Acesandkernels 110927145112-phpapp02


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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
  • Ask participants to take out their Creating Our Futures Handouts…
  • Review a few answers from the handout. This is the lead in to ACES.
  • 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.
  • It was found that the higher ones ACE score, the more likely a person was to have clusters of issues.
  • The Study established that ACEs lead to risk factors for the 10 most common causes of early death in the United States.
  • 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 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.
  • 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.
  • 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.
  • Acesandkernels 110927145112-phpapp02

    1. 1. Recipes for Success<br />Creating Thriving Children in the Classroom and the Community<br />Presented by Joe Neigel<br />North Everett Coalition<br />September 27th, 2011<br />
    2. 2. Our Goals Today<br />Learn about the Adverse Childhood Experiences Study and how early life trauma influences behavior and health outcomes<br />Consider some additional factors that contribute to difficulty in the classroom, the community and at home<br />Examine how we can apply low and no-cost <br />strategies to significantly influence a positive <br />school culture, reduce classroom disruptions <br />and protect our most valuable natural resource<br />
    3. 3. Creating Our Futures<br />Before we begin, let’s take two or three minutes to paint our futures…<br />Warning: <br />This is a time for idealism<br />
    4. 4. What Did You Write?<br />
    5. 5. Lifelong Costs of Trauma?<br />
    6. 6. The Adverse Childhood Experiences Study<br />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)<br /><ul><li>Middle class, average age of 57
    7. 7. 80% white, 10% black, 10% Asian
    8. 8. 74% some college
    9. 9. 44% graduated college
    10. 10. 49.5% men</li></ul>Examines three forms of abuse and household dysfunction<br />
    11. 11. The Adverse Experiences<br />Child physical abuse <br />Child sexual abuse<br />Child emotional abuse<br />Neglect<br />Mentally ill, depressed or suicidal person in the home<br />Drug addicted or alcoholic family member<br />Witnessing domestic violence against the mother<br />Loss of a parent to death or abandonment, including abandonment by divorce<br />Incarceration of any family member<br />
    12. 12. The ACE Score Calculator<br />
    13. 13. Counting ACES<br />The ACE Score is the number of categories of adverse childhood experiences to which a person was exposed.<br />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.<br />
    14. 14. ACE Score Findings<br /><ul><li>ACEs are very common (what remains uncommon is their recognition or acknowledgement)
    15. 15. They are well-concealed by time, shame, by secrecy and social taboo
    16. 16. ACEs are strong indicators of what happens later in life, in terms of health risks, diseases and premature death</li></li></ul><li>ACES are a cumulative measure of childhood stress<br />“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.”<br /> — Oprah Winfrey<br />
    17. 17. Graded Relationships<br />There is a strong “dose/response” relationship between a person’s ACE score and their number of resulting outcomes and health problems.<br />Dose/Response is a measure of “cause and effect.”<br />
    18. 18. ACE-Related Issues and Clusters<br />
    19. 19. Smoking<br />We can see the cause and effect relationship ACEs create in people and in populations. <br />
    20. 20. Adult Alcoholism<br />We can see the cause and effect relationship ACEs create in people and in populations. <br />
    21. 21. Intravenous Drug Use<br />We can see the cause and effect relationship ACEs create in people and in populations. <br />
    22. 22. Chronic Depression<br />We can see the cause and effect relationship ACEs create in people and in populations. <br />
    23. 23. Attempted Suicide<br />We can see the cause and effect relationship ACEs create in people and in populations. <br />
    24. 24. ACEs lead to risk factors for the 10 most common causes of early death in the United States<br />
    25. 25. Early Death in the US<br /><ul><li>With an ACE score of 0, the majority of adults have few, if any, risk factors for diseases leading to early death
    26. 26.  With an ACE score of 4 or more, the majority of adults have multiple risk factors for these diseases, or the diseases themselves.
