Module Three: Psychobiology: ACES and ProQol. A collaborative effort of Kaiser Permanente and The...
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Transcript of Module Three: Psychobiology: ACES and ProQol. A collaborative effort of Kaiser Permanente and The...
Traumatization occurs when both internal and external resources are inadequate to
cope with external threat.
Van der Kolk, 1989
A collaborative effort of Kaiser Permanente and The Centers for Disease Control
Vincent J. Felitti, M.D.Robert F. Anda, M.D.
THE RELATIONSHIP OF ADVERSE CHILDHOOD EXPERIENCES TO
ADULT HEALTH STATUS
CHILDHOOD ADVERSITY BY CATEGORIES(18 years or younger)
Abuse Household
Psychological (by parents) Substance Abuse
Physical (by parents) Mental Illness
Sexual (anyone) Parental separation/divorce
Emotional neglect Mother Treated Violently
Physical neglect Imprisoned Household Member
PERCENT OF PARTICIPANTS EXPOSED TO AT LEAST ONE ADVERSE
CHILDHOOD EXPERIENCE
67%
33%
Those reporting no exposure
Those reporting exposure to at least one ACE
Two Thirds of the participants had at least one adverse childhood event.
With such a large sample size, we might extrapolate…
ADVERSE CHILDHOOD EXPERIENCES (ACE STUDY)
ACE SCORE
These numbers may suggest that 2/3 of the U.S. population may have been exposed to at least one adverse childhood experience!
These numbers may suggest that 2/3 of the people who come to us for services may
have been exposed to at least one adverse childhood experience!
ACE StudyStrong, graded relation to childhood adversity in
childhood:
Smoking Attempted suicide
COPD Revictimization
Heart Disease Teen pregnancy
Diabetes Fractures
Obesity Promiscuity
Hepatitis Sexually transmitted disease
Alcoholism Poor job performance
Other substance abuse Poor self-rated health
Depression Violent relationships
ACES & INTERPERSONAL VIOLENCE
As the number of ACE increases the number of co-occurring or “co-morbid” conditions increases.
As the number of violent experiences increases, the risks of victimization among women and perpetration by men also increase by about 60% to 70%.
As the ACEs score increases the likelihood of revictimization – of being raped, of being assaulted - increases steadily
Early Death
DiseaseDisability
Social Problems
High Risk Behaviors
Social, Emotional, Cognitive Problems
Childhood Adversity
TRAUMA DISRUPTS ATTACHMENT
AND DISRUPTED ATTACHMENT WRECKS HAVOC WITH EVERYTHING ELSE
ATTACHMENT TRAUMA• Substantial• unplanned separation• Mental illness• Imprisonment• Substance abuse
Physical abuse Sexual abuse
Emotional abuseNeglect
Abandonment
ATTACHMENT TRAUMA
Attachment injuries that occur when an individual feels abandoned by an attachment figure at a time of crisis.
Loss of an attachment figure through death.
ATTACHMENT AND ABUSE(ALEXANDER, 1992)
Cessation of abuse does not necessarily change relational imbalances in family
Cessation of abuse does not change internal working model of relationships
This working model drives relationships and behavior
How to care for self and others
How to manage emotions
How to behave
What should be expected or anticipated
What to remember and what to forget
INTERGENERATIONAL TRANSMISSION
Early Death
DiseaseDisability
Social Problems
High Risk Behaviors
Social, Emotional, Cognitive Problems
Childhood Adversity
Out of 350 people working in social services
Psychological abuse (Parents) 37%Physical abuse (parents) 29%Sexually abused 25%Emotional neglect 35%Physical neglect 12%Substance abuser in household 40%Separated from one/both parents 41%Witnessed DV 21%Imprisoned household member 10%
It’s Not Just the Clients
DISCUSSION• What were the protective things in your lives that helped you become
who you are? • What do you think people need to recover from their experiences?
(Ex: structure, discipline, love, faith, etc.)• What we can offer our clients to help them be successful in our
program? • What are our hopes for our clients? What would recovery
or success in our program look like for them?
• How do we define it vs. how they might define it?
• What are some of the success you are most proud of in your work with our clients
THE SANCTUARY TOOLKITCom
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