Sally Ember's Blog, page 26

My Notes, Thoughts, Resources and Recommendations for “Trauma-Informed” Education/Care and ACEs (Adverse Childhood Experiences)

My Notes, Thoughts, Resources and Recommendations

for “Trauma-Informed” Education/Care

and ACEs (Adverse Childhood Experiences)

For those of us old enough to remember or who have studied sociology, psychology and/or education prior to 2000, there were precursors to this research: Risk Factors, which ACEs are a subset of, as well as Protective Factors and Resilience. For more about this important research, go here or https://youth.gov/youth-topics/youth-mental-health/risk-and-protective-factors-youth:

Relevant to ACEs are the Common Risk Factors for Childhood and Adolescent Problems, by Level of Influence

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image from Devereux Center for Resilient Children

Environmental Risk Factors Factors

—Laws and norms favorable to antisocial behavior

—Poverty and economic deprivation

—Low economic opportunity

—Neighborhood disorganization

—Low neighborhood attachment
Interpersonal and Social Risk Factors Factors

—Family communication and conflict

—Poor parent–child bonding

—Poor family management practices

—Family alcohol and drug use

—School failure

—Low commitment to school

—Rejection by conforming peer groups

—Association with antisocial peers
Individual Risk Factors Factors

—Family history of alcoholism

—Sensation-seeking orientation

—Poor impulse control

—Attention deficits

—Hyperactivity
Adapted from Fraser et al., 2004; Jenson & Howard, 1999; and Hawkins et al., 1998

from https://us.corwin.com/sites/default/files/upm-binaries/5975_Chapter_1_Jenson_Fraser__I_Proof.pdf

Some heart-wrenching causation connections between childhood stress and adult medical problems have already been made:

—“…[M]ost adult women with fibromyalgia [emphasis mine]… have had stressful childhoods as reported by the journal, Stress and Health in 2009….The early chronic experience of stress appears to exert a much larger influence in contributing to the pain of fibromyalgia than any current stressful life event, as a 2006 study reported in the journal, Psychoneuroendocrinolgy. from http://medicalhealthnews.info/fibromyalgia-linked-childhood-stress-unprocessed-negative-emotions-2/

The relationships between childhood experiences (“nurture”) and adult health have long been the subject of research. One precursor to ACEs research, for almost thirty years, the information derived from the biannual Youth Risk Behavior Survey (YRBSS) has been instrumental in determining what communities’ needs were, what prevention areas to focus upon, and how prevalent certain risky behaviors were over time because the USA government, in conjunction with state and municipal authories and school systems, began administering the YRBSS in 1990 and continues to this day, in odd years. Much of the data from the YRBSS overlaps with data needed and gathered about ACEs. See below.

The YRBSS (https://www.cdc.gov/healthyyouth/data/yrbs/overview.htm) was developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability, and social problems among youth and adults in the United States. These behaviors, often established during childhood and early adolescence, include

Behaviors that contribute to unintentional injuries and violence.
Sexual behaviors related to unintended pregnancy and sexually transmitted infections, including HIV infection.
Alcohol and other drug use.
Tobacco use.
Unhealthy dietary behaviors.
Inadequate physical activity.

In addition, the YRBSS monitors the prevalence of obesity and asthma and other priority health-related behaviors plus sexual identity and sex of sexual contacts.

From 1991 through 2015, the YRBSS has collected data from more than 3.8 million high school students in more than 1,700 separate surveys.

ACEs research and subsequent work are building on all of these studies their data to help us advance in our understands, prevention, intervention and mitigation of trauma. The ACEs researchers began with this survey and its 10 categories (see below).

The 10 ACEs (Adverse Childhood Experiences) are, in summary form:

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image from https://cdv.org/what-is-cdv/adverse-childhood-experiences/

If you want to have each category be more fully defined (and some of them do include aspects you might not usually consider, so I recommend reviewing these if you haven’t, yet), go here, where you can actually “fill out” the survey at the same time:

https://www.ncjfcj.org/sites/default/files/Finding%20Your%20ACE%20Score.pdf

However, if you find all this obvious, so is your score: you get one point for each of the ACEs that occurred in your childhood (before age 18 years old). The total of these = your ACEs score.

This ACEs number is important for examining the likelihood (statiscally speaking) of your having adverse consequences later in life (see below). The stats have three sections:

—> 0, 1 or 2 ACEs

—> 3 – 7 ACEs

—> more than 7 ACEs

The statistics tended to group in these ways in recognition of what types and how many negative consequences were most likely to occur for those with those ACEs numbers. Below is a description of the original study.

The Adverse Childhood Experiences (ACEs) Original Research:

“From 1995 to 1997, Kaiser Permanente’s Health Appraisal Clinic, in collaboration with Centers for Disease Control and Prevention, implemented one of the largest studies ever conducted on the origins of risk factors that have negative health and social consequences and the cumulative incidence and influence of psychological and physical abuse including: neglect, sexual abuse, witnessing violence, exposure to substance abuse, mental illness, suicidal behavior, and imprisonment of a family member (independent variables) on dependent variables that were measures of both mental health (depression, suicidality) and physical health (heart disease, cancer, chronic lung disease, skeletal fractures, liver disease, obesity) and health-related behaviors (alcoholism, drug abuse, smoking, high numbers of sexual partners) and poor self-rated health (Felitti et al. 1998).

“The ACE questionnaire was constructed using selected questions from published surveys (American Journal of Preventive Medicine, 2017). Prior to the survey there had been little study of the relationship between early childhood adverse experiences and adult medical problems and behaviors (Felitti et al. 1998).

