1. 1 Reversing the Tide Proven strategies to reduce the individual, community & business risks fostered by adverse childhood experiences DRAFT

2. 2 Today we’ll gain knowledge, skills &ideas: To ensure that people in our community—including those facing major life challenges—have joyful, productive and fulfilling lives; And improve the profitability of businesses in our community.

3. 3 The Way You Spend Your Days Matters XXXXXXX XXXXXXX XXXXXXX XXXXXXX

4. 4 “Our prime purpose in this life is to help others. And if you can't help them, at least don't hurt them.” -Dalai Lama

5. 5 Pathway to Improved Quality of Life Childhood Experience/ Stressors Home, Work & Community Life Emotional & Intellectual Achievement Development & Health of Brain & Body

6. 6 The Brain’s Developmental Sequence

7. 7 Examples of Developmental Outcomes Early Childhood Self-regulation Production of happy hormones Verbal memory Regulation/ dys- regulation of mental health Adolescence Executive function Sound judgment Understanding of consequences Middle Childhood Connection between hemispheres Multi-modal problem solving Understanding social cues

8. 8 Brains to Fit the Life We 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 WHY IT WORKS Under the worst conditions, such as war & famine, both the individual & the species survive. INDIVIDUAL characteristics & traits Competitive Hot tempered Impulsive Hyper vigilant “Brawn over brains” Toxic Stress 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” Neutral Start: All brains are made to adapt WHY IT WORKS By striving for cooperative relationships, individual & species live peacefully.

9. 9 Socially & Economically Valued Skills INDIVIDUAL characteristics & traits Competitive Hot tempered Impulsive Hyper vigilant “Brawn over brains” Brainstorm: What kinds of jobs are a good fit? Why? What knowledge and skills would a young person need to develop to be successful at those jobs? What kind of learning environment would best support a young person in acquiring the needed knowledge and skills?

10. 10 Adverse Childhood Experiences Study: Physical, Mental & Behavioral Health Built by Experience

11. 11 1.Child physical abuse 2.Child sexual abuse 3.Child emotional abuse 4.Neglect 5.Mentally ill, depressed or suicidal person in the home 6.Drug addicted or alcoholic family member 7.Witnessing domestic violence against the mother 8.Divorce or parental separation 9.Incarceration of any member of the household The Adverse Childhood Experiences (ACEs)

12. 12 Dose gets bigger Response gets bigger Dose-Response Relationship: More ACEs = More Disease

13. 13 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

14. 14 High ACEs Creates Pathways to Lower Quality of Life: High Risk of Poverty High Risk for: Mental Illness Substance Abuse Incarceration Trouble: School Failure High Risk Sex Relationship Issues Toxic Stress Poor Health: Chronic Illness Attention, Emotional & Behavior Issues Poverty Jobless Homeless Alone Hopeless

15. 15 Alcohol, tobacco & other drug addiction Auto-immune disease Chronic obstructive pulmonary disease & ischemic heart disease Depression, anxiety & other mental illnesses Diabetes Multiple divorces Fetal death High risk sexual activity, STDs & unintended pregnancy Work problems—including absenteeism, productivity & on-the-job injury Intimate partner violence—perpetration & victimization Suicide attempts Liver disease Lung cancer Obesity Self-regulation & anger management problems Skeletal fractures Life-long Physical, Mental & Behavioral Health Outcomes Linked to ACEs

16. 16 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

17. 17 XXXXXX X XXXXXXX XXXXXX X XXXXXXX If our community really understood how ACEs get wired into biology, what might change? What are a few things our community might do differently to help everyone have more joyful, fulfilling & productive lives?

18. 18 ACEs and Disability in Washington 84.2% of Washington adults e xperienced no disruption to daily activity in the last month due to disability 9.1% disabling condition + 1-15 days disrupted activity (LOW) 3.2% disabling condition + 16-29 days disrupted activity (MODERATE) 3.5% disabling condition + 30 days disrupted activity (HIGH)

19. 19 ACE StudyWashington BRFSS Prevalence of ACEs: ACE Study & Washington State BRFSS

20. 20 “ Muscles aching to work, minds aching to create - this is man.” – John Steinbeck, The Grapes of Wrath

21. 21 ACEs & Disability Child Abuse Permanent Injury Permanent Disability High ACE Score Substance Abuse Temporary Disability from Work Anxiety, Depression, Other Mental Health Disorder Intermittent Disability On-the-Job Injury High ACE Score

22. 22 Lost Time Doubles Risk of Unemployment over Disability Alone No Disability No Lost Time Disability No Lost Time Disability Any Lost Time Unemployment (%)

23. 23 For the most part, resilience is about the positive day-to-day ways we interact with, support and help each other. How might we go about making fostering resilience a key component of leadership in our community?

