StrongCommunitiesRaise StrongKidsImpetus for Community Action
“The solution of alladult problemstomorrow dependsin large measureupon the way ourchildren grow uptoday.”~ Margaret Mead,A...
“The solution of all adultproblems tomorrowdepends in largemeasure upon the wayour children grow uptoday.”~ Margaret Mead,...
What Are ACEs?Adverse Childhood Experiences• Traumatic experiences inchildhood• Sometimes referred to astoxic stress or ch...
ACEs Often Last a Lifetime . . .But They Don’t Have To• Healing can occur• The cycle can bebroken• Safe, stable,nurturingr...
Quick SurveyRate Your Awareness of the ACE Study:- No Knowledge of ACE Research- Some Knowledge- More Than Most- Expert
Complete ACE Questionnaire• What does it make you think about?• Keep in mind your thoughts as we presentthe ACE Study
Two Categories of ACEs1) Growing up (prior to age 18) in ahousehold with abuse:• Recurrent physical abuse• Recurrent emoti...
What Do ACEs Look Like?
Two Categories of ACEs, cont.2) Growing up with Household Dysfunction:• Alcohol or drug abuser• Incarcerated householdmemb...
Why is This Important?Because ACEs are:• Surprisingly common• Occur in clusters• Basis for common public health problems• ...
QuestionHow do you see ACEsmanifested in kids and familiesin your community?
How It All Started
How It All Started
“Turning Gold into Lead”
Study Participants• 26,000 adults invited to participate;17,337 accepted• Solidly middle class• Average age = 57
DemographicsGender Female 54% Male 46%Race White 74.8% Hispanic/Latino 11.2% Asian/PacificIslander 7.2% African-American 4...
ACE Scores• 1/3 of adults have an ACE score of 0• Majority of adults withACE score of 0 have few,if any, risk factors ford...
ACE Scores• Women are 50% more likely than men tohave an ACE Score >5• If any one ACE is present, there is 87%chance at le...
AZ Data• Children – Natl. Children’s Health Survey• Adults – St. Luke’s Health Survey
ACEs are CommonACE Score Prevalence0 33%1 26%2 16%3 10%4 or more 16%
Group Question:Do you think ACEsare common inyour community?Why or why not?
Out of 100 People
All the world is full of suffering, it is also full of overcoming.-Helen Keller
Aces are Interrelated, Self-Perpetuating,& Have a Cumulative Stressor Effect• Number of different categories of ACEs (ACEs...
Aces are interrelated, self-perpetuating,& have a cumulative stressor effect• Number of different categories ofACEs (ACE s...
ACE’s are Highly InterrelatedAlcohol Abuse in the Home and the Risk of OtherHousehold Exposures During Childhood
• ACE score of 4 or more may result in multiple risk factorsfor these diseases or the disease themselves• ACE score of 6 o...
Evidence Suggests• Many chronic diseases in adults aredetermined decades earlier, byexperiences in childhood• Risk factors...
Top 10 Risk Factors forDeath in USAsmokingsevere obesityphysical inactivitydepressionsuicide attemptalcoholismillic...
Top 10 RiskFactors forDeath in USAsmokingsevere obesityphysical inactivitydepressionsuicide attemptalcoholismillici...
Life Long Physical, Mental &Behavioral Outcomes ofACEs• Alcoholism & alcoholabuse• Chronic obstructivepulmonary disease &i...
Lifelong physical, mental &behavioral outcomes of ACEs• Alcoholism & alcohol abuse• Chronic obstructive pulmonarydisease &...
Dr. David McCollum, retired ED physician and co-founder of the Academy on Violence & Abuse(organization aimed at health pr...
Seeking to Cope• Risk factors/behaviorsunderlying adult diseases areeffective coping devices.• What is viewed as a problem...
Coping Solutions• What are conventionallyviewed as Public Healthproblems are oftenpersonal solutions tolong concealed adve...
ACEs and Addiction“It’s hard to get enough ofsomething that almostworks.”ACE findings suggest thata major factor, if not t...
ACE findings suggestthat:a major factor, if not themain factor, underlyingaddiction isACEs that have nothealed and areconc...
ADVERSE CHILDHOOD EXPERIENCEAdverse ChildhoodExperiences• ACEs are the greatest single predictor for health,attendance and...
ACEs in theclassroom• ACEs are the greatest single predictorfor health, attendance and behavior.• ACEs are the second stro...
ACEs in theclassroom• ACEs are the greatest single predictorfor health, attendance and behavior.• ACEs are the second stro...
ACE Pyramid
Jim Sporleder of Lincoln High School tried a newapproach with his students. Using a moretrauma sensitive approach, Mr. Spo...
“Pyramid of Hope”“Before we can get our students prepared for learning, we have to focus on theirwounds and history of fai...
Design your own“Pyramid of Hope”
3 Things you should knowabout Brain Development• We are hard wired tosurvive.• Brain architecture isestablished early in l...
3 Core Concepts in Early Brain DevelopmentHarvard Center for The Developing Child
1.) Toxic Stress derails healthy development
2.) “Serve and Return” Interaction shapesbrain circuitry.Nurturing, responsive, and individualized interactions from birth...
3.) Experiences Build Brain Architecture
Serve and ReturnNurturing, responsive, andindividualized interactionsfrom birth build healthy brainstructure.serve and ret...
“Brain Hero”• http://developingchild.harvard.edu/index.php/re
Stress and the BrainExcessive and repeated stress:(Neglect, violence, chaos, hostility,unpredictability, rejection)Causes ...
Stress and the BrainExcessive and repeated stress:• Neglect, Violence• Chaos, unpredictability• Hostility, rejectionCauses...
Toxic Stress• Causes children to live in fight, flight or fright(freeze) mode.• Short attention span• Struggle learning; f...
