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Adverse Childhood Experiences: The Hidden Public Health Crisis

March 20, 2023

In 2014, Pediatrician Nadine Burke, later appointed as Surgeon General of California (2019-2022), presented a TedTalk which summarized a major public health crisis impacting Americans. Dr. Burke Harris stated:

In the mid-’90s, the CDC and Kaiser Permanente discovered an exposure that dramatically increased the risk for seven out of ten of the leading causes of death in the United States. In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20-year difference in life expectancy. And yet, doctors today are not trained in routine screening or treatment. Now, the exposure I’m talking about is not a pesticide or a packaging chemical. It’s childhood trauma.”

When Dr. Burke Harris references childhood trauma, she explains that this term falls under a larger category of what is called Adverse Childhood Experiences (ACE). The Centers for Disease Control and Prevention (CDC) define ACE as “…traumatic events that occur in childhood such as experiencing violence, abuse, or neglect, witnessing violence in the home or community and/or having a family member attempt or die by suicide. Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with substance use, mental health problems, or instability due to parental separation or household members being in jail or prison.” According to the CDC, 61% of adults surveyed had experienced at least one type of ACE before age 18, and nearly 1 in 6 reported they had experienced four or more.

The original ACE study in the 1990’s, in which more than 17,000 individuals across 25 states participated, found a direct link between a high of number of ACEs causing greater negative outcomes across the span of a person’s life.

This is illustrated by the CDC’s ACE Pyramid:

Additional surveys taken in the late 2010’s, assessing the impacts of ACE in smaller and more diverse communities have replicated this link and identified that the impacts of ACE may also increase the risk for the commercial sexual exploitation of children.

With such profound results and studies about ACE, it is concerning that so many in the general public haven’t heard of it. In our community engagement and education efforts, Children’s Cove has often found that even professionals and community members have heard not of ACE.

It is hard to understand how a public health crisis of this magnitude goes largely unnoticed or unknown in the general community. It certainly isn’t due to the lack of evidence-based information. So why is this? Dr. Burke Harris offers a theory in her TedTalk:

You know, at first I thought that we marginalized the issue because it doesn’t apply to us. That’s an issue for those kids in those neighborhoods. Which is weird, because the data doesn’t bear that out… If I were to ask how many people in this room grew up with a family member who suffered from mental illness, I bet a few hands would go up. And then if I were to ask how many folks had a parent who maybe drank too much, or who really believed that if you spare the rod, you spoil the child, I bet a few more hands would go up. Even in this room, this is an issue that touches many of us, and I am beginning to believe that we marginalize the issue because it does apply to us. Maybe it’s easier to see in other zip codes because we don’t want to look at it. We’d rather be sick.”

Is this the case? Is the lack of awareness, conversation and acknowledgement of the problem exist because it impacts so many of us?

Let’s find out.

The full questionnaire in the original ACE study was very comprehensive with more than 200 questions. So, in order to help more people, the organization ACEs Too High winnowed down those questions to a simple questionnaire, and here it is:

Prior to your 18th birthday:

• Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you or act in a way that made you afraid that you might be physically hurt?
• Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you or ever hit you so hard that you had marks or were injured?
• Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way or attempt or have oral, anal, or vaginal intercourse with you?
• Did you often or very often feel that no one in your family loved you or thought you were important or special? Or your family didn’t look out for each other, feel close to each other, or support each other?
• Did you often or very often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? Or were your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
• Were your parents ever separated or divorced?
• Was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her or sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard, or ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
• Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
• Was a household member depressed or mentally ill, or did a household member attempt suicide?
• Did a household member go to prison?

Every time a person answers “yes” to one of the above questions, it is an affirmation of an Adverse Childhood Experience.

Regardless of the total number, it is important to understand that individuals may be negatively impacted across time, however, it is not a given.  There is hope for a better future when positive experiences, protective factors, and early-intervention efforts are implemented following trauma. These mitigating actions can reduce the influence of ACE to lessen the unhealthy impacts across someone’s lifespan.

