Positive Adaptation - Resilience Trumps ACEs

Report
RESILIENCE:
POSITIVE
ADAPTATION
Strengths, Health, & Thriving
FACTORS THAT INFLUENCE HEALTH
Health
Care
10%
Environment
22%
Genetics 17%
How We Live
51%
Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975, Georgia Bureau of State Services, Health Analysis and Planning for Preventive Services, p. 35,
1978
ACE REDUCTION: A POWERFUL FRAMEWORK FOR THRIVING
A: Improve General
Community Capacity
to Come Together, Identify
and Address Issues that
Matter Most.
B: Reduce Median Adverse
Childhood Experiences
(ACEs) Scores from One
Generation to the Next.
C: Improve Societal Expectations and
Response to High ACE People to Reduce
Secondary Trauma, Reduce Burden of
Chronic Disease and Optimize Wellbeing
Through The Lifespan.
Physiologic
Adaptation;
Hard-wired Rapid
Stress Response
Toxic Stress:
Cumulative
Stressors
Over Time;
Sensitive
Developmental
Periods
Nutrition
Genetic Predispositions
Physical, Chemical, &
Built Environment
Relational Environment
Foundations
of
Healthy Development
and
Sources of Adversity
Skill-Building Stress:
Short-Term Stressors in
Supportive Environments;
Protection in Sensitive
Developmental Periods
Epigenetics:
Individual
Experience
Affects Gene
Expression
Societal
Expectations and
Response to
Behavior
Adapted to
Relational,
Benevolent World
– Well Matched to
Societal
Expectations
Developmental Determinants of Health
Prosperity
Health-Related
Behavior
Physical &
Mental Health
Life-Span
Outcomes
Adapted from Shonkoff, J.P., “Building a New Biodevelopmental Framework to Guide
the Future of Early Childhood Policy,” Child Development, Jan./Feb. 2010.
WHAT IS RESILIENCE?
The natural human capacity to navigate life well.
(HeavyRunner & Marshall, 2003)
The capacity to absorb disturbance and reorganize while undergoing change, yet still
retain essentially the same function, structure,
identity, feedbacks.
RESILIENCE OCCURS
AT ALL LEVELS:
(Walker et al., 2002)
Individual
The ability of an individual, system or
organization to meet challenges, survive, and
do well despite adversity.
(Kirmayer, 2009)
Family
Community
National,
Global,
Ecosystem
PHASES IN RESILIENCE RESEARCH
Descriptive – What do resilient individuals have in
common?
Predictive – How questions: identify and understand
processes that might lead to resilience, including risk and
protective factors.
Contextual –Why ages, stages, personal and family history,
community context matter for promotion of resilience.
Integrative – Encompasses rapid advances in the study of genes, developmental
neurobiology, neural plasticity, and the conditions, contexts, and processes that affect
positive adaptation throughout the lifespan.
“Resilience rests, fundamentally, on relationships”.
Suniya Luthar; Resilience in development: A synthesis of research across five decades; 2006, p. 780
RESILIENCE AS A DEVELOPMENTAL PROCESS
• We develop competencies & characteristics that
prepare us to be effective in the world we’re
growing into.
• We develop the capacity to adapt in the face of
challenges.
• None of us is perfect—we’ll all have moments when we don’t appear to be
very well adapted to the conditions we’re facing.
• Resilience is complex; it is possible to be resilient in one setting and
pathological in another.
Interactions
Among
Biology,
Psychology,
Social
Factors
AgeAppropriate
Social
Behavior
(Developmental
Tasks)
Developmental
Framework for
Resilience
Multiple
Contexts
Age Related
Patterns of
Competence
Interactions
Among
Biology,
Psychology,
Social Factors
AgeAppropriate
Social Behavior
(Developmental
Tasks)
Age Related
Patterns of
Competence
Developmental
Framework for
Resilience
Multiple
Contexts
Growth
Protection
Nourishment
Wholeness
FINDING
MEANING
TEMPERING
MASTERY
HOPE
RELATIONAL
EXPERIENCE
RECONSTRUC
TING IDENTITY
REVISING
ATTACHMENT &
BELONGING
From: Loss, Trauma, and Resilience; Therapeutic Work
with Ambiguous Loss; Dr. Pauline Boss; 2006
NORMALIZIN
G
AMBIVALENC
E
THREE CORE PROTECTIVE SYSTEMS
1.
