community magnitude for ace prevention & response4.2 million adults involved: 2.1 million in...

COMMUNITY MAGNITUDE

FOR

ACE PREVENTION & RESPONSE

Generating Powerful Solutions to Complex Adaptive Problems

WA STATE FAMILY POLICY COUNCIL

Formed in 1989 as Washington State Governor’s Subcabinet on Families

Local Networks added 1994

6/22/2012 4th ICCP 2012 Barcelona 2

1. Focus• Realize long term commitment • Use a learning systems approach • Aim to improve the RATES of interrelated problems

2. Learn & Illuminate • Use a framework that unites• Establish cyclic opportunities with diverse learners• Use contract & reporting structure that controls for learning

3. Employ Results-Based Decision Making• Use Data; Expect innovation• Reconstruct natural supports that help families to thrive• Improve responsiveness & strategic resource alignment

4. Expand leadership • Anyone who wants to help is a leader• Intentionally diversify – sector, class, discipline, culture• Public engagement = public will to re-invest savings

EFFECTIVE PROCESS

Model of Community Empowerment – Stages


FOCUS

Pre-Commitment Committing Shifting Persisting Thriving

MAPPING SEVERITY

ARCHIVAL INDICATORS

DO WE NEED TO BE

A DIFFERENT

KIND OF PARTNER?

ACE PREVALENCE BY ZIP CODE IN 1 WA COUNTYState average 26% ≥ 3 ACE; 5% ≥ 6 ACELt Blue: 31% ≥ 3 ACE; 4% ≥ 6 ACEPeach: 41% ≥ 3 ACE; 13% ≥ 6 ACEOrange: 59% ≥ 3 ACE; 20% ≥ 6 ACE

RESILIENCE

Individual

Family

National, Global, Ecosystem

RESILIENCE OCCURS AT ALL LEVELS

The natural human capacity to navigate life well.

(HeavyRunner & Marshall, 2003)

Community

PERSON PREPARATION

COMMUNITYPREPARATION

Intervention-Interdiction Shift Context & Reciprocity

Public Education

& Health Education Campaigns

Direct Services to People with

Risk

GENERAL COMMUNITY CAPACITY DEVELOPMENT MODEL(We measure community capacity.)

General Community Capacity Development is a public health approach to solving interrelated problems by improving:

1. Peoples’ connections,

2. Shared responsibility, and the

3. Collective impact of their efforts.

This model is powerful because success in one

phase propels success in the next. It is a virtuous cycle

that has the power to improve population health.

BETTER OUTCOMES AMONG 18-34 YEAR OLDSUSING FPC COMMUNITY CAPACITY DEVELOPMENT MODEL

38% 36% 34%29%

No Networks Using FPC Model

Forming, Using FPC Model

Shifting and Persisting

Thriving (High Capacity Scores Over 6 Biennia)

% WITH 3 OR MORE ACES

43%

54% 52%

63%




Thriving (High Capacity Scores Over 6 Biennia)

% with Post High School Education

87%

89%

91%

94%



Shifting and PersistingThriving (High Capacity Scores Over 6 Biennia)

% Employed

Committing

4.2 Million Adults Involved: 2.1 Million in Thriving Stage

Pre-committing Number of Adults 0.9 million

Percent of Adults Statewide 17 %

Committing Number of Adults 1.2 million



Number of Adults 0.9 million


Thriving Number of Adults 2.1 million



Committing Shifting Persisting Thriving

Highest Community

Capacity Scores

27%

12%

33%

7%

0%

5%

10%

15%

20%

25%

30%

35%

0 1 2 3 4, 5 6,7,8

Persistance & In Crisis Communities vs. Thriving Communities(18-34 yr olds)

Persistance& In Crisis Thriving

ACE ACE SCORES OF WASHINGTON ADULTS AGES 18-34 Mid-Capacity Scoring (blue) vs. High Capacity Scoring (stripe) Communities

