3 Children’s Resilience Initiative Children’s Resilience Project Washington State included the ACE survey as part of its Behavioral Risk Factor Surveillance Survey (BRFSS) through the Department of Health, funded by The Gates Foundation.We will now have a better understanding of our State’s health outcomes, rather than relying on San Diego’s data set.Now, CRI is funding the research to gather the ACE score for Walla Walla County. Pierce County and Whatcom County will also soon have their own ACE scores.(Washington Data: statewide and 3 counties)62% of Washington adults who responded to this survey acknowledged at least one ACE, 25% acknowledged 3 or more, 5% report 6 or more.One estimate suggests a typical Washington State classroom would have 43% of students experiencing 3 or more ACEs. Even if YOUR child has no ACEs, the chances are that their friends and classmates DO.Of concern to us as parents are the # experiencing verbal abuse (33%) which is the most damaging of the ACEs ; the # experiencing divorce 21% - (national data suggests these youth are more likely to drop out of school or experience teen pregnancy than there counterparts, and in WW, we have very few services to help children going through parental divorce)3
4 Demographics:City of 31,670 (54% of County pop); 8,780 in CPCounty of 58,800Caucasian with ~25% Hispanic/Latino3 collegesState PenitentiaryWine “takeover” in agricultural community with conservative history1 in 4 children live in poverty, 1 in 5 in hidden poverty; F& R luch rates vary from 45-92% (2009 figures)65% have HS degreeMedian home $180,000Per capita income $33,059Per household $44,000Walatsa “running waters”26th (of 39 counties) in size 1,271 sq mi“Cradle of PNW History”- early Tribes (Cayuse, WW, Umatilla)Lewis and Clark- 1805Missionaries- Marcus Whitman s wars
5 A community response to Adverse Childhood Experiences Children’s Resilience InitiativeADVERSE CHILDHOOD EXPERIENCEA community response toAdverse Childhood ExperiencesBroad-based CRI TeamRaise awareness of ACEsFoster resilienceEmbed principles in the practice of organizationsand programsHands – how many are familiar with the ACEs research done by the CDC and Kaiser Permanente in San Diego?Research done in the late 1990’s which correlated ten specific experiences in childhood with adulthood health and behavior problems. The CRI effort developed as a community initiative to raise awareness of the potential devastating effect of these ACEs, their impact on brain development in childhood and ways to foster resilience in our children and adults. Embed principles into existing providers- we are not an organization5
6 To create a community conversant in ACEs and Resilience through: Children’s Resilience InitiativeADVERSE CHILDHOOD EXPERIENCEGoal:To create a community conversantin ACEs and Resilience through:Community educationParent awarenessLearning tools:-Interactive website-Deck of Cards-Parent Handbook-Coloring BookOver 300 presentations to individuals, agencies, parents and community organizations-Speakers’ Bureau to assist in presentationsTrainings – both ACEs primary researchers plus conferences and trainings focusing on Complex Trauma for school staffs AND general community. Entire WWPS staff given a half day to attend training on the brain and trauma impact. (Unanimous vote of School Board)-Materials adapted for use in Home Visits, birthing classes and Baby BagsWW Valley – 25% Latino – Materials are in Spanish & English- Developed tools*Website developed with portals for parents, providers and community members (WE WILL SHOW YOU THE WEBSITE A LITTLE LATER ON)*Facebook Page*Playing Cards & Handbook - ACEs & Resilience – Spanish & English* Coloring Book-6
7 Iceberg MetaphorThis slide depicts the amount of beliefs, assumptions, values, mental models that are under the surface. Without recognizing them, they influence everything we think – prior to change, we must see the lens through which we see! The part of the iceberg we see is actually supported by the 95% of the iceberg we don’t see. If we respond to only the 5%, we miss responding to what is really happening at the surface. Same analogy for health and community: do we react to the behavior (the 5% we see but spend 95% of our effort on) or deal with the root causes (the 95% of the reason)? This research challenges us to re-think our assumptions and the lens through which we view the world
8 Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCEADVERSE CHILDHOOD EXPERIENCES STUDYCenters for Disease Control and Kaiser Permanente in San Diego, CA.17,100 AdultsTracked health outcomes based on childhood ACEsWe’re going to change gears to a different body of research.This is epidemiological research. Epidemiology studies how disease moves across and affects the population as a whole.It can be challenging to think in terms of the whole population because we all know individuals who don’t fit the mold.Still, it’s important to think about the population as a whole because, when we make public policy, we have to think from this perspective.This study, called the adverse childhood experiences study, was conducted between 1994 and 1997 by the Centers for Disease Control and Kaiser Permanente San Diego. There were over 17,000 participants in the study.Each participant was asked 70 questions about their childhood experiences and then their health records were used to identify health outcomes.The adverse childhood experiences questions came from existing standardized instruments. The researchers did not make up their own new ideas about what is child abuse or domestic violence, they used existing tools in those fields.If you would like to see more details about the study, you can go to the Centers for Disease Control web site and search for the ACE study. The address is back on the second slide. You’ll find that there have been over 60 peer-reviewed scientific articles written from this data.
