Adverse Childhood Experiences and Evidence Based Kernels

Responding to ACES at Park Place Middle School

Joe NeigelAugust 28, 2014

Our Goals This Morning

Review the Adverse Childhood Experiences Study and how early life trauma influences behavior, health outcomes and readiness to learn.

Discover how ACES impact students and educators at Park Place Middle School.

Consider simple, evidence‐based strategies educators can adopt to mitigate the harm ACES cause to students and the learning environment.

Adverse Childhood Experiences Study (ACES)

ACES began as a weight‐loss study at Kaiser‐Permanente inSouthern California. It became the largest study evercompleted to examine the health and social effects oftraumatic childhood experiences over the lifespan.

Middle class, average age of 57 80% white, 10% black, 10% Asian 74% some college 44% graduated college 49.5% men

Examines three general forms of abuse and household dysfunction.

The Adverse Experiences• Child physical abuse

• Child sexual abuse

• Child emotional abuse

• Neglect

• Mentally ill, depressed or suicidal person in the home

• Drug addicted or alcoholic family member

• Witnessing domestic violence against the mother

• Loss of a parent to death or abandonment, including abandonment by divorce

• Incarceration of any family member

ACE Score Calculator

ACE Study Findings

ACEs are very common.

They are well‐concealed.

The ACE Study found that the number of categories, not necessarily the frequency or severity of the experiences within a category, determine health outcomes across the population as a whole.

ACEs are strong indicators of what happens later in life, in terms of health risks, diseases and premature death.

The Science Behind ACES

A child’s environment and experience shapes their behavior and health.

Our brain is designed to prioritize survival.

Cortisol is released when our “Fight, Flight, or Freeze” response is triggered.

Toxic Stress

Toxic Stress Prolonged exposure to Cortisol is toxic, and makes permanent changes to the brain.

This means your students may be perfectly suited to survive in their home environment, but they may not know how to act in the classroom or other “normal” situations.

Toxic Stress Hormone exposure even changes how genes are expressed, allowing for Mothers or Fathers to pass on survival characteristics from generation to generation.

Recognizing some signs of traumatic brain development

Hypervigilance ‐ “Always on the ready.”

Display of trauma induced ADHD symptoms, including an inability to stay on task or follow directions.

Early onset of sexualized behaviors and activity.

More impulsive, aggressive and disruptivebehaviors, including those leading to suspension.

Being less able to tolerate stress.

Other Negative Effects Prolonged exposure to Cortisol is shown to have negative effects, such as:

Impaired cognitive performance

Weakened immune system

Hyperglycemia (fatigue, excessive thirst/urination)

Decreased bone density

Decrease in muscle tissue

Higher blood pressure

Slower healing, and other health consequences

Increased risk of physical and mental health problems, including development of health risk behaviors

Graded Relationships in Health Risk Behaviors

• There is a strong “dose/response” relationship between a person’s ACE score and the likelihoodthey will adopt personal solutions that lead to serious health problems.

• Dose/Response is a direct measure of “cause and effect.”

Dose‐Response: More Gas = More Miles

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Smoking• We can see the cause and effect relationship ACEs create in people and in populations.

Alcoholism• We can see the cause and effect relationship ACEs create in people and in populations.

Intravenous Drug Use• We can see the cause and effect relationship ACEs create in people and in populations.

Chronic Depression• We can see the cause and effect relationship ACEs create in people and in populations.

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ACE Score

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Attempted Suicide• We can see the cause and effect relationship ACEs create in people and in populations.

ACEs lead to risk factors for the 10 most common causes of early death in the United States

Early Death in the US• With an ACE score of 0, the majority of adults have few, if any,

risk factors for diseases leading to early death

• With an ACE score of 4 or more, the majority of adults have multiple risk factors for these diseases, or the diseases themselves.

• Prepare yourself for this –

The things we identify as risk factors (obesity, illicit drug use, promiscuity) are, in fact, effective short‐term devices – coping

mechanisms – for the trauma experienced as a child

Reframing Our Point of View• This is an important idea. Framing this

another way, many of the things termed public health problems are actually personal solutions.

“What is conventionally viewed as a problem is actually a solution to an unrecognized prior adversity.”

Dr. Vincent Felitti, co‐principal investigator of ACE Study

ACEs Impact Park Place MSWe also know ACES drive :

• Special education needs

• Grade repetition

• Problems at school

• Educator burnout

Meet Mallory

Getting to Know Mallory

• Mallory is in 8th grade at Park Place Middle School.

• Mallory’s Counselor, Jennifer Garcia, knows her mother physically abused her in the past. As a result, her known ACE Score is “1.”

