Children’s Resilience Initiative
One Community’s Response to ACEs
through Resilience
Indiana Caring for Youth Symposium
May 22, 2013
Our Goal Today
To explore the impact of
Resilience– the
powerful force that
can drive action
forward for our
community–
within the context of
ACEs, brain
development, and
health outcomes.
Children’s Resilience Initiative
Key learning:
• How
daily childhood experiences affect how the
brain develops
• How that shapes who we become as adults and
what kind of life we have
• That early negative experience is not fate,
that an ACE score is not a life sentence
• That we can help our children develop the
resilience to rise above life’s challenges
• There is a very real promise of hope and healing
A community response to
Adverse Childhood
Experiences
• Broad-based Children’s Resilience Initiative
(CRI) Team
• Raise awareness of ACEs
• Foster resilience
• Embed principles in the practice of organizations
and programs
Making all of our systems traumainformed is a social movement. It
addresses a big missing piece of
human rights.
Children are safer when they
have value. A community’s
norms and values about how
adults respect children provide
stronger safety nets than law
enforcement can do alone.
Adverse Childhood
Experiences
(ACE) Study
Centers for Disease Control and Kaiser Permanente
HMO in San Diego, CA.
17,300 Adults
Tracked health outcomes based on childhood ACEs
75% Caucasian, 39% college graduates, 36% some college,
living wage jobs with insurance; median age 57 yr. old
Adverse Childhood
Experiences
(ACE) Study
Centers for Disease Control and Kaiser Permanente
HMO in San Diego, CA.
17,300 Adults
Tracked health outcomes based on childhood ACEs
75% Caucasian, 39% college graduates, 36% some college,
living wage jobs with insurance; median age 57 yr. old
ADVERSE
CHILDHOOD
EXPERIENCE
Children’s
Resilience
Initiative
INTEGRATING BRAIN & EPIDEMIOLOGICAL RESEARCH
What are the
Adverse Childhood Experiences?
1. Child physical abuse
2. Child sexual abuse
3.
4.
5.
6.
Child emotional abuse
Physical Neglect
Emotional Neglect
Mentally ill, depressed or suicidal person in the home
7. Drug addicted or alcoholic family member
8. Witnessing domestic violence against the mother
9. Loss of a parent to death or abandonment, including
abandonment by divorce
10. Incarceration of any family member
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
Response gets bigger
Dose-Response Relationship:
More ACEs = More Disease
Dose gets bigger
Higher ACE Score Increases
Smoking
6 of 100 people with 0 ACEs smoke
11 of 100 people with 3 ACEs smoke
17 of 100 people with 7 ACEs smoke
ACE Score Increases Suicide
Attempt
1 of 100 people with 0 ACEs attempt suicide
10 of 100 people with 3 ACEs attempt suicide
20 of 100 people with 7 ACEs attempt suicide
Life-long Physical, Mental & Behavioral
Health Outcomes Linked to ACEs
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Alcohol, tobacco & other drug addiction
Auto-immune disease
Chronic obstructive pulmonary disease & ischemic heart disease
Depression, anxiety & other mental illness
Diabetes
Multiple divorces
Fetal death
High risk sexual activity, STDs & unintended pregnancy
Intimate partner violence—perpetration & victimization
Liver disease
Lung cancer
Obesity
Self-regulation & anger management problems
Skeletal fractures
Suicide attempts
Work problems—including absenteeism, productivity & on-the-job injury
A Significant Portion of Outcomes
is Attributable To ACES
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 (≥ 50 sexual partners)
(based on females in original study)
Population
Attributable
Risk- WA
State Data
Percentage of
ACE impact
to sectors
of life and
society
• 62%: at least 1 ACE
• 25%: 3 or more ACE
• 5%: more than 6
• Cluster/co-occur
87%
with 1 ACE
have another
• 1 in 3 Emotional Abuse
• 1 in 4 Sexual Abuse
• > 1 in 5 Substance Abuse
• > 1 in 5 Loss of Parent
• 1 in 7 Mental Illness
• 1 in 7 Physical Abuse
• 1 in 8 DV
ACEs & Disability
Child
Abuse
High ACE
Score
High ACE
Score
Permanent
Disability
Permanent
Injury
Substance
Abuse
On-the-Job
Injury
Anxiety, Depression,
Other Mental Health
Disorder
Temporary
Disability
from Work
Intermittent
Disability
The truth about childhood is stored up in our
bodies and lives in our souls. Our intellect
can be tricked, our feelings can be numbed
and manipulated, our perception shamed and
confused, our bodies tricked with medication,
but our soul never forgets. And because we
are one, one whole soul, in one body,
someday our body will present its bill.
