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Strong
Communities
Raise Strong
Kids
Impetus for Community Action
“The solution of all
adult problems
tomorrow depends
in large measure
upon the way our
children grow up
today.”
~ Margaret...
What Are ACEs?
Adverse Childhood Experiences
• Traumatic experiences in
childhood
• Sometimes referred to as
toxic stress ...
ACEs Often Last a Lifetime . . .
But They Don’t Have To
• Healing can occur
• The cycle can be
broken
• Safe, stable,
nurt...
Quick Survey
Rate Your Awareness of the ACE Study:
- No Knowledge of ACE Research
- Some Knowledge
- More Than Most
- Expe...
Complete ACE Questionnaire
• What does it make you think about?
• Keep in mind your thoughts as we present
the ACE Study
What Do ACEs Look Like?
Two Categories of ACEs
1) Growing up (prior to age 18) in a
household with abuse:
• Recurrent physical abuse
• Recurrent e...
Two Categories of ACEs, cont.
2) Growing up with Household Dysfunction:
• Alcohol or drug abuser
• Incarcerated household
...
Why is This
Important?
Because ACEs are:
• Surprisingly common
• Occur in clusters
• Basis for common public
health proble...
Question
How do you see ACEs
manifested in kids and families
in your community?
How It All Started
Watch Horizon interview Dr.Vincent Felitti
Watch overview of ACE Study (DV
Arizona ACE Initiative
“Turning Gold into Lead”
Study Participants
• 26,000 adults invited to participate;
17,337 accepted
• Solidly middle class
• Average age = 57
*Keep...
Demographics of participants
ACE Scores
• 1/3 of adults have an ACE score of 0
• Majority of adults with
ACE score of 0 have few,
if any, risk factors ...
ACE Scores
• Women are 50% more likely than men to
have an ACE Score >5
• If any one ACE is present, there is 87%
chance a...
Arizona Children 0 – 17 years
(2011/2012 Natl. Survey of Children's Health)
• 42.5 % - Zero ACEs
• 26.4 % - One ACE
• 31.1...
ACEs are Common
ACE Score Prevalence
0 33%
1 26%
2 16%
3 10%
4 or more 16%
Group Question:
Do you think ACEs
are common in
your community?
Why or why not?
With 0 ACEs
1 in 16 smokes
1 in 69 are alcoholic
1 in 480 use IV drugs
1 in 14 has heart isease
1 in 96 attempts suicide
W...
All the world is full of suffering, it is also full of overcoming.
-Helen Keller
ACEs are Interrelated and have a
Cumulative Stressor Effect
It is the number of
different categories, not
the intensity/fr...
ACEs are Interrelated and have a
Cumulative Stressor Effect
Without interruption,
ACEs escalate
across generations.
ACE’s are Highly Interrelated
Alcohol Abuse in the Home and the Risk of Other
Household Exposures During Childhood
• ACE score of 4 or more may result in multiple risk
factors for these diseases or the disease themselves
• ACE score of 6...
Evidence Suggests
• Many chronic diseases in adults are determined
decades earlier by experiences in childhood.
• Risk fac...
Top 10 Risk
Factors for
Death in USA
smoking
severe obesity
physical inactivity
depression
suicide attempt
alcoholis...
Life Long Physical, Mental &
Behavioral Outcomes of ACEs
• Alcoholism & alcohol
abuse
• Chronic obstructive
pulmonary dise...
Dr. David McCollum, retired ED physician and co-founder of the Academy on Violence & Abuse
(organization aimed at health p...
Coping Solutions
• What are conventionally
viewed as Public Health
problems are often
personal solutions to
long concealed...
Seeking to Cope
• Risk factors/behaviors
underlying adult
diseases are effective
coping devices.
• Dismissing these
coping...
ACEs and Addiction
“It’s hard to get enough of
something that almost
works.” Dr. Vincent Filetti
ACE findings suggest that...
ACEs in the
Classroom
• ACEs are the greatest single
predictor for health, attendance
and behavior.
• ACEs are the second ...
ACE Pyramid
Jim Sporleder of Lincoln High School tried a new
approach with his students. Using a more
trauma sensitive approach, Mr. S...
“Pyramid of Hope”
“Before we can get our students prepared for learning, we have to focus on their
wounds and history of f...
Design your own
“Pyramid of Hope”
Brain Development
• We are hard wired to
survive.
• Brain architecture is
established early in life.
• Healthy brain archi...
3 Core Concepts in Early Brain Development
Harvard Center for The Developing Child
1.) Experiences Build Brain Architecture
Experiences Build Brain Architecture Clip
2.) “Serve and Return” Interaction shapes
brain circuitry.
Nurturing, responsive, and individualized interactions from bir...
3.) Toxic Stress derails healthy development
Toxic Stress Clip
“Brain Hero”
Brain Hero Clip
Harvard Center for the Developing Child
Stress and the Brain
Excessive and repeated stress:
• Neglect, Violence
• Chaos, unpredictability
• Hostility, rejection
C...
