Understanding Adverse Childhood Experiences (ACEs) and the Need for Protective Factors

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Adverse Childhood Experiences, or ACEs, identifies certain life experiences that could be key indicators of health problems that surface later in life. What's made this study so impactful? Alex Colston, a New Vista Licensed Marriage and Family Therapist and Clinician Educator for Children's Services, joins us in this episode to unpack the ACEs study and to highlight the importance of having Protective Factors to move deeper into a healthy life.


Kevin Wallace  0:11  
Hey there, welcome to The Good Ahead Podcast where we host conversations in the areas of mental health, substance use, and intellectual and developmental disabilities. I'm your host Kevin Wallace with New Vista. I'm joined by Alex Colston, a Licensed Marriage and Family Therapist and a clinician educator for New Vista. And for this episode, we're walking through Adverse Childhood Experiences, or ACEs. What qualifies as an adverse childhood experience? And why does this study really matter when it comes to a person's mental health and well being? Alex also dives into the importance of protective factors, and that every kid would come to know four key things: that they are seen, heard, valued, and delighted in. That's the end goal; what every human needs. So thanks for being with us., and I hope you enjoy the episode.

Welcome in today, we have with us Alex Colston. Alex is a clinician educator for Children's Services at New Vista and we're going to be talking about adverse childhood experiences or ACEs for short. So welcome in Alex,

Alex Colston  1:30  
thank you very much. I'm happy to be here. Yeah, man,

Kevin Wallace  1:32  
Well, I'm excited to get into this conversation, because adverse childhood experiences again, or ACEs for short, has been this really revelational study that is being implemented into the mental health world and something that maybe not a lot of people know about. And so wanted to have you on to tell us a little bit about what ACES is, and how we can be mindful of this, and how this is being used in the mental health world to help children and people all over the place that have had these kinds of adverse childhood experiences. And so if you would, before we get into it, I'd love to hear what you what you do at New Vista. And I guess what your world looks like, as you're helping kids and counseling them.

Alex Colston  2:28  
Yes. So I'm, I'm an LMFT, Licensed Marriage and Family Therapist. I'm a clinician educator, which for New Vista means that I carry a small caseload working with, for me kids and families, and, and a lot of support for schools as well. And then the clinician educator part is that we, in the clinician educator roles also provide consultation and training to clinicians that are all across the agency, so all across 17 counties, but can also provide support and training for people outside of the agency as well. So and for me being working specifically with Children's Services, I'm more likely to be providing support to schools and other agencies and groups that are supporting and caring well for kids. And wherever they are in the community.

Kevin Wallace  3:22  
Awesome. Well, let's let's just break into this conversation about what adverse childhood experiences is. So if you would just tell us about what what it is and I guess how it came to be, what the study is all about, and now, why it's relevant to what you're doing, as a therapist.

Alex Colston  3:41  
Sure, so adverse childhood experiences, really is the name of the study that that came out in the early 2000s, from Kaiser Permanente. And it was one of the first pieces of research that that really began to integrate both the physical and the mental health world. And that's what I think is super cool about it. The study showed really negative health outcomes that were linked to experiences in childhood that we're what we call adverse. And so the study looked at three groups of adversity that a child might experience. So household dysfunction, which might look like having a parent or caregiver that abused alcohol or drugs, having a parent or caregiver that also had some mental health issues that they were dealing with, and that were probably untreated, witnessing domestic violence, community violence, that kind of thing. And then I think what we usually think about for trauma for kids when you're thinking specifically about physical abuse, sexual abuse, neglect, psychological abuse, those pieces are also included in you know, the grouping with adverse childhood experiences. And so what the study found is that Basically, you know, if you had these experiences that are pretty adverse for children to be going through that, you're more likely, depending upon how, how much adversity you experience. So it's not necessarily just like a one time thing, meaning you're going to have all these negative health outcomes, because one time you're you witnessed community violence, but really, the dosage is what we're looking at. So if if someone if a child experienced a high dosage of adversity in childhood, then they are more likely or more at risk to develop both physical and mental health problems later on in life. And so that could be things on the physical and like cardiovascular disease and pulmonary and liver disease. And it could be depression, and higher suicide rates and adoption of risky behaviors, like any kind of addictive sort of behavior or unsafe sexual risky behaviors as well. So all of those are higher, or they're more likely. And people are higher at higher risk of developing those both those diseases, and those behaviors, if they have high doses of adversity in childhood is lasting.

