Aces and Kernels presenation to Marysville School District
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  • This presentation is a summation of evidence compiled by Dr. Robert Anda of the CDC and Dr. Vincent Filletti of Kaiser Permenente in Southern California, as well as research compiled by Dr. Dennis Embry.
  • Explain our goals for the day
  • Before we begin, I want to acknowledge that I’m excited to be here today because you are literally building our future. You’ve been called to a profession that few people have the skills to pursue. You know that every student carries a suitcase through life. That suitcase is filled with tools you’re teaching them to use now, and bricks that will way them down until the grave. Based on your calling, what tools do you want to pack in their suitcase? What bricks do you hope to unload from it?
  • Ask about the audience’s perception of the costs of child abuse and other adversity experienced during childhood. Most likely, many of the major ACE related outcomes will come up (but not all). That’s great, because we’re just trying verbalize here that we already know abuse is bad (many just don’t realize how comprehensively bad it is – and we’ll lead them to that).
  • The ACE Study was developed by doctors at Kaiser Permanente in partnership with the Centers for Disease Control in the 1990’s. The need for a study became apparent when Kaiser Permanente’s nationally renowned weight loss program recognized that its most successful clients (in terms of weight loss) were the ones who were dropping out of the program prematurely. The quest for answers ultimately led the researchers to focus on abuse and dysfunction experienced by their clients as children.
  • Pass out the ACE Score calculator (if you haven’t already). This is the tool developed by Dr. Anda and his colleagues at the CDC to determine the ACE score. Each question is requires a “Yes” or “No” answer. Each “Yes” answer equals one point. Each “No” answer equals zero points. A person’s ACE Score is the sum of all the yes answers.A person’s ACE Score is private. Ask participants to keep their own score in mind as you walk them through the rest of the presentation. It could be that they are persons of great resilience and so will disbelieve the rest of the presentation. Those folks should be reminded that although they were protected, look at others in their lives or family who were not as resilient (or fortunate).
  • The intuition of a modern sage… This is exactly what the ACE Study found.
  • We know there are a few key factors that impact brain development: age of trauma, type of trauma and gender. Interestingly, ACES found that humiliation (emotional abuse) was the most significantly weighted form of a trauma a child could experience – emotional abuse was connected to the most severe health outcomes.
  • Kuelbs, 2009; Perry, 2001; Shore, 2001; Teicher et al, 2002
  • The Study established that ACEs lead to risk factors for the 10 most common causes of early death in the United States.
  • It was found that the higher ones ACE score, the more likely a person was to have clusters of issues.
  • The ACE Pyramid illustrates the momentum adverse childhood experiences have in a person’s life. If you begin life with a foundation of adversity, without intervention some form of social, emotional or cognitive impairment will develop to enable a person to adapt to their adverse environment. The ACE Study show this will lead to the adoption of health risk behaviors (or an individual’s personal solution) in childhood and adolescence, which are typically risk factors for disease, disability and social problems, which ultimately lead to an early death. This is not the foundation you want if you plan to send your kids to an ivy league school, or even to graduate from high school!
  • According to the initial ACE Study findings, average life expectancy is reduced by 19 years for a person with an ACE score of 6 or more.
  • According to the Family Policy Council, the Washington State Behavioral Risk Factor Surveillance System (an annual phone based national health survey locally coordinated by various County Health Districts) projects this as the number of students with ACEs in the average classroom.
  • This component of the presentation was adapted from the work of Dr. Dennis Embry at Paxis Institute. You can learn more at
  • If Americans ate the same about of linoleic acid (e.g., soybean oil, cotton see oil, corn oil) as the UK, Canada or Australia, homicides would drop from 30,000 to 2,000.
  • Mothers who eat NO fish during pregnancy, per US Government recommendations, have twice as many low IQ children as mothers who eat fish twice a week.
  • Ample research shows television viewing is directly linked to obesity, sexual promiscuity, teen pregnancy, violence and substance abuse.

Aces and Kernels presenation to Marysville School District Aces and Kernels presenation to Marysville School District Presentation Transcript

  • Creating Thriving Children in theClassroom and the Community(Or: How I learned to stop worrying and love the ball.) Presented by Joe Neigel Marysville Together October 12, 2012
  • Learn about the Adverse Childhood Experiences Study andhow early life trauma influences behavior and long-termhealth outcomes.Consider some additional factors that contribute todifficulty in the classroom, the community and at home.Examine how we can apply low and no-coststrategies to significantly influence a positiveschool culture, reduce classroom disruptionsand protect our most valuable natural resource.
