Module Three:Psychobiology:

ACESand

ProQol

Traumatization occurs when both internal and external resources are inadequate to

cope with external threat.

Van der Kolk, 1989

A collaborative effort of Kaiser Permanente and The Centers for Disease Control

Vincent J. Felitti, M.D.Robert F. Anda, M.D.

THE RELATIONSHIP OF ADVERSE CHILDHOOD EXPERIENCES TO

ADULT HEALTH STATUS

CHILDHOOD ADVERSITY BY CATEGORIES(18 years or younger)

Abuse Household

Psychological (by parents) Substance Abuse

Physical (by parents) Mental Illness

Sexual (anyone) Parental separation/divorce

Emotional neglect Mother Treated Violently

Physical neglect Imprisoned Household Member

PERCENT OF PARTICIPANTS EXPOSED TO AT LEAST ONE ADVERSE

CHILDHOOD EXPERIENCE

67%

33%

Those reporting no exposure

Those reporting exposure to at least one ACE

Two Thirds of the participants had at least one adverse childhood event.

With such a large sample size, we might extrapolate…

ADVERSE CHILDHOOD EXPERIENCES (ACE STUDY)

ACE SCORE

These numbers may suggest that 2/3 of the U.S. population may have been exposed to at least one adverse childhood experience!

These numbers may suggest that 2/3 of the people who come to us for services may

have been exposed to at least one adverse childhood experience!

ACE StudyStrong, graded relation to childhood adversity in

childhood:

Smoking Attempted suicide

COPD Revictimization

Heart Disease Teen pregnancy

Diabetes Fractures

Obesity Promiscuity

Hepatitis Sexually transmitted disease

Alcoholism Poor job performance

Other substance abuse Poor self-rated health

Depression Violent relationships

ACES & INTERPERSONAL VIOLENCE

As the number of ACE increases the number of co-occurring or “co-morbid” conditions increases.

As the number of violent experiences increases, the risks of victimization among women and perpetration by men also increase by about 60% to 70%.

As the ACEs score increases the likelihood of revictimization – of being raped, of being assaulted - increases steadily

Early Death

DiseaseDisability

Social Problems

High Risk Behaviors

Social, Emotional, Cognitive Problems

Childhood Adversity

TRAUMA DISRUPTS ATTACHMENT

AND DISRUPTED ATTACHMENT WRECKS HAVOC WITH EVERYTHING ELSE

ATTACHMENT TRAUMA• Substantial• unplanned separation• Mental illness• Imprisonment• Substance abuse

Physical abuse Sexual abuse

Emotional abuseNeglect

Abandonment

ATTACHMENT TRAUMA

Attachment injuries that occur when an individual feels abandoned by an attachment figure at a time of crisis.

Loss of an attachment figure through death.

ATTACHMENT AND ABUSE(ALEXANDER, 1992)

Cessation of abuse does not necessarily change relational imbalances in family

Cessation of abuse does not change internal working model of relationships

This working model drives relationships and behavior

How to care for self and others

How to manage emotions

How to behave

What should be expected or anticipated

What to remember and what to forget

INTERGENERATIONAL TRANSMISSION

Early Death

DiseaseDisability

Social Problems

High Risk Behaviors

Social, Emotional, Cognitive Problems

Childhood Adversity

Out of 350 people working in social services

Psychological abuse (Parents) 37%Physical abuse (parents) 29%Sexually abused 25%Emotional neglect 35%Physical neglect 12%Substance abuser in household 40%Separated from one/both parents 41%Witnessed DV 21%Imprisoned household member 10%

It’s Not Just the Clients

DISCUSSION• What were the protective things in your lives that helped you become

who you are? • What do you think people need to recover from their experiences?

(Ex: structure, discipline, love, faith, etc.)• What we can offer our clients to help them be successful in our

program? • What are our hopes for our clients? What would recovery

or success in our program look like for them?

• How do we define it vs. how they might define it?

• What are some of the success you are most proud of in your work with our clients

THE SANCTUARY TOOLKITCom

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PROFESSIONAL QUALITY OF LIFE SCALE (PROQOL)

Scales for…

Compassion Satisfaction

Burnout

Secondary Trauma