• Causes children to live infight, flight or fright (freeze)mode.• Short attention span• Struggle learning; fall behind in...
Toxic StressIt is fact not opinion that “Toxic Stress/ACE’s”has a severe impact on the brain developmentand a person’s fut...
“It is fact not opinion that “Toxic Stress/ACE’s” has a severeimpact on the brain development and a person’s future. Itis ...
By adolescence, childrenseek relief through:• Drinking alcohol*• Smoking tobacco• Sexual promiscuity• Using drugs*• Overea...
Behavior is PredictableAll behavior (both good and bad) has meaningWe need to look closelyat what preceded thebehaviorWhat...
All behavior (both good and bad) has meaningWe need to ask ourselves what might be goingon going on beneath the surface.
What DoesThis LookLike?Teen that is:– Edgy, hot tempered– Impulsive– Hyper-vigilant
High Risk Teen Behaviors• May not be the core problem• They may be coping devices• A way to feel safe or just feel better
Trauma and Ongoing Stressin Infants and Toddlers• Increased arousal, elevated stresshormones and other biochemical changes...
What Does This Look Like?• Changes in eating or sleeping routines• Changes in growth and development• Changes in relations...
Behaviors Associated with EarlyChildhood TraumaAges 0 - 2• Dysregulated eating, sleepingpatterns• Developmental regression...
The 4thVital Sign• Respiration, heart rate, blood pressure andrelationships• Behaviors are children’s means of expression•...
Break
Adverse Childhood Experiencesvs. Smoking as an Adult024681012141618200 1 2 3 4-5 6 or moreACE Score
Adverse Childhood Experiencesvs. Adult Alcoholism024681012141618%AlcoholicACE Score0 1 2 3 >=4
ACE Score vs.Intravenous Drug Use00.511.522.533.5%HaveInjectedDrugs0 1 2 3 4 or moreACE Score
Adverse Childhood ExperiencesAdverse Childhood Experiencesvs. Likelihood of > 50 Sexualvs. Likelihood of > 50 SexualPartne...
ACE Score vs. UnintendedACE Score vs. UnintendedPregnancy or Elective AbortionPregnancy or Elective Abortion01020304050607...
Childhood ExperiencesUnderlie Chronic Depression01020304050607080%WithaLifetimeHistoryofDepression0 1 2 3 >=4ACE ScoreWome...
Childhood ExperiencesUnderlie Later Suicide0510152025%AttemptingSuicideACE Score0 1 2 3 >=4
ACE Score vs.Serious Job Problems024681012141618%withJobProblems0 1 2 3 4 or moreACE Score
Health Care Costs• $2.6 trillion in US (2010) • Over 10 times amount spent in 1980• 17.9% of the Gross Domestic Product • ...
Reducing CostsResearch shows that just asking about ACEs – significantly decreases doctor office visits and costs.
Pay Now or Pay Later• Pay now for programs proven to buffer the stress, or pay later in rising health costs.• “Early child...
Pay Now or Pay Later• Pay now for programs proven to buffer the stress, or pay later in rising health costs.• “Early child...
Cost of Child Abuse• 2012 CDC Report - one year confirmed costs:$124 billion over lifetime of traumatized children
ACEsACEs are theare the Pipeline toPipeline toPrisonPrison• 1 in 104 American adults is behind bars• 1 in 33 American adul...
ACEsACEs are theare the Pipeline toPipeline toPrisonPrison• 1 in 104 American adults is behind bars• 1 in 33 American adul...
Take Break Here?
View Video Here?• Healing Neen and/or Trauma Sensitive School video?
Our Challenge• We can and must “immunize” kids against the effects of ACEs. • We can and must reduce the numbers of ACEs f...
Caring CommunitiesCan Help Reduce ACEs
Examples of CaringCommunities Action• Health Care - Center for Youth Wellness, San Francisco • Education – Lincoln High, W...
How DoWe MeettheChallenge?
Three Important Concepts• Protective Factors• Resilience• Trauma-Informed Care
Protective Factors• Increase health and well-being of children and families• Critical to success at home, work and community
Resilience• Ability to deal with life’s ups and downs• Resilience Trumps ACEs
Trauma Informed Care• Not “What’s wrong with you?”; instead “What happened to you?”• Symptoms (substance abuse, etc) are a...
It Starts With You!• Identify and understand the importance of protective factors• Utilize protective factors in your own ...
Parent Café Activity?
Protective Factors• Conditions that increase health and well being• Critical for everyone regardless of age, sex, ethnicit...
Protective Factors that StrengthenFamilies and Communities• Nurturing and Attachment• Knowledge of Parenting    and Child ...
Five Protective Factors that Strengthen Families • Parental Resilience• Social Connections• Concrete Support in Time of Ne...
Nurturing and PositiveRelationshipsare the key to mentally healthy children and adolescents  
Safe, Stable, NurturingRelationshipsSafe = free from harmStable = a high degree of consistencyNurturing = compassionate, r...
What Does This Look Like?Someone you turn to:• Who?• How you feel?• What she or he does?
Building Supportive RelationshipsStarts with Modeling:• Asking questions and wondering• Becoming an active listener• Point...
View “Healing Neen” Here?
Building Nurturingand Attachment• Observe, attend  and listen to children• Provide  safe and stable home life• Model  cari...
 • Set up activities that promote bonding and attachment• Acknowledge nurturing behavior• Provide information on related t...
Knowledge of Parenting andChild DevelopmentWhy Is This Important?Parenting is not staticIf parents don’t understand behavi...
Increasing KnowledgeBegin where parents are at:  – discuss  hopes and dreams for their children– identify strengths and bu...
   • Educate parents on what to expect next• Model and teach positive ways to manage challenging behaviors (routines, limi...
The power of resiliencemoderates the effects ofserious life challengesand provides hope andhealing
The power of resilience moderatesthe effects of serious lifechallenges and provides hope andhealing.
