Snohomish County Reclaiming Futures: Responding to ACES in the Juvenile Justice Community

Responding to ACES in the Juvenile Justice Community
Joe Neigel
Reclaiming Futures Change Team
September 24, 2015

Our Goals Today
Review the Adverse Childhood Experiences Study and how
early life trauma influences behavior and health.
Discover how ACES impact youth in Snohomish County.
Consider strategies the Reclaiming Futures Change Team
can promote and adopt to mitigate the impact ACES have
on youth engaged in the juvenile justice and substance use
disorder treatment systems.

Adverse Childhood
Experiences Study (ACES)
ACES began as a weight-loss study at Kaiser-Permanente in
Southern California. It became the largest study ever
completed to examine the health and social effects of
traumatic childhood experiences over the lifespan.
 Middle class, average age of 57
 80% white, 10% black, 10% Asian
 74% some college
 44% graduated college
 49.5% men
Examines three general forms of abuse
and household dysfunction.

The Adverse Experiences
• Child physical abuse
• Child sexual abuse
• Child emotional abuse
• Neglect
• Mentally ill, depressed or suicidal person in the home
• Drug addicted or alcoholic family member
• Witnessing domestic violence against the mother
• Loss of a parent to death or abandonment, including
abandonment by divorce
• Incarceration of any family member

ACEs in Snohomish County
0.00%
10.00%
20.00%
30.00%
40.00%
0 1
2
3
4 or
More
35.30%
22.90%
12.60%
9.20%
20.10%
Snohomish
Washington

ACE Study Findings
 ACEs are very common.
 They are well-concealed.
 The ACE Study found that the number of categories,
not necessarily the frequency or severity of the
experiences within a category, determine health
outcomes across the population as a whole.
 ACEs are strong indicators of what happens later in
life, in terms of health risks, diseases and premature
death.

The Science Behind ACES
 A child’s environment and experience
shapes their behavior and health.
 Our brain is designed to prioritize
survival.
 Cortisol is released when our “Fight,
Flight, or Freeze” response is triggered.

Toxic Stress
 Prolonged exposure to Cortisol is toxic, and
makes permanent changes to the brain.
 This means you may encounter young
people who are perfectly suited to survive in
their home environment, but may not know
how to act in the classroom, community or
other “normal” situations.

Recognizing some signs of traumatic
brain development
 Hypervigilance - “Always on the ready.”
 Display of trauma induced ADHD symptoms, including an
inability to stay on task or follow directions.
 Early onset of sexualized behaviors and activity.
 More impulsive, aggressive and disruptive
behaviors, including those leading to
suspension or arrest.
 Being less able to tolerate stress.

Other Negative Effects
 Prolonged exposure to Cortisol is shown to have negative effects, such as:
 Impaired cognitive performance
 Weakened immune system
 Hyperglycemia (fatigue, excessive thirst/urination)
 Decreased bone density
 Decrease in muscle tissue
 Higher blood pressure
 Slower healing, and other health consequences
 Increased risk of physical and mental health problems, including
development of health risk behaviors

Graded Relationships in
Health Risk Behaviors
• There is a strong “dose/response” relationship
between a person’s ACE score and the likelihood
they will adopt personal solutions that lead to
serious health problems.
• Dose/Response is a direct measure of “cause and
effect.”

Dose-Response:
More Gas = More Miles
0
50
100
150
200
250
300
350
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
NumberofMilesYouCanDrive
(Response)
Gallons of Gas
(Dose Gets Bigger)

Smoking
• We can see the cause and effect relationship
ACEs create in people and in populations.

Alcoholism

Intravenous Drug Use

Chronic Depression
0
10
20
30
40
50
60
70
80
0 1 2 3 >=4
%WithaLifetimeHistoryof
Depression
ACE Score
Women
Men

Attempted Suicide

ACEs lead to risk factors for the 10
most common causes of early
death in the United States

Reframing Our Point of View
• With an ACE score of 0, the majority of adults have few, if any,
risk factors for diseases leading to early death
• With an ACE score of 4 or more, the majority of adults have
multiple risk factors for these diseases, or the diseases
themselves.
• Prepare yourself for this –
Much of what we see as problem behaviors
should actually be viewed as a
personal solution to an unrecognized prior
adversity.

