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Karina Forrest-Perkins MHR LADC CEO | The Wayside House
Brain Development, the Adverse Childhood Experiences Study, and how the accumulation of stress changes our future… Project TurnAbout March Karina Forrest-Perkins MHR LADC CEO | The Wayside House
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Welcome and FYI… Greetings! ______________________________________ Safety and Self-care is our highest priority. If you would like to speak with someone about what you heard today, or if you would like a moment to step away from the presentation, please do so.
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Our Brain and Body…
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How we are made… Our Human gift…
The Brain: Human Beings have multiple regions of our brain which contribute to our thoughts and behavior. Today we will focus on only three. Survival Mechanism (1) Autonomic Functioning - Survival Limbic Mechanism (2) Hormonal and Neurotransmitter Control - Emotional Frontal and Pre-Frontal Cortex (3) Judgment, Planning, Course Correction, Intentional boundaries – Executive Function and more
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E C S The intent of this gift is that we use all three…
* To stay (Survival) Safe and Alive so we have experiences… * To (Emotional) Feel and Sense our experiences… * To (Cognitive) Think about, Plan for, and Make Meaning of our experiences…
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Regardless of where we come from: our ethnicity, our race, our gender, our place of birth, our preferences…. We all experience stress and we all have the same type of response to the accumulation of stress…. ‘Human Biology of Stress’
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All of us… Directional growth patterns – most primitive to most advanced (0-26) Reorganization Between ages 12-14 Mapping 0-26 Neuro-Genesis lifelong Frontal and Pre-Frontal Cortex Limbic - Midbrain Region Survival Region
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Remember the #s… 1. IMPACT - The regions we develop and use most often have a bearing on our human interaction; on our ability to be spiritual; on our learning styles; and how we value self and others. Basically how we develop determines how we “are” in the world and how we develop our worldview. 3 2 1
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ENVIRONMENTAL IMPACT:
How the brain adapts to our environment… Need for Interaction (experience dependent) It is “co-created”… Neurological Prioritizing Arborization, Utilization and Pruning Myelination wrapping and reinforcement of neurons and pathways (Hard wiring our experiences into our Biology) Karina A. Forrest-Perkins MHR LADC
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(JUST FYI…) What is happening around the ages of 12-14?
►Puberty ►Reorganization from concrete thinking to abstract ►Pruning from the arborization process This is with no substance use, abuse, or dependence…no trauma…no adversity at all.
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The Stress Response & The Adaptation to the Accumulation of Stress
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Our responses to threat…
Audience example
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All of us…Simplified description of Stress Response
Stress hormones keep us safe… We are built to withstand approx. 20” of stress And we adapt so that we know how to function in the environment we spend the most time in… Adrenaline catalyzes the production of cortisol… [2] Cortisol Frontal and Pre-Frontal Cortex Limbic Mechanism Survival Mechanism Stress catalyzes the production of Adrenaline… [1]
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Our responses typically follow the order of cognitive shut down…
FLIGHT While you are still able to use your executive functions FIGHT While you are still able to feel emotion FREEZE Once both frontal and midbrain functions have slowed or stopped FAINT lost consciousness
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Cognitive Shut-Down… A simple way to understand or explain it…
#3 goes first #2 goes second #1 is what is left alert as long as possible in order to keep you safe. Cortisol 3 2 1
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Cognitive Shut-Down… The more prepared you become for danger, the less your body perceives you need relational skills so the less capable you will become in accessing the more sophisticated parts of the brain. The more upset we become, the less sophisticated our thinking becomes. The more we have had to survive the quicker our brains are able to slow or shut down. If we have to survive this is very helpful! If we are triggered by a conversation with someone at work/home, that is not so helpful. We may say something designed to defend ourselves instead of maintaining our best thinking for the good of the relationship. This will have social consequences.
