Call to Action1viuw040k2mx3a7mwz1lwva5-wpengine.netdna-ssl.com/wp...Presentation Goals: • Increase awareness of key research on brain science; particularly as it relates to the prevention
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Presented by the Early Childhood Workgroup of The Governor's Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery Prevention Task Force Call to Action: Prevention Across the Lifespan
The Governor's Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery
Prevention Task Force
Call to Action: Prevention Across the Lifespan
Presentation Goals: • Increase awareness of key research on brain
science; particularly as it relates to the prevention of substance use disorders.
• Increase awareness that intervention in the early childhood years is critical to preventing substance misuse and substance use disorders.
• Strengthen the connection between NH’s
Substance Use Disorder (SUD) field and the Early Childhood field as a strategy for prevention.
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Presentation Notes
INTRO SLIDE (Traci) Talking Points = With the current opioid epidemic and the immense amount of research that has been coming out in recent years regarding brain science and how we, as humans, develop, we see ourselves at an important crossroads. The Commission is currently embarking on the development of a new state plan and we are entering into a time period where we’ll be advocating for resources. This Commission has the power and influence to shape how work “in the field” is implemented. Prenatal (conception to birth) Infancy & Toddlerhood (conception to birth) Preschool (birth to 3 years) Transition to School (ages 6 through 8 years)
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March 2016, NIDA Report “Intervening early in childhood can alter the life course trajectory in a positive direction (Kellam et al., 2008; Kitzman et al., 2010).Substance abuse and other problem behaviors that manifest during adolescence have their roots in the developmental changes that occur earlier—as far back as the prenatal period. While prevention can be effective at any age, it can have particularly strong effects when applied early in a person’s life, when development is most easily shaped and the child’s life is most easily set on a positive course.” August 2016 http://www.new-futures.org/sites/default/files/pages/attachments/2016%20Five%20Point%20Agenda%20White%20Paper.pdf
Facing Addiction in America: 2016 US Surgeon General’s Report
• The experiences a person has early in childhood and in adolescence can set the stage for future substance use and escalation to a substance use disorder or addiction. These predictors show much consistency across gender, race and ethnicity, and income.
• Well-supported scientific evidence demonstrates that a variety of prevention programs and policies that address these predictors prevent substance initiation, harmful use, and substance use related problems. These programs and policies are effective at different stages of the lifespan, from infancy to adulthood, suggesting that it is never too early and never too late to prevent substance misuse and related problems.
Facing Addiction in America: 2016 US Surgeon General’s Report
Early
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•Early life stressors increase addiction risk
Adol
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•Brain is particularly vulnerable to substance exposure
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So, the Surgeon General’s Report essentially identified two key stages of development – early childhood and adolescence – that are of particular interest in terms of the impact that risk factors can have on the development of an SUD. Need to refine talking points, but the long version: The experiences a person has early in childhood and in adolescence can set the stage for future substance use and, sometimes, escalation to a substance use disorder or addiction. Early life stressors can include physical, emotional, and sexual abuse; neglect; household instability (such as parental substance use and conflict, mental illness, or incarceration of household members);45 and poverty.46 Research suggests that the stress caused by these risk factors may act on the same stress circuits in the brain as addictive substances, which may explain why they increase addiction risk.47 Adolescence is a critical period in the vulnerability to substance use and use disorders, because a hallmark of this developmental period is risk taking and experimentation, which for some young people includes trying alcohol, marijuana, or other drugs. In addition, the brain undergoes significant changes during this life stage, making it particularly vulnerable to substance exposure.48 Importantly, See Chapter 1 - Introduction and Overview and Chapter 3 - Prevention Programs and Policies. NEUROBIOLOGY PAGE | 2-22 the frontal cortex—a region in the front part of the brain that includes the prefrontal cortex—does not fully develop until the early to mid-20s, and research shows that heavy drinking and drug use during adolescence affects development of this critical area of the brain.49 About three quarters (74 percent) of 18- to 30-year-olds admitted to treatment programs began using substances at the age of 17 or younger.50 Individuals who start using substances during adolescence often experience more chronic and intensive use, and they are at greater risk of developing a substance use disorder compared with those who begin use at an older age. In other words, the earlier the exposure, the greater the risk.