  • • ACES is the largest study ever completed that examines the health and social effects of traumatic childhood experiences throughout a person’s lifespan (more than 17,000 participants)  Middle class, average age of 57  80% white, 10% black, 10% Asian  74% some college  44% graduated college  49.5% men• Examines three forms of abuse and household dysfunction
  • • 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
  • • The ACE Score is the number of categories of adverse childhood experiences to which a person was exposed.• 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 very common (what remainsuncommon is their recognition oracknowledgement)They are well-concealed by time, shame, bysecrecy and social tabooACEs are strong indicators of what happenslater in life, in terms of health risks, diseasesand premature death
  • “My greatest failure was in believing that the weight issue was just about weight. It’s not. It’s about not handling stress properly. It’s about sexual abuse. It’s about all the things that cause other people to become alcoholics and drug addicts.” — Oprah Winfrey
  • Like you, Oprah didn’t need research to tell herthat a child’s environment and experiences shapetheir long-term health.We also know that our environment shapes ourbrain development, which by design prioritizessurvival.To ensure survival, our brain produces ahormone called Cortisol that is released duringtimes of intense stress or danger – it triggers our“flight or fight” response.
  • Prolonged exposure to Cortisol is toxic, andmakes permanent changes to the brain.This means a person may be perfectly suited tosurvive in their home environment, but they maynot know how to act in normal situations.Toxic Stress Hormone exposure even changes theDNA of a person, allowing for Mothers or Fathersto pass on their “survival characteristics” fromgeneration to generation.
  • AGE OF TRAUMA TYPE OF ABUSE Because the brain Because different develops over types of abuse time, the activate different consequences of processes that shapetrauma relate to the the brain, type ofarea of the brain that abuse plays a is developing at the significant role in time of abuse. brain architecture. GENDER Although both boys and girls are affected by maltreatment, the effects of sexual abuse are more profound in girls while the effects of neglect are more profound in boys.
  • Hypervigilance - “Always on the ready”Development of trauma induced ADHD symptomsEarly onset of sexual activityMore impulsive, aggressive behaviorsLess able to tolerate stressIncreased risk of physical and mental healthproblems, including development of health riskbehaviors
  • • There is a strong “dose/response” relationship between a person’s ACE score and their number of resulting outcomes and health problems.• Dose/Response is a measure of “cause and effect.”
  • • We can see the cause and effect relationship ACEs create in people and in populations.
  • • We can see the cause and effect relationship ACEs create in people and in populations.
  • • We can see the cause and effect relationship ACEs create in people and in populations.
  • • We can see the cause and effect relationship ACEs create in people and in populations. 80 Women% With a Lifetime History of 70 Men 60 Depression 50 40 30 20 10 0 0 1 2 3 >=4 ACE Score
  • • We can see the cause and effect relationship ACEs create in people and in populations.
  • Partial List of ACE Dose/Response OutcomesAlcoholism & alcohol abuse Liver diseaseChronic obstructive pulmonary Obesitydisease & ischemic heart diseaseDepression Sexually transmitted diseaseFetal death SmokingHigh risk sexual activity Suicide attemptsIllicit drug use Unintended pregnancyIntimate partner violence Early DeathThree or more marriages Increased Emergency Room UseIncreased Pharmacy Use Significant Financial Problems
  • With an ACE score of 0, the majority of adults havefew, if any, risk factors for diseases leading to earlydeath With an ACE score of 4 or more, the majority ofadults have multiple risk factors for these diseases,or the diseases themselves. Prepare yourself for this – The things we identify as risk factors (obesity, illicitdrug use, promiscuity) are, in fact, effective short-term devices – coping mechanisms – for the trauma experienced as a child
  • This is an important idea. Framing thisanother way, many of the things termedpublic health problems are actuallypersonal 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
  • To put it simply, childhood experiences arethe most powerful determinants of who webecome as adults.