We believe that the best way to mitigate the lifelong impacts of ACE in our communities is by talking about it. We need to continue conversations in our family and friend groups, ask teachers, counselors, and pediatricians if they have heard of the ACE study and if not, ask them to learn about it. Our society needs the ACE study to become a requirement in higher education degrees for those who wish to work in counseling, social work, or medicine.

It can be hard for individuals to acknowledge ACE experiences, but in doing so it may change the narrative of one’s own childhood and relationships with family and friends. It can also be beneficial to prevention efforts by helping to identify ways in which families and communities could reduce the likelihood of ACE in the next generation.

Understanding protective factors and working as a community to support children and families is critical, as well as acknowledging the impacts of ACE and how to reduce the effects of these experiences through early intervention. As a Child Advocacy Center for Cape Cod and the Islands, Children’s Cove will utilize evidenced based practices to help children who have experienced violence and abuse. Our network of community providers is here to offer hope and healing to mitigate the long-term impacts of trauma.

If you would like to learn more about how we can create a community where children are free of abuse, have a voice that is heard, and can enjoy healthy, safe, and empowered lives, please contact Jacob Stapledon, Community Engagement and Education Program Manager at Children’s Cove.

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Catfishing and Sextortion: Real World Danger

February 16, 2023

In 2012, MTV started a series which highlighted the deceptive practices of individuals in the online dating world, titled “Catfish.” As a common internet term, “catfish” is someone who creates a fake profile on social media, dating, and chatroom sites. This is often done by combining another person’s photos with false personal information (height, weight, age, etc.) to create a realistic fake identity. Catfishing was dismissed at first, but it is on the rise and can no longer be disregarded, as it carries real burdens, emotional damage, actual physical harm, and sexual exploitation.

A notable case of catfishing was subject of a Netflix documentary, “ Untold: The Girlfriend Who Didn’t Exist,” which detailed the events surrounding Notre Dame football player Manti Malietau Louis Te’o, or Manti Te’o. During 2012, Te’o was the victim of an online catfishing relationship which he believed to be real and was very emotionally invested. The perpetrator of the catfishing, Ronaiah “Naya” Tuiasosopo, used photos of a high school acquaintance of hers to develop a fake online identity known as Lennay Kekua. The elaborate details, utilization of photos, stories of a car accident and diagnosis of leukemia kept Te’o invested and involved in this catfishing hoax. Tuiasosopo used other acquaintances to validate their online Lennay persona and when Lennay eventually died from her supposed leukemia illness, Te’o was devastated.

During this catfishing incident, Te’o, a promising NFL prospect, often referenced the death of girlfriend “Lennay” in press conferences and recorded interviews as an influential part of his football career. However, when more questions about her death and his stories about their relationship were raised, it was discovered Lennay did not exist. While it was eventually discovered Te’o was a victim of catfishing, at the time future football prospects were jeopardized due to accusations that he participated in the catfishing hoax to garner public favor. The backlash against Te’o was vicious, and as a result he was isolated, and suffered from severe depression and anxiety.

However, some catfishing cases have escalated into even more dangerous and lethal situations. Thomas Montgomery, a married 46-year-old father of two murdered his co-worker, 22-year-old Brian Barrett as a part of an online love triangle caused by catfishing.

In 2005, Montgomery created the persona of an 18-year-old male in an online chatroom and started an online relationship with an alleged “18-year-old girl.” This relationship took place over a year as he exchanged photos of his younger self with this girl. When his secret was found out and the “girl” discovered his true age, she somehow found and began messaging Montgomery’s co-worker Barret online in the same forum.  Her goal was to make Montgomery angry and jealous.  At the same time, the “girl” known as “talhotblond” continued to chat with Montgomery.  Ultimately, Montgomery’s rage and jealousy grew to the point where he shot and killed Barret. As the investigation unfolded, it came to light that “talhotblond” was actually Mary Shieler, a 45-year-old married mother who had used her daughter’s photos to create her fake online profile to talk to numerous men.

Then in November 2022, catfishing caused a kidnapping and multiple murders that made news headlines for weeks. Austin Lee Edwards, a Virginia State Sheriff’s Deputy, traveled to Riverside California, kidnapped a 15-year-old girl after murdering three of her family members and set their home on fire. Edwards had met this girl online while posing as a 17-year-old male. They had numerous online conversations, shared explicit messages, and images with one another.  Little is known about when, how long, and what platform was used for this online exchange, but the consequences were dire. While the girl was eventually rescued, Edwards died in a shootout with law-enforcement leaving many questions unanswered.

