Early Brain Development + Adverse Childhood Experiences x Advocacy = Proactive practices for children and families most in need of support.

1. Early
Brain
Development
+
Adverse
Childhood
Experiences
x
Advocacy
=
Proac;ve
prac;ces
for
children
and
families
most
in
need
of
support
Most
material
developed
by
the
Early
Brain
and
Child
Development
Leadership
Workgroup
A
program
of
the
American
Academy
of
Pediatrics
Rosemary L. Wilson, LMSW
Early Childhood Comprehensive Systems Coordinator
Department of Health and Environmental Control
CT SC Home Visiting Summit – September 2014

2.
The Adverse Childhood Experiences Study– the
Largest Public Health Study You Never Heard Of
Jane Ellen Stevens Huffington Post
Excessive Stress Disrupts the
Architecture of the Developing Brain
Center on the Developing Child Harvard University
Community Members Gather to Fight
Adverse Childhood Experiences
United Way of East Central Iowa
How Much Could We Improve
Children’s Life Chances by Intervening
Early and Often? CCF
Brief #54 Brookings

4. “Change
the
First
Five
Years
and
You
Change
Everything”
h4p://www.youtube.com/watch?v=GbSp88PBe9E

5. The
architecture
of
the
brain
depends
on
the
mutual
influences
of
the
following
• GeneGcs
• Environment
• Experience
The
Biology
of
Health
Source:
NaGonal
ScienGfic
Council
on
the
Developing
Child,
Working
Paper
5,
The
Timing
and
Quality
of
Early
Experiences
Combine
to
Shape
Brain
Architecture.
Center
on
the
Developing
Child
at
Harvard
University.

6. Shaping
the
Capacity
of
the
Brain
• The
interacGve
influences
of
genes
and
experiences
shape
the
architecture
of
the
developing
brain
• Brains
are
built
from
the
bo4om
up

7. Why
Early
Experiences
MaDer
Newborn
Brain
Average
Weight
333
grams
2
Year
Old’s
Brain
Average
Weight
999
grams
Brain
photo
courtesy
IsaacMao,
Flickr

12. Trauma
leaves
tracks
in
the
developing
brain

13. Source:
Bruce
Perry,
MD,
PhD,
Child
Trauma
Academy
Early
Stress

15. What is the Adverse Childhood
Experiences (ACE) Study?
The largest study of its kind that looks at the
health and social effects of adverse
childhood experiences over a lifespan.

16. What is the Adverse Childhood
Experiences (ACE) Study?
Study participants were middle-class Americans from
San Diego, 80% white, 74% attended college,
average age of 57, split evenly between men and
women.
NOTE: Not exactly an impoverished or “at-risk population”

17. Prevalence
of
Adverse
Childhood
Experiences
Adverse
Childhood
Experiences
• Physical,
sexual
or
emoGonal
abuse
• Physical
or
emoGonal
neglect
• Household
mental
illness
• Living
in
a
household
with
substance
abuse
• Having
a
parent/caregiver
divorce
or
separate
• Exposure
to
domesGc
violence
• Living
in
a
household
where
a
member
was
or
has
been
incarcerated
ACE
Score
(1
point
for
each
category
listed)
Prevalence
in
Study
0
33%
1
26%
2
16%
3
10%
4
6%
5
5%
Data from : www.cdc.gov/nccdphp/ace/

18. We know that:
Early Adverse Experiences (ACEs) contribute directly to the risk
for long-term physical and mental health.
U.S. Dept. Health and Human Services, 2010

19. As the ACE Score increases, the risk of
the following health problems increases:
Health Problems
• Alcoholism/alcohol abuse
• STDs
• COPD
• Depression
• Fetal death
• Health related QOL
• Liver disease
• Smoking
• Unintended pregnancy
• Suicide attempts
• Intimate partner violence
• Ischemic heart disease
ACE Score Women Men
0 35% 38%
1 25% 28%
2 16% 16%
3 10% 9%
4 or more 15% 9%
Data from : www.cdc.gov/nccdphp/ace/

20. Number of Risk
Factors
Source: Center on the Developing Child Harvard University. InBrief: the Impact of Early Adversity on Children’s Development.
Statistics from research from Barth, et al. (2008)
ChildrenwithDevelopmental
Delays
1-2
3
5
4
6
7
20%
40%
60%
80%
100%
Significant Adversity Impairs Development
in the First Three Years

21. Slide
modified
from
V.
J.
Felic
Why
are
ACEs
important?
Significant
adversity
in
childhood
is
strongly
associated
with
unhealthy
lifestyles
and
poor
health
decades
later.

22. ACEs
Skeletal
Fractures
Relationship
Problems
Smoking
General Health and
Social Functioning
Prevalent
Diseases
Sexual
Health
Risk Factors for
Common Diseases
Hallucinations
Mental
Health
ACEs Impact Multiple Outcomes
Difficulty in job
performance
Married to an
Alcoholic
High perceived
stress
Alcoholism
Promiscuity
Illicit Drugs
Obesity
Multiple Somatic
Symptoms
IV Drugs
High Perceived
Risk of HIV
Poor Perceived
Health
Ischemic Heart Disease
Sexually
Transmitted
Diseases
Cancer Liver Disease
Chronic Lung
Disease
Early Age of
First
Intercourse
Sexual Dissatisfaction
Unintended
Pregnancy
Teen
Pregnancy
Teen Paternity Fetal Death
Depression
Anxiety
Panic Reactions
Sleep
Disturbances
Memory
Disturbances
Poor Anger
Control
Poor Self-
Rated Health

23. ACEs
are
common–
in
fact
the
number
of
people
affected
by
ACEs
outnumbers
those
who
have
not
been
affected
by
ACEs.

24. ACEs
are
not
desGny,
and
early
trauma
does
not
have
to
dictate
a
life
story

25. Slide
modified
from
V.
J.
Felec
What
happens
early
can
change
lives
.
.
.
The
social
and
physical
environment
can
serve
as
a
buffer
to
these
“bad
things.”

