Intro to Adverse Childhood Experiences

1. Intro to Adverse Childhood Experiences PPT Created by Amanda Merck Salud America! Community Health Program University of Texas Health San Antonio in collaboration with the West Virginia Center for Children’s Justice 2019

2. Intro to ACEs Adverse Childhood Experiences (ACEs): • Definition & Impact • Effects • Response

3. ACEs: Definition & Impact Adverse childhood experiences (ACEs) are potentially traumatic events that can have negative, lasting effects on health and well-being ABUSE • Emotional • Sexual • Physical • Domestic violence • Witnessing violence • Bullying • Cyberbullying • Institutional LOSS • Death • Abandonment • Neglect • Separation • Natural Disaster • Accidents • Terrorism • War CHRONIC STRESS • Poverty • Racism • Invasive medical procedure • Community trauma • Family member with substance use disorder Definition: Child Trends

4. ACEs: Definition & Impact Source: Substance Abuse and Mental Health Service Administration

5. ACEs: Definition & Impact National study of 5,117 Latinos ages 18-74 found 77.8% experienced at least one ACE in childhood (in contrast to the 46% of youth in general who are currently exposed to ACEs). The same study found that 28.7% of Latinos experienced four ACEs or more. Learn more: Salud America! Research Review, 2017, http://salud.to/latinochild

6. ACEs: Definition & Impact 60% of U.S. children have been exposed to violence, crime, or abuse.

7. ACEs: Definition & Impact 1 in 15 U.S. children are exposed to domestic violence a year.

8. Intro to ACEs Adverse Childhood Experiences (ACEs): • Definition & Impact • Effects • Response

9. ACEs: Effects Changes a child’s brain: • Repeated/chronic activation of stress hormones bypass thinking part of brain and activate survival part of brain, aka fight, flight, or freeze • Strengthens fight, flight, or freeze neural pathways then become efficient and predominant • Interrupts normal development and impairs complex thought and learning

10. ACEs: Effects Changes a child’s behavior: Aggression, irritable, whiny, clingy, moody More headaches, stomachaches, and overreaction to minor bumps and bruises Difficulty identifying or labeling feelings, communicating needs and controlling impulses Problems with focus, easily startled, and over-reacts to sounds, touch, and sirens Distrust of others, authority Dissociation, checking out, and under-reaction Source: Dr. Joy Gilbert, Trauma, Toxic Stress and the Effects on Children Educator Skills

11. ACEs: Effects Causes long-term problems: Chronic absenteeism, attention problems, suspension, and expulsion Smoking, substance abuse, teen pregnancy, dropping out of high school, failed relationships, domestic violence, and involvement in criminal justice system Anxiety, depression, cardiovascular disease, diabetes, cancer, stroke, asthma, lupus, multiple sclerosis, osteoporosis, viral infections and autoimmune diseases.

12. ACEs: Effects Like a needle on a record player, complex trauma wears a groove in the brain. A reminder of the trauma can cause their bodies to replay their traumatic reaction—mobilizing them to either run from or fight the threat, while shutting down other systems that help them think and reason.

13. ACEs: Effects • S Kids have no sense of feeling safe in their own skin or their environment. • A Kids don’t know how to have healthy attachments to others. • R Kids don’t know how to self regulate. • A Kids don’t know how to act.

14. Why healthcare leaders should care Trauma in kids is linked to adult health and social problems in many studies.

15. Why police leaders should care Traumatized kids often engage in riskier behaviors than their peers.

16. Why school leaders should care Trauma turns off kids’ learning switch! • Decreased reading ability • Lower GPA • Higher rate of school absences • Increased drop-out • More suspensions and expulsions National Child Traumatic Stress Network – Child Trauma Toolkit for Educators 2008

17. Why school leaders should care A traumatized kid sees the world as a dangerous place, including school. Unfortunately, many adopt behavioral coping mechanisms that can frustrate educators, evoke exasperated reprisal. Reactivity and Impulsivity Aggression Defiance Withdrawal Perfectionism

18. Trauma happens daily

19. The next day in school… Are these children: • Hungry? • Falling asleep in class? • Doing their homework? • Failing a test? • Staring off into space? • Having an outburst?