• Keep in mind ‐ ACEs travel in clusters: Among people exposed to physical abuse, 84% report at least 2 additional ACEs.

Mallory’s Grades

Mallory appears to have trouble paying attention in class. She doesn’t turn in her homework and

seems to have a hard time following directions; her grades reflect this.

• 8th graders like Mallory, who indicated being victims of physical abuse on our Healthy Youth Survey, were nearly twice as likely (1.7x) to report getting C’s, D’s and F’s.

Bullying and Safety at School

Mallory has trouble making lasting friendships and is frequently the target of bullying behavior.

• 8th graders like Mallory, who indicated they had been physically abused by an adult, were:

Nearly twice as likely (1.8x) to report being the victims of bullying.

2.5x more likely to report missing days of school because they felt unsafe.

Mallory’s Mental HealthMallory seems pretty disengaged in class and always looks tired. She can’t seem to remember facts from 10 minutes ago.• 8th graders who report being physically abused by an

adult were 2.5x more likely to report being depressedon the last HYS.

• Students like Mallory were also 2.9x more likely to report contemplating suicide.

• Unfortunately, these 8th graders are also 2.5x less likely to report knowing an adult they can turn to when feeling depressed.

Mallory’s Personal SolutionsMallory was caught bringing a flask of alcohol to school in 7th grade. She talked with Sandra Olson and avoided most of her suspension, but she and her family really haven’t engaged with any helping adults since then.

• 8th graders like Mallory are 3.8x more likely to report current alcohol use, and

• They are 3.1x more likely indicate any other type of current drug use, including Marijuana.

Mallory’s in every classroom

Nearly 1 in 7 8th graders at Park Place Middle School indicated they had been physically abused by an adult on the last Healthy Youth Survey.

ACE Effects in SchoolLow School Engagement

Source: National Survey of Children’s Health, Johns Hopkins University (2012)

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ACE Effects in SchoolDoes Not Finish Tasks Started


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ACE Effects in SchoolHighly Externalizing Behavior


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ACE Effects in SchoolHousehold Contacted Due to Problems at School


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ACE Effects in SchoolGrade Repetition


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Beyond the HallwaysLife‐long Negative Outcomes Linked to ACEs

Partial List of ACE Dose/Response Outcomes

Alcoholism & alcohol abuse School Drop‐Out

Chronic obstructive pulmonary disease & ischemic heart disease

Intimate partner violence—perpetration & victimization

Depression and other MH issues Sexually transmitted disease

Chronic Unemployment Obesity

High risk sexual activity Suicide attempts

Illicit drug use Unintended pregnancy

Intimate partner violence Early Death

Three or more marriages Increased Emergency Room Use

Increased Pharmacy Use Significant Financial Problems

Population Attributable Risk PAR = The difference in rate of a condition between an exposed population and an unexposed population.

In this case, it is a calculation used by the CDC to estimate the proportion of a health outcome that is attributable to ACE

Takes into account:The increased risk due to each level of ACE

The prevalence of the number of ACE categories

Population Attributable Risk

Current Smoking

Smoking NotAttributable toAce

SmokingAttributable toACE

78.3%

21.7%

Risk data from Felitti, et. Al: PAR analysis: RE Voorhees


Ever Using Illicit Drugs

32.1% notattributable toACE

67.9%attributable toACE


67.9%

32.1%



Alcoholism

3.2% of self‐reportedalcoholism notattributable toACE96.8% of self‐reportedalcoholismattributable toACE

96.8%

3.2%



Reporting Having Attempted Suicide

0% ofattemptedsuicide notattributable toACE100% ofattemptedsuicide isattributable toACE

100%

How ACES Increase Suicide Attempts

1 of 100 people with 0 ACEs attempt suicide



ACEs Path

“Personal Solution”

Psychological Depletion

• Whether you like it or not, you are on the ACEs frontline.

• The constant demand of caring for others as you manage your classrooms can lead to burnout:• Illness• Chronic fatigue• Emotional exhaustion• Indifference or detachment• Isolation from colleagues• A lack of personal satisfaction

• Trauma‐informed schools and classrooms can create an environment where teachers and students with injured brains will thrive.

• Evidence‐based Kernels can lead you from intuitive responses to intentional action.

• Safe and predictable classrooms are the key to working successfully with trauma‐impacted youth.

• Mood is your internal emotional state.

• Affect is how you externalize your emotions through verbal and non‐verbal cues.

• Research shows that trauma‐impacted youth are particularly aware of changes in affect, which trigger the fight, flight, or freeze response and decreases the capacity to learn.