  • PAR = The difference in rate of a conditionbetween an exposed population and anunexposed population.In this case, it is a calculation used by theCDC to estimate the proportion of a healthoutcome that is attributable to ACETakes into account:The increased risk due to each level of ACEThe prevalence of the number of ACE categories
  • Current Smoking Smoking Not Attributable to 21.7% Ace Smoking 78.3% Attributable to ACERisk data from Felitti, et. Al: PAR analysis: RE Voorhees
  • Ever Using Illicit Drugs 32.1% not attributable to 32.1% ACE 67.9% 67.9% attributable to ACERisk data from Felitti, et. Al: PAR analysis: RE Voorhees
  • Alcoholism 3.2% 3.2% of self- reported alcoholism not attributable to 96.8% ACE 96.8% of self- reported alcoholism attributable to ACERisk data from Felitti, et. Al: PAR analysis: RE Voorhees
  • Reporting Having Attempted Suicide 0% of attempted suicide not 100% attributable to ACE 100% of attempted suicide is attributable to ACERisk data from Felitti, et. Al: PAR analysis: RE Voorhees
  • “PersonalSolution”
  • 60Percent in Age Group 50 19-34 35-49 40 50-64 >=65 30 20 10 0 0 2 4 ACE Score
  • Adversity is not our destiny. Every person can heal.
  • Our culture is killing our kids.
  • Depression, bipolar disorder, anxiety and suicidality are increasing in youth.
  • ADHD, conduct disorders and self mutilation (cutting behaviors) are increasing in youth.
  • Younger kids are committing more serious crimes.
  • Obesity has become epidemic in youth.
  • Bullying and aggression continue to grow.
  • Serious addictions are happening at younger ages.
  • Our youth are suffering from majordevelopmental deficiencies unrecognizedby the majority of our culture, including:Essential brain nutrient deficienciesMovement deficienciesReinforcement deficiencies
  • • Brain nutrient deficiencies lead to serious problems for youth, and the people who interact with them. • They are specifically known to cause: Increases Decreases Illness and Death in… in… from…Impulsivity Self-Control Heart diseaseBipolar disorder I.Q. StrokeDepression Academic achievement ObesitySuicide DiabetesADHD Alzheimer’sAggression & Homicide CancerSubstance abuse** Domestic Violence**
  • Many youth in the United States exhibitsome form of Omega-3 deficiency. Omega-6 Omega-3 (soybean, corn, cotton seed oil) (fish and range-fed stock)
  • • The alterations in brain chemistry that have resulted from our changing diet during the last 50 years contributes to trends of depression, bipolar disorder, autism, violence and academic problems.
  • • Movement deficiencies also lead to serious problems for youth • These deficiencies are specifically known to cause: Increases Decreases Illness and Death in… in… from…Depression Academic achievement Heart diseaseSuicide Social Competence StrokeADHD ObesityAggression DiabetesBullying Bone fracturesTobacco Use
  • • Some national trends: 82% of mothers do not let their children play outside because of fear of crime. Many parents do not let their children roam with other children because of “stranger danger” fears. Parks, playgrounds and sidewalks for children are not being built. From 1981 to 1997, outside play time for young children declined from 15 hours to 11 hours. 70% of US mothers played outside as children, but only 31% of their children do today.
  • • Ample research shows television viewing is directly linked to obesity, sexual promiscuity, teen pregnancy, violence, ADHD symptoms, decreased academic achievement and substance abuse.• It leads to vicarious trauma exposure and can create PTSD symptoms in youth, which may include having difficulty controlling emotions and reactions.  Having trouble beginning and maintaining relationships and friendships.  Having low self-esteem.  Having problems keeping up in school.
  • • Reinforcement deficiencies lead to serious problems for youth and society • These deficiencies are specifically known to cause: Increases Decreases Illness and Death in… in… from…Depression Academic achievement Intentional injuriesADHD Social Competence Unintentional injuriesAggression Infectious diseasesBullying Stress-related illnessLegal and illicit drug use
  • • What are the social reinforcers in your classroom for this…
  • • What are the social reinforcers in your classroom for this…
  • • Attention is a reward, and our culture tends to give big and frequent rewards for bad things done by teens and adults today.• Every child has an “attention” gas tank. They need it filled in order to be whole people.  Praise and positive attention are like premium gasoline: they make children run at their best.  Negative attention is like regular unleaded gasoline: it will do.• Criticism and punishment reinforce negative behaviors, while praise and recognition reinforce positive behaviors. A child will behave in the manner that gets him the most attention!• Think about how video games influence youth: young people spend hours in front of a screen for nothing more than electronic “atta boy” or a “you go girl.”