20. The next day in school… Are these schools: • “Trauma-sensitive schools” (safe places where kids can build positive relationships with adults and peers, learn to manage their emotions and behavioral responses, and find academic success)?

21. Intro to ACEs Adverse Childhood Experiences (ACEs): • Definition & Impact • Effects • Response

22. ACEs: Response “Many of these children are not at-risk anymore. They are wounded. Their deep scars of emotional, physical, and mental pain are stuffed deep inside because, as a society, we are led to believe that they will go away.” -Joe Hendershott Author, “Reaching the Wounded Student”

23. ACEs: Response Good news: Resiliency! Many changes can be reversed if the trauma is interrupted AND the child is nurtured in a safe environment: Provide stable, consistent, predictable relationships Recognize trauma-related behaviors in children so your reaction to their behavior does not further traumatize the child Help kids feel safe, first, then teach skills for self-regulation

24. ACEs: Response Good news: Resiliency! Extend empathy, mercy, grace Alternative discipline, like community service Give wounded students different avenues to express themselves (music, art, etc.) Build self-esteem, find redeeming qualities Understand/work on student’s emotional intelligence Self care

25. School Response Trauma-Sensitive Schools are ones where: • Realizes the impact of adverse childhood experiences on neurobiological development and attachment; • Recognizethe impact trauma on learning and behavior; • Respond by building resilience and avoiding re-traumatization (Perry & Daniels, 2016; SAMSHA, 2015)

26. School Response “What’s wrong with you?” “What happened to you?” Two big questions… Source: Aces Too High

27. School Response “What’s wrong with you?” “What happened to you?” You can point the finger at parents and wait for them to change. Counseling would help, but they’d have to agree to participate. Free or low-cost counseling for people who can’t afford it isn’t a given in these days of social service budgets stripped to the bone. And counseling would take months, if not years to change the family dynamics. In the meantime, the boy continues to suffer and his behavior grows more belligerent. Change the schools to become safe and nurturing, so that kids can learn no matter what’s going on at home…or in their neighborhoods…or in their extended families. The reality is, a school’s traditional response – suspending, expelling or putting a child like Sam into special education classes – further traumatizes already traumatized children. That’s the tried and true road to prison or dropping out of school, and a life damaged for no good reason. …with two schools of thought: Source: Aces Too High

28. School Response

29. Handle with Care Response The “Handle With Care” program enables police to notify schools if they encounter a child at a traumatic scene, so schools and mental healthcare leaders can provide trauma-sensitive support right away, to help kids succeed.

30. Handle With Care Response Police encounter kids at scene, send heads-up to schools. Schools prep trauma-sensitive support for these kids. Mental health providers partner for on-site therapy.

31. School Response “Never worry about numbers. Help one person at a time, and always start with the person nearest you.” -Mother Teresa

32. Learn More • Blueprint for educators and communities to ensure that children traumatized by exposure to violence succeed in school • Understand the impact of trauma on learning & educate staff • Courtesy of Massachusetts Advocates for Children: Trauma Learning Policy Initiative

33. Learn More • 2 Free 20-Minute Online Training Modules • Trauma-Informed Approach, Part I defines trauma and discusses adverse childhood experiences, or ACEs; the effects or reactions to trauma, and developing a shift from the existing paradigm to a trauma-informed approach. • https://uthscsa.edu/learning-modules/teen-health/trauma/course-1/ • Use the password: UTteenhealth • Trauma-Informed Approach, Part II reviews how individuals can respond to traumatized youth, manage disclosures of abuse, and covers mandatory reporting. It also discusses how to refrain from re-traumatization and gives tips for building resiliency. • https://uthscsa.edu/learning-modules/teen-health/trauma/course-2/ • Use the password: UTteenhealth • Courtesy of University of Texas Health at San Antonio Teen Health

34. Inspiring people to drive community change for the health of Latino and all kids. Creating Culturally Relevant Multimedia Research | Supporting Policy, System, & Environmental Changes www.salud-america.org saludamerica@uthscsa.edu