Catfishing is also used for the online sexploitation of children.  This has become a regular practice and is on the rise. The National Center for Missing and Exploited Children reported a 97% increase in cases involving online enticement of children in 2020, and a dramatic increase in cases of sextortion. According to NCMEC, Sextortion “is a form of child sexual exploitation where children are threatened or blackmailed, most often with the possibility of sharing with the public a nude or sexual images of them, by a person who demands additional sexual content, sexual activity or money from the child.”

These situations often arise through the means of catfishing, pretending to be someone similarly aged, making fake profiles, and sending fake or stolen images to gain trust. These cases are on the rise locally as referrals for sexual exploitation of children has increased in southeastern Massachusetts by 40%.  In addition, the targeting of young men for sextortion has increased to become one of the highest targeted groups nationally.

Another recent post by NCMEC details the dire consequences of sexploitation by catfishing:

When we talk about online safety, when we ask parents and teens to Take the Pledge and to Be Smart and Be Safe Online, it isn’t because it is something were just supposed to say. It’s because we are seeing the dramatic increase in catfishing and sexploitation right here on Cape Cod, Nantucket, and Martha’s Vineyard. We are imploring parents and caregivers to Have the Conversation with your children; about online safety, about body safety, about family rules and values. Please start these conversations early, and even if you didn’t, start them now. Have these conversations often, because the risks to children and dangers they may encounter online are just as frequent.

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Sexual Exploitation of Children on the Rise: The Regional Report for 2022

January 24, 2023

This report, and the data and information included within was written with input and information provided by team members from Children’s Cove: The Cape & Islands Child Advocacy Center, Bristol County Children’s Advocacy Center, and  Plymouth County Children’s Advocacy Center.

For the last two years, the Children’s Advocacy Centers for Cape Cod & the Islands, Bristol County and Plymouth County have collaborated to write an article during January, which is Human Trafficking Prevention Month. These articles have provided general information to raise awareness of this issues impacting our region. This year, our centers committed to provide specific and action-oriented information because regionally there has been a dramatic increase in referrals in 2022 with 420 children impacted in our region, a 40% increase since last year. Child Advocacy Centers (CACs) in Southeastern Massachusetts work collaboratively with every branch of law enforcement and child protective services to provide a coordinated response to the sexual exploitation and trafficking of children. Our communities are at a critical crossroads to stem the tide of exploitation happening to our youth. This report contains information our organizations believe our communities need to know.

Background and the Current Issue

Human trafficking is widely defined as “a crime that involves exploiting a person for labor, services, or commercial sex.” Massachusetts state law defines the trafficking of children as the Commercial Sexual Exploitation of Children (CSEC). The CACs of Massachusetts recognize that CSEC occurs when a person under the age of 18 is offered, or given, something of value to them in exchange for some type of sexual act. It doesn’t have to be in person, and it doesn’t need to be money for it to be commercial sexual exploitation. Value could be anything to a child, this includes food, clothing, a warm place to sleep, better grades, vapes, alcohol, or other substances, a trip to a salon, or even a ride somewhere.

Child Sexual Abuse Material (CSAM) is also considered a form of sexual exploitation and abuse. Often referred to as child pornography, CSAM is any photo, video, or visual image of a child under 18 engaged in sexual behavior or unclothed. CSAM is much more than photos and videos; it is a form of exploitation and abuse documented and shared across the internet in perpetuity. Every time an image is viewed, shared, paid for, or downloaded, the child is being revictimized and a crime has taken place.

In 2020, the Covid-19 pandemic hit and resulted in billions of dollars being invested into updating internet-based systems access across the country. The purchase of internet-enabled devices skyrocketed due to families attending school and working from home. Even children attending preschool were provided internet-accessible devices to bring home.

