COMMUNITY MAGNITUDE FOR ACE PREVENTION & RESPONSE. Generating Powerful Solutions to Complex Adaptive Problems

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1 COMMUNITY MAGNITUDE FOR ACE PREVENTION & RESPONSE Generating Powerful Solutions to Complex Adaptive Problems

2 WA STATE FAMILY POLICY COUNCIL Formed in 1989 as Washington State Governor s Subcabinet on Families Local Networks added /22/2012 4th ICCP 2012 Barcelona 2

3 EFFECTIVE PROCESS 1. Focus Realize long term commitment Use a learning systems approach Aim to improve the RATES of interrelated problems 2. Learn & Illuminate Use a framework that unites Establish cyclic opportunities with diverse learners Use contract & reporting structure that controls for learning 3. Employ Results-Based Decision Making Use Data; Expect innovation Reconstruct natural supports that help families to thrive Improve responsiveness & strategic resource alignment 4. Expand leadership Anyone who wants to help is a leader Intentionally diversify sector, class, discipline, culture Public engagement = public will to re-invest savings

4 FOCUS Model of Community Empowerment Stages Pre- Commitment Committing Shifting Persisting Thriving 6/22/2012 4th ICCP 2012 Barcelona 4

5 MAPPING SEVERITY ARCHIVAL INDICATORS DO WE NEED TO BE A DIFFERENT KIND OF PARTNER?

7 ACE PREVALENCE BY ZIP CODE IN 1 WA COUNTY State average 26% 3 ACE; 5% 6 ACE Lt Blue: 31% 3 ACE; 4% 6 ACE Peach: 41% 3 ACE; 13% 6 ACE Orange: 59% 3 ACE; 20% 6 ACE

8 RESILIENCE The natural human capacity to navigate life well. (HeavyRunner & Marshall, 2003) Individual Family Community National, Global, Ecosystem RESILIENCE OCCURS AT ALL LEVELS

9 PERSON PREPARATION COMMUNITY PREPARATION Intervention-Interdiction Shift Context & Reciprocity

10 Public Education & Health Education Campaigns Direct Services to People with Risk

GENERAL COMMUNITY CAPACITY DEVELOPMENT MODEL (We measure community capacity.) General Community Capacity Development is a public health approach to solving interrelated problems by improving: 1.

11 GENERAL COMMUNITY CAPACITY DEVELOPMENT MODEL (We measure community capacity.) General Community Capacity Development is a public health approach to solving interrelated problems by improving: 1. Peoples connections, 2. Shared responsibility, and the 3. Collective impact of their efforts. This model is powerful because success in one phase propels success in the next. It is a virtuous cycle that has the power to improve population health.

12 BETTER OUTCOMES AMONG YEAR OLDS USING FPC COMMUNITY CAPACITY DEVELOPMENT MODEL % WITH 3 OR MORE ACES % Employed 91% 94% 38% 36% 34% 29% 87% 89% No Networks Using FPC Model Forming, Using FPC Model Shifting and PersistingThriving (High Capacity Scores Over 6 Biennia) % with Post High School Education 63% 54% 52% No Networks Using FPC Model Forming, Using FPC Model Committing Shifting and Persisting Thriving (High Capacity Scores Over 6 Biennia) 43% No Networks Forming, Using FPC Model Using FPC Model Shifting and Persisting Thriving (High Capacity Scores Over 6 Biennia)

13 4.2 Million Adults Involved: 2.1 Million in Thriving Stage Pre-committing Number of Adults 0.9 million Percent of Adults Statewide 17 % Committing Number of Adults 1.2 million Percent of Adults Statewide 24 % Shifting and Persisting Number of Adults 0.9 million Percent of Adults Statewide 18 % Thriving Number of Adults 2.1 million Percent of Adults Statewide 41 % 6/22/2012 4th ICCP 2012 Barcelona 13

14 Committing Shifting Persisting Thriving

15 Highest Community Capacity Scores

35% ACE ACE SCORES OF WASHINGTON ADULTS AGES 18-34 Persistance & In Crisis Communities vs. Thriving Communities (18-34 yr olds) Mid-Capacity Scoring (blue) vs.

