Overcoming Adverse Childhood Experiences: …...Overcoming Adverse Childhood Experiences: Creating...
77
Overcoming Adverse Childhood Experiences: Creating Hope for a Healthier Arizona Wildfire 2019 Annual Conference July 19, 2019 Marcia Stanton, MSW [email protected]
Transcript of Overcoming Adverse Childhood Experiences: …...Overcoming Adverse Childhood Experiences: Creating...
Overcoming Adverse Childhood Experiences: Creating Hope for a Healthier Arizona
Wildfire 2019 Annual ConferenceJuly 19, 2019
Marcia Stanton, MSW [email protected]
Scientific AdvancesAre driving a paradigm shift in understanding
how child development impacts human health and disease across the lifespan
Science is Clear• Toxic stress caused by
ACEs can profoundly alter the otherwise healthy development of a child
• “Children’s exposure to ACEs is the greatest unaddressed public health threat of our time.” Dr. Robert Block, former president, American Academy of Pediatrics
The Adverse Childhood (ACE) Study Experiences
"Probably the most important public health study most people never heard of.”
Your Awareness of ACE Study?
- No Knowledge- Some Knowledge- More Than Most- Expert
This Can Be a Tough Topic . . .
Take Care of Yourself
What are ACEs?
1) Abuse or Neglect
- Recurrent physical abuse
- Recurrent emotional abuse
- Sexual abuse
- Emotional or physical
neglect
2) Household Instability
- Alcohol or drug abuser
- Incarcerated household member
- Someone chronically depressed,
suicidal, institutionalized or
mentally ill
- Mother being treated violently
- One or no parents
Many Other Types of Trauma
– Poverty
– Extreme Illness or Injury
– Bullying
– Homelessness
– Growing Up in Foster Care
– Historical Trauma
– Community Violence
– Judged Unfairly on Race/Ethnicity, Gender Identity, Sexual Orientation, Place of Birth, Disability or Religion
QuestionWhat do you think is average ACE score children in Arizona?
Community Also Plays a Role
ACE Scores
• Think of ACE score as cholesterol score for
childhood trauma
• The more ACEs, the
greater the risk
ACE Scores
1/3 of Adults have
ACE Score of 0
Majority with ACE score of 0, have few, if any, risk factors for diseases that are common causes of death in US
• 4 or more may result in multiple risk factors for chronic diseases or disease themselves
• 6 or more may result in a 20 year decrease in life expectancy
4 or More ACEs
• Associated with significantly increased risk for 7 out of 10 leading adult causes of death:
- heart disease - COPD
- stroke - diabetes
- cancer - suicide
- Alzheimer's
With 0 ACEs
1 in 16 smokes
1 in 69 are alcoholic
1 in 480 use IV drugs
1 in 14 has heart disease
1 in 96 attempts suicide
With 3 ACEs
1 in 9 smokes
1 in 9 are alcoholic
1 in 43 use IV drugs
1 in 7 has heart disease
1 in 10 attempts suicide
With 7+ ACEs
1 in 6 smokes
1 in 6 are alcoholic
1 in 30 use IV drugs
1 in 6 has heart disease
1 in 5 attempts suicide
33%Report No ACEs
51%Report 1-3 ACEs
16%Report 4-10 ACEs
Out of 100 people…
Statistics from “The High Cost of Adverse Childhood Experiences compiled by Krista Goldstine-Cole, education director, Washington Family Policy Council
Poverty as an ACE• “Being poor is associated with so many
childhood adversities that it may be considered an ACE in itself, more pervasive and persistent than all others.”
• “Poverty acts as reinforcing mechanism, disproportionately burdening low-income families with stressors that give rise to adverse conditions, which then convey additional stress and cognitive dysfunction.”
N C Med J. 2018 Mar-Apr;79(2):124-126. doi: 10.18043/ncm.79.2.124
ACEs are Like an Oil Spill
ACEs are Interrelated and PredictiveWithout interruption, ACEs tend to escalate across generations
Timing is Important
• Adverse experiences 0 to 2 months predicted negative child outcomes
• Relational poverty 0 to 2 months also predicted negative outcomes
• Adverse experiences later in life predicted negative outcomes less strongly
• Perinatal developmental experiences more strongly associated with compromised current functioning than occurring other periods
• Current relational health - overall strongest predictor of outcomes
• Impact of early adversity may increase, not decrease, over timeBeyond the ACE score: Examining relationships between timing of developmental adversity, relational health and developmental outcomes in children, Hambrick, Erin P. et al., Archives of Psychiatric Nursing, Volume 33, Issue 3, 238 - 247
Problem . . . or Solution?• What are conventionally viewed as Public Health
problems, are often personal solutions to long concealed, embarrassing, and shame filled adverse childhood experiences By adolescence, children seek
relief:• Drinking alcohol• Smoking tobacco*• Sexual promiscuity• Using drugs* • Overeating/eating disorders• Delinquent behavior, violence• High-risk sports, etc.
