Adverse Childhood Experience Study: “Greatest public health discovery of our time.”

What are ACEs?

What is the Biology of Stress?

EQUATION TO REMEMBER:Strong, Frequent, Prolonged Exposure to an

Adverse Experience

+ No Adult Support

= Toxic Stress

Let’s watch the movie

Resilience: the “Science of Hope”

Resilience is the ability to thrive, adapt

and cope despite tough and stressful

times.

It is a skill that can be taught, learned

and practiced.

Resilience does not mean “get over

it”. It means caring adults have power

to buffer rather than cement the

effect of toxic stress.

Guided Discussion

1. What touched you the most? What had real meaning for you

from what you saw in the film?

2. What is a health or social issue in the film that you were

surprised tied back to ACEs?

3. What are your thoughts about the ACE scores of those in this room?

4. How does a person with an ACE score of 0 or 1 relate

differently than a person with an ACE score of 4+ ?

5. Who is at risk for toxic stress due to trauma in our community?

6. How can we get this information into the hands of the general population?

ACE StudyStrong, Frequent, Prolonged

Exposure to an Adverse

Experience + No Adult Support =

TOXIC STRESS

Toxic Stress can actually change

brain architecture to predispose

maladaptive behaviors. In turn, this

can lead to early onset of chronic

disease and premature death.

The Resilience movement is to

create trauma-informed systems

and self-healing communities

where the perspective is not

“What’s wrong with you?” but

instead “What happened to you?”

Review: Biology of Stress & Science of Hope

“We need to put to bed forever the sense that

children who are born under disadvantaged

conditions circumstances are doomed to poor

life outcomes. Science is saying that is not

true,” Dr. Jack Shonkoff, Harvard University

“Why are we waiting for them to fall apart?” Dr.

David Johnson, Clinical Psychologist

Science of Hope: PEOPLE ARE RESILIENT!

Lakota “Three Sisters Story” told by Dr. Donald Warne, American Indian

Public Health Resource Center, on Prairie Doc

https://www.youtube.com/watch?v=4qad2yfPdR0&feature=youtu.be

Go to minute 39:36

How do we get upstream? “Science of Hope”

Resilience isn’t just for children Adults can learn skills, too.

“We need a two generation approach recognizing that the child is

experiencing ACEs now and the parent likely experienced ACEs

during their own early years.” Angela Giardino, M.D., Ph.D., Texas

Children’s Hospital

If we want to produce dramatic impacts on the outcomes for kids

experiencing toxic stress, we have to transform the lives of the adults

who are taking care of them.” Dr. Jack Shonkoff, Harvard University

“If we can get the science into the hands of the general

population, they will invent very wise actions.”

What would you like to invent?

“Will you stay?”

Historical Trauma

Toxic Stress

Adverse Childhood

Experiences (ACEs)

Biology of Stress: The ACEs model helps to

understand how trauma is transmitted intergenerationally

Types of Trauma

• Affects approximately 90% U.S. adult population.

• Potentially traumatic events include

• Acute events

• Interpersonal trauma

• Community violence or military combat

• Insidious trauma

• Cultural and historical trauma

• Intergenerational trauma

• Institutional trauma

(Kilpatrick, Resnick, Milanak, Miller, Keyes, & Friedman, 2013)

Slide adopted from SAMHSA Trauma-Informed Interviewing Training, March 2016

Stress without the buffering response of a strong adult relationship causes prolonged, brain-controlled secretion of stress hormones

Cortisol, norepinephrine, epinephrine, etc.

Stress responses are beneficial in the short term with adult support, but can be damaging to health if they occur over long periods of time

Constant wear and tear

Potentially permanent changes in gene regulation (epigenetic effect)

Biology of Stress: Physiologic Response

Biology of Stress: Impact of Extreme

Neglect

Bruce Perry, MD

Joshua Arvidson, 2011

17

Joshua Arvidson, 2011

18

Joshua Arvidson, 2011

Biology of Stress: The grim toll of

ACEsPremature Death:

In 2015, the median age at death was 80 for all South Dakotans

For white residents the median age at death was 81 years

For American Indians median age at death was 56 years

SD Department of Health Website http://doh.sd.gov/statistics/2015Vital/Mortality.pdf

An American Indian (AI) infant has less of a chance of

surviving to celebrate a first birthday than white infants.

South Dakota Department of Health Website,

http://doh.sd.gov/statistics/2015Vital/InfantMortalit

y.pdf

Compiled for SWO by Northern Plains Tribal

Epidemiology Center from Division of Vital Records,

North Dakota Dept. of Health; Office of Health

Statistics, South Dakota Dept. of Health.

The 5-year incremental infant

mortality rate (2011-2015) is

5.35 for white infants and

12.34 for AI infants.

