A Compassionate Response to Adverse Childhood Experiences January 9, Susan Martin Yakima, WA

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1 A Compassionate Response to Adverse Childhood Experiences January 9, 2017 Susan Martin Yakima, WA

2 The Adverse Childhood Experiences study and why is it important. How can the field of neuroscience can help us understand and teach brain science. Strategies for increasing resiliency. Slmartin Consulting

3 UNDERSTANDING SCIENTIFIC DISCOVERIES SOMETIMES REQUIRES UNLEARNING WHAT WE ONCE BELIEVED TO BE TRUE Slmartin Consulting

4 A Shift in Perspective Slmartin Consulting

5 EXPERIENCE DRIVES DEVELOPMENT Determines function & specialty of cells exposed to certain hormones Activate systems prematurely & makes them more sensitive to future stressors Regulates myelination the coating of nerves with fat Regulates the development of receptor cells the decoder rings of the brain Determines how brain cells network with each other, shaping mass & function of the brain at maturity Stress-related chemicals kill off baby brain cells Slmartin Consulting

6 Synaptic Density: From Rob Anda Slmartin Consulting

7 CONSEQUENCES OF BIOLOGICAL OUTCOMES Slmartin Consulting

8 Still Face Experiment Slmartin Consulting

9 How we get wired impacts our world view.

10 Development: A Magnificent Dance of Experience & Adaptation Development is Sequential 3 Factors Drive Outcomes 1. Type of Experience 2. Gender 3. Age Sensitive Periods

11 Toxic Stress is Hard-Wired Into Biology Amygdala/Hippocampus Ramp up and slow down Small stress=big response Early Childhood Attention, Long Term Memory, Mental Health, Goal-oriented Action Pre-puberty - Adolescence Middle Childhood Corpus Callosum Right-Left Brain Communication, Social Cues, Insight, Movement, Language & Math Early Adulthood Cortex Thinking Executive function Hope

12 ADVERSE CHILDHOOD EXPERIENCE

13 Stress is Hard-Wired Into Biology Emotional Reaction, Verbal Memory, Spatial Memory Judgment Early Childhood Attention, Long Term Memory, Mental Health, Goal-oriented Action Pre-puberty - Adolescence Middle Childhood Right-Left Brain Communication, Social Cues, Insight, Movement, Language & Math

14 Threat Appraisal and Detection in Traumatized Children Copyright WSU 2012 Information may be used with attribution

15 Brains to Fit the Life We ll Live Predictable Patterns: Electrical & Chemical Functioning; Brain Mass & Gene Expression Fear and Danger Nurturing INDIVIDUAL characteristics & traits Hyper vigilant Numb Hyper reactive Withdrawn Emotionally Detached INDIVIDUAL characteristics & traits Relationship-oriented Reflective Shift focus - seize opportunity Biological wiring matches social expectations Outcome Able to survive in the worst of conditions Dissonance between biological expectations & social reality Outcome Able to survive in the best of conditions

16 It is Hard to Play Chess in a Hurricane 17

17 Hand Model Slmartin Consulting

18 Enduring Effects COGNITIVE SOCIAL MENTAL HEALTH SUBSTANCE ABUSE PHYSICAL AGILITY SAFETY CHRONIC DISEASE PRODUCTIVITY STATUS

19 Discussion Questions In what ways does this idea that trauma gets woven into our bodies and cells challenge your thinking? How do you monitor your perception of events? What do you do to suspend judgment? How do you monitor, adjust, adapt, so that you know this is not about me?

20 Break Time!

21 Mr. Rogers

22 The Adverse Childhood Experiences Study By Vincent J. Felitti and Robert F. Anda Slmartin Consulting

23 Adverse Childhood Experience Study Largest Study of its Kind Over 17,000 participants Both Retrospective and Prospective Over 100 Peer-Reviewed Journal Articles Shifting the Paradigm Helps Us Understand Drivers of Population Health and Wellbeing

24 A Public Health Paradox What are conventionally viewed as Public Health problems are often personal solutions to long-concealed adverse childhood experiences. Felitti, 2011 It s hard to give up something that almost works. Slmartin Consulting

25 WHAT ARE THE ADVERSE CHILDHOOD EXPERIENCES (ACEs)? 1. Child physical abuse 2. Child sexual abuse 3. Child emotional abuse 4. Neglect 5. Mentally ill, depressed or suicidal person in the home 6. Drug addicted or alcoholic family member 7. Witnessing domestic violence against the mother 8. Loss of a parent to death, abandonment, divorce 9. Incarceration of any family member Slmartin Consulting

26 Prevalence of Adverse Childhood Experiences Abuse, by Category Prevalence Neglect, by Category Household Dysfunction, by Category Household Dysfunction, by Category Slmartin Consulting

