Presentation on theme: "Adverse Childhood Experiences, Complex Trauma, and Community Responses"— Presentation transcript:
1Adverse Childhood Experiences, Complex Trauma, and Community Responses Christopher Blodgett, Ph.D.Washington State University
2Five Takeaways for Today Quality relationships fix many thingsAdverse Childhood Experiences, are the public health problem facing AmericaUnderstanding trauma can guide what we do to make things betterTrauma is the least interesting thing you can know about another personWe have to look to each other and unusual partners for a problem this big
3Understand Trauma but Build Resilience Resilience- positive adaptation despite adversityIn early childhood, successful secure attachmentIn later childhood, mastery of school and establishing meaningful peer and adult relationshipsIn adults, meaningful intimate and loving relationshipsA virtuous cycle- Reduces exposure to vulnerability and increase access to protective resources(Luthar & Cicchetti, 2000) content adapted from this article
4Building Resiliency as the Positive Health Goal Focus on positive growth in addition to reduction of riskHarm reduction as the goalAdopt a developmental and an ecological approach to assessment and provision of interventionsCommit to persistent efforts with high risk familiesBuild community capacity as the principal resource(Luthar & Cicchetti, 2000) content adapted from this article
5Relationship is the Evidence-Based Practice Trauma results primarily from disrupted relationshipsFocus on relationship as the vehicle for life successAttachment key to well-being across the life spanCritical role of core caregiver-infant relationshipsEarly learning creates persistent but potentially modifiable responsesProgressive role of extended caregivers and intimate relationships
6Attachment: Can I Depend on You When I Need You? Attachment is the maintenance of a desired distance to a caregiver both physically and emotionally. The desired distance depends on the situation.The caregiver as a safe haven soothes and comforts activation and creates readiness to explore in the childChild may be ‘activated’ (seek closer proximity due to fear or uncertainty) by internal/external cuesIdeally, activation stops when the child’s desired distance is exceeded by the actual distanceThe belief that the caregiver will be available as a secure base if needed provides a child the safety to explore their worldWhen something happens that is outside of my comfort zone and my ability to cope, I am wired to find you and come closer.What we are talking about here is a person’s ability to modulate on their own. Modulation means “the ability to maintain a comfortable level of arousal.” Another word for modulation is “emotional regulation” but since the ARC model used the term modulation, we’re using it also for consistency.So when a person can modulate on their own, they can stand a larger distance from their caregiver. When they can’t modulate on their own, they need that distance to shrink. It shrinks based on the amount of distress that person is feeling.
74 Core Principles of Attachment Attachment is an innate motivating forceIn order to learn, you have to feel safe and free to exploreFear and uncertainty activate attachment needsAttachment offers a safe havenAttachment offers a secure baseYou build bonds by being accessible and responsiveIsolation and loss are inherently traumatizingDeveloped by Susan Johnson who created EFT. She uses attachment theory to help create health with couples. Her model is one of only two counseling models for couples endorsed by the APA. It has a 70% effectiveness rate (most are closer to 20%).Some of these are review, but you can take this list as a way to sum up attachment in 10 sentences.We won’t go into great depth on these, but if there are any you’d like more information on, please include that in your eval so we get an idea of what we should cover in the future.
