Health and Development Session 1: Impact of Adverse Childhood Experiences

1. Health and DevelopmentSession 1: Impact of Adverse Childhood Experiences Integration of Services Training Series

2. Module 1 Goal Apply knowledge of Health and Development through your work with children, families and other service providers.

3. Module 1 Objectives • To understand how environmental factors such as childhood maltreatment can impact development. • To understand the childhood and long-term health consequences of adverse childhood experiences.

4. Module 1 Objectives • Understandthe screening process for health and developmental issues. • Work with medical and developmental specialists to obtain assessments/examinations, family-centered planning and provide for appropriate interventions. • Understand how to work with medical and developmental specialists to establish continual support in these areas at the time of case transition. 4

5. Agenda • Session 1 - 2 hrs • Session 2 - 2 hrs • Session 3 - 2 hrs

6. Life Long Impacts • The Adverse Childhood Experiences/Centers for Disease Control and other studies show potential life-long impacts • The impacts are shown to be cumulative • The more adverse childhood experiences, the more likely to have multiple health conditions and other disorders. 6

7. Felitti (2004) – reproduced with permission 7

8. What are the associated medical conditions? Heart disease Cancer Chronic Bronchitis or emphysema History of Hepatitis/liver disease 8

9. What are the associated medical conditions? • Skeletal fractures • Obesity • Diabetes • Sexually Transmitted Disease

10. How are adverse childhood experiences linked to later health conditions? Behavioral responses to adverse childhood conditions place people at risk Resulting household stress and possible domestic violence 10

11. Ace Score vs. Smoking Felitti – reproduced with permission 11

12. Ace Score vs. Intravenous Drug Use Felitti – reproduced with permission 12

13. Felitti – reproduced with permission

14. Shown with permission from www.cavalcadeproductions.com 800-345-5530

16. Shawn Coughlin (2010)

18. The Science of Child Development 18

19. Center for the Developing Child, Harvard University 19

20. Shawn insert the NSCDC slide on Persistent Stress Changes Brain Architecture 20

21. How does chronic stress impact physical health? Sustained or frequent activation of the hormonal systems can have serious consequences to development. Cortisol, when released long-term, impacts gene expression in neural circuits. This impacts the person’s ability to modulate stress responses. 21

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23. Early Interventions in Florida • Early Head Start • Head Start • Early Steps • Healthy Start

24. What we know about impact of multi-risk environments on children Child Abuse and Neglect during early childhood results in the most damage to development Complex Childhood Trauma Impact on children is known through research 24

25. National Scientific Council on the Developing Child (2010). Persistent fear and anxiety can affect young children’s learning and development: Working paper no. 9, pg. 4. Available from http://www.developingchild.net

26. Attachments Attachments are impacted by: • Parents • Child • Environment

27. Attachment Relationships Key Factors • Person specific • Persistent • Have emotional significance • Driven by desire for contact/proximity • Involuntary separation results in distress

28. Key Age-Related Transitions in Attachment • At 7 – 9 months babies show stranger wariness • Attachment develops across first two years of development • Parental proximity is critical • By age three children show more tolerance for separation • Long separations and disruptions can be detrimental

29. Secure Attachments • Parent’s Behaviors • Child’s Behaviors

30. Insecure with Avoidance • Parent’s Behaviors • Child’s Behaviors

31. Insecure Attachment with Ambivalence and Resistance • Parent’s Behaviors • Child’s Behaviors

32. Attachment Issues for Children in Child Welfare • Insecure • Person specific • Context specific

33. Connectedness – School Age Children • Child feels emotionally connected with parents • Child knows parents are looking out for his emotional well-being • Looks to the parent to help make important decisions • Enjoys spending time with parent

34. Kisha’s Song

35. Health and DevelopmentSession 2: Screening

36. Protective and Risk Factors • Protective and risk factors are transactional in nature • Identification of protective and risk factors is an essential component in screening and assessments. • Factors are viewed as part of the individual’s characteristics or part of environment features and transactions. - Davies, 2004 and Horwath, 2009

37. Protective factors may include areas such as: • Intelligence • Flexible (easy going) temperament • Athletic ability • Good school performance and relationships with peers • A close relationship with an adult • Faith and community participation • Shared care giving with adult family members and friends, etc. - Davies, 2004 and Horwath, 2009

38. Risk factors may include areas such as: • Medical problems • Sensory integration and emotional regulation problems. • Unresponsive parenting • Poverty • Social Isolation • Poor relationships with extended family etc. • Feisty (difficult) temperament - Davies, 2004 and Horwath, 2009

39. Sudden Unexpected Death of an Infant (SUDI) • Sudden Unexpexted Death of an Infant (SUDI) is an initially unexplained death • The cause of deaths such as suffocation are determined later • Sudden Infant Death (SID) is the term used for a death when no cause is determined

40. Sudden Unexpected Death of an Infant –Risk Factors • Young maternal age • Smoking during pregnancy – five times the risk • Exposure to second hand smoke • Inadequate prenatal care • Low Birth Weight - Bright Futures

41. Risk Factors that Parents Can Control • Don’t smoke are be around smokers during pregnancy and don’t expose the baby to smoke. • Where children sleep and on what surface– don’t co-sleep and have the baby sleep on a firm surface. • No loose bedding, or soft objects in the crib. • How children sleep--- Back to Sleep - Bright Futures

42. Substance Exposed Newborns • This discussion includes the use of alcohol and illicit drugs and does not address cigarette smoking. • About 10 to 11% of births show exposure. • Harm can be lifelong • Younger women are at a higher probability for using substance during pregnancy. - SAMHSA, 2009

43. Risk Has Not Been Reduced • The rate of substance abuse in women has not improved significantly. • If the mother does not disclose use it is often difficult to detect exposure at the time of birth. - Office of Applied Studies

44. Substance Use and Abuse Remains a Problem • Illicit drugs used during pregnancy can include: • Cocaine • opiates • Methamphetamines • Barbiturates

45. Risks for the Infant • Risks include: • Miscarriage • Pre-mature birth • Complications at delivery • Later neurological problems • Medical problems

46. Use of alcohol during pregnancy • The use of alcohol during pregnancy can have a devastating impact on the child’ development and future. • Fetal Alcohol Syndrome (FAS) includes physical, neurological, behavioral and cognitive disorders. • Fetal Alcohol Effect (FAE) is not physically obvious but can have very similar consequences for health and development.

47. Fetal Alcohol Effect • Women may drink not knowing that they are pregnant.

48. Fetal Alcohol Effect, Cont. • Symptoms may include cognitive delays, speech and language delays, behavioral problems, problems in regulating emotions and deficits in problem solving. • Children with FAE may have problems forming relationships.

49. Inflicted Traumatic Brain Injury • Child maltreatment is the leading cause of serious head injuries in children under the age of two. • Rates of survival of a serious head injury for infants and toddlers is from 60 to 85% Keenan et al. 2003

50. Inflicted Traumatic Brain Injury • “Inflicted” means that is was caused directly by human behavior • Maltreatment is the primary cause of Inflicted TBI • It is suspected that many cases of less severe TBI go undetected