• Causes children to live in fight,
flight or fright (freeze) mode.
• Short attention span
• Struggle learning; fall behin...
“It is fact not opinion that “Toxic Stress/ACE’s” has a severe
impact on the brain development and a person’s future. It
i...
Having a hard time
with my feelings
Having a hard time
with my feelings
Calming down, but
not quite calm enough
yet.
I thi...
By adolescence, children
seek relief through:
• Drinking alcohol*
• Smoking tobacco
• Sexual promiscuity
• Using drugs*
• ...
All behavior (both good and bad) has meaning
We need to ask ourselves what might be going on
going on beneath the surface.
What Does
This Look
Like?
Teen that is:
– Edgy, hot tempered
– Impulsive
– Hyper-vigilant
Or some teens may be
withdrawn, feel
anxious/depressed,
have somatic complaints
and/or isolate.
High Risk Teen Behaviors
• May not be the core problem
• They may be coping devices
• A way to feel safe or just feel bett...
Traumatic Stress
Responses
Trauma is complex and
reactions are different for
everyone.
“Children can exhibit a wide range ...
What Can this Look Like?
• Changes in eating or sleeping routines
• Changes in growth and development
• Changes in relatio...
Complex Trauma
“Complex trauma describes both children’s
exposure to multiple traumatic events
and the wide-ranging, long-...
Possible Reactions of
Children 0-6
Exposed to Traumatic Stress
National Child Traumatic
Stress Network
• Excessive temper
...
Possible Reactions of
Older Children
Exposed to Traumatic Stress
Children ages 6-12 may:
• Have difficulty paying attentio...
The 4th
Vital Sign
Respiration, heart rate, blood pressure and
relationships
To heal, children need recognition and
unders...
Break 
ACEs don’t explain everything.
• The next series of slides spotlight the connection between
ACEs and adult health.
• Keep ...
Adverse Childhood Experiences
vs. Smoking as an Adult
0
2
4
6
8
10
12
14
16
18
20
0 1 2 3 4-5 6 or more
ACE Score
Adverse Childhood Experiences
vs. Adult Alcoholism
0
2
4
6
8
10
12
14
16
18
%Alcoholic
ACE Score
0 1 2 3 >=4
ACE Score vs.
Intravenous Drug Use
0
0.5
1
1.5
2
2.5
3
3.5
%HaveInjectedDrugs
0 1 2 3 4 or more
ACE Score
Adverse Childhood ExperiencesAdverse Childhood Experiences
vs. Likelihood of > 50 Sexualvs. Likelihood of > 50 Sexual
Part...
ACE Score vs. UnintendedACE Score vs. Unintended
Pregnancy or Elective AbortionPregnancy or Elective Abortion
0
10
20
30
4...
Childhood Experiences
Underlie Chronic Depression
0
10
20
30
40
50
60
70
80
%WithaLifetimeHistoryof
Depression
0 1 2 3 >=4...
Childhood Experiences
Underlie Later Suicide
0
5
10
15
20
25
%AttemptingSuicide
ACE Score
0 1 2 3 >=4
ACE Score vs.
Serious Job Problems
0
2
4
6
8
10
12
14
16
18
%withJobProblems
0 1 2 3 4 or more
ACE Score
“A large portion of many health, safety and
prosperity conditions is attributable to
Adverse Childhood Experiences.” Washi...
Health Care Costs
• $2.6 trillion in US (2010)
• Over 10 times amount spent in 1980
• 17.9% of the Gross Domestic Product
...
Reducing Costs
Research 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 chi...
Prevention Works
“It has been proven that effective early prevention
efforts are less costly to our nation and to
individu...
Cost of Child Abuse
• 2012 CDC Report - one year confirmed costs:
$124 billion over lifetime of traumatized children
ACEsACEs are theare the
Pipeline to PrisonPipeline to Prison
• 1 in 6 state male inmates reported being
physically or sexu...
Our Challenge
• We can and must “immunize” kids against
the effects of ACEs.
• We can and must reduce the numbers of
ACEs ...
Caring Communities
Can Help Reduce ACEs
Examples of Caring
Communities Action
• Health Care - Center for Youth Wellness, San Francisco
• Education – Lincoln High,...
Examples of Caring
Communities Action in AZ
• Healthy Families Arizona
• Family Support as part of In Home Services
• Who ...
How Do
We Meet
the
Challenge?
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
commu...
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...
Lunch 
It Starts With You!
• Identify and understand the importance of
protective factors
• Utilize protective factors in your ow...
A Story of Resiliency
“Where there’s breath
there’s hope.”
Tonier Cain
For two decades Tonier “Neen” Cain
endured routine ...
Protective Factors
• Conditions that increase health and well being
• Critical for everyone regardless of age, sex,
ethnic...
Protective Factors that Strengthen
Families and Communities
• Nurturing and Attachment
• Knowledge of Parenting
and Child ...
