Early  Brain  Development    +    Adverse  Childhood  Experiences  x    

Advocacy  =  Proac;ve  prac;ces  for  children  and  families  most  in  need  of  support  

   

Most  material  developed  by  the  Early  Brain  and  Child  Development  Leadership  Workgroup  

A  program  of  the  American  Academy  of  Pediatrics  

Rosemary L. Wilson, LMSW Early Childhood Comprehensive Systems Coordinator

Department of Health and Environmental Control

CT SC Home Visiting Summit – September 2014

     

The Adverse Childhood Experiences Study– the Largest Public Health Study You Never Heard Of Jane Ellen Stevens Huffington Post

Excessive Stress Disrupts the Architecture of the Developing Brain Center on the Developing Child Harvard University

Community Members Gather to Fight Adverse Childhood Experiences United Way of East Central Iowa

How Much Could We Improve Children’s Life Chances by Intervening Early and Often? CCF Brief #54 Brookings

“Change  the  First  Five  Years  and  You  Change  Everything”  

                 

h4p://www.youtube.com/watch?v=GbSp88PBe9E    

The  architecture  of  the  brain  depends  on  the  mutual  influences  of  the  following  

•  GeneGcs  •  Environment  •  Experience  

         

The  Biology  of  Health  

Source:  NaGonal  ScienGfic  Council  on  the  Developing  Child,  Working  Paper  5,  The  Timing  and  Quality  of  Early  Experiences  Combine  to  Shape  Brain  Architecture.  Center  on  the  Developing  Child  at  Harvard  University.  

Shaping  the  Capacity  of  the  Brain  •  The  interacGve  influences  of  genes  and  experiences  shape  the  architecture  of  the  developing  brain  

•  Brains  are  built  from  the  bo4om  up  

Why  Early  Experiences  MaDer  

Newborn  Brain  Average  Weight  

333  grams  

2  Year  Old’s  Brain  Average  Weight  

999  grams  Brain  photo  courtesy  IsaacMao,  Flickr  

Trauma  leaves  tracks  in  the  

developing  brain  

Source:  Bruce  Perry,  MD,  PhD,  Child  Trauma  Academy  

Early  Stress  

What is the Adverse Childhood Experiences (ACE) Study?

The largest study of its kind that looks at the health and social effects of adverse

childhood experiences over a lifespan.

What is the Adverse Childhood Experiences (ACE) Study?

Study participants were middle-class Americans from San Diego, 80% white, 74% attended college,

average age of 57, split evenly between men and women.

NOTE: Not exactly an impoverished or “at-risk population”

Prevalence  of  Adverse  Childhood  Experiences  

Adverse  Childhood  Experiences    

•  Physical,  sexual  or  emoGonal  abuse  

•  Physical  or  emoGonal  neglect  •  Household  mental  illness  •  Living  in  a  household  with    

substance  abuse  •  Having  a  parent/caregiver  divorce  

or  separate  •  Exposure  to  domesGc  violence  •  Living  in  a  household  where    a  

member  was  or  has  been  incarcerated  

ACE  Score                        (1  point  for  each  category  listed)  

Prevalence  in  Study  

0   33%  

1   26%  

2   16%  

3   10%  

4   6%  

5   5%  

Data from : www.cdc.gov/nccdphp/ace/

We know that: Early Adverse Experiences (ACEs) contribute directly to the risk for long-term physical and mental health.

U.S. Dept. Health and Human Services, 2010

As the ACE Score increases, the risk of the following health problems increases:

Health Problems •  Alcoholism/alcohol abuse •  STDs •  COPD •  Depression •  Fetal death •  Health related QOL •  Liver disease •  Smoking •  Unintended pregnancy •  Suicide attempts •  Intimate partner violence •  Ischemic heart disease

ACE Score Women Men

0 35% 38%

1 25% 28%

2 16% 16%

3 10% 9%

4 or more 15% 9%

Data from : www.cdc.gov/nccdphp/ace/

Number of Risk Factors

Source: Center on the Developing Child Harvard University. InBrief: the Impact of Early Adversity on Children’s Development. Statistics from research from Barth, et al. (2008)

Chi

ldre

n w

ith

Dev

elop

men

tal

Del

ays

1-2 3 5 4 6 7

20%

40%

60%

80%

100%

Significant Adversity Impairs Development in the First Three Years

Slide  modified  from  V.  J.  Felic  

Why  are  ACEs  important?  

Significant  adversity  in  childhood  is  strongly  associated  with  unhealthy  lifestyles  and    

poor  health  decades  later.      

ACEs

Skeletal Fractures

Relationship Problems

Smoking

General Health and Social Functioning

Prevalent Diseases

Sexual Health

Risk Factors for Common Diseases

Hallucinations

Mental Health

ACEs Impact Multiple Outcomes

Difficulty in job performance

Married to an Alcoholic

High perceived stress

Alcoholism

Promiscuity

Illicit Drugs

Obesity

Multiple Somatic Symptoms

IV Drugs

High Perceived Risk of HIV

Poor Perceived Health

Ischemic Heart Disease Sexually

Transmitted Diseases

Cancer Liver Disease

Chronic Lung Disease

Early Age of First

Intercourse Sexual Dissatisfaction

Unintended Pregnancy

Teen Pregnancy

Teen Paternity Fetal Death

Depression

Anxiety

Panic Reactions

Sleep Disturbances

Memory Disturbances

Poor Anger Control

Poor Self-Rated Health

ACEs  are  common–  in  fact  the  number  of  

 people  affected  by  ACEs    outnumbers  those  who    

have  not  been  affected  by  ACEs.    