27 A CLASSIC CAUSAL RELATIONSHIP MORE ACEs = MORE HEALTH PROBLEMS Dose gets bigger Dose-response is a direct measure of cause & effect. The response in this case the occurrence of the health condition is caused directly by the size of the dose in this case, the number of ACEs. Slmartin Consulting

28 Percent of Population with Problem Percent of Population Currently Smoking A Significant Portion Of Risk for Disease Is Attributable to ACEs Current Smoking- Washington Smoking Heavy Drinking or 5 6,7, or 8 Binge Drinking Number of ACE Categories Drinking and Driving Had a Drug Problem Ever Had a Drug Problem Original ACE Study 12 Addicted to Drugs Ever Injected Drugs Number of ACE Categories

29 % of Population with Asthma % of Population with C-V Disease A Significant Portion of Chronic Disease is Attributable to ACEs Cardio Vascular Disease Cancer Diabetes Asthma Auto Immune Disease Chronic obstructive pulmonary disease Ischemic heart disease Liver Disease Cardio Vascular Disease or 5 6,7, or 8 3 Number of ACE Categories Asthma ACE Score 12

30 Percent of Population Percent of Population A Large Portion of Mental Illness Is Attributable to ACEs Anxiety Depression Serious and persistent mental illness Frequent mental distress Nervousness Suicide attempts Emotional problems that restrict activities or 5 6,7, or Number of ACE Categories Treatment for Mental Health Condition or 5 6,7, or 8 Number of ACE Categories

31 Relationship to the Ace Score and Alcohol Use and Abuse 33

32 Percent of Population Percent of Population A Large Portion of Mental Illness Is Attributable to ACEs Anxiety Depression Serious and persistent mental illness Frequent mental distress Nervousness Suicide attempts Emotional problems that restrict activities or 5 6,7, or Number of ACE Categories Treatment for Mental Health Condition or 5 6,7, or 8 Number of ACE Categories

33 Childhood Experiences Underlie Chronic Depression 35

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35 % Reporting IV Drug Use ADVERSE CHILDHOOD EXPERIENCE ACE STUDY DOSE RESPONSE FINDINGS Intravenous Drug Use ACE Score 37

36 PROBABILITY OF SAMPLE OUTCOMES GIVEN 100 AMERICAN ADULTS 33 Report No ACEs 51 Report 1-3 ACES 16 Report 4-8 ACEs WITH 0 ACEs 1 in 16 smokes 1 in 69 are alcoholic 1 in 480 uses IV drugs 1 in 14 has heart disease 1 in 96 attempts suicide WITH 3 ACEs 1 in 9 smokes 1 in 9 are alcoholic 1 in 43 uses IV drugs 1 in 7 has heart disease 1 in 10 attempts suicide WITH 7+ ACEs 1 in 6 smokes 1 in 6 are alcoholic 1 in 30 use IV drugs 1 in 6 has heart disease 1 in 5 attempts suicide

37 ACEs are Common Among Washington Adults INFORMATION FROM THE 2009 WASHINGTON STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM SURVEY (BRFSS) 62% have at least one ACE category 26% have three 5% have six

38 ACE S AND ELEMENTARY SCHOOL CHILDREN At Ages 5-12, Complex Trauma is Common ACE + Homelessness; Pile-up of Toxic Stressors Predicts: Health, Attendance, Behavior Academic Failure ACE indicators included: referral to child protective services, family violence, exposures to community violence, and residential instability (using a McKinney Vento definition) Study findings from Spokane Elementary Schools; Blodgett & Harrington; 2010

39 ACEs and High School Sophomores and Seniors Population Average 41

40 EARLY TRAUMA & STRESS Predictable patterns of brain development, traits & behaviors Significant risk of early use/abuse of: Alcohol, tobacco, illicit & prescription drugs ADVERSE CHILDHOOD EXPERIENCE Predictable/Preventable Slowed language & reading Lateralization Diminished IQ Poor decision making skills Attention problems ADD ADHD Aggressive behavior Social isolation among peers Poor understanding of social cues = conflict Special education School failure Bullying Suspension Delinquency Dropping out Low-wage jobs Unemployment Public Assistance Prison Chronic health problems Debilitating mental health

41 ACE REDUCTION Reliably Predicts Improved HEALTH WELL-BEING PRODUCTIVITY Population Attributable Risk for ACE related problems ranges from 20% to 70%

42 ADVERSE CHILDHOOD EXPERIENCE What if Hearts trumped ACE s? Healthy Environments And Relationships That Support.

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44 18.00% SOCIAL/EMOTIONAL SUPPORT AS A RESILIENCE FACTOR 16.00% 15.70% 14.00% 12.00% 10.40% 10.00% 9.10% 8.00% 7.50% 7.00% 7.20% 8.20% 6.00% 5.70% 4.00% 2.00% 1.40% 0.00% Cardiovascular Diabetes Receive Treatment for Mental Illness Rarely/Never Rarely/Never Receive Support Always/Usually Have Sometimes Receive Support Always/Usually Have Support

