This story is part of our Overcoming ACEs series, a journalism project highlighting North Philly’s solutions to America’s childhood adversity problem. The solutions we share through this project can benefit people at risk or who have experienced adverse childhood experiences (ACEs). However, not all solutions were designed to prevent ACEs, and not everyone featured has experienced them.
Last Tuesday, Esperanza Health Center offered its first community wellness program at its new CORE wellness facility in Kensington.
The bilingual program, called FamilyFit, brings families together once a week for eight weeks to promote a holistic, family-centered approach to health.
For 90 minutes every Tuesday, instead of parents and caregivers watching from the sidelines, they are learning kickboxing, taekwondo, yoga, and Zumba with their kids. They are also exploring new ingredients and snacks, and talking about ways to reduce stress.
“It’s hilarious because the kids have never seen mom be all she can be, playing some crazy game at the gym,” said Debra Ortiz-Vasquez, Esperanza’s director of community health and wellness. “The kids are laughing at their parents, or in awe, like ‘How did she do that with an infant on her hip?’”
The Kensington FamilyFit program grew out of a program under the same name at Esperanza’s Hunting Park location. According to Ortiz-Vasquez, Esperanza created the original program to respond to health challenges they were seeing in their clinic. Common health challenges they saw included diabetes, hypertension, and obesity.
After investigating their options, including visiting a family health education program in Lancaster, Pennsylvania, they chose a family-focused approach. Programs that engage families are known for creating sustainable changes in health behaviors, Ortiz-Vasquez said.
“There is this intergenerational transmission of unhealthy habits,” said Ortiz-Vasquez. “If mom is not doing great around some health habits, her daughters are not going to do great. But if she changes her way of being, the generations will follow.”
A look at Kensington’s health factors and outcomes
The health challenges FamilyFit targets impact Kensington area residents at high rates. In a 2019 study about the health of Philadelphia’s neighborhoods, researchers found that in Upper Kensington (northeast of Lehigh and Kensington Avenues):
- 14.3% of residents have diabetes
- 31.1% of residents have hypertension
- 40.4% of adults are obese
The same study also ranked Upper Kensington as having one of the worst health factors and health outcomes among Philadelphia neighborhoods.
Health outcomes like the overall quality of life in the neighborhood were especially negative, including:
- 22.7% with poor mental health
- 22.4% with poor physical health
Meanwhile, the neighborhoods with the highest-ranking health factors and outcomes were Center City East and Center City West.
A case for holistic health programs that reduce childhood toxic stress?
While Esperanza’s FamilyFit program was not designed to prevent or treat childhood trauma, the health outcomes it aims to improve (diabetes, hypertension, and obesity) are directly linked to childhood adversity and the “toxic stress response” that often follows it.
Stress can be positive, tolerable, or toxic. Toxic stress occurs when a person’s stress response system is constantly activated. Although people of all ages can experience toxic stress, it is especially harmful when it happens to children because they are still developing.
Common causes of childhood toxic stress are known as “adverse childhood experiences” or “ACEs.” In high doses, ACEs can lead to negative, long-term impacts on children’s brains, immune systems, hormones, and metabolisms. It can also alter their DNA.
Common ACE exposures can be found in family systems, community environments, or both. Additionally, adverse community conditions impact family systems because families exist within broader communities (like neighborhoods). Meanwhile, policy and other social factors trickle down to affect community and family conditions, too.
Family ACE exposures
The original ACEs study surveyed more than 17,000 American adults about their exposure to the following family-level ACEs:
- Abuse (physical, emotional, or sexual)
- Neglect (physical or emotional)
- Parental incarceration
- Parental mental illness
- Parental loss/separation
- Parental substance dependence
That study found that most Americans had experienced one or more ACEs, and the more ACEs someone experienced, the worse health outcomes they had later in life.
People who experienced ACEs were at an increased risk for behavioral health outcomes like:
- Alcohol misuse
- Drug misuse
- High-risk sexual activity
- Smoking
They were also at increased risk for mental health outcomes, such as:
- Anxiety
- Depression
- Post-traumatic stress
- Suicide
Finally, they were also at increased risk for various physical health disorders, including:
- Cancer
- Chronic obstructive pulmonary disease (COPD)
- Heart disease
- Hypertension
- Liver disease
- Obesity
- Stroke
Community ACE exposures
One major limitation of the original ACEs study is that it was conducted with a mostly white, middle- and upper-class sample. Since then, there has been a push in Philadelphia and across the country to look at community-level causes of childhood toxic stress. A leader in this movement has been the Philadelphia ACE Project.
