1. Reducing Intergenerational Violence: Our Role as Physicians AMWA 2016

3. http://theskooloflife.com

4. FAILURES OF MAZLOW’S= TRAUMA TRAUMA LEADS TO HEALTH DISPARITIES INTERGENERATIONAL VIOLENCE REQUIRES TRAUMA RESPONSIVE CARE CARE

5. ACES=FAILURES OF MAZLOW’S= TRAUMA EMOTIONAL ABUSE PHYSICAL ABUSE SEXUAL ABUSE EMOTIONAL NEGLECT PHYSICAL NEGLECT PARENTAL SEPARATION/DIVORCE PARENT TREATED VIOLENTLY ADDICTED PARENT MENTALLY ILL PARENT INCARCERATION OF A PARENT

6. WHAT CAN PHYSICIANS DO? PICK UP ON CLUES OF TRAUMA ASK “WHAT HAPPENED TO YOU?” SAY “I’M SORRY, THAT WAS NOT YOUR FAULT” PROVIDE TRAUMA RESPONSIVE CARE ENHANCE RESILIENCE

7. ACEs vs. Current Smoking %

8. ACES Followed by Intravenous Drug Use N = 8,022 p<0.001N = 8,022 p<0.001

9. ACES Followed by Adult Alcoholism 0 1 2 3 4+

10. ACES Followed by Depression

11. ACES Followed by Suicide Attempt 1 2 0 3 4 +4 +

12. ACE Score and the Risk of Being a Victim of Domestic Violence

13. ACE Score and the Risk of Perpetrating Domestic Violence

15. TELOMERE SHORTENING = PREMATURE AGING

16. County Sheriff Call Volumes

17. Mobile Outreach Clinic Stops

18. TRAUMA RESPONSIVE CARE The University of Florida launched the Mobile Outreach Clinic in January of 2010 Stops 6 at-risk neighborhoods around Alachua County

22. TRAUMA IS INTERGENERATIONAL Don Spirit, 51Christine Jeffers, 47 Edward Kuhlmann, 29 Sarah Spirit, 28 James Stewart, 23 Kaleb, 11 Kylie, 9 Jonathan, 8 Destiny, 5 Brandon, 4 Alanna, 2 mo.

23. Resilience Resilience is afforded by meeting each person’s Mazlow’s hierarchy of needs These are: Physiologic needs, safety needs, belonging needs, self- esteem needs Anyone in a caregiving role without these needs met for themselves will need support from agencies, institutions, and programs to provide these needs for others We think of trauma as failure to meet Mazlow’s hierarchy of needs

24. GOOD NEWS RESILIENCE TRUMPS ACES! EXAMPLE: “I THINK OF MYSELF AS A STRONG PERSON WHEN DEALINGWITH LIFE’S CHALLENGES AND DIFFICULTIES” Telomere length improves with stress reduction (mindfulness, yoga)

25. IS YOUR SERVICE PROVISION TRAUMA RESPONSIVE? From Pathways to Resilience “Experience of Service” measure, developed by Dr. Michael Ungar, School of Social Work, Dalhousie University, Nova Scotia, Canada “Think of a service you offer children, youth, families, and answer these questions from the perspective of your clients…” Use a Likert scale

26. Overall, I am satisfied with the services I received

27. I had a say in how this service was delivered to me I could get the service when I needed it The location of the service was convenient Staff respected my religious and spiritual beliefs

28. Staff spoke in a way that I understood Staff were sensitive to my cultural and ethnic background I am now better able to cope when things go wrong There was a service I needed but I could not get

29. Trauma responsive PROVIDER “Is this a good day for the examination?” “Is there anyone you would like to have with you in exam room?” “Would you prefer a male or female provider?” “You are in control of the pace of this exam. Ask us to stop at any time.”

30. HOW TO ASK… HAS ANYTHING BAD, SAD, OR SCARY HAPPENED TO YOUR CHILD RECENTLY? HAS YOUR HOME LIFE CHANGED IN ANY SIGNIFICANT WAY (MOVING, NEW PEOPLE IN THE HOME, PEOPLE LEAVING THE HOME)? WHAT DIFFERENCES HAVE YOU NOTICED IN YOUR __________(CHILD, SLEEP, MOOD) SINCE THE EVENT?

31. WHAT DO I SAY IF THEY SAY YES??? I AM SO SORRY TO HEAR THAT YOU ________. THANK YOU FOR SHARING THAT INFORMATION. I KNOW WE CAN WORK TOGETHER TO HELP YOU/YOUR CHILD.”

32. REVIEW LOOK FOR CLUES OF TRAUMA ASK “WHAT HAPPENED TO YOU?” SAY “I’M SORRY, THAT WAS NOT YOUR FAULT” PROVIDE TRAUMA RESPONSIVE CARE ENHANCE RESILIENCE (SLEEP, NOURISHMENT, EXERCISE, PLEASURABLE ACTIVITY, MINDFULNESS DISCIPLINE)

33. For further information Nancy Hardt, MD nhardt@nhardt@gmail.com 352-514-3991