Transcript Adversity and Toxic Stress in Childhood Can Make Us Sick

Using ACEs in our everyday work:
Implications for clients and
programs
Kristen Rector – Prevent Child Abuse Tennessee
Jennifer Drake-Croft – The Family Center
ACES in Childhood Can Make Us Sick
•Lifelong health and well being
•Brain health
•Educational achievement
•Mental, physical and intellectual
development
•Workforce readiness and
productivity
Public Health Burden
 Children exposed to violence and other forms
of adverse childhood experiences may exhibit:
 a range of developmental problems and symptoms,
both internal (depression or anxiety) and external
(aggression or conduct problems)
 Exposure to violence can:
 Interfere with a child’s ability to think and
learn
 Disrupt the course of healthy physical,
emotional, and intellectual development
 Increase risk of:
 health and mental health problems
 use of health and mental health
services
 involvement with child welfare and
juvenile justice systems
The Adverse Childhood Experiences (ACE)
Study
A collaborative effort of Kaiser Permanente
and the CDC
 Kaiser Permanente HMO population in
San Diego
 Over 17,000 participants - average age
of 57
 Study of the impact of adverse
childhood experiences on health
throughout the lifespan
Felitti, VJ et al. American Journal of Preventive Medicine 1998;14:245–258
www.acestudy.org
What Are Adverse Childhood
Experiences (ACEs)?
Experiences that represent medical and social problems of national importance
Childhood maltreatment (physical, sexual, emotional)
Neglect (physical and emotional)
Household dysfunction:
Growing up with intimate partner violence
Household substance abuse
Household mental illness
Parental separation or divorce
Incarcerated household member
ACE Score
• Total number of categories of ACEs that each
participant reported
– Example: Experiencing physical abuse as a child is an ACE
score of one
– Experiencing physical abuse plus witnessing IPV is an ACE
store of two
•
More than half had at least one ACE
•
If one category of ACE is present, there is an 84% likelihood of
additional categories being present.
Adverse Childhood Experiences Reported by
Adults Five States, 2009
• First published report to document prevalence
of ACEs in population-based representative
sample from multiple states stratified by
demographic characteristics, including sex,
age, education, and race/ethnicity.
• Approximately 59% reported one or more ACEs
CDC MMWR, December 17, 2010/59(49); 1609-1613
ACE STUDY FINDINGS
As ACE score goes up, so does risk for:
Health-risk Behaviors
 Sexual promiscuity
 Sexual perpetration
 Alcohol abuse
 Illicit/injected drug use
 Smoking
Disease and Injury
 STDs, including HIV
 Gynecological
problems
 Heart disease
 Diabetes
 Stroke
 Cancer
 Suicide
Mental health and well-being
 Depression, post-traumatic
stress disorder (PTSD)
 Aggression
 Anxiety
 Somatic complaints
 Attempted suicide
 Social ostracism
 Anxiety
 Academic achievement
 Re-victimization
 Unwanted pregnancy

Job problems; lost time from
work
ACE STUDY FINDINGS
 As ACE score goes up, so does risk for:
 Smoking
 Organic disease (pulmonary, heart & liver disease)
 Adult alcoholism & drug use
 Depression and suicide attempts
 Multiple sexual partners
 STD’s and Rape (from 5% to 33%)
 Hallucinations
 Risk for intimate partner violence
 Addictions
 Dying early
 Job Problems and lost time from work
 www.acestudy.org
ACEs effect your brain
development, hormone production,
cellular health, and even the
expression of your DNA
http://communityresiliencecookbook.org/
The Power of Prevention
The Power of Parenting
Nurturing Relationships
Make and Keep Us Well
Importance of Early
Experiences/Relationships
• Early experiences are built into our bodies and brains--- for
better or for worse
• Healthy development in the early years provides the
building blocks for future learning, behavior, and health:
– educational achievement
– economic productivity
– responsible citizenship
– lifelong health
– strong communities
– successful parenting of the next generation
http://www.developingchild.harvard.edu
The Cost of ACEs
ACEs are the LEADING determinant of health,
social and economic wellbeing of our nation
What was YOUR
reaction when you
learned about the
ACE study?
