Presentation Title - ACEs Connection

Hard Times and Healing Toolkit A Resilience Framework for Domestic Violence (DV) and Adverse Childhood Experiences (ACEs) Linda Chamberlain, Ph.D. MPH Capacitar Facilitator Tension and Trauma Releasing Exercises (TRE) Practitioner Feldenkrais Trainee [email protected] Acknowledgments

Fulbright Arctic Initiative, 2015-16 Alaska Network on Domestic Violence and Sexual Assault The Federation of Mother and Child Homes and Shelters [Finland] Domestic violence shelters, service providers and survivors in Alaska and Finland Patrick Sidmore, Alaska Mental Health Board Connections Matter, Iowa Illustrations by Victoria Robustello, Art student at State University of

New York New Paltz State of Alaska, Chronic Disease Prevention and Health Promotion Who is the Toolkit for? Service providers who work with children, families and adults who have experienced domestic violence and/or other potentially traumatic events Communities, organizations and anyone interested in learning more about trauma, resilience and our capacity to heal

This toolkit is a resource that provides information based on best and promising practices. This resource does not provide medical or therapeutic advice. Toolkit provides information and resources to: Support a trauma-informed and strengths-based approach that promotes resilience Examine how the intersections between domestic violence and adverse childhood experiences (ACEs) can inform our work Promote community education and building

partnerships Development of the Toolkit was guided by input from a survey of domestic violence shelters in Alaska, focus groups with staff at several domestic violence shelters in Finland and feedback from the Federation of Mother and Child Homes and Shelters in Finland. The Toolkit was piloted at trainings organized by the Alaska Network on Domestic Violence and Sexual Assault and the Washington State Coalition on Domestic Violence. Overview of Toolkit Trauma-Informed Approach

Focus on Strengths and SkillsResilience Vicarious Trauma The Brain and Stress Connection Between Domestic Violence (DV) and Adverse Childhood Experiences (ACEs) Strategies to Promote Self-Regulation and Healing More About Using the Toolkit Hyperlinks connect to on-line videos and other resources Most resources are open access; books and

curricula may require purchase Check Notes view of PowerPoint slide for additional information Activities, breath work and movement integrated into Toolkit Being Trauma-Informed Starts With Us Trauma is common and diverse Be aware of how you feel and only do what feels comfortable and safe Understanding how the suffering of others can

affect us is a key step in becoming traumainformed We have to take care of ourselves to be able to best serve our clients 7 Lets Get Grounded What strategies do you use to help yourself or a child become more

centered and grounded? Artwork by Victoria Robustello Trauma-Informed Resilience Framework AN E P HO


TO Understanding how trauma RS TRE S D can affect us is a pathway to healing

POTENTIALLY TRAUMATIC EVENTS Our Past is Not Our Destiny Four RS of TRAUMAINFORMED APPROACH REALIZATION of how trauma can affect individuals, families and systems RECOGNIZE signs of trauma RESPONDS with trauma-informed approach in every part of

organization RESIST RETRAUMATIZATION Trauma-Informed Practice (TIP) Scales Client survey tool measures: Environment of agency and mutual respect Access to information on trauma Opportunities for connections Emphasis on strengths

Cultural responsiveness & inclusivity Support for parenting Resilience is Relational Strengths and skills we can develop throughout our lifetime Shaped relationships, environment and adaptive systems

family, school, community, culture Buffers effects of trauma AT ITS BEST, TRAUMAINFORMED CARE IS RESILIENCEINFORMED CARE SAMSHA, 2014 Some of the Essential Ingredients Someone starts-the catalyst! Local efforts Engage local leaders Steering committee Join Collective impact

Local resources Mission, goals, action steps Slogan Local data, local urgency Communication tools Resource

Vicarious Trauma Having a prevention plan for vicarious trauma is the first step to a traumainformed approach Vicarious Trauma = Process of change over time Changes in our view of ourselves, others, and world as a result of

exposure to suffering of others Can affect your work, the way you interact with family and friends and your well-being Trauma Stewardship, 2009 Van Dernoot Lipsky The Brain-Body Connection

Under Stress (Video) What are some signs of how vicarious trauma can affect us and our workplace? PERSONAL ORGANIZATIONAL Isolating from others

Negative atmosphere Mentally and physically exhausted Frequent miscommunications Mad, sad, dont enjoy things you use to Self-medicating Feeling no one understands you Cant bounce back

Interpersonal conflicts Ethical or boundary violations High rates of staff turnover and absences Reduced productivity 20 Resource: Developing a Prevention Plan for Vicarious Trauma Organizational and Personal SelfCare Checklists

