BRINGING ACES AWARENESS TO SONOMACOUNTY. TRAUMA INFORMED TRAUMA RESPONSIVE.
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Transcript of BRINGING ACES AWARENESS TO SONOMACOUNTY. TRAUMA INFORMED TRAUMA RESPONSIVE.
BRINGING ACES AWARENESS TO SONOMACOUNTY
TRAUMA IN
FORMED
T RAU
MA
RE S P O
NS I V
E
THE ADVERSE CHILDHOOD EXPERIENCES (ACES) STUDY 1995-1997
The largest study ever done to examine the health and social effects of adverse childhood experience over the life span.
17,000+ participants
Abuse
Psychological
Physical
Sexual
Neglect
Emotional
Physical
Household Dysfunction
Substance Abuse
Parent Absent
Mental Illness
Domestic Violence
Criminal Behavior
10 QUESTIONS/3 CATEGORIES
Abuse
Psychological 11%
Physical 28%
Sexual 21%
Neglect
Emotional 15%
Physical 10%
Household Dysfunction
Substance Abuse 27%
Parent Absent 23%
Mental Illness 17%
Domestic Violence13%
Criminal Behavior 6%
ORIGINAL FINDINGS
LOCAL HELPERS (BLUE RIBBON EVENT MAY 2015)Abuse
Psychological 11% 53%
Physical 28% 23%
Sexual 21% 28%
Neglect
Emotional 15% 25%
Physical 10% 12%
LOCAL HELPERS CONTINUED
Household Dysfunction
Substance Abuse 27% 51%
Parent Absent 23% 46%
Mental Illness 17% 47%
Domestic Violence 13% 16%
Criminal Behavior 6% 9%
CONCLUSIONS
Adverse Childhood Experiences are Common
ACEs occur together - If you have one ACE, there is an 87% chance that you have more than one.
The more ACEs you have, the higher the risk of physical, mental and social problems.
Adverse Childhood Experiences (ACEs)
THE # 1 CHRONIC HEALTH EPIDEMIC in the United States“The impact of ACEs can now only be
ignored as a matter of conscious choice. With this information comes the responsibility to use it.” Anda and Brown, CDC
CHILDHOOD EXPERIENCES UNDERLINE CHRONIC DEPRESSION
CHILDHOOD EXPERIENCES VS. ADULT ALCOHOLISM
ACES AND UNEMPLOYMENT
Source: Soc Psychiatry & Epidemiology; Liu, et al., (2013)
ACES AND POPULATION ATTRIBUTABLE RISKS
ACE Score
Multiple Sexual
Partners*
3 or More
Marriages*
Had Unwanted Pregnancy* (abortion)
0 1.0 1.0 1.0
1 1.6 1.5 1.5 2 1.9 1.6 1.7
3 3.4 2.3 2.3 4 4.4 2.9 2.1
>5 5.8 3.8 2.9
HEALTH RISK BEHAVIORS: COPING MECHANISMS “Risk” behaviors begin as
survival skills for the traumatized child
Immediate psychological benefit as coping devices
When human interactions cannot induce reward, people turn to other ways of relieving distress
Yesterday’s solutions often cause problems today
USE DEPENDENT DEVELOPMENT
Plasticity: Capacity to adapt to environment
Patterned, repetitive activity reinforces formation of brain circuits
The most used areas of the brain are the most developed
When children live with fear, the areas of their brains controlling the fear response can become overdeveloped.
Earliest experiences have greatest impact as brain organizes around expected patterns
IMPACT OF TOXIC STRESS
Humans are designed to deal with intermittent stress, not chronic stress.
We were not designed to fight the tiger all day long!
In children, stress becomes toxic when it is not buffered by the comfort of a supportive adult.
Trauma and Toxic Stress cause
Changes in physiology
Changes in brain architecture
Changes in skills, abilities and behavior
Changes in health and mental health
WHAT
DOES T
HIS LO
OK
LIKE
IN S
ONOMA COUNTY
?
Results for Sonoma County● Napa/Sonoma data
combined● Estimated prevalence of
22% have 4 or more ACEs ● Increased risk for
depression, suicide attempts, drug and alcohol use, heart disease, stroke, COPD, diabetes, and Alzheimer's
ESPEC
IALL
Y FOR O
UR STU
DENTS
ACE ESTIMATES FOR CHILDREN IN SONOMA COUNTY
Based on the National Survey of Children’s Health, and estimated 3,011 children in Sonoma County had 5 or more ACEs in 2011/2012!
An additional 2,335 children had 4 ACEs
HOME ENVIRONMENT AND ACES (CA)
For all children, hours spent playing videogames and watching TV was significantly related to ACE scores.
