Ace Train the Trainer Presentation

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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!

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