1. Trauma-Informed Care for Adverse Childhood Experience Survivors David D. Clarke, MD President, Psychophysiologic Disorders Association Collaborative Family Healthcare Association 17 th Annual Conference October 15-17, 2015 Portland, Oregon U.S.A. Session # D1a Friday, October 16, 2015

2. Faculty Disclosure The presenters of this session currently have the following relevant financial relationships during the past 12 months. – Book Royalty that is donated to a non-profit

3. Learning Objectives At the conclusion of this session, the participant will be able to: Assess ACE Survivors for multiple sources of psychosocial stress common in this population Understand the process of recovery from ACEs as it relates to development of psychophysiologic symptoms Initiate treatment for common long-term effects of ACEs

4. Bibliography / Reference 1. Clarke, DD. They Can’t Find Anything Wrong! Sentient Publications, 2007. 2. Schubiner, H. Unlearn Your Pain. 2012 3. Anderson F & Sherman E. Pathways to Pain Relief. 2013 4.Felitti VJ et al (1998). The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine. 14:245-258. 5. Oldfield, G. Chronic Pain. 2014. 6. Academy on Violence and Abuse. ACEs DVD. 2012. 7.Hill JC et all. Comparison of stratified primary care management for low back pain with current best practice (StarT Back): a randomized controlled trial. Lancet Oct 2011; p 1560 – 1571.

5. Learning Assessment A learning assessment is required for CE credit. So… A question and answer period will be conducted at the end of this presentation.

6. 6 A Baffling Illness

7. 7 Cause of Presenting Symptoms Landa, Psychosomatic Medicine, 2012.

8. 8 Adverse Childhood Experience Study Seven Factors Measured (n=18,000) Abuse: 1. Physical 2. Sexual 3. Psychological Household Occurrences: 4. Substance Abuse 5. Mental Illness 6. Domestic Violence 7. Householder Imprisoned

9. 9 4+ ACEs vs Zero ACEs Odds Ratios IV Drug Use 11.0 Suicide Attempt 9.5 Alcohol Abuse 5.3 Domestic Violence 5.0 Multiple Somatic Sx 2.7 COPD 2.4 Obesity 1.8

10. 10 ACE Survivor Evaluation I Nature & Degree of Childhood Stress

11. 11 ACE Survivor Evaluation II Current Stress

12. 12 ACE Survivor Evaluation III Poor Self- Care Skills

13. 13 ACE Survivor Evaluation IV Depression

14. 14 ACE Survivor Evaluation V Post- Traumatic Stress

15. 15 ACE Survivor Evaluation VI Anxiety Disorder

16. 16 ACE Recovery Process I Low Self-Esteem Physical or sexual abuse Parental drug abuse Neglect Adult responsibilities Witnessing violence Lack of approval

17. 17 ACE Recovery Process I Negative Initial Outcomes Bad Partners Addictions Quick Temper Eating Disorders Mental Health Problems Self-mutilation Self-sacrifice Inability to feel emotions

18. 18 ACE Recovery Process I Positive Initial Outcomes Reliable Detail-Oriented Compassionate Hard-Working

19. 19 ACE Recovery Process II I Deserve Better More respect More support Get as much as you give “I am a great person who was born in a bad place.” GPBI Syndrome

20. 20 ACE Recovery Process III: Rage Often unexpressed due to: Anger is unpleasant Many years learning to suppress emotion Hope for reconciliation

21. 21 Treatment I Listing Your Stresses

22. 22 Treatment II Self-Care Time

23. 23 Treatment III Acknowledge the Heroism of Surviving ACEs

24. 24 Treatment IV Writing

25. Treatment V Mental Health Counseling

26. 26 The Mystery Solved

27. 27 www.PPDAssociation.org www.stressillness.com www.unlearnyourpain.com

28. 28 Until there is a blood test… “Wonderful.” (Yale) “Truly remarkable.” (UNC) “Extremely valuable.” (Berkeley) “A spectacular accomplishment.” (OHSU) www.stressillness.com All earnings used only to support lectures.

29. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!