*Note: nicotine and methamphetamines are anti-depressants
High Risk Teen Behaviors
• May not be core problem
• They may be coping devices
• A way to feel safe or just feel better
• Dismissing as “bad habits” or “self destructive behavior” misses their functionality
What We See
What We Don’t See
We need to ask “What happened first?”
ACEs Don’t Explain Everything
Many Individuals with High ACE Scores Do Nothave Poor Health Outcomes
2016 Natl. Survey of Children’s Health (Does not include child maltreatment or neglect)
• Nearly half – 34 million kids -at least 1 ACE
• 1 in 5 children - 2 or more• 1 in 7 children - 3 or more• Fewer than 2 in 5 flourish
with 2 or more ACEs
Child and Adolescent Health Measurement Initiative. Data Resource Center for Child and Adolescent Health. 2016 National Survey of Children’s Health (NSCH) data query. Retrieved [08/07dd/18] from www.childhealthdata.org. CAHMI: www.cahmi.org
Arizona Children, 0 – 172016-2017 National Survey of Children's Health
• Two + ACEs: 27%
•Natl. Average: 20%
Child and Adolescent Health Measurement Initiative. 2016-2017 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB). Retrieved [01/22/19] from www.childhealthdata.org. CAHMI: www.cahmi.org.
Arizona Children
• Ethnic minority children have disproportionately higher share of 6+ ACEs
• Estimated 69,213
have 5+ ACEs
AZ Kids with 5+ ACEs Would Fill State Farm Stadium
Or, Equal Population of Flagstaff
Poor Children More Likely to Have 3+ ACEs
ACEs in AZ Teens & Adults
8th,10th & 12th Graders
AZ Youth Survey:53% Adults Insulted Them
47% Parents Separated or Divorced
25% Lived with Alcoholic
23% Incarcerated Household Member
23% Lived with Adults Who Fought
17% Lived with Drug User
2016 Arizona Youth Surveyhttp://www.azcjc.gov/ACJC.Web/pubs/2016_Arizona_Youth_Survey_State_Report.pdf
ACEs in AZ Adults
AZ BRFSS:32% Verbal Abuse
26% Parents Separated or Divorced
22% Drinking Problem in Household
9% Incarcerated Household Member
16% Violence Between Adults
12% Drug Use in Household
2014-2016 AZ Behavioral Risk Factor Surveillance System
33
Getting It Right the First Time
• Creating the right conditions in early childhood is more effective and far less costly than addressing a multitude of problems later on
Consequences of Not Getting It Right
Economic Impact
• CDC - US lifetime costs based on substantiated cases of child maltreatment in 2015 - $428 billion annually
• Australia 2015 - unresolved childhood trauma in adults -$9.1 billion annually https://www.blueknot.org.au/ABOUT-US/Media/Blog/ID/123/ACEs-Reduce-Lifespan-Create-Economic-Impact-of-91-Billion
ACEs in the Classroom
Greatest single predictor for health, attendance and behavior
• Children with 4 or more ACEs - three times as likely to take ADHD medication compared with children with less than four ACEs (Ruiz "How Childhood Trauma Could Be Mistaken for ADHD", The Atlantic, 7 July 2014)
ACEs in Foster Care
• More than half of kids reported for child abuse experienced 4 or more ACEs by time of 1st contact
• More than 90% have multiple ACEs
(Nat’l Survey Child and Adolescent Well-Being (NSCAW), No. 20: Adverse Child Experiences in NSCAW, 2013)
ACEs are a Pipeline to Prison
Childhood and Adult Trauma Experiences of Incarcerated Persons and Their Relationship to Adult Behavioral Health Problems and Treatment) Intl. Journal of Environ Res Public Health. 2012 May; 9(5): 1908–1926. Published online 2012 May 18. Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense.
ACEs and Addiction
Findings suggest:• A major factor, if not the main
factor, underlying addiction is ACEs that have not healed and are concealed from awareness by shame, secrecy, and social taboo.
“It’s hard to get enough of something that almost works.” Vincent Felitti, MD
Children exposed to 5+ significant adversities in first 3 years face a
76% likelihood of having one or more delays in development.