16 35% ACE ACE SCORES OF WASHINGTON ADULTS AGES Persistance & In Crisis Communities vs. Thriving Communities (18-34 yr olds) Mid-Capacity Scoring (blue) vs. High Capacity Scoring (stripe) Communities 33% 30% 25% 20% 15% 27% Biggest Change = Fewer People with 6-8 ACEs 10% 12% 5% 7% 0% , 5 6,7,8 Shifting Persistance& & Persisting In Crisis Thriving

17 Number of Problems at High Rates HIGH COMMUNITY CAPACITY SCORES HIGHLY CORRELATED WITH RATE REDUCTIONS IN MANY SOCIAL PROBLEM Problems Pile-Up in Low Capacity Communities Problems with Bad Rate Trends : Child Abuse & Neglect Domestic Violence Youth Violence Youth Substance Abuse Youth Suicide Teen Pregnancy & STDs Dropping Out of School # of Problems with Bad Rate Tends COMMUNITY CAPACITY REDUCES MAJOR SOCIAL PROBLEMS PROBLEMS PILE-UP IN LOW CAPACITY COUNTIES Community Capacity Scores FEWER PROBLEMS IN HIGH CAPACITY COUNTIES Community Capacity Scores Low Middle High Problems Plummet in High Capacity Communities Success builds on success, making community health and well-being sustainable. The Community Capacity Development process is iterative, sets the course for reaching a community capacity tipping point where multiple rates come down simultaneously

18 SUPPORT & INCENTIVIZE A LEARNING SYSTEM

19 UNIFYING FRAMEWORK Brain Science Consequences of Toxic Stress on Human Development; Developmental Neurobiology, Biopsychology Adverse Childhood Experience The Most Powerful Determinate of the Public s Health Positive Adaptation Individual, Family, Community, Societal Resilience & Capacity for Transformative Improvements; What We All Can Do Systems Science Helps us see how we collectively create our current reality points to higher leverage solutions

20 BRAIN RESEARCH See for example: Teicher, M et al. Neurobiological & Behavioral Consequences of Exposure to Childhood Traumatic Stress, Stress in Health and Disease, BB Arnetz & R Ekman (eds) Scars that Won t Heal: The Neurobiology of Child Abuse, Scientific American, March, EPIDEMIOLOGICAL RESEARCH See for Example: Felitti, VJ, Anda, RF et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine (14:4) ; For a full list of publications, see RESILIENCY RESEARCH Masten, AS. Ordinary Magic: Resilience Process in Development. American Psychologist. March, 2001 Boss, P; Loss, Trauma and Resilience Therapeutic Work with Ambiguous Loss; WW Norton & Co; 2006 Longhi, D; Community Networks Building Community Capacity, Reducing Rates of Child and Family Problems, 2008; How Do High Risk Counties Protect All Youth, 2009 Dr. Gregory Cajete; Native Science: Natural laws of Interdependence 2000 SYSTEMS SCIENCE Many Leaders, for example: Margaret Wheatley, Peter Senge, Daniel Kim, Bob Stilger, Steve Waddell, Gregory Bateson, Eleanor Ostrom, Tom Hurley, Albert-László Barabási

21 Generally Unseen Generally Seen EVENTS PATTERN STRUCTURES COLLECTIVE ACTION MENTAL MODELS VALUES Education Presents emerging research so powerful that, when understood, it transforms mental models So that We create transformative conversations So that Leaders throughout the state organize most effectively to support thriving families and communities Adapted from the systems thinking iceberg

22 Dr John Snow 1854 Cholera Death is Caused by Miasmas 1. New Way of Thinking 2. Shoe Leather Epidemiology 3. Lives Saved

23 FOUNDATIONS OF HEALTHY DEVELOPMENT Genetic Predispositions Experience Adapted from Shonkoff, J.P., Building a New Biodevelopmental Framework to guide the Future of Public Policy, Child Development, Jan./Feb. 2010