ACEs  are  not  desGny,  and  early  trauma  does  not  have  to  dictate  a  

life  story  

Slide  modified  from  V.  J.  Felec  

What  happens  early  can  change  lives  .  .  .  

The  social  and  physical  environment  can  serve  as  a  buffer  to  these  “bad  things.”  

ACEs  and  the  Brain      Early  nurturing,  responsive  interacGons  build  healthy  brain  architecture  that  serves  as  the  

foundaGon  for  health  and  well-­‐being.

How  You  Can  Build  the  Founda;on  for  Healthier  Lives  

If  Toxic  Stress  is  the  missing  link  between  ACE  exposure  and  poor  adult  outcomes,  we  need  to  know:  •  Are  there  ways  to:  

–  treat,    – mi;gate,  and/or    –  immunize  against  the  effects  of  toxic  stress?  

Resilience  is  the  capacity  to  thrive  in  both  good  ;mes  

and  difficult  ones.  And  it  can  be  built  and  nourished  at  any  age,  in  every  human  being.  

Resilience isn’t just a gift of nature or an exercise of will;

resilience grows through positive experiences,

supportive environments and the caring intervention of others.

http://communityresiliencecookbook.org/

Safe, Stable, Nurturing Relationships and Environments became The CDC strategic direction for child maltreatment prevention and their vision for what we want for all children

Essentials for Childhood is the broad “umbrella” for all of CDC child maltreatment work Essentials for Childhood – Steps to Create Safe, Stable, and Nurturing Relationships document

SAFE, STABLE, NURTURING RELATIONSHIPS (SSNRs)

http://www.cdc.gov/violenceprevention/childmaltreatment/essentials

• Safety: The extent to which a child is free from fear and secure from physical or psychological harm within their social and physical environment • Stability: The degree of predictability and consistency in a child’s social, emotional, and physical environment • Nurturing: The extent to which a parent or caregiver is available and able to sensitively respond to and meet the needs of their child

Essentials for Childhood (EfC)

•  A document that proposes strategies that communities can consider to promote Safe, Stable, Nurturing Relationships (SSNRs) and Environments

•  Steps for promoting SSNRs are suggested in four goal areas: –  Raise Awareness and Commitment to Support SSNRs and Prefent Child

Maltreatment –  Use Data to Inform Solutions –  Create the context for Healthy Children and Families through Norms Change

and Programs –  Create the Context for Healthy Children and Families through Policies –  Currently available Public Health Leadership Toolkit http://veto violence.cdc.gov./childmaltreatment/phl/ Media sources, ACEs infographic: Videos

Increasing Effectiveness Through Moving from Isolated Impact to Collective Impact: Fundamentally different, more disciplined, and highly structured and higher performing approach to large scale social impact than other types of collaboration

Promote  the  Five  R’s  of  Early  Childhood  Educa;on    

•  Reading  together  as  a  daily  family  acGvity  •  Rhyming,  playing,  talking,  singing  and  cuddling  together  ohen  

•  Rou;nes  and  regular  Gmes  for  meals,  play  and  sleeping,  which  help  children  know  what  they  can  expect  and  what  is  expected  of  them  

•  Rewards  for  everyday  successes,  realizing  that  praise  from  those  closest  to  a  child  is  a  very  potent  reward  

•  Rela;onships  that  are  reciprocal,  nurturing  and  enduring  are  the  foundaGon  of  healthy  child  development  

EffecGve  Treatments  for  Childhood  Adversity    

Treatments that have been designed specifically to address toxic stress and trauma are the most effective. Including parents in treatment is important in helping the child “practice” new therapeutic strategies at home and creating a more stable, supportive environment. Evidence-based treatments include: Child-Parent Psychotherapy (CPP) – seeks to heal the effects of stress on young children through helping the parent and child develop a more positive relationship, regulate affect and behavior, and alter unhealthy behavior patterns and beliefs Source: Toxic Stress and Trauma-Informed Pediatric Care By Elaine Gottlieb

EffecGve  Treatments  for  Childhood  Adversity    Trauma-Focused Cognitive Behavioral Therapy –

includes stress management and relaxation skills; techniques to help children deal with emotional dysregulation; cognitive coping skills to help them recognize the relationship between current thoughts, feelings and behaviors, and traumatic experiences; and guidance in developing a trauma narrative to process what happened during traumatic experiences Attachment, Self-Regulation, and Competency (ARC) uses a variety of treatments and services to address three key areas that are affected by trauma -- attachment, self-regulation and competency –and are important for resiliency In addition, medications are sometimes used to relieve symptoms such as depression, sleeping difficulties and anxiety. Source: Toxic Stress and Trauma-Informed Pediatric Care By Elaine Gottlieb

Public  Investment  in  Children  by  Age  

The  Heckman  Equa;on  

Source: heckmanequation.org

“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths.” —Elisabeth Kübler-Ross, Psychiatrist & Author

         

Videos  for  HV  PresentaGon      

h4ps://www.youtube.com/watch?v=zQZnO0Mr_vY&feature=youtu.be  

   

h4p://billmoyers.com/episode/full-­‐show-­‐maya-­‐angelou-­‐on-­‐facing-­‐evil/  

   

Thanks for listening!

Rosemary L. Wilson, LMSW DHEC – Early Childhood Comprehensive Systems

wilsonr@dhec.sc.gov

“How wonderful it is that nobody need wait a single moment before starting to improve the world.” —Anne Frank