Biggest Change =

Fewer People with 6-8 ACEs

Shifting & Persisting

HIGH COMMUNITY CAPACITY SCORES HIGHLY CORRELATED WITH

RATE REDUCTIONS IN MANY SOCIAL PROBLEM

Problems Pile-Up in

Low Capacity Communities

Problems with Bad Rate Trends 1998-2006:

Child Abuse & Neglect

Domestic Violence Youth Violence

Youth Substance Abuse Youth Suicide

Teen Pregnancy & STDs Dropping Out of School

Problems Plummet in High Capacity

Communities

Success builds on success, making

community health and well-being

sustainable.

COMMUNITY CAPACITY REDUCES MAJOR SOCIAL PROBLEMS

PROBLEMS PILE-UP IN FEWER PROBLEMS IN LOW CAPACITY COUNTIES HIGH CAPACITY COUNTIES

Community Capacity Scores

# of Problems with Bad

Rate Tends

N

um

ber

of

Pro

ble

ms

at H

igh

Rat

es

1

2

3

4

5

6

7

8

Community Capacity Scores Low Middle High

The Community Capacity Development process is iterative, sets the course for reaching a community capacity tipping point

where multiple rates come down simultaneously

SUPPORT & INCENTIVIZE A LEARNING SYSTEM

Brain Science –Consequences of Toxic Stress on Human Development; Developmental Neurobiology, Biopsychology

Adverse Childhood Experience –The Most Powerful Determinate of the Public’s Health

Positive Adaptation –Individual, Family, Community, Societal Resilience & Capacity for Transformative Improvements; What We All Can Do…

Systems Science –Helps us see how we collectively create our current reality –points to higher leverage solutions

UNIFYING FRAMEWORK

BRAIN RESEARCH

See for example: Teicher, M et al. “Neurobiological & Behavioral Consequences of Exposure to Childhood Traumatic Stress,” Stress in Health and Disease, BB Arnetz & R Ekman (eds). 2006. “Scars that Won’t Heal: The Neurobiology of Child Abuse,” Scientific American, March, 2002.

EPIDEMIOLOGICAL RESEARCH

See for Example: Felitti, VJ, Anda, RF et al. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine. 1998. (14:4) ; For a full list of publications, see http://www.cdc.gov/nccdphp/ace/publications.htm

RESILIENCY RESEARCH

Masten, AS. “Ordinary Magic: Resilience Process in Development.” American Psychologist. March, 2001 Boss, P; Loss, Trauma and Resilience – Therapeutic Work with Ambiguous Loss; WW Norton & Co; 2006Longhi, D; Community Networks – Building Community Capacity, Reducing Rates of Child and Family Problems, 2008; How Do High Risk Counties Protect All Youth, 2009Dr. Gregory Cajete; “Native Science: Natural laws of Interdependence” 2000

SYSTEMS SCIENCE

Many Leaders, for example: Margaret Wheatley, Peter Senge, Daniel Kim, Bob Stilger, Steve Waddell, Gregory Bateson, Eleanor Ostrom, Tom Hurley, Albert-László Barabási

EVENTS

PATTERNGen

era

lly S

een

Gen

era

lly U

nseen

EducationPresents emerging research so powerful that, when understood, it transforms mental models

So that

We create transformative conversations So that

Leaders throughout the state organize most effectively to support thriving families and communities

STRUCTURES

MENTAL MODELS

VALUES

COLLECTIVE ACTION

Adapted from the systems thinking iceberg

Dr John Snow1854

Cholera Death is Caused by Miasmas

1. New Way of Thinking

2. Shoe Leather Epidemiology

3. Lives Saved

FOUNDATIONS OF HEALTHY DEVELOPMENT

Genetic Predispositions

Experience

Adapted from Shonkoff, J.P., Building a New Biodevelopmental

Framework to guide the Future of Public Policy, Child Development,

Jan./Feb. 2010

BRAIN DEVELOPMENT PATTERNS

OUTCOMEIndividual & species survive the worst conditions.

