1. The Effect of Early Adversity on Brain Development, Learning, and Health: Mobilizing Brain Science to Improve Children’s Mental Health and Catalyse Positive System Change CMHO Conference November 21, 2016

2. A Science-Based Theory of Change Informs More Effective Policies and Programs
Preconception
Prenatal
Policy & Program Levers for Innovation
1. Biological Adaptations or Disruptions - The biology of health explains how experiences and environmental influences “get under the skin” and interact with genetic predispositions, which then result in physiological adaptations or disruptions that affect lifelong outcomes in learning, behavior, and both physical and mental well-being.
2. Foundations of Healthy Development - The foundations of health establish a context within which the early roots of physical and mental well-being are nourished. These include a stable and responsive environment of relationships, Safe and supportive physical, chemical, and built environments, and sound and appropriate nutrition.
3. Caregiver & Community Capacities – Caregiver and community capacities to promote health and prevent disease and disability refers to the ability of family members, early childhood program staff, neighborhoods, voluntary associations, and the parents’ workplaces to support and strengthen the foundations of child health. These capacities can be grouped into three categories: time and commitment; financial, psychological, and institutional resources; and skills and knowledge.
4. Policy & Program Levers for Innovation - Public and private sector policies and programs can strengthen the foundations of health by enhancing the capacities of caregivers and communities in the multiple settings in which children develop. Relevant policies include legislative and administrative actions that affect public health, child care and early education, child welfare, early intervention, family economic stability, community development, housing, environmental protection, and primary health care.
Biological Adaptations or Disruptions
Early Childhood
Caregiver & Community Capacities
Foundations of Healthy Development
Health & Development Across the Lifespan
Middle Childhood
Adolescence
Adulthood
Source: Center on the Developing Child (2010) 2

3. National Scientific Council Working Papers

4. FrameWorks Institute
Nonprofit think tank that conducts communications research to advance the resolution of social problems.
FW has worked on a host of social problems in the US, Canada and Europe, from early childhood development and children’s mental health to climate change and immigration.
Methods:
Map the gaps between lay and expert understanding.
Develop simplifying models that explain an important scientific concept and channel public thinking about a topic in ways consistent with the science.
Test effectiveness of the models with the general public.
Simplifying models are concrete, familiar, mechanistic metaphors that help explain an expert concept so that it fits into the way the public thinks. When expert information does not fit into existing cultural models it has nowhere to go, and can entrench negative beliefs about the issue. The Simplifying Model fills this cognitive hole and allows the public to use expert information in thinking about and understanding the issue. Allows experts and the public to talk to each other in a meaningful way.

5. Bridging the gap between science, policy and practice through:
Knowledge mobilization
Professional development and training
Supporting research with impact

6. AFWI Δ in systems AFWI Theory of Action Δ in change agents
Improved health & wellness outcomes for individuals & families
AFWI Theory of Action
Knowledge base
Identification of change agents
Δ in change agents
Relationships
Narrative & language
Understanding & beliefs
Behaviors & practices
Knowledge mobilization
activities
Research on ECD & A/MH*
Media & communications
Presentations & convenings
Networking
Symposia
Relationship building
Program development
Education & training
Broad adoption of approaches to ECD & A/MH* rooted in the knowledge
Δ in systems
Resource allocation
Institutions & organizations
Government policy
Professional practice
Assumptions
Understanding how the brain works and develops will overcome existing misperceptions and underlying beliefs and will support changes in individual behavior and systems related to ECD & A/MH*
Change agents identified by AFWI will act as drivers of systems change by spreading knowledge throughout systems (“ripple effect”)
* Early Childhood Development & Addiction/Mental Health

7. Change Agents are Working Across the Province

8. Findings: Overall Summary
AFWI Is Contributing to Changes in Individuals, Organizations, and Systems, but the Amount of Change Varies
Some Change
Significant Change
Efficacy and role in creating change
Changing behaviors
Increasing understanding
Forming or deepening relationships
Individual Change
Adopting new practices
Increasing sense of priority
Institutionalizing the core story
Changing in activities
Increasing conversation
Discussing changes to activities
Sharing the core story
Organizational Change
Funding reallocation
Changing policy or strategy
Ownership over policy implementation
Increasing cross-sector work
Approving high-visibility policy documents
Increasing cross-sector dialogue
Systems Change
Changing professional practice standards
Funding reallocation

