Prompting an emergence of research and social work practice on trauma and children is the landmark study of Adverse Childhood Experiences (ACE). First published in 1998, the Adverse Childhood Experiences Study (ACE Study) was a simple but profound investigation that has revolutionized how we understand the relationship between childhood and long-term health as adults. Led by researchers Dr. Vincent Felitti and Dr. Robert Anda, the ACE Study surveyed more than 17,000 adults, between 1995 and 1997 utilizing a questionnaire reporting traumatic experiences during childhood. Almost two-thirds (63.9%) of participants reported having one or more adverse childhood experiences. One in eight participants (12.5%) reported having four or more ACEs. Researchers found strong dose–response relationships between the number of ACEs and the risk of disease (Center for Youth Wellness [CYW], 2017). Co-principal Investigators of the ACE Study, Felitti and Anda, found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults (Felitti et al., 1998).

The film, Resilience: The Biology of Stress and the Science of Hope, is the second part in a documentary duo that chronicles Adverse Childhood Experiences (ACEs). The first film, Paper Tigers, provided viewers with innovative research that undeniably magnified the national conversation around ACEs and spurred critical thinking among researchers, practitioners, medical professionals and others. Equipped with knowledge regarding the impact of an overstimulated fight or flight response, there were more questions than answers. Now, Resilience, advances the dialogue by introducing interventions and strategies that transcend perceived trauma-related limitations.

Framing our understanding of trauma is the belief that it is not the stressful experience itself that exacerbates the stressful response. We now know that it is how the individual’s body, mind and spirit responds to that stress. Dr. Nadine Burke Harris described the most vivid example of this trichotomy in the film as she instructs viewers to imagine being chased by a bear, and the fight or flight response is activated to support survival. However, if that same response occurs repeatedly when the bear is not present, the experience of toxic stress is exacerbated (Redford & Pritzker, 2016). The individual’s ability to learn, think, feel, and behave is compromised by a persistent internal alarm. Toxic stress caused by ACEs can profoundly alter the otherwise healthy development of a child. As Dr. Robert W. Block, former president of the American Academy of Pediatrics, noted, “Children’s exposure to Adverse Childhood Experiences are the greatest unaddressed public health threat facing our nation today” (Center for Youth Wellness [CYW], 2017).

Our idyllic perceptions of childhood as a time of innocence and safety within a family’s protective positioning is ripped apart as we are confronted with the reality of ACE scores in populations more diverse than one would imagine. During the film, the ACE questionnaire was distributed to professionals from education, healthcare, law enforcement, mental health, etc., attending the Building Better Lives Conference. Their score results surfaced on the screen and revealed that 34% of attendees had four or more ACEs. This moment captures the skeptics who believe the alarm about trauma is over-exaggerated. Viewers witness the light bulbs going off around the room as they come face to face with their own reality.

Resilience compels viewers to consider how to create a response that would mitigate some of the negative outcomes. Developing trauma informed systems of care is an organizational aspiration for many social service agencies and organizations. There is growing attention to the need to create trauma-informed child welfare systems that are more aware of and responsive to the needs of vulnerable and traumatized children (Conradi, Igleman, & Ryan, 2007). Because adverse childhood experiences are common and have strong long-term associations with adult health risk behaviors, health status, and diseases, increased attention to primary, secondary, and tertiary prevention strategies is needed. These strategies include prevention of the occurrence of adverse childhood experiences, preventing the adoption of health risk behaviors as responses to adverse experiences during childhood and adolescence, and, finally, helping change the health risk behaviors and ameliorating the disease burden among adults whose health problems may represent a long-term consequence of adverse childhood experiences (Felitti et al., 1998).

Recent research on the long-term benefit of early home visitation on reducing the prevalence of adverse childhood experiences is promising (Felitti et al., 1998). In the film, viewers witness the encounter between a home-visiting professional and a parent. The professional’s support of the parent’s strength to make one phone call that may potentially change the trajectory of she and her children’s potential for healing, induces cynicism and hope, which is the dichotomy of direct social work practice in many arenas.

The film features Dr. Burke Harris’ office at Bayview Hunters Point in San Francisco, where life expectancy is reduced by 10 years compared to neighboring communities (Redford & Pritzker, 2016). Unlike any pediatric examination most people have witnessed, viewers engage as Dr. Burke Harris examines a pediatric client. As his aunt listens and encourages, Dr. Burke Harris explores her patient’s exposure to violence, school and family stressors and anything else that might be occurring. This young boy reveals that a friend recently died because of community violence and he is concerned for his own safety. Although the reason for many referrals is ADHD, the root cause is often revealed to be in childhood experiences, exposure to violence, and the absence of parental and community buffering. Dr. Burke Harris has each caregiver complete the ACE’s questionnaire on the child’s experiences. “I don’t need to know which ones, only how many” (Redford & Pritzker, 2016). In her practice, children with ACE scores of four and above are 32 times as likely to have behavior problems at school. Dr. Burke Harris’ approach is to excavate her patients’ hidden histories of trauma, then prescribe measures proven to relieve anxiety: breathing exercises, play therapy, and the like” (Smith, 2013, p. 29). “We now know was is happening to children’s brains and bodies with the experience of toxic stress. This current research puts to bed forever that children born to disadvantaged circumstances are doomed to poor outcomes. Resilience is not something you’re born with, it gets built over time (Redford & Pritzker, 2016).”

One of the ways the film displays to build resilience is the incorporation of psychodrama in an elementary classroom, around an all-knowing adult figure, who reads the children’s letters of concern and responds to each one in a penned nurturing voice, offering guidance and support. Viewers may find themselves with questions regarding what happens when serious issues are revealed, resulting in unintentional feelings of betrayal from a child whose words result in systemic action. Yet, the pensive expressions on their faces as they write the letters and relieved exuberance displayed as they receive a response, is undeniable. A meta-analysis conducted on the basis of 25 experimentally designed studies showed an overall effect size that points to a large size improvement effect similar to or better than that commonly reported for group psychotherapy in general (Kipper & Ritchie, 2003).

The film poignantly identified six practices to build resilience: reduce child’s dose of adversity with home visits and parent understanding and leadership; therapeutic interventions by clinicians knowledgeable about traumatic stress; mindfulness and meditation; nutrition; sleep hygiene; and education. According to Burke Harris (Redford & Pritzker, 2016), the overall cure for toxic stress is strong parental buffering, described as recognizing natural and endemic strengths (Redford & Pritzker, 2016).

This film captures the opportunity we have to generate solutions, and compels interventions that create opportunities for growth and recovery in populations exposed to traumatic stress. It allows adults to determine their point of entry into the healing dynamic. Hope often seems so intangible, yet coupled with the research the film introduces, the scientific element is apparent. The outcomes provide support for the actions and interventions vividly displayed in the film.

Although Resilience articulated six strategies to promote resilience, the requisite details regarding strategies for implementation to obtain expressed impressive data outcomes is needed. As the film displayed outcomes in different counties towards the end of the film, making a link between those outcomes and specific strategies utilized in each county, would provide a meaningful roadmap for others to follow.

In conclusion, Resilience, excels in exemplifying the prolific research conducted on Adverse Childhood Experiences, toxic stress and the disease process. The ability to display science and humanity while crafting a call to action through Resilience, is remarkable and timely. The film’s effectiveness far outweighs critical questions around programmatic and policy details. Resilience calls into reckoning, each parent, professional and community’s apathy around the capacity to change the world through making a purposeful investment in each child.