“The ACE survey data was collected by mail from two waves of a sample of 17,000 adult members of Kaiser’s Health Maintenance Organization in San Diego, California between 1995 and 1997. The sample size itself was impressive. The release of the study findings was shocking to many when they showed the extent to which adverse childhood events negatively shaped future social and physical health outcomes, including life expectancy.

“Perhaps less surprising, the findings showed that the more negative events a child experienced the higher the likelihood s/he had as an adult of suffering an array of health and behavior problems including alcoholism, chronic pulmonary disease, depression, illicit drug use, liver disease, adolescent pregnancy and many more (Centers for Disease Control and Prevention 2014a, b). Further, adults with the highest level of ACEs had a life expectancy 20 years less than those without high levels of ACEs. The study sample did not consist primarily of low-income minority adults, a demographic often found to be “at risk.” It was mainly comprised of white, middle and upper income employed people; people who might be expected to have had more stable childhood environments because of parents’ employment and income.

“The original ACE study has generated more than 70 scientific articles, scores of conference presentations, and has shaped the design of research and as well as social programs. It is beyond the scope of this article to present a comprehensive review of the studies of the ACE survey, but ACEs Too High (2017) provides a list of ACE studies by year.

“Studies using the ACE questionnaire have expanded beyond Kaiser’s sample of white, HMO patients to include, for example, special populations such as children of alcoholics (Dube et al. 2001), and children with an incarcerated parent (Geller et al. 2009) and have found higher prevalences of ACEs than in the original Kaiser sample.

“ACE Studies of justice-involved populations (Baglivio et al. 2014; Messina and Grella 2006; Miller and Najavits 2012; Reavis et al. 2013) including juvenile justice-involved youth (Dierkhising et al. 2013) are raising awareness of the association of early childhood trauma and offender behaviors and needs, as are studies of justice-involved samples that include a focus on childhood trauma without using the ACE questionnaire (Wolff and Shi 2012). The studies consistently find elevated rates of childhood trauma in incarcerated populations and offender groups. For example, the Reavis et al. study (2013) of incarcerated males found ACE scores above 4 to be four times higher than in a normative male population.

“By bringing attention to the powerful impact that negative childhood experiences have on future health and functioning, the ACE study demonstrates the importance of gathering information early in the lives of children and their families and designing early intervention programs that target violence and neglect. It also points to the importance of collecting trauma histories from clients and highlights the essential role of prevention in program design. A particularly important contribution the Ace survey has made to offender and incarcerated groups is to emphasize the importance of trauma-targeted interventions in jails and prisons as well as in diversion programs.”

FMI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409906/

More about How ACEs Operate in Our Lives

This is a depiction of ACEs and their impacts in the form of a “pyramid of bad consequences”: if 3 or more ACEs form our lives’ “foundation,” we are much more likely to have a lot of other problems, including physical and mental health issues, suicidal ideation, criminal tendencies to the point of incarceration, and possible early death in our futures.

Even having 1 or 2 ACEs can wreck a person’s life and/or health if enough mitigating factors aren’t present, especially when the adverse experience was

—horrific,

—happened at a formative time, and/or

—was prolonged/repeated.

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image from https://www.communitycommons.org/2014/08/aces-adverse-childhood-experiences/

This excellent 2014 TEDMED talk on ACEs from a health care perspective

is on video, with presenter, Dr. Nadine Burke Harris, MD

Burke offers the best summary of the study, its origins and findings, and their immediate and long-term applications for health care and other professionals as well as anyone affected by multiple ACEs.

“Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain.

“This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.”

Worth your time to watch: https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime

ACEs High Scores Linked

to Adult Emotional and Physical Health Problems

There is a cycle regarding ACEs that usually occurs. Learning about how this cycle works is first. Then, figuring out how to intervene, interrupt and contravene the impacts can occur next.

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image from https://dribbble.com/shots/2214296-Adverse-Childhood-Experiences-infographic

Know that Adverse Childhood Experiences (ACEs) are common

In case you were wondering about the prevalence of ACEs, here are some recent statistics from a small but supposedly representative sample and their source.

Of the 17,337 individuals surveyed, here is the prevalence of each possible adverse experience, from most to least, represented as a percentage:

—Physical abuse towards the child – 28.3%

—Substance abuse in the household – 26.9%

—Parental separation/divorce – 23.3%

—Sexual abuse toward the child – 20.7%

—Mental Illness in the household – 19.4%

—Emotional neglect towards the child – 14.8%

—Domestic violence in the household – 12.7%

—Emotional abuse towards the child – 10.6%

—Physical neglect towards the child – 9.9%

—Imprisoned household member – 4.7%

ACEs are linked with a greater risk

of many problems in later life

These include:

Alcohol abuse and dependence
Early smoking initiation and current smoking status
Illicit drug use
IV drug abuse
Obesity
Suicide attempts
Depression
Anxiety
Hyperactivity
Sleep Disturbances
Hallucinations
Eating disorders
Suicide attempts
Post-traumatic stress disorder
Conduct disorder
Teen or unintended pregnancies
Intimate partner violence
Improper brain development
Impaired learning ability and general cognitive difficulties
Attention and memory difficulties
Visual and/or motor impairment
Lower language development
Impaired social and emotional skills
Poorer quality of life

Nikki Gratix offers more links and stats about ACEs and long-term effects, with our first glimmers of hope (link is below the text, here):

“Another long-term study indicated that approximately 80% of young adults who had previously been abused qualified for at least one psychiatric diagnosis at the age of 21 (Silverman, Reinherz & Gianconia, 1996).

