Above: these wooden frogs are percussion instruments that make soothing sounds when played in the office of Anna Leblanc, licensed music therapist at the Justice Resource Institute.
By Yahni Lapa & Harry Gustafson
An Introduction to ACEs
Anna Leblanc tells a story of one of her patients: a teenager exploring their gender identity coming home to a father who refused to acknowledge the child’s they/them pronouns. Leblanc is an expressive arts therapist at the Justice Resource Institute in Acton, MA. She works directly with clients of all ages, using music and the arts to create a comfortable environment for those who may be struggling and could benefit from an expressive outlet.
In expressive arts therapy sessions with this teen in particular, Leblanc found that music-based exercises are helping them to be more expressive about their experiences at home. She encourages this patient to bring in lyrics to songs they have been listening to recently. Together, they unpack the lyrical content and explore how the words reflect what the teen is experiencing.
This lack of recognition from a parent can negatively affect a child’s mental health during a critical time in their adolescent development. This type of experience qualifies as an ACE – an Adverse Childhood Experience.
ACEs is an umbrella term referring to an array of large and small traumatic experiences that can accumulate over time and harm a young person’s present and future health and well-being. Physical, sexual or emotional abuse, neglect, or household adversity as a result of domestic violence, incarceration, substance use, parental mental health problems or family breakdown are some of the different types of ACEs that can affect children throughout life.
The relationship between ACEs and health was first introduced in a study published in 1998 which found that a higher number of ACEs was associated with a higher number of risk factors for leading causes of death in adulthood. Studies estimate that upwards of 64% of individuals experience at least one ACE during the course of their childhood, making it imperative to prevent them.
Another method of lyrical-based music therapy that Leblanc employs is black-out poetry. In this exercise, Leblanc and her patient will print out existing song lyrics and, using a black marker, cross out, circle, or highlight certain words to create a different idea.
Watch Anna explain her black-out poetry exercise in this video.
Pictured: The collection of instruments in Leblanc's office.
New Solutions To Old Problems
Similarly, music therapy is a newer alternative to traditional medicine and treatment, but based on the classic concept that sound and music can have positive effects on a person’s mood.
There are many potential forms of mental health treatment that can be successful depending on the case. “But sometimes,” says Leblanc, “all the kid needs is just to bang it out on the drum. ‘I'm frustrated.’ Okay. Take it out on the drum.”
Leblanc adds that her exercises work in a way that is similar to cognitive behavioral therapy (CBT). CBT can address what is going on with a person’s mood, but it falls short of addressing the physiological link between mind and body. CBT approaches focus on mitigating individual psychological harms, but do not address the social pathways that mediate the negative impacts of ACEs. Patients who meet the criteria for having one or more ACEs have an 80% chance of experiencing physical and mental health disabilities when they are older, according to Leblanc.
ACEs can follow an intergenerational pattern. For example, research suggests that children who experience physical abuse may be more likely to commit violence, including abusing or neglecting their own children, and to be revictimized in the future. ACEs align with a shifting public health focus to upstream thinking and the prevention of negative behaviors and outcomes before they occur.
Pictured right: A collection of pronoun pins at Leblanc's office.
Despite the vast amount of knowledge around the negative impacts that ACEs have on a child’s health and well-being, they often go unreported and unrecognized. Adverse childhood experiences can be subjective based on individual experience, and it can be difficult to find a one-size-fits-all approach to address them. For this reason, it is helpful to talk about behaviors as symptoms emerging from experience, in order to promote certain therapies or programs that highlight social connection and belonging, or social support.
“One of my primary coping skills was always music,” Leblanc says about her own experience processing thoughts and feelings in life. A lifelong musician, she decided to pursue music and expressive arts therapy as an undergraduate at Lesley University. She adds that this form of alternative treatment often creates a space that allows patients to open up about feelings that they were otherwise unable to express verbally.
While music therapy can take many forms – from hospital bedside performance to interactive instrument playing – it can also be as simple as having patients talk about what songs they listen to in various moods and how those songs relate to feelings.
“I'll say, ‘What's your favorite song?’” Leblanc says. “A lot of the time people are picking music specifically based on how they're feeling. I think we unintentionally navigate toward songs that describe our feelings or how things are happening in our lives.”
While she works with clients of all ages, Leblanc notices that younger generations are becoming increasingly open to different forms of therapy. “I think it's truly a generational thing,” she says. “It's also a cultural thing. We're seeing a lot of breaking down of generational trauma. So the kids are coming in and they're like, I'm struggling and I want to talk about this.”