Parental ResilienceGood outcomes in spite ofserious threats, toxic stressResilient people:– are prepared to beeffective in...
Resilience is• Feeling connected tocaring family andcommunity• Self-regulation skills• Positive view of self• Motivation t...
Begin with yourself• Take care of own mental health• Develop healthy coping devices(regular exercise, reading, listening t...
Building Resilience• Recognize early signsof stress and connectpeople to resources• Develop a trustingrelationship andprov...
Teach theSeven C’s You didn’t CAUSE itYou can’t CURE itYou can’t CONTROL itYou can help take CARE of yourselfBy COMMUNICAT...
• Teach skills toyouth• Plan activitiesfocusing onnutrition,exercising orrelaxationtechniques• Help childrendevelop health...
• Volunteer – reach out and help others• Be a mentor• Start a Community Circle of Care• Model/teach problem solvingskills,...
Social ConnectionsNetwork of emotionally supportive friends, family andneighborsImportant to:– Ease burden of parenting– D...
Building Social Connections• Identify what parents have in place; build on it• Provide opportunities for parents to get to...
Concrete Supportsin Time of Need• Food, shelter, basicservices critical to childwell-being• Link caregivers tocommunity re...
Social and EmotionalCompetence of Children• Relate/interact with others• Regulate own emotions• Communicate feelingsDelays...
Building Social/EmotionalCompetence• Teach social skills• Educate parents on importance ofsocial/emotional skills• Provide...
7 Strategiesto BuildStrongCommunities
Provide Information• Educational workshops• Radio announcements• Community meetings• Web-based• Written material• Conversa...
Enhance SkillsOffer workshops/activities designed toincrease skills of participant:– Training– Classes– Consultation– Coun...
Provide Support• Be a good neighbor• Offer mentoring orsupport groups• Offer to help• Spend quality andquantity time with ...
Enhance Access andReduce Barriers• Seek grants, build localcollaborations• Offer food, shelter, seekprofessional help if n...
Change Consequences• Thank someone for their hard work• Publicly recognize a community group thathelps strengthen families...
Change the Physical Design• Lead/participate in clean-upeffort• Initiate change to make yourcommunity safer• Set up place ...
Modify/ChangePolicy• Talk to legislators andphilanthropists aboutsupporting effective programs• Contribute to child abusep...
Question• How can we build protective factors inthe families we serve?• How can we help build resiliency in thefamilies we...
If our society is to prosper in the future, weneed to make sure that all children have theopportunity to develop intellect...
In Summary• “It is easier to build strong children than torepair broken men” ~Frederick Douglass (1817-1895)• “Children ma...
In Summary“It is easier to build strong children than torepair broken men” ~ Frederick Douglass (1817-1895)
Now What?• Questions?• Ideas for utilizing ACEresearch in your community?• What resources do you need?• What challenges do...
Turn to Your Neighbor• Share what resonated the most with youtoday.• How are you going to use thisinformation?
To Get Involved ContactMarcia Stanton, Child Abuse Prevention Coordinator,Phoenix Children’s Hospitalmstanto@phoenixchildr...
Parenting Resources• 1-877-705-KIDS (5437) - Birth to Five ParentingQuestions Helpline• 1-800-4-A-CHILD (422-4453) - Crisi...
Information & Resources• ACE Study findings and information- www.acestudy.org or www.cdc.gov• ACEs Too High – www.acestooh...
More Information & Resources• National Center for Trauma-Informed Care –www.mentalhealth.samhsa.gov/nctic• National Child ...
More Resources• 3 ½ hour ACE Online Course - $29 -http://www.fpc.wa.gov/acecourse.html• Ready Nation– http://www.readynati...
Works CitedACE Study:The CDC Adverse Childhood Experiences (ACE) Study homepage presents a wealth ofinformation on the ACE...
Works CitedEconomic Costs:CDC Injury Prevention Center includes well-researched articles on the cost of child abuse(http:/...
Thank You for Helping Make OurCommunity Strong!
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
Strong Communities Raise Strong Kids
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  • Scientific discoveries about how experience effects lifelong physical, mental, behavioral health are emerging rapidly. The technologies available to study brain development and population health have improved dramatically in the last decade. In the fall of 2009, the Institute of Medicine published a report on preventing mental, emotional and behavioral disorders in youth. In that publication they explained that much of what is discussed in this latest book simply was not known at the time of the Institute of Medicine’s last publication fifteen years ago. Just as scientific knowledge has changed, so has our understanding of the challenges we face together,. We rightly have a sense of urgency in our interest in taking major strides toward a healthier, safer and more just world. We ask questions that don’t have simple answers: Why do some people come into adulthood with abundant opportunities and capabilities, and others arrive at adulthood without equal opportunity for success and fulfillment? How do we work collectively to make dramatic improvements to health, safety, school and work success and well-being? How do we balance high expectations and appropriate accommodation so that we achieve equity in our society? Answering questions like these will require us to look beyond the everyday events that are easily observed, and see driving forces and complex causal pathways to the reality we experience. Our values and vision for the future, and our beliefs about the way the world works are powerful filters in our minds. People cannot realize what we can’t imagine. – and we don’t imagine possibilities that fall outside of our mental models about how the world works. Because we want to achieve big strides toward a time when all people thrive, we will need to develop the skill and habit of challenging the thoughts and mental models that may be holding us back. People who study problem solving in very complex systems teach that when we are challenging our own mental models, it’s helpful to point it out. That way our brain is more open to the new message. Mental model challenges will be identified as we go along. Let’s see our first one.
  • Credit Jim
  • Embed video
  • he most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention.... A loving silence often has far more power to heal and to connect than the most well-intentioned words.
