Revised Keynote Presentation - Children`s Trust Foundation

Report
Adverse Childhood Experiences,
Complex Trauma, and Community
Responses
Christopher Blodgett, Ph.D.
Washington State University
Five Takeaways for Today
2
 Quality relationships fix many things
 Adverse Childhood Experiences, are the public
health problem facing America
 Understanding trauma can guide what we do to
make things better
 Trauma is the least interesting thing you can know
about another person
 We have to look to each other and unusual partners
for a problem this big
Understand Trauma but Build Resilience
3
 Resilience- positive




adaptation despite adversity
In early childhood, successful
secure attachment
In later childhood, mastery of
school and establishing
meaningful peer and adult
relationships
In adults, meaningful intimate
and loving relationships
A virtuous cycle- Reduces
exposure to vulnerability and
increase access to protective
resources
Building Resiliency as the Positive Health Goal
4
 Focus on positive growth in




addition to reduction of risk
Harm reduction as the goal
Adopt a developmental and
an ecological approach to
assessment and provision of
interventions
Commit to persistent efforts
with high risk families
Build community capacity
as the principal resource
Relationship is the Evidence-Based Practice
5
 Trauma results primarily from
disrupted relationships
 Focus on relationship as the
vehicle for life success
 Attachment key to well-being
across the life span



Critical role of core caregiverinfant relationships
Early learning creates persistent
but potentially modifiable
responses
Progressive role of extended
caregivers and intimate
relationships
Attachment: Can I Depend on You When I Need You?
Attachment is the maintenance of a desired distance to a caregiver both physically
and emotionally. The desired distance depends on the situation.
The
caregiver as
a safe haven
soothes and
comforts
activation
and creates
readiness to
explore in
the child
Child may be
‘activated’ (seek
closer proximity due
to fear or
uncertainty) by
internal/external
cues
The belief that the
caregiver will be
available as a secure
base if needed
provides a child the
safety to explore
their world
Ideally,
activation stops
when the child’s
desired distance
is exceeded by
the actual
distance
4 Core Principles of Attachment
Attachment is an innate
motivating force
In order to learn, you have
to feel safe and free to
explore
1.
2.



3.
4.
Fear and uncertainty activate
attachment needs
Attachment offers a safe haven
Attachment offers a secure
base
You build bonds by being
accessible and responsive
Isolation and loss are
inherently traumatizing
Directions of Attachment
View of Self is positive
Dismissingavoidant-I
can’t rely on
you, so I
only rely on
me.
View of others
is negative
DisorganizedI’m not okay
with you and
I’m not okay
without you.
My fear is
unsolvable.
Secure
Attachment
- I can rely
on me and I
can rely on
you
Preoccupied
AmbivalentI can’t rely
on me, so I
rely on you
View of Self is Negative
View of others
is positive
User’s Manual for Your Brain
9
 Principle 1: Our brains
are designed to benefit
from rich and
supportive intimate
social relationships.
 Principle 2: Brain
function is hierarchical.
We feel and then we
think.
 Principle 3: Brain
systems change with use
throughout life.
Toxic Stress Places Health at Risk
10
 Toxic stress

Persistent, unpredictable,
overwhelming
 Adverse Childhood
Experiences as the
origins of toxic stress
 Complex trauma as
adaptation and survival
Toxic Stress Places Brain Development at Risk
11
1.
2.
3.
4.
5.
Access to adequate
stimulation at key times
Elevated stress hormone
levels can change brain
structure
Functional immaturity of
the threat-arousal
management system
Brain development follows
use
Survival trumps learning
Complex Trauma and ACEs
12
 The process of exposure to ACEs and the process of
adjustment.
 The ‘complex’ in complex trauma risk:
Early exposure at times of critical development
 Multiple risks
 Unpredictable and persistent
 Who you love is who you may not be able to count on

 Natural responses to extraordinary circumstances.
 Complex trauma involves common challenges and
responses that can be understood and guide our
actions.
Natural Responses to Extraordinary
Circumstances
13
 Sense of self and ability to influence the world
Not feeling worthy of love, not trusting love
 Feel incapable of having a positive impact on the
outside world
 Diminished sense of self worth = diminished
persistence in effort, giving up on or distorting
relationships
 Self-regulation
 Arousal and hyper-vigilance
 Survival and automatic behaviors- aggression,
withdrawal, dissociation
 Poor impulse control
 Trauma impairs emotional learning- constricts
response and ability to form relationships

We Swim in Adversity
The Adverse Childhood Experiences Study
14
 Substance Abuse
 Parental Separation/Divorce
 Mental Illness
 Battered Mother
 Criminal Behavior
 Psychological Abuse
 Physical Abuse
 Sexual Abuse
 Emotional Neglect
 Physical Neglect
27%
23%
17%
13%
6%
11%
28%
21%
15%
10%
ACEs Have a Dose Effect on Health
• With four or more
categories of childhood
exposure, compared to
adults with no ACEs
– 4- to 12-fold increased
alcoholism, drug abuse,
depression, and suicide
attempt
– 2- to 4-fold increase in poor
self-rated health
– 3- to 4-fold increase in chronic
illness (heart disease, liver
disease)
– Earlier death with >6 ACEs
Women
%
Men
%
Total
%
0
35
38
36
1
25
28
26
2
16
16
16
3
10
9
10
4 or
more
15
9
13
(ACE
Score)
15
Impact-ACE Risk Pyramid
We don’t know much of what we need
to know right now
Copyright WSU AHEC 2012 Reproduction
with attribution permitted
17
How Do We Move to Community Responses to
ACEs and Trauma?
18
 Each of us has to name the problem
 Trauma compromises our universal systems caring
for children


