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PREVENTIONCOMMUNITY OF PRACTICE
The Impact of Adverse Childhood Experiences (ACEs) on Substance Use Disorder:
Implications for Prevention, Part 2November 6, 2019
WELCOME
Purpose of Prevention CoP
The purpose of this CoP is to serve as a vehicle for the prevention
workforce to:
1. increase best practice knowledge relative to effective prevention;
2. build collegiality and professional mentoring among those delivering
prevention services;
3. improve communication between and within systems of care
addressing substance misuse; and
4. promote a recovery and resiliency oriented set of principles and
practice constructs.
Components of Prevention CoP
Systems Focused Group Meetings
Conference Calls
Resources and Tools
Email Based Discussion Group
Technical Assistance
Agenda
10:00 – 10:15 Welcome and Introductions
10:15 – 10:35 Review from Last Meeting (Part 1)
10:35 – 11:25 Peer Perspectives
11:25 – 11:55Facilitated Discussion Connecting ACES to Prevention
Work Across the State
11:55 – 12:00 Wrap Up and Evaluations
Objectives
1. Describe the role of protective factors in prevention of the impact of Adverse Childhood Experiences (ACEs).
2. Identify practices who examined risk and protective factors in their community to identify potential impact and outcomes.
3. Discuss how current protective factors have similarities across the state and how the field can coordinate better around the promotion of protective factors in reducing the impact of ACEs.
PREVENTION COMMUNITY OF PRACTICE
CONTACT LIST
PREVENTION COMMUNITY OF PRACTICE
2020
Top pick: Bi monthly meetings for 2 hours
Second choice: Bi monthly meetings for 2 hours + 1 hour networking
Overview of Key Points from Last Meeting
Julie Yerkes
Adverse Childhood Experiences
• 50% at least one
• 25% reported 2 or more
• Women 3.5x as likely to have experienced 5 + ACEs
• Dose response between # of experiences and:
• Poor health (heart, liver, lung & bone disease; cancer); 50 or more sexual partners, Obesity and physical inactivity
• Alcoholism, Drug abuse, Smoking
• Depression, Psychiatric hospitalization, Suicide attempts, Hallucinations
• Any ACE increased suicide risk by 2-5x
10
Experiencing Physical, Sexual, or Psychological abuse; Witness violence toward mother;
Household members with Substance Use Disorder, Suicide attempts or Incarceration
Felitti et al 1998, Dube et al 2001, Weigh et al. 2010 Courtesy of Linda Douglas
Courtesy of Linda Douglas
Trauma-Informed Approaches
• Use empowerment-based approach to counteract the experiences of abuse
• Focus on strengths
• Support empowerment through skill-building
• Help create stability and supports
• Empathic engagement that provides:
• Information & choices
• Respect, connection, and hope
• Access to tools, resources, and skills
12
Harris and Fallot 2001; Saakvitne et al. 2000; Warshaw 2009 Courtesy of Linda Douglas
Implications for Prevention
Reduce risk factors
Increase protective factors
Resiliency Building Blocks
Competency
Self Regulation
Attachment
Adolescent Health Working Group 2013Courtesy of Linda Douglas
Protective Factors
• Positive parent or family engagement1
• Family support1
• School connectedness1
• Feeling that someone stood by you in hard times2
• Having someone to talk with about difficult feelings2
• Positive connection to other adults3
• Safe, supportive, connected neighborhood3
• Strong community infrastructure (services for those in need) 3
• Local, state policies and practices that support healthy norms and child-youth programs3
• Range of opportunities in the community3
• Meaningful youth engagement3
Resources
1. CDC.gov High Risk Substance Use Among Youth
2. Sage, R., Bethell, C., Linkenbach, et al. (2017) Balancing Aces with Hope, New
Insights into the Role of Positive Experiences on Child and Family Development.