Attachment, Self‐Regulation & CompetencyKinniburgh, Blaustein, Spinazzola & van der Kolk, 2005, Psychiatric Annals, pp. 424‐430.

ARC ‐Managing Affect

• Traumatized children often have difficulty communicating, so their behaviors may then become a “front” for conveying unmet needs or their own unregulated affect.

• Adults may respond to the most distressing symptom, rather than the underlying emotion or need.

• Ask ‐ “What’s happening here?” rather than “What’s wrong with this child?”


ARC ‐ Attunement

• Being predictable and having consistent responses to student behavior are vital to establishing safety and reducing a child’s need to exert control.

• Traumatized children may initially react to negative or positive responses.

• An intentional focus on building success, rather than establishing limits – which may be associated with powerlessness or vulnerability – should be your priority.


ARC ‐ Consistency

• Building routines and rituals, particularly around trouble areas, can make your classroom fun and predictable.

• Research shows that establishing routines enhances student:

Feelings of safety

Ability to build trust and feeling of reliability within a relationship

Anticipation of the event


ARC ‐ Routines & Rituals

• These four strategies come from the Attachment, Self‐Regulation and Competency research conducted by Kinniburgh and Blaustein.

• You can learn more about ARC framework and training atwww.traumacenter.org

• The Compassionate Schools Initiative from OSPI also provides a framework for understanding the negative impacts of stress and trauma on learning.

ARC & Compassionate Schools

• Kernels are low or no‐cost to implement.

• That means we can unleash access to strategies that support safety, relationship and skill building essential to the foundations of successful brain development.

• Kernels give us a way to implement evidence based practices that will mitigate the ACES trajectory.

• A kernel is the smallest unit of scientifically proven behavioral influence.

• Kernels produce quick easily measured change that can grow into much bigger change over time.

• They can be used alone OR combined with other kernels to create new programs, strategies or policies.

• Combinations of Kernels are considered “behavioral vaccines.”

• “Planted” Kernels create a culture.

Kernels

Challenge – Feelings of Safety

• Also known as “handshakes.”

• Frequent friendly physical and verbal greetings impact social status and perceptions of safety and harm.

• It also affects behavior streams of aggression, hostility or politeness.

Pleasant Greeting with Physical Touch

Challenge – Praise

When any person receives specific, spoken recognition for engagement in a target act or behavior, it is widely demonstrated to:• Improve school performance• Improve adult/child interactions• Improve organizational functioning• Increase the frequency of the target

behavior

Verbal Praise

Verbal Praise As a Social Reinforcer

What are the social reinforcers in your home, classroom or community for this behavior?

Paying attention.

Verbal Praise As a Social Reinforcer

How about for this behavior?

Showing off.

Peer to Peer Notes

Notes of praise written from one peer to another, then read aloud or posted on a public display is widely shown to:

• Increase positive friendships• Reduce neighborhood disorganization and crime

• Increase sense of safety• Increase volunteerism• Increase behaviors you want to see more of

Adult to Child Notes

• Notes from adults to children recognizing them for a SPECIFIC action or behavior is demonstrated to help youth of all ages to:

• Do better at school• Be more socially competent• Reduce ADHD, aggression and problem behaviors

• Increase the behaviors you want to see more of

Beat the Timer

Steps:• Announce Beat the Timer• Say how long the timer will be set for• Say what behaviors are to beat the

timer• Announce the timer is about to begin• Praise positive behavior while timer is

ticking• Celebrate success and occasionally

reward

Copy Cat (Paragraph Shrinking)

• After talking with your child, ask him to repeat what was said in 8‐10 words.

• Repeat if summary is poor.

• Praise if the summary is good.

• Helps with retention and understanding of what is said or read.

The Social Development Strategy

Random CallingThis kernel is sometimes referred to as “Ritalin on a Stick” and is proven effective by research.Start by putting the names of all the students in the classroom on separate sticks. Every few minutes, the teacher picks a stick randomly to call on student to answer a question, to help, or to do something that maintains attention, generates motor behavior and creates a response. Typically, the stick is put back into the container so that might drawn again, randomly at any given time.Random calling results in:

Equality in participation. Increased attention will be paid to the

lesson Increased academic performance Decreases in disruptive behavior

Challenge – Recognition

Positive Note Home for Inhibition

When an adult sends a positive note home with a student for inhibiting an otherwise disruptive behavior, good things happen, particularly when a reward at home occurs in response.

This strategy is demonstrated to reduce disruptive and aggressive behavior, problems at home and increases engagement at school.