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The Amygdala and Learning
Prefrontal Cortex Sensory Input Conscious Response and Learning Amygdala Prefrontal Cortex Amygdala “…Mindful thinking results when the prefrontal cortex is allowed to process sensory information that arrives at the amygdala. An example is “counting to ten” when you’re frustrated or angry. Counting gives the amygdala time to allow the input to move on to the prefrontal cortex and be analyzed more accurately.” from The MindUP Curriculum, Flight, Fight or Freeze (See former slide) From The MindUp Curriculum 17
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SELF-MANAGEMENT The Significance of Managing Triggers
In the moment . . . we have 8 to 15 seconds to stop the trigger… In the aftermath . . . it takes 6 to 8 hours to return to normal levels…
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Genetics v Epigenetics
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Epigenetics…what is this?
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Our Chromosomes…Our DNA…Telomeres…
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Neuro-Synaptic Development
At birth the baby has ~100 billion neurons with 50 trillion connections or synapses. In the first three months of life the synapses multiply more than 20 times. At one year the brain has 1,000 trillion synapses. On average between the age of 0-5, children produce over 20,000 connections per second. In adulthood we produce ~400 connections per day.
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Brain Science Summary Brain Development is Sequential and Organized Experience is hard-wired into our biology and Adaptations may occur Our Behavior is often impacted chemically by stress Our Environment can impact what genes you express and what genes you do not Experience in one period of time affects members differently (Age, Gender) Behavior, affect, attitude, capacities may not be “choices”- They may be responses to stress accumulation during development We may need to rethink some of our strategies for prevention, care and treatment that were determined before we knew this information.
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This is not suggesting something is wrong with the brain…On the contrary, it says more about what is happening in the environment. GARDENING: If a plant does not flower in the spring…what do you do to ensure it will flower next year? Check the nutrients in the soil, check the sunlight, check how much water the plant receives, and possibly prune the plant. But you do not just prune the plant. Eventually you may have to move the plant to another environment so it gets what it needs to survive. Our brain has a masterful ability to adapt and adjust to the demands placed before us…if we ever are in need of survival skills, then growing up in a non-threatening environment may not serve us as well. Likewise if we grow up in a dangerous/violent environment, it will be challenging for us to adjust our behavior to a non-violent one without allowing our brains the time they need for adaptation.
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Behavioral Implications
What is Happening? What you may see… Hyper vigilance Hard to calm down Routinized Defense Prepared to Fight – quick to anger or defense Overly aware of your surroundings Externally in tune with environment Survival Skills the strongest Less in tune with self, your needs, your body clues, and your impact on others Quick to make assumptions about others – Barrier to trust, seeing the world as adversarial to you versus something you can engage with. We want to be safe, right? Lack of Predictability in Behavior (Causes loop in service environments) Caused by having to be “prepared” regardless. Cannot stay organized, focused, paced, predictable… Client hypervigilance manifests in behavior and in service environment. The accumulation of multiple clients with this dynamic causes stress in staff. Staff then insert dysregulation into the environment and the clients are hyper-exposed. Circular milieu effect. Self Loathing, Self target of blame and shame. What is wrong with me? Instead of What is happening to me? Victim thinking - Loss of personal accountability – Negativity Does not value self. If I don’t matter, nothing in my life does either. Subconscious loop. Tendency to re-enact painful episodes (tethered to your past) Tendency to create a drama where there is not one Quick criticism, resolute judgment Resentment, bitterness & unresolved losses…
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When individuals who have grown up with high stress accumulation do not receive the supports they need to balance this condition; then they transmit the same problem onto the next generation and the accumulation process starts all over again. We all pay for this lack of investment. It shows up in our lives, in our families, in our schools, in our communities, in our treatment centers, in our cities, in our prisons, in our counties, in our states, in our emergency rooms, in our cemeteries, in our nation and beyond. Hundreds of billions of dollars annually support strategies that do not intervene early enough. This is not saying that we do not provide good care sometimes but the care that we do provide is too late, is not enough, is spilling into the next generation, is many times contributing to stress, is using out of date science and system delivery, and, misses too many people who would benefit from it.
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Break!