8Directions of Attachment View of Self is positiveDismissing-avoidant-I can’t rely on you, so I only rely on me.Secure Attachment- I can rely on me and I can rely on youDisorganized- I’m not okay with you and I’m not okay without you. My fear is unsolvable.Preoccupied Ambivalent- I can’t rely on me, so I rely on youView of othersis negativeView of othersis positive5 styles of attachmentThere is a gradient with these- most people have a predominant style, but it’s not “which box do you fit in?” You can have a mostly secure attachment with one or two moments that feel ambivalent, but you’re mostly secure.It’s a fluid process where we as helping professionals find opportunities to help another feel secure and build on it.This process is not something we outgrow. It continues all throughout our lifetime.Earned secure attachment- where a person’s primary caregiver can’t meet those attachment needs and the child forms an insecure attachment style. But, someone else at another point in their life gives them the opportunity to experience secure attachment and they use that other person to heal attachment wounds and move to a secure attachment.Can be a teacher, coach, relative, etc.Also is often what takes place in adult friendships, relationships, marriages.This doesn’t mean that you’re substituting what a parent does. A secure attachment is just to another human being, not necessarily your parents. You, as the helper, can provide a place where, for 6 hours a day, this child gets to feel safe and be responded to in a way that meets those attachment needs of secure base/safe haven. It also means, for the parents you work with, that you can begin to give them a sense of safety that they’ve never had before, and even model to them how to respond to their children as a secure base/safe haven.You guys are powerful!!!So all this means that what attachment suggests is that if you as a helping professional work with a child or a parent with a mindful intention, it can be powerful enough to help a child develop secure attachment.We can talk about this in much more depth in the future. Just remember it is NEVER TOO LATE to heal attachment.Nearly 40% of the US population has an insecure attachment style. About 10% is somewhere on the Disorganized gradient. Isn’t that interesting when we also consider that 35-40% has experienced complex trauma?View of Self is Negative
9User’s Manual for Your Brain Principle 1: Our brains are designed to benefit from rich and supportive intimate social relationships.Principle 2: Brain function is hierarchical. We feel and then we think.Principle 3: Brain systems change with use throughout life.Adapted from Bruce Perry:
10Toxic Stress Places Health at Risk Persistent, unpredictable, overwhelmingAdverse Childhood Experiences as the origins of toxic stressComplex trauma as adaptation and survival
11Toxic Stress Places Brain Development at Risk Access to adequate stimulation at key timesElevated stress hormone levels can change brain structureFunctional immaturity of the threat-arousal management systemBrain development follows useSurvival trumps learningApplying findings from animal experimental studies with supporting human clinical studies (correlation evidence)Dunedin longitudinal studies suggest more direct causal association.Catecholamines include dopamine, epinephrine, and norepinephrineFrom Bruce Perry:Principle 1: Brain function is hierarchical. Our first responses are based in non-conscious, reflexive, and conditioned responses.Principle 2: The brain develops in a sequential fashion.Principle 3: The brain develops most rapidly early in life.Principle 4: Brain systems change with use throughout life.Principle 5: Our brains are designed to benefit from rich and supportive intimate social relationships.Principle 6: We feel and then we think.Principle 7: Neural systems can be changed, but some systems are easier to change than others.Principle 8: Stress can change brain development.
12Complex Trauma and ACEs The process of exposure to ACEs and the process of adjustment.The ‘complex’ in complex trauma risk:Early exposure at times of critical developmentMultiple risksUnpredictable and persistentWho you love is who you may not be able to count onNatural responses to extraordinary circumstances.Complex trauma involves common challenges and responses that can be understood and guide our actions.Knowing that loss and injury has occurred offers little to guide intervention. Knowing how development is disrupted and the nature of trauma behavior consequences can provide a focus for mitigation and recovery provides the framework for intervention.The concept of complex trauma lets us focus on the responses to be managed and the capacities to build.