What are your
reservations about
administering the ACE
questionnaire to your
clients?
How assessing ACEs benefits
your organization?
 Helps you understand if you are
reaching your target population
 You can tailor interventions to
address past traumas that might
impact parenting
 You can better help the public,
donors, and funders better
understand the impact of trauma
on your population
 Helps staff operate in a more
trauma-informed manner
How assessing ACEs benefits
your CLIENT
 Creates an “aha moment”
and buy-in to the urgency of
adopting healthy parenting
practices
 Motivation to change by knowing
their own story
 Allows parent to receive
more tailored services that
meet their needs
 Empowers parent to reframe
from thinking from believing
they are “bad” to
understanding they are hurt
 Discover and build resilience
ACE Scores at The Family Center
Initial reservations of staff
 Triggering clients
 Discomfort with asking
questions
 Fear of stigmatization by
talking directly about abuse
 Fear of turning
psychoeducation into
therapy
 Fear of inducing guilt and
shame
Administering ACE at The Family Center
 Preparation to administer assessment
 Staff watched a webinar from the FRIENDS website on ACE
administration with clients
 Identifying how to share ACE information in a way that ties in
with current education
 Use of empowering language along with strategies to
decrease ACEs for their children
 Transparency about WHY we collect ACEs and how we use
the information
 Emphasize the healing power of safe, stable, nurturing
relationships if ACEs have already accumulated for the child
 Create a handout where they can record their ACE score and
learn more at www.acestoohigh.com
Administering ACE at PCAT
Normalize
Guide conversation
on change
Inform of study
Implementing the tool – Prevent
Child Abuse TN (PCAT)
Safety first
Extremely sensitive
information
Using empathy
Provide follow up/referrals
ACES are common
Make time to discuss
Results of ACEs Data Collection at
The Family Center
94% Experienced
Household
Dysfunction
71% Separation / Divorce
Compare to 23%
79% Experienced
Child Abuse
69% Experienced
Child Neglect
74% Emotional
65%
Emotional
Compare to 11%
56% Domestic Violence
Compare to 13%
Compare to 15%
55% Household Mental
Illness
43% Physical
Compare to 19%
Compare to 28%
55% Household Substance
Abuse
Compare to 27%
49% Incarcerated Family
Member
Compare to 5%
37% Sexual
Compare to 21%
41% Physical
Compare to 10%
Results of ACEs Data Collection
at The Family Center
74%
• Have 4 or more ACEs
44%
• Have 7 or more ACEs
• Results in 5 – 10 years earlier death
• Compare to 13% from original ACE study
•
Results in 20 years earlier death
Anthony’s Story
Lacey’s Story
 Both parents alcoholics
 Mother depressed
 Father frequently absent,
left several times between
the ages of 5-12 and then
finally “for good” at 12.
 What will happen to her as
an adult?
 http://vimeo.com/75914128
Teaching Lacey about ACES
 New ways of coping: safe
coping strategies
 Understanding triggers
 Relating the cycle of addiction
 Renewed relationship with her
own parents through
understanding her parent’s
ACES
 Family awareness of the
importance of togetherness
 Learning to deal with stress in a
healthier way
Partnering with Parents to Prevent ACES
 Institute for Safe
Families
 Educational resource
 Booklet that looks like
an app with QR codes
 Co branded by
Prevent Child Abuse
America and the
Academy of Pediatrics
The Amazing Brain
Booklet to help parents
understand the impact of
trauma on early brain
development
Understanding a parent’s adverse
childhood experience takes nothing away
from understanding her resilience
It puts into perspective how
spectacularly resilient she may be, the
strengths she is building on for the next
phase of her life, and opens the space
to talk about the life she wants for her
family and her new baby