ACEs Impact Every Classroom in
Snohomish County
We also know ACES drive :
• Special education
needs
• Grade repetition
• Problems at school

Getting to Know Mallory
• Mallory is in the 8th grade in Monroe School District.
• Her counselor knows Mallory’s mother physically
abused the girl in her past. As a result, Mallory’s known
ACE Score is “1.”
• Keep in mind - ACEs travel in clusters:
Among people exposed to physical abuse,
84% report at least 2 additional ACEs.
• (Research shows childhood physical abuse leads to
higher rates of self-reported total offending, violent
offending, and property offending, even after
controlling for prior delinquent behavior)
(Teague, Mazerolle, Legosz, & Sanderson, 2008

Mallory’s Grades
Mallory appears to have trouble paying attention
in class. She doesn’t turn in her homework and
seems to have a hard time following directions; her
grades reflect this.
• Students like Mallory, who indicated being
victims of physical abuse on the Healthy Youth
Survey, were nearly twice as likely (1.8x) to
report getting C’s, D’s and F’s.

Bullying and Safety at School
Mallory has trouble making lasting friendships
and is frequently the target of bullying behavior.
• 8th graders like Mallory, who indicated they had been
physically abused by an adult, were:
 Nearly twice as likely (1.9x) to report being the
victims of bullying.
 3.6x more likely to report
missing days of school
because they felt unsafe.

Mallory’s Mental Health
Mallory seems pretty disengaged in class and
always looks tired. She can’t seem to remember
facts from 10 minutes ago.
• Students who report being physically abused by an
adult were more than twice as likely (2.4x) to report
being depressed on the most recent HYS.
• Students like Mallory were also 3.5x more likely to
report contemplating suicide.

Mallory’s Personal Solutions
Mallory was caught bringing a flask of alcohol to school
in 7th grade. She talked with Sandra Olson and avoided
most of her suspension, but she and her family really
haven’t engaged with any helping adults since then.
• Students like Mallory are 3.4x more likely to report
current alcohol use, and
• They are 4x more likely to indicate any other type
of current drug use, including Marijuana use.

Mallory’s in every classroom
1 in 4 8th graders in Snohomish County indicated they had been physically
abused by an adult on the most recent Healthy Youth Survey.

ACE Effects in School
Low School Engagement
Source: National Survey of Children’s Health, Johns Hopkins University (2012)
0%
10%
20%
30%
40%
50%
60%
0 ACE 1 ACE 2 ACE 3+ ACEs
The student only “sometimes,” “rarely,” or “never” cares about school or does all the required homework.

Does Not Finish Tasks Started
0%
10%
20%
30%
40%
50%
60%
The student “sometimes,” “rarely,” or “never” finishes tasks he starts or follows through with what he says he will do.

Highly Externalizing Behavior
0%
5%
10%
15%
20%
25%
30%
35%
40%
The student “usually” or “always” argues too much or “sometimes,” “usually,” or “always” is cruel, mean to, or bullies others.

Household Contacted Due to Problems at School
0%
10%
20%
30%
40%
50%
60%

Grade Repetition
0%
5%
10%
15%
20%
25%

ACE Effects in Juvenile Justice
OJJDP’s Journal of Juvenile Justice published a juvenile justice study in
Spring, 2014.
• Examine the prevalence of ACEs in a population of 64,329 juvenile
offenders in Florida.
• JJ–involved youth more
likely to experience multiple
forms of trauma
(Confirmed Pierce County
Study finding these youth
are 3x more ACES than
initial study population)

Gender

Type of Trauma

Re-offense Risk (PACT Full Assessment)

Beyond the Detention Pod
Life-long Negative Outcomes Linked to ACEs
Partial List of ACE Dose/Response Outcomes
Alcoholism & alcohol abuse School Drop-Out
Chronic obstructive pulmonary
disease & ischemic heart disease
Intimate partner violence—
perpetration & victimization
Depression and other MH issues Sexually transmitted disease
Chronic Unemployment Obesity
High risk sexual activity Suicide attempts
Illicit drug use Unintended pregnancy
Intimate partner violence Early Death
Three or more marriages Increased Emergency Room Use
Increased Pharmacy Use Significant Financial Problems

What Are the Implications?
To put it simply, childhood experiences are the most
powerful determinants of who we become as adults.

