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Understanding Childhood Trauma and its Lifelong Effects

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Understanding Childhood Trauma and its Lifelong Effects A Systems Approach Healthy People Stable Families Strong Communities Joanne Mooney and Carole Wilcox – PowerPoint PPT presentation

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Title: Understanding Childhood Trauma and its Lifelong Effects


1
Understanding Childhood Traumaandits Lifelong
Effects A Systems Approach
  • Healthy People Stable Families Strong
    Communities

Joanne Mooney and Carole Wilcox Child Safety and
Permanency Division, MNDHS
2
Overview of Presentation
  • Adverse effects on healthy development due to
    toxic stress and trauma
  • Approaches to improving the odds
  • Development of a trauma informed Minnesota public
    child welfare system
  • Building hope from resiliency

3
Orientation
  • What do we hope for our children?

4
MN Public Child Welfare System Hope for Children
  • Based on the child welfare practice model built
    form lessons learned over the last decade of
    reforms
  • Shift from Family Bubble or Deficit Oriented
    Models to Models that focus on strengths,
    health, thriving.
  • We work with parents and partners to ensure that
    children and families are supported to achieve
    equitable optimal development regardless of race,
    ethnicity, socioeconomic status or tribal status

5
Positive Adaptation A Focus on Well-Being
  • Child Well-Being includes
  • Healthy social emotional functioning
  • Safe, secure and responsive environments for
    families
  • Conditions that allow children to be successful
    during childhood and into adulthood
  • This means no child in Minnesota should ever
    experience extended hunger, be homeless, live in
    poverty or go without health care.

6
Equality or Parity?
7
Timing is Everything When it Comes to Brain
Development
  • Health trajectories!
  • Our healthy path is particularly affected during
    critical or sensitive periods. Early programming
    is key.
  • Critical or Sensitive Periods. While adverse
    events and exposures can have an impact at any
    point in a persons life course, the impact is
    greatest at specific critical or sensitive
    periods of development.
  • Early Programming. Early experiences can
    program an individuals future health and
    development.

8
Our Past Stays With Us
  • Today's Experiences ? Tomorrow's Health
  • The lifecourse is an integrated continuum of risk
    and protective exposures, experiences and
    interactions
  • Health pathways or trajectories are built and
    modified over the lifespan

9
Trauma and Early Brain Development
  • During the early period of life, a babys brain
    is forming 700 neural connections every second.
    The experience of trauma during this stage
    impacts healthy development.
  • Trauma is the experience of an event by a person
    that is emotionally painful or distressful which
    often results in lasting mental and physical
    effects.
  • Growing scientific knowledge links childhood
    toxic stress with disruptions of the developing
    nervous, cardiovascular, immune, and metabolic
    systems.

10
Trauma and Early Brain Development
  • These disruptions can lead to lifelong
    impairments in learning, behavior, and both
    physical and mental health.
  • Disruption in Neural Development that concern
    child welfare
  • Failure to expose youth to appropriate
    experiences at the critical times (Neglect)
  • Overwhelming the brains alarm system (Abuse)

11
Adverse Childhood ExperiencesChange How Our
Brains Work
Toxic stress video http//developingchild.harvard
.edu/resources/multimedia/videos/three_core_concep
ts/toxic_stress/
12
Impact of Trauma
  • Short Term
  • Eating
  • Sleeping
  • Toileting
  • Attention Concentration
  • Withdrawal
  • Avoidance
  • Fearfulness
  • Re-experiencing/
  • Flashbacks
  • Aggression Turning passive into active
  • Relationships
  • Partial memory loss
  • Long Term
  • Depression
  • Anxiety
  • PTSD
  • Personality
  • Alcohol or Other Drug Problems
  • Becoming Violent Towards Others

13
Trauma-informed worldview
14
Now AddChild Poverty Based on 3-year averages
from the American Community Survey (ACS) for
Minnesota 2007-2009 (children for whom poverty
status is determined)
15
Poverty and Neglect
  • There is a relationship between neglect and
    poverty. Neglect is defined as the failure to
    provide for a childs basic needs when
    reasonably able to do so. Disproportionate
    referrals occur by community reporters to the
    public child welfare system.
  • The Fourth National Incidence Study found
    families under the poverty level to be reported
    at 7 times the rate of families over the poverty
    level.
  • Conditions of poverty can create circumstances of
    a child being neglected due to parents lack of
    financial resources. When this occurs, public
    child welfare agencies should work to improve the
    conditions that influence neglect and meet
    protective needs while making no determination of
    maltreatment.
  • Families of color are more likely to be in
    poverty as an artifact of historical racism.
  • Therefore higher neglect rates of families of
    color can be tied in large part to higher poverty
    rates.

