Adverse Childhood Experience (ACE)

& ResiliencyMatthew Doll, PhD

Heather Schmidt, DO

Strength-Based ModelNot asking “What’s wrong with you?” but asking, “What happened to you?”

Helps reframe people’s history so they know they were not born bad, that they are not responsible for their childhoods, and that they can have hope to change their lives and their children’s lives.

Personal responsibility with the power of self-understanding.

The Five Parts of ACE’s ScienceACE surveys - who, how many, with what consequences.

Toxic stress effects on the brainToxic stress effects on the bodyToxic stress passed from generation to generation

Resilience research

Trauma Derails DevelopmentExposure to trauma causes the brain to develop in a way

that will help the child survive in a dangerous world.Children with traumatic histories often operate within

“survival of the moment.”Higher order brain functions are temporarily put on hold.Verbal encoding may be put on hold.Actions and responses are generated at lower levels of

the brain (e.g. limbic system).Limbic system increases heart rate and blood pressure to

increase flow to muscles, so blood flow selectively diverted to parts of the body necessary to survival.

Stunning difference between a brain with proper stimulation and one that has been deprived. - Bruce Perry, Baylor College of Medicine

Relationships are the Basis of a Child's Stress Response System

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Child's Arousal Over Time with Attuned Caregiving

Relationships are the Basis of a Child's Stress Response System

Adapted from B. Perry, MD, PhD. (2009)

Put Simply…The pattern of fear, threat, unpredictability, frustration, chaos, hunger and pain over-stimulates the brain leading the child to develop a high-stress pattern.

Can be mitigated by individual difference in resiliency, supportive relationships.

Many adults continue to struggle unrecognized/untreated.

The Invisible SuitcaseTrauma shapes beliefs and experiencesAbout ourselvesAbout those who care for usAbout those we care forAbout the world we see

Attachment Earliest relationships critical for capacity to

self-regulate. Perspective taking - 10 out of 10 children

securely attached to mothers that can do this, versus one out of 17 that can’t.

Still Face Experiment (2:49) https://www.youtube.com/watch?v=apzXGEbZht0

Attachment, cont.Neglectful and traumatic early relationships set up a person to respond with dysregulation when “triggered” in subsequent relationships.

60 percent of the general population is thought to have disturbed attachment.

Remember - we can help each other here! Model and act with compassion.

Coping

Allostatic Load, Disrupted Neurological Development

Complex Trauma/ ACE

Race/Social Conditions/ Local Context

Generational Embodiment/Historical Trauma

ACE-Related Odds Of Having a Physical Health Condition

Health Condition 0 ACEs 1 ACEs 2 ACEs 3 ACEs 4+ ACEs

Arthritis 100% 130% 145% 155% 236%Asthma 100% 115% 118% 160% 231%Cancer 100% 112% 101% 111% 157%COPD 100% 120% 161% 220% 399%Diabetes 100% 128% 132% 115% 201%Heart Attack 100% 148% 144% 287% 232%Heart Disease 100% 123% 149% 250% 285%Kidney Disease 100% 83% 164% 179% 263%Stroke 100% 114% 117% 180% 281%Vision 100% 167% 181% 199% 354%Source: Iowa ACEs 360

“Male child with an ACE score of six has a 4,600 percent increase in likelihood of later becoming an IV drug user when compared to a male child with an ACE score of zero. Might heroin be used for the relief of profound anguish dating back to childhood experiences? Might it be the best coping device that an individual can find?”

(Felitti et al, 1998)

Harvard Report on Cancer Prevention, Cancer Causes and Control 1999;10:167.

ACE Study

Therefore…We need to presume the clients we serve(and ourselves) have a history of traumatic stress and exercise “universal precautions” by creating systems of care that are trauma informed. (Hodas, 2005)

Paper Tigers (2:11)

https://www.youtube.com/watch?v=iV3wzUhJSKs

Other Factors Influencing Stress

Sources of Resilience

TemperamentSocial-

emotional supportsLearned

social-emotional skills Caregiver

response

Other VulnerabilitiesTemperament

Delays in development

Limited social-emotional supports

AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013

Resources at Agnesian HealthCare

Wellness….. Integrated care The Zone & RMC Wellness Center Spiritual Care Services Behavioral Health Services Employee Assistance Program Health Resource Center at St. Agnes Hospital

Yoga classes Mindfulness classes Meditation classes Cooking classes And more!

Time to Think About Self-Care Own ACE score Vicarious trauma Have to care for self

when caring for others Belly breathing, four

square, lazy 8, Breath2Relax….

Safe place image Laugh….a lot!

What We Want To Do When people start escalating or display inappropriate

behaviors, be empathetic, be calm, show care and concern.

We want to ask questions - but not what we sometimes do, “Look at Henry, there he goes with his old tricks again.”

We want to ask: “What might we be doing that is triggering for him? What might we not be doing that could support him?”

The GoalThe entire community…

…integrates trauma-informed/resilience-building practices…

…based on ACEs science.

Current State Doll & Associates has been conducting ACE

assessments since 2014. There is much interest within Agnesian HealthCare:

Executive Team; Heather Schmidt, DO; Ed Kartheiser; Michael DeGere, DPM; Sr. Mary Mollison; Tiffany Parker; Jim Mugan

Community interest: Agnesian HealthCare Foundation grant to support FDLSD, Law Enforcement, Department of Social Services, Fond du Lac County, Jim Salasek facilitates regular meetings (CSIFDL.org).

Epigenics and Bob Marleyhttps://m.youtube.com/watch?v=uHAs0QkJ3dQ

1:22-2:39 1:17min

Discussion & Questions

Resources www.CSIFDL.org - Working for safe and healthy schools and communities

in Fond du Lac County. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Appro

ach - How an organization, system or service sector can become trauma informed.

www.ACEsConnection.com – A social network for people who are implementing trauma-informed and resilience-building practices based on ACEs research.

ACEsTooHigh.com - A news site for the general public. The CDC-Kaiser Permanente ACE Study - The official ACE Study site,

provided by the CDC. The Center on the Developing Child at Harvard University – Reports, tools

and videos about the neurobiology of toxic stress and resilience.