For 6-17 year olds, school problems were significantly related to ACE scores. The higher a child’s ACE score, the more days of school were missed and the more disengaged children were with school.
CORRELATING ACES
For 6-17 year olds, adequate sleep was significantly related to ACE scores. The higher a child’s ACE score, the more sleep-deprived they were.
ACES AND SOCIAL ENVIRONMENTS
For all children, poverty and living in an unsupportive neighborhood were significantly related to ACE scores. The higher a child’s ACE score, the more impoverished a family was and fewer social supports were available in their neighborhood.
WHO IS IN YOUR CLASS?
The Story ofDaisy D Juan M
CONTEXT
Recent research on ADHD shows that even though children can have the gene for this disorder, how it expresses may be affected by adverse childhood experiences. It is not a “context free condition.”
http://acesconnection.com
PRO-SOCIAL BEHAVIORS
The ability to form healthy relationships is dependent on learned social skills
Children’s social skill learning is directly related to the characteristics of their environments
Disordered environments = dysfunctional skillsViolence teaches withdrawal, anxiety, distrust, over –reaction and /or aggression as coping behaviors
TRAUMATIZED CHILDREN
Appear guarded and anxious
Difficult to re-direct, reject support
Highly emotionally reactive
Difficulty settling after outbursts
Hold on to grievances
May not take responsibility for behavior
Make the same mistakes over and over
TRAUMATIZED CHILDREN
See world as threatening and bewildering
World is punitive, judgmental, blaming, humiliating
Control is external, not internalized
People are unpredictable and untrustworthy
Defend themselves about all else
Believe that admitting mistakes is worse than telling the truth
STATE DEPENDENT FUNCTIONINGIn order to learn, we must vacillate between calm
and alertAlert: take in new concrete informationCalm: process, integrate and self soothe
Children coping with trauma have higher baselines: may enter classroom in state of alarm
Children coping with trauma are more sensitive to threat: seemingly benign triggers may escalate them into fear or terror
As arousal increases, reaction is orchestrated by increasingly lower parts of the brain.
Corresponds with sequence of development: when frightened, we all function as toddlers
RESILIENCE
Strength under adversity.
Resilience Through the Lifespan Study People are more resilient than we realize There are, however, limits to emotional endurance,
even for the most resilient among us. Human understanding can play a very important role in
determining who rises about life’s challenges, human misunderstanding can play a very important role in determining who succumbs.
For children/youth at risk for serious emotional, behavioral and learning problems, can simply going to school each day actually protect them from negative outcomes years down the road?
BUILDING RESILIENCE
The single most common factor for children who develop resilience is at least one
stable and committed relationship with an adult
This can be a teacher, coach or other school personnel
Nurturing and positive relationship with an adult who sees their strengths
A relationship as brief as one school year can make a dramatic lasting impact
TRAUMA RESPONSIVE
Resilience and context are inseparable.
In a environment that you perceive as dangerous and threatening, it makes no sense from a survival point of view to appear conspicuously vulnerable.
RESILIENCE IN CONTEXT
Environments that are safe, free from bullying
Differences are legitimized rather than stigmatized
Children and adults learn to see themselves through their strengths, not their challenges
Opportunity to learn to work hard and treat mistakes as learning experiences.
Good modeling
THE PROBLEM WITH PUNISHMENTChildren coping with trauma assume the
world is a dangerous place – perceive threat in benign situations
Children coping with trauma may try hard to appear in control even when feeling out of control (coping response to chaos at home)
Adult frustration and punitive reactions Strengthen the child’s expectations of confrontation and danger
Reinforce negative self-image
REWARD CONTINUUM
Children coping with trauma can be dysregulated by human interactions instead of regulated and rewarded
Diminishing reward options with shift up arousal continuum
Adult approval is not an adequate reward for a traumatized child or one that is hyper-aroused
Removal from the group is not an adequate consequence
PROMOTE SENSE OF SAFETY
Highly structured environmentPredictable schedulePredictable routinesPredictable consequences Predictable rewards
Zero tolerance for bullying
Alert children to loud noises before they occur
Adults are respectful, calm and confident
“Peace corner” in the classroom
RHYTHM AND REGULATION
Brainstem must be regulated before we can access cortex: somato-senseory – bottom up modulation
Brainstem regulates through patterned, rhythmic activity because it developed in-utero.
When we are highly aroused, we unconsciously self-soothe with rhythm: singing, walking, rocking, head banging, stereotyped behaviors
Use rhythm to regulate state of arousal – mirror their rhythm and use soothing tone of voice – to get child to alert state, then can use relational rewards.