“Neglected or abused children are also

—59% more likely to be arrested during their childhood,

—28% more likely to engage in criminal behaviour as adults, and

—30% more likely to engage in violent crime as an adult (Widom & Maxfield, 2001).

“Abuse and neglect during childhood can also negatively impact the ability of individuals to effectively establish and maintain healthy romantic adult relationships (Colman & Widom, 2004). As relationship warmth and social connection are key protective factors for long-term health and happiness, many of these greater risks could at least be partially explained by the greater risk of interpersonal conflict, disconnection and isolation.

“Individuals who have had negative experiences during their childhood can still grow and flourish as adults, and can also be more resilient as a result of learning how to overcome significant challenges when they are younger.

This diagram, below, depicts the Risk Factors, Protective Factors and Resilience interactive model clearly:

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image from https://www.slideshare.net/PreventionWorks/bc-pc-december-13-2012, The InterdisciplinaryScience of Prevention Bernalillo County DWI Program Planning Council Meeting December 13, 2012 Frank G. Magourilos, MPS, CPS, ICPS Prevention Works

“A major longitudinal study even found that what goes right during childhood is often more important than what goes wrong [emphasis mine], and having even one safe, stable and nurturing figure in a child’s life can reduce the later risk of psychological and physical health problems [emphasis mine] (Vaillant, 2015).

“Creating safe, stable and nurturing environments (SSNREs) is the key to having a positive impact on reducing ACEs going forward.”

LINK to the above: https://www.nikigratrix.com/silent-aces-epidemic-attachment-developmental-trauma/

FMI: “Steps to Create Safe, Stable, Nurturing Relationships and Environments,” 2014, https://www.cdc.gov/violenceprevention/pdf/essentials_for_childhood_framework.pdf

4 Quadrants/Types of Attachment:

I found this set of connections (below) to be a very helpful rubric for understanding the ways trauma impacts our ability to choose appropriate partners/friends, even colleagues and form positive relationships when we suffer from many ACEs because it brings in the main principles of John Bowlby‘s attachment theory quite intelligently.

secure = consistent, responsive early care

= low anxiety, low avoidance

= positive views of self and others; comfortable relying on others, easily comforted
preoccupied = inconsistent early care

= high anxiety, low avoidance

negative view of selves but positive views of others; emotionally dependent, negative affects, hyper vigilance, low self-esteem
dismissive = early unresponsive care

= low anxiety, high avoidance

positive view of selves (see selves as resilient and not needing others), but negative views of others; uncomfortable with closeness, denial of attachment needs, avoidance of closeness, intimacy, dependency or close relationships; high self-reliance and independence
fearful = frequent rejection/abandonment by early caregivers

= high anxiety, high avoidance

seek social contact but inhibited by fear of rejection; approach/avoidance behavior in relationships; high negative affects and poor self-esteem

INTERVENTIONS & SOLUTIONS:

Trauma-Informed Care vs. Ordinary Care

As mentioned previously in this post, Protective Factors contribute to Resilience, and both are great predictors of how well a child or adult will do when affected by ACEs (or any other Risk Factors). The basic formula is that when any of the Risk Factors is present (and the higher the number, the worse the situation is for that person), increasing the number and types of Protective Factors for that person is very likely to increase their Resilience, which, in turn, decreases the likelihood that the person will succumb to peer pressure or inner motivation to engage in risky behaviors or fall victim to other risks and those consequences.

Similarly to Risk Factors (see above), researchers have divided Protective Factors into three categories: Individual, Family and Community

Researchers are also discovering that these same Protective Factors, particularly those that arise from within the Community and Individual (since Family is presumed to be the source/cause of the ACEs) can increase that person’s tendency toward Resilience, which then can mitigate the effects of ACEs as well.

Individual Protective Factors include:

—Positive physical development

—Academic achievement/intellectual development

—High self-esteem

—Emotional self-regulation

—Good coping skills and problem-solving skills

—Engagement and connections in two or more of the following contexts: school, with peers, in athletics, employment, religion, culture

Family Protective Factors include:

—Family provides structure, limits, rules, monitoring, and predictability

—Supportive relationships with family members

—Clear expectations for behavior and values

Community (School, Neighborhood, and Community) Protective Factors include:

—Presence of mentors and support for development of skills and interests

—Opportunities for engagement within school and community

—Positive norms

—Clear expectations for behavior

—Physical and psychological safety

from: https://youth.gov/youth-topics/youth-mental-health/risk-and-protective-factors-youth

Some researchers have further divided these Factors into three age groupings: Early Childhood (ages newborn – 5 or 6 [school-age]), Childhood (ages 5 or 6 – 11 or 12 [ending before middle school or junior high school age]), and Adolescence (middle/junior high school and high school ages, 11 or 12 – 18). This classification is used to study each sector and period of a youth’s life more closely.

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image from http://buncombeaces.org/

“Once you know your ACEs score and its impact, there are personal strategies and community resources that exist to help you. Asking for help, developing trusting relationships, forming a positive attitude, and paying attention to your instincts and feelings are ways to improve your life. These can assist in breaking the cycle of ACEs in your family.

“Reaching out to a trusted member of your community such as a doctor, a counselor, a teacher, or a church or spiritual leader is another way to get help [emphsis mine]….Using these suggestions, both early in a child’s life and as an adult, can lessen the impact of ACEs on you and your family.”