  • Strong Communities Raise Strong Kids

    1. 1. StrongCommunitiesRaise StrongKidsImpetus for Community Action
    2. 2. “The solution of alladult problemstomorrow dependsin large measureupon the way ourchildren grow uptoday.”~ Margaret Mead,Anthropologist
    3. 3. “The solution of all adultproblems tomorrowdepends in largemeasure upon the wayour children grow uptoday.”~ Margaret Mead,Anthropologist
    4. 4. What Are ACEs?Adverse Childhood Experiences• Traumatic experiences inchildhood• Sometimes referred to astoxic stress or childhoodtrauma
    5. 5. ACEs Often Last a Lifetime . . .But They Don’t Have To• Healing can occur• The cycle can bebroken• Safe, stable,nurturingrelationships healparent and child
    6. 6. Quick SurveyRate Your Awareness of the ACE Study:- No Knowledge of ACE Research- Some Knowledge- More Than Most- Expert
    7. 7. Complete ACE Questionnaire• What does it make you think about?• Keep in mind your thoughts as we presentthe ACE Study
    8. 8. Two Categories of ACEs1) Growing up (prior to age 18) in ahousehold with abuse:• Recurrent physical abuse• Recurrent emotional abuse• Sexual abuse• Emotional or physical neglect
    9. 9. What Do ACEs Look Like?
    10. 10. Two Categories of ACEs, cont.2) Growing up with Household Dysfunction:• Alcohol or drug abuser• Incarcerated householdmember.• Someone chronically depressed,suicidal, institutionalized or mentally ill.• Mother being treated violently.• One or no parents.
    11. 11. Why is This Important?Because ACEs are:• Surprisingly common• Occur in clusters• Basis for common public health problems• Strong predictors of later social functioning,well-being, health risks, disease, and death
    12. 12. QuestionHow do you see ACEsmanifested in kids and familiesin your community?
    13. 13. How It All Started
    14. 14. How It All Started
    15. 15. “Turning Gold into Lead”
    16. 16. Study Participants• 26,000 adults invited to participate;17,337 accepted• Solidly middle class• Average age = 57
    17. 17. DemographicsGender Female 54% Male 46%Race White 74.8% Hispanic/Latino 11.2% Asian/PacificIslander 7.2% African-American 4.6% Other 1.9%Age (years) 19-29 5.3% 30-39 9.8% 40-49 18.6%50-59 19.9% 60 and over 46.4%Education Not High School Graduate 7.2%High School Graduate 17.6%Some College 35.9%College Graduate or Higher 39.3%
    18. 18. ACE Scores• 1/3 of adults have an ACE score of 0• Majority of adults withACE score of 0 have few,if any, risk factors fordiseases that are commoncauses of death in the US.
    19. 19. ACE Scores• Women are 50% more likely than men tohave an ACE Score >5• If any one ACE is present, there is 87%chance at least one other ACE is present,and a 50% chance of 3 others• This combination makes ACEs the leadingdeterminant of the health and socialwell-being of our nation
    20. 20. AZ Data• Children – Natl. Children’s Health Survey• Adults – St. Luke’s Health Survey
    21. 21. ACEs are CommonACE Score Prevalence0 33%1 26%2 16%3 10%4 or more 16%
    22. 22. Group Question:Do you think ACEsare common inyour community?Why or why not?
    23. 23. Out of 100 People
    24. 24. All the world is full of suffering, it is also full of overcoming.-Helen Keller
    25. 25. Aces are Interrelated, Self-Perpetuating,& Have a Cumulative Stressor Effect• Number of different categories of ACEs (ACEscore) - determine health outcomes, notintensity or frequency of a single category• Without interruption, ACEsescalate across generations
    26. 26. Aces are interrelated, self-perpetuating,& have a cumulative stressor effect• Number of different categories ofACEs (ACE score) - determinehealth outcomes, not intensity orfrequency of a single category• Without interruption, ACEsescalate across generations
    27. 27. ACE’s are Highly InterrelatedAlcohol Abuse in the Home and the Risk of OtherHousehold Exposures During Childhood
    28. 28. • ACE score of 4 or more may result in multiple risk factorsfor these diseases or the disease themselves• ACE score of 6 or more may result in a 20 year decreasein life expectancy
    29. 29. Evidence Suggests• Many chronic diseases in adults aredetermined decades earlier, byexperiences in childhood• Risk factors/behaviors for these diseasesare initiated during childhood oradolescence and continue into adult life.
    30. 30. Top 10 Risk Factors forDeath in USAsmokingsevere obesityphysical inactivitydepressionsuicide attemptalcoholismillicit drug useinjected drug use50+ sexual partnershistory of STD
    31. 31. Top 10 RiskFactors forDeath in USAsmokingsevere obesityphysical inactivitydepressionsuicide attemptalcoholismillicit drug useinjected drug use50+ sexual partnershistory of STD
    32. 32. Life Long Physical, Mental &Behavioral Outcomes ofACEs• Alcoholism & alcoholabuse• Chronic obstructivepulmonary disease &ischemic heart disease• Depression• Fetal death• High risk sexual activity• Illicit drug use• Intimate partner violence• Liver disease• Obesity• Sexually transmitteddisease• Smoking• Suicide attempts• Unintended pregnancy*** The higher the ACE Score,the greater the incidence of co-occurring conditions from thislist.
    33. 33. Lifelong physical, mental &behavioral outcomes of ACEs• Alcoholism & alcohol abuse• Chronic obstructive pulmonarydisease & ischemic heart disease• Depression• Fetal death• High risk sexual activity• Illicit drug use• Intimate partner violence• Liver disease• Obesity• Sexually transmitted disease• Smoking• Suicide attempts• Unintended pregnancy“The ACE health outcomes read likeA “who’s who” list of the top majorhealth problems in the United States.”Dr. Robert AndaCo-principal researcher on the ACEstudy
    34. 34. Dr. David McCollum, retired ED physician and co-founder of the Academy on Violence & Abuse(organization aimed at health professionals - provides education and research on the effects ofviolence and abuse on health).