Principal Lottery

When a status figure sends a note home or calls a parent about a student’s positive behavior, research shows that action results in:

Increases in academic achievement

Reductions in disruptive behavior

Reductions in aggression

Auditory/Visual Signal for Transition

The attention kernel works for students and adults. It results in: Immediate reduction in transition time

Increased academic engagement

Reduced disruptive behavior

Reduced aggression and bullying

Reduced trauma response in traumatized people.

Beat the Timer

Beat the timer makes daily routines run smoother, reduces parent/child conflict and reduces accidental attention to negative behavior. Research shows that this simple game: • Increases compliance• Increases accuracy and

completion of homework• Helps with chores

Premack’s Principle

Also known as the Mystery Motivator, Granny’s Wacky Prizes, Prize Bowl and the Game of Life.Results in a reduction in deviant behavior across the lifespan, reduces problem behavior at school, increases desirable behavior in all age groups and reduces addiction. Motivates youth and adults

to do their best and improve

Taps into “intrinsic” motivations

Fosters self‐regulation instead of excitement

Brain on the Ball

• Suitable for preschoolers through adults• Sitting on therapy balls is shown to increase

attention, improve academic achievement, reduces ADHD symptoms without medication and reduce disruptive behavior

Other Kernels

Graphic/Node Maps

Choral Responding

Peer to Peer Tutoring

Nasal Breathing

Omega 3

Private Reprimands

More!

The Bottom Line

• Share what you learned today with your colleagues, especially if they aren’t in this room.

• Consider implementing strategies that seem like a fit for your classroom.

• Reframe your perspective: working with difficult children is hard, but recognizing their behavior as a personal solution might help.

• Partner with me. If you need it, I give you my permission to do what’s in your heart.

Johnny

ResourcesPresenter: Joe Neigel

Snohomish County Human ServicesAlcohol and Other Drug Prevention3000 Rockefeller Ave. m/s 305Everett, WA 98201(425) 388‐[email protected]

Power Point: http://www.slideshare.net/jneigel/aces‐and‐kernels‐parents‐2013‐04

Kernels: http://promiseneighborhoods.org/kernels/Orhttp://bit.ly/embry_kernels

ACES: http://www.cdc.gov/ace/index.htmOrhttp://www.acestudy.org/Orhttp://www.fpc.wa.gov/Orhttp://www.acestoohigh.com

ARC Training: http://www.traumacenter.org/research/ascot.php

OSPI Initiative: http://www.k12.wa.us/CompassionateSchools/

ACEs in Snohomish County

35.3%

22.9%

12.6%9.2% 7.5%

12.6%

37.8%

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13.6%9.6%

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The Darrington Experience

• After seeing a presentation like this, a champion emerged at Darrington Elementary School. With her help, we identified the Good Behavior Game and Brain on the Ball as strategies that were a good fit for her classroom.

• Research shows the Good Behavior Game implemented in a 1st grade classroom for one school year produces:

• 60‐90 minutes more time to teach and learn each day.

• 75‐125 fewer disruptions per hour in classes.• 20%‐30% reduction in need for special education

The Darrington Experience

• The effects are even more profound over the lifetime of a Good Behavior Game participant:• 50% ‐ 70% reduction in mental health difficulties (e.g.,

ADHD and conduct symptoms).• A 10% to 30% reduction injuries or stress related

complaints.• Reduction in directly observable symptoms of ADHD such

as inattention and fidgeting, even for children not on medication.

• 30% to 60% reduction in referrals, suspensions or expulsions

• At age 13, reduced initiation of smoking by 26% and of hard drugs by more than 50%.

• At age 19, increased the likelihood of high school graduation by 21% and of college attendance by 62%.

Our Investment

• The County invested approximately $450 in Good Behavior Game manuals and materials.

• Teachers noticed immediate reductions in disruptions and increases in teaching time.

• Teachers implemented the Good Behavior Game in combination with another kernel – alternative seating strategy.

• They replaced all chairs in 1st – 3rd grade with therapy balls.

Our Investment

• Therapy balls were ordered to each student’s measurement, and had feet to prevent rolling or tip‐overs.

Our Investment

• Teachers report:• The kids like them• Helps them focus• Works especially well

partnered with the “Behavior Game”

• Comfortable• Better handwriting• Seems to give the students stamina for writing for

longer periods of time• In other classrooms, extra balls are used as a reward.

• Rate of disruptions per student per hour: Goheen (74% reduction) and Monte Calvo (86% reduction) teaching Math.

Adverse Childhood Experiences and Evidence Based Kernels

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