10 Key Components of Trauma-Informed Care:

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image from https://www.chcs.org/resource/10-key-ingredients-trauma-informed-care/

“Trauma-Informed” (for educational settings, care, caregivers, institutions, youth programs, prisons, juvenile detention centers, court and police officers, etc.) is the newest way to describe what we MUST create and strengthen given our understanding of ACEs and the impacts of trauma throughout one’s lifetime. When society has better methods for prevention, we hope this won’t be as necessary. Until then, we are in dire need of more training, better programs, and more awareness.

https://www.rchc.net/wp-content/uploads/2017/08/Trauma-Informed-Care-slides.pdf

Research confirms that a person’s ability to Cope with trauma (and the neurodevelopmental effects) is rooted in the presence or absence of these circumstances and factors:

– Frequency – Single vs. repeated trauma (obviously, even one trauma is terrible, but more often is worse)

– Age when trauma occurred or began (the younger a person is, the worse off the person is likely to be)

– Agent – natural vs. human (weather disasters, earthquakes and fires are horribly traumatic, but war, interpersonal and domestic violence (being the victim OR the witness), and other human-inflicted harm are WORSE than “natural” causes of trauma when it comes to effects on the victims)

– Nature of the trauma – accidental vs. purposeful (particularly when the perpetrator was supposed to have been trustworthy and purported to “love” the victim, intentional harm is the worst type of trauma for a child)

– Environmental supports – Innate Resilience (there is some evidence in the fairly new field of epigenetics that some of us are “naturally” more resilient, particularly when it comes to resisting or lessening the effects of ACEs in the forms of bad health/diseases. Let’s find out WHY!)

A lot of research on what contributes to resilience is happening NOW and recently.

From 2017, we can read: “Epigenetic Embedding of Early Adversity and Developmental Risk,” from Marla B. Sokolowski, PhD, F.R.S.C., W. Thomas Boyce, MD, Co-Directors of the Child and Brain Development Program, Canadian Institute for Advanced Research (CIFAR), Canada, who discovered: “[T]he embedding of adversity-related epigenetic marks is associated with increased susceptibility to compromised development and mental health….

“[A]dverse conditions in early childhood affect the number and placement of epigenetic marks on the DNA sequence. The developmental and health effects of early exposures to adversity and stress are socioeconomically partitioned, with children from the lower ranks of social class sustaining greater and more severe threats to normative development. Epigenetic processes that affect gene expression almost certainly have an impact on adversity-related, maladaptive outcomes….

“Adverse early childhood experiences can leave lasting marks on genes that are involved with stress responses, immunity and mental health, underscoring the importance of creating an optimal early childhood environment for each and every child.”

Other researchers created two categories of children to show the differences in fragility, “‘orchid children’…are more sensitive to both negative and positive environmental factors than their more resilient counterparts, called ‘dandelion children,'” which the above researchers utilized in their studies.

http://www.child-encyclopedia.com/epigenetics/according-experts/epigenetic-embedding-early-adversity-and-developmental-risk

A great podcast/radio show, On Being, with host, Krista Tippett, provides many informative, entertaining and important audio experiences. This one is very relevant, here: RACHEL YEHUDA talks about “How Trauma and Resilience Cross Generations.”

“The new field of epigenetics sees that genes can be turned on and off and expressed differently through changes in environment and behavior. Rachel Yehuda is a pioneer in understanding how the effects of stress and trauma can transmit biologically, beyond cataclysmic events, to the next generation. She has studied the children of Holocaust survivors and of pregnant women who survived the 9/11 attacks.

“But her science is a form of power for flourishing beyond the traumas large and small that mark each of our lives and those of our families and communities [emphasis mine].”

Read the transcript and/or listen to podcast: https://onbeing.org/programs/rachel-yehuda-how-trauma-and-resilience-cross-generations-nov2017/

If you have more time and prefer the video format, Bruce McEwen, Ph.D., talks about “The Resilient Brain: Epigenetics, Stress and the Lifecourse,” at Cornell University in 2017.

For science geeks, this study is awesome! “Epigenetic modulation of inflammation and synaptic plasticity promotes resilience against stress in mice”: https://www.nature.com/articles/s41467-017-02794-5

“Three key neuroscience concepts are recommended for inclusion in Trauma-Informed Care programs and practices in ways that can enrich program design and guide the development of practical, Resilience -oriented interventions that can be evaluated for outcomes.

“A Resilience -oriented approach to TIC is recommended that moves from trauma information to neuroscience-based action with practical skills to build greater capacity for self-regulation and self-care in both service providers and clients.”

Another source of info about ACEs comes from this report, below (audio-only, with some text), from my former home-town public radio station, KRCB, in the North Bay, San Francisco Bay Area, California:

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image from http://radio.krcb.org/post/educating-fellows-counter-adverse-childhood-experiences#stream/0

Individual Protective Factors and Professional Training and Environmental Factors that Assist with Coping with ACEs are:

—Social support

—Supervision and consultation

—Resolution of one’s personal issues

—Strong ethical principles of practice

—Knowledge of theory

—On-going training

—Emotional intelligence/regulation

—Awareness of the potential and impact of Violent Trauma (VT).

https://damonashworthpsychology.com/2017/09/14/the-10-things-you-need-to-know-about-the-adverse-childhood-experiences-study/

Then, of course, we have Oprah weighing in (finally) a few weeks ago:

Oprah’s 60 Minutes segment on ACES, 3/11/18

[image error]

image from https://www.chcs.org/project/advancing-trauma-informed-care/

Oprah (and others) talk about how we need to shift our focus from “What is wrong with you?” to “What happened to you?” with all traumatized individuals.

https://www.cbsnews.com/news/oprah-winfrey-treating-childhood-trauma/

This video also mentions two important area of research about the brain and mental health related to ACEs or positive experiences. Good to know, but I’m still wanting more about what HELPS post-ACEs. Here we go!