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The Adverse Childhood Experiences Study
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Adverse Childhood Experiences
Centers for Disease Control and Prevention & Kaiser Permanente Center for Preventive Medicine 1995 and 1997
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The Adverse Childhood Experiences (ACE) Study
Examines the health and social effects of ACEs throughout the lifespan Studied among 17,421 members of the Kaiser Health Plan in San Diego County.
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ACE Categories Recurrent physical abuse
Survey Question: Did you experience any of the following ten categories of risk prior to the age of 18? Recurrent physical abuse Recurrent emotional abuse Contact sexual abuse An individual with an alcohol and/or drug abuse problem in the household An incarcerated household member Someone with chronic and untreated mental illness Witnessed your Mother treated violently One or no parents Emotional Neglect Physical Neglect
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If you have 1, you are 95% more likely to have more than 1; if you have 2 you are 82% more likely to have more than 2….
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54-67% have at least 1
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If this were a Virus or some Contagion, we would already be working toward a solution…Ebola, Zika, Enterovirus, … Child Maltreatment affects 1.3 million children annually with over 3.3 million reports of investigated and confirmed maltreatment events
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First use of chemicals Brain chemistry structurally and chemically changes over time causing lack of normal function in the midbrain Once dependency has taken place people use just to feel normal
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THRESHOLD of TOLERANCE
A threshold is a point at which we perceive a stimulus and act on it. We are born with a large number of physical thresholds. We have a hearing threshold below which we cannot hear We have a noise threshold beyond which noise becomes intolerable We have a pain threshold beyond which we cannot tolerate pain We also have an emotional threshold. When we exit this band, we are no longer able to tolerate the emotional trigger we are experiencing….in other words, we are unable to use learned and skilled behavior strategies to cope with it. (Reminder: What part of the brain do we have to use when we access our learned coping skills?)
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Emotional Band Width Normal Range of Emotions – If they stay IN the Band, then you are able to cope, to apply skills, to stay “present”
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Emotional Band Width NO COPING SKILLS HERE!!! NO COPING SKILLS HERE!!!
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Threshold of Tolerance Emotional Band Width
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Emotional Band Width with Neurological Adaptation
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The Re-Enactment Triangle
PERSECUTOR RESCUER Talk about one of the MOST common traps we get into when we feel unsafe. We seek what is “known” for us…a place we go without thinking, an automatic respite. Unfortunately, we do not recognize that we are caught in a trap and dance around and around the triangle in one place after another of blame, self-loathing, fear, and pretense. TRAUMA DEMANDS REPETITION…. VICTIM
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The Re-Enactment Triangle
PERSECUTOR RESCUER The PERSECUTOR: When playing the “Persecutor” role we are operating from a position of some kind of power, tend to bully, find fault, accuse others, lead by threats, and are often blaming and shaming. EXAMPLES: VICTIM
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The Re-Enactment Triangle
PERSECUTOR RESCUER RESCUER: When in the Rescuer role, we are working hard to “help” someone else but are often feeling martyred, guilty, angry under the surface, and may be considered meddler by others. This role seeks control of others and believes that if they intervene they can CONTROL the outcome of someone else’s choices. This person many times flies under the radar…it is hard to find fault with someone who is constantly trying to “Help” everyone else. You often find repeating dramas in a household or workplace consistently surrounding this person. WHAT MAKES THIS DANGEROUS – As long as one person is in the triangle. They seek a RESCUER – Play victim and seek a rescuer or they turn persecutor and get you as a victim. VICTIM
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The Re-Enactment Triangle
PERSECUTOR RESCUER VICTIM: In the Victim role, we become helpless, incompetent, oppressed, and hopeless. EVERYTHING we do is because of what SOMEONE ELSE has done to us. The bottom line is that if we are a VICTIM, we are NEVER ACCOUNTABLE for our behavior. Our Bx is ALWAYS present because of SOMEONE ELSE and their SUPERIOR POWER OVER US and OUR LIVES. EXAMPLES: The person driving slow in front of us, the restaurant being out of the food we want the most, well, I wouldn’t be this way if you hadn't said what you said. This is just the consequence of your actions, so deal with it. NO ACCOUNTABILITY. DOES NOT MEAN you were never victimized, but it does mean you have taken on the persona of a victim and surrendered all your personal power over choice and life course. VICTIM
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BOUNDARIES & ACCOUNTABILITY
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My Stuff/Their Stuff MY PART THEIR PART Myths of Power…
PERSONAL POWER… EMPOWERMENT… OWNERSHIP… Where do I end and someone else begins? When am I accountable? When is someone else?
