BRINGING ACES AWARENESS TO SONOMACOUNTY

TRAUMA IN

FORMED

T RAU

MA

RE S P O

NS I V

E

THE ADVERSE CHILDHOOD EXPERIENCES (ACES) STUDY 1995-1997

The largest study ever done to examine the health and social effects of adverse childhood experience over the life span.

17,000+ participants

Abuse

Psychological

Physical

Sexual

Neglect

Emotional

Physical

Household Dysfunction

Substance Abuse

Parent Absent

Mental Illness

Domestic Violence

Criminal Behavior

10 QUESTIONS/3 CATEGORIES

Abuse

Psychological 11%

Physical 28%

Sexual 21%

Neglect

Emotional 15%

Physical 10%

Household Dysfunction

Substance Abuse 27%

Parent Absent 23%

Mental Illness 17%

Domestic Violence13%

Criminal Behavior 6%

ORIGINAL FINDINGS

LOCAL HELPERS (BLUE RIBBON EVENT MAY 2015)Abuse

Psychological 11% 53%

Physical 28% 23%

Sexual 21% 28%

Neglect

Emotional 15% 25%

Physical 10% 12%

LOCAL HELPERS CONTINUED

Household Dysfunction

Substance Abuse 27% 51%

Parent Absent 23% 46%

Mental Illness 17% 47%

Domestic Violence 13% 16%

Criminal Behavior 6% 9%

CONCLUSIONS

Adverse Childhood Experiences are Common

ACEs occur together - If you have one ACE, there is an 87% chance that you have more than one.

The more ACEs you have, the higher the risk of physical, mental and social problems.

Adverse Childhood Experiences (ACEs)

THE # 1 CHRONIC HEALTH EPIDEMIC in the United States“The impact of ACEs can now only be

ignored as a matter of conscious choice.  With this information comes the responsibility to use it.” Anda and Brown, CDC

CHILDHOOD EXPERIENCES UNDERLINE CHRONIC DEPRESSION

CHILDHOOD EXPERIENCES VS. ADULT ALCOHOLISM

ACES AND UNEMPLOYMENT

Source: Soc Psychiatry & Epidemiology; Liu, et al., (2013)

ACES AND POPULATION ATTRIBUTABLE RISKS

ACE Score

Multiple Sexual

Partners*

3 or More

Marriages*

Had Unwanted Pregnancy* (abortion)

0 1.0 1.0 1.0

1 1.6 1.5 1.5 2 1.9 1.6 1.7

3 3.4 2.3 2.3 4 4.4 2.9 2.1

>5 5.8 3.8 2.9

HEALTH RISK BEHAVIORS: COPING MECHANISMS “Risk” behaviors begin as

survival skills for the traumatized child

Immediate psychological benefit as coping devices

When human interactions cannot induce reward, people turn to other ways of relieving distress

Yesterday’s solutions often cause problems today

USE DEPENDENT DEVELOPMENT

Plasticity: Capacity to adapt to environment

Patterned, repetitive activity reinforces formation of brain circuits

The most used areas of the brain are the most developed

When children live with fear, the areas of their brains controlling the fear response can become overdeveloped.

Earliest experiences have greatest impact as brain organizes around expected patterns

IMPACT OF TOXIC STRESS

Humans are designed to deal with intermittent stress, not chronic stress.

We were not designed to fight the tiger all day long!

In children, stress becomes toxic when it is not buffered by the comfort of a supportive adult.

Trauma and Toxic Stress cause

Changes in physiology

Changes in brain architecture

Changes in skills, abilities and behavior

Changes in health and mental health

WHAT

DOES T

HIS LO

OK

LIKE

IN S

ONOMA COUNTY

?

Results for Sonoma County● Napa/Sonoma data

combined● Estimated prevalence of

22% have 4 or more ACEs ● Increased risk for

depression, suicide attempts, drug and alcohol use, heart disease, stroke, COPD, diabetes, and Alzheimer's

ESPEC

IALL

Y FOR O

UR STU

DENTS

ACE ESTIMATES FOR CHILDREN IN SONOMA COUNTY

Based on the National Survey of Children’s Health, and estimated 3,011 children in Sonoma County had 5 or more ACEs in 2011/2012!

An additional 2,335 children had 4 ACEs

HOME ENVIRONMENT AND ACES (CA)

For all children, hours spent playing videogames and watching TV was significantly related to ACE scores.

For 6-17 year olds, school problems were significantly related to ACE scores. The higher a child’s ACE score, the more days of school were missed and the more disengaged children were with school.