TEACH EMOTIONAL REGULATIONChildren coping with trauma must learn
how to control their emotions, or they will “just keep loosing it”
Teach children to recognize their reaction to stress and to control it.
Ask: “You really looked stressed. On a scale of 1-10, where are you with your anger?”
Teach rhythmic and mindfulness based tools for modulating emotions
Deep breathing, rhythmic exercise
TEACH EMOTIONAL REGULATIONWeave social-emotional learning into
academic topicsEmpathy building exercises: ex - write a story about a typical day in your partner’s life
Classical music during independent work time
Opportunity for “fidgety” time during listening activities
Include time for physical activities: yoga, theater
Give children goal-directed tasks that involve movement – ex: passing out papers
SUPPORTIVE SCHOOLS
Has to be an organizational commitment to the policy or philosophy of TRAUMA INFORMED CARE
Staff should know prevalence, impact and have some strategies.
Environment – how to make it more inviting
Support with kindness and respect
Collaborative
Individualized
LINCOLN HIGH SCHOOL
2009-2010 (Before new approach)798 suspensions (days students were out of school)
50 expulsions600 written referrals
2010-2011 (After new approach) 135 suspensions (days students were out of school)
30 expulsions 320 written referrals
Movie – Paper Tigers
“No matter how many times you save the world, it always manages to get back in jeopardy again. Sometimes I just want it to stay saved! You know, for a little bit? I feel like the maid; I just cleaned up this mess! Can we keep it clean for...for ten minutes!" ~ Mr. Incredible
It’s like a client is standing in a river raging with current and has a boulder fall right in front of her and the resulting splash knocks her over. The boulder is trauma. The parent educator is standing some distance behind in the same river and experiences the after wave. It is smaller, it is nowhere near what the client experiences, but it is the same shape and nature…….” J Peters
WHAT IS THIS FEELING CALLED?
Compassion Satisfaction (the pleasure and joy found in working with and helping children and families.)vs.
Compassion Fatigue
Secondary Traumatic Stress – happens right after. Is a normal reaction to a not normal problem. Can occur right after hearing the story. Acute at first and then wanes over time.
Burn-Out – Often gradual onset of feelings. Associated with feeling hopeless or that job is too difficult. Can be associated with high work load or unsupportive environment.
Vicarious Trauma – Occurs over an extended period of time due to continued exposure to other’s suffering. More likely to occur if you relate it to your own history of trauma.
COMPASSION IS NOT BOUNDLESS
TRAUMA RESPONSIVE
Must include a supportive staff environment.
How do you recognize your own signs of stress or compassion fatigue?
Who can you go to for support?
Can you work with others who have the same goals?
RELAXATION EXERCISES
Why do relaxation exercises work?
Helps to change your physiology. When you are stressed, you are on guard for perceived threats. You have a negative bias. When you are less stressed, you are more in control and therefore can be more intentional and better at what you do.
Think of it not as stress management, but as self-management.
As you look at these exercises – make a note – do you think they would work well for you? For someone in your family? For a parent? For a child?
RELAXATION EXERCISES
Mental “Reset” Exercises Three Part Breath: Inhale-Hold-Exhale for equal counts. (3-11 minutes a
day, remember you can practice before you get up in the morning) 4-7-8 Breath: Inhale through nose for 4, hold for a count of 7, exhale
through the mouth (with a whoosh) for a count of 8.
Reverse Frustration/AngerCooling Breath: Inhale like sipping on a straw. Exhale
through nose.
Flush Negative Memories/Feeling ShameInhale 4 quick “segmented” breathes through nose.Exhale 1 breath with a “whoosh” through mouth.
RELAXATION EXERCISES
Anger Regulation Karate Chop –use hands in a chopping motion as fast and
vigorous as you can. Other activities include flicking and shadow boxing while thinking about what angered you. (Away from the source of anger!)
Relax to Release ControlInhale to a count of 3, exhale to a count of 6. Practice to
make your inhale/exhale longer, but both of the same length.
Relax to SleepIf you wake up at night, try left nostril breathing to put
you back to sleep.
RESOURCESwww.acesstudy.org
www.cdc.gov/violenceprevention/acestudy
www.acestoohigh.com and www.acesconnection.com/g/sonoma-county-aces-connection
www.communityresiliencecookbook.org
www.developiongchild.harvard.edu
http://www.ed.gov/news/press-releases/educators-gather-white-house-rethink-school-discipline
WWW.traumasensitiveschools.org
Grace Harris, MFT
Parent Resources Director
California Parenting Institute3650 Standish Avenue, Santa Rosa, CA
95407
Office: 707.585.6108 x1103 Fax: 707.585.6155
[email protected] www.calparents.org