Pregnancy Health Survey for Parents of Newborns

on the Lake Traverse ReservationSara DeCoteau, Bonny Specker, Ph.D.,

Sherry Johnson, Ed.D., Teresa Binkley, Ph.D., Tianna Beare, Audrey German, Peggy Peters, & Maggie Minett

Sisseton-Wahpeton Oyate & South Dakota State University

Funded through the Sanford Collaborative

Research Center for American Indian

Health Pilot Grant 2015 from the National

Institutes of Health, Minority Health &

Health Disparities Research, Federal Award

No. 5U54MD008164-04

Pregnancy Health Survey for Parents of Newborns on

the Lake Traverse Reservation ACE Score Results 2015

44.6

22.0

14.1

5.9

13.4

18.5

23.7

15.5

8.8

33.4

12.2

21.1

12.2

16.7

37.8

14.3

23.8

19.0

11.1

31.7

0

10

20

30

40

50

0 1 2 3 4+

Pe

rce

nt

ACE Score Categories

SD White

SD Amer Indian

SWO Mother

SWO Father

ACE Score Comparison Discussion44.6

22.0

14.1

5.9

13.4

18.5

23.7

15.5

8.8

33.4

12.2

21.1

12.2

16.7

37.8

14.3

23.8

19.0

11.1

31.7

0

10

20

30

40

50

0 1 2 3 4+

Per

cen

t

ACE Score Categories

SD White

SD Amer Indian

SWO Mother

SWO Father

• Fewer SWO mothers and fathers had ACE scores of 0 than SD White Mothers. In the ACE Study

36% had a score of 0, compared to 14% of SWO fathers and 12% of SWO mothers.

• ACE scores for the 1 and 2 categories were comparable between populations and the ACE

Study.

• Beginning with scores of 3 or higher, contrasts begin to emerge:

• 16.7% of SWO mothers had a score of 3, compared to 9.5% in the ACE Study, 11.1% for SWO

fathers, 8.8% of SD American Indian mothers, and 5.9% of SD White mothers.

• In the ACE Study, 12.4% had a score of 4%. This was similar to the SD White mothers rate at

13.4%. The rate for SWO mothers was three times higher at 37.8%. SD American Indian

mothers and SWO fathers were similarly high at 33.4% and 31.7%.

ACEs and Population Attributable Risks

© 2013www.ACEInterface.com

What are the

implications for

“Science of

Hope”? Where

we can establish

a baseline

measure, we can

monitor change

over time as

interventions are

implemented.

Science of Hope:

1. Safety – creating an environment of

physical and psychological safety

2. Trustworthiness and

Transparency – operating with

transparency to build and maintain

trust

3. Peer Support – providing an

opportunity for support and mutual

self-help from fellow trauma survivors

4. Collaboration and

Mutuality – placing importance

upon the healing power of

relationships (everyone has a role)

5. Empowerment, Voice, and

Choice – understanding the unifying

power of shared experiences of trauma

and cultivating self-advocacy

6. Cultural, Historical, and

Gender Issues – moving past

cultural stereotypes and leveraging the

healing value of traditional cultural

connections by addressing historical

trauma

Six Key Principles of a Trauma-Informed Approach

S

A

M

H

S

A

2

0

1

4

Science of Hope: Practical To-do’s

• Don’t talk bad about others

• Engage with respect and compassion

Share what you know

• Spend more time, less money

• Choose to empower and elevate others

• Set achievable goals; grow them with

time

• Celebrate accomplishments (yours too!)

• Be kind to you so you can be kind to

others

Science of Hope: Change the First Five Years and You Change Everything

https://youtu.be/GbSp88PBe9E

Guided Discussion (Continued)

7. Identify the programs and policies our community is already using to build resilience?

8. What strategies or methods to build resilience might

work here?

9. What are the barriers to implementing these strategies?

How can we get around them?

10.What can the First 1,000 Days Initiative Interagency Forum do?

a) Short term (NOW)

b) Medium term (2018)

c) Long term (next five years)

LINKS TO VIDEOS ABOUT ACES

Prairie Doc, American Indian Health Care, January 2017

https://www.youtube.com/watch?v=4qad2yfPdR0&feature=youtu.be or you can view

TED Talks Motivational Film

http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?share=19391661a0#t-676574

“Can Family Secrets Make You Sick?”

http://www.npr.org/blogs/health/2015/03/02/377569413/can-family-secrets-make-you-sick

Change the First Five Years and You Change Everything

http://www.youtube.com/watch?v=GbSp88PBe9E

Children’s Hospital of Wisconsin, Pediatric Grand Rounds – August 4, 2017, featuring Dr. Nadine Burke-Harris, Presentation with Slides

http://chw-external.mediasite.com/Mediasite/Play/266cc8440022486ba288884d696110f21d

Children’s Hospital of Wisconsin, Pediatric Grand Rounds, August 4, 2017, featuring Dr. Nadine Burke-Harris, Questions & Answers (Too Small to Fail: The Power of Parents)

http://chw-external.mediasite.com/Mediasite/Play/e117ec800c7b45789429be5253fd99ff1d