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Bing & Miriam Webster Dictionaries

When Culture Heals … FlourishTo Prosper with Sustained, Continuous, Steady, Strong Growing Well-being

Great Time of Discovery

NEAR Science▪ Neuroscience▪ Epigenetics▪ Adverse Childhood Experiences (ACEs)▪ Resilient Communities

Living Systems▪ Chaos Theory▪ Network Theory▪ Quantum Theory▪ Relativity (Space-Time)▪ Distributed knowledge

Moving from Risks to Gifts

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Dangerous

Safe

BRAIN

Prepares for anticipated world

OUTCOMEIndividual &

species survive the worst conditions

CHARACTERISTICS

“Brawn over Brains”

Focused: Fight, Flight or Freeze

TOXIC STRESS

OUTCOMEIndividual &

species survive in good times; vulnerable in

poor conditions

CHARACTERISTICS

”Process over Power”

Multi-focused: Relational

Hardwired for Anticipated World

Dissonance between biological expectations & social reality

fuels problems

Adapted from the research of Martin Teicher, MD, Ph.D

Conception

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NEAR Informed Approach

• Recognizing effects

• Realizing prevalence

• Resisting reject/eject

• Responding: right fit

What Fires Together Wires Together

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AGEEXPERIENCEGENDER

Age of Experience Matters(examples, not a comprehensive list)

Fetal exposure to Low birth weight, cardio vascular, diabetesstress chemicals

Maltreatment in:

First few months Anticipate pleasure, attach & belong

First 5 years Emotional regulation, fear, panic

Middle childhood Suicide risk, executive dysfunction, social cues

Pre-puberty Navigate physical space, mental illness,

Adolescence Risk behaviors, long term memory

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Epigenetics

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“The experiences of a parent, before even conceiving offspring, markedly influence both structure and function in the nervous system of subsequent generations.”

Dr Brian Dias, Emory University, 2014

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”From a translational perspective, our results allow us to appreciate how the experiences of a parent,

“Parents with their own genetic vulnerabilities can pass on protection to the next generation provided that they are given the right support.”

Van der Kolk, 2014, The Body Keeps the Score, p. 157

Epigenetics

Unique Experiences of the World

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Dr. John Snow1854

Cholera Death is Caused by Miasmas

1. New Way of Thinking

2. Shoe Leather Epidemiology

3. Lives Saved

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Abuse1. Child physical abuse (28%)2. Child sexual abuse (21%)3. Child emotional abuse (11%)

Neglect4. Physical Neglect (10%)5. Emotional Neglect (15%)

Indicators of Family Dysfunction6. Mentally ill, depressed or suicidal person in the home (19%)7. Drug addicted or alcoholic family member (27%)8. Parental discord – indicated by divorce, separation (23%)9. Witnessing domestic violence against the mother (13%)10. Incarceration of any family member (5%)

Adverse Childhood Experiences

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0

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0 1 2 3 4 or 5 ≥

ACEs are Common in California

California ACE Study2011-2013: California Adults

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10.0

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30.0

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90.0

ACEs are Common Across the Globe1-3 range: 45-79%; ≥4 range: 6-32%

0 1,2,3 ≥4

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Higher ACE score (dose)

La

rge

r P

erc

en

t o

f

Popula

tion A

ffecte

d

(re

sp

on

se

)

Dose-response

is a direct

measure of

cause and

effect.

ACE: Cumulative Effect

A classic causal

relationship

More ACE = more

health problems

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Prevalent DiseaseCardiovascular CancerAsthmaDiabetesAuto immuneCOPDIschemic heart diseaseLiver disease

Health & Social ProblemsFair or poor healthLife dissatisfactionHealth-related limits to quality of lifeDisability that impedes daily functioningDon’t complete secondary educationUnemploymentHistory of adult homelessness

RiskSmokingHeavy drinkingObesityRisk of AIDSTaking painkillers to get highObesity

Outcomes Attributable to ACEs

Intergenerational ACE TransmissionMental IllnessDrugs or Alcohol ProblemMultiple divorces, separationsVictim of family violenceAdult incarceration

Poor Mental HealthFrequent mental distressSleep disturbancesNervousnessMH problem requiring medicationEmotional problems restrict activitiesSerious & persistent mental illness