26. ACEs
and
the
Brain
Early
nurturing,
responsive
interacGons
build
healthy
brain
architecture
that
serves
as
the
foundaGon
for
health
and
well-­‐being.

27. How
You
Can
Build
the
Founda;on
for
Healthier
Lives
If
Toxic
Stress
is
the
missing
link
between
ACE
exposure
and
poor
adult
outcomes,
we
need
to
know:
• Are
there
ways
to:
– treat,
– mi;gate,
and/or
– immunize
against
the
effects
of
toxic
stress?

29. Resilience
is
the
capacity
to
thrive
in
both
good
;mes
and
difficult
ones.
And
it
can
be
built
and
nourished
at
any
age,
in
every
human
being.

30. Resilience isn’t just a gift of nature or an
exercise of will;
resilience grows through
positive experiences,
supportive environments and
the caring intervention of others.

31. http://communityresiliencecookbook.org/

32. Safe, Stable, Nurturing Relationships and
Environments became
The CDC strategic direction for child
maltreatment prevention and their vision for
what we want for all children
Essentials for Childhood is the
broad “umbrella” for all of CDC
child maltreatment work
Essentials for Childhood – Steps to Create
Safe, Stable, and Nurturing Relationships
document

33. SAFE, STABLE, NURTURING RELATIONSHIPS
(SSNRs)
http://www.cdc.gov/violenceprevention/childmaltreatment/essentials
• Safety: The extent to which a child is free from fear and
secure from physical or psychological harm within their social
and physical environment
• Stability: The degree of predictability and consistency in a
child’s social, emotional, and physical environment
• Nurturing: The extent to which a parent or caregiver is
available and able to sensitively respond to and meet the
needs of their child

34. Essentials for Childhood (EfC)
• A document that proposes strategies that communities can consider to
promote Safe, Stable, Nurturing Relationships (SSNRs) and
Environments
• Steps for promoting SSNRs are suggested in four goal areas:
– Raise Awareness and Commitment to Support SSNRs and Prefent Child
Maltreatment
– Use Data to Inform Solutions
– Create the context for Healthy Children and Families through Norms Change
and Programs
– Create the Context for Healthy Children and Families through Policies
– Currently available Public Health Leadership Toolkit
http://veto violence.cdc.gov./childmaltreatment/phl/
Media sources, ACEs infographic: Videos

35. Increasing Effectiveness Through
Moving from Isolated Impact
to Collective Impact:
Fundamentally different,
more disciplined, and
highly structured and higher
performing approach to
large scale social impact than
other types of collaboration

36. Promote
the
Five
R’s
of
Early
Childhood
Educa;on
• Reading
together
as
a
daily
family
acGvity
• Rhyming,
playing,
talking,
singing
and
cuddling
together
ohen
• Rou;nes
and
regular
Gmes
for
meals,
play
and
sleeping,
which
help
children
know
what
they
can
expect
and
what
is
expected
of
them
• Rewards
for
everyday
successes,
realizing
that
praise
from
those
closest
to
a
child
is
a
very
potent
reward
• Rela;onships
that
are
reciprocal,
nurturing
and
enduring
are
the
foundaGon
of
healthy
child
development

37. EffecGve
Treatments
for
Childhood
Adversity
Treatments that have been designed specifically to address
toxic stress and trauma are the most effective. Including
parents in treatment is important in helping the child
“practice” new therapeutic strategies at home and creating a
more stable, supportive environment.
Evidence-based treatments include:
Child-Parent Psychotherapy (CPP) – seeks to heal the
effects of stress on young children through helping the
parent and child develop a more positive relationship,
regulate affect and behavior, and alter unhealthy behavior
patterns and beliefs
Source: Toxic Stress and Trauma-Informed Pediatric Care By Elaine Gottlieb

38. EffecGve
Treatments
for
Childhood
Adversity
Trauma-Focused Cognitive Behavioral Therapy –
includes stress management and relaxation skills; techniques to help
children deal with emotional dysregulation; cognitive coping skills to
help them recognize the relationship between current thoughts,
feelings and behaviors, and traumatic experiences; and guidance in
developing a trauma narrative to process what happened during
traumatic experiences
Attachment, Self-Regulation, and Competency (ARC)
uses a variety of treatments and services to address three key areas
that are affected by trauma -- attachment, self-regulation and
competency –and are important for resiliency
In addition, medications are sometimes used to relieve symptoms such as depression,
sleeping difficulties and anxiety.
Source: Toxic Stress and Trauma-Informed Pediatric Care By Elaine Gottlieb

39. Public
Investment
in
Children
by
Age

40. The
Heckman
Equa;on
Source: heckmanequation.org

41. “The most beautiful people we
have known are those who
have known defeat, known
suffering, known struggle,
known loss, and have found
their way out of the depths.”
—Elisabeth Kübler-Ross, Psychiatrist & Author

42.
Videos
for
HV
PresentaGon
h4ps://www.youtube.com/watch?
v=zQZnO0Mr_vY&feature=youtu.be
h4p://billmoyers.com/episode/full-­‐
show-­‐maya-­‐angelou-­‐on-­‐facing-­‐evil/

43. Thanks for listening!
Rosemary L. Wilson, LMSW
DHEC – Early Childhood Comprehensive Systems
wilsonr@dhec.sc.gov

44. “How wonderful it is that nobody
need wait a single moment before
starting to improve the world.”
—Anne Frank