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

• Understand the 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
7
Felitti (2004) reproduced with permission
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
11
Felitti reproduced with permission
12
Ace Score vs. Intravenous Drug Use
Felitti reproduced with permission
12
13
Felitti reproduced with permission
14
Shown with permission from www.cavalcadeproduction
s.com 800-345-5530
15
(No Transcript)
16
Shawn Coughlin (2010)
17
(No Transcript)
18
The Science of Child Development
18
19
19
Center for the Developing Child, Harvard
University
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 persons ability to modulate
  stress responses.

21
22
22
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 childrens 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

• Parents Behaviors
• Childs Behaviors

30
Insecure with Avoidance

• Parents Behaviors
• Childs Behaviors

31
Insecure Attachment with Ambivalence and
Resistance

• Parents Behaviors
• Childs 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
Kishas 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 individuals
  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

• Dont smoke are be around smokers during
  pregnancy and dont expose the baby to smoke.
• Where children sleep and on what surface dont
  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

51
Mild to Moderate TBI

• Mild to moderate TBI may be difficult to diagnose
• Symptoms are very similar to the symptoms for
  mental health disorders, and results of pre-natal
  exposure to substances.
• It is almost impossible sometimes to tell why a
  child or parent is having a particular problem.
• The most important thing is to try and find an
  intervention or coping mechanism that helps.
• - Keenan et al JAMA 2003

52
American Academy of Pediatrics

• The American Academy of Pediatrics (AAP) has long
  recognized that the health of the individual
  child is the product of myriad social,
  environmental, and genetic factors and that
  adverse conditions in any of these areas
  undermine the wellness of the child.

53
Health Care Vulnerabilities

• Children and adolescents in foster care are known
  to be at high risk for persistent and chronic
• physical
• emotional
• developmental conditions
• because of multiple and cumulative adverse events
  in their lives.
• - AAP

54
Research shows

• high rates of chronic medical problems,
  developmental delays, educational problems, and
  behavioral health disorders.
• between 80 and 90 of the children have
  abnormalities in at least one body system
  resulting in special health care needs.

55
Physical conditions include

• growth abnormalities,
• neurological disorders,
• asthma,
• failure to thrive,
• malnutrition,
• infectious diseases,
• exposure to high rates of lead,
• hearing and vision problems and
• dental decay

56
Screening Process

• Collecting initial information
• Observation (Positive signs of safety and
  worries)
• Interviewing Telling Their Story
• Use of standardized or formal screening

57
Health and DevelopmentSession 3 Assessments,
Interventions and Collaboration
58
Review

• Raised in multi-risk situations
• Living in poverty
• Experiencing poor health

59

• Poor health can be detrimental to parenting.

60
Family Centered Practice Model
61
Assessments for Health Care

• A comprehensive health assessment
• Parents involvement assessment
• Parents understanding of the findings

62
Safety-Risk Asssessment

• Signs of Present Danger
• Child Vulnerability
• Protective Capabilities

63
Helping Babies from the Bench
64
(No Transcript)