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The Adverse Childhood Experiences Study March 13, 2014

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Presentation Overview 1)Adverse Childhood Experiences Study Findings 2) How to create stable, nurturing relationships and communities

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The study Examined health and social effects of adverse childhood experiences throughout lifespan Conducted by Dr. Robert Anda, CDC and Dr. Vincent Felitti, Kaiser Permanente Decade-long study involving 17,000 people Demographics: primary care setting, educated, middle class, predominantly white Largest study ever done on the subject

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10 COMMON TRAUMAS CHILDHOOD ABUSE Physical Emotional Sexual CHILDHOOD NEGLECT Physical Emotional HOUSEHOLD DYSFUNCTION Substance Abuser Mental Illness Parental loss Witnessing violence Crime in household Source: Dr. Robert Anda and Dr. Vincint Felitti, Adverse Childhood Experiences Study, 1995

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Impact of ACEs on Early Brain Development

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Emotional regulation Verbal & spacial memory, Management of fear, panic emotional understanding, emotional responses Ability to put the brakes on outbursts Thinking & judgment Early Childhood Middle Childhood Cross-brain function Language & math proficiency & integration Notice & interpret social cues Spoken language Meaning from visual cues Vulnerability: PTSD, suicide, profound depression Long term memory Executive function Affect, attention Regulating mental health Movement through space Reacting to peripheral details Pre-puberty & Adolescence Stress is Hard-Wired Into Biology

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What it found Of those surveyed: 1 in 4 exposed to 2 categories of ACEs 1 in 5 experienced 3 or more. 22% were sexually abused as children. 66% of the women experienced abuse, violence or family strife in childhood. ACEs are common

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Typical High School Classroom

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Childhood experiences are powerful determinants of who we become as adults. What it found

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ACEs are commonly linked to: Developmental impairment in children Chronic depression Attempted suicide Alcohol use Smoking Illicit drug use Risky sexual behaviors Liver disease Heart disease Victim of domestic violence Impaired worker performance Health-related quality of life Early mortality

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What it found RISK FACTOR% INCREASE Smoking242% Obesity222% Depression357% Illicit drug use443% Injected drug use1,133% Sexually Transmitted Diseases 298% Attempted suicide1,525% Alcoholism555% People with 4 or more ACEs compared to those with 0 ACEs

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Given 100 American Adults 33 Report No ACEs 51 Report 1-3 ACEs 16 Report 4-8 ACEs WITH 0 ACEs 1 in 16 smokes 1 in 69 are alcoholic 1 in 480 uses IV drugs 1 in 14 has heart disease 1 in 96 attempts suicide WITH 3 ACEs 1 in 9 smokes 1 in 9 are alcoholic 1 in 43 uses IV drugs 1 in 7 has heart disease 1 in 10 attempts suicide WITH 7+ ACEs 1 in 6 smokes 1 in 6 are alcoholic 1 in 30 use IV drugs 1 in 6 has heart disease 1 in 5 attempts suicide Probability of outcomes

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Impaired Worker Performance Prevalence of Impaired Performance (%)

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Alcohol use and abuse Alcoholic Married an Alcoholic Percent with alcohol-related problem

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The ACE Score, Smoking, and Lung Disease

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Teen Sexual Behaviors Intercourse by Age 15 Teen PregnancyTeen Paternity

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Attempted Suicide 1 2 0 3 +4++4+

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The Magnitude of the Solution ACE reduction reliably predicts simultaneous decrease in all of these conditions. Population attributable risk Source: Washington Family Policy Council

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Please take a few minutes to complete the survey anonymously. The ACE survey

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Do you see any of these ACEs in children in your care? In your friends and colleagues? In yourself? Does this survey make sense? What questions do you have about this survey or what it means? What can we do with this information? Reflections

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Now what?

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children

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For children with ACEs, adults can help by Understanding ACEs Create environments where children feel safe Help children identify their feelings and learn how to manage their emotions Create protective factors in the schools, communities and at home From Spokane Regional Health District: Community & Family Services Division; Stress and Brain Development, Understanding Adverse Childhood Experiences (ACEs) Resilience Trumps ACEs

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Parental Resilience Ability to problem-solve and build relationships Nurturing and attachment Listening and responding to a child in a supportive way Social Connections Having family, friends, or neighbors who are willing to help or listen Concrete Supports Having childs basic needs met: housing, food, clothing, and healthcare Knowledge of parenting and child development Increasing parents knowledge of development and appropriate expectations for their childs behavior Social and emotional competence of children Helping children to interact positively with others, manage their emotions, and communicate feelings From Spokane Regional Health District: Community & Family Services Division; Stress and Brain Development, Understanding Adverse Childhood Experiences (ACEs) Creating Protective Factors

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Principle One: Always Empower, Never Disempower Students affected by trauma often compete with their teachers for power. This is because they believe that controlling their environment is the way to achieve safety (Craig, 1992).

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Principle Two: Provide Unconditional Positive Regard Traumatic events make it difficult for children to trust. They make it difficult to feel worthy, take initiative, and form relationships. Students struggling with trauma dont need another adult to tell them what is wrong with them. What they do need, what helps them thrive, is an adult who treats them with simple sustained kindness, an adult who can empathize with the challenges they face moving between home and school.

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Principle Three: Maintain High Expectations Teachers may be so concerned about disempowering their students that they may be hesitant to set limits. As a consequence, expectations for achievement are lowered. Doing so inadvertently sends negative messages such as you are too damaged to behave or you are different than others so I am giving up on you. Note that these messages can increase the perception of the student that they are powerless. Increased feelings of powerlessness lead to increased symptoms of traumatic affect.

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Principle Four: Check Assumptions, Observe and Question Traumatic events can affect any person, family or group of people. When we make assumptions about who is likely to be traumatized based on a stereotype of any one group of people, this may stop us from seeing who actually has been affected by trauma. 1) Identify Assumptions. 2) Observe. 3) Ask Questions; and 4) Listen.

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Principle Five: Be a Relationship Coach Compassionate teachers think of themselves as relationship coaches. After all, the relationships we establish with and among students influence the tone and demeanor in our classrooms.

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Principle Six: Provide Guided Opportunities for Helpful Participation Meaningful participation gives us opportunities to be heard, to make choices, to have responsibilities, to belong, and to engage in problem solving. When we make meaningful contributions to the welfare of others, we improve our own feelings of self- worth. Helping others strengthens resiliency. Providing guided opportunities for participation is an important principle of compassionate teaching. Such supervised opportunities can provide solace, create mutual trust, and affirm the self-worth of those involved.

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10 Ways to Build Resilience 1)Make connections 2)Avoid seeing crises as insurmountable problems 3)Accept that change is a part of living 4)Move toward your goals 5)Take decisive actions Source: America Psychological Association

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10 Ways to Build Resilience 6) Look for opportunities for self- discovery 7) Nurture a positive view of yourself 8) Keep things in perspective 9) Maintain a hopeful outlook 10) Take care of yourself Source: America Psychological Association

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Questions? Thank You!

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What principles or ways to build resilience resonated with me? What didnt I like or agree with about this information? What is one real thing I can do with this information? Change in mindset the way we see children. How have my views changed with this information? Change in action the way we act with children, colleagues, etc. What will I do with this information? Change in advocacy telling friends about this information. Who will I tell about this information? Group Discussion: What now?