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Children’s Resilience Initiative

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1 Children’s Resilience Initiative
One Community’s Response to Adverse Childhood Experiences: ACEs No text. Generously supported by the Gates Foundation


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 CP County of 58,800 Caucasian with ~25% Hispanic/Latino 3 colleges State Penitentiary Wine “takeover” in agricultural community with conservative history 1 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 degree Median home $180,000 Per capita income $33,059 Per household $44,000 Walatsa “running waters” 26th (of 39 counties) in size 1,271 sq mi “Cradle of PNW History”- early Tribes (Cayuse, WW, Umatilla) Lewis and Clark- 1805 Missionaries- Marcus Whitman s wars

5 A community response to Adverse Childhood Experiences
Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCE A community response to Adverse Childhood Experiences Broad-based CRI Team Raise awareness of ACEs Foster resilience Embed principles in the practice of organizations and programs Hands – 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 organization 5

6 To create a community conversant in ACEs and Resilience through:
Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCE Goal: To create a community conversant in ACEs and Resilience through: Community education Parent awareness Learning tools: -Interactive website -Deck of Cards -Parent Handbook -Coloring Book Over 300 presentations to individuals, agencies, parents and community organizations -Speakers’ Bureau to assist in presentations Trainings – 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 Bags WW 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 Metaphor This 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 EXPERIENCE ADVERSE CHILDHOOD EXPERIENCES STUDY Centers for Disease Control and Kaiser Permanente in San Diego, CA. 17,100 Adults Tracked health outcomes based on childhood ACEs We’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.

Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCE ADVERSE CHILDHOOD EXPERIENCES Child physical abuse Child sexual abuse Child emotional abuse Physical neglect Emotional neglect Mentally ill, depressed or suicidal person in the home Drug addicted or alcoholic family member Witnessing domestic violence against the mother Loss of a parent to death or abandonment, including abandonment by divorce Incarceration of any family member These 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 EXPERIENCE INTEGRATING BRAIN & EPIDEMIOLOGY RESEARCH Epidemiology Findings Brain Research Findings Maltreatment, trauma & Adverse Childhood Experiences Poor health & excessive use of healthcare systems Cognitive, social, behavioral & health outcomes (Brain Research & Epidemiological Findings) Predictable adaptation during brain development cause cognitive, social, & behavioral traits Integrating 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 Death Resilience is the key to countering this scenario!

11 Survival Mode Response
Children’s Resilience Initiative Survival Mode Response Stressed Can’t: Brains Respond Learn or Process effectively Allow time to de-escalate Remember 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

Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCE CONSEQUENCES OF BIOLOGICAL OUTCOMES COGNITIVE Slowed language development Attention problems (ADD/ADHD) Speech delay Poor verbal memory/recall Loss of brain matter/IQ SOCIAL Aggression & violent outbursts Poor self-control of emotion Can’t modify behavior in response to social cues Social isolation—can’t navigate friendship MENTAL HEALTH Poor social/emotional development Alcohol, tobacco & other drug abuse—vulnerable to early initiation Adolescent & adult mental health disorders—especially depression, suicide, dissociative disorder, borderline personality disorder, PTSD I 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-RELATED 54% of depression 58% of suicide attempts 39% of ever smoking 26% of current smoking 65% of alcoholism 50% of drug abuse 78% of IV drug use 48% of promiscuity (having more than 50 sexual partners) …are attributable to ACEs

Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCE A CLASSIC CAUSAL RELATIONSHIP MORE ACEs = MORE HEALTH PROBLEMS Increasing health issues Dose-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

Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCE LIFE LONG PHYSICAL, MENTAL & BEHAVIORAL OUTCOMES OF ACEs Alcoholism & alcohol abuse Chronic obstructive pulmonary disease & ischemic heart disease Depression Fetal death High risk sexual activity Illicit drug use Intimate partner violence Liver disease Obesity Sexually transmitted disease Smoking Suicide attempts Unintended pregnancy These 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 of co-occurring conditions from this list.

16 Children’s Resilience Initiative

Children’s Resilience Initiative ADVERSE CHILDHOOD EXPERIENCE What we see in this research… ACEs drive: Health outcomes & healthcare costs Special education needs Rates of school failure Intergenerational patterns of high-cost social problems Caseloads for the highest-cost social problems We 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

18 Website Landing Page

19 Children’s Resilience Initiative
PARENT TOOLS: Parent PowerPoints CRI Website facebook with weekly feature/blogs Deck of Cards and Parent Handbook Coloring Book Parent Tips New Baby Packet Models – Service & Resilience Speakers’ Bureau Paradigm Shift Trainings Resources Note: google analytics data (4 months 735 unique users w/ pages/visit and 6K page views) 19

20 “Through the lens of ACEs” with circle of services Resilience is the “heart” of the circle


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 DRAFT What is RESILIENCE? Adapted from the research of Masten; Brooks & Goldstein; Boss Ph.D The ability to recover from or adjust to change How? Give choices Give chores/affirmation Give opportunity for mastering skills Give sense of connecting to the world 1. Give Choices When 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 Chores Chores that tell a child: “Your contribution is necessary and valuable. We need you them do something here.” 3. Mastering Skills Mastery of skills that are complex and take time. Sports, music, chess. Not only do kids learn that their effort changes outcomes, but often these are learned in relationship with a competent, caring adult. Sense of connection beyond just self With 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 Blaustein Attachment - feeling connected, loved, valued, a part of family, community, world Regulation - learning about emotions and feelings and how to express them in a healthy way Competence - acting rather than reacting, accepting oneself and making good choices The 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 BUILDING Think: lack of skill not intentional misbehavior Think: building missing skills not shaming for lack of skills Think: nurture not criticize Think: teach not blame Think: discipline not punishment Reframe 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 alienation A 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 resilience 25

26 Children’s Resilience Initiative
One strategy for helping child identify emotional state Stress Zone Learning Zone Comfort Zone This 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!

27 Website Landing Page

28 Children’s Resilience Initiative
Models – Service & Resilience Speakers’ Bureau Paradigm Shift – Lincoln/Health Center Trainings Resources Recent examples in medical world: 1. American College of Obstetricians and Gynecologists (screen for intimate partner violence) 2. American Academy of Pediatrics- policy statement on “your new job is to reduce toxic 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 abuse FPC online training- $29 28

29 From the individual to the collective: lessons being learned
Children’s Resilience Initiative From the individual to the collective: lessons being learned Community mental models → emphasize understanding and sensitivity → trauma history Providers, parents, community → shame and blame → positive healing → social support → positive change A community can come together to work collectively to build resilience into the daily life experience of a child Summary If 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 Initiative One Woman’s Response to ACEs Minute

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:
Thank You! No text. Generously supported by the Gates Foundation 32

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