With the lockdowns and impacts of remote learning, there was a limitation of in-person social interaction for children and teens. “Sexting” (sending sexually explicit text messages and images) became a social norm which continues to this day. At times, these images live right in personal devices of kids and teens, the place a parent would never suspect. Because of the rapid change of the virtual world intertwining with the real world, there has been no adjustment in the conversations about dating and sexual exploration. It is for these reasons that it is easy to understand how photos exchanged at one point mutually from attraction, can quickly be used for exploitation.

Because of the changes in social norms, and offenders navigating to online spaces, CSAM and online sexual exploitation of children have made up the vast majority of referrals in our region. According to the National Center for Missing and Exploited Children, reports of online exploitation rose by 35% between 2020 and 2021, and increased more than 73% from pre-pandemic levels.

The State of Our Region: Referrals on the Rise

Regionally, our centers have seen a surprising increase in online sexual exploitation. These referrals mirror that of national trends with a 40% increase.  Of the 420 referrals, it included 355 female identified children, 63 male identified children and 2 transgender identified individuals. The range of ages for children impacted were from 5 years old to 17 years old and the distribution of these cases were that approximately 77% of these cases were individuals between 13 years old and 17 years old, and 23% were children who were 12 years old and younger.

This information has provided our centers with critical information and concern. Two key data points stand out: the rates of younger children (under 13 years old) being victimized online is on the rise, with several 5- to 8-year-old children included. Additionally, the number of male-identified youth referred for services has also increased. It is imperative our communities understand that sexual exploitation does not discriminate by age, gender identity, socioeconomic status, or sexual partner preference. These crimes against children are those of opportunity and cases have originated from nearly every town regardless of economic status or geographical location.

While case referrals on the Cape & Islands have remained consistent, there has been an uptick in cases in Plymouth and Bristol Counties, with most of those cases originating online. These regions also saw the largest spike of children under 13 being sexually exploited. Because of the increase in access and use of internet-enabled devices and rapidly changing norms for youth, these cases are happening faster and more frequently.

Parents and Caregivers Can Be the Key to Prevention

Being a parent in the digital age is incredibly hard. The enmeshment of the online and real world has significantly limited a parent’s options of restricting internet access on their children’s devices. This comes with the added danger that if a child can access the internet, they are at risk of exploitation. Unfortunately, it is not practical for parents to remove internet-accessible devices altogether, which may be part of the reason these referrals are on the rise.

Cases of exploitation can take place on all internet accessible devices in the home. This includes video game consoles, school-based devices, and even apps associated with school use. If parents and caregivers don’t have regular conversations about safety, and monitor all internet-enabled devices, the opportunity for exploitation to happen in plain sight remains high.

It is important for parents to understand how to use the popular apps and platforms kids and teens are using. The most prominent apps where exploitation has taken place are TikTok, Snapchat, Discord, Instagram, and WhatsApp. Video livestreaming apps and platforms like Facetime, Zoom, Skype, or Omegle have also been increasingly used regionally for exploitation.

We recommend parents understand the privacy settings of these applications in order to increase the safety barrier between children and potential exploitation online. The organizations Common Sense Media and The Institute for Responsible Online and Cellphone Communication, provide information and resources for parents to learn about various programs, applications, and ways to reduce risk on child-accessible internet enabled devices.  There are additional resources at the end of this article as well.

In some cases, children have been threatened to stay compliant due to the demands of an offender. It may be difficult for a child to come to a caregiver for help if they are fearful of the threats being made to them. Staying calm and knowing how to take action is crucial in helping a child who is a victim of online exploitation. The more parents and caregivers engage in their child’s online life, and discuss the risks of online sexual exploitation, the more likely children will confide in their parents when issues arise.

Sexual Exploitation: Here’s What to Look For

Here are some of the signs which are more closely related to abuse or exploitation. These include:

• Significant or sudden change in behavior
• Ceases engaging in social activities, hobbies, or friend groups
• Unexplained absences from school
• Regularly runs away from home, or goes missing from care, sometimes out of the area they live in
• Lies about their age and identity or has secret online profiles and cell phones
• Has profiles to dating sites used for adults
• Has material items inconsistent with the child’s access to money or socioeconomic status
• Has regular access to vapes, alcohol or other substances
• Has large amounts of cash, pre-paid cards, or hotel keys
• Deposits into bank accounts or online accounts

Be aware of the signs, sometimes one or several exist. Kids and teens have a knack for keeping things from their parents. This is why conversations between children and parents about online safety is critical.