9 ADVERSE CHILDHOOD EXPERIENCES Children’s Resilience InitiativeADVERSE CHILDHOOD EXPERIENCEADVERSE CHILDHOOD EXPERIENCESChild physical abuseChild sexual abuseChild emotional abusePhysical neglectEmotional neglectMentally ill, depressed or suicidal person in the homeDrug addicted or alcoholic family memberWitnessing domestic violence against the motherLoss of a parent to death or abandonment, including abandonment by divorceIncarceration of any family memberThese are the Adverse Childhood Experiences researchers asked about.In the first wave of the study—about 8,000 people, they only asked about 8—they didn’t include neglect. In the next wave, they did ask about neglect. So in some of the data, you see 8 and some you see 9 or 10. That’s the difference – we’ve included physical and emotional neglect.The researchers did ask about severity of abuse, duration and other kinds of questions that are important to folks working in child safety. But when it comes to health outcomes, they found that what matters is the number of kinds of adverse childhood experiences.Each of the 9 was worth one point. If a participant in the study had an alcoholic mom and a drug addicted dad, they got one point for substance abuse in the family. Even if they were physically abused on 20 occasions, they got one point. Because in the end, the data said clearly that the most profound health effects come from having multiple forms of adverse childhood experience.As we begin to look more deeply at the results, I want to acknowledge that this information can be hard for us. It can be hard for several reasons. First, as parents, aunts, uncles and grandparents we sometimes worry that our actions will have a lasting, negative effects and this study can amplify that worry. Second, this data can make us sad. Even if our own children are fine, and even if we don’t have children, we all know about others in our community who are struggling, and this can bring us great sadness. And third, we all know, and this study reminds us, that at least half of the people in this room have had adverse childhood experiences. So it’s tough to hear the data. I want you to know that you can—and should—do whatever works for you if you find yourself overwhelmed by this information. You may cry or leave the room, what ever works. Over 2,000 Washingtonians have seen this Power Point. And as a rule, they have reported that they feel liberated. It helps to know, “Oh yes, these things in my life are connected. That’s what happened.”
10 Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCEINTEGRATING BRAIN & EPIDEMIOLOGY RESEARCHEpidemiology FindingsBrain Research FindingsMaltreatment, trauma & Adverse Childhood ExperiencesPoor health & excessive use of healthcare systemsCognitive, social, behavioral & health outcomes(Brain Research & Epidemiological Findings)Predictable adaptation during brain development cause cognitive, social, & behavioral traitsIntegrating brain and epidemiology research creates a valuable picture.Trauma in childhood affects brain development in predictable ways. The ways that brains are altered by trauma impacts thinking, learning, behaviors, relational experience and health throughout the lifetime. Emphasize link to violence between childhood trauma and adult behaviors.Both the brain researchers and the epidemiological researchers have found causal links between trauma and health outcomes.Epidemiologist have found causal relationships between adverse childhood experiences and lifelong mental, physical and behavioral health challenges, healthcare use, and early death.Early DeathResilience is the key to countering this scenario!
11 Survival Mode Response Children’s Resilience InitiativeSurvival Mode ResponseStressedCan’t:BrainsRespondLearn orProcess effectivelyAllow time to de-escalateRemember we said there are over 100 chemicals and hormones running around in our brain at any given time?Under stress, as we said before, a brain goes to “Fight, flight or freeze” mode- our basic survival response where everything shuts down except that primal response mechanism. One of the most important take home messages we hope you leave with is, DON’T ATTEMPT TO SOLVE ISSES WHEN YOU OR YOUR CHILD ARE IN A STRESS RESPONSE PATTERN. Walk away, calm down, use the Jim Sporleder bull’s eye red zone idea, anything to allow all those chemicals to drain, so you and your child can then talk, when neither of you are in the red zone!11
12 CONSEQUENCES OF BIOLOGICAL OUTCOMES Children’s Resilience InitiativeADVERSE CHILDHOOD EXPERIENCECONSEQUENCES OF BIOLOGICAL OUTCOMESCOGNITIVESlowed language developmentAttention problems (ADD/ADHD)Speech delayPoor verbal memory/recallLoss of brain matter/IQSOCIALAggression & violent outburstsPoor self-control of emotionCan’t modify behavior in response to social cuesSocial isolation—can’t navigate friendshipMENTAL HEALTHPoor social/emotional developmentAlcohol, tobacco & other drug abuse—vulnerable to early initiationAdolescent & adult mental health disorders—especially depression, suicide, dissociative disorder, borderline personality disorder, PTSDI have shown you the regions of the brain know to be affected by child maltreatment.Based on what those parts of the brain do, here is a portrait of what we might expect for traumatized children.Effects are really seen in 3 domains—cognitive (that’s thinking and learning), social skills and mental health.Dr. Teicher’s work has documented language delay, aggression, social isolation and poor mental health. Other studies we’ll look at today have similar findings.What we want to take note of is what the study tells us about why. Many of us have the mental model that traumatized kids learn to behave aggressively when adults are aggressive with them. And there may be some truth to that. But in addition the brain research teaches us that there are physical things that happen to the brain and to the brain chemistry that prime the traumatized child to be aggressive, to behave as if the world is malevolent and survival depends on being aggressive first and thinking about it later.We may need to change our thinking here so that we don’t think about aggressiveness as a learned behavior and instead we think about how to help a person who is hard wired for a dangerous world to take characteristics of impulsiveness and aggressiveness and hone those into skills of quick and decisive leadership.