    35. 35. Seeking to Cope• Risk factors/behaviorsunderlying adult diseases areeffective coping devices.• What is viewed as a problem isactually a solution to badexperiences.• Dismissing these coping devicesas “bad habits” or “selfdestructive behavior” missestheir functionality.
    36. 36. Coping Solutions• What are conventionallyviewed as Public Healthproblems are oftenpersonal solutions tolong concealed adversechildhood experiences.
    37. 37. ACEs and Addiction“It’s hard to get enough ofsomething that almostworks.”ACE findings suggest thata major factor, if not themain factor, underlyingaddiction is ACEs thathave not healed and areconcealed from awarenessby shame, secrecy, andsocial taboo.
    38. 38. ACE findings suggestthat:a major factor, if not themain factor, underlyingaddiction isACEs that have nothealed and areconcealed fromawareness by shame,secrecy, and socialtaboo.“It’s hard to get enoughof something thatalmost works.”
    39. 39. ADVERSE CHILDHOOD EXPERIENCEAdverse ChildhoodExperiences• ACEs are the greatest single predictor for health,attendance and behavior.• ACEs are the second strongest predictor, after specialeducation status, for academic failure.• The relationship between academic achievement andhealth status appears much less related to income thanto ACEs.
    40. 40. ACEs in theclassroom• ACEs are the greatest single predictorfor health, attendance and behavior.• ACEs are the second strongestpredictor, after special education status,for academic failure.• The relationship between academicachievement and health status appearsmuch less related to income than toACEs.
    41. 41. ACEs in theclassroom• ACEs are the greatest single predictorfor health, attendance and behavior.• ACEs are the second strongestpredictor, after special education status,for academic failure.• The relationship between academicachievement and health status appearsmuch less related to income than toACEs.
    42. 42. ACE Pyramid
    43. 43. Jim Sporleder of Lincoln High School tried a newapproach with his students. Using a moretrauma sensitive approach, Mr. Sporleder andstaff changed the entire culture of the school.ACEs in Action!
    44. 44. “Pyramid of Hope”“Before we can get our students prepared for learning, we have to focus on theirwounds and history of failures”Jim Sporleder (principal of Lincoln High School)
    45. 45. Design your own“Pyramid of Hope”
    46. 46. 3 Things you should knowabout Brain Development• We are hard wired tosurvive.• Brain architecture isestablished early in life.• Healthy brain architecture isthe necessary foundationrequired for optimal futurelearning, behavior andhealth.
    47. 47. 3 Core Concepts in Early Brain DevelopmentHarvard Center for The Developing Child
    48. 48. 1.) Toxic Stress derails healthy development
    49. 49. 2.) “Serve and Return” Interaction shapesbrain circuitry.Nurturing, responsive, and individualized interactions from birth build healthybrain structure
    50. 50. 3.) Experiences Build Brain Architecture
    51. 51. Serve and ReturnNurturing, responsive, andindividualized interactionsfrom birth build healthy brainstructure.serve and return
    52. 52. “Brain Hero”• http://developingchild.harvard.edu/index.php/re
    53. 53. Stress and the BrainExcessive and repeated stress:(Neglect, violence, chaos, hostility,unpredictability, rejection)Causes disruption of brain architecture:– Impairs cell growth– Interferes with healthy neural circuits (friesbrain with overdose of stress hormones)
    54. 54. Stress and the BrainExcessive and repeated stress:• Neglect, Violence• Chaos, unpredictability• Hostility, rejectionCauses disruption of brain architecture:• Impairs cell growth• Interferes with healthy neural circuits• Strains brain with overdose of stresshormones
    55. 55. Toxic Stress• Causes children to live in fight, flight or fright(freeze) mode.• Short attention span• Struggle learning; fall behind in school• Respond to world as constant danger• Distrustful of adults• Unable to develop healthypeer relationships• Feel failure, despair,shame and frustration
    56. 56. • Causes children to live infight, flight or fright (freeze)mode.• Short attention span• Struggle learning; fall behind inschool• Respond to world as constantdanger• Distrustful of adults• Unable to develop healthypeer relationships• Feel failure, despair,shame and frustrationToxic Stress impactschildren in theFollowing ways:
    57. 57. Toxic StressIt is fact not opinion that “Toxic Stress/ACE’s”has a severe impact on the brain developmentand a person’s future. It is a strong predictorwith negative outcomes without theintervention of a positive adult relationship(s).You can choose not to accept the findings, butyou can’t deny them.StressedCan’t:Brains• Respond• Learn or• Process effectivelyAllow time to de-
    58. 58. “It is fact not opinion that “Toxic Stress/ACE’s” has a severeimpact on the brain development and a person’s future. Itis a strong predictor with negative outcomes without theintervention of a positive adult relationship(s).”Jim Sporleder• Respond• Learn• Processeffectively
    59. 59. By adolescence, childrenseek relief through:• Drinking alcohol*• Smoking tobacco• Sexual promiscuity• Using drugs*• Overeating/eating disorders• Delinquent behavior, violence• High-risk sports, etc.* Note: nicotine and methamphetamines areanti-depressants
    60. 60. Behavior is PredictableAll behavior (both good and bad) has meaningWe need to look closelyat what preceded thebehaviorWhat happenedfirst that is causing thisbehavior?
    61. 61. All behavior (both good and bad) has meaningWe need to ask ourselves what might be goingon going on beneath the surface.