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EMPOWERMENT tr.v. em·pow·ered, em·pow·er·ing, em·pow·ers
1. To invest with power, authority. 2. To equip or supply with ability; enable
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THE POWER TO CHOOSE TRUST – IS IT EARNED?
Can we be perfect enough to earn it? Art of Language – Victim or Victimized? Am I a Survivor….a Thrive-r…. or a combination of many things that make up my past? TAKING CREDIT? Accountability? Courage? Do I matter enough to speak my truth? Do I have enough courage to speak it? Am I willing to take the consequences of doing it? Resentment? Bitterness? Regret? Anger? What is keeping me tied to my past? Why am I allowing that to continue?
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TRUST Is trust a choice or can it be earned? How might I think of trust differently in order to rebuild my sense of personal power?
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From Self Awareness to Self Management
Trigger Reaction PAUSE Self awareness is the first step in creating the PAUSE Knowing and owning triggers Self management creates space for the pause, resulting in having CHOICES on how to react
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Developing Emotional Literacy
Self Awareness Tool: Developing Emotional Literacy PRACTICE…PRACTICE…PRACTICE…. When you are safe, calm, and not needing the skill Then when you need the skill it is easier to access and perform… Recognizing a feeling as it happens is the keystone of emotional intelligence. Notice and name emotions – use emotional literacy list. (practice now) Create a time for daily check in on emotions and impact on self. Ask a partner or good friend to tell you what they see. Hand out feelings list and in pairs name what you are feeling now.
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SHAME v GUILT I have done something or thought something that is bad for me or others Versus I am bad I am worthless, I am not lovable
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Healing…must be more than just a focus on our brain and body…
Knowledge Spirit Skills
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Stress reduction practices: examples
Self-Awareness to Self-Value – Breathing Staying Present v Human Tendency Mind and Body work – Not just therapy Mindfulness Practices – All day long Physical activity – Throughout the day Practicing Safe Relationships – Circle v Desks and Tables Washington Ex – Cedar Instrument MDE recommendations for physical activity in the classroom Mind Up!Curriculumn Positive Discipline n the Classroom, Nelson, et al. Vickhoff, et. al. (2013) Music structure determines heart rate variability of singers. Frontiers in Psychology Vol 4, Art 334. doi: /fpsyg education.state.mn.us
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To Ponder… How was this information meaningful to you? What are some things you are already doing that reflect this information? What would you like to do using this information? What are some Action Steps you can take NOW that are cost neutral? What about those that have a cost? How do you use this information to empower yourself, your work, your clients, and your colleagues?
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Understanding Opportunities for Change
Understanding Opportunities for Change * How do we unpack all this and make it useful? * What is your action plan?
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POLICY Policy is symbolic Policy reflects the values, the moral imperatives, the boundaries and the code of the society in which it exists. Unintentionally, through apathy or worse, we allow our Policies to give our needs a last minute and glanced-over solution. Policy many times looks more like reactivity than responsiveness…it mirrors the level of crisis to which we have become accustomed. It mirrors our biological state.
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What might be Policy Barriers? Why?
Lack of Knowledge about the current science/conditions Lack of understanding on how this impacts our future Resistance to resourcing our social services appropriately – seen as either too much spending, inefficient spending, not enough data, outside the scope of their accountability, etc. Seeing potential solutions as a worse option to the bad option already being employed… Political/partisan gamesmanship Other – Put your local issue here __________ You are already giving tacit permission for billions of dollars in spending…don’t tell me another 250k is going to be against your moral code. Using the social welfare of our human population as bait is detestable.
