Adverse Childhood Experiences

Resilience

-The ability to adapt in the face of adversity, trauma, tragedy or stress -"Bouncing back" -Relience is ordinary, not extraordinary

Trauma-Informed Care

-Recognizes that trauma affects many individuals in the care setting -Services provided often re-traumatize patients -Providing services to ALL patients, we prevent re-traumatizig or disempowering people

Factors of Resilience

-Resilient parents/adults -Building attachment and nurturing relationships -Building social connections -Meeting basic needs -Building love and trust -Exemplary role models -Encouraging persons

Nurses and ACEs

-Self-awareness of exposure to ACEs and potential impact on your own health -Recognize ACEs as health risk (ex. falls, AIDS, substance abuse, HTN) -Screen for ACEs among patients -Anticipatory guidance on trauma prevention -Advocacy to reduce violence and trauma in community

ACE Study Results

-2/3 had at least 1 ACE -More than 25% grew up in a household with an alcoholic or drug user -25% had been beaten as children -1 in 6 people had 4 or more ACEs -If one ACE present, at lest 86% chance that at least one other category is present -Women are 50% more likely than men to have an ACE score of 5 or more

ACE Results for people with 4 or more ACEs

-2x likely to smoke -7x likely to be alcoholics 6x likely to have had sex before age 15 -2x likely to have cancer or heart disease -12x more likely to have attempted suicide -Men with 6 or more ACEs were 46x more likely to have injected drugs

The effects of ACEs and Learning

-51% of children with 4+ ACE scores had learning and behavior problems in school compared with only 3% of children with NO ACE score

ACE Study Conclusions

-ACEs are very common -ACEs are interrelated and tend to occur in clusters (occurrence of 1 should prompt a search for more) -ACE score has strong dose-response relationship to numerous health, social, and behavioral problems throughout a person's life -ACEs are the basis for many public health problems

Neuroplasticity

-Development of the brain based on experiences -Most development between ages 0-5 y.o. -Toxic stress changes brain structure: Loss of brain cells; Damage to cell connections; Enlargement/shrinking of brain; Hyperactivity -Cortisol suppresses immune system

Trauma and Youth

-Difficulty managing "big" emotions -Chronic irritability and anxiety -Difficult with empathy (more likely to bully) -Unable to express needs in words -Cannot see the bigger picture -Do not appreciate how behavior impacts others -Difficulty working in groups/connecting with others

What is the ACE Study?

-Kaiser Permanente of San Diego and CDC, 1995-1997 -Physical exam and survey of: Child maltreatment; Family dysfunction; Current health status and behaviors -N=17,337 HMO members

De-escalation Strategies

-Notice the signs of distress -Make a quick connection with the person -Re-direct through reasonable choices or alternatives -After calm, discuss what happened -Only assign consequences in a period of calm

Trauma Informed Schools

-Recognize that certain behaviors may be r/t traumatic experiences -All staff and teachers are trained to use practices designed to redirect or calm these behaviors -Shifts from asking "what is wrong with you?" to "what happened to you?" -Then you can ask, "How can we shift our school/classroom environment to respond more effectively to your needs?"

How to Build Resilience

1. Make connections 2. Avoid seeing crises as insurmountable problems 3. Accept that change is a part of living 4. Move towards your goals 5. Take decisive actions 6. Look for opportunities for self-discovery 7. Nurture a positive view of yourself 8. Keep things in perspective 9. Maintain a hopeful outlook 10. Take care of yourself

ACE Events

1. Physical abuse 2. Emotional abuse 3, Sexual abuse 4. Alcohol or drug abuser in the house 5. Incarcerated household member 6. Someone in household who s chronically depressed, mentally ill, institutionalized or suicidal 7. Violence in the home 8. Parents separate or divorced 9. Emotional neglect 10. Physical neglect

Dose-Response Relationship

A correlation where the higher the # of ACEs one has, the more negative the outcomes

The primary factor in creating resilience in a trauma-affected child is: A. Having supportive adult relationships B. Staying in school C. Adopting healthy lifestyle behaviors D. Seeing other people dealing with stress negatively

A. Having supportive adult relationships

ACEs have been linked to all of the following EXCEPT: A. Chronic health conditions B. Drug seeking behavior in hospitals C. Early death D. Difficulty in school

B. Drug seeking behavior in hospitals

The difference between trauma-informed care and trauma-specific care is: A. Trauma-informed care seeks to find a treatment for the trauma B. Trauma-informed care seeks to understand the effect trauma has on a client C. Trauma-informed care is focused on healing clients who experience trauma

B. Trauma-informed care seeks to understand the effect trauma has on a client

In the ACE study, the dose-response relationship indicates: A. An association between the number of ACEs and the positive health outcomes B. An association between the number of risky behaviors and the number of ACEs C. An association between the number of ACEs and the negative health outcomes D. An association between the number of risky behaviors and the negative health outcomes

C. An association between the number of ACEs and the negative health outcomes

All of the following are de-escalation strategies EXCEPT: A. Quickly connecting with the student B. Offering a choice for alternative behavior C. Explaining the consequences of his behavior D. Recognizing a pre-arranged signal

C. Explaining the consequences of his behavior

The physiologic mechanism by which ACEs lead to negative health outcomes is thought to be: A. Development of risky health behaviors B. Lack of access to medical care in the formative years C. Repeated activation of the stress-response system D. Enlargement of the cells in the pre-frontal cortex

C. Repeated activation of the stress-response system

ACEs contribute to poor health outcomes by which of the following mechanisms EXCEPT A. Risky behavior choices B. Overactive stress response C. Changes in brain chemistry D. Absentee parents

D. Absentee parents

An appropriate intervention when dealing with a trauma-affected student who is agitated is to: A. Ignore the behavior B. Send the student to the principal's office C. Give the student a warning D. Ask the student to visit the mindfulness area

D. Ask the student to visit the mindfulness area

All of the following are true statements about ACEs EXCEPT: A. ACEs are common occurrences B. ACEs are linked to poor health outcomes C. Persons with one ACE are likely to experience other traumatic events D. Men are more likely than women to report ACEs

D. Men are more likely than women to report ACEs

All of the following are ways a nurse can help a parent counteract the consequences of trauma EXCEPT: A. Teach the child to confront stressful situations in a calm manner B. Teach the child to talk through their feelings C. Teach the child to take deep breaths D. Teach the child to ignore negative feelings

D. Teach the child to ignore negative feelings

What is Toxic Stress?

Extreme, frequent, or extended activation of the body's stress response without the buffering presence of a supportive adult

What was the purpose of the ACE Study?

To examine relationships between a broad range of ACEs and a wide range of health and social consequences in adulthood

Trauma-specific v. Trauma-informed

Trauma-specific: Aims to provide treatment to directly address traumatic experiences. Goal is healing Trauma-informed: Aims to avoid re-traumatizing clients by providing assistance by recognizing and attending to dynamics present in trauma