    27. 27.  Prepare yourself for this – </li></ul>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<br />
    28. 28. Reframing Our Point of View<br /><ul><li>This is an important idea. Framing this another way, many of the things termed public health problems are actually personal solutions.</li></ul>“What is conventionally viewed as a problem is actually a solution to an unrecognized prior adversity.” <br />Dr. Vincent Felitti, <br />co-principal investigator of ACE Study<br />
    29. 29. What are the Implications?<br /><ul><li>To put it simply, childhood experiences are the most powerful determinants of who we become as adults.</li></li></ul><li>Population Attributable Risk<br /><ul><li>PAR = The difference in rate of a condition between an exposed population and an unexposed population.
    30. 30. In this case, it is a calculation used by the CDC to estimate the proportion of a health outcome that is attributable to ACE
    31. 31. Takes into account:
    32. 32. The increased risk due to each level of ACE
    33. 33. The prevalence of the number of ACE categories</li></li></ul><li>Population Attributable Risk<br />21.7%<br />78.3%<br />Risk data from Felitti, et. Al: PAR analysis: RE Voorhees<br />
    34. 34. Population Attributable Risk<br />32.1%<br />67.9%<br />Risk data from Felitti, et. Al: PAR analysis: RE Voorhees<br />
    35. 35. Population Attributable Risk<br />3.2%<br />96.8%<br />Risk data from Felitti, et. Al: PAR analysis: RE Voorhees<br />
    36. 36. Population Attributable Risk<br />100%<br />Risk data from Felitti, et. Al: PAR analysis: RE Voorhees<br />
    37. 37. The ACE Pyramid<br />“Personal Solution”<br />
    38. 38. ACE Scores Snohomish County ATR, STH & WRAPS Programs<br />
    39. 39. ACE Scores Snohomish County ATR, STH & WRAPS Programs<br />
    40. 40. ACE Scores Snohomish County ATR, STH & WRAPS Programs<br /># of ATR Clients by Drug of Choice and ACE Score<br />
    41. 41. ACE Scores In Washington Classrooms<br />
    42. 42. ACE Scores Impact Mortality<br />
    43. 43. What Should We Do with This Information?<br /><ul><li>Share what you’ve learned! Talk to peers, colleagues, policy makers and local leaders. If people are interested, let’s organize this training for them.
    44. 44. Use it to guide your work.
    45. 45. Consider implementing a combination of the strategies we’ll be talking about next.</li></li></ul><li>Before We Move On…<br />Adversity is not our destiny.<br />Every person can heal.<br />
    46. 46. Contributing Factors<br />Our culture is killing our kids.<br />
    47. 47. Mental Health<br />Depression, bipolar disorder, anxiety and suicidality are increasing in youth.<br />
    48. 48. Behavior<br />ADHD, conduct disorders and self mutilation (cutting behaviors) are increasing in youth.<br />
    49. 49. Criminal Justice<br />Younger kids are committing more serious crimes.<br />
    50. 50. Diet<br />Obesity has become epidemic in youth.<br />
    51. 51. Social Skills<br />Bullying and aggression continue to grow.<br />
    52. 52. Addiction<br />Serious addictions are happening at younger ages.<br />
    53. 53.
    54. 54. It’s Not Just ACEs!<br /><ul><li>Our youth are suffering from major developmental deficiencies unrecognized by the majority of our culture, including:
    55. 55. Essential brain nutrient deficiencies
    56. 56. Movement deficiencies
    57. 57. Reinforcement deficiencies</li></li></ul><li>Brain Nutrient Deficiencies<br />Brain nutrient deficiencies lead to serious problems for youth, and the people who interact with them.<br />They are specifically known to cause:<br />
    58. 58. Omega-6 vs. Omega-3<br /><ul><li>Many youth in the United States exhibit some form of Omega-3 deficiency.</li></ul>Omega-6<br />(soybean, corn, cotton seed oil)<br />Omega-3<br />(fish and range-fed stock)<br />
    59. 59. What Do Kids Eat Most of the Day?<br />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. <br />
    60. 60. Omega-6 Intake Influences Depression<br />
    61. 61. Omega-6 Intake Influences Violence<br />
    62. 62.
