ACE REDUCTION

& RESILIENCE PROMOTION

A Powerful Approach

for Prevention and Recovery

State and Local

Collaborative Councils
Structure the Partnership
Community Public
Health and Safety
Networks

Policies
Directly
Affect
Children,
Families

Local Residents and Professionals

plus State Agency Staff are
Members

Family Policy Council

Supports Local & State Policy Improvement
Governor, DSHS, DOH, CTED, ESD, OSPI, DEL, OPD, Legislators

Community
Network
Coalition (CNC)
A membership
organizations serving
Community Networks

PURPOSE
1. Reconstruct Natural Supports that Help Families to Thrive
2. Improve Responsiveness of Service and Policy

3. Improve the Rates of:

Child Abuse & Neglect
Youth Violence
Domestic Violence
Youth Substance Abuse
Youth Suicide
Teen Pregnancy
Dropping out of School
Child Out-of-Home Placement

PERSON
PREPARATION

COMMUNITY
PREPARATION

UNIFYING FRAMEWORK
Brain Science Consequences of Toxic Stress on Human Development;
Developmental Neurobiology

Adverse Childhood Experience

The Most Powerful Determinate of the Publics Health
Positive Adaptation
Individual, Family, Community, Societal Resilience & Capacity for
Transformative Improvements ; What We All Can Do
Systems Science
Helps us see how we collectively create our current reality; and points to
higher leverage solutions to problems

BRAIN RESEARCH
See for example: Teicher, M et al. Neurobiological & Behavioral
Consequences of Exposure to Childhood Traumatic Stress, Stress in
Health and Disease, BB Arnetz & R Ekman (eds). 2006.
Teicher, M. Scars that Wont Heal: The Neurobiology of Child
Abuse, Scientific American, March, 2002, pp. 68-75.

EPIDEMIOLOGICAL RESEARCH
See for Example: Felitti, VJ, Anda, RF et al. Relationship of Childhood Abuse and Household
Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive
Medicine. 1998. (14:4)
For a full list of publications, see http://www.cdc.gov/nccdphp/ace/publications.htm

RESILIENCY RESEARCH
Masten, AS. Ordinary Magic: Resilience Process in Development. American Psychologist. March,
2001 (56:3), pp. 227-238.

Boss, P; Loss, Trauma and Resilience Therapeutic Work with Ambiguous Loss; WW Norton &
Company; 2006
Longhi, D; Community Networks Building Community Capacity, Reducing Rates of Child and Family
Problems, 2008; How Do High Risk Counties Protect All Youth, 2009

FOUNDATIONS OF HEALTHY DEVELOPMENT

Genetic
Predispositions

Experience

Adapted from Shonkoff, J.P., Building a New Biodevelopmental

Framework to guide the Future of Public Policy, Child Development,
Jan./Feb. 2010

BRAIN DEVELOPMENT PATTERNS

Adapted from the research of Martin Teicher, MD, Ph.D
BRAIN
Hormones, chemicals &
cellular systems prepare
for a tough life in an evil
world

Hormones
exert pressures
on cells;
INDIVIDUAL
OUTCOME
these
& function.
Edgydetermine growth
Individual
&
Hot temper

species survive

The
presence of hormones
activates
Impulsive
the worst
systems.
Stress hormones
make
Hyper vigilant
conditions.
systems
to future stressors.
Brawnsensitive
over
brains

Hormones regulate myelinationthe

coating of nerves with fat.

TRAUMATIC
STRESS

Hormones & other neurochemicals

regulate the proliferation and
maturation of receptor cells.

NEUTRAL
START
BRAIN
Hormones, chemicals &
cellular systems prepare
for life in a benevolent
world

INDIVIDUAL
Laid back
Neurochemicals
facilitateOUTCOME
the growth of
Individual
&
Relationshipnew synapses, determining
speciesthe
liveoverall
oriented
mass & function of thepeacefully
brain at in
Thinks things
good times;
maturity.
through
vulnerable in
Process
over
Certain
brain
chemicalspoor
areconditions
toxic to
power

young brain cells.