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SYSTEM IMPROVEMENT Not system change or system transformation – that connotes nothing positive…let’s call it what it is… system improvement
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System Improvement Barriers?
Consider the barriers systemically New information tacked on an archaic system Expecting it to do something it was not designed to do Old, fragile infrastructure Traumatized by repeated failures operationally Compassion or Dis-compassion Fatigue Poor outcomes with current practices while demanding evidence based practices – irrational strategy Funding streams intended to ensure status quo Fear from the workplace – with innovation will their jobs be obsolete?
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Community Norms How do we change the way we think as a community? Do we know about this science at a community level? If we did, would we change how we live? Most change attempts to take place by top down strategies. This sounds good but it is very inefficient. Big systems are slow. They take a LONG time to turn around. So use a multi-modal approach instead. Also try not to say top down. That assumes someone is on the bottom. You will hear that this is too big, too complicated to address successfully. Yes, this is complex. So was the germ theory and we innovated successfully with that new science in a far more primitive society. Don’t let the enormity of the problem allow you and others to remain victimized by it.
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Barriers to improving Community Norms?
Debate of scarcity v plenty (Not enough time, money, energy to do anything new…) Historical Trauma – Lack of Trust Seeing our “part” in the greater picture Why does this matter to me? To us? What motivates us? Isolation practices increasing Community crime and terrorism have contributed to this immensely My children tried to use that on me about brushing their teeth and bathing. It is about priorities, not scarcity.
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Consider our Language and Values
Vulnerable Conditions not Populations The Language of SUD and MH Providers Community Organizing v Community Building Paternalism v Empowerment & Accountability Discussion of Resilience as a Long Range Solution Leaving out the strengths in an effort to spotlight a problem. What is our priority value as a community? A society? A system? Children abused every year, individuals waiting until they are sick or injured before we intervene, the Emergency Room philosophy of care…isn’t our human capital worth more than this?
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Community Workplace Health Critical Component
Must have not only PHYSICAL SAFETY, but EMOTIONAL and MORAL SAFETY. As systems transform they become stronger and at the same time exhausted. They need periods of rest, renewal, and patience. This “cover” needs to be built into the transformational process for change. Not that accountability disappears, but in fact, that there is space for excellence to emerge, accountability to be chosen v forced, and pride in our common values.
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Individual and Family Healing the existing adult population Creating an infrastructure that supports healthy child development from conception throughout the life-course.
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Barriers to Individual and Family Healing?
This is sobering information and many times the trauma we have faced will take years to adjust. This is scary work. It takes years and years of self-reflection, self-discovery, new levels of accountability, and thousands of positive change points in our life trajectory. What are my definitions? Do I consider healing to be a bad thing? A weak thing? Healing is a strength. It is necessary and natural. Our bodies grow and renew through healing every minute of every day. So then must our minds, spirits, relationships, communities, and systems.
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Seek IMMEDIATE Cost Neutral Strategies
WHAT DO YOU WANT or NEED TO TAKE THIS TO THE NEXT LEVEL? Find the two or three or four individuals/organizations that are committed. Set meetings on a regular schedule….coffee…before work after work…who can show up shows up. Commit to the Intention to pursue the spread and influence of this information. Seek existing vehicles or networks to pilot projects. Inform everyone throughout those networks – volunteer your time if necessary.
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Cost Neutral Strategies Continued…
GO DEEP INTO YOUR OPERATIONS… Inspect your Internal Codes of Ethics or Values, your Policies, the policies of your workplace, your community center, your state… Initiate Re-Assignment of Scopes of work internally to reflect changes Initiate Language changes, embed TIC in performance evaluations, org charts, etc… Inspect Practices (Staff Dev, Discipline, Interactions, Hierarchy, etc) Consistent Assessment of Progress
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Cost Neutral Strategies Continued…
Report to each other, keep a log of progress, use this when you engage in other networks. Avoid the choir for now… go to those who would never have a reason to know this information…talk about the risk of this being left unaddressed and how it impacts safe driving, following the law, being a good consumer, getting to work on time, lost days at work, poor employee performance, poverty, etc.