Kevin Wallace  6:16  
And so what is the structure I guess, of , is there a certain amount of adverse childhood experiences like I think is like 10, or something like that a list of what would be considered as adverse childhood experiences?

Alex Colston  6:32  
Yeah, so the study looked at 10. And, you know, the study was done on adults. And so we were, in this study, they looked at, the researchers looked at, you know, if, as an adult, you go back, and you look at these 10 items, which were part of those groupings that talked about earlier, and household dysfunction, and child abuse and the neglect. If you experienced, you know, one or more of these 10 items on the list, then you may or may not, what the research found is that you may or may not be, you have a higher risk of developing, you know, certain physical health problems. And so there's 10 total, that's on the adult version of the aces. So there's a, there's a way to sort of assess and find out what your ACE score is, and what your the likelihood for, you know, developing certain problems later in life might be

Kevin Wallace  7:28  
Yeah, I guess you can take a test or something online. Yeah, I'll include a link in the description of this episode, to get to an ACEs test that you can take for yourself.

Alex Colston  7:40  
Yeah, that's great. So and then on, you know, the work that I do is more on the child and a bit. And so there is there's a, there's a separate youth ace assessment that we can do. And it actually includes more than 10. So it's the research has expanded a little bit looking at kids right now, and what might be adverse for them. And so it includes things like racial trauma and community traumas, and might include some other events that might that we know are probably traumatic or are probably adverse for kids as well. And so there's a different assessment for kids and there is for adults, but about they're important to look at.

Kevin Wallace  8:22  
Yeah, and you, you mentioned the word trauma or traumatic, and I want to have you expand a little bit on what makes this different from trauma. And so what what does the word Why is it adverse? And not like traumatic?

Alex Colston  8:36  
Yeah, yeah. So trauma is a is a whole field in and of itself to with lots and lots and lots of research on what trauma is, and is defined, maybe a little bit differently. And so, you might, you know, you could have a three on the ACE on the ACE questionnaire, and that's your ACE score, right, a three. But maybe the things that you experienced, that were adverse in childhood, even though your your score is a three, maybe each of them only happened one time, and maybe for you, you had a safe, stable, nurturing caregiver that was able to come alongside you and help you talk about and process and feel safe again. And so maybe even though you experienced some level of adversity, your history with adversity did not become something that looked like destiny are your your you might be just as likely as according to the research to develop certain problems, but it might not develop into what we call trauma. And trauma is more about the significant loss of control and adverse experiences that really do shape and begin to change the architecture of the brain because what we store trauma memory in our body and our nervous system, and we often have I have this very light trigger, like a light switch that won't shut all the way off for our alarm center in our brain if we've been touched by trauma. And our brains are always trying to keep us safe and always trying to move us towards survival. And so if we've experienced something that's adverse, or that's really scary, and we've lost a sense of control, during that time that our brain is going to learn from that and want to protect us in the future, right. So it's going to continually you flip off that switch for the alarm center to turn it on to make sure that we're going to be okay. And what that does over time is it creates this chronic activation of the stress system. And so trauma can absolutely impact long term mental and physical health outcomes, just like add adverse childhood experiences. And so they are similar, you know, but what I think is important for people to understand is that, regardless of your ACE score, you know, that you that may or may not also be trauma. And so there may or may not be, you know, a difference in understanding sort of the impact of it. And so what we really are looking at is the dosage, and also the intensity, right? So not so, did you have, yes, a three on the ACE score, but they were one time each, or was the three of a three on the ACE score, and it was chronic for you. Those three adverse experiences are happening all the time, you know, every day during your development? Yeah. And so that will radically change the way the brain is developing over time, right, and childhood.

Kevin Wallace  11:35  
Yeah, great. Well, how common are these experiences? I mean, is it just happening in certain populations? Or is this happening more generally across the board? Has the research come out with any specific identifiers of who is experiencing these?

Alex Colston  11:56  
Yeah, that's a good question. So the original research looked at the majority of the participants were highly educated, they were wide, they were more affluent. And they began the original research looking at and seeing these significant outcomes, and the higher your ACE score, the higher your likelihood to develop these physical, you know, chronic conditions. But well, what we know now is that, you know, adversity, and or trauma can affect anyone right across, across any system across, you know, regardless of your age, or gender, anyone can experience something that is traumatic. And that's a little bit of a difference, too, because we can experience trauma as an adult, you know, and maybe not have a whole lot of adversity as a kid. But when we're talking about ACEs, we're really looking at just what has happened, you know, before you turned 18. Yeah. So as far as the research goes, so, but adverse adverse childhood experiences can affect anyone that's within that, you know, any child or adolescent.