Nurturing and Positive
Relationships
are the key to mentally healthy children and
adolescents
Safe, Stable, Nurturing
Relationships
Safe = free from harm
Stable = a high degree of consistency
Nurturing = compassionat...
Building Nurturing
and Attachment
• Observe, attend and
listen to children
• Provide safe and
stable home life
• Model car...
Nurturing and Attachment
• Set up activities that promote
bonding and attachment
• Acknowledge nurturing behavior
• Provid...
What Does This Look Like?
Someone you turn to:
• Who?
• How you feel?
• What she or he does?
Knowledge of Parenting and
Child Development
Why Is This Important?
Parenting is not static
If parents don’t understand
be...
Knowledge of Parenting and
Child Development
Begin where parents are at:
– discuss hopes and dreams for their children
– i...
Parental Resilience
Good outcomes in spite of
serious threats, toxic stress
Resilient people:
– are prepared to be
effecti...
Parental Resilience
• Recognize early signs
of stress and connect
people to resources
• Develop a trusting
relationship an...
The power of resilience moderates
the effects of serious life
challenges and provides hope and
healing.
Begin with yourself
• Take care of own mental health
• Develop healthy coping devices
(regular exercise, reading, listenin...
Building Social Connections
• Identify what parents have in place; build on it
• Provide opportunities for parents to get ...
Concrete Supports
in Time of Need
• Food, shelter, basic
services critical to child
well-being
• Link caregivers to
commun...
Children’s Social and
Emotional Competence
• Build kid’s ability to express emotions,
self-regulate behaviors and get alon...
Building Social/Emotional
Competence
• Teach social skills
• Educate parents on importance of
social/emotional skills
• Pr...
Parent Café in a box…helps individuals or
community agencies get started…(using) the
five protective factors that help str...
Exercise Agreements
•Speak from your own experience
•Listen attentively
•No judgments, positive or negative
•Do not give a...
One-On-One Active Listening
•One person answers the questions and
the other is silent for 2.5 min, then
switch…
•Q1: Who a...
One-On-One Debrief
•How was that for you?
•What did you learn about yourself?
One-On-One Conversation
•Take 5 min or so to discuss the theme
of Resilience…
•From each card, one of you read aloud
the q...
Conversation Harvest
•Any “ah–ha” moments?
•Write yourself a short commitment
Strategies to
Build Strong
Communities
Provide Information
• Educational workshops
• Radio announcements
• Community meetings
• Web-based
• Written material
• Co...
Enhance Skills
Offer workshops/activities designed to
increase skills of participant:
– Training
– Classes
– Consultation
...
Provide Support
• Be a good neighbor
• Offer mentoring or
support groups
• Offer to help
• Spend quality and
quantity time...
Enhance Access and
Reduce Barriers
• Seek grants, build local
collaborations
• Offer food, shelter, seek
professional help...
Change Consequences
• Thank someone for their hard work
• Publicly recognize a community group that
helps strengthen famil...
Change the Physical Design
• Lead/participate in clean-up
effort
• Initiate change to make your
community safer
• Set up p...
Modify/Change
Policy
• Talk to legislators and
philanthropists about
supporting effective programs
• Contribute to child a...
Planning for Strong Communities
and Raising Strong Kids
• What is the goal you want to achieve in your
community?
• What s...
Planning for Strong
Communities and Raising
Strong Kids
2:00 – 2:30 Presentation Planning
2:30 – 3:00 Group Presentations
Now What?
• Questions?
• Ideas for utilizing ACE
research in your community?
• What resources do you need?
• What challeng...
Turn to Your Neighbor
• Share what resonated the most with you
today.
• How are you going to use this
information?
Question
• How can we build protective factors in
the families we serve?
• How can we help build resiliency in the
familie...
If our society is to prosper in the future,
we need to make sure that all children have
the opportunity to develop intelle...
In Summary
“It is easier to build strong children than to
repair broken men” ~ Frederick Douglass (1817-
1895)
• “Children...
To Get Involved Contact
Marcia Stanton, Child Abuse Prevention Coordinator,
Phoenix Children’s Hospital
mstanto@phoenixchi...
Parenting Resources
• 1-877-705-KIDS (5437) - Birth to Five Parenting
Questions Helpline
• 1-800-4-A-CHILD (422-4453) - Cr...
Information & Resources
• ACE Study findings and information
- www.acestudy.org or www.cdc.gov
• ACEs Too High – www.acest...
More Information & Resources
• National Center for Trauma-Informed Care –
www.mentalhealth.samhsa.gov/nctic
• National Chi...
More Resources
• 3 ½ hour ACE Online Course - $29 -
http://www.fpc.wa.gov/acecourse.html
• Ready Nation– http://www.readyn...
Works Cited
ACE Study:
The CDC Adverse Childhood Experiences (ACE) Study homepage presents a wealth of
information on the ...