Health & Social ProblemsPanic ReactionsDepressionAnxietyHallucinationsSleep DisturbancesSevere ObesityPainSmoking AlcoholismIllicit Drug UseIV Drug UseEarly IntercoursePromiscuitySexual DissatisfactionAmnesia (Childhood)Problems with AngerPerpetration of Family

Violence

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1

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0 1 2 3 4 5 6 7,8

Mea

n #

of

Co

-Occ

urr

ing

Ou

tco

mes

ACE Score

ACEs and Co-Occurring Problems

Affect Regulation

Somatic Issues

Substance Use

Sexuality

Memory

Arousal

ACE Interface, 2016

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•Slowed language & reading•Lateralization•Diminished IQ•Poor decision making skills•Memory Problems

•Attention problems•ADD•ADHD

•Aggressive behavior•Social isolation among peers•Poor understanding of social

cues = conflict

•Special education

•School failure•Dropping out

•Suspension•Expulsion•Delinquency •Incarceration

ADULT STRESS

•Low-wage jobs

•Unemployment

•Public Assistance

•Prison

•Teen Pregnancy

•Chronic health problems

•Debilitating mental illness

•Victimization

NEXT GEN RISK

EARLY TRAUMA & STRESS

Predictable patterns of

brain development,

traits & behaviors

Prevent the Progression of Adversity

•Social & •Relational

Problems

Significant risk of early

use/abuse of:Alcohol, tobacco,

illicit & prescription

drugs

Parent ACE Scores Predict Child ACE Scores

Children of Parents with ACE Scores ≥4, are:

1. 6.3x more likely to experience household substance abuse2. 10.4x more likely to experience homelessness3. 12.7x more likely to experience neglect4. 44x more likely to be exposed to intimate partner violence

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Functional Days

DAYS WITH

POOR

HEALTH

During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

Support Functioning: Prevent Adult Adversity

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% w

ith

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-30

Dis

abili

ty-I

nte

rru

pte

d

Day

s a

Mo

nth

Number of Major Stress Categories In AdulthoodAdded to ACE Score of ≥3

Adults with ≥3 ACEs

Plus

Major Stress Categories:

1. Homelessness

2. Incarceration

3. Chronic illness

4. Separation/Divorce

5. Severe Depression

6. Work-related Injury/ Illness

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Promote Virtuous Cycle of Health

Moderate ACE Effects, Improve Wellbeing

Among Parenting Adults

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Prevent High ACE Scores

among Children

Mutually Reinforcing

8 7

“What’s predictable is

preventable.”

Dr. Robert Anda

Dr. Robert Anda

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20%

59%

43%

69%41%

78%

45%

62%

Out of Work >1Year

No Satisfaction with

Neighborhood

Serious & Persistent

Mental Illness

15 of 30 Days Disturbed Work -

Emotional Problems

IV Drugs

Drunk Driving

VictimIntimate Partner Violence

Incarceration

ACEs

61%

Worker Injury

25% 15 of 30 Days Disturbed Work-

Ill Health

Law & Justice

Workforce

Civic Engagement

Safety

Controls: gender, age, income, education, race-ethnicity

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Discussion

• Given some of the ways people are affected by developmental adversity, what’s an example of something we do that is radically right for accommodating normal adaptations?

• What, if anything, came to mind that we might think about changing?

We Teach Everyone NEAR ScienceTo create capacity: common language, meaning, and skills for recognizing what’s helping or hurting, and for engaging people most affected by ACEs in hope-filled action.

In service of a culture shift toward communities that are flooded with opportunities for healing; where it is usual for people to: 1. Have opportunity for a change moment:

feel seen, understood, and accepted.

2. Develop compassion for self, make meaning from experiences, and build on core gifts.

3. Know the most powerful determinant of health: ACEs.

4. Make decisions and take actions to build adults’ capacities to protect and respond to child needs.

To prevent ACE accumulation, and thereby generate a BIG shift in health and wellbeing for this generation of children, and all who will follow.

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Systematic Noticing

Discussion

• What processes might we put into place to systematically notice whether our services and systems are helping or hurting?

• Who, on our teams, would be positioned to notice?