~ Alice Miller
Closing thoughts on
ACE Study
• The science behind this is fact
• “Witness” phenomenon
• 35% reduction in office visits
• 11% reduction in ER visits
• 80% of diagnostics is family history
• AMA and Three National Academies
• Hope, healing and a future
BRAIN RESEARCH:
THE NEUROBIOLOGY OF
MALTREATMENT
See for example: “Neurobiological and Behavioral Consequences of Exposure to Childhood Traumatic
Stress,” Stress in Health and Disease, BB Arnetz and R Ekman (eds). 2006. Martin Teicher, Jacqueline
Samson, Akemi Tomoda, Majed Ashy, and Susan Anderson
Teicher, M. “Scars that Won’t Heal: The Neurobiology of Child Abuse,” Scientific American, March, 2002,
pp. 68-75.
EXPERIENCE DRIVES DEVELOPMENT
The brain works using chemicals and electricity
Genetic
Predispositions
Experience
Experience Shapes Brain’s
Developmental Sequence
• Size, shape & efficiency of brain regions can be reduced
• Chemistry- those created early are most easily produced for life
• Electrical grid- wiring, efficiency impacted
Example Developmental Outcomes
Middle Childhood
• Connection between hemispheres
• Multi-modal problem solving
• Understanding social cues
Adolescence
Early
Childhood
• Self-regulation
• Production of
hormone paths
• Verbal memory
• Regulation/
dysregulation of
mental health
• Executive
function
• Sound judgment
• Understanding of
consequences
Brains to Fit the Life We’ll Live
Toxic
Stress
Assuming a
neutral start:
All brains will
adapt to
survive
DEVELOPMENT
INDIVIDUAL
for a tough life:
• Emotion processing
regions smaller, less
efficient
• Efficient production of
stress-related chemicals
• Dysregulated happy
hormones
• Fewer receptors for
calming
• Less white matter
characteristics
& traits
• Competitive
• Hot tempered
• Impulsive
• Hyper vigilant
• “Brawn over
brains” or
• Withdrawn
• Emotionally
detached
• Numb
DEVELOPMENT
for a good life:
• Emotion processing
regions robust and
efficient
• Abundant happy
hormones
• High density white matter,
especially in mid-brain
INDIVIDUAL
characteristics
& traits
• Laid back
• Relationshiporiented
• Reflective
• “Process over
power”
WHY IT
WORKS
Under the worst
conditions, such
as war & famine,
both the
individual & the
species survive.
WHY IT
WORKS
By striving for
cooperative
relationships,
individual &
species live
peacefully.
Key Variables In Brain Outcomes
Critical Time:
Age of Maltreatment
The brain develops over
time. The effects of
maltreatment
correspond to the
region and/or
function that is
developing at the time
of maltreatment.
Types of Abuse
Gender
Different types of
maltreatment
activate different
processes that shape
the brain, such as
chemicals &
hormones, electrical
activity, cell growth,
& specialization of
cells.
Although both boys & girls are
affected by maltreatment the effects
of sexual abuse are more profound in
girls while the effects of neglect are
more profound in boys.
CORPUS CALLOSUM
HIPPOCAMPUS
The center for:
•Controlling emotional
reactions
•Constructing verbal memory
•Constructing spatial memory
VULNERABLE TO:
All forms of maltreatment in the
first 2-3 years of life.
Integrates hemispheres &
facilitates:
• Language development
• Proficiency in math
• Processing of social cues, such
as facial expression
RIGHT TEMPORAL GYRUS
Center for spoken language.
VULNERABLE TO:
Emotional abuse, especially between
ages 7 and 9.
VULNERABLE TO:
Neglect in infancy.
Sexual abuse in the
elementary school years.
27
ACE Study: A Paradigm Shift
• Behavioral responses resemble common delinquent
behaviors and are under-identified as trauma
symptoms
• Stress manifestation is different by ages, stages,
expression
• Many just don’t connect the symptoms to trauma
…Thus leading to punishment rather than help
Why do some rise above
the ACE load and others
don’t?
• Attachment to caring adult(s) via mentors
• Opportunities
• Choices
• Relationships
• Timing
This is NOT about letting people
off the hook, or excusing
actions because of trauma
history
Data suggest accountability CAN
actually increase!
Children’s Resilience Initiative
Opportunities for
Resilience
Moving forward
with this powerful
information
For the most part,
resilience is about the dayto-day ways we interact
with and help each other.
Current research is
discovering that nurturance
is actually reparative and
regenerative!!
Resilience Occurs At All Levels
A universal capacity
which allows a person,
group, or community
to prevent, minimize,
or overcome the
damaging effects
of adversity.
Dr. Edith Grotberg
Individual
Family
Community
National,
Global,
Ecosystem
A “Trauma Lens” can help to better
understand a patient’s behavior.
A shift in perspective
from:
“What is wrong with this
person?”
to
“What has this person
been through?”
