The Magnitude of the Solution. Building Self-Healing Communities

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Andra Ray
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1 The Magnitude of the Solution Building Self-Healing Communities

2 Beyond Resilience Flourish To Flourish: To Prosper with Sustained, Continuous, Steady, Strong Growing Well Bing & Miriam Webster Dictionaries

3 Hardwired for Anticipated World Dangerous Conception Safe BRAIN Prepares for anticipated world TOXIC STRESS CHARACTERISTICS Brawn over Brains Focused: Fight, Flight or Freeze CHARACTERISTICS Process over Power Multi-focused: Relational OUTCOME Individual & species survive the worst conditions OUTCOME Individual & species survive in good times; vulnerable in poor conditions Adapted from the research of Martin Teicher, MD, Ph.D

5 Epigenetics Van der Kolk, 2014, The Body Keeps the Score, p. 157 From a translation al perspectiv e, our results allow us to appreciate how the experience s of a Parents with their own genetic vulnerabilities can pass on protection to the next generation provided that they are given the right support.

6 Each Person; A Unique Experience of the World

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

10 Adverse Childhood Experience Categories

12 Percent of Population with Problem Percent of Population Currently Smoking ACEs and Risk Early & Continuing Smoking Early, Heavy, & Binge Drinking Drinking and Driving Had a Drug Problem Addicted to Drugs Ever Injected Drugs Prescription Drug Use Self-Reported Addiction Smoking- Washington or 5 6,7, or 8 Number of ACE Categories Ever Had a Drug Problem- ACE Study ACE Interface, Number of ACE Categories

13 Percent of Population with Asthma Percent of Population with C V Disease ACEs and Chronic Disease Cardio Vascular Cancer Diabetes Asthma ACE Interface, 2016 Auto-Immune Disease Chronic Obstructive Pulmonary Disease Liver Disease Ischemic Heart Disease Cardio Vascular Disease or 5 6,7,8 ACE Score Asthma ACE Score

14 Percent of Population Percent of Population ACEs & Behavioral Health Anxiety 15 Depression Sleep disturbance Serious & persistent mental illness Frequent mental distress Nervousness Suicide attempts Emotional problems restrict activities Sexual risk behaviors Teen pregnancy ACE Interface, or 5 6,7, or 8 Number of ACE Categories Treatment for Mental Health Condition or 5 6,7, or 8 Number of ACE Categories

50% 40% 30% ACE Score 0 1 2 3 4+ 36.2% 33.4% 33.0% 28.5% 25.7% 20% 10% 6.1% 4.2% 12.

15 % of Participants Alcohol: Age at First Use Percentage of Participants reported Age of Initiation of Alcohol Use by total number of Adverse Childhood Experiences (ACE score) 50% 40% 30% ACE Score % 33.4% 33.0% 28.5% 25.7% 20% 10% 6.1% 4.2% 12.1% 8.5% 16.9% 0% 14 years old or younger 15 to 17 years old Age at Initiation of Alcohol Use

25% 20% 15% 10% 5% 0% 0 1 2 3 4+ 19.9% 15.7% 16.1% 12.5% 10.2% 10.4% 7.8% 5.2% 3.

16 % of Participants Adult Alcohol Use Percentage of Participants reported Heavy Drinking, Alcoholism, and Marrying an Alcoholic by ACE score 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% % 15.7% 16.1% 12.5% 10.2% 10.4% 7.8% 5.2% 3.1% 16.0% 12.2% 17.1% 20.9% 26.2% 33.9% Heavy Drinking Alcoholic Married Alcoholic

% of Participants Illicit Drug Use: Age at First Use Percentage of Participants reported Age at Initiation of Illicit Drug Use by ACE score 30% 25% 20% 15% 10% 5% 0%

17 % of Participants Illicit Drug Use: Age at First Use Percentage of Participants reported Age at Initiation of Illicit Drug Use by ACE score 30% 25% 20% 15% 10% 5% 0% ACE Score % 13.4% 9.9% 10.6% 9.3% 6.5% 4.7% 3.1% 4.1% 3.8% 0.7% 1.5% 14 years old or younger 15 to 18 years old Age at Initiation of Illicit Drug Use

