Transcript Adverse Childhood Experiences (ACE) Study and Inter

The Adverse Childhood Experiences
(ACE) Study, Substance Abuse, and
Trauma Informed Care for Home
Visitors
Jennifer Stout, LICSW, MLADC
Goals
• 1. Describe the Adverse Childhood
Experiences Study and why it is important.
• 2. Examine the relationship between adverse
childhood experiences and substance abuse.
• 3. Talk about opportunities in home visiting to
provide inter-generational trauma-informed
care.
The ACE Study
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Kaiser Permanente, San Diego
17,000 volunteers
About 50/50 male/female participants
Almost half had college degrees
Mean age was 57
Adverse Childhood Experiences
• 1. Recurrent physical abuse
• 2. Recurrent severe emotional abuse
• 3. Contact sexual abuse
• 4. Physical neglect
• 5. Emotional neglect
Growing up in a household…
• 6. where someone was in prison
• 7. where the mother was treated violently
• 8. with an alcoholic or drug user
• 9. where someone was chronically depressed, mentally ill,
or suicidal
• 10. where at least 1 biological parent was lost to the
person during childhood, regardless of the cause.
According to the study, ACE’s:
• are vastly more common than
recognized or acknowledged
• have a powerful relation to adult
health and behaviors a halfcentury later.
ACE are more common that
expected…
• 64%of study participants reported at least 1 ACE
score.
• If you experienced 1 adverse childhood
experience, you had an 80% chance of having at
least 1 more.
• 20% had 3, 12% had 4 or more
• 16% of men and 26% of women reported
childhood sexual abuse
• 66% of the women in the sample experienced
abuse, violence, or household dysfunction in
childhood. (Felitti, 2002)
ACE have a powerful relationship to
adult health
As the number of adverse childhood experiences
increased, the number of health and social outcomes
also increased:
Including obesity, diabetes, substance abuse, and mental
illness
*********MAJOR PUBLIC HEALTH CRISES********
“Every adult was once a child”
Robert Block
Types of Trauma
• Acute Trauma “is an emotional
response to a terrible event like an
accident, rape or natural disaster.
Immediately after the event, shock and
denial are typical”
• PTSD may develop.
• (American Psychological Association)
• Complex/Chronic Trauma + childhood=
– Exposure to multiple traumatic events, that
are
• Relational
• Chronic
• Long-term
These events begin early in life and can
impact the very formation of self, interfere
with the child having a primary source of
safety and stability created through secure
attachment.
• “Traumatic events are extraordinary, not
because they occur rarely, but rather because
they overwhelm the ordinary human
adaptations to life.” — Judith Herman,
Trauma and Recovery
• HOW?
• The Stress Response
• “Young children cannot manage most dangers”Patricia Crittendon, PhD
• Positive stress response
• Tolerable stress response
• Toxic stress response
Toxic Stress Response
• Toxic Stress in the Developing Child
TOXIC STRESS AND THE YOUNG CHILD
• Toxic stress can disrupt the development of
neural circuits in the brain in early childhood.
• High levels of stress hormones can suppress
the body’s immune system and impact
physical health.
• Sustained high levels of cortisol can damage
the hippocampus, an area of the brain
responsible for memory and learning.
What does this look like?
Biologically: problems with movement and sensation,
hypersensitivity to physical contact, difficulty with balance and
coordination.
Physically: stomach problems, fast heart rates, difficulty sleeping.
Socially: relationships can be characterized by boundary problems
or distrust. They can have difficulty empathizing with others.
Intellectually: trouble focusing, completing tasks, understanding
their part in what happens to them, leaning difficulties.
Emotionally: difficulty regulating mood, knowing their feelings,
low self esteem, not a clear sense of self.
Behaviorally: poor impulse control, aggression, or becomes passive
and fearful, have a heightened awareness of potential dangers.
Aren’t we talking about substance
abuse????
Trauma and Toxic Stress in
Adolescence
• Prefrontal cortex development promotes:
– Assessing behavioral consequences
– Appraising of danger and safety
– Meeting long term goals
THIS DEVELOPMENT IS IMPAIRED BY TOXIC STRESS
What does this look like?
• Behavioral: reckless, aggressive risk taking
behavior, (danger of re-vicimization, sa)
• Emotional: feel angry, ashamed, low self
esteem, anxious, depressed, over or
underestimating danger
• Physical: poor sleep, disturbed eating
• Social: feeling alone, childish”, expecting
maltreatment
• Intellectual: underachievement at school
Adopting High Risk Behaviors
Alcohol abuse
Illicit drug abuse
Obesity (overeating)
Promiscuity
Risk of pathologic gambling
Alcohol, Drugs, and ACE
• Maltreated children are at 1/3 greater risk for using
drugs as teenagers (Kelley, Thornberry, and Smith, 1997)
• People with high ACE scored were more likely to
initiate alcohol and illicit drug use at an earlier age.