Use checklists to brainstorm (page 37) about steps During recruitment During orientation During employment When leaving position VICARIOUS RESILIENCE = Process of positive growth and empowerment

by working with clients who are coping with and overcoming adversity (Engstrom et al, 2008) -Recognizing peoples capacity to heal -Reaffirming the value of the work you do -Gift of HOPE The Professional Quality of Life Scale (PROQOL Version 5 2009) measures compassion satisfaction and compassion fatigue The Brain

Explains! Neuroplasticity= Risk and Resilience Capacity of our brains to adapt and change in response to experience and environment Its Never Too Late to change Your Brain,

Rewire and Heal We need to feel safe to think and learn, but stress can push us DOWNSTAIRS in our brain Relationships, Setting priorities Positive Stress Tolerable Stress Normal and essential part of healthy

development Brief increases in heart rate and blood pressure Mild elevations in hormonal levels Examples: new preschool or day-care, sports competition Bodys alert systems activated to greater

degree Activation is timelimited and buffered by supportive relationships Brain-body recovers Examples: illness in family, divorce, natural disaster Toxic Stress Can occur with strong,

frequent and/or prolonged adversity Disrupts brain architecture and body systems risk of stress-related disease and cognitive impairment Examples: exposure to violence, neglect, caregiver substance

abuse Prolonged, intense, multiple stressors, not addressed Self-regulation and coping skills, trauma-informed caregivers, supportive relationships, best practices Resources for Caregivers and Service Providers: The Amazing Brain Series Download PDF files of Amazing Brain Booklets

at: What is Trauma? Event, series of events or circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and Has lasting adverse effects on individuals functioning and mental, physical, social, emotional, or spiritual well-being SAMSHA, 2014

My Name is Trauma Trauma can: -be felt in the body -make you feel anxious -affect your memory -make it difficult to be yourself My Name is Trauma, childrens book by Paula Audrey Rivera &

Jon Jon Rivero, 2014 Adverse Childhood Experiences (ACEs) Primer Video KPJR Films: Paper Tigers and Resilience Capacitar Practices of Hope & Healing: Centering

What Are Adverse Childhood Experiences? Positive answer to any questions for each type of ACE counts as one to

create the ACE Score Based on Robert Wood Johnson Info-graphic at Key Findings from ACE Study Many adults disclosed Adverse childhood experiences (ACEs) ACEs clusterlikely to

experience more than one adversity ACEs are associated with increased risk of mental, physical & behavioral health problems Landmark study by Felitti et al, 1998; followed by more than 60 publications with this dataset ; go to following website to find this study and other publications: Based on Robert Wood Johnson Info-graphic at

Children with 3 or more ACEs are nearly 4 times more likely to have developmental delays Marie-Mitchell et al, 2013

Prevalence of 2 or More ACEs among U.S. Children with Selected Health/Health Risk Factors Health Factor 2 or more ACEs (%) Asthma 33.4% ADHD 45.2% Autism spectrum disorder 34.4%

Behavior problem 61.4% Who bully 55.4% National Survey of Childrens Health Excludes child abuse & neglect; includes exposure to community violence, poverty and discrimination; Bethel et al, 2014 Intersection Between Domestic Violence and Adverse Childhood Experiences (ACEs)

95% probability that a child growing up with domestic violence will be exposed to at least one other adverse childhood experience (ACE) More than one-third (36%) of children exposed to domestic violence have 4 or more other ACEs Dube et al, 2002 39 Alaskan Adult Population ACE Scores

Source: 2014 & 2015 Alaska BRFSS, Section of Chronic Disease Prevention and Health Promotion, Alaska Division of Public Health, Graphic by Alaska Mental Health Board Staff Alaskan Adult Population ACE Scores if They Witnessed Domestic Violence Source: 2014 & 2015 Alaska BRFSS, Section of Chronic Disease Prevention and Health Promotion, Alaska Division of Public Health, Graphic by Alaska Mental Health Board Staff Dating Violence and Adverse Childhood Experiences (ACEs)

In a nationally representative sample, ACEs were predictive of physical dating violence, accounting for more than one half of dating violence victimization (53%) and perpetration (56%) Miller et al, 2011 Artwork by Victoria Robustello

Why Talk About Adverse Childhood Experiences (ACEs) research? We are often working with co-occurring and past trauma in addition to domestic violence Has expanded our understanding of trauma and resilience Self-understanding is a key step for healing Its not about whats wrong with me, its about understanding

what happened to me * Key observation from the original ACEs Study National Review of Best Practices for Children Experiencing Domestic Violence Characteristics of Best Practices for Children Exposed to Violence

Working with child and caregiver Trauma-informed parenting skills Coping and stress management skills for child and parent Enhancing childrens social and emotional regulation skills Healing Power of Relationships: Children Building Resilience in Children Resilience Needs Relationships Increase childrens exposure to people who care about them I told Grandma how brave you were. Shes proud of you. Let them know its okay to ask for help Be a brain builder establish routines, creative play, board games, exercise