24. 24 Resilience is the ability to “meet challenges, survive and do well despite adversity” –Kirmayer, 2009

25. 25 Unemployment: Lost Days & Resilience % Unemployed High ResilienceLow Resilience

26. 26 Unemployment: ACEs by Resilience High ResilienceLow Resilience % Unemployed

27. 27 Unemployment by ACE & Days Able to Do Usual Activities 0-2 ACEs3+ ACEs Unemployment Rate (%)

28. 28 Community Capacity - The ability of community members to use the assets of their community, e.g. residents, associations and institutions, to improve the quality of life for those living in the community. Each community's collection of assets is unique and reflects the specific characteristics of its population, its political structures and geography. Community capacity is defined as “the combined influence of a community’s commitment, resources, and skills that can be deployed to build on community strengths and address community problems.” A variety of individuals, families, community groups and institutions contribute to community capacity. Each is a potential partner in the work of strengthening the viability and vitality of communities. In partnership, each can gain in capacity. Community capacity is the interaction of human, organizational, and social capital existing within a given community that can be leveraged to solve collective problems and improve or maintain the well-being of a given community. It may operate through informal social processes and/or organized efforts by individuals, organizations, and the networks of association among them and between them and the broader systems of which the community is a part.

29. 29 Low Capacity High Capacity High Community Capacity, High Social/Emotional Support Ages 18-34, 3-8 ACEs % Reporting Social/Emotional Support Frequency of Social/Emotional Support

30. 30 Serious Mental Illness & Community Capacity Ages 18-34, 3-8 ACEs Low Capacity High Capacity % Reporting Mental Illness Serious Mental Illness Severe Depression

31. 31 Factors that contribute to resilience include: Close relationships with family and friends A positive view of yourself and confidence in your strengths and abilities The ability to manage strong feelings and impulses Good problem-solving and communication skills Feeling in control Seeking help and resources Seeing yourself as resilient (rather than as a victim) Coping with stress in healthy ways and avoiding harmful coping strategies, such as substance abuse Helping others Finding positive meaning in your life despite difficult or traumatic events This Emotional Life is a co-production of the NOVA/WGBH Science Unit and Vulcan Productions, Inc. A Film by Kunhardt McGee Productions. ©/™ 2009 WGBH Educational Foundation and Vulcan Productions, Inc.NOVA/WGBH Science UnitVulcan Productions, Inc.Kunhardt McGee ProductionsWGBH Educational FoundationVulcan Productions, Inc. All Rights Reserved.

32. 32 Psychologists Richard G. Tedeschi and Lawrence Calhoun have found in many cases that reports of growth after traumatic events far outnumber the reports of disorders. They describe five areas of growth reported by people who have experienced traumatic events: Discovery of new opportunities and possibilities that were not present before- Closer relationships with others, especially others who suffer- Greater appreciation for life- Greater sense of personal strength: “If I lived through that, I can face anything”- Spiritual growth- We need to understand and remember that growth comes from the struggle to cope with the trauma—not from the event itself.

33. 33 “Rugged individualism” is a stereotype in American culture, and a myth. Resilient people are resourceful, and friends and family are among their most important resources. Resilient people have strong social networks, close connections to family and friends, are able to self-disclose about their troubles to people close to them, and ask for help when they need it.

34. 34 Community Capacity Building Recognition and Inventory of Existing Assets Cultural and Historic Heritage Health and Well Being Economic Opportunity Sustainable Environment Community Services and Infrastructure Social Networks and Civic Engagement

35. 35 Community Capacity Development

36. 36 Next Steps Make a time and a space for our community to: ▫Learn about ACEs and ▫Generate ACE-informed solutions to ACE-related problems Use the strengths of many to improve resilience among adults with high ACE scores, such as: ▫Generating accommodations for normal response to toxic stress, ▫Reducing trauma triggers in schools and the workplace, ▫Promoting healthy social networks at work ▫Supporting employees in developing skills and habits that are transferable to great parenting – especially the kind that will prevent ACEs in the next generation Lead efforts to develop community capacity, for example, by: ▫Participating in, co-leading or convening community dialogues addressing issues that matter the most to us ▫Learning together ▫Initiatives to expand leadership in generating community solutions ▫Lending expertise and time to help community leaders become results-oriented and to measure results

37. 37 Thank you! Skamania Klickitat Community Network Building strong, healthy communities 1-866-631-1997 http://community.gorge.net/skcnparentsupport

38. 38 http://vetoviolence.cdc.gov/childmaltreatment/phl/resource_center_infographic.html