• Participants with high ACE scores were more likely to
identify as an alcoholic and marry an alcoholic.
• They were more likely to experience addiction.
• They were more likely to have more than 30 sexual
partners & engage in sexual intercourse earlier.
(DHHS, 2008)
Alcohol, Drugs and ACE continued…
• One study estimates that as many as 75% of women in
treatment for alcoholism have a history of sexual abuse.
• Approximately 50%-60% of women and 20% of men in
chemical dependency programs report having been victims of
sexual abuse, 69% of women and 80% of men report physical
abuse. (Matsakis, 1994)
• Women who have an ACE score of 4 or more have are 78%
more likely to inject drugs compared to women with an ACE
score of 0.
• A male with an ACE score of 6 has a 46-fold (4,600%)
increased risk of becoming an injection drug user later in life.
(Miller, 2011)
• “Since no one injects heroin to get endocarditis
or AIDS, why is it used? Might heroin be used for
the relief of profound anguish dating back to
childhood experiences? Might its psychoactive
effects be the best coping device that an
individual can find? Is intravenous drug use
properly viewed as a personal solution to
problems that are well concealed by social
niceties and taboo? If so, is intravenous drug use
a public health problem or a personal solution? Is
it both? Is drug abuse self-destructive or is it a
desperate attempt at self-healing, albeit while
accepting a significant future risk? “- Felitti, 2002
How do home visitors help??
Powerful opportunity for
intergenerational trauma-informed
intervention
1. Using trauma informed interactions
with caregivers and children to promote
healing.
2. Alleviating toxic stress for the child and
caregiver
What is being Trauma Informed??
• “A trauma informed approach is based on the
recognition that many behaviors and
responses (often seen as symptoms)
expressed by survivors and consumers are
directly related to traumatic experiences that
often cause mental health, substance abuse,
and physical health concerns.”
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National Center for Trauma Informed Care
Substance Abuse and Mental Health Service Administration
TIC Guiding Values
• Understand the impact & prevalence of
trauma
• Communicate with compassion
• Promote safety
• Earn trust
• Embrace diversity
TIC guiding values continued
• Provide holistic care
• Respect human rights
• Purse the person’s strengths, choice, and
autonomy
• Share power
• Barnes, Meyer, and Williamson
Harvard’s Center for the Developing
Child says…
• The most effective prevention (of toxic stress) is
to reduce exposure of young children to
extremely stressful conditions…Programs or
services can remediate the conditions or provide
stable, buffering relationships with adult
caregivers. Research shows that, even under
stressful conditions, supportive, responsive
relationships with caring adults as early in life as
possible can prevent or reverse the damaging
effects of toxic stress response.
The Pew Center on the States Says…
• “Evidence shows that when families volunteer
to receive home based support in partnership
with trained professionals, their children are
born healthier and are less likely to suffer
from abuse or neglect.”
Conclusions:
• As home visitors, you are in the unique position
to CHANGE BRAINS!!
– Offer support, information, and modeling to the
parent, child, and parent-child diad.
– Your trauma-informed interactions help heal the
caregiver and offer an opportunity for children to
increase experiences of safety so that their brains can
go about the business of thinking and learning.
– This builds RESILIENCE for both caregiver and childstress and danger may happen, but positive
adaptation and coping can, too.
• [email protected]
References:
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Bloom, Sandra. “Doubls Trouble: The Perils of Substance Abuse and PTSD” (2000).
Ott, David. “Trauma Informed Care:Top 10 Tips for Caregivers and Case Managers”.
Barnes, Barbara, Claudia Meyer and Martha Williamson. “Trauma Informed Care”.
Cave, Cathey and Niki Miller. “Trauma and Its Impact”.
Carson, Kathy et al. “Adverse Childhood Experiences and Evidence Based Home Visiting”. (2011)
Center for Nonviolence and Social Justice (website)
Crittendon, Patricia M. “A dynamic maturation Model of Attachment”. (2006)
Lucenko, Barbara et al. “Adverse Childhood Experiences Associated with behavioral health Problems in Adolescents”. (2012)
Middlebrooks, Jennifer and Natalie Audage. “The Effects of Childhood Stress on Health Across the Lifespan” (DHHS, CDC)
Jennings, AnnPhD. “The ACE Study and Unaddressed Childhood Trauma.
Felitti, Vincent. “The Relationship of Adverse Childhood Experiences to Adult Health, Turning Gold into Lead”. (2002)
McEwan, Bruce. “Brain on Stress: How the Social Environment gets under the Skin”. (2013)
Anda, Felitti et al. “The enduring effects of abuse and related adverse experiences in childhood”. (2006)
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www.acestudy.org
www.acesconnections.org