NEUTRAL START TRAUMATIC STRESS BRAIN DEVELOPMENT PATTERNS BRAIN Hormones, chemicals & cellular systems prepare for a tough life in an evil world BRAIN Hormones, chemicals & cellular systems prepare

INDIVIDUAL Edgy Hot temper Impulsive Hyper vigilant Brawn over brains INDIVIDUAL Laid back Relationshiporiented Thinks things through Process over power OUTCOME Individual & species survive the worst

24 NEUTRAL START TRAUMATIC STRESS BRAIN DEVELOPMENT PATTERNS BRAIN Hormones, chemicals & cellular systems prepare for a tough life in an evil world BRAIN Hormones, chemicals & cellular systems prepare for life in a benevolent world Adapted from the research of Martin Teicher, MD, Ph.D By Washington Family Policy Council Hormones exert pressures on cells; these determine growth & function. INDIVIDUAL Edgy Hot temper Impulsive Hyper vigilant Brawn over brains INDIVIDUAL Laid back Relationshiporiented Thinks things through Process over power OUTCOME Individual & species survive the worst conditions. The presence of hormones activates systems. Stress hormones make systems sensitive to future stressors. Hormones regulate myelination the coating of nerves with fat. Hormones & other neurochemicals regulate the proliferation and maturation of receptor cells. OUTCOME Individual & species live peacefully in good times; vulnerable in poor conditions Neurochemicals facilitate the growth of new synapses, determining the overall mass & function of the brain at maturity. Certain brain chemicals are toxic to young brain cells.

25 Brain Development for Dangerous World NEUTRAL START TRAUMATIC STRESS ADAPTATION TO ANTICIPATED WORLD BRAIN Hormones, chemicals & cellular systems prepare for a tough life in a dangerous world INDIVIDUAL Edgy Immune to Social Cues Quick to act Hyper vigilant Brawn over brains OUTCOME Individual & species survive the worst conditions. Normal Biological Response to Toxic Stress Bumps Up Against Social Expectations Brain Development for Safe World BRAIN Hormones, chemicals & cellular systems prepare for life in a benevolent world Adapted from the research of Martin Teicher, MD, Ph.D By Washington Family Policy Council INDIVIDUAL Laid back Relationshiporiented Thinks things through Process over power OUTCOME Individual & species live peacefully in good times; vulnerable in poor conditions

26 DISCUSSION In your experience, how do our major social services, health, justice, education and/or mental health systems respond to young people who act on brawn over brains? How do these systems responses work for children and families?

EARLY CHILDHOOD HIPPOCAMPUS The center for: Controlling emotional reactions Constructing verbal memory Constructing spatial memory - All forms of maltreatment in the first 2-3 years of life - Sexual

27 EARLY CHILDHOOD HIPPOCAMPUS The center for: Controlling emotional reactions Constructing verbal memory Constructing spatial memory - All forms of maltreatment in the first 2-3 years of life - Sexual abuse at ages 3-5 Adaptation: Emotionally reactive brain s braking mechanism fails Poor regulation of behavior Difficulty with verbal & spatial memory Net loss in volume becomes evident in the 20s. TRAUMA IS HARD-WIRED INTO BIOLOGY ADOLESCENCE CORTEX Center for: Thinking & judgment Executive function Long term memory Vision -Witnessing DV -Sexual abuse Adaptation: Poor executive function Impulsiveness Diminished abstract reasoning No hope for the future Limiting field of vision MIDDLE CHILDHOOD CORPUS CALLOSUM Integrates hemispheres & facilitates: Language development Proficiency in math Processing of social cues, such as facial expression - Neglect in infancy - Sexual abuse at ages 9 and 10 Adaptation: Language delay Diminished math capacity Diminished integration & coordination Difficulty with social cues