Kevin Wallace  12:57  
Yeah. Okay. And then what, what would qualify as a, as a number that would really, like lead to the negative health outcomes later in life that you're talking about? Like these chronic illnesses are really severe mental health issues.

Alex Colston  13:14  
Right. So what what we see in the research is that about half of the population has zero to one. Okay, so zero to one ace, meaning that they've had one adverse childhood experience. And that could be something that was chronic to be their childhood, but really just one, so that's about half the population. And then when we get into, you know, two, three, and four or more ACEs, we're looking at sort of the rest of the other half of the population, with four or more being the most likely to develop these chronic conditions. So the higher the score, the more likely you are to the more at risk you are of developing chronic both physical and mental health issues. So four or more is really what we want to you know, that's when it becomes a little bit more concerning.

Kevin Wallace  14:14  
This break in the conversation serves as a reminder that you can find links to additional resources from today's episode, and a link to take your own ACEs test all found in the episode description. And if this conversation stirs your interest to talk to a therapist and get the help you need, call our 24-Hour Helpline at 1.800.928.8000. Okay, back to the conversation with Alex.

Now, let's maybe transition into more of the positive side. This isn't just bad news, I guess. Whenever we're, when we're aware of these potential negative effects that these experiences have on people, what do you do with that? So What what's, what's this idea of protective factors that come into play? And how how does this help us down the road? Or even early on in childhood to avoid the adverse childhood experiences?

Alex Colston  15:18  
Yeah, so protective factors are they act as buffers to the potential, you know, developing mental and physical negative health outcomes, right? So, protective factor is something that can be in place that helps to provide some level of healing for the body and the mind that can make sure that kids have what they need to be okay, regardless of their ACE score. And that's the research, I mean, the research behind protective factors and what we know and you can find this information on like the here in Kentucky for Kentucky Strengthening Families program, that's a really good resource to to understand the protective factors and the research behind it. But there are six identified, according to Kentucky Strengthening Families, there's six identified protective factors that that when in place, we know that regardless of a kid's score, if they can have these protective factors in place, they're going to be okay, meaning they're going to have what they need for recovery of the adversity that they've experienced. And so they're going to have, there for, you know, a better outcome, both through mental, and in thinking about mental and physical health.

Kevin Wallace  16:35  
So it's, so the protective factors are not necessarily a reaction to ACEs. It's something that you want to have established early on in life and that serves as a preventative source to avoid adverse childhood experiences.

Alex Colston  16:50  
Sure, so the protective factors, that's a good question, the protective factors are separate from aces, right? So they, you know, regardless of, if you have adverse childhood experiences or not, the protective factors are good, they're good for all humans to have. And so even if you don't have a significant level of adversity, and you have these protective factors, they're great stuff for human development, okay. And then if you do, though, have significant adversity, and you can also have these protective factors in place, or be working toward getting them in place, right? Then there's the impact for a child who has had significant adversity, and now has systems and programs and good stuff in place for them, these protective factors, they're going to be okay, and be less likely to develop the negative health outcomes. So it can be preventative, you know, and that, you know, if we can all as humans have these six protective factors, I think we'd be okay. You know, we'd be, we'd be alright, regardless of what life throws at us. So they can be preventative in that way. But they're also really good to focus on when you know that a child has had significant adversity or been touched by trauma, that these that getting these protective factors in place, are going to be a great piece to that for the child and for the family's recovery process.

Kevin Wallace  18:15  
Yeah. Great. Let's talk about the protective factors then specifically. You said there's six. So would you mind opening that up and telling us a little bit about what each one is?