13 Children’s Resilience Initiative A significant portion of Health Issues across the population is ACE-RELATED54% of depression58% of suicide attempts39% of ever smoking26% of current smoking65% of alcoholism50% of drug abuse78% of IV drug use48% of promiscuity (having more than 50 sexual partners)…are attributable to ACEs
14 A CLASSIC CAUSAL RELATIONSHIP MORE ACEs = MORE HEALTH PROBLEMS Children’s Resilience InitiativeADVERSE CHILDHOOD EXPERIENCEA CLASSIC CAUSAL RELATIONSHIPMORE ACEs = MORE HEALTH PROBLEMSIncreasing health issuesDose-response is a direct measure of cause & effect.The “response”—in this case the occurrence of the health condition—is caused directly by the size of the “dose”—in this case, the number of ACEs.The relationship between adverse childhood experiences and health problems is a dose-response relationship. That is, the bigger the dose of ACEs, the bigger the number of health problems.We all understand this relationship. If you give your car a bigger dose of gas, you can drive more miles. If you get a bigger dose of money from your job, you can spend more at the mall.When the population has a bigger dose of adverse childhood experience, there is more disease.Increasing ACE score
15 LIFE LONG PHYSICAL, MENTAL & BEHAVIORAL OUTCOMES OF ACEs Children’s Resilience InitiativeADVERSE CHILDHOOD EXPERIENCELIFE LONG PHYSICAL, MENTAL & BEHAVIORAL OUTCOMES OF ACEsAlcoholism & alcohol abuseChronic obstructive pulmonary disease & ischemic heart diseaseDepressionFetal deathHigh risk sexual activityIllicit drug useIntimate partner violenceLiver diseaseObesitySexually transmitted diseaseSmokingSuicide attemptsUnintended pregnancyThese are the disease and health outcomes known to have a dose response relationship with adverse childhood experience.This list comes from the Centers for Disease Control web site.If you read the literature, you’ll also find a dose response relationship with 3 or more marriages, skeletal fractures, hallucinations that cannot be attributed to drug use, anxiety and a few others as well.Let me give you some examples of how big the connection is.The higher the ACE Score, the greater the incidence ofco-occurring conditions from this list.
17 ADVERSE CHILDHOOD EXPERIENCE Children’s Resilience InitiativeADVERSE CHILDHOOD EXPERIENCEWhat we see in this research…ACEs drive:Health outcomes & healthcare costsSpecial education needsRates of school failureIntergenerational patterns of high-cost social problemsCaseloads for the highest-cost social problemsWe also see that we can prevent and protect children from ACEs.We have the power to reduce ACEs in the next generation, and the privilege of helping people with many ACEs to live joyful and fulfilling lives.Child maltreatment and other adverse childhood experiences are driving the pattern of escalating costs in our health, education, justice and social services systems.This brain research and epidemiological research helps us deepen our understanding. It gives us a spring board. It invites us to talk, consider, develop ideas and act so that every family and every child in Washington has the opportunity to thrive, and to make a contribution to the community and the economy, regardless of the path they start out on.ANNETT CLIP
22 Five Road Signs: Strengthening Families Framework Strengthening Families- National Resource Center for Community-Based Child Abuse Prevention (DHHS)Five Road Signs: Strengthening Families Framework
23 Children’s Resilience Project Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCE DRAFTWhat is RESILIENCE?Adapted from the research of Masten; Brooks & Goldstein; Boss Ph.DThe ability to recover from or adjust to changeHow?Give choicesGive chores/affirmationGive opportunity for mastering skillsGive sense of connecting to the world1. Give ChoicesWhen we give kids choices—and act on them—they gain some sense of control. We may not be able to get parents to do this, but we may be able to build it in to our other contacts with kids.Give ChoresChores that tell a child: “Your contribution is necessary and valuable. We need youthem do something here.”3. Mastering SkillsMastery of skills that are complex and take time. Sports, music, chess. Not only dokids learn that their effort changes outcomes, but often these are learned inrelationship with a competent, caring adult.Sense of connection beyond just selfWith all the things that paint a grim picture, it’s really important to talk about resilience.What fosters resilience?How do we accent the positive?By helping kids develop the skills, characteristics and attributes that are necessary to adapt to the environment as it changes and as it challenges.