The Bedrock of the Granite State
The future prosperity of New Hampshire depends on our ability to steward the next generation who will live, work, and lead in our state.
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Read the text of the slide as it appears, and then: We know that the healthy development of children provides a strong foundation for healthy and competent adulthood, responsible citizenship, economic productivity, strong communities, and a sustainable society. In short, Capable children are the bedrock of a strong and prosperous Granite State. Our future depends on them.
What develops?
The Brain’s Architecture
Like a house, the brain is built from the bottom up. Early experiences set the foundation for the architecture of the maturing brain, establishing a sturdy or fragile base for all the development that follows.
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Read the text of the slide as it appears. Then, sum up with: “The basic architecture of the brain is constructed through a process that begins early in life and continues into adulthood. While genes provide the basic blueprint, experiences influence how or whether genes are expressed. Together, they shape the quality of brain architecture, establishing a sturdy or fragile foundation for what follows. Because more complex skills are built on top of simple skills, it is critical to make the foundations as strong as possible. So, clearly, getting things right the first time is easier than trying to fix them later.” Source: The Science of Early Childhood Development. (2007) National Scientific Council on the Developing Child. http://www.developingchild.net
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[Before playing the video, give this Introduction:] “This 90-second video from the Center on the Developing Child at Harvard demonstrates basic, foundational concepts that are built upon decades of developmental science and recent advances in neuroscience, molecular biology, and genomics. These advances give us a much better understanding of how early experiences are built into our bodies and brains, for better or for worse, with lifelong consequences for learning, behavior, and health.” Source: Center on the Developing Child at Harvard University (2011) http://www.developingchild.harvard.edu
How does development happen?
Serve and Return Relationships
Strong brain architecture is formed by the “serve and return” relationships children have with supportive adults. When children reach out for connections and communications, and adults reciprocate, this back-and-forth process wires the brain with the connections needed for healthy brain architecture.
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Read the text of the slide as it appears. Then say: “So, this “serve and return” is similar to a game of tennis, volleyball, or playing catch—one person serves, the other responds. you need two people, each responding in kind. Serve and return works best within an trusting relationship between a child and an adult who is responsive to the child’s own unique individuality. These mutually rewarding interactions are essential for the development of healthy brain circuits and increasingly complex skills.” “Regular and reliable “serve and return” interactions with trusted adults are the active ingredient in the brain building process. When we ensure that young children’s environments are full of serve and return experiences, we are ensuring a strong foundation for later development. Source: The Science of Early Childhood Development. (2007) National Scientific Council on the Developing Child. http://www.developingchild.net
What derails development?
Toxic Stress Unlike mild, short-lived stress that can be good for growth, certain types of stress can weaken the brain’s architecture. Experiences such as exposure to violence can cause toxic stress responses in the brain, with lifelong consequences in health, learning and behavior. Supportive adults can buffer toxic stress, however, reducing or preventing its effects.