“Winfrey speaks to Dr. Bruce Perry, a psychiatristand neuroscientist who authorities have consulted on high-profile events, such as school shootings. She also visits two organizations that treat their clients with the so-called “trauma-informed care” approach shaped by Dr. Perry. Both the agencies, SaintA and the Nia Imani Family Center, are in Milwaukee, where Winfrey spent part of her youth and experienced her own instances of childhood trauma.”

So, we know that chaos, threats, inconsistency, uncertainty, neglect, violence each constitutes a kind of traumas for children, and experiencing even one of these increases vulnerability in later life to many types of issues (academic, physical and mental health, interpersonal difficulties, employment problems).

That is the reason we need to move from focusing on consequences to preventing/mitigating early traumas/wounds.

One main “movement” is to bring in more institutions that provide “trauma-informed care.” Installing these changes is the best way to transform education, social and human services programming and treatment.

ACEs and I

I have written about ACEs before, disclosing that I have a very high ACEs score (9.5 out of 10). By the statistics reported since the early 1990s (see below), I should be in prison, institutionalized, or already dead. But, I’m not. Why is that?

Again, we need to ask “what happened?” rather than “what’s wrong?” to/with a child. Then, we need to build on strengths rather than focus on deficiencies or problems.

Why do some of us not have PTSD after many ACEs? Our reactions seem to be proportional to the numbers and frequency of whatever positive, protective, nurturing relationships we have had in early life. I am an example of an unusual case. See below.

I decided to look more deeply into this topic: what fosters Resilience? How do children and youth with high trauma scores not be completely unhealthy or miserable as adults? My discoveries are in this post and will keep coming.

Please comment on my site, on this post, regardless of where you’re reading this. The post is available starting 4/11/18: http://www.sallyember.com/blog or https://wp.me/p2bP0n-27w

Other Resources

Alice Miller‘s work = relevant because her main recommendation and research evidence are in alignment with ACEs’ researchers and therapists: it only takes ONE significant adult in a traumatized child’s life to greatly mitigate and even ameliorate the effects and later consequences of the trauma. I can attest to that truth.

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Drama of the Gifted Child by Alice Miller

Here is a great post about this book and Miller‘s work: https://www.psychologytoday.com/us/blog/suffer-the-children/201206/the-drama-the-gifted-child

Some local/regional resources (near both USA coasts), and more on their site, from CHCS (Center for Healthcare Strategies):

Center for Youth Wellness, San Francisco, CA, will implement adverse childhood experiences (ACE) screening, care coordination, and data management strategies to further its integrated care approach for addressing the physical and behavioral health needs of families with ACE exposure.

Greater Newark Healthcare Coalition, Newark, NJ, will establish care coordination, trauma screening and treatment, professional development, and data integration practices.

Montefiore Medical Group, Bronx, NY, will train all staff within its 22-practice outpatient ambulatory care network in trauma-informed approaches to care using a multi-disciplinary train-the-trainer model including patient representatives.

San Francisco Department of Public Health, San Francisco, CA, will develop a leadership model, learning community, and collaborative work group that will infuse trauma-informed systems’ principles and practices into public health and other child-, youth-, and family-serving agencies.

Stephen and Sandra Sheller 11th Street Family Health Services, Philadelphia, PA, will train all staff to adopt a standard approach to collective mindfulness practice and use an integrated mind-body treatment model in working with patients who have experienced trauma.

Women’s HIV Program at the University of California, San Francisco, CA, will develop a formal service integration partnership with the Trauma Recovery Center at San Francisco General Hospital to address the effects of lifetime trauma on adults.

Young Adults With Type 1 Diabetes Show Abnormal Brain Activity (reblogged)

“The harrowing conclusion from the study authors is that even young, healthy adults with type 1 diabetes [born with the disease rather than “acquired” it later in life; often called “juvenile diabetes”] ‘already have aberrant neural processing [emphasis mine] relative to their non-diabetic peers, employing compensatory responses to perform the task, and glucose management and duration may play a central role.’

“What would be the findings among type 1s who keep their A1c in non-diabetic range, one might wonder? This study suggests it is likely that elevated blood sugar over time is what changes the brain activity [emphasis mine]. These effects are possibly compounded over time in those with comorbidities like obesity and high blood pressure.”

Having diabetes may affect the way our brains work. Research is taking place to find out exactly how this occurs. In a recent study, researchers describe how tying diabetes to cognitive impairment is tricky because many people with diabetes have other conditions like high blood pressure and obesity, which also affect cognition. That’s why they […]

via Young Adults With Type 1 Diabetes Show Abnormal Brain Activity — SOMEONE SOMEWHERE

#TEDGlobal2017 line-up, here

On August 27, 2017, an extraordinary group of people gathered in Arusha, Tanzania, for TEDGlobal 2017, a four-day TED Conference for “those with a genuine interest in the betterment of the continent,” said curator Emeka Okafor. As Okafor put it: “Africa has an opportunity to reframe the future of work, cultural production, entrepreneurship, agribusiness. We…

via Sneak preview lineup unveiled for Africa’s next TED Conference — TED Blog

#TEDtalk #neuroscience DBS (Deep Brain Stimulation) breakthroughs

As usual, the TED community has lots of news to share this week. Below, some highlights. Surface-level brain stimulation. The delivery of an electric current to the part of the brain involved in movement control, known as deep brain stimulation, is sometimes used to treat people with Parkinson’s disease, depression, epilepsy and obsessive compulsive disorder.…

via A noninvasive method for deep brain stimulation, a new class of Emerging Explorers, and much more — TED Blog