About a decade ago, researchers with the Philadelphia ACE Project conducted the Philadelphia Expanded ACE Survey. The survey aimed to measure family- and community-level adversity in Philadelphia, which has a population with more racial and socioeconomic diversity than the original ACEs study.
The expanded ACEs they researched included:
- Bullying
- Living in foster care
- Neighborhood adversity
- Racism
- Witnessing violence
The expanded ACEs study found that 70% of Philly residents had experienced one or more of the original ACEs, and 40% experienced four or more.
Additionally, they found that 40% of city residents had experienced four or more of the expanded, community-level ACEs. Importantly, many of the residents who experienced expanded ACEs did not experience family-level ACEs.
That means that while children might have a healthy family system with positive experiences, many of them are still exposed to ACEs outside the home.
Evidence-based ACE supports
However, there are lots of evidence-based supports that reduce the impact of ACEs and toxic stress on behavioral, mental, and physical health.
One specific buffer that reduces the impact of toxic stress is fostering strong relationships between caregivers and their kids. Other effective buffers include building life skills around exercise, nutrition, and reducing negative emotions.
Both of these are foundational to the FamilyFit program.
Others include interventions like cognitive behavioral therapy (CBT), psychological education, parent and caregiver training, wraparound services, educational interventions, housing interventions, and more.
How Kensington’s FamilyFit program works
The Kensington FamilyFit program meets every Tuesday from 4 to 5:30 p.m. until April 11. Each session includes approximately 45 minutes to an hour of nutrition or wellness activities and 30 to 45 minutes of fitness at the end.
The CORE, where the Kensington FamilyFit program is located, stands for “Community, Opportunity, Resiliency, and Equity.” It is located at 3222 H Street, a block from Kensington and Allegheny avenues, adjacent to Esperanza’s health center.
Esperanza designed the program with careful consideration for cultural diversity and inclusion, said Lianette Pappaterra, Esperanza’s community programs manager.
For example, the program is fully bilingual, meaning that the whole family can participate in the program together, whether they speak English or Spanish. This also reduces the pressure kids feel to translate for their parents and other caregivers, giving them time to be kids.
The nutrition lessons are considerate of culture, too, Pappaterra said. For example, when they do MyPlate activities to help people visualize their meals, they expect everybody’s plates to look different.
“A MyPlate for a Puerto Rican family is going to look very different than for an African American family than for a Middle Eastern family,” Pappaterra said. “So for Latino culture, sofrito is a staple, and it’s chock full of really good stuff.”
Pappaterra emphasized the importance of the program celebrating cultural staples like sofrito, a Puerto Rican sauce. However, she said the program will encourage families to try healthy ingredient changes, like adding spinach, which will increase the sofrito’s nutritional value without affecting the flavor too much.
Additionally, Ortiz-Vasquez said the program also considers shared power among the facilitators, instructors, and participants.
An effective, but not a single solution
The approach FamilyFit uses has proven effective for some of the Hunting Park participants, Ortiz-Vasquez said.
However, it is not intended as a single solution for the health outcomes it aims to improve, including diabetes, hypertension, and obesity.
It is also not the only solution for secondary benefits, such as the potential reduction of childhood toxic stress.
This is especially true since the program is available to residents once per week.
According to Pappaterra, Esperanza decided to require fewer hours for the Kensington program than the Hunting Park one since the program is new to the neighborhood and still connecting with program advocates.
They also wanted to reduce the time commitment for busy parents until they better understand their needs and availability. Esperanza plans to adapt the program as needed, Ortiz-Vasquez said.
However, Pappaterra said they are partnering with local organizations and programs, such as New Kensington Community Development Corporation’s (NKCDC) Nourish program.
Another limitation is that FamilyFit is only offered at one site across a neighborhood with tens of thousands of residents.
But Ortiz-Vasquez is focused on the impact FamilyFit can have on the kids in Kensington that they are able to reach.
“As they walk from Point A to Point B, they probably see a lot of things,” Ortiz-Vasquez said. “But once they get to Point B, they can just relax, they can breathe, they can run and not worry about the things that are on the streets.”
Want to learn more about the program?
Click here to view the registration form.
Editors: Zari Tarazona Designer: Jillian Bauer-Reese