Build feelings of competence and mastery 20 practical strategies backed by science at: Helping Parents, Helps Kids Addressing needs of children without helping parents leave either the child or parent behind When we support children and parents

together, we see far greater results Children exposed to domestic violence whose mothers have better mental health and parenting skills are more resilient Graham-Bermann et al, 2009

See Two Generation Approach at 5 Core Principles of Trauma-Informed Parenting 1. Meet parents where they are at in terms of their life experiences and build on their strengths 2. Help parents/caregivers understand how experiences they had as children can affect their well-being and how they parent 3. Help parents/caregivers to recognize that trauma can affect children in many different ways 4. Coach parents on positive discipline and parenting

strategies that promote resilience 5. Offer tools to help parents/caregivers manage stress Chamberlain L. in ACEs: Best Practices, Academy on Violence and Abuse, 2015; Resource for Caregivers Positive, supportive approach to help us understand how childhood trauma can affect our health, how we parent and our childrens wellbeing Practical strategies to cope with stress and hard times for adults and children

Download PDF versions of the Amazing Brain Booklets at: Parenting with ACEs Monthly Live On-Line Chats s Simple and Effective Tools to Promote Resilience, Self-Regulation and Healing

Just Breathe Anxiety is expressed first in our breath shallow breathing, holding breath Children need simple strategies and tools that use their breath to calm and quiet their brains Glitter in Water Bottle Free resources available at Breathing S.T.A.R. Smile Take a deep breath (inhale) And Relax your eyes

(exhale) To download directions to help children make a breathing star, go to: Self-Regulation is a Skill Self-regulation is the ability to manage thoughts and feelings, control impulses and problem-solve Problems with self-regulation are common with childhood trauma and high levels of

stress Can be learned at any age! Self-Regulation and Toxic Stress Report 3, OPRE, 2016 5-4-3-2-1 Coping Technique 5 things you see 4 things you touch 3 things you hear

2 things you smell 1 thing you taste -4-3-2-1-grounding-technique Drumming Individual or group; use hand, drum, stick Self-calming technique brainstem Start with free time for child/group to drum Choose a rhythm that is easy to follow and slowly increase until fast, then slow down and stay slower

until child/group wants to go faster! Slow down again (ideally 70-80 beats per minute) and close with free time drumming Helps to recognize experience of calm and provide non-verbal outlet for emotions Source: Fostering Hope: Foster Care Training Worker Resource, Victoria, AU 2010 Learning Self-Regulation We do, we do a relaxation. It is like, you do a jellyfish, you lay down, and then you relax and you are a jellyfish, first you are a fishbone and become tense

[shows]and then you calm down, then youre calm, then you are the jellyfish, and then you feel-ah! Its really easy, a piece of cake! Look [shows]! Child in domestic violence intervention group for ages 4-6 years old (Pernebo & Almqvist, 2014) Progressive Relaxation Exercise Make it fun by choosing animals that children know and like. Remind them to breath in deeply and exhale slowly, observing how their bodies feelwhat feels tight, what feels loose and what feels different afterwards.

1. You are a monkey and you want to stretchstretch your legs out in front, stretch your arms high above your head, now drop your arms to the side, lets try again and touch the sky! 2. Be a turtle and go in and out of your shell ;bring your shoulders up towards your ears and then drop them way down 3. You have a lemon in each hand, squeeze hard to get all the juice out, now let go and drop the lemon, now squeeze again, then let go 4. Your tummy is a bridge and here comes your favorite animal to cross the bridge.make your tummy very strong, take a breath in and tighten those muscles, now breathe out and let your tummy be soft Adapted from

Calm Box Fidgets Bubbles, pinwheels Engage senses

Scented (pine needles) Soft (velvet) Rough (burlap) Squishy (ball) Moldable (clay) Bristles (hairbrush) Calm Box created by the Washington State Coalition Against Domestic Violence Resource

For Kids, By Kids Faster than a speeding spitball, more powerful than a playground bully, able to breeze through homework and finish nightly chores in a single bound, its Master of Mindfulnesshere to conquer stress, worry, and any trouble that comes your way! SMILING MIND

Free Mindfulness App for Children, Youth and Adults Australian non-profit dedicated to making mindfulness available Audio programs for 7-9, 1012, 13-15, 16-18 year olds and adults Also classroom, sport, workplace and bite size For more information about Train-the-Trainers with the Toolkit, our work on the science of resilience and hope, and teaching brain-body practices to prevent vicarious trauma and promote selfregulation and well-being please contact: Linda Chamberlain, PhD MPH [email protected]

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