Population Attributable Risk
 PAR = The difference in rate of a condition
between an exposed population and an
unexposed population.
 In this case, it is a calculation used by the
CDC to estimate the proportion of a health
outcome that is attributable to ACE
 Takes into account:
The increased risk due to each level of ACE
The prevalence of the number of ACE categories

Current Smoking
Smoking Not
Attributable to
Ace
Smoking
Attributable to
ACE
78.3%
21.7%
Risk data from Felitti, et. Al: PAR analysis: RE Voorhees

Ever Using Illicit Drugs
32.1% not
attributable to
ACE
67.9%
attributable to
ACE
67.9%
32.1%

Alcoholism
3.2% of self-
reported
alcoholism not
attributable to
ACE
96.8% of self-
reported
alcoholism
attributable to
ACE
96.8%
3.2%

Reporting Having Attempted Suicide
0% of
attempted
suicide not
attributable to
ACE
100% of
attempted
suicide is
attributable to
ACE
100%

How ACES Increase Suicide
Attempts
Less than 1 of 100 people with 0 ACEs attempt suicide
10 of 100 people with 3 ACEs attempt suicide
20 of 100 people with 7 ACEs attempt suicide

ACEs Path
“Personal
Solution”

ACEs Impact Mortality
0
10
20
30
40
50
60
0 2 4
PercentinAgeGroup
ACE Score
19-34 35-49
50-64 >=65

Psychological Depletion
• Whether you like it or not, you and your staff
are on the ACEs frontline.
• The constant demand of responding to the
trauma experience of others can lead to
burnout:
• Illness
• Chronic fatigue
• Emotional exhaustion
• Indifference or detachment
• Isolation from colleagues
• A lack of personal satisfaction

• Trauma-informed communities and agencies can create
an environment where young people with injured brains,
and the adults who serve and care for them, will thrive.
• Evidence-based Kernels can lead you from intuitive
responses to intentional action.
• Consistent and predictable environments are the key to
working successfully with trauma-impacted youth.

• Mood is your internal emotional state.
• Affect is how you externalize your emotions through
verbal and non-verbal cues.
• Research shows that trauma-impacted youth are
particularly aware of changes in affect, which trigger the
fight, flight, or freeze response and decreases the
capacity to learn.
Attachment, Self-Regulation & Competency
Kinniburgh, Blaustein, Spinazzola & van der Kolk, 2005, Psychiatric Annals, pp. 424-430.
ARC - Managing Affect

• Traumatized children often have difficulty
communicating, so their behaviors may then become a
“front” for conveying unmet needs or their own
unregulated affect.
• Adults may respond to the most distressing symptom,
rather than the underlying emotion or need.
• Ask - “What’s happening here?” rather than “What’s
wrong with this child?”
ARC - Attunement

• Being predictable and having consistent responses to
behavior are vital to establishing safety and reducing a
child’s need to exert control.
• Traumatized children may initially react to negative or
positive responses.
• An intentional focus on building success, rather than
establishing limits – which may be associated with
powerlessness or vulnerability – should be your priority.
ARC - Consistency

• Building daily routines and rituals, particularly around
trouble areas, can make your setting fun and predictable.
• Research shows that establishing routines enhances
student:
 Feelings of safety
 Ability to build trust and feeling of reliability within a
relationship
 Anticipation of the event
ARC - Routines & Rituals

• Kernels are low or no-cost to implement.
• That means we can unleash access to strategies that
support safety, relationship and skill building essential to
the foundations of successful brain development.
• Kernels give us a way to implement
evidence based practices that will
interrupt the ACES trajectory
and improve outcomes.

• A kernel is the smallest unit of scientifically proven
behavioral influence.
• Kernels produce quick easily measured change that
can grow into much bigger change over time.
• They can be used alone OR combined with other
kernels to create new programs, strategies or
policies.
• Combinations of Kernels are
considered “behavioral vaccines.”
• “Planted” Kernels create a culture.
Kernels

The alterations in brain chemistry that have resulted from our
changing diet during the last 50 years contributes to trends of
depression, bipolar disorder, autism, violence and academic
problems.
Omega-3 Deficiency

Snohomish County Reclaiming Futures: Responding to ACES in the Juvenile Justice Community

Kernel: Omega-3 Supplementation
• Omega 3 has no harmful effects
• Well-documented evidence for Reducing aggression,
depression, anxiety, bipolar disorder, post partum
depression and borderline personality disorder
• 2002 Oxford University study and 2009 Dutch study
of found Omega-3 supplementation achieved a 37%
reduction in episodes of inmate aggression.
• In 2006, the American Psychiatric Association
recommend that all psychiatric patients receive at
least 1 gram of omega-3 per day to reduce
symptoms of mental illness.