Works Cited
Economic Costs:
CDC Injury Prevention Center includes well-researched articles on the cost of child abuse
(htt...
Helpful Clips to Enhance
Your WorkshopAn overview of the ACE Study
http:/youtube/v3A_HexLxDY/
A compelling video highlight...
Thank You for Helping Make Our
Community Strong!
Ace Train the Trainer Presentation
Ace Train the Trainer Presentation
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Ace Train the Trainer Presentation

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Ace Train the Trainer Presentation

  1. 1. Strong Communities Raise Strong Kids Impetus for Community Action
  2. 2. “The solution of all adult problems tomorrow depends in large measure upon the way our children grow up today.” ~ Margaret Mead, Anthropologist
  3. 3. What Are ACEs? Adverse Childhood Experiences • Traumatic experiences in childhood • Sometimes referred to as toxic stress or childhood trauma
  4. 4. ACEs Often Last a Lifetime . . . But They Don’t Have To • Healing can occur • The cycle can be broken • Safe, stable, nurturing relationships heal parent and child
  5. 5. Quick Survey Rate Your Awareness of the ACE Study: - No Knowledge of ACE Research - Some Knowledge - More Than Most - Expert
  6. 6. Complete ACE Questionnaire • What does it make you think about? • Keep in mind your thoughts as we present the ACE Study
  7. 7. What Do ACEs Look Like?
  8. 8. Two Categories of ACEs 1) Growing up (prior to age 18) in a household with abuse: • Recurrent physical abuse • Recurrent emotional abuse • Sexual abuse • Emotional or physical neglect
  9. 9. Two Categories of ACEs, cont. 2) Growing up with Household Dysfunction: • Alcohol or drug abuser • Incarcerated household member. • Someone chronically depressed, suicidal, institutionalized or mentally ill. • Mother being treated violently. • One or no parents.
  10. 10. 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
  11. 11. Question How do you see ACEs manifested in kids and families in your community?
  12. 12. How It All Started Watch Horizon interview Dr.Vincent Felitti Watch overview of ACE Study (DV
  13. 13. Arizona ACE Initiative
  14. 14. “Turning Gold into Lead”
  15. 15. Study Participants • 26,000 adults invited to participate; 17,337 accepted • Solidly middle class • Average age = 57 *Keep in mind there are ongoing studies. This demographic information is on the original study participants. See www.cdcreport.com profiling 5 states that have collected data.
  16. 16. Demographics of participants
  17. 17. ACE Scores • 1/3 of adults have an ACE score of 0 • Majority of adults with ACE score of 0 have few, if any, risk factors for diseases that are common causes of death in the US.
  18. 18. ACE Scores • Women are 50% more likely than men to have 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 leading determinant of the health and social well-being of our nation
  19. 19. Arizona Children 0 – 17 years (2011/2012 Natl. Survey of Children's Health) • 42.5 % - Zero ACEs • 26.4 % - One ACE • 31.1 % - 2 or more ACEs • National Average - 22.6% - 2 or more ACEs
  20. 20. ACEs are Common ACE Score Prevalence 0 33% 1 26% 2 16% 3 10% 4 or more 16%
  21. 21. Group Question: Do you think ACEs are common in your community? Why or why not?
  22. 22. With 0 ACEs 1 in 16 smokes 1 in 69 are alcoholic 1 in 480 use IV drugs 1 in 14 has heart isease 1 in 96 attempts suicide With 0 ACEs 1 in 16 smokes 1 in 69 are alcoholic 1 in 480 use IV drugs 1 in 14 has heart isease 1 in 96 attempts suicide With 3 ACEs 1 in 9 smokes 1 in 9 are alcoholic 1 in 43 use IV drugs 1 in 7 has heart disease 1 in 10 attempts suicide With 3 ACEs 1 in 9 smokes 1 in 9 are alcoholic 1 in 43 use IV drugs 1 in 7 has heart disease 1 in 10 attempts suicide With 7+ ACEs 1 in 6 smokes 1 in 6 are alcoholic 1 in 30 use IV drugs 1 in 6 has heart disease 1 in 5 attempts suicide With 7+ ACEs 1 in 6 smokes 1 in 6 are alcoholic 1 in 30 use IV drugs 1 in 6 has heart disease 1 in 5 attempts suicide 33% Report No ACEs 33% Report No ACEs 51% Report 1-3 ACEs 51% Report 1-3 ACEs 16% Report 4-10 ACEs 16% Report 4-10 ACEs Out of 100 people…
  23. 23. All the world is full of suffering, it is also full of overcoming. -Helen Keller
  24. 24. ACEs are Interrelated and have a Cumulative Stressor Effect It is the number of different categories, not the intensity/frequency of the ACEs that determine health outcomes.
  25. 25. ACEs are Interrelated and have a Cumulative Stressor Effect Without interruption, ACEs escalate across generations.
