Brain Research: Early Experiences Matter Opening Minds, 2016
Disclosure I declare that neither I, or my immediate family, have a financial interest or other relationship with any manufacturer/s of a commercial product/s or service/s which may be discussed at the conference.
Acknowledgements The PROTECT initiative wants to acknowledge the commitment from the Substance Abuse and Mental Health Services Administration (SAMHSA) to support programs, including ours, that specifically address trauma and that do technical assistance work that focuses on prevention, treatment, and recovery from trauma. This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant HRSA-13-177 Early Childhood Comprehensive Systems: Building Health Through Integration. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
OBJECTIVES Review what we know about ACE Discuss what it means to be trauma-informed Consider how to build resiliency in ourselves and in the community
The Foundation of a Successful Society is Built in Early Childhood
How Brains are Built: The Core Story of Brain Development https://www.youtube.com/watch?v=lmvwoe1ky8s
The Influence of Adverse Childhood Experience (ACE) on Developmental Outcomes
ACEs Impact Multiple Outcomes Smoking Alcoholism Promiscuity High Perceived Risk of HIV Obesity Risk Factors for Common Diseases Poor Perceived Health IV Drugs Multiple Somatic Symptoms Cancer Skeletal Fractures Sexually Transmitted Diseases Illicit Drugs Relationship Problems High perceived stress Prevalent Diseases Difficulty in job performance General Health and Social Functioning Liver Disease Chronic Lung Disease Ischemic Heart Disease ACEs Married to an Alcoholic Sexual Health Teen Paternity Teen Pregnancy Depression Mental Health Anxiety Unintended Pregnancy Sexual Dissatisfaction Fetal Death Poor Self- Rated Health Hallucinations Sleep Disturbances Memory Disturbances Panic Reactions Poor Anger Control Early Age of First Intercourse
ACES include: Emotional, physical, and/or sexual abuse Emotional and/or physical neglect Mother treated violently Household substance abuse or mental illness Parental separation through divorce, incarceration, or military deployment
As the ACE Score Increases, the risk of the following increases: Substance abuse Sexually transmitted disease Respiratory, liver, heart disease Fetal death Suicide attempts Depression Smoking Unintended pregnancy Intimate partner violence Data from : www.cdc.gov/nccdphp/ace/
Understanding the Impact of ACE Death Early Death Disease & Disability Adoption of Health-Risk Behaviors Social, Emotional, and Cognitive Impairment Conception Adverse Childhood Experiences 11
ACEs and the Brain WHAT IS THE ROLE OF STRESS?
Fight or flight Adrenal response Cardiovascular changes Immune activation Energy supply
Three Levels of Stress Response: Positive, Tolerable, Toxic POSITIVE Important to development in the context of stable and supportive relationships
Positive Stress Child sees someone approaching with an immunization syringe Parent leaving on the first day of school
Three Levels of Stress Response: Positive, Tolerable, Toxic TOLERABLE Serious and temporary, but impact buffered by supportive relationships and safe environments
Tolerable Stress Death of a family member Serious illness Natural disaster
Three Levels of Stress Response: Positive, Tolerable, Toxic TOXIC Prolonged activation of stress response systems in the absence of protective relationships
Toxic Stress Child abuse/neglect Parental substance abuse Chronic homelessness
Toxic Stress and Brain Development Toxic stress in early childhood: associated with persistent effects on the nervous system and stress hormone system can damage developing brain architecture can lead to lifelong problems in learning, behavior and both physical and mental health
We understand the effects of adverse childhood experiences Brain chemistry changes when toxic stress is the norm Negatively influences the ability for healthy social/emotional learning, academic and workplace success Drives worker compensation costs and chronic workplace absenteeism Unable to sustain important personal and professional relationships The number of ACE is more important than a specific ACE
Effect of ACE on our work, our patients, our colleagues, ourselves Reduced nurturing capacity or maladaptive responses to their children. Diminished capacity to respond to additional stressors in a healthy way. ACEs increase the chance of social risk factors, mental health issues, substance abuse, IPV ACEs can perpetuate a continuing exposure to ACEs across generations
If we just stop to think about what we know, we might feel like this
The Good News Adverse experiences and other trauma in childhood, however, do not dictate the future of the child! Adverse events and protective factors experienced together have the potential to foster resilience.