Community, Spiritual & Cultural Life
2. Attachment & Belonging
3.
Capabilities
“Nurturing the healthy development of these protective systems affords
the most important preparation or ‘inoculation’ for overcoming
potential threats and adversities in human development. Similarly,
damage or destruction of these systems has dire consequences for the
positive adaptive capacity of individuals.”
Ann Masten, 2009
• Faith, hope, sense of meaning
KEY SYSTEMS COMMUNITY,
CULTURE,
SPIRITUALITY
FOR
RESILIENCE Nourishment
Protection
Wholeness
Growth
CAPABILITY
• Engagement with effective orgs –
schools, work, pro-social groups
• Network of supports/services &
opportunity to help others
• Cultures providing positive
standards, expectations, rituals,
relationships & supports
ATTACHMENT
&
BELONGING
• Bonds with parents and/or
caregivers
• Positive relationships with
competent and nurturing
adults
• Friends or romantic partners
who provide a sense of
security & belonging
• Intellectual & employable skills
• Self regulation – self control,
executive function, flexible
thinking
• Ability to direct & control
attention, emotion, behavior
• Positive self view, efficacy
COMMUNITY, CULTURE, SPIRITUAL LIFE
PRENATAL – INFANCY
COMMUNITY,
CULTURE,
SPIRITUAL
RITUALS &
TRADITIONS
IN
CHILDHOOD
MIDDLE CHILDHOOD
PRE-TEEN & TEEN YEARS
Spiritual engagement
that demands active
participation in a
community of faith
Structure, rules, &
responsibility to
contribute to family and
community
Parents/Family has: Spiritual engagement demands active participation in a community of faith
Rituals & traditions supporting connection with the land (for some people)
Value systems that include notions of personhood, ethics, religion or spirituality
Cultural knowledge and practices supporting coherence and a source of stability & support
PRE-CONCEPTION
ADULT
PROTECTIVE
COMMUNITY,
CULTURE,
SPIRITUAL
RITUALS &
TRADITIONS
PRE-SCHOOL
PREGNANCY
WITH YOUNG
CHILDREN
MOVING TOWARD
MID-LIFE
Spiritual engagement that demands active participation in a community of faith
Rituals & traditions supporting connection with the land (for some people)
Value systems that include notions of personhood, ethics, religion or spirituality
Cultural knowledge and practices supporting coherence and a source of stability & support
SUPPORTING ATTACHMENT & BELONGING
PRENATAL – INFANCY
PRE-SCHOOL
MIDDLE CHILDHOOD
PRE-TEEN & TEEN YEARS
Four or fewer children; 2+ years between siblings
ATTACHMENT &
BELONGING IN
CHILDHOOD
Maternal competence: proportion of positive
interactions with child
Close bond with caregiver
Parents have circle of people they can count on for
help and support
Caregiver sensitivity and
responsiveness to infant needs
No prolonged separation from
parent in first year
ADULT
ATTACHMENT &
BELONGING
PRE-CONCEPTION
PREGNANCY
Number of stressful life
events reported in
childhood, adolescence
Establish relationship
with helper (doula,
visitor, etc.) opens door
to whole program of
help, improves quality in
relating with child
Find ecological Niche for
child – support in family,
social network
Emotional support from friends and family
Sources of support that increase competencies, efficacy,
opportunity to develop strengths, gifts and interests, and
decrease stressful life
WITH YOUNG
CHILDREN
MOVING TOWARD
MID-LIFE
Number of persons the
individual turned to in
times of crisis
Help seeking; social
network building (which
also helps to mitigate the
negative effects of
poverty)
Rewarded with repeated
