Children’s Resilience Initiative One Community’s Response to ACEs through Resilience

1. Children’s Resilience Initiative One Community’s Response to ACEs through Resilience Indiana Caring for Youth Symposium May 22, 2013

2. Our Goal Today To explore the impact of Resilience– the powerful force that can drive action forward for our community– within the context of ACEs, brain development, and health outcomes.

3. Children’s Resilience Initiative • Key learning: • How daily childhood experiences affect how the • brain develops • How that shapes who we become as adults and • what kind of life we have • That early negative experience is not fate, • that an ACE score is not a life sentence • That we can help our children develop the • resilience to rise above life’s challenges • There is a very real promise of hope and healing

4. A community response to Adverse Childhood Experiences • Broad-based Children’s Resilience Initiative • (CRI) Team • Raise awareness of ACEs • Foster resilience • Embed principles in the practice of organizations • and programs

5. Making all of our systems trauma-informed is a social movement. It addresses a big missing piece of human rights. Children are safer when they have value. A community’s norms and values about how adults respect children provide stronger safety nets than law enforcement can do alone.

6. Adverse Childhood Experiences (ACE) Study Centers for Disease Control and Kaiser Permanente HMO in San Diego, CA. 17,300 Adults Tracked health outcomes based on childhood ACEs 75% Caucasian, 39% college graduates, 36% some college, living wage jobs with insurance; median age 57 yr. old

7. Adverse Childhood Experiences (ACE) Study Centers for Disease Control and Kaiser Permanente HMO in San Diego, CA. 17,300 Adults Tracked health outcomes based on childhood ACEs 75% Caucasian, 39% college graduates, 36% some college, living wage jobs with insurance; median age 57 yr. old

8. Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCE INTEGRATING BRAIN & EPIDEMIOLOGICAL RESEARCH

9. What are the Adverse Childhood Experiences? • Child physical abuse • Child sexual abuse • Child emotional abuse • Physical Neglect • Emotional Neglect • Mentally ill, depressed or suicidal person in the home • Drug addicted or alcoholic family member • Witnessing domestic violence against the mother • Loss of a parent to death or abandonment, including abandonment by divorce • Incarceration of any family member

10. Adverse Childhood Experiences(ACEs) THE# 1 CHRONIC HEALTH EPIDEMIC in the United States “The impact of ACEs can now only be ignored as a matter of conscious choice.  With this information comes the responsibility to use it.” Anda and Brown, CDC

11. Dose-Response Relationship: More ACEs = More Disease Response gets bigger Dose gets bigger

12. Higher ACE Score Increases Smoking 6 of 100 people with 0 ACEs smoke 11 of 100 people with 3 ACEs smoke 17 of 100 people with 7 ACEs smoke

13. ACE Score Increases Suicide Attempt 1 of 100 people with 0 ACEs attempt suicide 10 of 100 people with 3 ACEs attempt suicide 20 of 100 people with 7 ACEs attempt suicide

14. Life-long Physical, Mental & Behavioral Health Outcomes Linked to ACEs • Alcohol, tobacco & other drug addiction • Auto-immune disease • Chronic obstructive pulmonary disease & ischemic heart disease • Depression, anxiety & other mental illness • Diabetes • Multiple divorces • Fetal death • High risk sexual activity, STDs & unintended pregnancy • Intimate partner violence—perpetration & victimization • Liver disease • Lung cancer • Obesity • Self-regulation & anger management problems • Skeletal fractures • Suicide attempts • Work problems—including absenteeism, productivity & on-the-job injury

15. A Significant Portion of Outcomes • is Attributable To ACES • 54% of depression • 58% of suicide attempts • 39% of ever smoking • 26% of current smoking • 65% of alcoholism • 50% of drug abuse • 78% of IV drug use • 48% of promiscuity (≥ 50 sexual partners) • (based on females in original study)