24 Children’s Resilience Initiative Three basic building blocks to success:Adapted from the research of Dr. Margaret BlausteinAttachment - feeling connected, loved, valued, a partof family, community, worldRegulation - learning about emotions and feelings andhow to express them in a healthy wayCompetence - acting rather than reacting, acceptingoneself and making good choicesThe Boston Trauma Center, a leading organization in the field of trauma work, has developed a scheme made up of three building blocks – Attachment, Regulation and Competence.24
25 Children’s Resilience Initiative SKILL BUILDINGThink: lack of skill not intentionalmisbehaviorThink: building missing skills not shamingfor lack of skillsThink: nurture not criticizeThink: teach not blameThink: discipline not punishmentReframe the misbehavior as possibly due to a lack of skills in areas such as impulse control, problem solving and empathy. Reframe as “skills deficit “ rather than purposeful behavior. This can lessen anger and punitive action (punishment) and instead invite interventions to develop and fortify the missing skills (Brooks 2012).ANYONE (parent, teacher, staff administrators) must be involved in the process of nurturing a caring and respectful environment)- the MOST powerful new data indicates NURTURING is #1 in buffering ACE. Care and respect outweigh feelings of anger, blame and alienationA main goal of discipline is to promote self-discipline. Ask child (student) to help create the rules and consequences, that empowers the child and provides a sense of ownership and personal control- major building blocks of resilience25
26 Children’s Resilience Initiative One strategy for helping child identify emotional stateStress ZoneLearning ZoneComfortZoneThis idea is from Jim Sporleder, the principal of our Alternative High School. He uses it to help kids learn to identity and express where they are in their “emotional climate”. If he sense they are in the red zone, he reminds the student that stressed brains can’t process well, so he encourages the opportunity to de-escalate. He finds that students become MORE responsible as a result, because he is raising the student’s level of perception and awareness, to where the student can then respond proactively, rather than reactively. He finds a higher level of accountability as a result. He has used the bull’s eye himself, and excused himself from a conversation if he feels he is getting a button pushed beyond his ability to cope too, so he acts as a great role model in using himself as the “I need a time out to de-escalate” moment. Out of school suspensions dropped from 800 to 135 as a result of Jim’s new understanding of looking at a student “through the lens of ACEs” and with respect for trauma history. He sees an increase in accountability and consequences, not a decrease. Discipline referrals are down by over 40%. This is truly a paradigm shift in action!!Great for role modeling too!
28 Children’s Resilience Initiative Models – Service & ResilienceSpeakers’ BureauParadigm Shift – Lincoln/Health CenterTrainingsResourcesRecent examples in medical world:1. American College of Obstetricians and Gynecologists (screen for intimate partnerviolence)2. American Academy of Pediatrics- policy statement on “your new job is to reducetoxic stress” to protect fragile developing brains. Emphasizes take an active leadership role in educating everyone about long-term consequences of …3. American Academy of Neurology: dysfunction related to maltreatment; screen for abuseFPC online training- fpc.wa.gov $2928
29 From the individual to the collective: lessons being learned Children’s Resilience InitiativeFrom the individual to the collective: lessons being learnedCommunity mental models → emphasize understanding and sensitivity → trauma historyProviders, parents, community → shame and blame → positive healing → social support → positive changeA community can come together to work collectively to build resilience into the daily life experience of a childSummaryIf you walk out of here with three messages in your mind, we suggest they be these three.And finally, parenting is the hardest job you’ll ever have! Don’t be afraid to ask for help! We are all in this together! We can only advance when we feel safe, and having a good network is part of that!
30 One Woman’s Response to ACEs Children’s Resilience InitiativeOne Woman’s Response to ACEsMinute
31 Children’s Resilience Initiative Empowering community understanding of the forces that shape us and our children:For further information, please contact:Teri Barila, Walla Walla Community Network(509)Mark Brown, Friends of Children of Walla Walla(509)31
32 Children’s Resilience Initiative Website: www.resiliencetrumpsaces.org Thank You!No text.Generously supported by the Gates Foundation32