promotions contributes to
sense of pride
NURTURING CAPABILITY
PRENATAL – INFANCY
CAPABILITY IN
CHILDHOOD
MIDDLE CHILDHOOD
PRE-TEEN & TEEN YEARS
Developmentally appropriate physical activity
Parental involvement in, promotion of, learning
Good health & nutrition; Safety
Ability to seek comfort, support or inspiration from others
Stimulation – sound, sight, touch
Scholastic competence
Play, laughter, exploration
Autonomy, social maturity, self efficacy,
mastery motivation
PRE-CONCEPTION
PARENTAL
CAPABILITY
PRE-SCHOOL
PREGNANCY
WITH YOUNG
CHILDREN
MOVING TOWARD
MID-LIFE
Exercise, e.g. walking at 60% of vital capacity
Identifying and using one’s core gifts
Good health; Safety
Ability to seek comfort, support or inspiration from others
Resourceful and Imagine self as
Continuing
Opening of
realistic in
mother, dream education: academic
opportunities
educational and interaction with and vocational skills Successful adaptation
vocational plans child; redefine
acquired
at midlife
self
Practice of seizing
opportunities
Growth
RISK & PROTECTION
INTERACT IN A CULTURAL CONTEXT
Protection
Nourishment
Individuals
Compensatory
Protective
Challenge
Family & Community
Cultural
Wholeness
Caring, Cohesion, Belief in Each Child
Belonging with Peers, School, Circle of Success
Non-punitive
Provisions and Resources to Assist Belief in Societal Values
Spirituality
Traditional Activities
Traditional Languages
Traditional healing
Elders
Before
WALLA WALLA COMMITMENT TO COMMUNITY
Neighbors Unite To Build Community Park
EXAMPLES OF PROGRAM & POLICY ACTIONS
• Parent Trust for Washington Children has incorporated the ACE questions into their
work with addicted parents facing court action (DV, termination of parental rights)
resulting in: 1) improved outcomes in parenting classes and 2) reduced relapse
among parents with 4 or more ACEs.
• Safe Harbor Crisis Nursery in the Tri-Cities has incorporated ACEs and trauma into its
day-to-day strategies and case management resulting in improved outcomes for
families.
• Children of Incarcerated Parents; the Legislature has mandated the executive branch to
engage in an initiative to address the needs of children of incarcerated parents. The
initiative and its processes are framed to address the likelihood that these children
have more than this one ACE.
• With the help of the Mental Health Transformation Grant and the Office of the
Superintendent of Public Instruction (OSPI), Spokane is exploring the
creation/implementation of trauma sensitive practices in public schools.
• OSPI introduced the Compassionate Schools initiative, which supports local school
districts in reducing the non-academic barriers to schools success that are created by
trauma (2008). (http://www.k12.wa.us/CompassionateSchools/default.aspx)
PORT GAMBLE S’KLALLAM TRIBE – CHI-E-CHEE (THE WORKERS) NETWORK
ADVERSE CHILDHOOD EXPERIENCE
We Can All Help
1. Build Capacity To Reduce
Adverse Childhood Experience
2. Promote Resilience
DRAFT
CAUTIONS ABOUT THE RESILIENCE APPROACH
1. Expectation for Thriving Despite Oppression
2. Strength Based ≠ Solutions
3. Attending to Characteristics & Factors that
Promote Resilience – Only Part of the Story
PARAMETERS FOR INTERVENTION
1. Pay attention to critical periods and
cultural context.
2. Understand resilience as both how we
engage with other people and how we
interact with our environment.
3. Enhance the relationship between person & context.
4. Embed interventions in familiar to social setting/community
contexts.
