1. Learner Mental Health Needs in Iowa August 7, 2014

2. Agenda  Mental Health Data  Great Smokey Mountain Study  Adverse Childhood Experiences (ACEs)  Brain Development  Iowa ACEs Study  Iowa Youth Survey  What can we do?

3.  About one-third – mental disorder across their lifetimes  More than ½ of youth – Co-occurrence with substance abuse  About 8% of teens – ages 13-18 – have anxiety disorder (symptoms? Age 6)  About 11 % - depressive disorder by age 18  Less than ¼ of adolescents receive treatment

4. Great Smoky Mountains Study (Published 2011)  1,420 participants  11 counties in the southeastern US  Assessed 9 times through ages 9 to 21  Prevalence for any mental health disorder by adulthood?

5. 82 % “Only a small percentage of young people meet criteria for a DSM disorder at any given time, but most do by young adulthood. As with other medical illness, psychiatric illness is a nearly universal experience.” (Copeland, Shanahan, Costello, & Angold, 2011)

6. Adverse Childhood Experiences (ACE) Study  Vincent Felitti (Kaiser) & Robert Anda (CDC)  Telephone surveys between 1995 and 1997  White, educated, middle class  17,000 members of Kaiser Health Plan in San Diego

7. ACEs – Adverse (Traumatic) Childhood Experiences  10 types of trauma  Three categories of Trauma  Abuse: physical, sexual, psychological  Neglect: emotional, physical  Household dysfunction: substance abuse, divorce, mental illness, battered mother, criminal behavior

8. Links childhood trauma to a range of health and social outcomes: AlcoholismLiver diseaseHeart disease COPDAdolescent pregnancy DepressedSmokingIntimate partner violence

11. Attempted Suicide Compared with 0 ACEs  1 ACEs80% increase  4 or more1,120% increase

13. What is the impact on learning? Likelihood of a learning delay  0 ACEs 10%  4 ACEs 40 %  6 - 7 ACEs 100%

14. Children with higher ACE scores are more likely to …  Be designated to special education  Fail a grade  Score lower on a standardized test  Have language difficulties  Be suspended or expelled  Have poorer health

15. Brain Development  Serve and Return  Toxic Stress

17. http://developingchild.harvard.edu/key _concepts/toxic_stress_response/

19. When the brain “downshifts”…  Fight  Flight  Freeze

20. Even when there is no real threat… Why?

21. Iowa ACEs Childhood Abuse  Physical abuse  Psychological abuse  Sexual abuse Household Dysfunction  Substance abuse  Member imprisoned  Mental illness  Adult violence  Parental separation or divorce

22.  At 28%  childhood emotional abuse was the most common ACE  55% of Iowa adults experienced at least one ACE

23. Zero ACEs  10% rated health poorly  1-3 “bad health days” 4 or more ACES  23% rated health poorly  5 – 7 “bad health” days in month

24. ACE-related odds of having a physical health condition Health Condition0 ACEs1 ACEs2 ACEs3 ACEs4+ ACEs Arthritis100%130%145%155%236% COPD100%120%161%220%399% Heart Disease100%123%149%250%285% Stroke100%114%117%180%281% Vision100%167%181%199%354%

25. ACEs and Depression

27. School age?  According to the Iowa Youth Survey (2012) 13 percent of Iowa’s youth in grades 6, 8, and 11 ( or 13,772) reported they have seriously thought about killing themselves within the past twelve months  7 percent (or 7,415) of these young people reported they actually developed a plan to do so  Not all suicides or attempts are due to ACEs

28. So, what do these results mean to me in my work?

29. What can we do tomorrow?  Has a sense of belonging, of being welcomed and valued  Is treated with dignity and respect - 2001 Bluestein, Jane: Creating Emotionally Safe Schools

30. Social emotional learning is an essential condition for academic success  “Survival trumps learning.” (Blodgett, 2012)  Actions learned to survive ACEs are not acceptable in schools.

31. “Calibrate our relationship and goals to the arousal level of the child.” “New learning cannot occur effectively in high states of painful arousal… Arousal level can be re-regulated to permit access to higher levels of thought and new learning.” Christopher Blodgett, 2012

32. Example One way  Adult gives direction  Child acts out  Adult punishes  Child escalates  Adult escalates Other Way  Adult gives direction  Child acts out  Adult changes goal: de-escalation  Child de-escalates  Adult changes activity/direction

33. How could our policies and practices differ?  Think: What’s wrong with you?  Do: When act out, punish.  Do: When frustrated, become angry.  Think: What happened to you?  Do: When act out, provide calming response or activity.  When frustrated, calm encouragement.

34. Think about adults with ACEs in Iowa? Teachers? Others? 1 in 3 Iowans experienced 2 or more ACEs 1 in 5 Iowans reported 3 or more ACEs 14% of Iowans experienced 4 or more ACEs

35. Self-Care  Before a caregiver can help a child manage emotional experiences, the caregiver must manage their own emotional experiences. (Blodgett, 2012)

36. http://developingchild.harvard.edu/sea rch/?cx=001599101917928556767%3Acfzj kqwnev8&cof=FORID%3A9&ie=UTF- 8&q=videos&sa=Search&siteurl=developi ngchild.harvard.edu%2Fresources%2F&re f=developingchild.harvard.edu%2F&ss=7 52j131456j6

38. And, by the way…  “ Relationship is the evidence-based practice.” Christopher Blodgett, 2012

39. Thank you. Web site: Iowa ACES 360