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ADVERSE CHILDHOOD EXPERIENCES (ACES)
WHEN CHRONIC STRESS AND ADVERSITY CAN
LEAD TO LIFELONG HEALTH CONSEQUENCES
Alice M. Forrester, PhD
Clifford Beers
New Haven, CT
aforrester@cliffordbeers.org
● Founded in 1913 by New Haven resident Clifford W. Beers
● Offers programs/services children and families need for mental health and
wellness
● Convenient, effective care
○ Clinic-based; community-based; home-based
● Engaging everyone (schools, lawmakers, providers, child-focused
organizations) to adopt trauma-informed practices for whole family
● Focuses on integrating the physical, mental and social determiants of
health
ABOUT CLIFFORD BEERS
Outpatient Clinic
93 Edwards Street, New Haven, CT
We want our children to be healthy, well and
productive members of society.
In order for this to happen they must have good mental health.
If children are in distress, we must recognize it and address it quickly.
OUR HOPE
What Do We Mean by “Adversity”?
Child trauma and adversity come in many forms and no term covers all of them.
• Bereavement/Separation
• Domestic Violence
• Impaired Caregiver
• Emotional Abuse
• Neglect
• Physical Abuse
• Sexual Abuse
• Community Violence
• Sexual Assault/Rape
• Serious Injury/Accident
• School Violence
• Illness/Medical Trauma
• Physical Assault
• Natural Disaster
• Extreme Interpersonal Violence
• Kidnapping
Research over last 25 years has proven the
potential for
life long health impact of chronic stress..we just
have different words to describe it…
Research over the last 25 years has proven the potential for
life long negative health impact of chronic stress.
We just have different words to describe the impact…
ACES?
Child
Traumatic
Stress?
Allostatic
load?
Complex
Trauma?
Post
Traumatic
Stress Disorder?
Chronic
Stress?
Toxic
Stress?
From: CAN Narratives, NCTSN, 2015
Data from the National Comorbidity Survey-Replication Sample (NCS-R) -
Putnam, Harris, Putnam, J Traumatic Stress, 26:435-442, 2013
CUMULATIVE ACES AND MENTAL HEALTH
CAN Narratives, NCTSN, 2015
CAN Narratives, NCTSN, 2015 Felitti et al., (1998) American Journal of Preventive Medicine, 14:245-258.
CUMULATIVE ACES AND HEALTH
Adverse Childhood Experiences
• Abuse and neglect (e.g., psychological, physical, sexual)
• Household dysfunction (e.g., domestic violence, substance abuse, mental illness)
Impact on Child Development
• Neuro-biologic effects (e.g., brain abnormalities, stress hormone dysregulation)
• Psychosocial effects (e.g., poor attachment, poor socialization, poor self-efficacy)
• Health risk behaviors (e.g., smoking, obesity, substance abuse, promiscuity)
Long-Term Consequences
Disease and Disability
• Major depression, suicide, PTSD
• Drug and alcohol abuse
• Heart disease
• Cancer
• Chronic lung disease
• Sexually transmitted diseases
• Intergenerational transmission of abuse
Social Problems
• Homelessness
• Prostitution
• Criminal behavior
• Unemployment
• Parenting problems
• High utilization of health and social services
HOW ACES WORK
CAN Narratives, NCTSN, 2015
For more information about ACES go to:
https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/
ACES IMPACT
GENERATIONS
CAN Narratives, NCTSN, 2015
WHAT CAN WE DO TO STOP THE
IMPACT OF ACES?
• Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress —
such as family and relationship problems, serious health problems or workplace and financial stressors.
• Research has shown that resilience is ordinary, not extraordinary.
• Being resilient does not mean that a person doesn't experience difficulty or distress. Emotional pain and sadness are common
in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve
considerable emotional distress.
• Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned
and developed in anyone.
• Resilient environments promote behaviors thoughts and actions in all of the community in order to support those in need.
PROMOTING RESILIENT ENVIRONMENTS
http://www.apa.org/helpce
nter/road-resilience.aspx
ADVERSITY
STRESS
TRAUMA
ABILITY TO ATTACH
TO OTHERS SAFETY
EMOTIONAL REGULATION
BASIC NEEDS MET
COMMUNITY CONNECTIONS
WHAT ARE THE SKILLS/ACTIONS TO CREATE
RESILIENT ENVIRONMENTS?
RESILIENCE: ABILITY TO ATTACH TO OTHERS
The ability to give and feel love, to feel safe and
secure in relationships.
These skills are developed early in infant parent
relationship, but if “broken” can be repaired by
developing trusting relationships in childhood or
adulthood.
Changing your approach in understanding another
person’s behavior from what’s wrong with you? to what
happened to you?
RESILIENCE: TO FEEL SAFE
Learning how to recognize and manage our
own emotional world as well as learning how
to understand the emotions in others is
critical to feeling whole and healthy.
RESILIENCE: EMOTIONAL REGULATION
Having loving accepting communities, not
avoidant of talking about difficult topics,
not critical nor punitive, but accepting and
compassionate, is an antidote to trauma
and adversity.