    62. 62. What DoesThis LookLike?Teen that is:– Edgy, hot tempered– Impulsive– Hyper-vigilant
    63. 63. High Risk Teen Behaviors• May not be the core problem• They may be coping devices• A way to feel safe or just feel better
    64. 64. Trauma and Ongoing Stressin Infants and Toddlers• Increased arousal, elevated stresshormones and other biochemical changesin the body and the brain, altering braindevelopment• Long-term effects on physical, mental, andemotional development
    65. 65. What Does This Look Like?• Changes in eating or sleeping routines• Changes in growth and development• Changes in relationships• Regressions in developmental abilities
    66. 66. Behaviors Associated with EarlyChildhood TraumaAges 0 - 2• Dysregulated eating, sleepingpatterns• Developmental regression• Irritability, sadness, anger• Poor appetite; low weight• Increased separation anxiety;clinginessNCTSN.org/earlychildhoodtraumaAges 3 - 6• Increased aggression• Somatic symptoms• Sleep difficulties/nightmares• Increased separation anxiety• New fears• Increased distractibility/highactivity level• Increased withdrawal/apathy• Developmental regression• Repetitive talk/play about theevent• Intrusive thoughts, memories,
    67. 67. The 4thVital Sign• Respiration, heart rate, blood pressure andrelationships• Behaviors are children’s means of expression• Caregivers often unable to understandconnection between traumatic event andchildren’s behaviors• To heal, children need recognition andunderstanding from their caregivers
    68. 68. Break
    69. 69. Adverse Childhood Experiencesvs. Smoking as an Adult024681012141618200 1 2 3 4-5 6 or moreACE Score
    70. 70. Adverse Childhood Experiencesvs. Adult Alcoholism024681012141618%AlcoholicACE Score0 1 2 3 >=4
    71. 71. ACE Score vs.Intravenous Drug Use00.511.522.533.5%HaveInjectedDrugs0 1 2 3 4 or moreACE Score
    72. 72. Adverse Childhood ExperiencesAdverse Childhood Experiencesvs. Likelihood of > 50 Sexualvs. Likelihood of > 50 SexualPartnersPartners01234AdjustedOddsRatio0 1 2 3 4 or moreACE Score
    73. 73. ACE Score vs. UnintendedACE Score vs. UnintendedPregnancy or Elective AbortionPregnancy or Elective Abortion01020304050607080%haveUnintendedPG,orAB0 1 2 3 4 or moreACE ScoreUnintended PregnancyElective Abortion
    74. 74. Childhood ExperiencesUnderlie Chronic Depression01020304050607080%WithaLifetimeHistoryofDepression0 1 2 3 >=4ACE ScoreWomenMen
    75. 75. Childhood ExperiencesUnderlie Later Suicide0510152025%AttemptingSuicideACE Score0 1 2 3 >=4
    76. 76. ACE Score vs.Serious Job Problems024681012141618%withJobProblems0 1 2 3 4 or moreACE Score
    77. 77. Health Care Costs• $2.6 trillion in US (2010) • Over 10 times amount spent in 1980• 17.9% of the Gross Domestic Product • AZ – $13.8 billion in 2010 - 18% GDP• 75% of health spending is for chronic diseases (heart disease, cancer, stroke, and diabetes)
    78. 78. Reducing CostsResearch shows that just asking about ACEs – significantly decreases doctor office visits and costs.
    79. 79. Pay Now or Pay Later• Pay now for programs proven to buffer the stress, or pay later in rising health costs.• “Early childhood investments of high quality have a lasting effect.”                             “$10 return on investment                                                                    for every $1 spent.” (James Heckman, Noble Laureate, Economics) 
    80. 80. Pay Now or Pay Later• Pay now for programs proven to buffer the stress, or pay later in rising health costs.• “Early childhood investments of high quality have a lasting effect.”   “$10 return on investmentfor every $1 spent.”(James Heckman, Noble
    81. 81. Cost of Child Abuse• 2012 CDC Report - one year confirmed costs:$124 billion over lifetime of traumatized children
    82. 82. ACEsACEs are theare the Pipeline toPipeline toPrisonPrison• 1 in 104 American adults is behind bars• 1 in 33 American adults is under correctional control• 1 in 4 of the world’s inmates is in a US prison or jail• 1 in 8 state employees works in corrections• 1 in 14 state general fund dollars is spent on correctionsHIGH COST, LOW RETURN: 1 in 2.3 inmates returnsto prison within 3 years of release                                                                                                                                                ( - ACES TOO HIGH)
    83. 83. ACEsACEs are theare the Pipeline toPipeline toPrisonPrison• 1 in 104 American adults is behind bars• 1 in 33 American adults is under correctional control• 1 in 4 of the world’s inmates is in a US prison or jail• 1 in 8 state employees works in corrections• 1 in 14 state general fund dollars is spent on correctionsHIGH COST, LOW RETURN: 1 in 2.3 inmates returnsto prison within 3 years of release                                                                                                                                                ( - ACES TOO HIGH)
    84. 84. Take Break Here?
    85. 85. View Video Here?• Healing Neen and/or Trauma Sensitive School video?
    86. 86. Our Challenge• We can and must “immunize” kids against the effects of ACEs. • We can and must reduce the numbers of ACEs for all children!
    87. 87. Caring CommunitiesCan Help Reduce ACEs
    88. 88. Examples of CaringCommunities Action• Health Care - Center for Youth Wellness, San Francisco • Education – Lincoln High, Walla Walla WA• Medicine – Jefferson Co Public Health• Communities – Tarpon Springs FL, Philadelphia Urban ACEs• Corrections -  Alaska Family Violence• Faith Community - CA• Juvenile Justice
    89. 89. How DoWe MeettheChallenge?
    90. 90. Three Important Concepts• Protective Factors• Resilience• Trauma-Informed Care
    91. 91. Protective Factors• Increase health and well-being of children and families• Critical to success at home, work and community
    92. 92. Resilience• Ability to deal with life’s ups and downs• Resilience Trumps ACEs
    93. 93. Trauma Informed Care• Not “What’s wrong with you?”; instead “What happened to you?”• Symptoms (substance abuse, etc) are adaptations to trauma• Shift from “The denial    stops here.” to “The    recovery starts here.”