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Read the slide, and then summarize with: �“Learning how to cope with adversity is an important part of healthy development. Moderate, short-lived stress responses in the body can promote growth, But toxic stress is the strong, unrelieved activation of the body’s stress management system in the absence of protective adult support. These toxic stress responses caused by, for example, exposure to violence, abuse or chronic neglect, can weaken the architecture of the developing brain, with long-term consequences for learning, behavior, and both physical and mental health.” Source: The Science of Early Childhood Development. (2007) National Scientific Council on the Developing Child. http://www.developingchild.net
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[Give the following introduction before playing the video:] “This last 90-second video from Harvard illustrates how “toxic stress” can derail development” Source: Center on the Developing Child at Harvard University (2011). http://www.developingchild.harvard.edu
Adverse Childhood Experiences are stressful or traumatic events, and include: •Physical abuse
• Mother treated violently • Household mental illness • Substance misuse in the home • Incarceration of a family
member • Loss of a parent
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Adverse childhood experiences (ACEs) are stressful or traumatic events, including abuse and neglect. They may also include household dysfunction such as witnessing domestic violence or growing up with family members who have substance use disorders. “The research findings presented here – commonly known as the ACE Study – ACE stands for Adverse Childhood Experiences - show us that not only does early adversity impact early functioning (such as developmental delays as show in previous slide), but early adversity actually gets built into the body, with lifelong effects on physical health. This graph shows that adults who recall having 7 or 8 serious adverse experiences in childhood are 3 times as likely to have cardiovascular disease as an adult. Other related studies now link significant adversity in childhood to increased risk of a range of other health issues, including diabetes, hypertension, stroke, obesity, and some forms of cancer.” Source: Dong M, Giles WH, Felitti VJ, Dube, SR, Williams JE, Chapman DP, Anda RF. Insights into causal pathways for ischemic heart disease: Adverse Childhood Experiences Study. Circulation 2004;110:1761–1766. [Should your audience ask, below is more information on the ACE study that might be helpful, particularly if you get questions asking for more detail on the study. This research comes from the Adverse Childhood Experience (ACE) Study - one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. This study followed children ages birth to 36 months who had been maltreated and found that the more risk factors they experienced, the greater their chance of experiencing problems in cognitive, social, emotional, and physical development. Risk factors or ACEs included were: Child Maltreatment, Caregiver Mental Health Problem, Caregiver Substance Abuse Problem, Domestic Violence, Biomedical Risk Condition, Poverty, Low Caregiver Education, Single Caregiver, 4 or More Children in Home, Minority Status. An individual exposed to none of the categories had an ACE Score of 0; an individual exposed to any four had an ACE Score of 4, etc.
A male child with 6 ACEs has a 4,600% increase in the likelihood of later becoming an IV drug user.
Compared to those with a score of 0, people with an ACE Score of 4 are: 7 times more likely to be addicted to alcohol 10 times more likely to inject street drugs
The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study Vincent J. Felitti, MD
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Need to really emphasize the significance of this slide. Handout the list of ACESs to have people understand what it means to have several ACEs…
What’s the solution?
Early Childhood
Prevention &
Intervention
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“We can catch children before they fall. We know what works. We simply have to close the gap between what we know and what we do.”
Heckman, J. (2007)
B-3 4-5 6-18 Post school
Rates of return to human
capital investment
Preschool programs
Schooling
Job training
Programs targeting the earliest years (7-10%)
Age in Years
Returns to a Unit Dollar Invested
B - 8
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[Explain the graphic with:] “The earlier we start, the greater the return. Not surprisingly, preventive intervention is more efficient and produces more favorable outcomes than later remediation. James Heckman is the 2000 Nobel Laureate in Economic Sciences and he has calculated a 7-10% Return on Investment for programs targeting the earliest years. This return on investment is for the individual, but the lion’s share of the benefit is to the public. As Dr. Heckman reminds us, “The least expensive problem to fix is the one you prevent from happening in the first place.”�
“The least expensive problem to fix is the one you prevent from happening in the first place.”
Heckman, James. (2007)
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The science of human development tells us that if we want to foster the kind of social-emotional health that avoids substance misuse, we need to start early and ensure that all children have access to the kind of developmental opportunities that build healthy brain architecture and avoid toxic stress. That is why we are asking the Governor’s Commission to approve investment in early childhood as part of its prevention efforts in its new strategic plan. There is lots of evidence that high quality early learning programs like Head Start, and high quality child care help to ensure the right start for children and are a great return on investment for the taxpayer. Those children whose parents are suffering from mental illness or from SUDs, children suffering toxic stress because of abuse or neglect or witnessing violence are at increased risk for poor outcomes. Programs such as evidence-based home visiting have been shown to help not only individual families but to be a great investment for all of us. We know that as a result of the current opioid crisis in the state there are an increasing number of children who are suffering toxic stress. If we fail to ensure that those children have access to programs and services that can mitigate that stress and give them access to environments with stable, supportive adults in their lives we may face even worse crises in the future. There are now an increasing number of programs in New Hampshire that are working to help to make sure that children who are victims of this crisis get the services and supports they need. ACERT, Programs that help addicted pregnant moms, those that shelter and offer services addicted moms and their children. These programs are grossly underfunded and not well coordinated. That is why we need your support for the kind of prevention that will ensure a healthy future for the Granite State.
