How Important is Predictability? How Residential Programs Can Heal Adverse Childhood Experiences

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Addiction and Adverse Childhood Experiences

In today’s culture, stress has become an almost inevitable part of life. And children are no exception to having these experiences. But there is a difference between “normal” types of stress and what have become known as “Adverse Childhood Experiences,” or ACEs.

One of the biggest amplifiers of ACEs, studies have shown, is a sense of chaos and randomness in a child or youth’s living environment. Moreover, this unpredictability is often exacerbated by the child welfare system that can keep children bouncing from foster home to group home, making them even more vulnerable to high-risk behaviors. Such high-risk behaviors include substance abuse and addiction.

But what can be done to help restore a sense of stability and predictability for those in addiction recovery who have suffered from ACEs?

In a recent article in a series of papers presented by the Association of Children’s Residential Centers (ACRC), the ACRC examines “the importance of cultivating predictability, an essential element of healthy neurobiological development,” and how residential programs—as well as recovery residential programs—can offer services that address this specific need.

What Are ACEs and How Common Are They?

ACEs are marked by the stress and trauma they inflict upon a child or youth. Varying degrees of abuse and/or neglect are the most common forms of ACEs, but they can have a number of different expressions. The effects of these types of ACEs usually result in “psychological distress, learned helplessness, and poor self-regulatory ability.”

Living situations that have chronic and severe stress elements are usually accompanied by a combination of the following:

  • Lack of structure
  • Lack of supervision
  • Lack of predictability
  • Experiences of randomness
  • Experiences of chaos
  • General sense of disorder

Of children in the welfare system, a recent study discovered that 90% of them had experienced more than one ACE which increased their risk of both physical and behavioral problems. Furthermore, 16% of this population had experienced four or more ACEs.

How Are ACEs Normally Treated?

The current system intended to help children with ACEs get out of troublesome situations is a mixed bag and has the potential to do more harm than good, at least in terms of long-term stability. The immediate goal is usually to remove them from harm, which although beneficial for some, usually also includes upheavals of location, consistency, and normalcy.

For most children, foster homes, group homes, and other alternative living situations are ultimately ineffective when it comes to positive developmental outcomes in the long run. Children and youths who spend multiple months or years in these systems are at a much higher risk for a number of negative consequences including:

  • Exacerbated experiences of randomness
  • Heightened sense of chaotic environments
  • Poor coping skills
  • High-risk behaviors
  • Suicidal thoughts and/or attempts
  • Sense of hopelessness

The high number of ACEs of children in an already unpredictable child welfare system eventually results in their referral to residential interventions. Or, if they are old enough, they may later be referred to an addiction recovery program with a residential option. So, what can residential programs offer and what are the long-term benefits?

How Can Residential Treatment Help?

Residential programs are designed to offer living environments that cultivate a greater sense of predictability and structure. But if these programs are equally short-lived and limited in their treatment scope, they can have the same negative effects on developmental health as the child welfare system.

The ACRC proposes two primary solutions to these issues: relational predictability and trauma-informed programmatic predictability.

Relational Predictability

Relational predictability can be defined as “predictable, reliably regulating…relational experiences that afford a degree of control and volition for the youth and family.” In other words, repeated and calming relational experiences have the potential to provide a greater sense of empowerment and agency in the child or youth.

As opposed to other practices common in residential programs—such as traditional talk therapies, psychotropic medications, and even individual psychotherapy—relational predictability allows the child to “learn through living.” And based on the ways that stress impacts the brain, the best way to develop skills and manage complex situations is the repetition of regulated, safe relationships.

Trauma-Informed Programmatic Predictability

In line with the relational predictability cultivated by the residential program’s staff and culture, trauma-informed strategies can provide predictability in the program structure itself. The examples proposed by the ACRC include:

  • Youth-Guided Practices: Activities, programs, and routines where the youth have a voice in the planning process help develop self-regulation and emotional maturity. Moreover, if practices are collaborative, they can help create environments of both individual and group empowerment and predictability.
  • Family Driven Care: Instead of isolating the youth in a program disconnected from their family or caregivers, family driven care involves all parties towards new modes of interaction. It can also build structures of support and predictability outside of the residential program itself.
  • Equity, Diversity, and Inclusion: Developing the practice of “cultural humility” can help youths become adaptable and self-reflective, which ultimately has a positive impact on how they manage stress responses and their own views of themselves.
  • Daily Routines and Rituals, and Individual Planning: In line with youth-guided practices, the more opportunities there are for self-organization and regulation, the better. These routines and rituals can also include life-cycle markers (birthdays, graduations, etc.). Individual planning extends to the more personal aspects of a youth’s life, including regulating social cues and personalized strategies.
  • Sensory Strategies and Relational Interactions: Sensory strategies can be developed by attuning the youth to their bodily experiences and how to de-escalate stressful situations. Furthermore, these strategies can be applied to relational interactions that develop further skills like empathy, reflective listening, and many more that help to maintain a sense of inner equilibrium and predictability. 


All in all, these relational and programmatic strategies help to provide structure and predictability for those in addiction recovery who have suffered from ACEs. And since residential programs are usually one of the final stops for addiction treatment, it is essential that residential interventions are able to meet some of the most important needs of their clients: cultivating predictability, developing a sense of safety, and reducing dysregulating stress.

If you are interested in the services offered by Pinnacle Recovery, please click here. 

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