  26. 26. ACE’s are Highly Interrelated Alcohol Abuse in the Home and the Risk of Other Household Exposures During Childhood
  27. 27. • ACE score of 4 or more may result in multiple risk factors for these diseases or the disease themselves • ACE score of 6 or more may result in a 20 year decrease in life expectancy
  28. 28. Evidence Suggests • Many chronic diseases in adults are determined decades earlier by experiences in childhood. • Risk factors/behaviors for these diseases are initiated during childhood or adolescence and continue into adult life.
  29. 29. Top 10 Risk Factors for Death in USA smoking severe obesity physical inactivity depression suicide attempt alcoholism illicit drug use injected drug use 50+ sexual partners history of STD
  30. 30. Life Long Physical, Mental & Behavioral Outcomes of ACEs • Alcoholism & alcohol abuse • Chronic obstructive pulmonary disease & 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 higher the ACE Score, the greater the incidence of co- occurring conditions from this list.
  31. 31. 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 of violence and abuse on health).
  32. 32. Coping Solutions • What are conventionally viewed as Public Health problems are often personal solutions to long concealed adverse childhood experiences.
  33. 33. Seeking to Cope • Risk factors/behaviors underlying adult diseases are effective coping devices. • Dismissing these coping devices as “bad habits” or “self destructive behavior” misses their functionality.
  34. 34. ACEs and Addiction “It’s hard to get enough of something that almost works.” Dr. Vincent Filetti ACE findings suggest that a major factor, if not the main factor, underlying addiction is ACEs that have not healed and are concealed from awareness by shame, secrecy, and social taboo.
  35. 35. ACEs in the Classroom • ACEs are the greatest single predictor for health, attendance and behavior. • ACEs are the second strongest predictor, after special education status, for academic failure. • The relationship between academic achievement and health status appears much less related to income than to ACEs.
  36. 36. ACE Pyramid
  37. 37. Jim Sporleder of Lincoln High School tried a new approach with his students. Using a more trauma sensitive approach, Mr. Sporleder and staff changed the entire culture of the school. ACEs in Action!
  38. 38. “Pyramid of Hope” “Before we can get our students prepared for learning, we have to focus on their wounds and history of failures” Jim Sporleder (principal of Lincoln High School)
  39. 39. Design your own “Pyramid of Hope”
  40. 40. Brain Development • We are hard wired to survive. • Brain architecture is established early in life. • Healthy brain architecture is the necessary foundation required for optimal future learning, behavior and health.
  41. 41. 3 Core Concepts in Early Brain Development Harvard Center for The Developing Child
  42. 42. 1.) Experiences Build Brain Architecture Experiences Build Brain Architecture Clip
  43. 43. 2.) “Serve and Return” Interaction shapes brain circuitry. Nurturing, responsive, and individualized interactions from birth build healthy brain structure Serve and Return Clip
  44. 44. 3.) Toxic Stress derails healthy development Toxic Stress Clip
  45. 45. “Brain Hero” Brain Hero Clip Harvard Center for the Developing Child
  46. 46. Stress and the Brain Excessive and repeated stress: • Neglect, Violence • Chaos, unpredictability • Hostility, rejection Causes disruption of brain architecture: • Impairs cell growth • Interferes with healthy neural circuits • Strains brain with overdose of stress hormones
  47. 47. • 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 healthy peer relationships • Feel failure, despair, shame and frustration Toxic Stress can impact children in the following ways:
  48. 48. “It is fact not opinion that “Toxic Stress/ACE’s” has a severe impact on the brain development and a person’s future. It is a strong predictor with negative outcomes without the intervention of a positive adult relationship(s).” Jim Sporleder • Respond • Learn • Process effectively
  49. 49. Having a hard time with my feelings Having a hard time with my feelings Calming down, but not quite calm enough yet. I think I am ready to learn. Visual tool used by Principal Jim Sporleder to help his students identify when they are ready to talk or to learn.
  50. 50. By adolescence, children seek relief through: • Drinking alcohol* • Smoking tobacco • Sexual promiscuity • Using drugs* • Overeating/eating disorders • Delinquent behavior, violence • High-risk sports, etc. * Note: nicotine and methamphetamines are anti-depressants
  51. 51. All behavior (both good and bad) has meaning We need to ask ourselves what might be going on going on beneath the surface.
  52. 52. What Does This Look Like? Teen that is: – Edgy, hot tempered – Impulsive – Hyper-vigilant
  53. 53. Or some teens may be withdrawn, feel anxious/depressed, have somatic complaints and/or isolate.