36
Survival Mode Response
Can’t effectively:
Stressed
Brains
• Respond
• Learn
• Process
Allow time to calm &
return to higher brain
functioning
MODELS OF RESILIENCE
Grotberg
I HAVE
(external
supports)
I AM
(personal
strengths)
Boss
Attachment
&
belonging
Blaustein Masten Brooks &
Goldstein
Attachment
Community, Regulation
culture
&
spirituality
I CAN
(social &
interpersonal
skills)
Capability
Competence
Connection
Positive
relationship
w/caring
adult
Affirmation
Self-esteem
through
emotional
awareness &
control
Chores,
choices,
mastery of
skills
Effectiveness
in one’s own
world
I HAVE (external supports)
• People around me I trust and who love me, no
matter what
• People who set limits for me so I know when to
stop before there is danger or trouble
• People who show me how to do things right by
the way they do things
• People who want me to learn to do things on my
own
• People who help me when I am sick, in danger,
or need to learn
= safety & security: core for developing resilience
I AM
(internal, personal strengths)
• A person people can like and love
• Glad to do nice things for others and show my
concern
• Respectful of myself and others
• Willing to be responsible for what I do
• Sure things will be all right
= inner strength or hope; feelings,
attitudes and beliefs within the child
I CAN (social/interpersonal
skills)
• Talk to others about things that frighten me or
bother me
• Find ways to solve problem that I face
• Control myself when I feel like doing something
not right or dangerous
• Figure out when it is a good time to talk to
someone or to take action
• Find someone to help me when I need it
= mastery, sense of future
Resilience
Treasure
Hunt Night
at
Elementary
School
A Positive Relationship
with One Adult
Children who experienced trauma
and grew up to be successful
consistently identified one variable:
connecting to an adult who they felt
cared about them and believed in
them.
▫ We can each be that caring person
Looking through the “trauma lens”…
“Not realizing that children exposed to
inescapable, overwhelming stress may act
out their pain, that they may misbehave, not
listen to us, or seek our attention in all the
wrong ways, can lead us to punish these
children for their misbehavior…
If only we knew what happened last night, or
this morning before she got to school, we
would be shielding the same child we’re now
reprimanding.”
On Playing A Poor Hand Well by Mark Katz
Children’s
Initiative
Children’s ResilienceResilience
Initiative
SKILL BUILDING
Think
Not
Lack of Skill
Intentional Misbehavior
Building Missing Skills
Shaming for Lack of Skills
Nurture
Criticize
Teach
Blame
Discipline
Punishment
Responses
•
•
•
•
•
Liberating- leave behind the shame and blame
I thought it was my fault
Now I know why I’m on my 4th marriage
This saved my life
I understand better now why my mother
parented the way she did, but I will break the
cycle
• I will be intentional in building resilience
• Hope and healing; I’m not alone
• Why haven’t I heard about this before?
Our Community’s Response
•
•
•
•
•
•
•
•
•
•
•
•
•
Website & facebook; resources, videos, news
Resilience tools for Parents
“New Parent” & “moving upstream” tools
Lincoln Alternative High School
The Health Center at Lincoln
Children’s Home Society
Commitment to Community
Christian Aide Center
One Officer’s Story
One Woman’s Story
WWPD, Sheriff Dept, Penitentiary trainings
Walla Walla Public Library partnership
Dept of Court Services, Judge, Attorney
49
50
Resilience Deck of Cards
includes 42 resilience
building blocks and 10
ACE cards, 2 sets of Jokers
and a Parent Handbook
Community Action Toolbox
Welcome to our Toolbox!
•Getting Started: A Fish Tale of Sorts
•Plow the Field
•Once is Not Enough
•Mid-Course Adjustments •New Targets
•Taking It On the Road •Vital Learnings
•Building the Framework • Nuts & Bolts
•Integration & Sustainability
•The “End” Game
A community of practice- one in which representatives
from each effort connect regularly to share what they
are learning (John Kania)
Children’s Resilience Initiative
The public health impact of ACEs can
now only be ignored as a matter of
conscious choice. With this information
comes the responsibility to use it.
R. Anda, MD & D. Brown, DSc/W. Foege
What we cannot argue anymore is that
there’s nothing we can do.
We can change our approach.
Paul Tough, How Children Succeed
Policy Implications
•
•
•
•
School policy on discipline, suspensions, etc.
Prevention as a priority and the will to act
Earlier intervention with home visits
Court system - mandatory class for divorcing
parents
• Awareness of potential for re-traumatization
• Medical field - universal screening/growing
recognition
• Systems responses - Empathic vs. punitive
response
Children’s Resilience
Initiative
Empowering community understanding of the forces
that shape us and our children
Website: www.resiliencetrumpsaces.org