Free online course from the grandmother of all creative writing courses – the University of Iowa — Writer’s Treasure Chest

Originally posted on BRIDGET WHELAN writer: The very first creative writing workshops were pioneered at the University of Iowa in the 1930s and they still have a mighty reputation today. They are now offering a free open online course to explore Walt Whitman’s writings on the American Civil War, looking at how writing and image…

via Free online course from the grandmother of all creative writing courses – the University of Iowa — Writer’s Treasure Chest

Help for #newauthors and #socialmedia

Originally posted on Morgan S Hazelwood: Part 1 | Part 2 | Part 3 | Part 4 | Part 5 Part 2: Creating Your Author Website and How To Start Blogging Last week, I shared my descent into social media and my guiding philosophies for interacting with others on the internet. Now, I’m going to…

via A Starter’s Guide For Fiction Writers Trying To “Establish A Social Media Presence” Part 2 — Viv Drewa – The Owl Lady

“I didn’t want to marry him; I wanted to BE him!” What attracts us to others?

“I didn’t want to marry him; I wanted to BE him!”

The above statement was yelled by a major character in the Jessica Jones series, Trish (played wonderfully by Rachael Taylor), when asked by Jessica (played amazingly by Krysten Ritter) why Trish hadn’t said “yes” to her lover’s very public, romantic, planned-out, catered marriage proposal. It certainly was appropriate, as explanations go, since Trish’s aspirations were to transition from being a radio talk show personality into becoming a serious journalist (which her erstwhile fiance already was).

Interestingly, this sentiment also gave me pause, personally and as a writer. That contemplation urther inspired me to pose the following questions, to myself and to you all:

What causes us to fail in relationships?

What attracts us to others?

Could what attracts us and what dooms us be the same?

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image from: https://everydayfeminism.com/2016/01/dealing-with-unrequited-love/

Are YOU attracted to people who have qualities you wish YOU possessed, in an unconscious attempt to acquire those qualities for yourself? This can apply to people you are cultivating as friends, people you work with or for, and/or people you are considering as lovers.

These types of feelings of attraction could have elements of:

—admiration (personal)

—respect (professional)

—envy (wanting what they have but not wishing they would lose it)

—jealousy (wanting what they have and wanting to take it from them, believing they do not deserve to have it as much as you do)

—intimidation (feeling inferior or afraid)

—possessiveness (showing off your connection to this person, “owning” their time or status as yours)

—sexual lust (perhaps believing your becoming lovers gives you power over this person)

—status hunger (wanting to improve your own and/or share theirs)

—aspirations for greatness (believing being closer to this person elevates you)

—desire for more intimacy (see above)

—wishes for shared glory (believing stardom “rubs off”)

—bids for approval (parentifying this person, to some degree)

and many more complications to simple attraction, most of which are based in our own insecurities.

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image from https://theotherhubby.com/2015/08/28/insecurity-relationships/ INSECURITY

A list of the usual qualities that could be aspects of that person which you believe that you lack and they already have include:

—components of physical appearance/style

—personality traits, especially charisma/star quality

—social or professional status

—employment/work situation

—education/training/skills

—property/finances

—talents

—fame/celebrity

—community respect or position

—family or other relationships

or, any other accomplishments/circumstances

The next question: How well does it work to hook up with, become friends or lovers with, even commit to, someone in order to gain one or more of the above for oneself?

Speaking for my own experiences, this quest doesn’t work at all, or not for very long.

When people have attempted to do that with me, it was like the situation described, but in reverse: they wanted what I already seemed to possess. At first, they admired me, liked me, complimented me, wanted to “show me off” to others. However, inevitably, they grew to resent me. They seemed to feel increasingly jealous of me. They ascribed negative motivations to me, believing I was patronizing or condescending to them (even though I was not feeling or thinking in those ways at all). Usually, we ended with their being intimidated by me or afraid of my view of them to the point of ruining our relationship.

I had one intimate friend beg me: “Stop looking at me with those eyes!”

I protested, perplexed: “These are the only eyes I have!”

Turned out, he was unable to cope with my seeing him as clearly as I did. Apparently, his self-esteem was so low that the ways I reflected him were unbearable to him. His fears and self-loathing are what destroyed our friendship.

[image error] “Comparison kills joy”

image from: http://international-relations-cliches.blogspot.com/2014/02/there-is-icky-us-car-commercial-that-is.html

When I have been attracted to someone’s “star quality,” wishing I could be more like them in their profession, have their talent, or enjoy their status, I would initially be so happy to become their friend or lover. But, as we grew closer, it became clear that I did not gain what I had hoped to gain. Our relationship never availed me of their circumstances.

I often would make myself indispensable to them, hoping to maintain our connection. This tactic often worked, as long as I could tolerate the unrequited nature of my love and they could appreciate my contributions to their life/work.

While I did enjoy getting to know each of them better and usually felt special for having been chosen to be closer to them, for however long it lasted (usually, not long), I was not as positively changed as I had wished to be; certainly, I was not turned “into” them by our intimacy.

Luckily, I am not the jealous or envious type to the point of losing my own self-regard to those feelings. So, often, we would become good friends or lovers and enjoy each other’s company, IF they could tolerate my fawning over them…. If not, we parted.

When we could work all this out, we continued in some capacity as companions, sometimes becoming life-long friends (you know who you are!). I continue to admire them; they seem not to be bothered by my adulation. I suppose they have their own reasons for enjoying me, for which I am grateful.

What’s your story?