Common need builds alliances
Education, primary health care, youth development
 Helping professionals understand their role -
appropriate response to trauma

Awareness, trauma informed planning, surveillance and
referral, role of natural relationships in repair
 Our initial experiences in early learning and K-12
education- Building the case, moving to action
Spokane Study ACEs Exposure in Elementary
Aged Children
• 2,100 randomly selected
children in 10 elementary
schools
• >200 teachers,
counselors, and building
administrators provided
knowledge of children’s
risk
• 5 Title I and 5 Non-Title I
schools
• Risk is greater as poverty
increases
•First study of its kind
Parents Divorced/Separated
Residential Instability
Domestic Violence Witness
CPS Involved
Jailed Family Member
Substance Abuse in Family Member
Basic Needs
Mental Health Disorder in Family Member
Physical Disability in Family Member
Community Violence Exposure
Parent/Caregiver Death
Lifetime
36%
9%
9%
9%
9%
7%
7%
5%
3%
3%
2%
Complex Trauma Risk in the Spokane
Students
Lifetime
ACE Exposure
Past 12 Month
ACE Exposure
55%
81%
23%
12%
10%
4%
12%
2%
None
One
Two
Three or More
Odds for Academic and Health Problems
with Increasing ACEs in Spokane Children
Academic
Failure
Severe
Attendance
Problems
Severe
School
Behavior
Concerns
Frequent
Reported
Poor
Health
3
5
6
4
Two ACEs
N=213
2.5
2.5
4
2.5
One ACE
N=476
1.5
2
2.5
2
No Known
ACEs =1,164
1.0
1.0
1.0
1.0
Three or More
ACEs N =248
Percent of Students with One or More Academic
Concerns by ACE Exposure
100%
90%
Percent of Students with Academic Problems
80%
70%
60%
50%
40%
30%
20%
10%
0%
No Known Adverse
Events
One or More Academic Concerns
34%
One Reported
Adverse Event
56%
Two Reported
Adverse Events
71%
Three or more
Adverse Events
80%
Readiness to Learn and ACEs
23
 RTL program
 RTL ACEs Scale =
 Adapting other assessment
 Basic Need
information in an adverse
framework
 Challenged data still
produces powerful effects
 Legal Problems


Data entered by more than
100 different service
providers
Data based on establishing a
relationship to collect
optimal data
Copyright WSU AHEC 2012 Reproduction with
attribution permitted
 Parenting Concerns
 Single Parent/Living Away




from Parents
CPS/Abuse Concerns
Homeless/Homeless Risk
Family Safety/Family
Violence
Family Substance Abuse
ACE Exposure in Readiness to Learn
N=5,443 RTL Students
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
N=5443 RTL Students
No Reported ACEs
19%
One ACE
32%
Two ACEs
22%
Copyright WSU AHEC 2012 Reproduction
with attribution permitted
Three ACEs
14%
Four or More ACEs
12%
24
RTL- ACEs and
Odds Ratios for
Academic Risk
Academic
Failure
Poor
Attendance
Four or More ACES
N=663
Three ACEs N=756
2.0
5.3
3.1
6.5
1
3.0
1.5
2.0
Two ACEs N=1,141
1
2.5
1.6
1.8
One ACE N=1,612
1
1.6
1.2
1.2
No Reported ACES
N=1,020
---
1
1
1
Copyright WSU AHEC 2012 Reproduction
with attribution permitted
School Behavioral
Behavior
Health
Problems
25
RTL-ACEs and academic success
Copyright WSU AHEC 2012 Reproduction
with attribution permitted
26
RTL students and social emotional
distress
Copyright WSU AHEC 2012 Reproduction
with attribution permitted
27
Screening for ACEs in Head Start
Children
• Parent report
• Adaptation of
original ACE screen
(0-9 items)
• Average ACEs
– Child M= 2.6
– Parent M=4.0
– 44% of children and
75% of parents have
3 or more ACEs
Copyright WSU AHEC 2012 Reproduction
with attribution permitted
28
ACE Exposure Groups and Mean Caregiver Initial DECA Scores N=104
Behavior Concern
Total Protective Factors
Attachment
Self Control
Initiative
40
45
50
55
60
65
70
Initiative
47
Self Control
46
Attachment
45
Total Protective Factors
45
Behavior Concern
65
3-4 ACEs
54
54
52
53
58
1-2 ACEs
54
53
54
53
57
No ACEs
50
53
55
51
55
5 or more ACEs
Why There is Reason for HopeTrauma Informed Practice in Education
 Social support and resources




build resiliency at any age.
Resiliency buffers the effects
of trauma.
Creating safety and
predictability creates
opportunity for new learning.
Understanding trauma
creates opportunities for new
behaviors.
Teachers can create powerful
relationships.
Managing trauma’s effects
may result in increasing
success for systems.
30
A Roadmap for Change in Education as One Example
 Response to Intervention as a public health principles adapted
into education settings
 Universal adoption of social emotional learning and trauma
informed actions to guide decision-making
 Trauma informed assessment and tailored response to children
and families most in need
 Sustainable interventions to prepare children to benefit from
universal education and supports
 Coordination of more intensive supports when required

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