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CONSIDERATIONS in programs
What do your staff and administration need in order to move forward? Take an inventory. Solicit feedback from all staff, not just some. Program-wise…What do your students/clients need right away in order to make additional progress? What do their families need? How might you see your service population differently? What might you do to encourage safety in the service setting? Boundaries? Encourage safety in relationships? Encourage empathy in relationships? What activities might you incorporate into your existing schedule to move this goal forward? Think in terms of changing what is on your plate, not adding to it.
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Things to consider… Respect the time it will take to address our adult population living with unresolved or chronic spiritual, physical, and emotional wounds. Respect the investment it will require on all our parts to make this change. This is short and long term. It will not happen fast. Respect the change that will be required in our mental models and what that will require of all of us. We heal and improve together so that our children and our grandchildren might develop within the fullness of possibility and might draw more strength from their past than vulnerability.
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What is Resilience?
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In other words, resilience emerges from ordinary magic.
Resilience is common and… arises from …normal rather than extraordinary human capabilities, relationships, and resources. In other words, resilience emerges from ordinary magic. Ann Masten, 2009
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The Short List of building Resilience Factors for Children and Youth
Effective parents and caregivers Connections to other competent and caring adults Pro-social, competent peers and friends (What part of your brain would have to be engaged to have these skills or to be able to access them?)
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…. 4. Problem-solving skills 5. Self-regulation skills 6. Positive beliefs about the self 7. Beliefs that life has Meaning 8. Spirituality, faith and religious affiliations
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9. Socioeconomic advantages 10. Effective teachers and schools
… 9. Socioeconomic advantages 10. Effective teachers and schools 11. Safe and effective communities Ordinary Magic, Ann Masten, U of Minnesota
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We don’t want to just build resilience to handle more adversity… we want to build resilience in individuals and families WHILE reducing overwhelming stressors in society.
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Where we are historically Dr. John Snow – Father of Epidemiology Miasma? 1854 – Cholera outbreak London England Germ Theory proposed in but was not endorsed until the late 1880s with viruses not being discovered and confirmed until the 1890s.
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Our human capital is our most precious resource. Period. Not oil
Our human capital is our most precious resource. Period. Not oil. Not natural gas. Not even water or oxygen.
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‘ Thank you!
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Resources – Authors - Major Contributors
People to research and learn from: Robert Anda MD, Bessel van der Kolk MD, Sandra Bloom MD, Bruce Perry MD, John Briere, Christine Courtois Articles: Understanding Interpersonal Trauma in Children: Why We Need a Developmentally Appropriate Trauma Diagnosis D'Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., van der Kolk, B., 2012, Vol. 82, No.2, The Heart of the Matter: Complex Trauma in Child Welfare Spinazzola, J., Habib, M., Knoverek A., Arvidson, J., Nisenbaum, J., Wentworth, R., Hodgdon, H., Pond, A., Kisiel, C., CW360 Trauma-Informed Child Welfare Practice-Winter 2013, CASCS, University of Minnesota, pp. 8-9, 37. Disorders of Extreme Stress: The Empirical Foundation of a Complex Adaptation to Trauma, Journal of Traumatic Stress van der Kolk, Roth, Pelcovitz, Sunday, and Spinazzola, 2005, , Vol. 18, No. 5, October 2005, pp. 389–399 Posttraumatic Stress Disorder Treatment Outcome Research: The Study of Unrepresentative Samples Spinazzola, Margaret Blaustein, and van der Kolk, 2005, Journal of Traumatic Stress, Vol. 18, No. 5, October 2005, pp. 425–436 Phenomenology and Psychological Assessment of Complex Posttraumatic States Briere and Spinazzola, 2005, Journal of Traumatic Stress, Vol. 18, No. 5, October 2005, pp. 401–412