5. Attend to possibilities for lasting impact & enduring change.
ENHANCING COMMUNITY
CAPACITY
A DYNAMIC PROCESS OF
CONNECTION
FAMILY POLICY COUNCIL
GENERAL COMMUNITY CAPACITY DEVELOPMENT MODEL
General Community Capacity is:
capacity to not only sustain programs,
but also to identify new community
problems as they arise, and develop
ways of addressing them.
General Capacity Development is a
dynamic process that enhances the
infrastructure, skills, and motivation
of a community – changing the way
we live with one another day-to-day.
Literature strongly supports the
importance of general capacity
building in the process of promoting
effective prevention. (Livet, 2008)
This model is powerful
because success in one phase
propels success in the next. It
is a virtuous cycle that has the
power to improve population
health.
VIRTUOUS REINFORCING CAPACITY BUILDING - SUSTAINABLE THRIVING
This model is
powerful because
success in one phase
propels success in
the next. It is a
virtuous cycle that
has the power to
improve population
health.
CAPACITY BUILDING HAS POWERFUL EFFECTS
6
Foundations for Healthy Development Improve
5.14
Five or more different problem rates come down
(http://www.fpc.wa.gov/publications/technicalpaper-ver3.pdf)
5
4
ACE Score Is Reduced from One Generation to the Next
Number of
Betterthan-State
Trends
1998 - 2006
3
2.33
The average ACE score of youth transitioning into adulthood
and parenthood is reduced in high capacity communities. Fewer people
have 3 or more ACEs, thus preventing many health problems
(http://www.fpc.wa.gov/publications/Relationship%20between%20ACEs%20and%20%20BH%20and%2
0PH%20%206%2024%2010.FINAL.pdf)
2
1.5
1.43
1
0
First
Second
Third
Fourth
Quartile Levels of Community Capacity
1997-2007
Improved Social Responses to High ACE People Result in Better Life Course
In high capacity communities, youth who have experienced Adverse Childhood Experiences are much
less likely to use alcohol, marijuana and tobacco; thereby dramatically reducing their risk for disease,
disability and problems at work, home and community
(http://www.fpc.wa.gov/publications/FPC_High%20Risk%20Protect%20Youth_Nov%2009.pdf &
http://www.fpc.wa.gov/publications/FPC_SocialNormative%20High%20Risk%20High%20Capacity_Dec%2009.pdf)
FAMILY POLICY COUNCIL RESILIENCE
MEASURES
MEASURES
1. Focus
2. Learning
3. Leadership
4. Results
COMMUNITY,
CULTURE,
SPIRITUALITY
• Family Policy Council
Community Capacity
Dynamics model + decade
of measurement quantify
neighborhood/community
transformation outcomes
ATTACHMENT
&
BELONGING
CAPABILITY
• One question in BRFSS
indicates attachment &
belonging, and gives
clues about community
capacity: How often do
you get your
social/emotional needs
met?
Before
WALLA WALLA COMMITMENT TO COMMUNITY
Neighbors Unite To Build Community Park
EXAMPLES OF PROGRAM & POLICY ACTIONS
• Parent Trust for Washington Children has incorporated the ACE questions into their
work with addicted parents facing court action (DV, termination of parental rights)
resulting in: 1) improved outcomes in parenting classes and 2) reduced relapse
among parents with 4 or more ACEs.
• Safe Harbor Crisis Nursery in the Tri-Cities has incorporated ACEs and trauma into its
day-to-day strategies and case management resulting in improved outcomes for
families.
• Children of Incarcerated Parents; the Legislature has mandated the executive branch to
engage in an initiative to address the needs of children of incarcerated parents. The
initiative and its processes are framed to address the likelihood that these children
have more than this one ACE.
• With the help of the Mental Health Transformation Grant and the Office of the
Superintendent of Public Instruction (OSPI), Spokane is exploring the
creation/implementation of trauma sensitive practices in public schools.