Alex Colston  18:26  
Yeah, so the there are, as I said, there's six protective factors. One of them is parental resilience. And what that means is that parents have this innate ability to go through hard things and keep getting back up and being okay. So, parents have what they need to manage their own to regulate their own emotions. They have what they need to find whatever resources they need in order to help the child or help the family bounce back from whatever hard life is bringing them, whatever adversity they're experiencing. So that's parental resilience. That's one. Another one is social connections. And so families can have friends and have a sense of community and belonging, people that they can count on in their life, then they are going to be more likely to also have access to call on those people when they need support. knowledge of child development is a third protective factor. And really, that's about families learning, and understanding how their child develops. So that could be early childhood, and then even thinking about school aged kids and adolescents. They're all working through regardless of age or working through a certain developmental milestone. And they're asking a developmental question for themselves. And if parents understand sort of what the role in childhood development for a five year old is, versus a 17 year old, they can be able to better support their child in that developmental task, whatever it might be. So for very young kids, for instance, in an infant, the developmental task for the infant is to learn to use their voice and to learn to trust. And if they can do that, they can move on to the next one, well, you know, the next developmental state, so families can know about that, then they can support their kids in their growth and development. Fourth protective factor is concrete support in times of need. And so that means that families either through their own network, or by accessing agency supports or other supports in their community that are available to them, they get what they need, based on I mean, if it's physical, like physical needs, they get their physical needs met for themselves and for the family and for the home, if they, if they can have access to that. And so they get, you know, if it's housing or transportation, or food or whatever it might be financial assistance, they have access to getting those those needs met for themselves. Another one is social emotional competence of children. And so that's where families really are able to teach emotional regulation for kids. So it's in for a very young kids, it's us mirroring the emotional experience of the child and reflecting that back to them. So they have a sense of knowing what at a deep level what that emotion is, and that it's okay. For older kids, it's more about regulation of that emotion. And so feeling it and allowing it to be there. And then being able to regulate behavior after that, yeah, because they've been able to regulate emotion, and so they're not reactive, they can make better choices in life. Um, a lot of that work is also done in schools. Thankfully, through social emotional learning curriculums that might be in place here in Fayette County, that's like school wide. I know it's not school wide, every district but in the state, but here in Fayette anyway, there's that piece of support that's provided. And so that's a protective factor that's in place, not even just from the family, but at the school level, too. And then the last one that is added on the Kentucky version that it's not on the national on, is nurturing and attachment. And so that really is sort of the base of what we do in therapy as well, I mean, a lot of the other protective factors we can help implement and try to get in place to other services. But in therapy, you know, we're really always working on both the emotional regulation piece of the child, but also developing, hopefully, strong secure bonds, and a feeling of felt safety with with between the parent and the child. And so if parents can ensure that kids are seeing heard valued parents or caregivers, whoever's sort of the adult in charge, if they can ensure that kids feel safe, that they are seen, heard, valued and delighted in, then, you know, that's the that's one of the it's it is a protective factor. But really, it's linked to a lot of other positive social outcomes for kids as well. So that's a lot of the work that I like to do with families that I'm sort of trained in and fit for, I think. And not just with families, but also in the schools when I'm working with them is developing safe, stable, nurturing relationships with kids. Big people take care of the little people is what I tell folks, a lot of the time, that's sort of, that's what kids need, you know, more than anything. And again, regardless of where they've come from, regardless of their history, doesn't have to become their destiny, you know, they can't hope and healing are always possible. And kids can always move toward healing. And we can as adults, too, but we need a significant amount of safety in our relationships and a significant amount of connection in order to actually do that work to heal and to be okay.

Kevin Wallace  23:47  
Yeah, yeah. Especially because as a child, you're you're I mean, that is the developmental stage. So you were developing as a human being and so much of what you're experiencing as a child will affect your life down the road.

Alex Colston  24:01  
That's right, yeah.

Kevin Wallace  24:02  
I mean, and that's so much of what you get to do right now. And I would, I'd love to hear a little bit more about what your clinical approach is. Going back to the the ACE study, what's your what's your approach when you're helping somebody with a score of ACEs that could indicate negative outcomes down the road?

