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PREVENTION COMMUNITY OF PRACTICE The Impact of Adverse Childhood Experiences (ACEs) on Substance Use Disorder: Implications for Prevention, Part 2 November 6, 2019

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Page 1: MAT CoP - 6-21-181viuw040k2mx3a7mwz1lwva5-wpengine.netdna-ssl.com/... · childhood-experiences-aces-hope.aspx 3. Risk and Protective Factors for Adolescent Substance Use(and other

PREVENTIONCOMMUNITY OF PRACTICE

The Impact of Adverse Childhood Experiences (ACEs) on Substance Use Disorder:

Implications for Prevention, Part 2November 6, 2019

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WELCOME

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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.

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Components of Prevention CoP

Systems Focused Group Meetings

Conference Calls

Resources and Tools

Email Based Discussion Group

Technical Assistance

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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

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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.

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PREVENTION COMMUNITY OF PRACTICE

CONTACT LIST

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PREVENTION COMMUNITY OF PRACTICE

2020

Top pick: Bi monthly meetings for 2 hours

Second choice: Bi monthly meetings for 2 hours + 1 hour networking

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Overview of Key Points from Last Meeting

Julie Yerkes

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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

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Courtesy of Linda Douglas

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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

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Implications for Prevention

Reduce risk factors

Increase protective factors

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Resiliency Building Blocks

Competency

Self Regulation

Attachment

Adolescent Health Working Group 2013Courtesy of Linda Douglas

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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

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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

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ACEs, Impact of Addiction and

Community-Based Supports for

Youth

Presenter: Monica Gallant, CPSDirector of Prevention Services Boys & Girls Club of Souhegan Valley

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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

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NH Drug Death Data: 212 Total Drug Deaths with addition 56 “pending toxicology.” Source: NH

Attorney General Office of Chief Medical Examiner September 2019

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Families and Addiction Characteristics

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FAMILY LAWS OF ADDICTION

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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

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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.

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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

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Emotional Consequences• Mistrust

• Guilt

• Shame

• Confusion

• Ambivalence

• Fear

• Insecurity

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Community Based SupportsWhat Can We Do?

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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?”

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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

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• Resilience Trailer: https://kpjrfilms.co/resilience/

Raising Awareness

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Community Level Trainings…

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Charles Appelstein, MSW

Understanding andResponding to

Children and Youth Using a Positive, Trauma–Informed,

Strength Based Approach

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Community Campaigns …

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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

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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

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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

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Source: DHHS: Bureau of Drug & Alcohol Services

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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.

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“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

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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

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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

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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.

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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

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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.

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• 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

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• 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

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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

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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

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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

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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

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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

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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

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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

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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

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• 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

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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.

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Final Thoughts

• 2 CEUs for CPS - Please hand in your evaluation!

• Please return your nametag

Thank you for coming!

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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]