18 % of Participants Adult Illicit Drug Use Percentage of Participants reported Lifetime Use of Illicit Drugs by ACE score 50% 45% 40% ACE Score % 35% 30% 25% 22.3% 25.6% 28.8% 20% 15% 10% 9.4% 15.2% 5% 0%

19 Mean # of Co-Occurring Outcomes ACEs and Co-Occurring Problems ,8 ACE Score Health & Social Problems Panic Reactions Depression Anxiety Hallucinations Sleep Disturbances Severe Obesity Pain Smoking Alcoholism Illicit Drug Use IV Drug Use Early Intercourse Promiscuity Sexual Dissatisfaction Amnesia (Childhood) Problems with Anger Perpetration of Family Violence Affect Regulation Somatic Issues Substance Use Sexuality Memory Arousal

20 Progression of Adversity EARLY TRAUMA & STRESS Predictable patterns of brain development, traits & behaviors Slowed language & reading Lateralization Diminished IQ Poor decision making skills Memory Problems Attention problems ADD ADHD Aggressive behavior Social isolation among peers Poor understanding of social cues = conflict Significant risk of early use/abuse of: Alcohol, tobacco, illicit & prescription drugs Special education School failure Dropping out Social & Relational Problems Suspension Expulsion Delinquency Dropping out ADULT STRESS Low-wage jobs Unemployment Public Assistance Prison Teen Pregnancy Chronic health problems Debilitating mental illness Victimization NEXT GEN RISK

21 Parent ACE Scores Predict Child ACE Scores Children of Parents with ACE Scores 4, are: x more likely to experience household substance abuse x more likely to experience homelessness x more likely to experience neglect 4. 44x more likely to be exposed to intimate partner violence

22 ACEs Impact Whole Communities While poverty continues to be an influence on youth wellbeing, community and youth ACEs are more consistent predictors of youth wellbeing. Dr. Christopher Blodgett, No School Alone, January 2015 ACE Interface, 2016

Community ACEs Predict Youth Risk Rate of adults with 3 ACEs in a community powerfully predicts child academics & risk Blodgett, No School Alone, 2015 Lower child test scores, Low neighborhood

23 Community ACEs Predict Youth Risk Rate of adults with 3 ACEs in a community powerfully predicts child academics & risk Blodgett, No School Alone, 2015 Lower child test scores, Low neighborhood attachment, More positive attitudes towards drug use, Lower levels of the social skills needed to succeed in schools and adulthood In high ACE communities, youth more likely to be kicked out; In high poverty communities, youth more likely to be absent or drop out.

24 A Trauma-Informed Approach Realizing prevalence Recognizing how it affects all individuals: customers, professionals, neighbors Resisting re-traumatization Responding by telling everyone, acting in own sphere of influence

25 Changing Policy and Practice to Stop the Progression of Adversity Child care stability Drop-in WIC staffed with nurses with home visiting experience Fatherhood education & payment alternatives in child support enforcement Anticipatory guidance for child welfare involved parents TANF: parenting classes & parent leadership count as work, could sanctions be an indicator of ACE-related stress response? Alternative sentencing for custodial parents

26 Prevention & Health Promotion 1. Self Management & Care 2. Trauma-Informed Practice 3. Community Context

27 Compassion Fatigue, Secondary Traumatic Stress A state of exhaustion and dysfunction biologically, psychologically, and socially as a result of prolonged exposure to compassion stress (Figley, 1995) Symptoms mimic post traumatic stress disorder: Re-experiencing personal trauma Increase in arousal and avoidance reactions related to indirect trauma Changes in memory & perception Changes in self-efficacy Depletion of personal resources Disruption of sense of safety, trust, independence

28 Impact on Teams Affective Response Behavioral Response Feel less safe with customers Chronically frustrated and angry Cynicism Helpless in face of enormity of problem Desire control authoritarian strategies Aggression & lateral violence Impairment of team learning Informal conversations diminish Team functioning increasingly fragmented

29 Compassion Fatigue Compassion Satisfaction Protective: Connected to Others Beliefs that Sustain Me I Make a Difference Satisfied Life has Purpose Happy Invigorated Understand My ACE History I m the Person I Want to Be

Unique Experience of the World

Unique Experience of the World Preparing for Anticipated World Dangerous BIOLOGY OF STRESS CHARACTERISTICS Brawn over Brains Focused: Fight, Flight or Freeze OUTCOME Individual & species survive the worst