Adaptation to Anticipated World

Brain Development for a Dangerous World
BRAIN
Hormones, chemicals &
cellular systems prepare
for a tough life in a
dangerous world
TRAUMATIC
STRESS

INDIVIDUAL
Edgy
Hot temper
Quick to act
Hyper vigilant
Brawn over
brains

OUTCOME
Individual &
species survive
the worst
conditions.

Normal Biological Response to Toxic Stress

Bumps Up Against Social Expectations

NEUTRAL
START
BRAIN
Hormones, chemicals &
cellular systems prepare
for life in a benevolent
world

INDIVIDUAL
Laid back
Relationshiporiented
Thinks things
through
Process over
power

OUTCOME
Individual &
species live
peacefully in
good times;
vulnerable in
poor conditions

Brain Development for a Safe & Friendly World

Adapted from the research of Martin Teicher, MD, Ph.D

DISCUSSION
In your experience, how do our major
social services, health, justice, education
and/or mental health systems respond to
young people who act on brawn over
brains?
How do these systems responses work
for children and families?

TRAUMA IS HARD-WIRED INTO BIOLOGY

MIDDLE CHILDHOOD
CORPUS CALLOSUM

EARLY CHILDHOOD

Integrates hemispheres &

facilitates:
Language development
Proficiency in math
Processing of social cues,
such as facial expression

HIPPOCAMPUS
The center for:
Controlling emotional reactions
Constructing verbal memory
Constructing spatial memory
- All forms of maltreatment in
the first 2-3 years of life
- Sexual abuse at ages 3-5
Adaptation:
Emotionally reactivebrains
braking mechanism fails
Poor regulation of behavior
Difficulty with verbal & spatial
memory
Net loss in volume becomes
evident in the 20s.

ADOLESCENCE
CORTEX
Center for:
Thinking & judgment
Executive function
Long term memory
Vision
-Witnessing DV
-Sexual abuse
Adaptation:
Poor executive function
Impulsiveness
Diminished abstract reasoning
No hope for the future
Limiting field of vision

- Neglect in infancy
- Sexual abuse at ages 9 and 10
Adaptation:
Language delay
Diminished math capacity
Diminished integration &
coordination
Difficulty with social cues

CONSEQUENCES OF BIOLOGICAL OUTCOMES

SOCIAL

Aggression & violent outbursts

Poor self-control of emotion
Cant modify behavior in response to social cues
Social isolationcant navigate friendship

MENTAL HEALTH
Poor social/emotional development
Alcohol, tobacco & other drug abusevulnerable to early initiation
Adolescent & adult mental health disordersespecially depression, suicide,
dissociative disorder, borderline personality disorder, PTSD

COGNITIVE

Slowed language development

Attention problems (ADD/ADHD)
Speech delay
Poor verbal memory/recall
Loss of brain matter/IQ

Washington workshops:
Present emerging research so
powerful that, when understood, it
transforms mental models
So that

We create transformative
conversations
So that

Leaders throughout the

state act most
effectively to support
thriving families and
communities

Dr John Snow
1854
Cholera Death is
Caused by Miasmas
1.

New Way of
Thinking

2.

Shoe Leather
Epidemiology

3.