Pictured right: An example of blackout poetry from Leblanc's office.
Marisabelle Díaz-Fálcon is an inpatient music therapist at Massachusetts General Hospital who works directly with children experiencing ACEs. She notices a “strong correlation” between an increased amount of ACEs and patients from certain minority and non-native English speaking backgrounds, namely Black and Brown youth and those with low health literacy levels.
Research shows that structural racism and low-socioeconomic background disproportionately impact certain communities. Children living in poverty, children living in non-English speaking households, and Black and Hispanic children are some of the most marginalized populations that have the highest prevalence of ACEs. The graph below breaks down English speakers and non-English speakers age 17 and younger and their risk of experiencing one or more ACEs during childhood.
Much of Díaz-Fálcon’s work at MGH involves recognizing which patients will benefit from music therapy. But that work is confined within the hospital’s walls. This leaves her with some sense of guilt, she says. “I'm doing everything I can while [children are in the hospital],” she says, “but what is it going to look like once they leave the hospital?”
She advocates for more work in music therapy to be done at the community level. Her alma mater, Berklee College of Music, is changing the narrative, bringing this much-needed support to the communities themselves. Berklee is home to the Center for Music Therapy, where many of the licensed music therapists working in the Boston area have received their education.
Out of Clinic, Into the Community
Joy Allen, chair of the Music Therapy Department and director of the Music and Health Institute, has decades of experience as a researcher, clinician, and educator of music therapy. Her work at Berklee, especially in pioneering the Music and Health Institute, emphasizes building community resources to combat public health problems. “Everything is about improving access to information and community impact,” she says.
Allen is critical of much public health research, which she calls “one-sided.” She hopes that the research her and her colleagues do can be used to create more sustainability within communities. “Research is often done to benefit the research versus the people,” she says. “It's not looking at impact, effectiveness, sustainability, and replicability from the community side. How do we make sure that we're not perpetuating more harm?”
Echoing one of Díaz-Falcón’s points, Allen recognizes that “most people are not treated in hospital settings; they're treated in communities.” Berklee seeks to set up collaborative, community-based experiences that “help people reconnect with their own identities and strengths.”
“In order for public health to really work,” Allen says, “it has to be informed by lived experiences and vice versa. The research has to trickle down, but the lived experiences have to trickle up, and that's really what [The Music and Health Institute] is doing.”
Right: These are the three most common types of ACEs that can negatively impact a child’s mental and physical health and wellbeing. Photo taken from the Policy Center for Maternal Mental Health.
“Research that is done is often done to benefit the research versus the people. It's not looking at impact, effectiveness, sustainability, and replicability from the community side. How do we make sure that we're not perpetuating more harm?”
Since 2018, at least 37 states and the District of Columbia have enacted or adopted legislation related to ACEs, including laws that address childhood trauma, child adversity, toxic stress or ACEs specifically. Many of the bills created implemented training for educators on ACEs and strengthened behavioral health supports for children.
To successfully promote social and emotional engagement among children experiencing ACEs, institutions like community health clinics should be carefully considered. This type of institution houses existing structures that are integral to the care of children experiencing adverse childhood experiences, and therefore have the ability to create sustainable change by altering the current structure of care to better fit the needs of the affected community.
The Community Music Center of Boston is one local organization that is taking on Joy Allen’s challenge to empower communities with music therapy resources. A.J. Gaudreau is one of CMCB’s working music therapists.
Since moving to Boston in 2021, Gaudreau has worked extensively with children under the age of 5. This age range is critical in children’s development of identity and self-understanding. He describes his work as being “about providing a space that allows for showing up however you are authentically, using the music to create that musical container, that space of safety where all the people that are present can feel okay with being themselves.”
“That connection from singing together as a group,” he says, “really allows that permission for folks to feel like they can be free, they can be themselves, and they can take the risks that they might not normally take in their own efforts to build their sense of community.”
In other words, through music therapy exercises like the one linked below, children can develop stronger senses of self, healthy coping mechanisms to deal with adverse experiences, and strengthen the bonds within their communities.
Gaudreau's exercise focuses on regulated breathing, using a simple chord progression on his guitar operate as the center of the exercise.
Watch A.J. Gaudreau walk through a music therapy-based mindful breathing exercise below.
Credits:
By Yahni Lapa & Harry Gustafson