Responding to Trauma SUGGESTIONS for us all
What does it mean to be Trauma-informed? The Four R s
Being trauma-informed Realization Recognition Responding Resist re-traumatizing
Trauma can look like other things Developmental delay ADHD Behavior issues
What you might observe Separation anxiety or clinginess Regression in previously mastered stages of development Lack of developmental progress Re-creating the traumatic event Difficulty at naptime or bedtime Increased physical complaints
The Science of Resilience https://www.youtube.com/watch?v=1r8hj72bfgo
What is Resiliency Demonstrate endurance Take on difficult challenges and still find meaning in life Rise above adversity Cope by tapping into hope when things look bleak
Factors for Building Resiliency cognitive capacity healthy attachment relationships (especially with parents and caregivers) the motivation and ability to learn and engage with the environment the ability to regulate emotions and behavior supportive environmental systems
Humans do not develop in isolation; there is a need for connection. Development proceeds through and by relationships.
Look for the helpers
You don t have to be a therapist to be therapeutic Dr. Mary Dobbins
What does it mean to be therapeutic?
How can you provide support? Respond through compassion, not discipline Be trauma-informed when assessing children s behaviors or your expectations of the family Provide consistency and stability in your interactions with children, families, colleagues Avoid labeling anyone dealing with trauma negatively
What s wrong with this person?
What has happened to this person?
Just as important
Take Care of Yourself! Increased irritability or impatience with families, patients, clients, students, or colleagues Decreased concentration Denying that traumatic events impact those we serve or feeling numb or detached Intense feelings and intrusive thoughts, that don t lessen over time, about someone else s trauma
STRESS!
Self-care Don t go it alone. Recognize compassion fatigue as an occupational hazard. Seek help with your own traumas. Guard against your work becoming the only activity that defines who you are. Address your physical, psychic, and spiritual needs.
None of the work of developing standards and protocols to create and maintain trauma-informed professional development is sustainable without intentional and committed organizational change management.
Our Goal: Systems Change
Concept of trauma and guidance for a trauma-informed approach
SAMHSA s Approach Concept of Trauma and Guidance for a Trauma-Informed Approach Integration of three threads of work Research Survivor Knowledge Practice
Trauma-Informed Approach Assumption that there are trauma-specific interventions Work to build resiliency Key trauma principles that can be incorporated into the organizational culture Tested implementation strategies
Six Principles to a Trauma-Informed Approach
Why use these principles Principles set a cultural precedence for what it means to be trauma informed Not a prescribed set of practices or procedures- gives flexibility to best fit organization Generalizable across multiple types of settings
Ten Domains for a Trauma-Informed Approach
Why use these domains Developing a trauma-informed approach requires change at multiples levels of an organization Provide a starting point for developing an organizational trauma-informed approach Flexibility. Not a checklist or a prescriptive step-by-step process
To learn more about becoming trauma-informed Tom Bradach Thursday 2-3:30 CC10D Being Trauma-Informed
Your charge today Think about all the children you serve Think about their families Think about the community in which you work Think about your colleagues Think about the ways you can build resilience with and for all of them
Project Contact Information Juanona Brewster, MDiv, MTS, MJ Senior Director, Child Development Initiatives Illinois Chapter, American Academy of Pediatrics 312/733-1026 ext. 203 jbrewster@illinoisaap.com Cherie Estrada Manager, Child Development Initiatives Illinois Chapter, American Academy of Pediatrics cestrada@illinoisaap.com 312/733-1026 ext. 237