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Adverse Childhood Experiences, Complex Trauma, and Community Responses Christopher Blodgett, Ph.D. Washington State University.

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Presentation on theme: "Adverse Childhood Experiences, Complex Trauma, and Community Responses Christopher Blodgett, Ph.D. Washington State University."— Presentation transcript:

1 Adverse Childhood Experiences, Complex Trauma, and Community Responses Christopher Blodgett, Ph.D. Washington State University

2 Five Takeaways for Today 2 Quality relationships fix many things Adverse Childhood Experiences, are the public health problem facing America Understanding trauma can guide what we do to make things better Trauma is the least interesting thing you can know about another person We have to look to each other and unusual partners for a problem this big

3 Understand Trauma but Build Resilience 3 Resilience- positive adaptation despite adversity In early childhood, successful secure attachment In later childhood, mastery of school and establishing meaningful peer and adult relationships In adults, meaningful intimate and loving relationships A virtuous cycle- Reduces exposure to vulnerability and increase access to protective resources

4 Building Resiliency as the Positive Health Goal 4 Focus on positive growth in addition to reduction of risk Harm reduction as the goal Adopt a developmental and an ecological approach to assessment and provision of interventions Commit to persistent efforts with high risk families Build community capacity as the principal resource

5 Relationship is the Evidence-Based Practice 5 Trauma results primarily from disrupted relationships Focus on relationship as the vehicle for life success Attachment key to well-being across the life span Critical role of core caregiver- infant relationships Early learning creates persistent but potentially modifiable responses Progressive role of extended caregivers and intimate relationships

6 Attachment: Can I Depend on You When I Need You? Child may be activated (seek closer proximity due to fear or uncertainty) by internal/external cues Ideally, activation stops when the childs desired distance is exceeded by the actual distance The caregiver as a safe haven soothes and comforts activation and creates readiness to explore in the child The belief that the caregiver will be available as a secure base if needed provides a child the safety to explore their world Attachment is the maintenance of a desired distance to a caregiver both physically and emotionally. The desired distance depends on the situation.

7 4 Core Principles of Attachment 1. Attachment is an innate motivating force 2. In order to learn, you have to feel safe and free to explore Fear and uncertainty activate attachment needs Attachment offers a safe haven Attachment offers a secure base 3. You build bonds by being accessible and responsive 4. Isolation and loss are inherently traumatizing

8 Directions of Attachment Dismissing- avoidant-I cant rely on you, so I only rely on me. Secure Attachment - I can rely on me and I can rely on you Disorganized- Im not okay with you and Im not okay without you. My fear is unsolvable. Preoccupied Ambivalent - I cant rely on me, so I rely on you View of Self is positive View of Self is Negative View of others is positive View of others is negative

9 Users 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. 9

10 Toxic Stress Places Health at Risk 10 Toxic stress Persistent, unpredictable, overwhelming Adverse Childhood Experiences as the origins of toxic stress Complex trauma as adaptation and survival

11 Toxic Stress Places Brain Development at Risk 11 1. Access to adequate stimulation at key times 2. Elevated stress hormone levels can change brain structure 3. Functional immaturity of the threat-arousal management system 4. Brain development follows use 5. Survival trumps learning

12 Complex Trauma and ACEs 12 The process of exposure to ACEs and the process of adjustment. The complex in complex trauma risk: Early exposure at times of critical development Multiple risks Unpredictable and persistent Who you love is who you may not be able to count on Natural responses to extraordinary circumstances. Complex trauma involves common challenges and responses that can be understood and guide our actions.

