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Week 6 Discussion 1: The Deepest Well

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  4. Week 6: Childhood Trauma and Maltreatment
  5. Week 6 Discussion 1: The Deepest Well

Completion requirements

Done:Make forum posts: 1

Value: 100 points

Due: Create your initial post by Day 4 and reply to at least two of your peers by Day 7.

Grading Category: Discussions

Note: In this type of discussion, you will not see the responses of your classmates until after you have posted your own response to the following question.

Overview

When you are a psychiatric mental health provider, you will encounter difficult and uncomfortable situations where individuals have experienced different traumas. Experiences of childhood abuse and neglect are known antecedents to developing many mental health and substance use disorders. There is no real way to prepare or plan for exposure to these circumstances. This assignment will help you begin to understand the emotional impact of secondary trauma and how to create a self-care plan to avoid caregiver burnout.

Initial Post

After you review all of the learning materials and watch the Week 6 child abuse video, pick two questions from the list to answer in your initial post. Your discussion post should address two of the following:

  • What is the definition of an adverse childhood event (ACE)? Are there different types of abuse? How many types of abuse did Dr. Harris encounter?
  • Discuss mental instability, substance use, and generational transmission. How is Dr. Harris coping with patients in these situations, and what skills will you incorporate into your practice? Explain your reasoning.
  • Discuss survival and resiliency theory. Relate two surprising facts that Dr. Harris points out about the ACE study.
  • What physical, psychiatric, and substance use disorders are associated with adverse childhood events? Give three examples from Dr. Harris’s patients.
  • Explain how the “dysregulated stress response” and Dr. Harris’s depiction of “BEARS” are related.
  • How is DNA modified by traumatic experiences, and what are the sequelae?

You will need to cite at least two research-based resources for this assignment.

Replies

Reply to at least two of your peers. In your reply posts, identify a new or heightened awareness you now have about a particular aspect of the discussion 

 topic. Discuss how this awareness may impact your practice.       

 

 

 

 

In reply to Devashish Rattan

Re: Week 6 Discussion 1: The Deepest Well

by Shanna Cipro – Monday, 2 October 2023, 5:58 PM

 

The purpose of this discussion post is to understand and identify adverse childhood events (ACEs) and the effects they have on the development of a child that effects their mental stability, increases the risk of substance use, and is generational in transmission. This post will also examine the concept of survival and resiliency in the face of ACEs, as well as surprising facts regarding the ACE Study. 

Discuss mental instability, substance use, and generational transmission. How is Dr. Harris coping with patients in these situations, and what skills will you incorporate into your practice? Explain your reasoning:

Wheeler (2020), explains that trauma has a lifelong imprint on a person, affecting how they perceive the world, act in the world, and how they participate in relationships. For children in particular adverse childhood experiences (ACEs) change their biology and patterns of growth and development at a molecular level (Wheeler, 2020). One of the most challenging facets of ACEs is the implications from the intergenerational continuity of childhood adversity. People that have experienced ACEs are more likely to have children with high ACE scores. This is due to the biological changes that occur within the parent and to the maladaptive coping skills that parents develop with the experienced their own ACEs that have gone untreated (Merrick & Guinn, 2018).

The association between increased ACE scores and mental health disorders and substance use is robust. Psychosis, suicidality, self-harm, insomnia, and risk of developing severe mental disorders like major depressive disorder, bipolar disorder, and schizophrenia have high correlation to increased ACE scores (Gu et al., 2022). Substance use disorders also have a high correlation to untreated ACEs and mental health (Gu et al., 2022 and Messina & Schepps, 2021). Incarceration also has a robust correlation to mental health disorders, substance use disorders, and not surprisingly a high prevalence of adverse childhood events (Messina & Schepps, 2021). Children who grow up with parents with mental health disorders, substance use disorders, and/or a history of incarceration begin the next generation of ACEs (Merrick & Guinn, 2018). 

In these situations, Dr. Harris approached treatment as a multifaceted multigenerational intervention to heal from toxic stress. Dr. Harris states that by understanding what regulates our stress response is integral in treating it: nutrition, exercise, mental health treatment, developing healthy relationships, being in nature and mindfulness which in turn helps to improve neurological functioning, hormone balance, and even our immunity (Harris, 2021). The clinic that Harris developed addressed each of these factors on a multigenerational level to improve family and community outcomes. Dr. Harris said the priority is to ensure the patient is safe before familial treatment can be done and expressed the need to have empathy and recognize the need to provide teaching and support to the parent or caretaker to add a protective layer for the child (Harris, 2021). Through my previous practice the need to offer support and make referrals to strengthen the whole family is integral to treatment success. 

Discuss survival and resiliency theory. Relate two surprising facts that Dr. Harris points out about the ACE study.

The concept of resilience related to the patient’s ability to meet desired health outcomes after experiencing adverse childhood events (ACEs). ACEs defy tolerability. Resilience and survival involve protective factors and support and the ability to adapt. When a child has a protective buffer to process a traumatic event, the child can see the adverse event in context, instead of developing maladaptive coping mechanism, and mental health concern related to the safety of their world (Masten & Barnes, 2018). The CDC-Kaiser ACE study was published over thirty years ago in 1998. Dr. Harris highlights that surprisingly participants in the Kaiser Study were Caucasian: 6,432 of the 8,056 participants. 50% of participants had a college degree (Felitti et al., 1998). Dr. Harris reminds us that ACE scores do not see race. Dr. Harris (2021) did differentiate between the openness in which ACEs are discussed in distinct cultures and races. She also spoke about ACEs that were not prevalent to suburban communities like gun violence. Additionally, the long-term health effects of ACEs place the patient at risk for increased heart, cancer, stroke, COPD, and diabetes- all inflammatory diseases (Harris, 2021). At times, the patient’s ACE score is their only risk factor. 

References

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). 

Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. 

American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8

Gu, W., Zhao, Q., Yuan, C., Yi, Z., Zhao, M., & Wang, Z. (2022). Impact of adverse childhood experiences on the 

symptom severity of different mental disorders: A cross-diagnostic study. General Psychiatry, 35(2). 

https://doi.org/10.1136/gpsych-2021-100741

Harris, B. N. (2021). The deepest well: Healing the long-term effects of childhood adversity. Mariner 

Books/HarperCollins.

Masten, A., & Barnes, A. (2018). Resilience in children: Developmental perspectives. Children, 5(7), 98. 

https://doi.org/10.3390/children5070098

Merrick, M. T., & Guinn, A. S. (2018). Child abuse and neglect: Breaking the intergenerational link. American Journal of 

Public Health, 108(9), 1117–1118. https://doi.org/10.2105/ajph.2018.304636

Messina, N. P., & Schepps, M. (2021). Opening the proverbial ‘can of worms’ on trauma‐specific treatment in prison: 

The Association of Adverse Childhood Experiences to treatment outcomes. Clinical Psychology & 

Psychotherapy, 28(5), 1210–1221. https://doi.org/10.1002/cpp.2568

Wheeler, K. (2020). Psychotherapy for the Advanced Practice Psychiatric Nurse. 

https://doi.org/10.1891/9780826193896

 

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