  54. 54. High Risk Teen Behaviors • May not be the core problem • They may be coping devices • A way to feel safe or just feel better
  55. 55. Traumatic Stress Responses Trauma is complex and reactions are different for everyone. “Children can exhibit a wide range of reactions to trauma and loss.” ***Factors such as the child’s prior history of trauma, temperament, expectations of danger, vulnerability, relocations, and coping resources of the family play a role in traumatic stress responses. National Center for Child Traumatic Stress
  56. 56. What Can this Look Like? • Changes in eating or sleeping routines • Changes in growth and development • Changes in relationships • Regressions in developmental abilities
  57. 57. Complex Trauma “Complex trauma describes both children’s exposure to multiple traumatic events and the wide-ranging, long-term impact of this exposure.” – Events such as abuse or profound neglect – Children may develop ways of coping that allow them to survive on a day to day basis (like hiding emotions or being overly sensitive to the moods/behaviors of adults) – These kinds of learned adaptations make sense in the context of constant physical and/or emotional threats. – However as the child grows and encounters safe situations or relationships, these adaptations may interfere with their capacity to love and be loved. National Child Traumatic Stress Network
  58. 58. Possible Reactions of Children 0-6 Exposed to Traumatic Stress National Child Traumatic Stress Network • Excessive temper • Regressive behaviors • Scream or cry excessively • Startle • Anxious, fearful or avoidant • Fear of separation • Irritability • Poor sleep/nightmares • Poor appetite, low weight or other digestive problems
  59. 59. Possible Reactions of Older Children Exposed to Traumatic Stress Children ages 6-12 may: • Have difficulty paying attention • Become quiet, upset, and withdrawn • Be tearful, sad and talk about scary feelings and ideas • Fight with peers or adults • Show changes in school performance • Want to be left alone • Eat more or less than usual • Get into trouble at home or school
  60. 60. The 4th Vital Sign Respiration, heart rate, blood pressure and relationships To heal, children need recognition and understanding from their caregivers
  61. 61. Break 
  62. 62. ACEs don’t explain everything. • The next series of slides spotlight the connection between ACEs and adult health. • Keep in mind as you look through the graphs, that this is just part of the story. There are many individuals with high ACE scores that do not have these poor health outcomes. • We will talk more about resiliency later.
  63. 63. Adverse Childhood Experiences vs. Smoking as an Adult 0 2 4 6 8 10 12 14 16 18 20 0 1 2 3 4-5 6 or more ACE Score
  64. 64. Adverse Childhood Experiences vs. Adult Alcoholism 0 2 4 6 8 10 12 14 16 18 %Alcoholic ACE Score 0 1 2 3 >=4
  65. 65. ACE Score vs. Intravenous Drug Use 0 0.5 1 1.5 2 2.5 3 3.5 %HaveInjectedDrugs 0 1 2 3 4 or more ACE Score
  66. 66. Adverse Childhood ExperiencesAdverse Childhood Experiences vs. Likelihood of > 50 Sexualvs. Likelihood of > 50 Sexual PartnersPartners 0 1 2 3 4 AdjustedOddsRatio 0 1 2 3 4 or more ACE Score
  67. 67. ACE Score vs. UnintendedACE Score vs. Unintended Pregnancy or Elective AbortionPregnancy or Elective Abortion 0 10 20 30 40 50 60 70 80 %haveUnintendedPG,orAB 0 1 2 3 4 or more ACE Score Unintended Pregnancy Elective Abortion
  68. 68. Childhood Experiences Underlie Chronic Depression 0 10 20 30 40 50 60 70 80 %WithaLifetimeHistoryof Depression 0 1 2 3 >=4 ACE Score Women Men
  69. 69. Childhood Experiences Underlie Later Suicide 0 5 10 15 20 25 %AttemptingSuicide ACE Score 0 1 2 3 >=4
  70. 70. ACE Score vs. Serious Job Problems 0 2 4 6 8 10 12 14 16 18 %withJobProblems 0 1 2 3 4 or more ACE Score
  71. 71. “A large portion of many health, safety and prosperity conditions is attributable to Adverse Childhood Experiences.” Washington Family Council
  72. 72. 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)
  73. 73. Reducing Costs Research shows that just asking about ACEs – significantly decreases doctor office visits and costs.
  74. 74. 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
  75. 75. Prevention Works “It has been proven that effective early prevention efforts are less costly to our nation and to individuals than trying to fix the adverse effects of child maltreatment.” Bryan Samuels, Commissioner at U.S. Department of Health and Human Services.
  76. 76. Cost of Child Abuse • 2012 CDC Report - one year confirmed costs: $124 billion over lifetime of traumatized children
  77. 77. ACEsACEs are theare the Pipeline to PrisonPipeline to Prison • 1 in 6 state male inmates reported being physically or sexually abused before age 18, and many more witnessed interpersonal violence. • Over half of male inmates (56%) report experiencing childhood physical trauma. • Over one-quarter (1/4) of incarcerated men report being abandoned during childhood or adolescence • Of the more than 93,000 children currently incarcerated, between 75 and 93 percent have experienced at least one traumatic experience. Childhood and Adult Trauma Experiences of Incarcerated Persons and Their Relationship to Adult Behavioral Health Problems and Treatment) Int Journal of Environ Res Public Health. 2012 May; 9(5): 1908–1926. Published online 2012 May 18. Healing Invisible Wounds: Why Investing in ,
  78. 78. 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!