16. Population Attributable Risk- WA State Data Percentage of ACE impact to sectors of life and society

17. ACEs are Prevalent, Pervasive and Cross All Sectors of Population • 62%: at least 1 ACE • 25%: 3 or more ACE • 5%: more than 6 • Cluster/co-occur • 1 in 3 Emotional Abuse • 1 in 4 Sexual Abuse • > 1 in 5 Substance Abuse • > 1 in 5 Loss of Parent • 1 in 7 Mental Illness • 1 in 7 Physical Abuse • 1 in 8 DV 87% with 1 ACE have another

18. ACEs & Disability Permanent Disability Child Abuse Permanent Injury Temporary Disability from Work High ACE Score Substance Abuse On-the-Job Injury Anxiety, Depression, Other Mental Health Disorder High ACE Score Intermittent Disability

19. The truth about childhood is stored up in our bodies and lives in our souls. Our intellect can be tricked, our feelings can be numbed and manipulated, our perception shamed and confused, our bodies tricked with medication, but our soul never forgets. And because we are one, one whole soul, in one body, someday our body will present its bill. ~ Alice Miller

20. Closing thoughts on ACE Study • The science behind this is fact • “Witness” phenomenon • 35% reduction in office visits • 11% reduction in ER visits • 80% of diagnostics is family history • AMA and Three National Academies • Hope, healing and a future

21. Brain Research: THE NEUROBIOLOGY OF MALTREATMENT See for example: “Neurobiological and Behavioral Consequences of Exposure to Childhood Traumatic Stress,” Stress in Health and Disease, BB Arnetz and R Ekman (eds). 2006. Martin Teicher, Jacqueline Samson, Akemi Tomoda, Majed Ashy, and Susan Anderson Teicher, M. “Scars that Won’t Heal: The Neurobiology of Child Abuse,” Scientific American, March, 2002, pp. 68-75.

22. Experience Drives Development The brain works using chemicals and electricity

23. Experience Shapes Brain’s Developmental Sequence • Size, shape & efficiency of brain regions can be reduced • Chemistry- those created early are most easily produced for life • Electrical grid- wiring, efficiency impacted

24. Example Developmental Outcomes • Middle Childhood • Connection between hemispheres • Multi-modal problem solving • Understanding social cues • Adolescence • Executive function • Sound judgment • Understanding of consequences • Early Childhood • Self-regulation • Production of hormone paths • Verbal memory • Regulation/ dysregulation of mental health

25. Brains to Fit the Life We’ll Live • DEVELOPMENT • for a tough life: • Emotion processing regions smaller, less efficient • Efficient production of stress-related chemicals • Dysregulated happy hormones • Fewer receptors for calming • Less white matter • INDIVIDUAL • characteristics & traits • Competitive • Hot tempered • Impulsive • Hyper vigilant • “Brawn over brains” or • Withdrawn • Emotionally detached • Numb WHY IT WORKS Under the worst conditions, such as war & famine, both the individual & the species survive. Toxic Stress Assuming a neutral start: All brains will adapt to survive WHY IT WORKS By striving for cooperative relationships, individual & species live peacefully. • DEVELOPMENT • for a good life: • Emotion processing regions robust and efficient • Abundant happy hormones • High density white matter, especially in mid-brain • INDIVIDUAL • characteristics & traits • Laid back • Relationship-oriented • Reflective • “Process over power”

26. Key Variables In Brain Outcomes Critical Time: Age of Maltreatment The brain develops over time. The effects of maltreatment correspond to the region and/or function that is developing at the time of maltreatment. Types of Abuse Different types of maltreatment activate different processes that shape the brain, such as chemicals & hormones, electrical activity, cell growth, & specialization of cells. Gender Although both boys & girls are affected by maltreatment the effects of sexual abuse are more profound in girls while the effects of neglect are more profound in boys.