13Natural Responses to Extraordinary Circumstances Sense of self and ability to influence the worldNot feeling worthy of love, not trusting loveFeel incapable of having a positive impact on the outside worldDiminished sense of self worth = diminished persistence in effort, giving up on or distorting relationshipsSelf-regulationArousal and hyper-vigilanceSurvival and automatic behaviors- aggression, withdrawal, dissociationPoor impulse controlTrauma impairs emotional learning- constricts response and ability to form relationshipsFeel incapable of having a positive impact on the outside worldHopelessnessDifficulty in initiating play or having safety with imagination and explorationLow self-esteem--diminished sense of self worthDisturbances of body imageShame and guilt; self blameUnsure of own needs and often lack capacity to get needs met
14We Swim in Adversity The Adverse Childhood Experiences Study Substance Abuse 27%Parental Separation/Divorce 23%Mental Illness 17%Battered Mother 13%Criminal Behavior 6%Psychological Abuse 11%Physical Abuse 28%Sexual Abuse 21%Emotional Neglect 15%Physical Neglect 10%
15ACEs Have a Dose Effect on Health (ACE Score)Women%MenTotal353836125282621631094 or more1513With four or more categories of childhood exposure, compared to adults with no ACEs4- to 12-fold increased alcoholism, drug abuse, depression, and suicide attempt2- to 4-fold increase in poor self-rated health3- to 4-fold increase in chronic illness (heart disease, liver disease)Earlier death with >6 ACEs
17We don’t know much of what we need to know right now Copyright WSU AHEC 2012 Reproduction with attribution permitted
18How Do We Move to Community Responses to ACEs and Trauma? Each of us has to name the problemTrauma compromises our universal systems caring for childrenCommon need builds alliancesEducation, primary health care, youth developmentHelping professionals understand their role -appropriate response to traumaAwareness, trauma informed planning, surveillance and referral, role of natural relationships in repairOur initial experiences in early learning and K-12 education- Building the case, moving to action
19Spokane Study ACEs Exposure in Elementary Aged Children 2,100 randomly selected children in 10 elementary schools>200 teachers, counselors, and building administrators provided knowledge of children’s risk5 Title I and 5 Non-Title I schoolsRisk is greater as poverty increasesFirst study of its kind
20Complex Trauma Risk in the Spokane Students LifetimeACE ExposurePast 12 MonthNone55%81%One23%12%Two10%4%Three or More2%
21Odds for Academic and Health Problems with Increasing ACEs in Spokane Children Academic FailureSevereAttendance ProblemsSevere SchoolBehavior ConcernsFrequent ReportedPoorHealthThree or More ACEs N =2483564Two ACEsN=2132.5One ACEN=4761.52No Known ACEs =1,1641.0
23Readiness to Learn and ACEs RTL programAdapting other assessment information in an adverse frameworkChallenged data still produces powerful effectsData entered by more than 100 different service providersData based on establishing a relationship to collect optimal data RTL ACEs Scale =Basic NeedLegal ProblemsParenting ConcernsSingle Parent/Living Away from ParentsCPS/Abuse ConcernsHomeless/Homeless RiskFamily Safety/Family ViolenceFamily Substance Abuse Copyright WSU AHEC 2012 Reproduction with attribution permitted
24Copyright WSU AHEC 2012 Reproduction with attribution permitted
25Behavioral Health Problems RTL- ACEs and Odds Ratios for Academic RiskAcademicFailurePoor AttendanceSchool BehaviorBehavioral Health ProblemsFour or More ACESN=6632.05.33.16.5Three ACEs N=75613.01.5Two ACEs N=1,1418.104.22.168One ACE N=1,6121.2No Reported ACESN=1,020---Copyright WSU AHEC 2012 Reproduction with attribution permitted
26RTL-ACEs and academic success Copyright WSU AHEC 2012 Reproduction with attribution permitted
27RTL students and social emotional distress Copyright WSU AHEC 2012 Reproduction with attribution permitted
28Screening for ACEs in Head Start Children Parent reportAdaptation of original ACE screen (0-9 items)Average ACEsChild M= 2.6Parent M=4.044% of children and 75% of parents have 3 or more ACEsCopyright WSU AHEC 2012 Reproduction with attribution permitted
30Why There is Reason for Hope- Trauma Informed Practice in Education Social support and resources build resiliency at any age. Resiliency buffers the effects of trauma.Creating safety and predictability creates opportunity for new learning.Understanding trauma creates opportunities for new behaviors.Teachers can create powerful relationships.Managing trauma’s effects may result in increasing success for systems.
31A Roadmap for Change in Education as One Example Response to Intervention as a public health principles adapted into education settingsUniversal adoption of social emotional learning and trauma informed actions to guide decision-makingTrauma informed assessment and tailored response to children and families most in needSustainable interventions to prepare children to benefit from universal education and supportsCoordination of more intensive supports when required