Lives Saved

IN THE LIVES OF WASHINGTONIANS:

ACEs ARE COMMON

ACEs CO-OCCUR / CLUSTER

26% of adults report 3 or more ACEs

1 or
More
ACE
62%

0 ACE
38%

5% of adults have 6 or more ACEs

Among adults exposed to physical abuse,
84% reported at least 2 more ACEs
Among adults exposed to sexual abuse,
72% reported at least 2 more ACEs

Adverse Childhood Experience & Population Health in Washington: The Face of a Chronic Public
Health Disaster - Results from the 2009 Behavioral Risk Factor Surveillance System
http://www.fpc.wa.gov/publications/ACEs%20in%20Washington.2009%20BRFSS.Final%20Report%207%207%202010.pdf

CUMULATIVE IMPACTS VARIED LIFE CHALLENGES

PSYCHIATRIC
DISORDERS

CHRONIC
DISEASE

CRITICAL
& SENSITIVE
DEVELOPMENTAL
PERIODS

IMPAIRED
COGNITION

early childhood, ages 7-9,

pre-puberty,
aging into adulthood

ADVERSE
CHILDHOOD
EXPERIENCE
MORE CATEGORIES GREATER IMPACT
Physical Abuse, Sexual Abuse
Emotional Abuse, Neglect
Witnessing Domestic Violence
Depression/Mental Illness in Home
Incarcerated Family Member
Substance Abuse in Home
Loss of a Parent

WORK/SCHOOL
Attendance, Behavior,
Performance

BRAIN
DEVELOPMENT
Electrical, Chemical,
Cellular Mass

ADAPTATION
Hard-Wired Into
Biology

ALCOHOL,
TOBACCO,
DRUGS
RISKY SEX

GENETICS
Including gender
Remember that experience
triggers gene expression
(Epigenetics)

OBESITY

CRIME
INTERGENERATIONAL
TRANSMISSION,
DISPARITY

POVERTY

What New Ways of Thinking Do the

ACE Study Findings Invite?
What Mental Models are Challenged
by the Study?

ADVERSE CHILDHOOD EXPERIENCE DATA

Will Help People:

1. Derive More Meaning From Archival and Survey Data (e.g.: HYS)
2. Identify High-Risk Communities with Greater Precision
3. Understand Drivers of Mental, Behavioral, Physical Health
4. Improve Evaluation Invest More Wisely Lower Costs
5. Leverage Resources & Partnerships - Achieve Greater Impacts
6. Inspire New Forms of Action

INDICATORS ARE A USEFUL BUT PUNY

SHADOW OF THE REALITY OF HUMAN LIVES
Risk, Protective, Resiliency, Asset Factors means the
conditions known to be antecedent to or empirically
associated with one or more at-risk behaviors.
These factors are typically used in three ways:
1) SET GOALS: As short term desired results e.g. reduce risk and improve
protective, resiliency or asset factors
2) PRIORITIZE: As a way to prioritize a population or select a particular service
3) LEARN & IMPROVE: To understand interrelationships among at-risk behaviors
and thereby design strategic action with limited resources

WHATS THE POTENTIAL?

1.

Bend the health care cost curve

2.

Drastically reduce mental health disorders and disability driven

by mental health and substance abuse disorders

3.

Stop disastrous cycles of intergenerational poverty

4.

Afford for all children

optimal development,
school completion,
arrival at adulthood with full potential for employment
success and a lifetime of well-being.

MAPPING
SEVERITY
ARCHIVAL
INDICATORS

OLDER CHILDREN - High School Sophomores and Seniors

ACE SCORES AMONG PARENTING ADULTS WHO EXPERIENCED CHILD ABUSE

Population
Average:

78%
have 3
or more
ACEs
29% have 6
or more
ACEs

ADVERSE CHILDHOOD EXPERIENCE AND INCOME

Earn Less Than

$20,000/year

Earn Between
$20,000 $35,000

Earn Over
$35,000/yr

High
ACE
High
ACE

High
ACE

SURVEILLANCE & ARCHIVAL DATA

ILLUMINATES GENERATIONAL TRANSMISSION
Example from Healthy Youth Survey and BRFSS
Region 6

Thurston
Mason
Grays Harbor
Lewis
Clark
Skamania
Klickitat
Clallam
Cowlitz
Jefferson
Pacific
Wahkiakum