CORRELATING ACES

For 6-17 year olds, adequate sleep was significantly related to ACE scores. The higher a child’s ACE score, the more sleep-deprived they were.

ACES AND SOCIAL ENVIRONMENTS

For all children, poverty and living in an unsupportive neighborhood were significantly related to ACE scores. The higher a child’s ACE score, the more impoverished a family was and fewer social supports were available in their neighborhood.

WHO IS IN YOUR CLASS?

The Story ofDaisy D Juan M

CONTEXT

Recent research on ADHD shows that even though children can have the gene for this disorder, how it expresses may be affected by adverse childhood experiences.  It is not a “context free condition.”

http://acesconnection.com

PRO-SOCIAL BEHAVIORS

The ability to form healthy relationships is dependent on learned social skills

Children’s social skill learning is directly related to the characteristics of their environments

Disordered environments = dysfunctional skillsViolence teaches withdrawal, anxiety, distrust, over –reaction and /or aggression as coping behaviors

TRAUMATIZED CHILDREN

Appear guarded and anxious

Difficult to re-direct, reject support

Highly emotionally reactive

Difficulty settling after outbursts

Hold on to grievances

May not take responsibility for behavior

Make the same mistakes over and over

TRAUMATIZED CHILDREN

See world as threatening and bewildering

World is punitive, judgmental, blaming, humiliating

Control is external, not internalized

People are unpredictable and untrustworthy

Defend themselves about all else

Believe that admitting mistakes is worse than telling the truth

STATE DEPENDENT FUNCTIONINGIn order to learn, we must vacillate between calm

and alertAlert: take in new concrete informationCalm: process, integrate and self soothe

Children coping with trauma have higher baselines: may enter classroom in state of alarm

Children coping with trauma are more sensitive to threat: seemingly benign triggers may escalate them into fear or terror

As arousal increases, reaction is orchestrated by increasingly lower parts of the brain.

Corresponds with sequence of development: when frightened, we all function as toddlers

RESILIENCE

Strength under adversity.

Resilience Through the Lifespan Study People are more resilient than we realize There are, however, limits to emotional endurance,

even for the most resilient among us. Human understanding can play a very important role in

determining who rises about life’s challenges, human misunderstanding can play a very important role in determining who succumbs.

For children/youth at risk for serious emotional, behavioral and learning problems, can simply going to school each day actually protect them from negative outcomes years down the road?

BUILDING RESILIENCE

The single most common factor for children who develop resilience is at least one

stable and committed relationship with an adult

This can be a teacher, coach or other school personnel

Nurturing and positive relationship with an adult who sees their strengths

A relationship as brief as one school year can make a dramatic lasting impact

TRAUMA RESPONSIVE

Resilience and context are inseparable.

In a environment that you perceive as dangerous and threatening, it makes no sense from a survival point of view to appear conspicuously vulnerable.

RESILIENCE IN CONTEXT

Environments that are safe, free from bullying

Differences are legitimized rather than stigmatized

Children and adults learn to see themselves through their strengths, not their challenges

Opportunity to learn to work hard and treat mistakes as learning experiences.

Good modeling

THE PROBLEM WITH PUNISHMENTChildren coping with trauma assume the

world is a dangerous place – perceive threat in benign situations

Children coping with trauma may try hard to appear in control even when feeling out of control (coping response to chaos at home)

Adult frustration and punitive reactions Strengthen the child’s expectations of confrontation and danger

Reinforce negative self-image

REWARD CONTINUUM

Children coping with trauma can be dysregulated by human interactions instead of regulated and rewarded

Diminishing reward options with shift up arousal continuum

Adult approval is not an adequate reward for a traumatized child or one that is hyper-aroused

Removal from the group is not an adequate consequence

PROMOTE SENSE OF SAFETY

Highly structured environmentPredictable schedulePredictable routinesPredictable consequences Predictable rewards

Zero tolerance for bullying

Alert children to loud noises before they occur

Adults are respectful, calm and confident

“Peace corner” in the classroom

RHYTHM AND REGULATION

Brainstem must be regulated before we can access cortex: somato-senseory – bottom up modulation

Brainstem regulates through patterned, rhythmic activity because it developed in-utero.

When we are highly aroused, we unconsciously self-soothe with rhythm: singing, walking, rocking, head banging, stereotyped behaviors

Use rhythm to regulate state of arousal – mirror their rhythm and use soothing tone of voice – to get child to alert state, then can use relational rewards.

TEACH EMOTIONAL REGULATIONChildren coping with trauma must learn

how to control their emotions, or they will “just keep loosing it”

Teach children to recognize their reaction to stress and to control it.