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BREAK

Executive Function Skills –The set of skills needed to do our most complex thinking and goal focused action.

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19 Response Inhibition18 Working Memory15 Emotional Control17 Flexibility26 Sustained Attention17 Task Initiation

24 Planning and Prioritizing16 Organization14 Time Management19 Goal-directed persistence39 Metacognition

Elements of Executive Function

Guare and Dawson 2013, pp. 42-43

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Time Management Response InhibitionFlexibilitySustained AttentionTask Initiation

Working MemoryEmotional ControlPlanning and PrioritizingOrganizationGoal-directed persistenceMetacognition

Executive Function Strengths- 96 Youth

96 Youth

1. Frequent anticipatory guidance

2. Active teaching & practice of EF skills

3. Individualized work to identify effective work-arounds for EF weaknesses

4. Praise and leadership opportunities that use EF strengths

5. Multiple-skill teams that employ distributed knowledge and skills

6. Peer reflection, then sharing among groups with particular strength of “what helps me be strong in this area?”

7. Practice verbalizing one’s strengths, weaknesses, and effective simple activities or strategies that help to offset a weakness (what helps me)

Strengthening EF Skills at School

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Historical TraumaIntergenerational AdversityACE AccumulationSensitive Developmental PeriodsProgression of Adversity Through LifePublic and Private Costs Community Variation

The Issues are Complex

Adversity

AdaptationSocietal

Response

Perfectly “designed” to produce the status quo.

Every community has it’s patterns.• Win, fail expectations, lose• Committee, sub, sub, committee• Survey, ignore, survey

Everyone participates in patterns• Values & principles• Mental models• Structure

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Resources are Finite

We need solutions that address the complexity of problems … andfoster measurable change in different community environments at modest costs

“Community is a living,

spiritual entity,

supported by every

responsible adult.”Gregory Cajete

Communities are PowerfulWe’re Creating a Culture of Wellbeing

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Framework for Action.

1) Tell everyone, enlist everyone who wants to

help. Ask them to act in their own sphere.

2) Focus on dynamics that sustain problems.

3) Use learning communities to fuel innovation.

4) Foster a results-orientation: periodically step

back to reflect; make decisions based on the

future we desire.

SHC Process

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Appreciative ActionUsing positive, appreciative, and participatory methods to

• Learn what’s generating the status quo,

• Understand the dreams and aspirations of residents for the future,

• Learn what works for whom in what context, and

• Facilitate continuous improvements

Emergence: Culture of Health

In nature, change begins as local actions spring up simultaneously in many different areas.

When these changes become connected, local actions can emerge in a powerful system that has many more capacities than could ever be predicted by analyzing the individual parts.

Emergent phenomena always• Possess new capacities different from the local

actions that engendered them • Surprise us by their appearance• Exert much more power than the sum of their parts

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Three Tiers of Facilitators

People: Groups that discuss and work together on current client/customer service improvement.

Plans: Groups that discuss and work together on activities with one-or two-year planning horizon.

Purpose: Groups that are focused on a ten-year view, having conversations about what needs to be in place for the capacity of the community to expand.

Discussion

• What groups or people are performing these functions now?

• What might need to change in order to make sure all get done, and/or that work in any one group informs the others?

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Adams

Common language & understanding, leads to system cohesion and alignment of strategies

Break

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Partners

1. Intentionally become trauma-informed family, friends, neighbors and professionals

2. Build common understanding, language, & ways to systematically notice

3. Work in own sphere of influence, while linking and leveraging efforts to galvanize connectivity

4. Strengthen healthy social networks

1. Leadership: expanding opportunities.

2. Focus: Coming together to discuss and understand matters of local importance

3. Learning: together.

4. Results: Shared times and venues for reflection and decision making, honest appraisal: are we helping, or are we hurting?