  • • Syndemics are multiple-related afflictions, disorders and disruptions in American society that cause: Rises in delinquency, crime, car crashes, violent injuries, and white-collar crimes Mental illness, child-maltreatment, domestic violence, sexually transmitted diseases, and addictions of all types Higher health-care and social-security costs Lower economic productivity and global competitiveness Vulnerability to terrorism and social instability
  • • These problems, evident in our homes, hallways and classrooms, seem big and messy.• Many of us feel too overwhelmed, overworked and overburdened to put our energy into programs and curricula that take precious resources to implement.• But we should remember that these big problems are really an aggregate of many smaller problems spread across a lot of people .• What if we could use small solutions to make just as big of an impact?
  • • A kernel is the smallest unit of scientifically proven behavioral influence.• They are the “active ingredients” of evidence-based programs.• A kernel is indivisible; that is, removing any part makes it inactive.• 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.
  • There are over 100 evidenced-based kernels you can plant for school and community-level change.
  • • “Turtle Breathing” is a technique for helping children with controlling anger.• Some elementary teachers use this technique in conjunction with the scripted story, “Tucker Turtle Takes Time to Tuck and Think.”• This technique: – Reduces anxiety – Reduces temper tantrums – Increases resiliency – Increases self-control
  • • Model remaining calm• Teach the child the steps of how to control feelings and calm down – Step 1: Recognize your feeling(s) – Step 2: Think “stop” – Step 3: Go inside your “shell” and take 3 deep breaths – Step 4: Come out when calm and think of a “solution”• Practice steps frequently• Prepare for and help the child handle possible disappointment or change• Recognize and comment when the child stays calm• Involve families: teach the “Turtle Technique”
  • • Notes from teachers to students 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 – Increases behaviors you want to see more of
  • • Notes of praise written from one peer to another, then read aloud or posted to a classroom or hallway display is widely shown to: – Improve school performance – Improve adult/child interactions – Improve organizational functioning – Increases behaviors you want to see more of
  • • When a 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
  • • Beat the timer makes daily routines run smoother, reduces adult child conflict and reduces accidental attention to negative behavior. Research shows that this simple game: – Increases compliance – Increases accuracy and completion of academics
  • • 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
  • • 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.• Cost: Harmonica• Steps: – Blow the Harmonica – Raise hand in peace sign • Praise students who quickly train their eyes on you • Make sure 95% of all students eyes on you BEFORE you give your next instruction• Give transition instruction – Recognize success and occasionally reward quick transitions
  • • Also known as the “Premack Principle,” 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
  • • Participants selects prizes from a list that are appropriate to your situation, time of day, activities, etc.• Randomly select when children win the game.• Use the prizes for a very short time with a clear start and stop• Rotate and freshen prizes• Use student ideas and behaviors
  • • This 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
  • • 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.• Greetings are also a key to positively influencing school and classroom culture.
  • • 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.
  • • 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
  • • Meaningful change in agency culture begins on the front lines.• If you need it, I personally give you permission to do what’s in your heart.
  • • The Good Behavior Game is a group behavior management strategy shown to have positive effect up to 30 years after implementation. In 2009, the Institute of Medicine reported it as one of the most powerful prevention strategies that classroom teachers can use.• Alternative Seating strategies – specifically, sitting on therapy balls – are shown to increase attention, improve academic achievement, reduce ADHD symptoms without medication and reduce disruptive behavior.• The goal of both strategies was to recapture teaching time lost to disruption while protecting youth from future substance abuse by teaching them self-regulation.
  • Rate of disruptions per student per hour: Goheen (74%reduction) and Monte Calvo (86% reduction) teaching Math.Pre-test observations made in December, 2011. Post-testobservations made in June, 2012.
  • Share what you’ve learned! Talk to yourcolleagues. If they weren’t here today, let’sorganize this training for them.Consider implementing strategies that will workfor your classroom.Reframe your perspective: working with difficultchildren is hard, but recognizing their behavior asa personal solution might help.Partner with me. If you need it, I give you mypermission to do what’s in your heart.