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A Trauma-Informed Approach

Adverse Childhood Experiences (ACEs):

Building Resilient Communities

Linda Chamberlain, Ph.D. MPH www.drlindachamberlain.com

Framework of Resiliency and Hope

The Brain Explains

What Everyone Needs to Know About the ACE Study

Trauma-Informed, Compassionate Communities

◦Community Resilience Cookbook!

Healing starts by

understanding how early

trauma affects health and

behavior

ADVERSE CHILDHOOD EXPERIENCES (ACEs)

ACEs MAY BE PART OF OUR PAST, BUT THEY DO NOT HAVE TO BE OUR DESTINY

◦Healthy relationships

◦ Social and emotional skills

◦Mastery of school

◦ Special skill

◦ It’s never too late

ACEs Can Be Overcome

(National Scientific Council on the Developing Child, 2004

Early emotional

experiences and a

child’s environment

become embedded

in architecture of

children’s brains

www.instituteforsafefamilies.org

Positive Stress Tolerable Stress Toxic Stress

• Normal and essential part of healthy development

• Brief increases in heart rate and blood pressure

• Mild elevations in hormonal levels

• Example: tough test at school. Playoff game.

• Body’s alert systems activated to a greater degree

• Activation is time-limited and buffered by caring adult relationships

• Brain and organs recover

• Example: death of a loved one, divorce, natural disaster

• Occurs with strong, frequent or prolonged adversity.

• Disrupts brain architecture and other organ systems.

• Increased risk of stress-related disease and cognitive impairment.

• Example: abuse, neglect, caregiver substance abuse

Intense, prolong, repeated, unaddressed

Social-Emotional buffering, Parental Resilience, Early Detection, Effective Intervention

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Physical health

problems

ACEs → ?

TOXIC STRESS BRAIN

Toxic Stress

Response

Mental

health problems

Self- medicate to cope

Adopt risky behaviors

Depressed immune system

Chronic inflammation

STOP

RESILIENCY

“Not realizing that children

exposed to inescapable, over-

whelming 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. The behavior is so

willful, so intentional. She

controlled herself yesterday, she

can control herself today. If we

only knew what happened last

night, or this morning before she

got to school, we would be

shielding the same child we’re

reprimanding.”

Playing a Poor Hand Well, Mark Katz

Self-understanding is a key step in healing

It’s not about what’s wrong with me, it’s about understanding what happened to me.

Survey Wave 1 71% response (9,508/13,454) n=13,000

Survey Wave II n=13,000

All medical evaluations abstracted

Present Health Status

Mortality National Death Index

Morbidity Hospitalization

Doctor Office Visits Emergency Room Visits Pharmacy Utilization

All medical evaluations abstracted

vs.

17,337 adults

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Abuse, by Category Psychological (by parents) 11% Physical (by parents) 28% Sexual (anyone) 22% Neglect, by Category

Emotional 15% Physical 10% Household Dysfunction, by Category Alcoholism or drug use in home 27% Loss of biological parent < age 18 23% Depression or mental illness in home 17% Mother treated violently 13% Imprisoned household member 5%

Prevalence (%) Scoring method to determine the “dose” of exposure to childhood trauma. Experiencing one category of ACE, ACE Score = 1

When the points are added up, the ACE Score is determined

An ACE Score of zero means a person reported no exposure to any of the categories of trauma

An ACE Score of 5 means a person reported exposure to five different categories of trauma

ACEs are Good Buddies…

ACE Score Prevalence

0 33% 1 25% 2 15% 3 10% 4 6% 5 or more 11%*

• If any one ACE is present, there is an 87% chance at least one other category of ACE is present, and 50% chance of 3 or >.

“….many of the adult diseases should be viewed as development disorders that begin early in life and persistent health disparities associated with poverty, discrimination or

maltreatment could be reduced by the alleviation of toxic stress in early children. ”

Heart disease

Cancer

Obesity

Smoking

Workplace problems

Mental health

problems

Sexual behavior

problems HIV Depression Drug use Alcoholism Suicide Unintended

pregnancy

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95% probability that a child growing up with DV will be exposed to at least one other ACE

More than one-third (36%) of children exposed to DV have 4 or more ACEs

- Dube et al, 2002

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# ACEs Odds Ratio

0 1.0

1 2.3

2 3.3

all 3 3.5

Male Perpetration

# ACEs Odds Ratio 0 1.0 1 1.9 2 3.3 all 3 3.8

Whitfield et al, 2003

Female Victimization

In a nationally

representative sample, ACEs were predictive of physical dating violence

ACEs accounted for 53.4% of dating violence victimization and 56.5% of dating violence perpetration

Miller et al, 2011

Childhood obesity

Early age at first

intercourse

Teen pregnancy

Bullying

Dating violence

Fighting and carrying weapon

to school

Early initiation of tobacco use

Early initiation of drug abuse

Early initiation of alcohol use

Self-mutilation and suicide

Anda et al, 2002; Anda et al, 1999; Boynton-Jarrett et al, 2010; Dube et al, 2006; Dube et al, 2003; Duke et all, 2010; Hillis et al, 2001; Miller et al, 2011

Increase risk of:

Children with 3 or more

ACEs are nearly 4 times

(OR=3.66) more likely to

have developmental delays

(Marie-Mitchell et al, 2013)

Children with 4 or more

ACEs are 32 times more

likely to have behavioral

problems in school (Burke et al, 2011)

Difficulty focusing

Poor emotional control

Unpredictable,

impulsive behavior

Over-reacting to noise,

physical contact, sudden

movement

NCTSN, 2008

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Teens exposed to ACEs are more likely to:

- to start drinking alcohol by age 14

-binge drink

-say that they drank to cope

during their first year of drinking

Dube et al, 2006

- 51 times greater among children/

- adolescents

Ace Reporter, winter 2006, Vol 1, Issue 3

Linda Chamberlain, PhD MPH State of Alaska Family Violence Prevention Project

www.communityresiliencecookbook.org

Someone starts-the catalyst!

Local efforts

Engage local leaders

Steering committee

Join ACEsConnection.com

Collective impact

Local resources

Mission, goals, action steps Slogan

Local data, local urgency

Communication tools

Public meetings

Walk the talk

Presenter network

Educate, present, educate, repeat!

Local ACEs survey

Feedback

Summits, Learning circles

Media outreach

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“Collective impact honors diversity of thought, what people bring to the table, and it acknowledges that this kind of work takes time.”

Sue Andrews Maine Resiliency Building Network (MBN)

Paths of Education and Activism Converge in

“ACEs Epicenter”

“The work is not the result of a top-down initiative or single funder’s

vision for change. It is, instead, the gradual flowering of multiple seeds,

planted by activist leaders in pediatrics, public health, behavioral

health, child welfare, justice and education.”

Formed task force

◦ Provides shared language and purpose with recognition that no one organization can solve complex problems

Local qualitative and quantitative data collection

College credit course on healthy parenting

Emergency room project called “Healing Hurting People” to support people impacted by community violence

Developed 6-week program called “Nurture the Parents” to educate children’s first teachers

“Instead of looking at the parent who dropped off a kid who was crying or had a dripping nose, and thinking the mom didn’t care, now [the staff] thinks, ‘I wonder what’s going on?”

Suzzanne O’Connor

United Way of Greater Philadelphia

We know that connection is the most valuable thing [for children]. When parents don’t give that, other adults have to chime in. So what does it look like to be able to turn a kid’s life around? We’re working to hunt down that secret sauce, to be able to replicate it and teach other people.”

Dr. Kenneth Ginsburg

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Positive, supportive approach for parents

Universal education with self-assessment

Simple language to convey core concepts

Practical strategies to reduce stress and promote protective factors for parents and children integrated as APPs and QR codes

PDF at www.instituteforsafefamilies.org Purchase booklets at www.multiplyingconnections.com/store

Started with local artist serving as vice-mayor who recognized many issues facing city stemmed from trauma

◦ Met with city manager and police chief to create list of

30 people who may be interested

◦ Formed steering committee that meets monthly and is

open to anyone

Participants include police chief, city manager, housing

authority, community health center, sheriff department’s

ex-offending program & community members

www.peace4tarpon.org

City developed memorandum of understanding with clear mission statement

Created community guide of services

Community education day

4 subcommittees meet regularly

◦ Community action, health and wellness, children’s initiative and social marketing

◦ New Education committee added

“We want to empower people to do something without having them think that they have to solve all the violence in the world.”

-Robin Saenger, Former Vice-Mayor of

Tarpon Springs

Housing authority staff receive trauma-informed training

Provides two apartments to regional agency offering mental health, child & family services

◦ Regional agency “trades” therapist hours to assist with on-site children’s program

Families in apartments receive home visits, parent training and tutors for kids from local college

4H is working with residents to plant garden

“There’s a reason for everything. In our housing authority, it’s trauma.”

Began by asking students and families what they needed-answers were basic

School now offers regular hearing and eye exams, free eyeglasses, weekend snacks, meals program & transportation to school events

Teachers participated in poverty workshop

Community members, parents and school staff, trained in community support, visit families in their homes 2x/year

◦ Trauma-informed care wheel helps teachers to understand what trauma can look like in classroom

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“For us one of the most compelling results of the research is that trauma doesn’t discriminate”

Another surprise was that learning the research around childhood trauma became a personal journey for many people…

[Next phase]-specific groups were targeted and people were ready to delve past the basics—It wasn’t ACEs 101

Preventing ACEs has become the lens to determine funding partners right now

Started when a priest & a physician planted the seed

Dawning realization that they were not dealing with the root cause

Service agencies crippled with secondary trauma

Sanctuary model implemented

Schools implemented mindfulness instruction and create “peace corners”

“You realize, in medical care, how little we really know people, how

ill-equipped we are to pull their stories apart. I was practicing with

half a stethoscope and one hand tied behind my back.” Dr. Jeffry Brenner, 2013 MacArthur Genius Award

www.acestoohigh.com: network with updates about

what is happening nationwide to address ACEs

www.albertafamilywellness.org

www.fosteringresilience.org

: videos on brain development and addiction

www.raisingresilientchildren.com resources and parent quiz on raising resilient children