27. CORPUS CALLOSUM • Integrates hemispheres & facilitates: • Language development • Proficiency in math • Processing of social cues, such as facial expression • HIPPOCAMPUS • The center for: • Controlling emotional reactions • Constructing verbal memory • Constructing spatial memory VULNERABLE TO: Neglect in infancy. Sexual abuse in the elementary school years. VULNERABLE TO: All forms of maltreatment in the first 2-3 years of life. RIGHT TEMPORAL GYRUS Center for spoken language. VULNERABLE TO: Emotional abuse, especially between ages 7 and 9. 27

29. ACE Study: A Paradigm Shift

30. Trauma is often overlooked because… Behavioral responses resemble common delinquent behaviors and are under-identified as trauma symptoms Stress manifestation is different by ages, stages, expression Many just don’t connect the symptoms to trauma …Thus leading to punishment rather than help

31. Why do some rise above the ACE load and others don’t? • Attachment to caring adult(s) via mentors • Opportunities • Choices • Relationships • Timing

32. This is NOT about letting people off the hook, or excusing actions because of trauma history Data suggest accountability CAN actually increase!

33. Children’s Resilience Initiative Opportunities for Resilience Moving forward with this powerful information

34. For the most part, resilience is about the day-to-day ways we interact with and help each other. Current research is discovering that nurturance is actually reparative and regenerative!!

35. Resilience Occurs At All Levels A universal capacity which allows a person, group, or community to prevent, minimize, or overcome the damaging effects of adversity. Dr. Edith Grotberg Community

36. A “Trauma Lens” can help to better understand a patient’s behavior. A shift in perspective from: “What is wrong with this person?” to “What has this person been through?” 36

37. Survival Mode Response • Can’t effectively: • Respond • Learn • Process • Allow time to calm & return to higher brain functioning Stressed Brains

38. MODELS OF RESILIENCE Grotberg Boss Attachment & belonging Community, culture & spirituality Capability Blaustein Attachment Regulation Competence Masten Connection Affirmation Chores, choices, mastery of skills Brooks & Goldstein Positive relationship w/caring adult Self-esteem through emotional awareness & control Effectiveness in one’s own world I HAVE (external supports) I AM (personal strengths) I CAN (social & interpersonalskills)

39. I HAVE (external supports) • People around me I trust and who love me, no matter what • People who set limits for me so I know when to stop before there is danger or trouble • People who show me how to do things right by the way they do things • People who want me to learn to do things on my own • People who help me when I am sick, in danger, or need to learn = safety & security: core for developing resilience

40. I AM (internal, personal strengths) • A person people can like and love • Glad to do nice things for others and show my concern • Respectful of myself and others • Willing to be responsible for what I do • Sure things will be all right = inner strength or hope; feelings, attitudes and beliefs within the child

41. I CAN (social/interpersonal skills) • Talk to others about things that frighten me or bother me • Find ways to solve problem that I face • Control myself when I feel like doing something not right or dangerous • Figure out when it is a good time to talk to someone or to take action • Find someone to help me when I need it = mastery, sense of future

42. Resilience Treasure Hunt Night at Elementary School

43. A Positive Relationship with One Adult Children who experienced trauma and grew up to be successful consistently identified one variable: connecting to an adult who they felt cared about them and believed in them. • We can each be that caring person

44. Looking through the “trauma lens”… “Not realizing that children exposed to inescapable, overwhelming stress may act out their pain, that they may misbehave, not listen to us, or seek our attention in all the wrong ways, can lead us to punish these children for their misbehavior…If only we knew what happened last night, or this morning before she got to school, we would be shielding the same child we’re now reprimanding.”On Playing A Poor Hand Well by Mark Katz

45. Children’s Resilience Initiative Children’s Resilience Initiative SKILL BUILDING

46. Responses • Liberating- leave behind the shame and blame • I thought it was my fault • Now I know why I’m on my 4th marriage • This saved my life • I understand better now why my mother parented the way she did, but I will break the cycle • I will be intentional in building resilience • Hope and healing; I’m not alone • Why haven’t I heard about this before?

47. Our Community’s Response Website & facebook; resources, videos, news Resilience tools for Parents “New Parent” & “moving upstream” tools Lincoln Alternative High School The Health Center at Lincoln Children’s Home Society Commitment to Community Christian Aide Center One Officer’s Story One Woman’s Story WWPD, Sheriff Dept, Penitentiary trainings Walla Walla Public Library partnership Dept of Court Services, Judge, Attorney

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