Equipping Parents is Vital
• Parenting classes are THE vital response to
preventing the intergenerational
transmission of ACES.
• Teens from households with poor family
management skills are nearly 3.2x more
likely to report carrying a weapon at
school and 3.6x more likely to report
being a member of a gang.
Source: 2014 Washington State Healthy Youth Survey

Spotlight: Parenting Wisely
Parenting Wisely is evidence-based online
parenting skills program. Extensive research and
clinical tests show that its use results in:
• Increased knowledge and use of good
parenting skills
• A decrease in youth behavior problems
• Improved problem solving
• Reduced spousal violence and violence
toward children
Success of the program has earned it the ranking
as a SAMHSA “Model Program” and an OJJDP
“Exemplary Program.”
Cost: $33 or less

• Also known as “handshakes.”
• Frequent friendly physical and
verbal greetings impact social status
and perceptions of safety and harm.
• It also affects behavior streams
of aggression, hostility and
politeness.
Kernel: Pleasant Greeting
with Physical Touch

When any person receives specific,
spoken recognition for engagement in
a target act or behavior, it is widely
demonstrated to:
• Improve school performance
• Improve adult/child interactions
• Improve organizational functioning
• Increase the frequency of the target
behavior
Kernel: Verbal Praise

Verbal Praise As a Social Reinforcer
What are the social reinforcers at your
agency for this behavior?
Paying attention.

Verbal Praise As a Social Reinforcer
How about for this behavior?
Showing off.

• Physical Play - Increases the child’s ability to have
healthy relationships.
• Non-Directive Play – When the parent sits beside the
child and describes out-loud what the child is doing –
improves the relationship with the parent, increases
the happiness and contentment of the child, and
results in greater attention span, improved creativity
and resourcefulness.
• Parent/child play is associated
with lower rates of delinquency,
substance abuse problems and
psychiatric disorders such as
depression and anxiety problems.
Kernel: Play

• “Turtle Breathing” is a technique for helping
children with controlling anger.
• Some parents use this technique in
conjunction with the scripted story, “Tucker
Turtle Takes Time to Tuck and Think.”
• This technique:
– Reduces anxiety
– Reduces temper tantrums
– Increases resiliency
– Increases self-control
Kernel: Turtle Breathing

Kernel: Peer to Peer Notes
Notes of praise written from one peer to
another, then read aloud or posted on a
public display is widely shown to:
• Increase positive friendships
• Reduce neighborhood
disorganization and
crime
• Increase sense of safety
• Increase volunteerism
• Increase behaviors you
want to see more of

Kernel: Adult to Child Notes
• Notes from adults to children
recognizing them for a SPECIFIC action
or behavior is demonstrated to help
students of all ages to:
• Do better at school
• Be more socially competent
• Reduce ADHD, aggression
and problem behaviors
• Increase the behaviors you
want to see more of

Kernel: Beat the Timer
Beat the timer makes daily routines
run smoother, reduces parent/child
conflict and reduces accidental
attention to negative behavior.
Research shows that this simple game:
• Increases compliance
• Increases accuracy and
completion of homework
• Helps with chores

Beat the Timer
Steps:
• Announce Beat the Timer
• Say how long the timer will be set for
• Say what behaviors are to beat the
timer
• Announce the timer is about to begin
• Praise positive behavior while timer is
ticking
• Celebrate success and occasionally
reward

Kernel: Copy Cat
(Paragraph Shrinking)
• After talking with your student, ask
him to repeat what was said in 8-10
words.
• Repeat if summary is poor.
• Praise if the summary
is good.
• Helps with retention
and understanding of
what is said or read.

Kernel: Positive Note Home
for Inhibition
When an adult sends a positive note home with
a student for inhibiting an otherwise disruptive
behavior, good things happen, particularly when
a reward at home occurs in response.
This strategy is demonstrated to reduce
disruptive and aggressive
behavior, problems at home
and increases engagement
at school.

Kernel: Status Figure Lottery
When a status figure sends a note home or calls
a parent about a student’s positive behavior,
research shows that action results in:
 Increases in academic achievement
 Reductions in disruptive behavior
 Reductions in aggression

Kernel: Auditory/Visual Signal for Transition
The attention kernel works for students and
adults. It results in:
 Immediate reduction in transition time
 Increased academic engagement
 Reduced disruptive behavior
 Reduced aggression and bullying
 Reduced trauma response in traumatized people.