  79. 79. Caring Communities Can Help Reduce ACEs
  80. 80. Examples of Caring Communities 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
  81. 81. Examples of Caring Communities Action in AZ • Healthy Families Arizona • Family Support as part of In Home Services • Who Do You Trust with Your Child? • ACE Consortium • Safe Sleep • Regional Child Abuse Prevention Councils • Protective Factors Framework • Arizona’s Children Association’s Post Trauma Strengths Development Program • New Directions Institute • Maricopa Family Support Alliance • MyChild’sReady Home Visitation Alliance
  82. 82. How Do We Meet the Challenge?
  83. 83. Three Important Concepts • Protective Factors • Resilience • Trauma-Informed Care
  84. 84. Protective Factors • Increase health and well-being of children and families • Critical to success at home, work and community
  85. 85. Resilience • Ability to deal with life’s ups and downs • Resilience Trumps ACEs
  86. 86. 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.”
  87. 87. Lunch 
  88. 88. 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
  89. 89. A Story of Resiliency “Where there’s breath there’s hope.” Tonier Cain For two decades Tonier “Neen” Cain endured routine physical and verbal abuse, homelessness, multiple rapes, beatings and was arrested 83 times. Her “upward spiral” began when she had the opportunity to go to a community trauma, mental health and addictions program. Healing Neen Trailer
  90. 90. 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
  91. 91. Protective Factors that Strengthen Families 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
  92. 92. Nurturing and Positive Relationships are the key to mentally healthy children and adolescents
  93. 93. Safe, Stable, Nurturing Relationships Safe = free from harm Stable = a high degree of consistency Nurturing = compassionate, responsive caregivers
  94. 94. Building Nurturing and 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
  95. 95. Nurturing and Attachment • 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
  96. 96. What Does This Look Like? Someone you turn to: • Who? • How you feel? • What she or he does?
  97. 97. Knowledge of Parenting and Child Development Why Is This Important? Parenting is not static If parents don’t understand behavior, they tend to interpret it as negative Normal challenges can lead to frustrations and harsh discipline
  98. 98. Knowledge of Parenting and Child Development Begin 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
  99. 99. Parental Resilience Good outcomes in spite of serious threats, toxic stress Resilient people: – are prepared to be effective in the world – can adapt to challenges – are mentally healthy
  100. 100. Parental Resilience • Recognize early signs of stress and connect people to resources • Develop a trusting relationship and provide support • Be a good neighbor • Look for and point out inner strengths
  101. 101. The power of resilience moderates the effects of serious life challenges and provides hope and healing.
  102. 102. Begin with yourself • Take care of own mental health • Develop healthy coping devices (regular exercise, reading, listening to music, etc.) • Seek out healthy family and friends for support • Use community supports (counseling, substance abuse treatment, self-help programs, etc.)
  103. 103. 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 new groups • Teach social skills
  104. 104. Concrete Supports in Time of Need • Food, shelter, basic services critical to child well-being • Link caregivers to community resources and extended family • Work on sustainability
  105. 105. Children’s Social and Emotional Competence • Build kid’s ability to express emotions, self-regulate behaviors and get along with others • Helps parents understand their children
  106. 106. Building Social/Emotional Competence • Teach social skills • Educate parents on importance of social/emotional skills • Provide healthy outlets – arts, sensory, exercise, etc. • Encourage parents to exchange ideas on what works • Take timely action when there is concern
  107. 107. Parent Café in a box…helps individuals or community agencies get started…(using) the five protective factors that help strengthen families. http://www.bestrongfamilies.net/
  108. 108. Exercise Agreements •Speak from your own experience •Listen attentively •No judgments, positive or negative •Do not give advice •Confidentiality •Turn cell phone off
  109. 109. One-On-One Active Listening •One person answers the questions and the other is silent for 2.5 min, then switch… •Q1: Who are you? •Q2: Who is in your family?
  110. 110. One-On-One Debrief •How was that for you? •What did you learn about yourself?
  111. 111. One-On-One Conversation •Take 5 min or so to discuss the theme of Resilience… •From each card, one of you read aloud the question matching Resilience •Agree on one question and discuss
  112. 112. Conversation Harvest •Any “ah–ha” moments? •Write yourself a short commitment
  113. 113. Strategies to Build Strong Communities
  114. 114. Provide Information • Educational workshops • Radio announcements • Community meetings • Web-based • Written material • Conversations
  115. 115. Enhance Skills Offer workshops/activities designed to increase skills of participant: – Training – Classes – Consultation – Counseling – Team sports, scouting, 4H
  116. 116. Provide Support • Be a good neighbor • Offer mentoring or support groups • Offer to help • Spend quality and quantity time with a child; read a book, share a meal
  117. 117. Enhance Access and Reduce Barriers • Seek grants, build local collaborations • Offer food, shelter, seek professional help if needed • Link clients to effective faith based activities, recreation, parenting classes, domestic violence shelters/education
  118. 118. Change Consequences • Thank someone for their hard work • Publicly recognize a community group that helps strengthen families • Publish newspaper article highlighting someone in the community • Give rewards to individuals or businesses for helping in the community
  119. 119. Change the Physical Design • Lead/participate in clean-up effort • Initiate change to make your community safer • Set up place where parents can gather and get information • Volunteer to paint a home • Support your local Child Abuse Prevention Council
  120. 120. Modify/Change Policy • Talk to legislators and philanthropists about supporting effective programs • Contribute to child abuse prevention programs via a tax check off • Support positive parenting programs, and services for domestic violence and mental health education
  121. 121. Planning for Strong Communities and Raising Strong Kids • What is the goal you want to achieve in your community? • What strategy(ies) will you use? • Who will assist you? • Who will be your audience? • When will you implement your strategy? • How will you know if you are successful? • How will you sustain your efforts?