28 CONSEQUENCES OF BIOLOGICAL OUTCOMES SOCIAL Aggression & violent outbursts Poor self-control of emotion Can t modify behavior in response to social cues Social isolation can t navigate friendship MENTAL HEALTH Poor social/emotional development Alcohol, tobacco & other drug abuse vulnerable to early initiation Adolescent & adult mental health disorders especially depression, suicide, dissociative disorder, borderline personality disorder, PTSD COGNITIVE Slowed language development Attention problems (ADD/ADHD) Speech delay Poor verbal memory/recall Loss of brain matter/iq

IN THE LIVES OF WASHINGTONIANS: ACEs ARE COMMON ACEs CO-OCCUR / CLUSTER

adults have 6 or more ACEs Among adults exposed to physical abuse, 84%

reported at least 2 more ACEs Adverse Childhood Experience & Population

Results from the 2009 Behavioral Risk Factor Surveillance System

29 IN THE LIVES OF WASHINGTONIANS: ACEs ARE COMMON ACEs CO-OCCUR / CLUSTER 26% of adults report 3 or more ACEs 1 or More ACE 62% 0 ACE 38% 5% of adults have 6 or more ACEs Among adults exposed to physical abuse, 84% reported at least 2 more ACEs Among adults exposed to sexual abuse, 72% reported at least 2 more ACEs Adverse Childhood Experience & Population Health in Washington: The Face of a Chronic Public Health Disaster - Results from the 2009 Behavioral Risk Factor Surveillance System

30 INDICATORS ARE A USEFUL BUT PUNY SHADOW OF THE REALITY OF HUMAN LIVES We are likely used to working with Risk, Protective, Resiliency, Asset Factors data conditions known to be antecedent to or empirically associated with a problem. These factors are typically used in three ways: 1. SET GOALS: As short term desired results e.g. reduce risk and improve protective, resiliency or asset factors 2. PRIORITIZE: As a way to prioritize a population or select a particular service 3. LEARN & IMPROVE: To understand interrelationships among at-risk behaviors and thereby design strategic action with limited resources

31 CRITICAL & SENSITIVE DEVELOPMENTAL PERIODS early childhood, ages 7-9, pre-puberty, aging into adulthood ADVERSE CHILDHOOD EXPERIENCE MORE CATEGORIES GREATER IMPACT Physical Abuse, Sexual Abuse Emotional Abuse, Neglect Witnessing Domestic Violence Depression/Mental Illness in Home Incarcerated Family Member Substance Abuse in Home Loss of a Parent UNEMPLOYMENT BRAIN DEVELOPMENT Electrical, Chemical, Cellular Mass CHRONIC DISEASE ADAPTATION Hard-Wired Into Biology PSYCHIATRIC DISORDERS IMPAIRED COGNITION WORK/SCHOOL Attendance, Behavior, Performance OBESITY ALCOHOL, TOBACCO, DRUGS GENETICS Including gender Remember that experience triggers gene expression (Epigenetics) INTERGENERATIONAL TRANSMISSION, DISPARITY RISKY SEX CRIME POVERTY HOMELESSNESS

32 STUDY FINDINGS CHALLENGE MENTAL MODELS Focus doesn t have to mean choose one Cause-effect isn t always a simple relationship Where is there no resistance to understanding a many-to-many relationship: Cumulative cause multiple effects?

33 WHAT S THE POTENTIAL? 1. Bend the health care cost curve 2. Drastically reduce disorders and disability 3. Stop disastrous cycles of intergenerational poverty 4. Afford for all children optimal development, school completion, arrival at adulthood with full potential for employment success and a lifetime of well-being. 5. Generate the kind of public will that supports sustained efforts for a full generation or more. 6. Improve workforce productivity; lower business costs; Improve global competitiveness ; boost and sustain economic recovery

34 Learn and Improve Will Help People: Understand drivers of mental, behavioral, physical health Give people clear facts that generate opportunities to tell everyone Set Goals Identify high-risk communities with greater precision stop generational transmission Leverage resources and partnerships to achieve greater impacts Prioritize ADVERSE CHILDHOOD EXPERIENCE DATA Invest More Wisely Lower Costs Help parents to organize their lives ad support networks so their children have fewer ACEs than they have