16
Historical Trauma
  • HISTORIC TRAUMA is the collective emotional and
    psychological injury both over the life span and
    across generations, resulting from a cataclysmic
    history of genocide.
  • Genocide is the intent to destroy a national,
    ethnic, racial or religious group (1948 Geneva
    Convention)
  • Historical trauma has a layering effect and is
    the "cumulative emotional and psychological
    wounding over the life span and across
    generations, emanating from massive group
    trauma."
  • Historical or intergenerational trauma is similar
    to that suffered by the Jewish people as a result
    of the Holocaust, Native Americans, the Japanese
    Americans interned in California at the beginning
    of World War II and African Americans suffering
    the aftermath of slavery.
  • Maria Yellow Horse Brave Heart, Research
    Associate Professor, Graduate School of Social
    Work, University of Denver

17
Effects of Historic Trauma
  • First Generation
  • Post Traumatic Stress Disorder
  • Subsequent Generations Historical Unresolved
    Trauma Survivor
  • Guilt, Depression, Anger
  • Psychic numbing
  • Victim identity/death identity
  • Thoughts of suicide
  • Nightmares
  • Preoccupation with trauma
  • Relational problems
  • Physical symptoms including diabetes and other
    disease associated with high stress hormones that
    wear out the body.

18
What is ACE?
19
High Individual and Public Costs of Trauma
  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease (COPD)
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease (IHD)
  • Liver disease
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases (STDs)
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy

20
(Graphic R. Anda, 2011)
21
Slide from R. Anda (2011), used with permission
22
Slide from R. Anda (2011), used with permission
23
Magnitude of the solution
A large portion of many health, safety and
prosperity conditions is attributable to Adverse
Childhood Experience. ACE reduction reliably
predicts a decrease in all of these conditions
simultaneously.
24
Ten Tribes StudyAdverse Childhood Exposures
  • Boarding School, Foster Care and Adoption
    perspectives added.
  • Cultural variables assessed.
  • 86 participants experienced one or more
    categories of exposure
  • 33 reported four or more categories.
  • Strong relationship between childhood sexual
    abuse and subsequent drinking problems among the
    general population similar in Native American
    population.
  • Combined sexual and physical abuse increased
    alcohol dependence for men.
  • Combined sexual abuse and boarding school
    attendance were significant for women.
  • Source Koss, M., Polacca, M., Yuan N., et al
    Adverse Childhood Exposures and Alcohol
    Dependence Among Seven Tribes American Journal
    of Preventative Medicine, 2003, pp. 238-244

25
States Collecting ACE Data2009-2011
18 States
2010
2009
2011
No data
Source Behavioral Risk Factor Surveillance
System, CDC.
26
HOPE
  • Children are vulnerable to risk but also
    amenable to intervention
  • Human brains have the capacity to change -
    Plasticity
  • Focus for children must be on relationships that
    are
  • Nurturing
  • Stable
  • Engaging

27
Resilience and Relationships
  • Resilience rests, fundamentally, on
    relationships
  • None of us is perfect
  • Resilience is complex
  • We have the capacity to adapt
  • Resiliency and protective factors help during
    adversity
  • Recovery is individual and environmentally
    influenced
  • Conclusion of SuniyaLuthar, in Resilience in
    development A synthesis of research across five
    decades. (2006, p. 780)

28
Key Components of Resilience
How is your community nurturing these three
components for resilience throughout the lifespan?
29
Discussion
  • How is your community nurturing these three
    components for resilience throughout the lifespan
    of the people you serve?
  • What do you need to do more of?
  • With whom?

30
Building Upon the Strengths of FamiliesThe
Protective Factors
  • Concrete Supports in Times of Need
  • Social Connections
  • Parental Resilience
  • Knowledge of Parenting and Child Development
  • Childrens Social and Emotional Competence

31
Embracing Culture
  • Culture is a system of shared actions, values and
    beliefs that guide behavior of families and
    communities
  • Recognizing importance and strength of cultural
    norms supports families and communities and helps
    them to flourish
  • Establishing shared leadership with diverse
    parents and caregivers improves supports and
    services for families and communities

32
Discussion
  • Protective Factor Card
  • How does this protective factor present itself in
    your personal life?
  • How does this protective factor present itself in
    your professional life?