    63. 63. Movement Deficiencies<br />Movement deficiencies also lead to serious problems for youth<br />These deficiencies are specifically known to cause:<br />
    64. 64. Movement Deficiencies<br />Some national trends:<br /><ul><li>82% of mothers do not let their children play outside because of fear of crime.
    65. 65. Many parents do not let their children roam with other children because of “stranger danger” fears.
    66. 66. Parks, playgrounds and sidewalks for children are not being built.
    67. 67. From 1981 to 1997, play time for young children declined from 15 hours to 11 hours.
    68. 68. 70% of US mothers played outside as children, but only 31% of their children do today.</li></li></ul><li>The Other Reason…<br />
    69. 69. Costs of Television Viewing<br />Ample research shows television viewing is directly linked to obesity, sexual promiscuity, teen pregnancy, violence, ADHD symptoms, decreased academic achievement and substance abuse.<br />It leads to vicarious trauma exposure and can create PTSD symptoms in youth, which may include Having difficulty controlling emotions and reactions.<br /><ul><li>Having trouble beginning and maintaining relationships and friendships.
    70. 70. Having low self-esteem.
    71. 71. Having problems keeping up in school.</li></li></ul><li>Reinforcement Deficiencies<br />Reinforcement deficiencies lead to serious problems for youth and society<br />These deficiencies are specifically known to cause:<br />
    72. 72. Social Reinforcers<br />What are the social reinforcers in your classroom for this…<br />
    73. 73. Social Reinforcers<br />What are the social reinforcers in your classroom for this…<br />
    74. 74. Common Reinforcements<br />Attention is a reward, and our culture tends to give big and frequent rewards for bad things done by teens and adults today.<br />Every child has an “attention” gas tank. They need it filled in order to be whole people. <br /><ul><li>Praise and positive attention are like premium gasoline: they make children run at their best.
    75. 75. Negative attention is like regular unleaded gasoline: it will do.</li></ul>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!<br />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.”<br />
    76. 76. Pandemic?<br />Syndemics are multiple-related afflictions, disorders and disruptions in American society that cause:<br /><ul><li>Rises in delinquency, crime, car crashes, violent injuries, and white-collar crimes
    77. 77. Mental illness, child-maltreatment, domestic violence, sexually transmitted diseases, and addictions of all types
    78. 78. Higher health-care and social-security costs
    79. 79. Lower economic productivity and global competitiveness
    80. 80. Vulnerability to terrorism and social instability</li></li></ul><li>Rethinking Our Approach<br />These problems, evident in our homes, hallways and classrooms, seem big and messy.<br />Many of us feel too overwhelmed, overworked and overburdened to put our energy into programs and curricula that take precious resources to implement.<br />But we should remember that these big problems are really an aggregate of many smaller problems spread across a lot of people .<br />What if we could use small solutions to make just as big of an impact? <br />
    81. 81. Kernels<br />A kernel is the smallest unit of scientifically proven behavioral influence.<br />They are the “active ingredients” of evidence-based programs.<br />A kernel is indivisible; that is, removing any part makes it inactive.<br />Kernels produce quick easily measured change that can grow into much bigger change over time.<br />They can be used alone OR combined with other kernels to create new programs, strategies or policies.<br />Combinations of Kernels are considered “behavioral vaccines.”<br />“Planted” Kernels create a culture.<br />
    82. 82. Picking Your Kernels for Planting<br />There are over 100 evidenced-based kernels you can plant for school and community-level change.<br />
    83. 83. Turtle Breathing<br />“Turtle Breathing” is a technique for helping children with controlling anger. <br />Some elementary teachers use this technique in conjunction with the scripted story, “Tucker Turtle Takes Time to Tuck and Think.”<br />This technique:<br />Reduces anxiety<br />Reduces temper tantrums<br />Increases resiliency<br />Increases self-control<br />
