CAFRU

Adverse Childhood Experiences (ACEs),

Complex Trauma, and Resilience

Christopher Blodgett, Ph.D. CLEAR Trauma Center Child and Family Research Unit Washington State University

Copyright WSU CLEAR Center 2015

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Emotional abuse

Physical abuse

Sexual abuse

Neglect

We have to expand how we talk about what puts people at risk

Separation and Divorce

Domestic Violence

Caregiver Mental Health Problems Caregiver Substance Abuse

Incarceration in the Family Racism and

Historical Trauma

Community Violence

Homelessness

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The Adverse Childhood Experiences (ACEs) study

ACE exposure ‘piles on’ Adults with four or more

ACEs compared to adults with no ACEs 4 to 12 times increase in

alcoholism, drug abuse, depression, and suicide attempt

2 to 4 times increase in poor self-rated health

3 to 4 times increase in chronic illness (heart disease, liver disease)

The ACE DOSE effect

A large portion of many health, safety and prosperity conditions is attributable to Adverse Childhood Experience. Lower ACEs reliably predicts a decrease in all of these conditions simultaneously.

POPULATION ATTRIBUTABLE

RISK

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We often don’t know about the bad things that happen to children

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We know ACEs are established early in life with resulting risk

• In more than 1,000 Spokane families

• 50% of parents and 25% of these 2-4 year old children already experienced four or more ACEs

• As children’s ACEs increase, teachers’ assessments of school readiness and social emotional development demonstrate the ‘ACE dose’ effect.

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Spokane Elementary ACEs Study: Odds for academic and health problems with increasing ACEs

Spokane Elementary

School Students

Academic Failure

Severe Attendance

Problems

Severe School

Behavior Concerns

Frequent Reported

Poor Health

Three or More ACEs N =248

3 5 6 4

Two ACEs N=213

2.5 2.5 4 2.5

One ACE N=476

1.5 2 2.5 2

No Known ACEs N=1,164

1.0 1.0 1.0 1.0

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Moving from the ‘what’ to ‘how’ as the framework for action

Complex Trauma- A mental health concept we can adapt to guide how we respond

Toxic stress and biology The ‘complex’ in complex

trauma risk: Early exposure at times

of critical development Multiple risks Unpredictable and

persistent. Who you love is who

you may not be able to count on.

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9 CAFRU Mapping complex trauma’s

risk Risk dimensions Impaired relationships

Social emotional development

Emotional regulation

Threat-arousal reactivity

Dissociation Cognitive

development Health risk

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Overarching goals- Support regulation to support success

Physical Safety: The program supports predictable and safe environments.

Emotional Safety: The program environment fosters trust and emphasizes authenticity, transparency, and quality of communication among clients, staff, and administration.

Predictability: Clients and staff know the expectations when a change is implemented or during periods of transition.

Consistency: trauma-informed values are collectively adopted and evident throughout the program

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Core brain development principles for change

Risk and protection is based

in brain development and function

Principle 1: Our brains are designed to benefit from rich and supportive intimate social relationships.

Principle 2: Brain function is hierarchical. We feel and then we think.

Principle 3: Brain development is ‘use dependent.’

Principle 4: Brain systems change with use throughout life.

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Benson, B, & Haith, M.M. (2009). Social and emotional development in infancy and early childhood. Denver, CO: Academic Press.

13 CAFRU Three part model for

understanding behaviors

Impacted Systems of meaning:

Assumption of Danger

Physiological and Behavioral Response: Safety Seeking/Need

Fulfillment

Interference from Developmental

Challenges: Reliance on Alternative

Adaptations

Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

14 CAFRU Threat-Arousal Axis in

traumatized individuals

The first response to change is emotional.

Trauma results in emotional distortions in response to change. Learned responses of

fear that are not matched to objective risk.

Heightened arousal as a trait (hyper-arousal, impulsivity).

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Understanding systems of meaning- The assumption of danger

Common triggers for children who have experienced developmental trauma Perception of a lack of

power

Unexpected change/transitions

Feeling shame

Feeling vulnerable or frightened

Feeling threatened or attacked

Intimacy and Positive attention

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Need fulfillment strategies In the absence of sensitive and consistent responses from

a caregiver, a child will develop their own strategies

Common need fulfillment strategies

Emotional/Relational needs

Emotionally Demanding behavior (whiny, interrupting, dramatic)

Seeking negative attention

Poor interpersonal boundaries

Attempt to control the environment “lying or manipulative”

Mastery

Physical Needs

Physical nurturance-seeking behavior (Sexualized behaviors, poor physical boundaries)

Hoarding or stealing food, clothing, objects

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17 CAFRU Support self-regulation to support

growth Calibrate our

relationship and goals to the arousal level of the child New learning can not

occur in high states of painful arousal.

Our present level of arousal defines our options.

To teach self-regulation, CO-REGULATE Copyright WSU CLEAR Trauma Center 2015

18 CAFRU Components for recovery

from complex trauma Interrupt

continuing trauma Are we

traumatizing?

Reduce and replace traumatic responses

Focus on social emotional competence

Build resilience Copyright WSU CLEAR Center 2015

19 CAFRU What are the targets for

building resilience?

Coping skills Build relationship

resources and skills Sense of efficacy A realistic but

positive sense of self Ability to

experience happiness

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20 CAFRU Resilience- What to

build Belief

Hope Self-efficacy

Skills Emotional regulation/tolerance for change Relational skills Executive function

Environment Social support Forgiving, repairable settings

Access to the social and material resources for adaptation

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21 CAFRU How to get started…

Trauma Aware Trauma Sensitive Trauma Informed Trauma Specific

If you assume trauma, how would you behave differently?

Keep resilience at the center of the work Move your focus from the individual to the relationship Make safety and predictability the foundation for your

action with others Bring where you are to this work.

As important as you are, if your institutions don’t change, you may not sustain what you do.

Copyright WSU CLEAR Center 2015