Ask: “You really looked stressed. On a scale of 1-10, where are you with your anger?”

Teach rhythmic and mindfulness based tools for modulating emotions

Deep breathing, rhythmic exercise

TEACH EMOTIONAL REGULATIONWeave social-emotional learning into

academic topicsEmpathy building exercises: ex - write a story about a typical day in your partner’s life

Classical music during independent work time

Opportunity for “fidgety” time during listening activities

Include time for physical activities: yoga, theater

Give children goal-directed tasks that involve movement – ex: passing out papers

SUPPORTIVE SCHOOLS

Has to be an organizational commitment to the policy or philosophy of TRAUMA INFORMED CARE

Staff should know prevalence, impact and have some strategies.

Environment – how to make it more inviting

Support with kindness and respect

Collaborative

Individualized

LINCOLN HIGH SCHOOL

2009-2010 (Before new approach)798 suspensions (days students were out of school)

50 expulsions600 written referrals

2010-2011 (After new approach) 135 suspensions (days students were out of school)

30 expulsions 320 written referrals

Movie – Paper Tigers

“No matter how many times you save the world, it always manages to get back in jeopardy again. Sometimes I just want it to stay saved! You know, for a little bit? I feel like the maid; I just cleaned up this mess! Can we keep it clean for...for ten minutes!" ~ Mr. Incredible

It’s like a client is standing in a river raging with current and has a boulder fall right in front of her and the resulting splash knocks her over. The boulder is trauma. The parent educator is standing some distance behind in the same river and experiences the after wave. It is smaller, it is nowhere near what the client experiences, but it is the same shape and nature…….” J Peters

WHAT IS THIS FEELING CALLED?

Compassion Satisfaction (the pleasure and joy found in working with and helping children and families.)vs.

Compassion Fatigue

Secondary Traumatic Stress – happens right after. Is a normal reaction to a not normal problem. Can occur right after hearing the story. Acute at first and then wanes over time.

Burn-Out – Often gradual onset of feelings. Associated with feeling hopeless or that job is too difficult. Can be associated with high work load or unsupportive environment.

Vicarious Trauma – Occurs over an extended period of time due to continued exposure to other’s suffering. More likely to occur if you relate it to your own history of trauma.

COMPASSION IS NOT BOUNDLESS

TRAUMA RESPONSIVE

Must include a supportive staff environment.

How do you recognize your own signs of stress or compassion fatigue?

Who can you go to for support?

Can you work with others who have the same goals?

RELAXATION EXERCISES

Why do relaxation exercises work?

Helps to change your physiology. When you are stressed, you are on guard for perceived threats. You have a negative bias. When you are less stressed, you are more in control and therefore can be more intentional and better at what you do.

Think of it not as stress management, but as self-management.

As you look at these exercises – make a note – do you think they would work well for you? For someone in your family? For a parent? For a child?

RELAXATION EXERCISES

Mental “Reset” Exercises Three Part Breath: Inhale-Hold-Exhale for equal counts. (3-11 minutes a

day, remember you can practice before you get up in the morning) 4-7-8 Breath: Inhale through nose for 4, hold for a count of 7, exhale

through the mouth (with a whoosh) for a count of 8.

Reverse Frustration/AngerCooling Breath: Inhale like sipping on a straw. Exhale

through nose.

Flush Negative Memories/Feeling ShameInhale 4 quick “segmented” breathes through nose.Exhale 1 breath with a “whoosh” through mouth.

RELAXATION EXERCISES

Anger Regulation Karate Chop –use hands in a chopping motion as fast and

vigorous as you can. Other activities include flicking and shadow boxing while thinking about what angered you. (Away from the source of anger!)

Relax to Release ControlInhale to a count of 3, exhale to a count of 6. Practice to

make your inhale/exhale longer, but both of the same length.

Relax to SleepIf you wake up at night, try left nostril breathing to put

you back to sleep.

RESOURCESwww.acesstudy.org

www.cdc.gov/violenceprevention/acestudy

www.acestoohigh.com and www.acesconnection.com/g/sonoma-county-aces-connection

www.communityresiliencecookbook.org

www.developiongchild.harvard.edu

http://www.ed.gov/news/press-releases/educators-gather-white-house-rethink-school-discipline

WWW.traumasensitiveschools.org

Grace Harris, MFT

Parent Resources Director

California Parenting Institute3650 Standish Avenue, Santa Rosa, CA

95407

Office: 707.585.6108 x1103  Fax: 707.585.6155

graceh@calparents.org    www.calparents.org