Comment here, please! http://www.sallyember.com/blog

What are our “roads not taken”? In some other timelines, we take them!

What are our “roads not taken”? In some other timelines, we take them!

“Everything that can happen IS happening,” in the simultaneous times of NOW in our multiverses’ alternate timelines. (Great video/book citation, here, from particle physicist and author, Brian Cox, Ph.D.: http://www.abc.net.au/radionational/programs/scienceshow/the-quantum-universe/4376486 .)

What other lives are you living, particularly in your work/professional sectors?

What if…?

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CHOICE POINTS image from http://bigpicturequestions.com/what-is-linear-time-vs-nonlinear-time/

For more about this and other aspects of the lived multiverse in a fictional context, please pick up my ebooks or paperbacks in the utopian science-fiction/romances for adults/NA/YA in The Spanners Series; links, blurbs, trailers, covers, more for the first three Volumes {Volume I, This Changes Everything, is permafree in ebook format} are here: http://www.sallyember.com/Spanners

My current and alternate timelines’ professions/work activities:

(I have worked as/in most of these, but not to the extent of having any be the focus of my entire life. My Curriculum Vitae [professional rèsumè] is over 5 pages long!)

How would my life have been different had I worked in/stayed longer in any one of these?

—recreation leader

—field hockey coach

—girls’ softball coach

—cheerleading coach

—camp counselor/camp director

—WSI [Water Safety Instructor]/waterfront director/lifeguard trainer/supervisor/swimming teacher

—canoeing instructor

—umpire (home plate and base), adult softball leagues

—classroom teacher (elementary, middle or high school) through retirement

—college professor (writing, teacher education) through tenure and retirement/Emerita status

—preschool teacher through retirement

—adult/community education instructor through retirement

—mother of more than one (birthing, fostering, adopting, step-parenting)

—world traveler

—princess/queen

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cast of Crystal Dreams, a play I wrote, directed and narrated

1984, Keene, New Hampshire

[I am second from the left, as “The Woman from the Well of Memories.”]

—political leader (elected, appointed)

—community/political organizer

—union representative/organizer

—psychic consultant (for individuals, police, organizations)

—spiritual teacher/leader/group member

—Buddhist nun

—meditation teacher

—research scientist

—medical doctor

—medical clairvoyant diagnostician

—psychotherapist

—bookkeeper/data processor/entry clerk

—multilingual translator (Spanish, Italian)

—nonprofit manager

—nonprofit event planner/cook

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cast of Rainbow Over the Junkyard, a play I starred in, co-wrote songs for and accompanied, conceived and directed by Mario Cossa

1983, Keene, New Hampshire

[I am in the back row, second from the left, as “Megan Andrews” and the color, orange.]

—actor/director

—article & news writer/freelance reporter

—editor/proofreader

—playwright (dramas/musicals)

—poet/lyricist/parody writer

—singer/songwriter

—film/theatre/TV critic

—theatre teacher/director (dramas/musicals)

—musician (pianist)

—piano teacher/music teacher (beginners/children)

—storyteller/performer

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I am reading from This Changes Everything, Volume I of The Spanners Series

2013, Fremont Writers’ Group, BookSmart, Newport Mall, California

What about yours?

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You need to double your Amazon security

Two-step verification may be necessary. WAPIMA (What a pain in my …).

Thanks, Jean, and Ape for posting/researching.

Jean's Writing

You heard right.

Time to double security and protect your books on Amazon. 

Now, not only do I need to work on this year’s taxes, but looks as if I may need to work on my Amazon account.

What the hell? Hackers are now invading Amazon? You’ve got to be kidding me.

I feel as if I’m playing Wack-a-Mole trying to avoid hackers and stupid people. This is getting ridiculous. I change my passwords from time to time, but now I’ve got to do more to keep these crooked jerks out.

Thanks to Janice Hardy over at Fiction University for the warning.

Here’s what I learned today about Amazon Security…


Kindle Direct Publishing (KDP) accounts are linked to my regular Amazon account.
Hackers attempt to break into customer Amazon accounts every single day.
If a Hacker gains access to my Amazon account they have access to my KDP.
A Hacker will…

View original post 155 more words

LAST DAY for #SMASHWORDS’ “Read An #Ebook Week”! #ebookweek18 Many #sales and #discounts, some #free, through March 10, 2018!

LAST DAY for #SMASHWORDS’ “Read An #Ebook Week”! #ebookweek18 Many #sales and #discounts, some #free, through March 10, 2018!

Get any ebook format you want on Smashwords!

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The Story Behind “Read an Ebook Week” (RAEW): Read an Ebook Week was created by Canadian Smashwords author, Rita Toews. If you’re interested to learn the story behind her creation of Read an Ebook Week, read the 2010 interview with Rita over at The Huffington Post . Please note that the prior web address mentioned in the interview, www. ebookweek.com, is now controlled by a squatter and is not associated with this promotion, so please don’t link to or promote the old address.

The Smashwords’ RAEW page is: https://www.smashwords.com/books/category/1/newest/1

The official Read an Ebook Week Facebook page, operated by Rita, is at https://www.facebook.com/pages/Read-an-E-Book-Week/193882590629749

Show your support for RAEW by “Liking” it on Facebook and sharing it.

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All three published Volumes of the sci-fi/romance/multiverse/utopian/paranormal (psi) ebooks in The Spanners Series for adults/NA/YA are participating in this great sale! And, if you prefer or want also to have paperbacks, scroll to the end for the Amazon links to utilize Kindle Matchbook discounts to purchase those!

