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 conditions Conception BRAIN Prepares for anticipated world Dissonance between biological expectations & social reality fuels problems Safe CHARACTERISTICS Process over Power Multi-focused: Relational OUTCOME Individual & species survive in good times; vulnerable in poor conditions Adapted from the research of Martin Teicher, MD, Ph.D

Adverse Childhood Experience & Population Health Dose of Stress During Childhood ACE Interface, 2016

Indicators of Family Dysfunction 1. Mentally ill, depressed or suicidal person in home 2. Family member with drug or alcohol addiction 3. Parental discord indicated by divorce, separation 4. Exposed to family violence 5. Incarceration of any family member Abuse 6. Child physical abuse 7. Child sexual abuse 8. Child emotional abuse Neglect 9. Physical Neglect 10. Emotional Neglect ACEs are Highly Interrelated

Higher Risk in Population (response) ACEs Have a Cumulative Effect Dose-response is a direct measure of cause and effect. Higher ACE score (dose)

Percent of Population with Problem Percent of Population Currently Smoking Current Smoking- Washington ACEs and Risk for Disease, Disability, Social Problems 30 25 20 16.3 20.8 28.5 Smoking 15 10 10.4 13.2 11.1 Heavy Drinking Binge Drinking 5 0 0 1 2 3 4 or 5 6,7, or 8 Number of ACE Categories Drinking and Driving Had a Drug Problem Addicted to Drugs Ever Injected Drugs 14 12 10 8 6 4 2 0 1.3 Original ACE Study Ever Had a Drug Problem 3 3.9 0 1 2 3 4 5 Number of ACE Categories 5 7.5 12

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 10 9 8 7 6 5 4 3 2 1 0 14 12 10 8 6 4 2 0 Cardio Vascular Disease 9.4 8.1 6.7 5.6 5.6 4.9 0 1 2 3 4 or 5 6,7,8 ACE Score Asthma 12 7.5 5 3.9 3 1.3 0 1 2 3 4 5 ACE Score

Percent of Population Percent of Population Anxiety ACEs and Mental Illness 16 14 12 15 Depression 10 8 7 8.8 Serious & persistent mental illness Frequent mental distress Nervousness Suicide attempts Emotional problems restrict activities 6 4 2 0 30 25 20 15 10 5 0 1.9 2.8 5 0 1 2 3 4 or 5 6,7, or 8 7.3 11 Number of ACE Categories Treatment for Mental Health Condition 14 15.5 19.3 24.5 0 1 2 3 4 or 5 6,7, or 8 Number of ACE Categories

Progressive Nature of Adversity EARLY TRAUMA & STRESS Predictable patterns of brain development, traits & behaviors Slowed language & reading Lateralization Diminished IQ Poor decision making skills Memory Problems Executive Skill Challenges 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 Incarceration ADULT STRESS Low-wage jobs Unemployment Public Assistance Prison Teen Pregnancy Chronic health problems Debilitating mental illness Victimization NEXT GEN RISK

Mean # of Co-Occurring Outcomes ACEs and Co-Occurring Problems 5 4 3 2 1 0 ACE Interface, 2016 0 1 2 3 4 5 6 7,8 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

The ACE Score is Not! -A diagnostic tool -A screening tool -A predictor at the individual level Or -A fun quiz Dr. Robert Anda, Co-Principal Investigator, The ACE Study 2013

The ACE Score is. A History tool A communication tool to comfortably talk about life experiences Becoming part of a common language A gateway to empathy, compassion, and healing Dr. Robert Anda, Co-Principal Investigator, The ACE Study 2013

Principles for Trauma-Informed Work Safety Trustworthiness Choice Collaboration Empowerment Peer Support

Establishing Safety First is Paramount Dr. Kate McLaughlin CAPABILITIES Self Efficacy Ability to Direct Attention Positive View Executive Skills Hope Self Regulation

Self regulation depends on having a friendly relationship with your body. Without it you have to rely on external regulation from medication, drugs like alcohol, constant reassurance, or compulsive compliance with the wishes of others. Van der Kolk, 2014, The Body Keeps the Score, p. 99

What Helps Individuals Self-regulate? Activate Social Engagement: 1. Healing Power of Community Expressed in Music, Rhythm, Theatre 2. Exercise & Play 3. Practicing Connection Calm Physical Tensions in Body: 1. Massage, Movement, Breathing 2. Mindfulness, Reflection, Yoga 3. Tapping Acupressure Points 4. Biofeedback, Neurofeedback 5. Eye Movement Desensitization & Reprocessing

The Issues are Complex Historical Trauma Intergenerational Adversity ACE Accumulation Sensitive Developmental Periods Progression of Adversity Through Life Public and Private Costs Community Variation

Resources are Finite We need solutions that address the complexity of problems and foster measurable change in different community environments at modest costs

Communities are Powerful We re Creating a Culture of Wellbeing Community is a living, spiritual entity, supported by every responsible adult. Gregory Cajete

New Era of Prevention 1. Effects Whole Person in Context 2. Understands Behavior as Language of Adaptation 3. Considers Experience Over Time - Prevents Progression of Adversity 4. Invests in Hope-filled Engagement 5. Employs Dual Generation Strategies 6. Respects the Importance of Culture & World View

Unconditional Positive Regard When I saw you I fell in love, and you smiled because you knew. William Shakespeare