• OSPI introduced the Compassionate Schools initiative, which supports local school
districts in reducing the non-academic barriers to schools success that are created by
trauma (2008). (http://www.k12.wa.us/CompassionateSchools/default.aspx)
PORT GAMBLE S’KLALLAM TRIBE – CHI-E-CHEE (THE WORKERS) NETWORK
ADVERSE CHILDHOOD EXPERIENCE
We Can All Help
1. Build Capacity To Reduce
Adverse Childhood Experience
2. Promote Resilience
DRAFT
CAUTIONS ABOUT THE RESILIENCE APPROACH
1. Expectation for Thriving Despite Oppression
2. Strength Based ≠ Solutions
3. Attending to Characteristics & Factors that
Promote Resilience – Only Part of the Story
PARAMETERS FOR INTERVENTION
1. Pay attention to critical periods and
cultural context.
2. Understand resilience as both how we
engage with other people and how we
interact with our environment.
3. Enhance the relationship between person & context.
4. Embed interventions in familiar to social setting/community
contexts.
5. Attend to possibilities for lasting impact & enduring change.
ENHANCING COMMUNITY
CAPACITY
A DYNAMIC PROCESS OF
CONNECTION
FAMILY POLICY COUNCIL
GENERAL COMMUNITY CAPACITY DEVELOPMENT MODEL
General Community Capacity is:
capacity to not only sustain programs,
but also to identify new community
problems as they arise, and develop
ways of addressing them.
General Capacity Development is a
dynamic process that enhances the
infrastructure, skills, and motivation
of a community – changing the way
we live with one another day-to-day.
Literature strongly supports the
importance of general capacity
building in the process of promoting
effective prevention. (Livet, 2008)
This model is powerful
because success in one phase
propels success in the next. It
is a virtuous cycle that has the
power to improve population
health.
VIRTUOUS REINFORCING CAPACITY BUILDING - SUSTAINABLE THRIVING
This model is
powerful because
success in one phase
propels success in
the next. It is a
virtuous cycle that
has the power to
improve population
health.
CAPACITY BUILDING HAS POWERFUL EFFECTS
6
Foundations for Healthy Development Improve
5.14
Five or more different problem rates come down
(http://www.fpc.wa.gov/publications/technicalpaper-ver3.pdf)
5
4
ACE Score Is Reduced from One Generation to the Next
Number of
Betterthan-State
Trends
1998 - 2006
3
2.33
The average ACE score of youth transitioning into adulthood
and parenthood is reduced in high capacity communities. Fewer people
have 3 or more ACEs, thus preventing many health problems
(http://www.fpc.wa.gov/publications/Relationship%20between%20ACEs%20and%20%20BH%20and%2
0PH%20%206%2024%2010.FINAL.pdf)
2
1.5
1.43
1
0
First
Second
Third
Fourth
Quartile Levels of Community Capacity
1997-2007
Improved Social Responses to High ACE People Result in Better Life Course
In high capacity communities, youth who have experienced Adverse Childhood Experiences are much
less likely to use alcohol, marijuana and tobacco; thereby dramatically reducing their risk for disease,
disability and problems at work, home and community
(http://www.fpc.wa.gov/publications/FPC_High%20Risk%20Protect%20Youth_Nov%2009.pdf &
http://www.fpc.wa.gov/publications/FPC_SocialNormative%20High%20Risk%20High%20Capacity_Dec%2009.pdf)
FAMILY POLICY COUNCIL RESILIENCE
MEASURES
MEASURES
1. Focus
2. Learning
3. Leadership
4. Results
COMMUNITY,
CULTURE,
SPIRITUALITY
• Family Policy Council
Community Capacity
Dynamics model + decade
of measurement quantify
neighborhood/community
transformation outcomes
ATTACHMENT
&
BELONGING
CAPABILITY
• One question in BRFSS
indicates attachment &
belonging, and gives
clues about community
capacity: How often do
you get your
social/emotional needs
met?

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