Self-Healing Communities produce safe, stable nurturing relationships & environments

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Successful Journey for Child Safety

Photo credit: Håkan Axelsson

In this place:• History of natural disasters• History of assault on way of life• Historical trauma affects large

portion of population• High ACE prevalence – bi-modal

split in scores• Stunning success for a small

investment

Call To Action

WAITAll of us know…

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Planning, Purchased Services,

Coordination, Colocation

Strategy Layering Over Time

8-10 Years

Planning, Purchased Services,

Coordination

+ Public Education, Professional

Development, Population-Specific

Strategy

Strategy Layering Over Time

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Planning, Purchased Services,

Coordination

+ Public Education,

Professional Development,

Population-Specific Strategy

+ Cross-training for Relationship-Based Pros,

Discipline- Specific Strategy,

Parent Leaders; Neighborhood Specific Efforts in High 911 Call

Areas

Strategy Layering Over Time

Turning Point

“Improve parent skills so parents can give sound advice and be good mentors to their children, and, in turn will gain skills and relationships to give sound advice to the community – and that advice will make a better system of help for them and for other families.”

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Planning, Purchased Services,

Coordination

+ Public Education,

Professional Development,

Population-Specific Strategy

+ Cross-training for

Relationship-Based Pros, Discipline-

Specific Strategy, Parent

Leaders; Neighborhood Specific Efforts

in High 911 Call Areas

+Networking Café, Learning Field Trips, Business/Community‘Together We Can’ Events, Time Bank,

Transportation Collaborative, Listening

Dialogues

Strategy Layering Over Time

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Discussion

• What stood out for you as you listened to this story?

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Designing High-Leverage Solutions

• Layer strategies over time

• Learn, manage, improve based on community experience –the power of feedback as an engine for success.

• Inserting effort to interrupt progression of adversity

• Illuminate values, principles, mental models that will interrupt status quo

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• How are our we learning and growing – our professional groups, organizations, and our community?

• What do we notice that lets us know that learning and continuous improvement is benefitting the lives of children and parenting adults?

SHC Process

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1. Engagement informed by neuroscience, epigenetics, adverse childhood experience and resilience research (NEAR)

2. Learning communities3. Hope and efficacy

3 Principles – Appreciative Inquiry

Grandmas to Go

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“A group of people who are continually enhancing their capacity to create the results they want.”

(Peter Senge, 1990)

Learning Culture - Learning Community

What are the barriers to asking for help?

Consensus:

“I would never ask for help because there are always too many strings.”

Learning from People Most Affected by ACEs

Interests & ValuesUsually Non-Negotiable

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Principle: Hope and Efficacy

Hope & EfficacyWe tend hope and efficacy by noticing, supporting

and celebrating hope-filled action.

Hope has three elements:

1. Imagine a better future

2. See a path to that future

3. Imagine oneself able to be on that path

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Better Lives in Walla Walla

-44% Adult arrests for violent crime-33% Domestic violence incidents-31% Births to teen moms (10-17)-59% Youth suicide attempts-18% Child sexually transmitted disease (B-19)-48% Teem arrests for alcohol-28% Teen arrests for drugs-64% Average yearly dropping out of high school

Based on archival state data 1998-2008

I need a Zoo!

• How are we learning about the hopes of people most affected by adversity; what might we need to be doing to ensure that people are building the relationships and skills they need to participate in hope-filled action?

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SHC Process

1. Inclusive leadership2. Emergent capabilities3. Right-fit solutions

3 Principles -- Emergence

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Principle: Inclusive Leadership with Downward Accountability

Barbara

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360 Turn Your Life Around

Shifting from a Vicious Cycle to a Virtuous Cycle

Virtuous Reinforcing CycleVicious Reinforcing Cycle

ACEs

Adaptation

Reject-Eject Societal Response

Adult Adversity

ACE-Attributable Problems

ACEs

Adaptation

Right-Fit Engagement

Adult Flourishing

Fewer ACE-Attributable

Problems

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• What is needed or next for developing “right-fit” responses to people affected by adversity?

• What discussions, if we were having them, would help us to develop “right-fit” solutions with the people of our communities?

• What kinds of tools should we be building to assess our progress with “right-fit” solutions over the long term?

Individual Reflection & Writing

• Please take four minutes to write – stream of consciousness:

• Imagine using this science in ways that make you proud. What would YOU LIKE to be doing?

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Holding Visible, What Once Was Invisible

When I saw you

I fell in love, and

you smiled

because you

knew.

William

Shakespeare

Thank YouLaura Porterlauraportergarden@gmail.comwww.aceinterface.com

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