INDIVIDUAL•Edgy•Hot temper•Impulsive•Hyper vigilant•“Brawn over

brains”

OUTCOMEIndividual & species live peacefully in good times; vulnerable in poor conditions

INDIVIDUAL•Laid back•Relationship-

oriented•Thinks things

through•“Process over

power”

Hormones exert pressures on cells; these determine growth & function.

The presence of hormones activates systems. Stress hormones make systems sensitive to future stressors.

Hormones regulate myelination—the coating of nerves with fat.

Hormones & other neurochemicalsregulate the proliferation and maturation of receptor cells.

Neurochemicals facilitate the growth of new synapses, determining the overall mass & function of the brain at maturity.

Certain brain chemicals are toxic to young brain cells.

BRAINHormones, chemicals & cellular systems prepare for a tough life in an evil world

BRAINHormones, chemicals & cellular systems prepare for life in a benevolent world

NEUTRAL START

Adapted from the research of Martin Teicher, MD, Ph.DBy Washington Family Policy Council

TRAUMATIC STRESS

NEUTRAL START

BRAINHormones, chemicals & cellular systems prepare for a tough life in a dangerous world

OUTCOMEIndividual & species survive the worst conditions.

INDIVIDUAL•Edgy•Immune to

Social Cues•Quick to act•Hyper vigilant•“Brawn over

brains”

BRAINHormones, chemicals & cellular systems prepare for life in a benevolent world

TRAUMATIC STRESS

OUTCOMEIndividual & species live peacefully in good times; vulnerable in poor conditions

INDIVIDUAL•Laid back•Relationship-

oriented•Thinks things

through•“Process over

power”

Brain Development for Dangerous World

Brain Development for Safe World

ADAPTATION TO ANTICIPATED WORLD

Normal Biological Response to Toxic Stress Bumps Up Against Social Expectations

Adapted from the research of Martin Teicher, MD, Ph.DBy Washington Family Policy Council

DISCUSSION

In your experience, how do our major social services, health, justice, education and/or mental health systems respond to young people who act on “brawn over brains”?

How do these systems’ responses work for children and families?

EARLY CHILDHOOD

HIPPOCAMPUS

The center for: •Controlling emotional reactions•Constructing verbal memory•Constructing spatial memory

MIDDLE CHILDHOOD

CORPUS CALLOSUM

Integrates hemispheres & facilitates:

• Language development• Proficiency in math• Processing of social cues,

such as facial expression

Adaptation:• Language delay• Diminished math capacity• Diminished integration & coordination

• Difficulty with social cues

Adaptation:• Emotionally reactive—brain’s

braking mechanism fails• Poor regulation of behavior• Difficulty with verbal & spatial

memory

Net loss in volume becomes evident in the 20s.

ADOLESCENCECORTEX

Center for:• Thinking & judgment• Executive function• Long term memory• Vision

Adaptation:• Poor executive function • Impulsiveness• Diminished abstract reasoning• No hope for the future• Limiting field of vision

TRAUMA IS HARD-WIRED INTO BIOLOGY

- All forms of maltreatment in the first 2-3 years of life- Sexual abuse at ages 3-5

- Neglect in infancy- Sexual abuse at ages 9 and 10

-Witnessing DV-Sexual abuse

CONSEQUENCES OF BIOLOGICAL OUTCOMESSOCIAL• Aggression & violent outbursts

• Poor self-control of emotion

• Can’t modify behavior in response to social cues

• Social isolation—can’t navigate friendship

MENTAL HEALTH• Poor social/emotional development

• Alcohol, tobacco & other drug abuse—vulnerable to early initiation

• Adolescent & adult mental health disorders—especially depression, suicide, dissociative disorder, borderline personality disorder, PTSD

COGNITIVE• Slowed language development

• Attention problems (ADD/ADHD)