Retrieved from https://www.alliance1.org/web/resources/pubs/balancing-adverse-
childhood-experiences-aces-hope.aspx
3. Risk and Protective Factors for Adolescent Substance Use(and other Problem
Behavior) A Review and Summary of the Research conducted by Prevention
Research Committee for Behavioral Health (2006) Behavioral Health
Epidemiological Outcomes Workgroup (2007) SPF/SIG Epidemiological Influences
Workgroup* (2010)
http://dhss.alaska.gov/dbh/Documents/Prevention/programs/spfsig/pdfs/Risk_Prote
ctive_Factors.pdf
ACEs, Impact of Addiction and
Community-Based Supports for
Youth
Presenter: Monica Gallant, CPSDirector of Prevention Services Boys & Girls Club of Souhegan Valley
18.5% of NH youth ages 0 – 17 have experienced at least 2 ACEs
NH DATA
Source: 2017 Souhegan Valley High School Youth Risk & Behavior Survey
NH Drug Death Data: 212 Total Drug Deaths with addition 56 “pending toxicology.” Source: NH
Attorney General Office of Chief Medical Examiner September 2019
Families and Addiction Characteristics
FAMILY LAWS OF ADDICTION
Source: http://www.aaets.org/article230.htm
Effects of Family Substance Use Disorder on Children and Families
• Children of Alcoholics or Other Drug Use (COAs) – any child whose parent (or parental caregiver) uses alcohol or other drugs in such a way that it causes problems in the child’s life. The consequences experienced by COAs include:
• Behavioral • Educational • Emotional
Behavioral Consequences
• Higher risk for emotional, physical and mental health problems
• Higher prevalence of depression, anxiety, eating disorders and suicide attempts among COAs than their peers
• COAs are 3-4 times more likely to become addicted to alcohol or other drugs themselves.
Educational Consequences
• More likely to have learning, emotional and/or behavioral disabilities
• May be unable to concentrate
• Energy is focused on the person with Substance Use Disorder
• Health problems such as stomach aches, migraines, or asthma
Emotional Consequences• Mistrust
• Guilt
• Shame
• Confusion
• Ambivalence
• Fear
• Insecurity
Community Based SupportsWhat Can We Do?
Developing a Trauma Informed Souhegan Valley Community
• Realize how widespread trauma is
• Recognize signs and symptoms
• Respond by integrating knowledge into practice
• Resist doing further harm – Change the question from “What’s wrong with you?” to “What happened to you?”
Find Your Connection
• Encourage a trauma-informed environment in your setting
• Know the resources in your community
• Know your community partners
• Identify gaps in support systems
• Educate your peers
• Integrated system of community-based supports
• Resilience Trailer: https://kpjrfilms.co/resilience/
Raising Awareness
Community Level Trainings…
Charles Appelstein, MSW
Understanding andResponding to
Children and Youth Using a Positive, Trauma–Informed,
Strength Based Approach
Community Campaigns …
Recent Activities:
• Suicide Prevention
• Mental Health Awareness
• Drug & Alcohol Education
• Photo Voice Projects
• Red Ribbon Week
• Peer Mentoring Training
• Youth Summit
Focus is on Leadership,
Advocacy & Community
Service
Children learn:
• Addiction is a disease
• Improved Family Communication
• How to Express Feelings Appropriately
• Healthy Coping Skills
• Self Care & Life Skills
• Staying Safe & Having Fun
Where: Boys & Girls Club of Souhegan Valley
When: *Thursdays, September 19, 2019 – June 11, 2020. Meetings will not be
held on holidays or if the club is closed for any reason.
Time: 4:00 – 5:00 pm
Room: Music Room (next to theater)
Questions: Contact Monica at (603) 769-0978
Souhegan Valley Alateen
Source: DHHS: Bureau of Drug & Alcohol Services
Outcomes
Program Outcome Involvement
CAST Coalition Increased Knowledge of ACEsIncreased Community Collaboration
400+ adults attended Resilience documentary, community level trainings and events
CAST Y.E.S. Team Increased Sense of Purpose through Workforce Development, Community Engagement, Leadership, Service & Advocacy
200+ youth and adults attend HOPE Fest80+ youth attend Youth SummitWMUR
Children’s Resilience Retreat Emotional Awareness, Improved Mental Health, Peer Mentoring, Civic Engagement, Advocacy,Community Collaboration
35+ youth in program40+ mentors in program
*Data collected through event evaluations, pre/post surveys and evaluations from youth programs and coalition members.
“I am always so happy when I leave here… this is the best thing that ever happened to me.” Abby, 17 YES Team
Testimonies …
“…The [retreat] program has helped me with sadness. I’ve learned what I can control and what I can’t and learning that I can have peace and not chaos.” Brenna, Age 8
… this program has helped me with my parents and problems with addiction. I have learned how to cope with it better than I used to. Now I have found ways to not get so upset about it all the time and ways to think about the better things that happened.” Anonymous
“The coalition provides an opportunity for a variety of stakeholders to address concerns and arrive at solutions that best meet the needs of the communities. Youth trainings allow schools to provide supports to students which may not have happened without the CAST organization. This is a format for building leadership to collaborate and discuss emerging issues related to teens.”