9. In Summary Common language + Common understanding +
Community and relationships +
Increased confidence +
Ripple effect - distributed leadership =
Emerging change initiatives in Alberta

10. The Core Story of Brain Development

11. How Do Brains Get Built?

12. Neural Circuits are Wired in a Bottom-Up Sequence
Source: C.A. Nelson (2000)

13. Experience-Based Pruning of Synapses During Childhood and Adolescence
Birth years years

14. What Kind of Experiences Shape Development?

15. Infants are Hard Wired for Social Interactions

16. Serve and Return Interactions With Adults Build
Cognitive, Social, and Emotional Skills in Children
Serve and return interactions with adults help build basic social, emotional, and cognitive skills that are important for healthy development, like paying attention, sharing and having empathy for others, and emotional regulation. These skills provide a solid foundation for more complex behaviours that are grouped together under the label of “executive function”.

17. Executive Function is Like Air Traffic Control: Helps Children Navigate Their World and Succeed in Life
EF skill set is based on cognitive, social and emotional competencies:
Attention
Working memory
Self-regulation
Delayed gratification
Planning and organization
Perseverance
Reasoning and evaluation
Problem solving
Cognitive flexibility

18. Serve and Return Interactions Alter
Neural Circuits and Gene Expression

19. The Biology of Early Adversity

20. Stress Also Shapes Brain Architecture
Toxic Stress: Prolonged activation of the stress response system in the absence of supportive adult relationships; e.g., abuse, neglect, living with an addicted or depressed parent.
Tolerable Stress: Serious but temporary activation of stress response, can damage brain architecture if not buffered by supportive adult relationships; e.g., death in the family.
Positive Stress: Brief activation of stress response system, required for healthy development; e.g., immunization, first day of school.

21. Anatomy of the Stress Response
Effect of Catecholamines (Adrenalin):
Increased heart rate, blood pressure
Decrease in non-essential functions (e.g., digestion, reproduction)
Blood clotting
Mobilization of glucose stores
Effect of Glucocorticoids (Cortisol):
Glucose metabolism
Insulin production
Immunosuppression
Negative feedback on HPA axis

22. Early Life Stress Affects Biology, Behaviour, and Impacts Lifelong Health

23. Short and Long Term Outcomes Associated with Early Adversity

24. Significant Adversity Impairs Development in the First Three Years
100%
80%
Children with Developmental Delays
60%
40%
20%
1-2 3 4 5 6 7
Number of Risk Factors
Source: Barth, et al. (2008)

25. Sensitivity to Anger in Abused Children
Pollak S D , and Kistler D J PNAS 2002;99:
©2002 by National Academy of Sciences

26. Early Adversity Increases Risk for Substance Use Disorders in Adulthood
Self-Report: Alcoholism Self-Report: Illicit Drugs 16 40 % 14 % 35 12 30 10 25 8 20 6 15 4 10 2 5
ACEs 1 2 3 4 1 2 3 4 5+
Source: Dube et al. (2002) Source: Dube et al. (2003)

27. Early Adversity Increases Risk for Depressive Disorders in Adulthood5 4 3
Odds Ratio 2 1 1 2 3 4 5+
ACEs
Source: Chapman et al. (2004)

28. Early Adversity Increases Risk for Adult Heart Disease
3.5 3
2.5
Odds Ratio 2
1.5 1
0.5 1 2 3 4
5,6
7,8
ACEs
Source: Dong et al. (2004)

29. Where Do We Go From Here?

30. What Determines Whether a Child’s Outcomes Will Be Good or Bad?
Resilience is a product of our genes and experiences, like a scale that can be tipped to one side or the other.

31. It’s NOT All Over By Age 6: Brain Still Maturing Until ~ 25 Years
Source: Gotgay, Giedd, et al., 2004

32. Brain Builders Video

33. Alberta Family Wellness Initiative WHERE SCIENCE MEETS REAL LIFE www
Alberta Family Wellness Initiative WHERE SCIENCE MEETS REAL LIFE