Alex Colston  24:24  
Sure. So if I'm, if I'm working with a child, or an adolescent, and their family, I'm a marriage and family therapist, I'm trained in working with the family and treating the family not just the child as an individual. So for me, there are a couple of pieces from not necessarily from ACEs research, but from the trauma informed care research. What we know really kids need and this could be at an individual level, for a child within the family and or even with In larger systems that they find themselves in, like in a school, so whether a kid is on their own, whether they're with a parent, whether they're with me in session, whether they're at school, what they need, we know what they need, and what they need in order to be okay. And in order to learn in order to grow and develop, is they need to feel safe. And they need to be connected. And they need to learn along the way, at developmentally appropriate ways. How to how to regulate their emotion and regulate their behavior. So those are the three pillars of trauma informed care, we're looking at felt safety and connection or relationships, and we're looking at managing emotions and behaviors, and so on in if I'm working with a family. felt safety isn't just about knowing that the child is safe. It is it's not even just about the it's not only the kid knowing that cognitively that they're safe, they have to feel safe. And if they've had an experience of adversity, or been touched by trauma, they might not feel safe, right, their alarm center, again, as we talked to earlier, is chronically activated. And they're always in sort of survival mode. And most of their brain energy is going to be going toward that part of their brain.

Yeah, because what you talked about earlier, a lot of what trauma is, is just a response to your body's response to negative experiences that you have in life. That's right. So it's, it's really like a self defense mechanism to combat that negative experience that may be coming into, into your reality.

That's right. That's right. So the felt safety piece for kids is important. So they you know, and there's lots of ways that we can do that, too, we can, I mean, through the connection and through the relationship that we have with kids, whether it's me as a therapist, or certainly you know, their caregiver, and or someone at school, you know, if they can find the big people, and they're like the adults in charge that are there to meet their need. And to help support them, they can know that they're not on their own, that they're not alone. And there is a big person here to help take care of me. And so that helps, can help to disarm fear a little bit in the brain. And so it can help to feel safe for that child to feel safe. There are other things too, because the alarm center, and the chronic or chronic activation of the stress system really is really is hard on the body over time, there are other things that we can also do to help support the brain to feel safe, like increasing hydration for kids and making sure that they have, you know, access to water all the time. And so if there's some research that shows that, you know, the more dehydrated, you are, then the last cognitive function that you that you have. And so we see that a lot in schools, kids are, are chronically dehydrated, if they have sort of like scheduled water breaks, and don't have immediate access to water all the time. And it's problematic, because if they don't have a lot of cognitive function, if they're dehydrated, you know, their brains really going into survival mode again, you know, and so it can potentially activate the stress response, which isn't going to have to help kids be in what we call their upstairs brain, which is where they learn at school. And so they can be dehydrated, they can have, you know, not feel safe based on their experience, they can have blood sugar drops, if they're not eating well enough or not having enough protein to help stabilize blood sugar, they could not have enough movement, because they're asked to sit still all the time, or have to be in the same place that could be at school that could be at home. All of these things affect the body physiologically, and so when you're when we're looking at trying to help kids feel safe and supporting the brain, it is about safe, stable, nurturing environments and people they'd need that in their lives. But they also need some other stuff to help support their physiology. And so that's things like hydration and movement and nutrition. And that will support help to support their their bodies to have what they need. If their bodies are physiologically regulated, they're going to have more of what they need to regulate emotion. And they're gonna have more of what they need to then regulate behavior. So all regulation starts in the body. Most of the families that are coming in or even the schools that I'm working with, they're bringing to me, the child as a problem with behavior, right. So that's what they're looking that's what they're seeing all the time. And what we know about behavior is that all behavior is an attempt to meet a need, and all behavior has a function to it. And so if instead of focusing behaviorally on just fixing the behavior, if we spend enough time to understand and to see the child for who they are, and to learn what might the function of a behavior be, and then we just meet that need for them, then the behaviors go away, unless it is physiological, and so we want to make sure that kids you know, we're going to take care of all that stuff too when I'm working with A child at school or with just a family, I'm going to help parents understand that piece of it, and then try to support making sure that kids needs in a holistic way are met, you know, so we're gonna start with the body. That's where all regulation starts.

Kevin Wallace  30:16  
Yeah, so a lot of the misbehavior that goes on, I guess, within schools is really just a kid acting out because they don't have their needs met.

