The Juice is Worth the Squeeze: The Development of Lemonade for Life
This post discusses the article, “Lemonade for Life — A pilot study on a hope-infused, trauma-informed approach to help families understand their past and focus on the future,” recently published in Children and Youth Services Review. Please click here to read the full article and learn more about the pilot study of Lemonade for Life.
The scene was the 2014 Pew Home Visiting Summit. Panels discussed the foundational research about adverse childhood experiences (ACEs) and its broader implications. Early childhood experiences play an increasingly clear role in a person’s development and life outcomes. At the Summit, presenters explained the enormity of public health risk of ACEs, including lifelong health impacts and cost to life potential.
- Health (obesity, diabetes, depression, suicide, STDs, heart disease, cancer, stroke)
- Behaviors (smoking, alcoholism, drug use, missed work)
- Life Potential (graduation rates, academic achievement)
Most importantly, the conference underscored that adverse childhood experiences are preventable. One morning over breakfast, while attending the Summit, Jackie Counts and Janet Horras lamented the lack of ACEs resources available to use with families. They felt compelled to do something about it, and with co-author Rebecca Gillam, they resolved to create a training and tools to help practitioners use ACEs research in their work.
As researchers and social workers, they understood that in the social work field it can take years to translate theory into actual practice. As ACEs and their impacts are clearly prevalent in social work, ACEs research needed to find its way from the academic realm into the hands of practitioners, and fast. The heavy burden placed on social workers by expansive caseloads, reporting procedures, and professional development activities presented a challenge that necessitated a new approach to bringing ACEs research into the field.
Thus, Lemonade for Life was born. Initially designed as a training and professional development opportunity for home visitors, the training presents the “Lemonade for Life” recipe as a way to talk with families about ACEs while offering support and tools for building hope and resilience. The ultimate goal is to improve the wellbeing of children and families by mitigating the effects of adverse childhood experiences.
Lemonade for Life trainers prepare a safe and intentional space to have difficult conversations about childhood trauma. Each trainer begins the full-day workshop by sharing personal experiences with ACEs, paving the way for vulnerability and empathy throughout the training session. With this underlying empathy and colorful lemonade decorations, participants understand that their work and effort matters when entering the room. Lemonade for Life builds a sense of community among participants of all backgrounds. Participants leave the training knowing that they can make a difference and can create positive change with this network of peers.
A typical training begins with a discussion on brain development and the foundations of ACEs research. Next, participants are trained in the use of the ACEs questionnaire developed by the researchers at Kaiser Permanente in the famous ACEs study. The final — and most unique — portion of the training offers hope and resilience tools: the Hope Map, the Building Strength and Resilience worksheet, the My Lemonade Stand worksheet, and tips on self-care for both families and the professionals working with them. This is the “what next” piece of the Lemonade for Life training and gives providers the tools they need to work with families.
The Lemonade for Life recipe is a holistic approach to the application of ACEs research into practice. The recipe demonstrates that there is more than one right way to add ingredients when working with parents who are experiencing difficult life circumstances. This approach helps home visitors meet families where they are, at the right time, with the right tools.
The Pilot Study
In the summer of 2014, Lemonade for Life developers and trainers from the Iowa Department of Public Health and the University of Kansas Center for Public Partnerships and Research (CPPR) began piloting and evaluating the Lemonade for Life program. The purpose of the pilot study was to begin to build the evidence base for Lemonade for Life. We strongly believed that the delivery mechanism of the material was making a demonstrable impact in the lives of both trainers and the participants. The first step to understanding this impact was to determine if participants were learning the content, if they were becoming more hopeful, and if they were feeling more comfortable with using the ACEs questionnaire in their day-to-day practice. Lemonade for Life was piloted with 24 home visitors and parent educators from Kansas and Iowa in the summer of 2014. A pre-training and post-training survey was conducted that included four primary sections:
- Demographic information about participants including their age, experience in their current role, and level of education;
- Participant experiences with ACEs personally and professionally;
- Portions of the Hope Scale (Lopez, 2013), and
- Participant perceptions of using ACEs in work with families
The results of the initial pilot showed promise. Participants took the Lemonade for Life materials to share with the families they served, and reported back: families were more engaged and starting to understand the connection between life choices and ACEs. The training and materials were easy for the home visitors and parent educators to understand and provided tangible tools for use in their work with families.
The pilot study shows that a return to basics — empathy, conversation, and withholding judgment — is the right path for training programs in this field. With simple tools, complex brain science, and years of ACEs research, much can be learned and applied in the field.
Lemonade for Life hopes to support ACEs research and follows a continuous quality improvement approach that emphasizes building an evidence base. Lemonade for Life aims to move the needle by approaching ACEs work from many directions. Since the time of the pilot, the Lemonade for Life program and evaluation efforts have developed significantly. In the past three years, over 500 people have been trained. As more people are trained, and more studies published, we hope to discover how families themselves are impacted by the training and practice of Lemonade for Life participants.
Keil earned his Master’s degree in Peace Studies from the UN-Mandated University for Peace in San Jose, Costa Rica. He is an Assistant Researcher at the Center for Public Partnerships and Research at the University of Kansas. You can find Keil’s other writings on conflict resolution, peace, and politics on his blog, Octaguante or on Twitter.
Shabrie earned her Master’s degree in Native American Studies from The University of Oklahoma in Norman, OK. She is an Assistant Researcher at the Center for Public Partnerships and Research at the University of Kansas. Outside of office hours, Shabrie spends most of her time exploring Lawrence, spending quality time with her dog, and mastering the grill.