Learn more about “the past” and how we can change its affect on our health. Presenters: Matthew Doll, PhD & Heather Schmidt, DO

1. Adverse Childhood
Experience (ACE)
& Resiliency
Matthew Doll, PhD
Heather Schmidt, DO

2. Strength-Based Model
Not asking “What’s wrong with you?” but
asking, “What happened to you?”
Helps reframe people’s history so they know
they were not born bad, that they are not
responsible for their childhoods, and that
they can have hope to change their lives and
their children’s lives.
Personal responsibility with the power of
self-understanding.

4. The Five Parts of ACE’s Science
ACE surveys - who, how many, with what
consequences.
Toxic stress effects on the brain
Toxic stress effects on the body
Toxic stress passed from generation to
generation
Resilience research

5. Trauma Derails Development
Exposure to trauma causes the brain to develop in a way
that will help the child survive in a dangerous world.
Children with traumatic histories often operate within
“survival of the moment.”
Higher order brain functions are temporarily put on hold.
Verbal encoding may be put on hold.
Actions and responses are generated at lower levels of
the brain (e.g. limbic system).
Limbic system increases heart rate and blood pressure to
increase flow to muscles, so blood flow selectively
diverted to parts of the body necessary to survival.

6. Stunning difference between a brain with proper
stimulation and one that has been deprived.
- Bruce Perry, Baylor College of Medicine

7. Relationships are the Basis of a
Child's Stress Response System
0
1
2
3
4
5
6
Child's Arousal
Over Time with
Attuned Caregiving

8. Relationships are the Basis of a
Child's Stress Response System
Adapted from B. Perry, MD, PhD. (2009)

9. Put Simply…
The pattern of fear, threat, unpredictability,
frustration, chaos, hunger and pain over-
stimulates the brain leading the child to
develop a high-stress pattern.
Can be mitigated by individual difference in
resiliency, supportive relationships.
Many adults continue to struggle
unrecognized/untreated.

10. The Invisible Suitcase
Trauma shapes beliefs and experiences
About ourselves
About those who care for us
About those we care for
About the world we see

11. Attachment
 Earliest relationships critical for capacity to
self-regulate.
 Perspective taking - 10 out of 10 children
securely attached to mothers that can do
this, versus one out of 17 that can’t.
 Still Face Experiment (2:49)
https://www.youtube.com/watch?v=apzXGEbZht0

12. Attachment, cont.
Neglectful and traumatic early relationships
set up a person to respond with
dysregulation when “triggered” in
subsequent relationships.
60 percent of the general population is
thought to have disturbed attachment.
Remember - we can help each other here!
Model and act with compassion.

14. Early Death
Burden of disease,
distress,
criminalization,
stigmatizaton
Coping
Allostatic Load, Disrupted
Neurological Development
Complex Trauma/ ACE
Race/Social Conditions/ Local Context
Generational Embodiment/Historical Trauma

16. ACE-Related Odds Of Having a Physical Health Condition
Health Condition 0 ACEs 1 ACEs 2 ACEs 3 ACEs 4+ ACEs
Arthritis 100% 130% 145% 155% 236%
Asthma 100% 115% 118% 160% 231%
Cancer 100% 112% 101% 111% 157%
COPD 100% 120% 161% 220% 399%
Diabetes 100% 128% 132% 115% 201%
Heart Attack 100% 148% 144% 287% 232%
Heart Disease 100% 123% 149% 250% 285%
Kidney Disease 100% 83% 164% 179% 263%
Stroke 100% 114% 117% 180% 281%
Vision 100% 167% 181% 199% 354%
Source: Iowa ACEs 360

20. “Male child with an ACE score of six has a
4,600 percent increase in likelihood of later
becoming an IV drug user when compared to
a male child with an ACE score of zero. Might
heroin be used for the relief of profound
anguish dating back to childhood
experiences? Might it be the best coping
device that an individual can find?”
(Felitti et al, 1998)
Harvard Report on Cancer Prevention, Cancer Causes and Control 1999;10:167.
ACE Study

21. Therefore…
We need to presume the clients we serve
(and ourselves) have a history of traumatic
stress and exercise “universal precautions”
by creating systems of care that are
trauma informed.
(Hodas, 2005)

24. Paper Tigers (2:11)
https://www.youtube.com/watch?v=iV3wzUhJSKs

25. Other Factors
Influencing Stress
Sources of Resilience
Temperament
Social-emotional supports
Learned social-emotional skills
Caregiver response
Other Vulnerabilities
Temperament
Delays in development
Limited social-emotional supports
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013

28. Resources at
Agnesian HealthCare
Wellness…..
 Integrated care
 The Zone & RMC Wellness Center
 Spiritual Care Services
 Behavioral Health Services
 Employee Assistance Program
 Health Resource Center at St. Agnes Hospital
 Yoga classes
 Mindfulness classes
 Meditation classes
 Cooking classes
 And more!

29. Time to Think About Self-Care
 Own ACE score
 Vicarious trauma
 Have to care for self
when caring for others
 Belly breathing, four
square, lazy 8,
Breath2Relax….
 Safe place image
 Laugh….a lot!

30. What We Want To Do
 When people start escalating or display
inappropriate behaviors, be empathetic, be
calm, show care and concern.
 We want to ask questions - but not what we
sometimes do, “Look at Henry, there he goes
with his old tricks again.”
 We want to ask: “What might we be doing that
is triggering for him? What might we not be
doing that could support him?”

31. The Goal
The entire community…
…integrates trauma-informed/resilience-
building practices…
…based on ACEs science.

32. Current State
 Doll & Associates has been conducting ACE
assessments since 2014.
 There is much interest within Agnesian HealthCare:
Executive Team; Heather Schmidt, DO; Ed Kartheiser;
Michael DeGere, DPM; Sr. Mary Mollison; Tiffany
Parker; Jim Mugan
 Community interest: Agnesian HealthCare
Foundation grant to support FDLSD, Law
Enforcement, Department of Social Services, Fond
du Lac County, Jim Salasek facilitates regular
meetings (CSIFDL.org).

33. Epigenics and Bob Marley
https://m.youtube.com/watch?v=uHAs0QkJ3dQ
1:22-2:39 1:17min

34. Discussion & Questions

35. Resources
 www.CSIFDL.org - Working for safe and healthy schools and communities
in Fond du Lac County.
 SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed
Approach - How an organization, system or service sector can become
trauma informed.
 www.ACEsConnection.com – A social network for people who are
implementing trauma-informed and resilience-building practices based on
ACEs research.
 ACEsTooHigh.com - A news site for the general public.
 The CDC-Kaiser Permanente ACE Study - The official ACE Study site,
provided by the CDC.
 The Center on the Developing Child at Harvard University – Reports, tools
and videos about the neurobiology of toxic stress and resilience.