RESILIENCE: COMMUNITY CONNECTION
Loving kindness, benevolence, spiritual and human connection are all
paths to healing from pain and loss
RESILIENCE: FAITH COMMUNITIES
QUESTIONS & DISCUSSION
ALICE M. FORRESTER, PHD, CEO
Clifford Beers
5 Science Park
New Haven, CT 06511
203-772-1270
aforrester@cliffordbeers.org

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Dr. Alice Forrester of Clifford Beers

  • 1. 1
  • 2. ADVERSE CHILDHOOD EXPERIENCES (ACES) WHEN CHRONIC STRESS AND ADVERSITY CAN LEAD TO LIFELONG HEALTH CONSEQUENCES Alice M. Forrester, PhD Clifford Beers New Haven, CT aforrester@cliffordbeers.org
  • 3. ● Founded in 1913 by New Haven resident Clifford W. Beers ● Offers programs/services children and families need for mental health and wellness ● Convenient, effective care ○ Clinic-based; community-based; home-based ● Engaging everyone (schools, lawmakers, providers, child-focused organizations) to adopt trauma-informed practices for whole family ● Focuses on integrating the physical, mental and social determiants of health ABOUT CLIFFORD BEERS Outpatient Clinic 93 Edwards Street, New Haven, CT
  • 4. We want our children to be healthy, well and productive members of society. In order for this to happen they must have good mental health. If children are in distress, we must recognize it and address it quickly. OUR HOPE
  • 5.
  • 6. What Do We Mean by “Adversity”? Child trauma and adversity come in many forms and no term covers all of them. • Bereavement/Separation • Domestic Violence • Impaired Caregiver • Emotional Abuse • Neglect • Physical Abuse • Sexual Abuse • Community Violence • Sexual Assault/Rape • Serious Injury/Accident • School Violence • Illness/Medical Trauma • Physical Assault • Natural Disaster • Extreme Interpersonal Violence • Kidnapping
  • 7. Research over last 25 years has proven the potential for life long health impact of chronic stress..we just have different words to describe it… Research over the last 25 years has proven the potential for life long negative health impact of chronic stress. We just have different words to describe the impact… ACES? Child Traumatic Stress? Allostatic load? Complex Trauma? Post Traumatic Stress Disorder? Chronic Stress? Toxic Stress? From: CAN Narratives, NCTSN, 2015
  • 8. Data from the National Comorbidity Survey-Replication Sample (NCS-R) - Putnam, Harris, Putnam, J Traumatic Stress, 26:435-442, 2013 CUMULATIVE ACES AND MENTAL HEALTH CAN Narratives, NCTSN, 2015
  • 9. CAN Narratives, NCTSN, 2015 Felitti et al., (1998) American Journal of Preventive Medicine, 14:245-258. CUMULATIVE ACES AND HEALTH
  • 10. Adverse Childhood Experiences • Abuse and neglect (e.g., psychological, physical, sexual) • Household dysfunction (e.g., domestic violence, substance abuse, mental illness) Impact on Child Development • Neuro-biologic effects (e.g., brain abnormalities, stress hormone dysregulation) • Psychosocial effects (e.g., poor attachment, poor socialization, poor self-efficacy) • Health risk behaviors (e.g., smoking, obesity, substance abuse, promiscuity) Long-Term Consequences Disease and Disability • Major depression, suicide, PTSD • Drug and alcohol abuse • Heart disease • Cancer • Chronic lung disease • Sexually transmitted diseases • Intergenerational transmission of abuse Social Problems • Homelessness • Prostitution • Criminal behavior • Unemployment • Parenting problems • High utilization of health and social services HOW ACES WORK CAN Narratives, NCTSN, 2015 For more information about ACES go to: https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/
  • 12. WHAT CAN WE DO TO STOP THE IMPACT OF ACES?
  • 13. • Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors. • Research has shown that resilience is ordinary, not extraordinary. • Being resilient does not mean that a person doesn't experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress. • Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned and developed in anyone. • Resilient environments promote behaviors thoughts and actions in all of the community in order to support those in need. PROMOTING RESILIENT ENVIRONMENTS http://www.apa.org/helpce nter/road-resilience.aspx
  • 14. ADVERSITY STRESS TRAUMA ABILITY TO ATTACH TO OTHERS SAFETY EMOTIONAL REGULATION BASIC NEEDS MET COMMUNITY CONNECTIONS WHAT ARE THE SKILLS/ACTIONS TO CREATE RESILIENT ENVIRONMENTS?
  • 15. RESILIENCE: ABILITY TO ATTACH TO OTHERS The ability to give and feel love, to feel safe and secure in relationships. These skills are developed early in infant parent relationship, but if “broken” can be repaired by developing trusting relationships in childhood or adulthood.
  • 16. Changing your approach in understanding another person’s behavior from what’s wrong with you? to what happened to you? RESILIENCE: TO FEEL SAFE
  • 17. Learning how to recognize and manage our own emotional world as well as learning how to understand the emotions in others is critical to feeling whole and healthy. RESILIENCE: EMOTIONAL REGULATION
  • 18. Having loving accepting communities, not avoidant of talking about difficult topics, not critical nor punitive, but accepting and compassionate, is an antidote to trauma and adversity. RESILIENCE: COMMUNITY CONNECTION
  • 19. Loving kindness, benevolence, spiritual and human connection are all paths to healing from pain and loss RESILIENCE: FAITH COMMUNITIES
  • 20. QUESTIONS & DISCUSSION ALICE M. FORRESTER, PHD, CEO Clifford Beers 5 Science Park New Haven, CT 06511 203-772-1270 aforrester@cliffordbeers.org