    84. 84. Turtle Breathing Technique<br />Model remaining calm<br />Teach the child the steps of how to control feelings and calm down<br />Step 1: Recognize your feeling(s)<br />Step 2: Think “stop”<br />Step 3: Go inside your “shell” and take 3 deep breaths<br />Step 4: Come out when calm and think of a “solution”<br />Practice steps frequently<br />Prepare for and help the child handle possible disappointment or change<br />Recognize and comment when the child stays calm<br />Involve families: teach the “Turtle Technique”<br />
    85. 85. Adult to Youth Notes<br />Notes from teachers to students recognizing them for a SPECIFIC action or behavior is demonstrated to help youth of all ages to:<br />Do better at school<br />Be more socially competent<br />Reduce ADHD, aggression and problem behaviors<br />Increases behaviors you want to see more of<br />
    86. 86. Adult to Youth Notes<br />
    87. 87. Peer to Peer Notes<br />Notes of praise written from one peer to another, then read aloud or posted to a classroom or hallway display is widely shown to:<br />Improve school performance<br />Improve adult/child interactions<br />Improve organizational functioning<br />Increases behaviors you want to see more of<br />
    88. 88. Peer to Peer Notes<br />
    89. 89. Verbal Praise<br />When a person receives specific, spoken recognition for engagement in a target act or behavior, it is widely demonstrated to:<br />Improve school performance<br />Improve adult/child interactions<br />Improve organizational functioning<br />Increase the frequency of the target behavior<br />
    90. 90. Beat the Timer<br />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: <br />Increases compliance<br />Increases accuracy and completion of academics<br />
    91. 91. Beat the Timer<br />Steps:<br />Announce Beat the Timer<br />Say how long the timer will be set for<br />Say what behaviors are to beat the timer<br />Announce the timer is about to begin<br />Praise positive behavior while timer is ticking<br />Celebrate success and occasionally reward<br />
    92. 92. Beat the Timer<br />
    93. 93. Auditory/Visual Signal for Transitions<br />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.<br />Cost: Harmonica<br />Steps:<br />Blow the Harmonica<br />Raise hand in peace sign<br />Praise students who quickly train their eyes on you<br />Make sure 95% of all students eyes on you BEFORE you give your next instruction <br />Give transition instruction<br />Recognize success and occasionally reward quick transitions<br />
    94. 94. Auditory/Visual Signal for Transitions<br />
    95. 95. Mystery Motivator<br />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<br />Motivates youth and adults to do their best and improve<br />Taps into “intrinsic” motivations<br />Fosters self-regulation instead of excitement<br />
    96. 96. Mystery Motivator Steps<br />Participants selects prizes from a list that are appropriate to your situation, time of day, activities, etc.<br />Randomly select when children win the game.<br />Use the prizes for a very short time with a clear start and stop<br />Rotate and freshen prizes<br />Use student ideas and behaviors<br />
    97. 97. Brain on the Ball<br />Suitable for preschoolers through adults<br />Sitting on therapy balls is shown to increase attention, improve academic achievement, reduces ADHD symptoms without medication and reduce disruptive behavior<br />
    98. 98. Random Calling<br />This kernel is sometimes referred to as “Ritalin on a Stick” and is proven effective by research.<br />Start by putting the names of all the students in the classroom on separate sticks. <br />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. <br />Typically, the stick is put back into the container so that might drawn again, randomly at any given time.<br />Random calling results in:<br />Equality in participation. <br />Increased attention will be paid to the lesson <br />Increased academic performance<br />Decreases in disruptive behavior<br />
    99. 99. Pleasant Greeting w/ Physical Touch<br />Also known as “handshakes.”<br />Frequent friendly physical and verbal greetings impact social status and perceptions of safety and harm.<br />It also affects behavior streams of aggression, hostility or politeness. <br />Greetings are also a key topositively influencing school and classroom culture.<br />
    100. 100. Positive Note Home for Inhibition<br />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.<br />This strategy is demonstrated to reduce disruptive and aggressive behavior, problems at home and increases engagement at school.<br />
    101. 101. The Bottom Line<br />Meaningful change in agency culture begins on the front lines.<br />If you need it, I personally give you permission to do what’s in your heart. <br />
    102. 102. Johnny…<br />