R-5

28.2

22.4

46

29

37 34 32

26 39 35 47 43

32.4

26.2

11

17.1

8.4

11

3.8

13 7 7.4

6 10 17 10

8.5

7.2

Pierce
Kitsap

King

R-4

Skagit
Island
Snohomish
Whatcom
San Juan

Region 3

33.1 48

8.5

Highest Prevalence Quartile

Region 2

Yakima
Kittitas
Asotin
Benton
Columbia
Franklin
Garfiled
Walla Walla

WA STATE
Spokane
Douglas
Ferry
Lincoln
Pend Oreille
Stevens
Adams
Chelan
Grant
Okanogan
Whitman

Region 1

4 4 3 4

4 3

11

4 1 3 4

1 1

24

4 2 3 2

2 4

14

4 3 3 3 1 3 1 2 4 2 1

1 1 1 2444 1

2 4 3 22

3 2

3 4 4 4 4 2 4 442 4 2

2 3 4 1 4 2 1 4 4 4 1

3 2 1 2322 3

2 2 3 21

3 2

2 3 4 4 2 4 4 143 4 4

4 2 2 2 3 4 1 2 2 4 1

2 4 4 2414 4

3 4 4 31

3 2

3 4 4 2 2 2 4 444 2 4

Second Highest Quartile

Third Quartile

Lowest Prevalence Quartile

TOXIC STRESS DURING DEVELOPMENT

Slowed language &

reading
Lateralization
Diminished IQ
Poor decision making
skills

Attention problems
ADD
ADHD
Aggressive behavior
Social isolation among
peers
Poor understanding of
social cues = conflict

POVERTY

Significant risk of early use/abuse of:

Alcohol, tobacco, illicit & prescription drugs

Predictable patterns of brain

development, traits & behaviors

EARLY TRAUMA & STRESS

FAST TRACK TO

Special
education
School failure
Dropping out

Low-wage jobs
Unemployment

Public Assistance
Prison
Chronic health
problems

Suspension
Expulsion
Delinquency
Dropping out

Debilitating
mental health

ACEs in WASHINGTON

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.
(Walker et al., 2002)

The ability of an individual, system or

organization to meet challenges, survive, and
do well despite adversity.
(Kirmayer, 2009)

RESILIENCE OCCURS
AT ALL LEVELS:
Individual
Family
Community

National,
Global,
Ecosystem

KEY COMPONENTS OF RESILIENCE

Faith, hope, sense of meaning
COMMUNITY,
CULTURE,
SPIRITUALITY

RELATIONAL
CONTEXT FOR
RESILIENCE

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

PEOPLE WITH HIGH RESILIENCE SCORES ARE

2 - 3 TIMES MORE LIKELY TO BE EMPLOYED
40%

FEELING
FORTUNATE

30%

Percent Unemployed

SOCIAL
&
EMOTIONAL
SUPPORT

35%

35%

25%

25%

23%

20%
17%

17%

16%

15%
12%

HOPE

10%
10%

8%

8%

10%

7%

5%

0%
0 ACE

1 ACE

2ACE

High Resilience Score

3 ACE

Low Resilience Score

4-5 ACE

6-8 ACE

HALF FULL OR HALF EMPTY?

How might we systematically
build on the strengths of children
affected by early maltreatment?
What academic and social
supports might we reasonably
provide?
How might we support
communities where a large
portion of the population have 68 ACEs?
What do we know about
mitigating effects? How might
we learn more?

Irritable or Passionate?
Decisive or Impulsive?
Protecting Interests
or Hypervigilant?
Lacking Empathy or
Rational?
Competitive
or Aggressive?
Independent or Detached?

PARAMETERS FOR ACTION

PROTECT & ACCOMMODATE
1. Pay attention to critical periods and
cultural context.

2. Understand resilience as how we engage

with other people and interact with our
environment- and how our environment
interacts with us.
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.

POPULATION
ATTRIBUTABLE
RISK
ACE reduction
reliably predicts
simultaneous
decrease in all of
these conditions.