The Role of the Adverse Childhood Study(ACES) in Creating Healthy Communities: a trauma sensitive approach

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1 The Role of the Adverse Childhood Study(ACES) in Creating Healthy Communities: a trauma sensitive approach Selena E. Sermeño, Ph.D Consulting Psychologist sesermeno@earthlink.net

2 Adverse Childhood Experiences study The ACE Study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente. Led by Co-principal Investigators Robert F. Anda, MD, MS, and Vincent J. Felitti, MD, the ACE Study is perhaps the largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life.

3 Adverse Childhood Study ( ACES) and Addiction In our detailed study of over 17,000 middle-class American adults of diverse ethnicity, we found that the compulsive use of nicotine, alcohol, and injected street drugs increases proportionally in a strong, graded, dose-response manner that closely parallels the intensity of adverse life experiences during childhood. This of course supports old psychoanalytic views and is at odds with current concepts, including those of biological psychiatry, drug-treatment programs, and drugeradication programs. Our findings are disturbing to some because they imply that the basic causes of addiction lie within us and the way we treat each other, not in drug dealers or dangerous chemicals. They suggest that billions of dollars have been spent everywhere except where the answer is to be found. Robert Anda, M.D and Vincent Felitti, M.D

4 ACES Study What is predictable is preventable Robert Anda, M.D. ( ACES Co-author) Film:

5 Trauma Trauma occurs when a person s internal and external resources are inadequate to cope with an external threat. This imbalance occurs during the experiencing, witnessing, or anticipating of said threat and proceeds to cause damaging biological effects that can express themselves in negative ways throughout the life course ( Kluft, Bloom & Kinzie, 2000) Effects vary based on the person, but the compounding of traumatic stress can lead to abnormal brain development and harmful alterations in a person s physical, social, emotional, and spiritual well being. Scattergood Foundation,

6 Trauma* A betrayal of one s right to safety A blow to one s copings rendering us helpless, exposed, raw and vulnerable; When human induced, an experience of humiliation, exposure, degradation; A violation to one s dignity and human rights A sudden disconnect from key life s dimensions where protection and belonging is to be found; Becomes embedded in culture; A shock, pulling the rug from under, exposure, loss of control, loss of power Changes physiology, affects development, impacts health * Sermeno, S.

7 Trauma: A loss of power and control. A sudden disconnect from basic developmental needs and longings of every human being. Loss of safety. The need for physical nurturance The need for love, affection/belonging The need for connection to something larger than ourselves The need for play The need to belong to a group of people who share traditions ( culture) The need for beauty and creative expression The need for pleasure The need to learn, to have intellectual stimulation The need for purpose, to contribute to society ( Work, school, etc) The need to enjoy the natural environment * Sermeno, S.

8 A bit of background... We are just beginning to understand the link between trauma and long term health; Experiences of human induced trauma are seldom understood within a human rights, human cruelty, or human dignity frame ; To fully understand trauma means to shift the conversation about services such as education, health, juvenile justice, mental health, etc. To fully understand trauma means to work across disciplines and to see its prevention and healing as the domain of everyone, not just health professionals.

9 Trauma Informed Care history Anna Jennings takes her life 1994-SAMHSA sponsors the Dare to Vision Conference which through the art and stories of many sexually abused women launches a paradigm shift for how to address trauma in the mental health system Recognition of the centrality of trauma Recognition of the story in trauma

10 A trauma informed community= compassion, human rights, social connection, education* Citizen participation in preventing and addressing trauma Citizen education on the meaning and impact of traumatic/adverse circumstances Eliminates negative stigma Leadership infrastructures understanding of the complex nature of traumatic circumstances and events Paradigm shift from illness to wellness and shame to full acceptance * * Sermeno, S.

11 Trauma Informed Care= Respect A way of understanding and responding to trauma by individuals, organizations and cultures; Behaviors and interventions guided by a profound understanding of terror, abandonment, humiliation and powerlessness A public health and human dignity approach to trauma Knowledge, principles, protocols, attitudes, commitment, models, etc. for responding to trauma.

12 Trauma Informed Public Policy What does it mean to be Trauma Informed? To take into account 3 key elements: Connection, communication and healing (CCH) At its core, it asks not what is wrong with you? but what happened to you? It connects a person s behavior to their trauma response rather than isolating their actions to the current circumstances and assuming a personality flaw. Scattergood Foundation,

13 Trauma Informed Care/communities* Empathy/ accompaniment Compassion Gratitude/recognizing the teacher inside suffering Dignifying No Shaming! No invisibility A way of life A way of connecting with each other * Sermeno, S.

14 From the Latin word Digna meaning to be worthy of recognition and belonging by simply being born. The DNA of healing and transformation.

15 Humiliation From Latin root, humus : of the earth, soil To shame To silence To expose To denigrate Experiences of humiliation are closely related to future violence To ignore and make invisible

16 "Engrave this upon your heart: there isn't anyone you couldn't love once you heard their story." --Mary Lou Kownacki

17 Universal Declaration of Human Rights

18 What can we do? Each one of us: be appreciative, welcoming, curious Our organizations: informed policy, training, strategic plans, work on procedures, involve patient input. Our families: be kind to each other, be welcoming, share decision making, celebrate one another, be forgiving Our communities: be a safe, inclusive, celebratory and welcoming space.