33
System Approach to Trauma
Education
Alcohol Other Drugs System
Child Welfare
Health Care
Trauma
Mental Health
Criminal Justice
Community Violence
34
PEDIATRICS Volume 129, Number 1, January 2012
35
Working Across Systems in Partnership
Primary Prevention Secondary Prevention Tertiary Prevention
Positive early care and education Positive social and emotional development Parenting skills Quality after-school programming Conflict resolution Youth leadership Quality education Social connections in neighborhoods Economic development Mentoring Mental health services Substance abuse services Family support services Domestic Abuse services Conflict interruption and street/community outreach Mental Health Services Substance Abuse Services Domestic Abuse Services Successful re-entry
36
Discussion Questions
  • How is the system you work within traumatizing
    children and families?
  • What will your system do to shift away from these
    policies, practices, or procedures?

37
Child Welfare System Perspective
  • What has Minnesotas Public Child Welfare System
    done to
  • Become trauma-informed?
  • Improve the odds for children and their families?

38
Minnesota Public Child Welfare System Context
  • State-supervised/County-administered (87
    counties)
  • Eleven federally recognized Tribes 2 American
    Indian Child Welfare Initiative Tribes
  • State with highest share of local property taxes
    for child welfare

39
MN Children in Out-of-home Care per 1,000 in the
Child Population by Race/Ethnicity, 20012010
40
What We Now Know
  • Relationships cause change
  • Leaders and partnerships impact change
  • Flexibility and adaptability
  • Employ strengths and engage capacities
  • Assure continuity of care and connections
  • Focus on well-being
  • Rely on professional, familial, community and
    cultural wisdom

41
Building Upon the Strong Foundation
  • Minimize trauma when a child enters the CW system
  • Engage parents as partners in safety planning
  • Parent Support Outreach Program
  • Family Assessment Response
  • Signs of Safety
  • Family Group Decision Making
  • If placement is necessary, make every effort to
    place children with relatives/kin
  • Conduct relative/kin searches early on
  • Continue to pursue available relative/kin
    resources
  • When placing children
  • keep them close to their homes
  • keep siblings together
  • maintain cultural connections and school
    stability
  • ensure frequent and quality visits with parents
    and children

42
Building Upon the Strong Foundation
  • Implement a systemic approach to creating
    trauma-informed child welfare system
  • Screen for trauma upon entrance to out of home
    care
  • Examine potential to integrate screening items
    into existing screening and/or assessment
    instruments.
  • Expand learning and training opportunities
  • Build knowledge of brain development and
    trauma-informed practice integrated into
    foundation training for social workers
  • Provide training to resource family providers

43
Building Upon the Strong Foundation
  • Improve capacity, access and availability for
    therapeutic services that are culturally
    sensitive and relevant
  • Coordinate with Childrens Mental Health Division
    and MNs Ambit Network to build capacity for
    trauma-informed mental health practitioners
  • Encourage child welfare workers to make
    trauma-centered referrals to providers
  • Include parent leaders to inform policy, program
    and practice enhancements

44
Relationships Are the Difference
  • Trauma can be created by disruption in healthy
    relationships
  • Trauma can be healed by development of healthy
    relationships
  • Keep the focus on relationships for children that
    are
  • Nurturing
  • Stable
  • Engaging

45
Building HopeResiliency and Change
  • How will YOU use your opportunities for
    integration and change?

46
Links to Sources
  • The Lifelong Effects of Early Childhood Adversity
    and Toxic Stress American Academy of Pediatrics
    http//aappolicy.aappublications.org/cgi/reprint/p
    ediatrics129/1/e232.pdf
  •   
  • Building a New Biodevelopmental Framework to
    Guide the Future of Early Childhood Policy
  • Dr. Jack P. Shonkoff http//steinhardt.nyu.edu
    /scmsAdmin/media/users/eez206/srb_conference/Build
    ing_a_New_Biodevelopmental_Framework_-_J__Shonkoff
    .pdf
  •  
  • Child Trauma Academy Dr. Bruce Perry
    http//www.childtrauma.org/
  • Adverse Childhood Experiences Washington State
    Family Policy Council http//www.fpc.wa.gov/
  • Strengthening Families  - A Protective Factors
    Framework Center for the Study of Social Policy
    http//www.cssp.org/reform/strengthening-families
  • Chapin Hall Child Family Policy Forum Public
    Systems Responding to Students Affect by Trauma
    http//www.chapinhall.org/sites/default/files/docu
    ments/Child_Family_Forum_Nov_1.pdf
  • Zero to Three Supporting the Development of
    Infants and Toddlers in the Child Welfare
    System  A Call to Action
  • http//www.zerotothree.org/public-policy/webinars-
    conference-calls/supporting-the-development-of-inf
    atns-and-toddlers-in-the-chld-welfare-system-a-cal
    l-to-action.html

47
JJoanne Mooney651.431.3879joann
e.mooney_at_state.mn.usCarole Wilcox651.431.4977c
arole.wilcox_at_state.mn.us
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