Source: Center on the Developing Child Harvard University. InBrief: the Impact of Early Adversity on Children’s Development. StaBsBcs from research from Barth, et al. (2008)
How ACEs “Get Under the Skin”Toxic Stress
“Extreme, frequent or extended activation of the body’s stress response, without the buffering presence of a supportive adult.”Sara B. Johnson, et al., The science of early life toxic stress for pediatric practice and advocacy, 131 PEDIATRICS 319 (2013), available at http://pediatrics.aappublications.org/content/131/2/319.full
Toxic Stress Early in Development
• Affects functioning of 3 highly integrated systems:
– the immune system
– the neuroendocrine system
– the central nervous system (Danese & McEwen, 2012)
Children and Stress
• Biologically predisposed to more physiologic stress
• Brain structures that modulate stress mature later
• Young children need safe, stable, and nurturing relationships to assist in regulating their stress
6 Things That Impact Epigenetic Regulation
https://chronicleofsocialchange.org/news-2/nadine-burke-harris-spreads-message-impact-child-trauma
• Healthy Relationships
• Sleep
• Exercise
• Nutrition
• Mindfulness
• Mental Health Interventions
“The 4th Vital Sign”
1) Respiration 2) Heart Rate 3) Blood pressure
4) Relationships
To heal from toxic stress, children need recognition and understanding from their caregivers
Gold, C. (2016, March 27). Early Relationships: The Fourth Vital Sign: Caregiving relationships support lifelong health from the moment of birth. [Blog post]. Retrieved from https://www.psychologytoday.com/blog/child-in-mind/201603/early-relationships-the-fourth-vital-sign
Trauma Results in Over Activation of Stress Response (Hot) System
When Hot System Perceives Threat, it Responds with Survival Strategies
Hot System Behaviors are Unconscious, Automatic, Involuntary
Hand on Hot Stove
Is behavior a planned intentional response?
Trauma Informed ApproachSAMHSA
Realize Respond Resist Recognize
Widespread Impact of Trauma
Signs and Symptoms of Trauma
By Applying Understanding into Organizational Culture, Policies and Services
Re-traumatization
Principles of Trauma Informed Carehttps://www.samhsa.gov/samhsaNewsLetter/Volume_22_Number_2/trauma_tip/guiding_principles.html
Not “What’s Wrong with You?”
• Instead “What happened to you?”
• Symptoms are adaptations to trauma
• Shift from “The denial
stops here.” to “The
recovery starts here.”
Essential Interventions
• Avoid Activating Stress Response System
• Regulate Relationally
• Love and Relationship Before Rules -“Connection Before Correction”
• Create Environment of Felt and Real Safety
Essential Interventions
• Adults Must Regulate Themselves No Matter What Kids Do
• “Dysregulation is as infectious as the flu!”
Sad Not Bad
Universal PrecautionsPresume that every person in a treatment setting has
been exposed to abuse, violence, neglect or other traumatic experiences.
“Kid gloves not latex gloves”
Stacking the Scale• Positive influences “stack the scale” with positive
weight and optimize resilience across multiple contexts
Positive Factors That Counterbalance Adversity
https://developingchild.harvard.edu/science/key-concepts/resilience/
Facilitating Supportive Adult-Child Relationships
At Least 1 Stable, Caring and Supportive Relationship
Building Sense of Mastery Over Life Circumstances and
Perceived Control
Strong Executive Function and Self-Regulation Skills
Mobilizing Sources of Faith, Hope, and Cultural Traditions
Two Generation Approach
• Connect the Dots between Past, Present and Future
• Ex: Home Visiting, Head Start
Principles to Improve Outcomes for Children and Families
https://developingchild.harvard.edu/resources/three-early-childhood-development-principles-improve-child-family-outcomes/
Self-Care
How Childhood Stress Affects Health Across the Lifetime
https://www.ted.com/talks/n_trauma_affects_health_across_a_lifetime
January 21, 2019 – “California Governor Appoints State's First-ever Surgeon General”
"This story has had more impact on me than practically anything I've ever done.”Oprah Winfrey https://www.cbsnews.com/news/oprah-winfrey-treating-childhood-trauma/
The 3 R's - Regulate; Relate; Reason“Programs don’t heal people. Relationships heal people.”
Changing Minds Campaignhttps://changingmindsnow.org/
Healing Gestures:
• Inspire• Celebrate• Comfort• Listen• Collaborate
Sesame Street in Communities https://sesamestreetincommunities.org/
Initiative to Help Children Cope with Traumatic ExperiencesFree Bilingual Resources for Parents and Professionals
“The more healthy relationships a child has, the more likely he will be to recover from trauma
and thrive.”― Bruce D. Perry, The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook
“When a flower doesn’t bloom, you fix the environment in which it grows, not the flower.” - Alexander den Heijer
ACEs Often Last a Lifetime . . . But They Don’t Have To
• Healing can occur
• The cycle can be broken
• Safe, stable, nurturing relationships heal
“In my end is my beginning.” ~ T.S. Eliot, Four Quartets
“It is easier to build strong children than to repair broken men” ~ Frederick Douglass (1817-1895)