13 Natural Responses to Extraordinary Circumstances 13 Sense of self and ability to influence the world Not feeling worthy of love, not trusting love Feel incapable of having a positive impact on the outside world Diminished sense of self worth = diminished persistence in effort, giving up on or distorting relationships Self-regulation Arousal and hyper-vigilance Survival and automatic behaviors- aggression, withdrawal, dissociation Poor impulse control Trauma impairs emotional learning- constricts response and ability to form relationships

14 We Swim in Adversity The Adverse Childhood Experiences Study 14 Substance Abuse27% Parental Separation/Divorce23% Mental Illness17% Battered Mother13% Criminal Behavior 6% Psychological Abuse11% Physical Abuse28% Sexual Abuse21% Emotional Neglect15% Physical Neglect10%

15 ACEs Have a Dose Effect on Health With four or more categories of childhood exposure, compared to adults with no ACEs – 4- to 12-fold increased alcoholism, drug abuse, depression, and suicide attempt – 2- to 4-fold increase in poor self-rated health – 3- to 4-fold increase in chronic illness (heart disease, liver disease) – Earlier death with >6 ACEs (ACE Score) Women % Men % Total % 0 353836 1 252826 2 16 3 109 4 or more 15913 15

16 Impact-ACE Risk Pyramid

17 We dont know much of what we need to know right now Copyright WSU AHEC 2012 Reproduction with attribution permitted 17

18 How Do We Move to Community Responses to ACEs and Trauma? 18 Each of us has to name the problem Trauma compromises our universal systems caring for children Common need builds alliances Education, primary health care, youth development Helping professionals understand their role - appropriate response to trauma Awareness, trauma informed planning, surveillance and referral, role of natural relationships in repair Our initial experiences in early learning and K-12 education- Building the case, moving to action

19 Spokane 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 childrens risk 5 Title I and 5 Non-Title I schools Risk is greater as poverty increases First study of its kind

20 Complex Trauma Risk in the Spokane Students Lifetime ACE Exposure Past 12 Month ACE Exposure None 55%81% One 23%12% Two 10%4% Three or More 12%2%

21 Odds for Academic and Health Problems with Increasing ACEs in Spokane Children Academic Failure Severe Attendance Problems Severe School Behavior Concerns Frequent Reported Poor Health Three or More ACEs N =248 3564 Two ACEs N=213 2.5 4 One ACE N=476 1.522.52 No Known ACEs =1,164 1.0


23 Readiness to Learn and ACEs Copyright WSU AHEC 2012 Reproduction with attribution permitted 23 RTL program Adapting other assessment information in an adverse framework Challenged data still produces powerful effects Data entered by more than 100 different service providers Data based on establishing a relationship to collect optimal data RTL ACEs Scale = Basic Need Legal Problems Parenting Concerns Single Parent/Living Away from Parents CPS/Abuse Concerns Homeless/Homeless Risk Family Safety/Family Violence Family Substance Abuse

24 24 Copyright WSU AHEC 2012 Reproduction with attribution permitted

25 25 RTL- ACEs and Odds Ratios for Academic Risk Academic Failure Poor Attendance School Behavior Behavioral Health Problems Four or More ACES N=663 Three ACEs N=756 Two ACEs N=1,141 One ACE N=1,612 11.61.2 No Reported ACES N=1,020 ---111 Copyright WSU AHEC 2012 Reproduction with attribution permitted

26 RTL-ACEs and academic success Copyright WSU AHEC 2012 Reproduction with attribution permitted 26

27 RTL students and social emotional distress Copyright WSU AHEC 2012 Reproduction with attribution permitted 27

28 Screening for ACEs in Head Start Children Parent report Adaptation of original ACE screen (0-9 items) Average ACEs – Child M= 2.6 – Parent M=4.0 – 44% of children and 75% of parents have 3 or more ACEs Copyright WSU AHEC 2012 Reproduction with attribution permitted 28


30 Why There is Reason for Hope- Trauma Informed Practice in Education 30 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 traumas effects may result in increasing success for systems.

31 A Roadmap for Change in Education as One Example Response to Intervention as a public health principles adapted into education settings Universal adoption of social emotional learning and trauma informed actions to guide decision-making Trauma informed assessment and tailored response to children and families most in need Sustainable interventions to prepare children to benefit from universal education and supports Coordination of more intensive supports when required

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