Alex Colston  30:25  
Yeah, that's great. That's x. That's exactly what I feel like I tell people 100 times a day when I'm in the school system. Yeah, that's it. So thank you for reflecting that back and putting it in one sentence instead of 20 for me, so, um, yes. So behavior, you know, is either unmet need, or, it's, it's a skill that has not been developed yet, those are the sort of the two pieces that we're not, and it's, it's a really sort of simplistic way of looking at it. But, you know, if a child has sensory issues, and there is a buzzing of a light, you know, above, in the fluorescent light in the classroom, or something, or the kid next to them is, you know, chewing on their pencil all day or whatever, and it's irritating them, you know, I mean, they're gonna sort of B kids with sensory issues, they're sort of like already primed, and really kind of just like humming on all the time, and it takes one little thing to happen to set them off, you know, because their, their nervous systems, their bodies are already dysregulated. So it can be it can be dysregulation, behavior can be dysregulation, or it can be unmet skill, you know, so, if kids don't know that, they can ask for what they want and need, and they can't trust that you as the adult in charge are going to meet that need for them, then they will just use their behavior to get their needs met. So it so it's about dysregulation or it's about, you know, unlearned skill, you know, that they need so, so that's another piece too. So it's the felt safety piece, it's the connection piece. So helping kids and parents or caregivers or whoever the adult in charge is learn to connect with the kid and to see hear value and delight in them. And if they can do that, and they can be consistent and show up and meet the needs for their kid. That's the connection piece that we want. So felt safety, connection, and then the other piece, the emotional behavioral regulation, that's the stuff that we're dealing with. When we're looking at behavior, we want to understand that all regulation, and even behavioral regulation, all regulation starts in the body. So kids have to have what they need to feel safe. They have to be primed, you know, for regulation and to be ready. And then they can regulate a little bit more, or they can learn the skill for regulating emotion. And after they've done that they can regulate their behavior a little bit better. But if you just take a behavioral approach, and you're not attending to the emotional piece, you're not attending to the connection, and you're not attending to the physiological piece, then you're you might find something that works like a reward system, but it's going to work for like two weeks,

Kevin Wallace  33:00  
Yeah you're just putting a band aid on a much deeper need.

Alex Colston  33:03  
Yeah, that's right, there you go. It's not meeting the need. And so that's the work that we're in is about meeting the needs.

Kevin Wallace  33:10  
Well it sounds like there's a lot of moving pieces to this, too. So what does New Vista do to help provide for identifying these moving pieces for a child and help meet those needs for the child to help them along the way to adulthood?

Alex Colston  33:26  
Yeah, so New Vista has a ton of services that are available, and even thinking about the protective factors specifically. So if, you know, a family could be referred for outpatient therapy services, right. So somewhat, they would come in and see someone like me, you know, who's do who can assess sort of their history and the family dynamics and what's going on, and begin to work with that family to help support meeting the child's needs. Now, maybe the family has, they don't have that one protective factor about, you know, really having in place concrete support in times of needs. And so we might hook them up here with another service that we have available, like our case management services, or peer support, or family support services, or people that can help provide resources, people that can help support the family along the way to getting resources that they need. So that would be one piece. So there's case management, peer support, family support, those are people with lived experience that can come alongside their families or the child or the child or adolescents, and walk help walk them through, you know, their healing and their recovery process. Those are really great supports. We have school liaison positions, those are fairly new for us. And those really are people who are kind of building the bridge and helping to maintain the bridge between us in schools and make sure that kids and families in the school systems have access to the services that we provide, to get their needs met again. There's Psychiatric services, we have primary care, you know all things to attend to the body. So really focusing on, you know, with the protective factors, focusing on trauma informed framework for helping kids feel safe, connected, manage emotions and behavior, all of that stuff. And then really holistically taking care of the whole child and the whole family. We have lots of services and programs here that that helped to do that, that helped to give kids and families what they need.

Kevin Wallace  35:27  
So good. And we love putting resources like this podcast out into the, into the community to help stay informed, and maybe even this conversation brings up things in your life that you want to look more into. So well, we'll again, include that test that test to the adverse childhood experiences test to help see what kind of score you might have. And and we'll include some more resources as well in the description for you to look more into and read about and hopefully getting more information outside of this podcast. But yeah, that's what we're about here in New Vista to help see the good ahead for all individuals. But for today, yeah, we're just we're grateful to have had you on and talk about these experiences and so thanks, Alex.

Alex Colston  36:14  
Alright, thanks. Thanks for having me.

Kevin Wallace  36:21  
Well, thank you for joining us in today's episode. This podcast is brought to you by New Vista. We assist individuals, children and families in the enhancement of their wellbeing through mental health substance use in Intellectual and Developmental Disability Services. We see the good ahead for all individuals in our communities. If you need help, call our 24-Hour Helpline at 1.800.928.8000 or visit our website at www.newvista.org. We hope you enjoyed today's episode, and we'll see you next time.