Andy Corey, HB Superintendent
RESOURCES
SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach
https://nicic.gov/samhsas-concept-trauma-and-guidance-trauma-informed-approach
For more information contact:
Monica Gallant, CPS
Director of Prevention Services
Boys & Girls Club of Souhegan Valley
56 Mont Vernon Street, Milford NH 03055
email: [email protected]
call: 603-672-1002 ext 39
ADVERSE CHILDHOOD
EXPERIENCES RESPONSE
TEAMErin Pettengill
Vice President of the Family Resource Center
Lakes Region Community Services
Kerri Lowe
ACERT Coordinator
Family Resource Center of Central NH
Eric S Adams
Prevention, Enforcement & Treatment Coordinator
Laconia Police Department
McKenzie Harrington-Bacote
Grants Administrator, Office of School Wellness
Laconia School District
BRAIN ARCHITECTURE:Shaped by early experiences
Simple skills come first; complex skills build on them
Strong foundation improves odds for positive outcomes; a weak foundation
increases the odds of problems later in life
TOXIC STRESS:Unlike mild, short-lived stress that can be good for growth, certain types of
stress can weaken the brain’s architecture.
Experiences such as abuse, neglect or exposure to violence can cause toxic
stress responses in the brain, with lifelong consequences in health, learning
and behavior.
ACEs: All types of abuse, neglect, & other
potentially traumatic experiences that occur
under age 18
• Linked to risky behaviors, chronic health
conditions, decreased life potential and early
death
• The more ACEs a child experiences the more likely
they are to experience negative effects
• ACE study: 64% had 1 ACE; 12.4% had 4 or more
• Some possible risk outcomes are exhibited in
behaviors, such as smoking, alcohol use, drug use,
promiscuity and lack of physical activity; and
affecting physical and mental health, such as
obesity, diabetes, depression, suicide attempts,
sexually transmitted diseases, heart disease,
cancer, stroke, COPD, broken bones
WHAT WE WERE SEEING• Laconia police responding to incident calls like a domestic violence situation or drug overdose, had
few, if any, options to help children present in such situations.
• Police Officers not educated in trauma, unaware of resources to connect children to.
• Bulk of calls Laconia Police respond to are domestic violence related.
• Laconia Schools were seeing a high percentage of students entering Kindergarten and preschool with 4+ ACEs.
• According to a two-year survey conducted and released last year by the Resource Center for Child & Adolescent Health, 23.4 percent of New Hampshire children have been impacted by one traumatic event and 18.5 percent of children statewide have been affected by two ACEs.
Research provides compelling evidence—suggesting urgent action needed—that such traumatic experiences for children can have significant long-term negative impacts. Children experiencing such trauma are vastly more likely to model similar behavior, to themselves become abusive, use drugs, and in a range of other ways, become significantly less healthy over time. Research even shows a strong link to a broad range of physical health effects, including cancer and heart conditions.
Early intervention is absolutely vital to ensure children’s physical, emotional, and mental wellbeing. ACERT is a comprehensive and coordinated system of supports focused specifically on affected children.
• The key to forming strong brain architecture is the
“serve and return” relationships young children
have with supportive adults in their lives.
• When children reach out for connections and
communications with adults, and adults
reciprocate, this back-and-forth process
continues, literally wiring the brain with the
connections needed for healthy development.
MITIGATING THE EFFECTS OF TRAUMA
• Highly specialized interventions with families as early
as possible for children can decrease the effects of
long-term toxic stress
• Put developmental and behavioral health at the
forefront when talking about children
• Ensure safe, supportive environments and programs
for children to develop and learn
• Mitigate toxic stress and health disparities by
creating a shared vision and plan among
community members and sectors
PREVENTION AND PROMOTION
CONNECTING TO SERVICES
• Home Visiting
• Parent Education Classes
• Domestic Violence Supports
• SUD Treatment and Recovery Supports
• Mental Health Supports(Counseling for Children and/or Family)
• Supports in Schools
• High Quality Childcare
• Sufficient Income and Resources for Low-Income Families
• Affordable Housing
• Afterschool care
• Mentor programs
MANCHESTER’S THEORY OF CHANGE
Levers
• Agency Partnerships• Systems• Professional Development
Strategies
• Respond to family crises• Link families to services &
opportunities
Protective Factors
• Parental Resilience• Concrete Supports in
Times of Need(+social connections, knowledge of parenting & child development, social/emotional competence of children)
Results• Strong, resilient families
• Mitigate effects of ACEs
WHAT DID WE DO?