• Speech delay

• Poor verbal memory/recall

• Loss of brain matter/IQ

ACEs CO-OCCUR / CLUSTER

26% of adults report 3 or more ACEs

5% of adults have 6 or more ACEs

Among adults exposed to physical abuse, 84% reported at least 2 more ACEs

Among adults exposed to sexual abuse, 72% reported at least 2 more ACEs

0 ACE38%

1 or More ACE62%

ACEs ARE COMMON

IN THE LIVES OF WASHINGTONIANS:

Adverse Childhood Experience & Population Health in Washington: The Face of a Chronic Public Health Disaster - Results from the 2009 Behavioral Risk Factor Surveillance System

http://www.fpc.wa.gov/publications/ACEs%20in%20Washington.2009%20BRFSS.Final%20Report%207%207%202010.pdf

http://www.fpc.wa.gov/publications/ACEs in Washington.2009 BRFSS.Final Report 7 7 2010.pdf



INDICATORS ARE A USEFUL BUT PUNY SHADOW OF THE REALITY OF HUMAN LIVES

We are likely used to working with “Risk, Protective, Resiliency, Asset Factors ” data…conditions known to be antecedent to or empirically associated with a problem.

These factors are typically used in three ways:

1. SET GOALS: As short term desired results e.g. reduce risk and improve protective, resiliency or asset factors

2. PRIORITIZE: As a way to prioritize a population or select a particular service

3. LEARN & IMPROVE: To understand interrelationships among at-risk behaviors and thereby design strategic action with limited resources

CHRONIC DISEASE

ALCOHOL, TOBACCO,

DRUGS

PSYCHIATRIC DISORDERS

RISKY SEX

IMPAIRED COGNITION

WORK/SCHOOLAttendance, Behavior,

Performance

GENETICSIncluding gender –

Remember that experience triggers gene expression

(Epigenetics)

CRITICAL & SENSITIVE

DEVELOPMENTAL PERIODS

early childhood, ages 7-9, pre-puberty,

aging into adulthood

ADVERSE CHILDHOODEXPERIENCE

MORE CATEGORIES – GREATER IMPACTPhysical Abuse, Sexual Abuse

Emotional Abuse, NeglectWitnessing Domestic Violence

Depression/Mental Illness in HomeIncarcerated Family Member

Substance Abuse in HomeLoss of a Parent

ADAPTATIONHard-Wired Into

Biology

BRAIN DEVELOPMENT

Electrical, Chemical, Cellular Mass

CRIME

OBESITY

POVERTYINTERGENERATIONAL

TRANSMISSION, DISPARITY HOMELESSNESS

UNEMPLOYMENT

STUDY FINDINGS CHALLENGE MENTAL MODELSFocus doesn’t have to mean “choose one…”

Cause-effect isn’t always a simple relationship…

Where is there no resistance to understanding a many-to-many

relationship:Cumulative cause multiple effects?

WHAT’S THE POTENTIAL?

1. Bend the health care cost curve

2. Drastically reduce disorders and disability

3. Stop disastrous cycles of intergenerational poverty

4. Afford for all children • optimal development, • school completion, • arrival at adulthood with full potential for employment

success and a lifetime of well-being.

5. Generate the kind of public will that supports sustained efforts for a full generation or more.

6. Improve workforce productivity; lower business costs; Improve global competitiveness ; boost and sustain economic recovery

Will Help People:

Learn and Improve

• Understand drivers of mental, behavioral, physical health

• Give people clear facts that generate opportunities to “tell everyone”

Set Goals

• Identify high-risk communities with greater precision – stop generational transmission

• Leverage resources and partnerships to achieve greater impacts

Prioritize

• Invest More Wisely – Lower Costs

• Help parents to organize their lives ad support networks so their children have fewer ACEs than they have