  122. 122. Planning for Strong Communities and Raising Strong Kids 2:00 – 2:30 Presentation Planning 2:30 – 3:00 Group Presentations
  123. 123. Now What? • Questions? • Ideas for utilizing ACE research in your community? • What resources do you need? • What challenges do you foresee?
  124. 124. Turn to Your Neighbor • Share what resonated the most with you today. • How are you going to use this information?
  125. 125. Question • How can we build protective factors in the families we serve? • How can we help build resiliency in the families we impact?
  126. 126. If our society is to prosper in the future, we need to make sure that all children have the opportunity to develop intellectually, socially and emotionally.
  127. 127. In Summary “It is easier to build strong children than to repair broken men” ~ Frederick Douglass (1817- 1895) • “Children make up 25% of our population, but 100% of our future.” ~Ian Jukes • Now what?
  128. 128. To Get Involved Contact Marcia Stanton, Child Abuse Prevention Coordinator, Phoenix Children’s Hospital mstanto@phoenixchildrens.com Mark Klym, MPA, Child Abuse Prevention Coordinator Office of Prevention and Family Support, Division of Children, Youth, and Families MKlym@azdes.gov
  129. 129. Parenting Resources • 1-877-705-KIDS (5437) - Birth to Five Parenting Questions Helpline • 1-800-4-A-CHILD (422-4453) - Crisis Line for emotional needs, info on child abuse/neglect Also go to: www.childhelp.org • www.azpbs.org/strongkids • www.apa.org/books • www.pbs.org/parents/childdevelopment • www.cdc.gov/parents
  130. 130. Information & Resources • ACE Study findings and information - www.acestudy.org or www.cdc.gov • ACEs Too High – www.acestoohigh.com • National Scientific Council on the Developing Child at Harvard University - www.developingchild.net • SAHMSA – Early Childhood Trauma Resources http://www.samhsa.gov/children/earlychildhoodmat.a
  131. 131. 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 - strengthening families and protective factors – www.cssp.org • Center for Injury Prevention and Control – www.cdc.gov/violenceprevention • American Psychological Assn – Resilience Guide - http://www.apa.org/helpcenter/road-resilience.aspx
  132. 132. 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/preventio nmonth/guide2012/ • ACE Response Network - http://www.aceresponse.org/
  133. 133. Works Cited ACE Study: The CDC Adverse Childhood Experiences (ACE) Study homepage presents a wealth of information on the ACE Study including a complete bibliography of ACE Study publications 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 has many resources on the prevention of child maltreatment (http://www.cdc.gov/violenceprevention/) and promoting nurturing relationships between 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 latest research 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 building resiliency 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 ).
  134. 134. Works Cited Economic 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 societal problems 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 for protecting 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 effective community 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 professionals on tips for working with children of alcoholics (http://www.nacoa.org).
  135. 135. Helpful Clips to Enhance Your WorkshopAn overview of the ACE Study http:/youtube/v3A_HexLxDY/ A compelling video highlighting the importance of early experiences http://youtube/GbSp88PBe9E Early experiences shape brain development http://www.youtube.com/watch? v=VNNsN9IJkws&feature=share&list=PLuKMerO1zya_3krFpcOKgaeB2_2z QgYua Caregiver responses shape brain development http://www.youtube.com/watch?v=m_5u8- QSh6A&feature=share&list=PLuKMerO1zya_3krFpcOKgaeB2_2zQgYua Toxic Stress derails brain development http://www.youtube.com/watch? v=rVwFkcOZHJw&feature=share&list=PLuKMerO1zya_3krFpcOKgaeB2_2z QgYua Lincoln High School and Health Center’s Trauma-sensitive approach http://youtube/Npd0B1pGx2U Resilience Trumps ACEs YouTube Channel http://www.youtube.com/user/ResilienceTrumpsAces?feature=watch Heeling Neen Trailer http://healingneen.com Change the First Five Years and You Change Everything http://www.youtube.com/watch?v=GbSp88PBe9E”
  136. 136. Thank You for Helping Make Our Community Strong!

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