• November 2018: Presentation to Laconia service providers by
Manchester ACERT on ACEs and success of their program
• Created a Steering Committee
• Family Resource Center agreed to pilot the program
• Release created between LPD, FRC and Laconia Schools
• Coordinator hired
• Police trained in promoting program, getting release signed
• Program launched September 3, 2019
• First referral received September 26, 2019
• 6 referrals received so far; 5 of 6 families engaging with ACERT program
• 14 children affected by program; referred to 31 programs; connected
with 21 programs
• Trauma training for entire police force in January 2020
• Continue to create a trauma-informed system of supports
LPD responds to event
with children present
Officer requests parent/guardian signature
on release/referral Leaves trauma pamphlet
Gives release/referral
to PET Officer
PET Officer contacts
family for signature
End process
PET Officer gets
referral to ACERT
Coordinator at FRC
Coordinator reviews
referral/triage for
appropriate response team
Coordinator calls family for
intake/explains ACERT/asks
to invite response team
members
Coordinator contacts
response team members
Coordinator emails school
social worker(s),
principal(s) and OSW
Program Director to notify
of event
Signed Not
signed
Signed Not
signed
Team responds Each member explains role
Family explains situation
Team members suggest
resources/services
Family signs releases for
referrals/completes intake
paperwork if appropriate
ACERT Coordinator
contacts referral
agencies
Agencies contact family
for intake/ACERT supports
family through process
ACERT provides ongoing
support to family, F/U
w/agencies
Discharge when family
connected to ongoing support
and resources
ACERT WORKFLOW
STEERING COMMITTEE/RESPONSE TEAM
• Laconia Police
• Laconia Schools
• New Beginnings
• Navigating Recovery
• DCYF
• Child Advocacy Center
• Lakes Region Mental Health
• HealthFirst
• Boys & Girls Club/LRCCS
• Family Resource Center
REFERRAL PROGRAMS (NOT ALL INCLUSIVE)
• Boys & Girls Club/LRCCS
• Head Start/Early Head Start
• School Social Workers/LADC
• Big Brothers/Big Sisters
• New Beginnings
• Navigating Recovery
• Community Action Program (Fuel
Assistance, WIC, Family Planning, Food
pantry, Security deposit loan fund)
• HealthFirst (Primary care, mental health
services, MAT, health insurance navigator)
• Lakes Region Mental Health Center
• Early Supports & Services
• Area Agency DD & ABD Services
• Comprehensive Family Supports (Step
Ahead)
• Parent Education
• Laconia Welfare
• Belknap House
• Carey House
• DHHS (Food stamps, Medicaid, TANF,
Caregiver grant)
• Prescott Farm
• Veteran services
• Servicelink
ANTICIPATED RESULTS:
• Increased awareness of and improved access to available services/resources
• Identifying and implementing needed services to better address the needs of children and families (equity & access)
• Greater efficiency and less duplication of services
• Enhanced relationships and ability to share information among providers, agencies, and partners
• Increased positive interactions with families and creation of natural support systems
• Informed and proactive agencies eager to work collaboratively to improve outcomes for children and families
HOW WILL WE EVALUATE?
• Steering Committee meets once a month to review process, make
changes as needed
• MOU’s between steering committee members will be reviewed as
needed for applicability and comprehensiveness
• Ongoing data tracking regarding # of referrals to ACERT, families
connected, # of referrals to programs, engagement with those
programs
• Review what gaps still exist and create plan to address them
• Track how many 1st responders and other service providers are trained
in ACEs
• Center on the Developing Child (2010).The Foundations of
Lifelong Health Are Built in Early Childhood. Retrieved from
www.developingchild.harvard.edu.
• National Alliance of Children’s Trust & prevention Funds.
Ctfalliance.org
• Manchester ACERT Program
• The Truth About ACEs. Robert Wood Johnson Foundation.
www.rwjf.org/aces.
REFERENCES
Group Discussion
• In small groups, assign a note-taker and reporter for the group and engage in the following:
– Discuss and record additional ACE activities, need
priorities and barriers that exist in your community
prevention work
– Identify ACE-related prevention efforts that you feel
should be a priority in your community/network. What
readiness steps are needed for implementation?
– Determine a “short list” of topics you are interested in
learning more about in order to expand your ACEs work.
Final Thoughts
• 2 CEUs for CPS - Please hand in your evaluation!
• Please return your nametag
Thank you for coming!
MELISSA SCHOEMMELL, MPH ADELAIDE MURRAY [email protected] [email protected]
KATY SHEA, MPH JILL BURKE, [email protected] [email protected]
ROB O’HANNON, MS C.M.P JULIE YERKESrobert.o’[email protected] [email protected]
ELIZABETH O’[email protected]