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Anda, R. F. , Felitti, R. F. , Walker,]. , Whitfield, C. , Bremner, D
Anda, R. F., Felitti, R. F., Walker,]., Whitfield, C., Bremner, D.]., Perry, B. D., Dube, S. R., & Giles, W. G. (2006). The enduring effects of childhood abuse and related experiences: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatric and Clinical Neuroscience, 256(3), Barfield, S., Gaskill, R., Dobson, C., & Perry, B. D. (submitted). Implementing the Neurosequential Model of Therapeutics© (NMT) with Filial Therapy in a therapeutic preschool setting: Implications for work with children with serious emotional disturbance. Perry, B. D. (2001) The neuroarcheology of childhood maltreatment: The neurodevelopmental costs of adverse childhood events. In K. Franey, R. Geffner, & R. Falconer (Eds.), The cost of maltreatment: Who pays? We all do (pp. San Diego: Family Violence and Sexual Assault Institute. Perry, B. D. (2006). The Neurosequential Model of Therapeutics: Applying principles of neuroscience to clinical work with traumatized and maltreated children. In N. B. Webb (Ed.), Working with traumatized youth in child welfare (pp ). New York: The Guilford Press. Perry, B. D. (2008). Child maltreatment: The role of abuse and neglect in developmental psychopathology. In T. P. Beauchaine & S. P. Hinshaw (Eds.), Textbook of child and adolescent psychopathology (pp. New York: Wiley.
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Resources – Online and In Person
CFHCC 40 W. 12th Street New York, NY (212) Collaborative Family Healthcare Coalition (CFHC) is a diverse group of physicians, nurses, psychologists, social workers, family therapists and other health care workers, working in both primary and tertiary care settings, who study, implement, and advocate for the collaborative family health care paradigm.
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Richard Davidson’s The Emotional Life of The Brain
Daniel Goleman Emotional Intelligence InsideOutcomes.biz Emotional Intelligence for Leaders Course The Whole Brain Child – D. Siegel, MD Building Resilience in Children and Teens – AAP, K. Ginsburg MD The Four Agreements – M. Ruiz National Scientific Council on the Developing Child Childstats.gov offers easy access to federal and state statistics and reports on children and their families, including: population and family characteristics, economic security, health, behavior and social environment, and education. National Child Traumatic Stress Network
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The International Society for Traumatic Stress Studies (ISTSS), founded in 1985, provides a forum for the sharing of research, clinical strategies, public policy concerns and theoretical formulations on trauma in the United States and around the world. ISTSS is dedicated to the discovery and dissemination of knowledge and to the stimulation of policy, program and service initiatives that seek to reduce traumatic stressors and their immediate and long-term consequences. ISTSS 60 Revere Drive, Suite 500 Northbrook, Illinois USA Phone: 847/ ; Fax: 847/ Centers for Disease Control and Prevention cdc.Gov
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Prevent Child Abuse America 200 S
Prevent Child Abuse America 200 S. Michigan Avenue, 17th Floor Chicago, Illinois (800) CHILDREN Tel: (312) Fax: (312) Child Welfare League of America 440 First Street, NW, Third Floor Washington, DC Tel: (202) Fax: (202) APSAC 407 South Dearborn Street Suite 1300 Chicago, IL The National Center for PTSD
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Websites and Online Learning:
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorder, Revised (DSM IV-R) 4th ed. Washington, DC: APA, 2000) Version Five (V) coming out 2013. Lise Addario, Six Degrees from Liberation: Legal Needs of Women in Criminal and Other Matters (Research and Statistics Report) (Ottawa: Department of Justice, 2002) Bruce Perry MD, Please feel free to research this website and Dr. Perry’s online course in trauma and brain development. Sandra Bloom MD,
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Karina A. Forrest Perkins MHR LADC
CEO | The Wayside House Founder | FTL Consulting
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