    94. 94. It Starts With You!• Identify and understand the importance of protective factors• Utilize protective factors in your own life• Empower others by educating and encouraging them to use protective factors
    95. 95. Parent Café Activity?
    96. 96. Protective Factors• Conditions that increase health and well being• Critical for everyone regardless of age, sex, ethnicity or racial heritage, economic status, special needs, or the dynamics of the family unit• Buffers that provide support and coping strategies
    97. 97. Protective Factors that StrengthenFamilies and Communities• Nurturing and Attachment• Knowledge of Parenting    and Child Development• Parental Resilience• Social Connections• Concrete Support in Time of Need• Social Emotional Competence of Children
    98. 98. Five Protective Factors that Strengthen Families • Parental Resilience• Social Connections• Concrete Support in Time of Need• Knowledge of Parenting    and Child Development• Social Emotional Competence                                       of Children
    99. 99. Nurturing and PositiveRelationshipsare the key to mentally healthy children and adolescents  
    100. 100. Safe, Stable, NurturingRelationshipsSafe = free from harmStable = a high degree of consistencyNurturing = compassionate, responsive caregivers
    101. 101. What Does This Look Like?Someone you turn to:• Who?• How you feel?• What she or he does?
    102. 102. Building Supportive RelationshipsStarts with Modeling:• Asking questions and wondering• Becoming an active listener• Pointing out the positive• Being empathetic
    103. 103. View “Healing Neen” Here?
    104. 104. Building Nurturingand Attachment• Observe, attend  and listen to children• Provide  safe and stable home life• Model  caring behavior• Respond to child’s needs• Use positive discipline• Notice and reinforce  child’s strengths
    105. 105.  • Set up activities that promote bonding and attachment• Acknowledge nurturing behavior• Provide information on related topics: – early secure attachments– responding to cries – shaken baby syndrome– how father’s nurture, etc.• Be a caring adult or mentor a child
    106. 106. Knowledge of Parenting andChild DevelopmentWhy Is This Important?Parenting is not staticIf parents don’t understand behavior, they tend to interpret it as negativeNormal challenges can lead to frustrations and harsh discipline
    107. 107. Increasing KnowledgeBegin where parents are at:  – discuss  hopes and dreams for their children– identify strengths and build on them– set up a time or place where parents can discuss  and get information– provide educational materials, websites  
    108. 108.    • Educate parents on what to expect next• Model and teach positive ways to manage challenging behaviors (routines, limits, redirection, logical consequences, etc.)• Attend or set up parenting classes• Learn/educate others signs of child abuse• Provide education on ACE’s
    109. 109. The power of resiliencemoderates the effects ofserious life challengesand provides hope andhealing
    110. 110. The power of resilience moderatesthe effects of serious lifechallenges and provides hope andhealing.
    111. 111. Parental ResilienceGood outcomes in spite ofserious threats, toxic stressResilient people:– are prepared to beeffective in the world– can adapt to challenges– are mentally healthy
    112. 112. Resilience is• Feeling connected tocaring family andcommunity• Self-regulation skills• Positive view of self• Motivation to beeffective in yourenvironment
    113. 113. Begin with yourself• Take care of own mental health• Develop healthy coping devices(regular exercise, reading, listening tomusic, etc.)• Seek out healthy family andfriends for support• Use community supports(counseling, substance abusetreatment, self-help programs, etc.)
    114. 114. Building Resilience• Recognize early signsof stress and connectpeople to resources• Develop a trustingrelationship andprovide support• Be a good neighbor• Look for and point outinner strengths
    115. 115. Teach theSeven C’s You didn’t CAUSE itYou can’t CURE itYou can’t CONTROL itYou can help take CARE of yourselfBy COMMUNICATING yourfeelings,Making health CHOICES, andCELEBRATING being yourself
    116. 116. • Teach skills toyouth• Plan activitiesfocusing onnutrition,exercising orrelaxationtechniques• Help childrendevelop healthyrelationships
    117. 117. • Volunteer – reach out and help others• Be a mentor• Start a Community Circle of Care• Model/teach problem solvingskills, planning ahead, goals
    118. 118. Social ConnectionsNetwork of emotionally supportive friends, family andneighborsImportant to:– Ease burden of parenting– Decrease isolation– Offer children broader access to supportive adults andpositive role models– Provide opportunities to help
    119. 119. Building Social Connections• Identify what parents have in place; build on it• Provide opportunities for parents to get together- use parents skills, abilities and interests• Look for community opportunities – faith based,schools, community centers, support groups• Provide encouragement and support to try newgroups• Teach social skills
    120. 120. Concrete Supportsin Time of Need• Food, shelter, basicservices critical to childwell-being• Link caregivers tocommunity resources andextended family• Work on sustainability
    121. 121. Social and EmotionalCompetence of Children• Relate/interact with others• Regulate own emotions• Communicate feelingsDelays increase child’s risk for abuse
    122. 122. Building Social/EmotionalCompetence• Teach social skills• Educate parents on importance ofsocial/emotional skills• Provide healthy outlets – arts, sensory,exercise, etc.• Encourage parents to exchange ideas onwhat works• Take timely action when there is concern
    123. 123. 7 Strategiesto BuildStrongCommunities
    124. 124. Provide Information• Educational workshops• Radio announcements• Community meetings• Web-based• Written material• Conversations
    125. 125. Enhance SkillsOffer workshops/activities designed toincrease skills of participant:– Training– Classes– Consultation– Counseling– Team sports,scouting, 4H
    126. 126. Provide Support• Be a good neighbor• Offer mentoring orsupport groups• Offer to help• Spend quality andquantity time with achild; read a book,share a meal
    127. 127. Enhance Access andReduce Barriers• Seek grants, build localcollaborations• Offer food, shelter, seekprofessional help if needed• Link clients to effective faithbased activities, recreation,parenting classes, domesticviolence shelters/education
    128. 128. Change Consequences• Thank someone for their hard work• Publicly recognize a community group thathelps strengthen families• Publish newspaper article highlightingsomeone in the community• Give rewards to individuals or businessesfor helping in the community
    129. 129. Change the Physical Design• Lead/participate in clean-upeffort• Initiate change to make yourcommunity safer• Set up place where parentscan gather and get information• Volunteer to paint a home• Support your local Child AbusePrevention Council
    130. 130. Modify/ChangePolicy• Talk to legislators andphilanthropists aboutsupporting effective programs• Contribute to child abuseprevention programs via a taxcheck off• Support positive parentingprograms, and services fordomestic violence and mentalhealth education
    131. 131. Question• How can we build protective factors inthe families we serve?• How can we help build resiliency in thefamilies we impact?