Leave the Door Open for Conversations Without Judgment

It is important for kids and teens to know that if they make a mistake, they can have a calm non-judgmental conversation with their parents and ask for help. Children need to know that their parents will always believe in them, advocate for them, and put their health and safety first. Even if you do have these conversations with your children, there will likely still be fear that if they mess up and tell you they will get into trouble. Having ongoing and regular conversations about safety with kids and teens will help them feel supported and can provide reassurance which will increase their likelihood to ask for help.

As a parent, if your children do make a mistake and report that something happened to them, remain calm, and don’t take quick action like deleting images or messages. These may be important to effectively report and get help. Here are some specific action steps to take:

• Try to gather basic information, without pressing for too many details.
• Identify when and where this happened, where images are now, who may have them (we recommend parents do not view them), and what app/platform it was on.
• Contact your local police department and reach out to your local Children’s Advocacy Center for guidance.
• If you see or suspect child sexual abuse material online on social media, you can report it to NCMEC through their Cyber Tipline.

You don’t need to know who an exploiter is, what’s important is that you make the report.

How Our Communities Can Make a Difference

While the topic of sexual exploitation and abuse of children is complicated and can feel overwhelming, anyone make a difference. Everyone can do their part to raise awareness of this issue. Reach out to your local Children’s Advocacy Center and ask how you can learn more about the issue, or request a training for your local community, school, non-profit organization, or business. If you have concerns that a child is being exploited, please report suspicious behaviors to your local Child Advocacy Center, law enforcement agency or file a report with the Department of Children and Families.

Together we can create a community where children are free of abuse, have a voice that is heard, and where they enjoy healthy, safe, and empowered lives.

Resources

Below are a series of links which may help you navigate safety online with your children.

• Take the Pledge to Be Safe and Be Smart Online
• Boston Children’s Hospital Digital Wellness Lab
• End Sexual Exploitation Internet Filtering Services
• Understanding Privacy Settings and Browser Control
• Parent’s guide to Snapchat
• Apple iOS Child Safety Features

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Parental Resilience and the Holiday Spirit

December 16, 2022

Each year, the holiday season seems to be celebrated earlier and earlier. Perhaps it is the need for brightness and joy, or the longing for connection and family. For children of all ages, it gives time for pause, celebration, and time shared with family for those all-important gift exchanges or cultural celebrations. However, it can also be a time of incredible stress for parents. And for those who have experienced trauma, or other challenges in their lives, stresses can feel heavier, and the holidays may seem more like a burden than a blessing.

At Children’s Cove we work closely with Cape Cod Children’s Place, an early learning center, family resource center, and the recipient of the Stop Abuse For Every child (SAFE) grant from the Children’s Trust. We work collaboratively to provide resources and support to parents raising children of all ages to prevent abuse and coordinate supportive services for those in our community who may have experienced trauma.

An additional part of our community engagement outreach work is to help families understand the 5 Protective Factors to strengthen families.  For the holidays, we thought we would focus on one component of the five factors – Parental Resilience.

The holiday season is a testing ground for many parents in the lessons of resilience, and it has nothing to do with toys or shopping lists. The end of the year, bills, expectations from children, encounters with family – both good and not so great, crunch time with jobs, sports and school, or our own histories of trauma, can make this time of year unbelievably challenging. So, it is paramount that a parent develops skills to manage their stress.

We asked our community partner Cindy Horgan, Executive Director of Cape Cod Children’s Place, and member of our Advisory Council, to provide some thoughts about parental resilience, and the ways parents can navigate this difficult time of year. Here are some thoughts Cindy shared with us:

This holiday season we hope that all parents remember, you are doing the best you can. Do not let expectations, real or imagined, take away from the incredible moments you can share with your family this year. And, if you need resources to help promote self-love, self-kindness, and self-care, there is a community here to support you.

Happy Holidays from the teams at Children’s Cove and Cape Cod Children’s Place!

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