45 Promote Virtuous Cycle of Health Improvement SUPPORT & ACCOMMODATE ADULTS PROTECT CHILDREN Moderate ACE Effects Improve Wellbeing Reduce Prevalence of High ACE Scores (c) DSHS PPA ACE Partnerships, 2013

46 Understanding Adverse Childhood Experiences isn t to know one s life path. It is to open doors for the future you would like for yourself and for future generations. Dr. Ronald Voorhees, MD, PhD Chief Office of Epidemiology & Biostatistics Allegheny County Health Department

47 Discussion 1. What surprises you about the ACE information? 2. How does the ACE study challenge your thinking? 3. Who will you share this with and how?

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49 Resiliency Resilience is the ability to meet challenges, survive and do well despite adversity Kirmayer, 2009

50 Resilience Occurs at All Levels Individual Family Community National, Global, Ecosystem (c) DSHS PPA ACE Partnerships, 2013

51 Reflection Think of a time when your life was really tough. Looking back, what helped you navigate that period of your life what helped you to move forward into better times? Jot down what comes to you. Categorize; Show of Hands: SELF FAMILY & FRIENDS COMMUNITY, CULTURE, SPIRITUALITY

52 Resilience: The Natural Capacity to Navigate Life Well INDIVIDUAL TRAITS RELATIONSHIPS COMMUNITY, CULTURE, SPIRITUALITY Skills and talents Self regulation self control Flexible thinking Ability to direct & control attention, emotion, behavior Positive self view Hope Attachment to caring adults Positive relationships Partners who provide a sense of security & belonging Family Places to gather Faith, hope, sense of meaning Access to services Engagement with effective orgs schools, work, prosocial groups Employment Network of supports/services Safety & opportunity to help others Recreation Cultures providing positive standards, expectations, rituals, relationships & supports Healthy Foods Housing Resilience definition: Iris HeavyRunner

53 What helps us feel secure? People * Places Routines * Rituals

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55 Resiliency at school 7 Cs: Building Resiliency Confidence Competence Connection Character Contribution Coping Control * Ken Ginsburg

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57 Social Emotional Skills Self awareness Self management Social awareness Relationship skills Responsible decisionmaking

58 Building Social Emotional Skills Relationships Responsive Respect Routines Repetition

59 If you don t think what I think... Feel what I feel... Experience what I experience... See what I see when I look at myself, others and the world around me.. How can you possibly know what s best for me? Spend time in your teens world Healing begins when we match our Response with the way teens are experiencing their world. Survival behaviors are driven by past experiences. Thoughts created private logic Words rarely help

60 For more than 50 years the Search Institute has been working to discover what kids need to be successful. Best known for the 40 Developmental Assets What can schools do? What about families? Strong Families Check out

61 Protective Factors Healthy Practices High Self Esteem Good problem solving skills Feeling of control in their own life Spirituality Avoiding alcohol, tobacco and other drugs Consistent home/family routines Parental/family support Monitoring youth s activities Regular school attendance and progress Having a good social support system Economic security Availability of constructive recreation Community bonding Feeling close to at least one adult

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64 Directions for ACE s and Resiliency Place all the ACE cards in one pile. Shuffle the resiliency cards and deal to all players. 1 st Round: One person draws an ACE and reads aloud. Participants look at their resiliency cards and choose the card you think will be most helpful for the person with the ACE card. ACE player collects all resiliency cards offered by participants (face down). Read all resiliency suggestions offered and choose the best match for you. Player that offered you the card you chose, gets the ACE card. Move to next player who reads next ACE, and repeat steps above. First player with 3 ACE cards WINS!

65 ADVERSE CHILDHOOD EXPERIENCE What if Hearts trumped ACE s? Healthy Environments And Relationships That Support.

66 Just living is not enough," said the butterfly, "one must have sunshine, freedom, and a little flower. Hans Christian Andersen, The Complete Fairy Tales

67 Personal Impact of Vicarious Trauma: Physical Emotional Behavioral Cognitive Relational World View (Spiritual) Emotional Social Financial Job Tasks Morale

68 Self Care Respect your significance Pay Attention Be aware of your own stuff Keep control in the hands of adults Ask for help Be curious

69 Overcoming Vicarious/Secondary Trauma Remind yourself that the children are safe and the trauma is over. Work hard to distinguish between your own interpretations and the child s actual experience. Acknowledge a connection with your own past trauma history. Focus on present-day lives. Build on children s strengths. Try not to generalize. Take frequent breaks (what brings you joy?) Seek support

70 Take time to laugh

71 Jessica s Affirmations

72 For the most part, resilience is about the day-to-day ways we interact with and help each other. We can work together professionally. We can support individuals, families, our community.