Camden Facts• $5400 per capita income in our immediate

neighborhood

• 1-75 people assaulted

• Murder rate that if NYC would be over 5000 last year and 7000 in 2012

• 50% of city is below 25 years old

• 65% of Camden residents lived in poverty, and 79 % of children lived in poor households

ACES: Adverse Childhood Experiences Study

• Connecting Health To Behavior

• Chronic Stress—same impact as a severe trauma

• Develop coping mechanisms to survive

ACES Questions:• Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or

humiliate you? or Act in a way that made you afraid that you might be physically hurt?

• Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

• Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?

• Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?

• Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

• Was a biological parent ever lost to you through divorce, abandonment, or other reason ?

• Was your mother or stepmother Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

• Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

• Was a household member depressed or mentally ill, or did a household member attempt suicide?

• Did a household member go to prison?

Positive & Tolerable Stress

Toxic Stress

Impact On Brain

Adverse Child Experiences Adverse Adult Experiences

A Day in America

• 1 mother dies in childbirth

• 76 babies die before their first birthday

• 390 babies are born to mothers who received late or no prenatal care.

• 860 babies are born at low birthweight

• 1,186 babies are born to teen mothers

A Day in America

• 1,707 babies are born without health insurance

• 2,171 babies are born into poverty

• 2,341 babies are born to mothers who are not high school graduates

• 3,742 babies are born to unmarried mothers

US Mothers

• >4 million births in a year

• 12% are to teenage mothers

• 33% are to single mothers

• 22% of mothers had less than a high school education

• 1 in 4 mothers will be a victim of intimate partner violence

• Greatest amongst the 16-19 year old women

Christopher S. Greeley, MD, FAAP

Poverty In United States

• In 2012, 22% of children lived in poverty (family income of less than $23,550

• 16.1 million children out of 46.5 million poor or 35% of all the poor are 18 or below

• Staggering implications for amount of chronic stress/adversity that is impacting people

Children in Low Income and Poor Households by age, 2011

<200%Poverty

0-3 3-5 6-11 12-17

Number

5.6 Million

5.9 million

10.9 million

10 million

Percent 49% 48% 45% 41%<100%

povertyNumbe

r3

million3.1

million5.4

MILLION4.7

MILLIONPercent 26% 25% 22% 19%

Policy Implications

Impact On Brain

Epigenetics

Futures Mean We Need To Take Brain Serious

Replace Mental with “BRAIN”

• Began in mid-19th century as “mental hygiene,” a subject actually taught in schools. (attributed to William Sweetzer, 1843)

• In 1893, Isaac Ray, a founder of the American Psychiatric Association, provided a definition of the term mental hygiene as "the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements. The management of the bodily powers in regard to exercise, rest, food, clothing and climate, the laws of breeding, the government of the passions, the sympathy with current emotions and opinions, the discipline of the intellect—all these come within the province of mental hygiene." (Rossi, A., Some Pre-World War II Antecedents of Community Mental Health Theory and Practice. Mental Hygiene, 1962, 46, 78-98).

New Term – BRAIN Health• Cardiac Disease

• Liver Disease

• Pulmonary Disease

• So, Brain Disease – eliminates stigma, allows for equal recognition and treatment, and……

• Creates necessity of PAYMENT for diagnosis and treatment!

Society does not tell a person withheart failure, jaundice, or asthma thatthey are bad, or caused their disease,or have something different from other

health problems!

Determinants Of Health

• Physical Environment

• Social-Economic Environment

• Impact Biology

• Behaviors

Determinants Of Health

Eco-Bio-Developmental Model

• Eco: = Ecology (The environment of family, neighborhood, community, support, access to health care, education, and other factors.

• Bio: = New discoveries daily that link health over the lifespan to early childhood Biologic responses to ecologic and other factors.

• Developmental: = The SCIENCE of human development, emphasizing opportunities for habilitation and rehabilitation.

Not Just Them!

Vicarious Trauma

• Organizations are impacted by exposure to trauma

• Trauma is contagious, like radiation

• Working near reactor

Vicarious Trauma

• Parallel Process

• Organizational Stress/Change

• Trauma Triangle of: Victim, Persecutor, Rescuer

• Compassion Fatigue/burnout

• Those in these professions have higher ACE Score

Impact To Hopeworks

• Institute Universal Precautions

• Begin Trauma Informed Care Practices

• Change Our Vision Statement: “Creating safe pathways through which we own our histories and discover new choices”

Trauma Informed Care• Create a culture, not just diagnostic

• Need to move towards vomit—opportunity

• Incarnational

• Behavior makes “sense”

• Lack of Safety is key issue for individuals

• Create survival coping mechanisms (think Amygdala)

• Surviving doesn’t equal thriving

Trauma Informed Care:S.E.L.FS.E.L.F

• Safety

• Emotion

• Loss/Change

• Future

Trauma Informed Practices

• Sanctuary

• Community Meeting

• Safety Plans

• Red Flag Meetings

• Self-Care Plans

Trauma Informed Care:Key ItemsKey Items

• Trauma Is Contagious

• Emotional Contagion

• “Act Like A Duck”

• Success is health, working through ACES

• Frankie

• Shawn

Impact On Ministry• Justice or Healing

• Communities of loss—who do we work with?

• Success—what are we doing?

• Who are we able to work with?

• Good people vs. prepared people (Chernobyl)

• We bring/or don’t bring our own history

• Brain Health must be weighed

KintsugiKintsugi (金継ぎ ?) (Japanese: golden joinery) or Kintsukuroi (金繕い ?) (Japanese: golden repair)

is the Japanese art of fixing broken pottery with a lacquer resin sprinkled with powdered gold. Kintsugi may have originated when shogun Ashikaga Yoshimasa sent a damaged Chinese tea bowl back to

China for repairs in the late 15th century. When it was returned repaired with ugly metal staples, it may have prompted Japanese craftsmen to look for a more aesthetic means of repair. Collectors became so enamored of the new art that some were accused of deliberately smashing valuable pottery so it

could be repaired with the gold seams of kintsugi. Kintsugi became closely associated with the ceramic utensils used for Japanese tea ceremony.