Volume I, This Changes Everything, The Spanners Series, by Sally Ember, Ed.D.

Dr. Clara Ackerman Branon, 58, begins having secret visits from holographic representations of  beings from the Many Worlds Collective, a consortium of planet and star systems in the multiverse. When Earth is invited to join the consortium, the secret visits are made public. Now Earthers must adjust their beliefs and ideas about life, religion, culture, identity and everything they think and are. Clara is selected to be the liaison between Earth and the Many Worlds Collective and she chooses Esperanza Enlaces to be the Media Contact. They team up to provide information to stave off riots and uncertainty. The Many Worlds Collective holos train Clara and the Psi-Warriors for the Psi Wars with the rebelling Psi-Defiers, communicate effectively with many species on Earth and off-planet, eliminate ordinary, elected governments and political boundaries, convene a new group of Global Leaders, and deal with family’s and friends’ reactions. 

In what multiple timelines of the ever-expanding multiverse do Clara and her long-time love, Epifanio Dang, get to be together and which leave Clara alone and lonely as the leader of Earth? This Changes Everything begins the 30-year story of Clara’s term as Earth’s first Chief Communicator, continuing in nine more Volumes of The Spanners Series. Are you ready for the changes?

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Vol I is PERMA-FREE!  

https://www.smashwords.com/books/view/376197

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Volume II, This Changes My Family and My Life Forever, The Spanners Series, by Sally Ember, Ed.D.

COUPON CODE for 25% off: QD25K

Intrigued by multiple timelines, aliens, psi skills, romance and planetary change? Clara and the alien “Band” are back in Volume II, This Changes My Family and My Life Forever, The Spanners Series. Now as Chief Communicator, Clara leads the way for interspecies communication on- and off-planet. Fighting these changes are the Psi-Defiers, led by one of the oldest friends of the Chief of the Psi-Warriors, its reluctant leader, Rabbi Moran Ackerman. Stories from younger Spanners about the first five years of The Transition fill Volume II. How would you do with the changes?

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Usually $3.99; “Read an Ebook Week” Promotional price: $2.99

https://www.smashwords.com/books/view/424969  

Enter the code prior to completing checkout.

COUPON CODE for Vol II, 25% off: QD25K

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Volume III, This Is/Is Not the Way I Want Things to Change, The Spanners Series, by Sally Ember, Ed.D.

COUPON CODE for 50% off: UR24R

Clara, Moran, Espe, Epifanio and the alien Band of holos are back in This Is /Is Not The Way I Want Things to Change of The Spanners Series. Psi-Defiers launch increasingly violent protests during this five-year Transition, attempting to block Earth’s membership into the Many Worlds Collective. To join, Earth’s nations and borders must dissolve and Psi-Warriors must strengthen in their battle against the rebels.

Clara, continuing as Earth’s first Chief Communicator, also juggles family conflicts and danger while creating psi skills training Campuses to help Earth through the Psi-Wars. Clara timults alternate versions of their futures as the leaders’ duties and consciences force them each to make difficult choices across multiple timelines while continuing to train and fight.

Will the Psi-Warriors’ and other leaders’ increasing psi skills, interspecies collaborations and budding alien alliances be enough for Earth to make it through The Transition intact? If there is no clear path for Clara’s and Epifanio’s love, does she partner with Steve or go it alone?

What do you do with wanted/unwanted changes?

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Usually $3.99; “Read an Ebook Week” Promotional price, Vol III: $2.00

https://www.smashwords.com/books/view/588331

Enter the code prior to completing checkout.

COUPON CODE for 50% off: UR24R

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Cover art and logo for The Spanners Series all by Aidana Willowraven: http://www.willowraven-illustration.blogspot.com/

BOOK TRAILERS for all three volumes, here:

Volume I, This Changes Everything

https://youtu.be/QJDEt1O8yQ8?list=PLPbfKicwk4dE_bsvzZO7X8-IIqqLY15uS

or

https://goo.gl/8OLVSr

AND

https://youtu.be/X_8ZFVY9BMg?list=PLPbfKicwk4dE_bsvzZO7X8-IIqqLY15uS

or

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AND

https://youtu.be/WL9lPK8IhRk?list=PLPbfKicwk4dE_bsvzZO7X8-IIqqLY15uS

or

https://goo.gl/APrn9P

Volume II, This Changes My Family and My Life Forever

https://youtu.be/WenvYeasiik?list=PLPbfKicwk4dE_bsvzZO7X8-IIqqLY15uS

or

https://goo.gl/ERqLHY

Volume III, This Is/Is Not the Way I Want Things to Change

https://youtu.be/uINdFH0XS18?list=PLPbfKicwk4dE_bsvzZO7X8-IIqqLY15uS

or

https://goo.gl/q9NGsg

AND

Find ALL books participating in the Smashwords’ Read An Ebook Week sale and stock up on your favorite genres, authors and titles OR scout out some new talent! https://www.smashwords.com/books/category/1/newest/1

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PAPERBACK LOVERS:

Kindle MatchBook includes all three Volumes of The Spanners Series!

Buy any ebook format and get a discount on the paperback of the same Volume (or vice-versa).

Amazon’s paperbacks’ links:

Vol I: http://www.amzn.com/B00HFELTG8

Vol II: http://www.amzn.com/B00KU5Q7KC

Vol III: http://www.amzn.com/B0177Z1KRM

Amazon’s ebooks’ pages:

Vol I: http://www.amzn.com/B00HFELTG8

Vol II: http://www.amzn.com/B00KU5Q7KC

Vol III: http://www.amzn.com/B0177Z1KRM

All published by Timult Books

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