biggest protective factor for your children is your relationship with them,” said Haney. “Having that caring, nurturing relationship with an adult, unconditional love and acceptance, is protective. Also wonderful news: we don’t have to be perfect. Those experiences are cumulative over time, so a generally positive, consistent response is good enough.”

Parents can focus on providing children with these crucial experiences to protect them against ACEs or help them heal: 

  • parent/caregiver unconditional love
  • spending time with a friend
  • volunteering or helping others
  • being active in a social group
  • having a mentor outside of the family
  • living in a clean, safe home with enough food
  • having opportunities to learn
  • having a hobby
  • being active or playing sports
  • having routines and fair rules at home

Haney advises families to regularly practice emotional regulation together through techniques like breathing or grounding. Families can simply inhale and exhale slowly together, or use a technique like box breathing (Breathe in while counting to four. Hold your breath for four seconds. Exhale while counting to four. Repeat.) Grounding reconnects the body to the present through use of the five senses. (Identify five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste or remember tasting.) Practicing these regulation skills consistently makes them easier to use to when we as parents or our children need them.

“We are building our brain capacity, developing patterns in the brain to come back to,” said Haney. “And these can be quick — you don’t have to spend big chunks of time practicing. It’s the small moments that make a difference.”

Shared mealtimes and taking a break from devices and technology are also key. Children flourish when parents are simply present with them, showing interest and curiosity in what’s going on in their lives, and those positive experiences further protect them from ACEs.

Parents also must acknowledge that not all parenting skills will come easily, especially if they didn’t have the benefit of being parented well, and it’s OK to ask for help.

“We have to take care of ourselves as adults and caregivers, seeking out support and learning those parenting skills,” said Haney. “And there is no shame in seeking mental health services. In many areas of our lives, we have to seek out new skills with the intent of providing the best we can for our kids.”

For those parents who feel they’ve damaged their relationship with their child, Haney offers the encouragement that children are always seeking connection with their parents, no matter their age, and that it’s never too late to get help or choose a different path.

Local families have several supports available to them through ODMHSAS. In partnership with OU Health Sciences, trauma-focused cognitive behavioral therapy supports children and adolescents impacted by trauma. Child-parent psychotherapy is available for children under 5 who have experienced trauma to move toward repair in their relationship with their parent.

ODMHSAS is also making an effort to get involved with families who need extra support earlier, even prior to children being born or conceived, through Family Care Plans, which provide treatment plans and resources to parents-to-be with substance use disorders.

“Harm happens in relationships but it’s also where healing occurs,” said Haney. “Relationships are messy and we may get things wrong. But we always have the opportunity for repair. Healthy relationships aren’t about the absence of conflict or struggle; they are about being able to come back together and repair.”

Community efforts expand support

As awareness about ACEs has increased in families and across communities, Oklahoma has steadily trended down in ACE scores, decreasing about six percentage points since 2017-2018, according to the National Survey of Children’s Health.

The community at large, including schools, government and others, has a critical role to play in focusing on initiatives that support families. For example, ODMHSAS partners with the Potts Family Foundation to provide training for local organizations to address ACEs and build self-healing communities. Called NEAR Science, the training focuses on how neurobiology, behaviors and environment are related to ACEs, as well as how to build resilience.

Because so many protective experiences happen in the school setting, ODMHSAS works with the Oklahoma State Department of Education to provide Project Aware grants for behavioral health aids to support teachers in the classroom. These individuals help consider what needs children are communicating through their behavior and how those needs can be met. Plus, they encourage classroom environments that are focused on meeting students’ relational needs before academic expectations are put in place.

“It isn’t possible to achieve academic outcomes that we want to see without addressing social-emotional needs,” said Haney. “We have to meet those emotional needs first so that kids are ready to learn and take in new information.”

In order to continue to reduce adverse childhood experiences from a community level, Haney advises government, businesses and organizations to provide (and families to advocate for): 

  • improved access to high-quality childcare so parents can provide for their families
  • investment in early childhood education programs and strong primary and secondary schools
  • access to affordable, safe housing
  • programs that promote connection and relationship-building for parents and children
  • social and economic supports that aid families who are facing financial hardships, limited educational opportunities and other conditions that put families at risk for ACEs
  • enhanced youth connections to caring adults and mentors and opportunities to build skills for managing emotions
  • family-friendly policies in the workplace, like paid family leave and flexible work schedules
  • access to substance use treatment and other parenting interventions, and reduced stigma around parents seeking help for mental health challenges, suicidal thoughts or substance use

When the community as a whole focuses on supporting families, the ripple effects of positive change extend beyond just our children.

“The way to address ACEs is through multigenerational care, not only for the child, but also for the adults,” said Haney. “And the benefit in reducing ACEs is not just for children. When parents focus on those protective factors and positive experiences, they also find purpose, meaning and joy.”


Editor’s note: This article is part of a 10-month series of articles and podcasts with 988 Mental Health Lifeline. Find the full series at

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