Kernel: Premack’s Principle
Also known as Contingency Management, the
Mystery Motivator, Granny’s Wacky Prizes,
Prize Bowl and the Game of Life.
Results in a reduction in deviant behavior
across the lifespan, reduces problem behavior
at school, increases desirable behavior in all
age groups and reduces addiction.
 Motivates youth and adults
to do their best and improve
 Taps into “intrinsic” motivations
 Fosters self-regulation instead
of excitement

Contingency Management by the Numbers
Effects of a randomized contingency management intervention on opiate abstinence and retention in methadone maintenance treatment in China.
Hser YI, Li J, Jiang H, Zhang R, Du J, Zhang C, Zhang B, Evans E, Wu F, Chang YJ, Peng C, Huang D, Stitzer ML, Roll J, Zhao M.
Addiction. 2011 Oct;106(10):1801-9. doi: 10.1111/j.1360-0443.2011.03490.x. Epub 2011 Jul 27.
PMID: 21793958

Kernel: Brain on the Ball
• Suitable for preschoolers through adults
• Sitting on therapy balls is shown to increase
attention, improve academic achievement,
reduce ADHD symptoms without
medication and reduce disruptive behavior

The Social Development Strategy

Other Kernels
 Graphic/Node Maps
 Choral Responding
 Peer to Peer Tutoring
 Nasal Breathing
 Random Calling
 Private Reprimands
 More!

The Bottom Line
• Reclaiming Futures asks why Treatment and other interventions
are unsuccessful for many juvenile justice involved youth.
• It may not be because of substandard care or a lack of
community supports… we may need a paradigm shift.
• Remember Kaiser Permanente’s diet and nutrition program
dropouts? The researchers learned that their very successful
intervention wasn’t just treating nutrition problems,
it was treating personal solutions!
• Take away a person’s solution before
they discover a better one, and you’re
just digging a hole for them to fall
back into.

• Do we routinely screen for trauma exposure and related symptoms?
• Do we make resources available to youth, families, and providers on
trauma exposure, its impact, and treatment?
• Do we engage in efforts to strengthen the resilience and protective
factors of youth and families impacted by and vulnerable to trauma
(think Kernels)?
• Do we address parent and caregiver trauma and its impact on the
family system?
• Do we maintain an environment of care for staff that addresses,
minimizes, and treats secondary traumatic stress, and that increases
staff resilience?
Policy Discussion Questions

Spotlight: Think Trauma
The National Child Traumatic Stress Network has a
Juvenile Justice training curriculum for Juvenile
Corrections Staff
• Respond appropriately to the behavioral and
emotional challenges of traumatized youth
• Help traumatized youth develop the ability to
recognize trauma or loss reminders
• Help traumatized youth recognize and develop
their strengths
• Help traumatized youth recognize survival coping
strategies and develop positive coping strategies
needed to grow into a healthy, productive, and
functional adult
• Take care of themselves and seek support from
others

Resources
Presenter: Joe Neigel
Monroe Community Coalition
200 E Fremont
Monroe, WA 98272
(360) 804-2594
neigelj@monroe.wednet.edu
Power Point: http://www.slideshare.net
Kernels: http://promiseneighborhoods.org/kernels/
Or
http://bit.ly/embry_kernels
ACES: http://www.cdc.gov/ace/index.htm
Or
http://www.acestudy.org/
Or
http://www.fpc.wa.gov/
Or
http://www.acestoohigh.com
ARC Training: http://www.traumacenter.org/research/ascot.php
OSPI Initiative: http://www.k12.wa.us/CompassionateSchools/

Spotlight: The Seven Challenges
Imagine going to a depression support group
where the only rule was that you couldn’t show
up depressed… this is essentially the restriction
that abstinence focused treatment programs
place on youth.
• Seven Challenges treatment programs don’t approve
of youth using drugs in the early stages of the
program, but it does acknowledge that youth need to
make the decision for themselves.
• The Seven Challenges is successful because it helps
youth understand what needs they are meeting by
using drugs, what harm they are causing, what risks
they are taking, and what it entails to make lasting
change. Then, when a decision is made, they learn the
tools and receive support that ensures success.

Snohomish County Reclaiming Futures: Responding to ACES in the Juvenile Justice Community

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