ADVERSE CHILDHOOD EXPERIENCE DATA

EVENTS

PATTERN

Gen

era

lly S

een

Gen

era

lly

Un

seen

What we did…

STRUCTURE

MENTAL MODELS

VALUES

COLLECTIVE ACTION

Tell Everyone

Surface MM

Act from Future

Purpose, Process, Principles

Notice, Reward, Feedback

Help, Support, Document

Adapted from the Systems Thinking Iceberg

EDUCATION AND TRAINING EXPANDS LEADERSHIP

6/22/2012 4th ICCP 2012 Barcelona 36Family Policy Council Education Plan; Goldstine-Cole; 2007

TECHNICAL ASSISTANCE

Brokering Connections

Experts Peers Agencies

Illuminating what needs

to be noticed

Exceptional Results

Positive Gossip

Public Displays

On-site Assistance

Co-leadingThought partner

Tools and skill building

Appreciative Feedback

Offering Innovation

Assisting with data

Incentive Grants for innovation

Educational Materials

Providing Guidance

Operational audits

Start-up Frameworks

Key Processes

Frameworks for action


ADVERSE EXPERIENCE & ELEMENTARY SCHOOL CHILDREN

FINDINGS:

1. Adverse Events are the greatest single predictor for health, attendance, behavior

2. Adverse Events are the second strongest predictor for academic failure (after special education status)

3. The relationship between academic achievement and health status appears much less related to income than to AEs

Dr. Chris Blodgett, Washington State University, Area Health Education Center

2101 children, ages 5-12, from 9 schools, randomly selected; about 50% of student population

Four of the schools are non-Title-One schools, five are Title-One schools

Adverse events include: referral to child protective services, family violence, exposures to community violence, residential instability (using McKinney Vento definition

Population

Average-

10th Grade

.

.

ACE SCORES AMONG PARENTING ADULTS WHO EXPERIENCED CHILD ABUSE

PopulationAverage:

78% have 3

or more ACEs

29% have 6 or more

ACEs

CAPABILITY

ATTACHMENT & BELONGING

COMMUNITY, CULTURE,

SPIRITUALITY

KEY SYSTEMS FOR RESILIENCE

8% 8% 7%

10% 10%

12%

17%16%

17%

25%23%

35%

0%

5%

10%

15%

20%

25%

30%

35%

40%

0 ACE 1 ACE 2ACE 3 ACE 4-5 ACE 6-8 ACE

Perc

en

t U

nem

plo

yed

PEOPLE WITH SUPPORT & HOPE ARE MORE LIKELY TO BE EMPLOYED

High Resilience Score Low Resilience Score

SOCIAL &

EMOTIONAL SUPPORT

FEELING FORTUNATE

HOPE

• How might we systematically build on the strengths of children affected by early maltreatment?

• What academic and social supports might we reasonably provide?

• How might we support communities where a large portion of the population have 6-8 ACEs?

• What do we know about mitigating effects? How might we learn more?

Competitive or Aggressive?

Decisive or Impulsive?

Irritable or Passionate?

Independent or Detached?

Lacking Empathy or Rational?

Protecting Interests or Hypervigilant?

EVENTS

PATTERNS

Gen

era

lly S

een

Gen

era

lly

Un

seen

In the Lincoln High School Story,

It took time; Listen for:

STRUCTURE

MENTAL MODELS

VALUES

COLLECTIVE ACTION

What MM had to change?

What did they re-structure?

Adapted from the Systems Thinking Iceberg

Take a learning systems approach

Form long-term partnership commitment with community leaders

Structure staff for both short and long term needs

Develop an education framework that unites people across professional disciplines, class lines, sectors, etc.

Hold a fundamental respect for the wisdom of every person – their culture, experience, capabilities, and aspirations

KEYS TO SUCCESS

ACE reduction reliably predicts

simultaneous decrease in all of these conditions.

Population attributable risk

MAGNITUDE OF THE SOLUTION

community magnitude for ace prevention & response4.2 million adults involved: 2.1 million in...

Documents