    132. 132. If our society is to prosper in the future, weneed to make sure that all children have theopportunity to develop intellectually, sociallyand emotionally.
    133. 133. In Summary• “It is easier to build strong children than torepair broken men” ~Frederick Douglass (1817-1895)• “Children make up 25% of our population,but 100% of our future.” ~Ian Jukes• Now what?
    134. 134. In Summary“It is easier to build strong children than torepair broken men” ~ Frederick Douglass (1817-1895)
    135. 135. Now What?• Questions?• Ideas for utilizing ACEresearch in your community?• What resources do you need?• What challenges do you foresee?
    136. 136. Turn to Your Neighbor• Share what resonated the most with youtoday.• How are you going to use thisinformation?
    137. 137. To Get Involved ContactMarcia Stanton, Child Abuse Prevention Coordinator,Phoenix Children’s Hospitalmstanto@phoenixchildrens.comJoan Shaffer, Program Manager,Southwest Human Developmentjshaffer@swhd.org
    138. 138. Parenting Resources• 1-877-705-KIDS (5437) - Birth to Five ParentingQuestions Helpline• 1-800-4-A-CHILD (422-4453) - Crisis Line foremotional needs, info on child abuse/neglectAlso go to: www.childhelp.org• www.azpbs.org/strongkids• www.apa.org/books• www.pbs.org/parents/childdevelopment• www.cdc.gov/parents
    139. 139. Information & Resources• ACE Study findings and information- www.acestudy.org or www.cdc.gov• ACEs Too High – www.acestoohigh.com• National Scientific Council on theDeveloping Child at Harvard University- www.developingchild.net• SAHMSA – Early Childhood Trauma Resourceshttp://www.samhsa.gov/children/earlychildhoodmat.asp
    140. 140. More Information & Resources• National Center for Trauma-Informed Care –www.mentalhealth.samhsa.gov/nctic• National Child Traumatic Stress Network –www.nctsnet.org• Center for Study of Social Policy - strengtheningfamilies and protective factors – www.cssp.org• Center for Injury Prevention and Control –www.cdc.gov/violenceprevention• American Psychological Assn – ResilienceGuide - http://www.apa.org/helpcenter/road-resilience.aspx
    141. 141. More Resources• 3 ½ hour ACE Online Course - $29 -http://www.fpc.wa.gov/acecourse.html• Ready Nation– http://www.readynation.org/• Resiliency Trumps ACEs –http://www.resiliencetrumpsaces.org• Healing Neen - http://healingneen.com/• NCAN Resource Booklet -http://www.childwelfare.gov/preventing/preventionmonth/guide2012/• ACE Response Network -http://www.aceresponse.org/
    142. 142. Works CitedACE Study:The CDC Adverse Childhood Experiences (ACE) Study homepage presents a wealth ofinformation on the ACE Study including a complete bibliography of ACE Studypublications by topic area (http://www.cdc.gov/ace/index.html).Safe, Stable, Nurturing Relationships:The CDC National Center for Injury Prevention and Control, Violence Prevention hasmany resources on the prevention of child maltreatment(http://www.cdc.gov/violenceprevention/) and promoting nurturing relationshipsbetween children and caregivers(http://www.cdc.gov/violenceprevention/pdf/CM_Strategic_Direction--Long-a.pdf ).Early Brain Development:The Center for the Developing Child at Harvard University has a wealth of the latestresearch and resources on the science of early childhood(http://developingchild.harvard.edu/ ).The Zero to Three Institute has many resources on the impact of trauma and buildingresiliency in young children(http://www.zerotothree.org/maltreatment/trauma/trauma.html ).First Things First has great info on the science of early brain development(http://www.azftf.gov/why/evidence/pages/brainscience.aspx ).
    143. 143. Works CitedEconomic Costs:CDC Injury Prevention Center includes well-researched articles on the cost of child abuse(http://www.cdc.gov/ViolencePrevention/childmaltreatment/EconomicCost.html ).The Heckman Equation has compelling resources for upstream solutions to societalproblems by investing in early and equal development of human potential(http://www.heckmanequation.org/content/heckman-101).Protective Factors:The Child Welfare Information Gateway has a wealth of well-researched resources forprotecting children and strengthening families(http://www.childwelfare.gov/can/factors/protective.cfm ).Environmental Prevention Strategies:The Community Anti-Drug Coalitions of America website includes resources for effectivecommunity problem-solving strategies(http://www.cadca.org/files/Beyond_the_Basics_EnvironmentalStrategies.pdf ).The 7 Cs Creed:National Association for Children of Alcoholics has a downloadable kit for professionalson tips for working with children of alcoholics (http://www.nacoa.org).
    144. 144. Thank You for Helping Make OurCommunity Strong!

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