35 Generally Unseen Generally Seen What we did EVENTS PATTERN Help, Support, Document Notice, Reward, Feedback STRUCTURE COLLECTIVE ACTION MENTAL MODELS VALUES Purpose, Process, Principles Act from Future Surface MM Tell Everyone Adapted from the Systems Thinking Iceberg

36 EDUCATION AND TRAINING EXPANDS LEADERSHIP 6/22/2012 4th ICCP 2012 Barcelona 36 Family Policy Council Education Plan; Goldstine-Cole; 2007

37 TECHNICAL ASSISTANCE Brokering Connections Experts Peers Agencies Illuminating what needs to be noticed Exceptional Results Positive Gossip Public Displays On-site Assistance Co-leading Thought partner Tools and skill building Appreciative Feedback Offering Innovation Assisting with data Incentive Grants for innovation Educational Materials Providing Guidance Operational audits Start-up Frameworks Key Processes Frameworks for action 6/22/2012 4th ICCP 2012 Barcelona 37

38 ADVERSE EXPERIENCE & ELEMENTARY SCHOOL CHILDREN 2101 children, ages 5-12, from 9 schools, randomly selected; about 50% of student population Four of the schools are non- Title-One schools, five are Title-One schools Adverse events include: referral to child protective services, family violence, exposures to community violence, residential instability (using McKinney Vento definition FINDINGS: 1. Adverse Events are the greatest single predictor for health, attendance, behavior 2. Adverse Events are the second strongest predictor for academic failure (after special education status) 3. The relationship between academic achievement and health status appears much less related to income than to AEs Dr. Chris Blodgett, Washington State University, Area Health Education Center

39 Population Average- 10 th Grade..

40 ACE SCORES AMONG PARENTING ADULTS WHO EXPERIENCED CHILD ABUSE Population Average: 78% have 3 or more ACEs 29% have 6 or more ACEs

41 KEY SYSTEMS FOR RESILIENCE COMMUNITY, CULTURE, SPIRITUALITY CAPABILITY ATTACHMENT & BELONGING

42 Percent Unemployed PEOPLE WITH SUPPORT & HOPE ARE MORE LIKELY TO BE EMPLOYED 40% SOCIAL & EMOTIONAL SUPPORT 35% 30% 25% 25% 23% 35% FEELING FORTUNATE HOPE 20% 15% 10% 17% 16% 8% 8% 7% 17% 10% 10% 12% 5% 0% 0 ACE 1 ACE 2ACE 3 ACE 4-5 ACE 6-8 ACE High Resilience Score Low Resilience Score

43 How might we systematically build on the strengths of children affected by early maltreatment? What academic and social supports might we reasonably provide? How might we support communities where a large portion of the population have 6-8 ACEs? What do we know about mitigating effects? How might we learn more? Irritable or Passionate? Decisive or Impulsive? Protecting Interests or Hypervigilant? Lacking Empathy or Rational? Competitive or Aggressive? Independent or Detached?

44 Generally Unseen Generally Seen In the Lincoln High School Story, It took time; Listen for: EVENTS PATTERNS What MM had to change? What did they re-structure? STRUCTURE COLLECTIVE ACTION MENTAL MODELS VALUES Adapted from the Systems Thinking Iceberg

45 KEYS TO SUCCESS Take a learning systems approach Form long-term partnership commitment with community leaders Structure staff for both short and long term needs Develop an education framework that unites people across professional disciplines, class lines, sectors, etc. Hold a fundamental respect for the wisdom of every person their culture, experience, capabilities, and aspirations

46 MAGNITUDE OF THE SOLUTION ACE reduction reliably predicts simultaneous decrease in all of these conditions. Population attributable risk

DRAFT THE HIGH COST OF ADVERSE CHILDHOOD EXPERIENCES

DRAFT THE HIGH COST OF ADVERSE CHILDHOOD EXPERIENCES THE HIGH COST OF ADVERSE CHILDHOOD EXPERIENCES 2007 Family Policy Council Please do not reproduce in part or in full without permission BRAIN RESEARCH See for example: Teicher, M et al. Neurobiological