Adverse Childhood Experiences: ACEs across the lifecourse Karen Clemmer, RN, MN, PHN. Sonoma County Maternal Child Adolescent Health Program

“Never before in the history of medicine have we had better insight into the factors that determine the health of an individual from infancy to adulthood, which is part of the life course perspective—a way of looking at life not as disconnected stages but as integrated across time.”

Adverse Childhood Experiences (ACE) Study Centers for Disease Control and Kaiser Permanente in San Diego, 17,300 Adults Tracked health outcomes based on childhood ACEs 75% Caucasian, 39% college graduates, 36% some college, living wage jobs with insurance; median age 57 yr. old

What are the Adverse Childhood Experiences? Child physical abuse Child sexual abuse Child emotional abuse Physical Neglect Emotional Neglect Mentally ill, depressed or suicidal person in the home Drug addicted or alcoholic family member Witnessing domestic violence against the mother Loss of a parent to death or abandonment, including abandonment by divorce Incarceration of any family member

Prevalence Adverse Childhood Experiences (ACEs) Study Centers for Disease Control & Prevention (CDC) Household dysfunction Substance abuse 27% Parental separation/divorce 23% Mental illness 19% Battered mother 13% Incarcerated household member 5% Abuse Psychological 11% Physical 28% Sexual 21% Neglect Emotional 15% Physical 10% Centers for Disease Control and Prevention

A “Trauma Lens” helps us understand behavior A shift in perspective from: “What is wrong with this person?” to “What has this person been through?” Isabel 6

Hidden Crisis Report on ACEs Results for Sonoma County 22% have 4 or more ACEs Increased risk for depression suicide attempt drug & alcohol use heart disease, stroke, COPD diabetes Alzheimer‘s

LOCAL HELPERS (BLUE RIBBON EVENT May 2015) Abuse Psychological 11% 53% Physical 28% 23% Sexual 21% 28% Neglect Emotional 15% 25% Physical 10% 12% Household Dysfunction Substance Abuse 27% 51% Parent Absent 23% 46% Mental Illness 17% 47% Domestic Violence 13% 16% Criminal Behavior 6% 9%

IMPACT OF TOXIC STRESS Humans are designed to deal with intermittent stress, not chronic stress. We were not designed to fight the tiger all day long! In children, stress becomes toxic when it is not buffered by the comfort of a supportive adult. Trauma and Toxic Stress cause Changes in physiology Changes in brain architecture Changes in skills, abilities and behavior Changes in health and mental health

Impact of Structural Brain Changes STRESS Dysregulation of the Hypothalamic-Pituitary-Adrenocortical Axis leads to increased secretion of adrenaline and cortisol by the adrenal gland. Inflammatory cytokines are also over-produced, leading to accelerated wear and tear on the heart, brain, immune system and elsewhere throughout the body. The end result? Toxic stress in childhood can lead to lifelong, multi-system disease.

In California, the Department of Health Care Services issued a slightly more conservative summary for a presentation coordinated by the California HealthCare Foundation, which publishes California Healthline. DHCS officials said the top 5% account for 51% of Medi-Cal spending.

How ACES Cross Generations

Trigger Alert!

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Traumatized Children Appear guarded and anxious Difficult to re-direct, reject support Highly emotionally reactive Difficulty settling after outbursts Hold on to grievances May not take responsibility for behavior Make the same mistakes over and over

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LOCAL data: Children 0-11yo

LOCAL data: Teens

ACE & School Performance Traumatized children are: 2.5x more likely to fail a grade in school score lower on standardized achievement tests more likely to struggle with receptive & expressive language suspended & expelled more often more frequently placed in special education

Promote Sense of Safety Highly structured environment Predictable schedule Predictable routines Predictable consequences Predictable rewards Zero tolerance for bullying Alert children to loud noises before they occur Adults are respectful, calm and confident “Peace corner” in the classroom

The most common factor for children who develop resilience is Building Resilience KEY SLIDE! The most common factor for children who develop resilience is at least one stable & committed relationship with an adult This can be a teacher, coach or other school personnel Nurturing and positive relationship with an adult who sees their strengths A relationship as brief as one school year can make a dramatic lasting impact

Learn More!

National Happenings The National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC) http://www.samhsa.gov/nctic National Association of State Mental Health Program Directors http://www.nasmhpd.org/TA/nctic.aspx Trauma-Informed Organizational Toolkit – The National Center on Family Homelessness http://www.familyhomelessness.org/media/90.pdf National Center for Domestic Violence, Trauma & Mental Health http://www.nationalcenterdvtraumamh.org National Child Traumatic Stress Network http://www.nctsn.org/ National Council for Community Behavioral Healthcare- Trauma Informed BHC http://www.thenationalcouncil.org/wp-content/uploads/2012/11/NC-Mag-Trauma-Web-Email.pdf The National Institute for Trauma and Loss in Children https://www.starr.org/training/tlc The National Association of States Directors of Developmental Disabilities Services http://www.nasddds.org/resource-library/behavioral-challenges/mental-health-treatment/trauma-informed-care/national-center-for-trauma-informed-care/ National Center for Social Work Trauma Education and Workforce Development http://www.ncswtraumaed.org/ Chadwick Center for Children and Families http://www.chadwickcenter.org/CTISP/ctisp.htm ACES Too High http://acestoohigh.com/ace-concepts-in-action/ Mandy

THANK YOU! Karen Clemmer, RN, MN, PHN Karen.Clemmer@Sonoma-county.org Department of Health Services, Public Health Division Maternal, Child, Adolescent Health Karen.Clemmer@Sonoma-county.org 707-565-4553 LEARN MORE! JOIN - Sonoma County ACES Connection! (Just Google “Sonoma County ACES Connections”) An on-line group Monthly meetings: 4th Wed of each month 12:30 – 2:00 625 Fifth Street, Santa Rosa