APNA 28th Annual Conference Session 1043: October 22, 2014
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1 Kathleen Gaffney, PMHCNS, CPNP, PMHS BC Dr. Joy A. Lauerer, DNP, PMHCNS BC, RN Dr. Colleen C. Williams, DNP, FPMHNP BC National Scientific Council on the Developing Child (2010). Early experiences can alter gene expression and affect long term development Working Paper No Lauerer, Gaffney, Williams 1
2 National Scientific Council on the Developing Child (2010). Early experiences can alter gene expression and affect long term development Working Paper National Scientific Council on the Developing Child (2010). Early experiences can alter gene expression and affect long term development Working Paper No No Edgar R, Mazor Y, Rinon A, Blumenthal J, et al. (2013) LifeMap Discovery : The Embryonic Development, Stem Cells, and Regenerative Medicine Research Portal. PLoS ONE 8(7): e doi: /journal.pone Cardiac Atrial septal defects Aberrant great vessels Ventricular septal defects Tetralogy of Fallot Ocular Strabismus Refractive problems secondary to small globes Retinal vascular anomalies Auditory Conductive hearing loss Neurosensory hearing loss Skeletal Hypoplastic nails Clinodactyly Shortened fifth digits Pectus excavatum, carinatum Radioulnar synostosis Klippel Feil syndrome Flexion contractures Hemivertebrae Camptodactyly Scoliosis Renal Aplastic, dysplastic Ureteral duplications Hypoplastic kidneys Hydronephrosis Horseshoe kidneys Lauerer, Gaffney, Williams 2
3 WEEK 4 Brain and spinal cord have begun to form. The heart begins to form. Arm and leg buds appear. Baby is now an embryo and 1/25 of an inch long. 1 in 6 Only 1 in 6 adults has ever had a health professional talk to them about alcohol. Many women simply may not know when they are first pregnant or may not be aware of the harm that alcohol consumption during pregnancy can cause. The sole cause of FASDs is the fetus being exposed to alcohol during pregnancy. my baby looks like/week 8/#rollover1 WEEK 8 FASDS ARE 100% PREVENTABLE! Lauerer, Gaffney, Williams 3
4 Obtained from Riken Research June 28, T Unpredictable Severe Number of Episodes Chronicity* Predictable Moderate Genetics Epigenetics Intrauterine Exposure* Vulnerability Resilience (Chamberland, Whittingstall, Fortin, Mathieu, & Descoteaux, 2014) ACE Study, Robert Anda, MD, MS with modifications* by Bruce Perry, MD, PhD Lauerer, Gaffney, Williams 4
5 alcoholism and alcohol abuse chronic obstructive liver disease risk for intimate partner violence pulmonary disease (COPD) multiple sexual partners depression sexually transmitted fetal death diseases (STDs) health-related quality of life smoking illicit drug use suicide attempts ischemic heart disease unintended pregnancies (IHD) Lauerer, Gaffney, Williams 5
6 2010 Anda R, Tietjen G, Schulman E, Felitti V, Croft J. Adverse childhood experiences and frequent headaches in adults. Headache Oct;50(9): Anda RF, Butchart A, Felitti VJ, Brown DW. Building a framework for global surveillance of the public health implications of adverse childhood experiences. AM J Prev. Med Jul;39(1): Brown DW, Anda RF, Felitti VJ, Edwards VJ, Malarcher AM, Croft JB, Giles WH. Adverse childhood experiences and the risk of lung cancer. BMC Public Health 2010;10:20. CDC. Adverse childhood experiences reported by adults five states, MMWR 2010;59(49): Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Macaluso M, Marks JS. (2010). The Protective Effect of Family Strengths in Childhood against Adolescent Pregnancy and Its Long Term Psychosocial Consequences. Permanente Journal, Vol. 14, No. 3, pp WHOLE LIFE PERSPECTIVE DEATH ACE PYRAMID Early Death Disease, Disability, Social Problems Adoption of Health Risk Behaviors Social, Emotional, Cognitive Development Disrupted Neurodevelopment CONCEPTION Adverse Prenatal and Childhood Experiences Lauerer, Gaffney, Williams 6
7 Poor Attachment/ abuse/neglect Reacts negatively due to faulty interpretation, negative world view and faulty brain development Fight/ fight or freeze response =aggressive responses Hypervigilent Interprets Stimuli Negatively Chronic Stress/ trauma affects Brain Development Lauerer, Gaffney, Williams 7
8 Family history Family Constellation: Mother, IP and IP s sister, age 14 years No family or community support Daughters attend a small religious school out of the neighborhood Single mother, History of SA and frequent SI, refuses MH interventions, Mood swings, will not supervise IP s medication administration, frequently sabotages daughters treatment by refusing to bring to clinic Threatens daughters with abandonment Limited income = food insecurity, housing insecure Lauerer, Gaffney, Williams 8
9 View change as an integral part of life, see the opportunity for growth: Change is always workable Help clients develop emotional intelligence and use this skill in their relationships Assist clients in reclaiming their voice. Develop an authentic or true self Practice self care, develop self soothing and self management skills Embrace sense of balance in life Barriers & Solutions Lauerer, Gaffney, Williams 9
10 Lauerer, Gaffney, Williams 10
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