Call to Action: The Prevention Task Force, on behalf of NH’s prevention field, is requesting: • That the Governor’s Commission on Substance Abuse
Prevention, Treatment and Recovery adopt Early Childhood as a target population.
What will this do? 2017-2020 State Plan Influence work in the SUD field Align and strengthen advocacy efforts Influence allocation of resources Promote a coordination of systems
Presenter
Presentation Notes
The science of human development tells us that if we want to foster the kind of social-emotional health that avoids substance misuse, we need to start early and ensure that all children have access to the kind of developmental opportunities that build healthy brain architecture and avoid toxic stress.
Support is needed for programs such as: • High quality early learning and child care programs • Home visiting programs for families at risk
• Community programs targeting sources of toxic stress
• Elementary school prevention programs
• Innovative programs addressing children who are
“secondary victims” of the opioid crisis
Presenter
Presentation Notes
There is lots of evidence that high quality early learning programs like Head Start, and high quality child care help to ensure the right start for children and are a great return on investment for the taxpayer. Those children whose parents are suffering from mental illness or from SUDs, children suffering toxic stress because of abuse or neglect or witnessing violence are at increased risk for poor outcomes. Programs such as evidence-based home visiting have been shown to help not only individual families but to be a great investment for all of us. We know that as a result of the current opioid crisis in the state there are an increasing number of children who are suffering toxic stress. If we fail to ensure that those children have access to programs and services that can mitigate that stress and give them access to environments with stable, supportive adults in their lives we may face even worse crises in the future. There are now an increasing number of programs in New Hampshire that are working to help to make sure that children who are victims of this crisis get the services and supports they need. •ACERT, •Programs that help pregnant moms with SUDs •those that shelter and offer services for moms with SUDs and their children. These programs are grossly underfunded and not well coordinated. That is why we need your support for the kind of prevention that will ensure a healthy future for the Granite State. "Few substance use prevention programs for children under the age of 10 have been evaluated for their effect on substance misuse and related problems. Such studies are rare because they require expensive long-term follow-up tracking and assessment to demonstrate an impact on substance initiation or misuse years or decades into the future. Consistent with general strategies to increase protective factors and decrease risk factors, universal prevention interventions for infants, preschoolers, and elementary school students have primarily focused on building healthy parent-child relationships, decreasing aggressive behavior, and building children’s social, emotional, and cognitive competence for the transition to school. Both universal and selective programs have shown reductions in child aggression and improvements in social competence and relations with peers and adults (generally predictive of favorable longer-term outcomes), but only a few have studied longer-term effects on substance use.107,108”
Sources Referenced In the Presentation “Experiences Build Brain Architecture” http://developingchild.harvard.edu/resources/experiences-build-brain-architecture/ Harvard University Center on the Developing Child at Harvard University “Toxic Stress Derails Development” http://developingchild.harvard.edu/science/key-concepts/brain-architecture/ Harvard University Center on the Developing Child at Harvard University “Principles of Substance Abuse Prevention for Early Childhood,” National Institute on Drug Abuse, March 2016 https://www.drugabuse.gov/publications/principles-substance-abuseprevention-early-childhood/index “Five Points For New Hampshire’s Future, Turning the Tide on our State’s Drug Crisis” New Futures, August 2016 http://www.newfutures.org/sites/default/files/pages/attachments/2016%20Five%20Point%20Agenda%20White%20Paper.pdf
Sources Referenced In the Presentation “Aces too High,” a news site that reports on research about adverse childhood experiences https://acestoohigh.com/ “Facing addiction in America, The Surgeon General’s Report on Alcohol, Drugs, and Health” https://addiction.surgeongeneral.gov/ “Framework for Action,” Spark NH, New Hampshire’s governor-appointed early childhood advisory council, http://sparknh.com/uploads/files/Framework%20for%20Action%20Spark%202016_Summy(1).pdf “Framework for Action Policy Paper,” Spark NH http://sparknh.com/uploads/files/Framework%20for%20Action%20Spark%202016_%202-3-16_sm(2).pdf
