Transcript No Slide Title

Adverse Childhood Experiences
a presentation for
SEPs
Based on a presentation by Kaiser Permanente and The Centers for Disease Control
Original
Vincent J. Felitti, M.D.
Robert F. Anda, M.D.
Modification
John Records, J.D.
Introduction to
Adverse Childhood
Experiences
(ACEs)
What do we mean by
Adverse Childhood Experiences?
Experiences while growing up that deeply impact a young person
and profoundly affect emotional and physical health later in
life.
How Important are ACEs?
Compare Louis Pasteur and his radical
theory:
• Germs cause infectious disease
• Initial resistance
• Generally accepted now
Adverse Childhood Experience (ACEs)
compared with Pasteur’s theory
• Underlying cause of noninfectious disease, implicated in 10
leading causes of death in the U.S.
• Initial skepticism
• Emerging acceptance (Kaiser, CDC)
ACEs Study
(overview)
The Adverse Childhood Experiences
(ACEs) Study
• The largest study of its kind ever done to examine the
health and social effects of adverse childhood
experiences over the lifespan (17,000+ participants)
The ACEs
Questions
The Adverse Childhood Experiences
(ACE) Study
Summary of Findings:
• Adverse Childhood Experiences (ACEs)
are very common
• ACEs are strong predictors of adult
health risks and disease
• ACEs are implicated in the 10 leading causes of death in the U.S.!
•
“I was actually stunned and I wept over what I saw.” ACEs
researcher Rob Anda, M.D.
•
Virtually every study shows that ACEs are strong predictors of
homelessness
Adverse Childhood Experiences Score
Number of categories adverse childhood experiences
are summed …
ACE score Prevalence
0
48%
1
25%
2
13%
3
7%
4 or more
7%
• More than half have at least one ACE
• If one ACE is present, the ACE Score is likely to range
from 2.4 to 4
ACEs Impact
Adverse Childhood Experiences
vs. Current Smoking
20
18
16
14
12
%
10
8
6
4
2
0
0
1
2
3
ACE Score
4-5
6 or more
ACE Score vs. Smoking and COPD
20
Percent With Problem
18
16
ACE Score:
0
1
2
3
4 or more
14
12
10
8
6
4
2
0
Regular smoking by age 14
COPD
Childhood Experiences vs.
Adult Alcoholism
18
16
4+
% Alcoholic
14
12
3
10
2
8
6
1
4
2
0
0
ACE Score
Childhood Experiences
Underlie Chronic Depression
% With a Lifetime History of
Depression
80
70
60
50
40
Women
Men
30
20
10
0
0
1
2
ACE Score
3
>=4
25
Childhood Experiences
Underlie Suicide
4+
% Attempting Suicide
20
15
3
10
2
5
0
1
0
ACE Score
Adverse Childhood Experiences vs.
Likelihood of > 50 Sexual Partners
Adjusted Odds Ratio
4
3
2
1
0
0
1
2
ACE Score
3
4 or more
Adverse Childhood Experiences vs.
History of STD
Adjusted Odds Ratio
3
2.5
2
1.5
1
0.5
0
0
1
2
ACE Score
3
4 or more
Childhood Experiences Underlie Rape
35
4+
30
% Reporting Rape
25
20
3
2
15
10
5
0
1
0
ACE Score
ACE Score and Hallucinations
Ever Hallucinated* (%)
12
10
Abused
Alcohol
or Drugs
8
No
Yes
6
4
2
0
0
1
2
3
4
5
ACE Score
*Adjusted for age, sex, race, and education.
6
>=7
ACE Score vs. Intravenous Drug Use
% Have Injected Drugs
3.5
3
2.5
2
1.5
1
0.5
0
0
1
2
3
4 or more
ACE Score
N = 8,022
p<0.001
ACE Score vs.
Serious Job Problems
18
% with Job Problems
16
14
12
10
8
6
4
2
0
0
1
2
ACE Score
3
4 or more
ACEs Discussion
Evidence from ACE Study Suggests:
Many chronic diseases in
adults are determined
decades earlier, by the
experiences of childhood.
Affective Response
Evidence from ACE Study Suggests:
Risk factors for these
diseases are initiated during
childhood or adolescence . . .
Seeking to Cope
Evidence from ACE Study Suggests:
. . . and continue
into adult life.
Outcome: social and biomedical damage
Evidence from ACE Study Suggests:
Adverse childhood experiences
are the most basic cause of
health risk behaviors, morbidity,
disability, mortality, and
healthcare costs.
Embodied Trauma
Death
Early
Death
Disease, Disability
Adoption of
Health-risk Behaviors
Social, Emotional, &
Cognitive Impairment
Adverse Childhood Experiences
The Influence of Adverse
Childhood Experiences Throughout Life
Birth
“The truth about childhood is stored up in
our bodies and lives in the depths of our
souls. Our intellect can be deceived, our
feelings can be numbed and manipulated,
our perceptions shamed and confused, our
bodies tricked with medication, but our soul
never forgets. And because we are one, one
whole soul in one body, someday our body
will present its bill.”
Alice Miller
Doing our best
to cope
The risk factors underlying
these adult diseases are
adaptive, coping devices.
(Smoking, severe obesity, physical
inactivity, depression, suicide attempt,
alcoholism, illicit drug use, injected drug
use, 50+ sexual partners, history of STD
(sexually transmitted disease)).
Dismissing them as “bad habits” or
“self-destructive behavior” totally
misses their function.
What is conventionally
viewed as a problem
is actually a solution to
an unrecognized prior
adversity.
Application to
Homelessness
What’s the real problem
we’re addressing?
 Addiction? Mental illness? Poor health?
Inability to find and keep a job?
 Homeless people most often are the
walking wounded, because of neglect and
repeated trauma that began with
numerous ACEs and that frequently
continue in adult life.
What’s the real problem we’re
addressing (con’t)?
 Homeless shelters and facilities are in fact
trauma wards.
 Should the fact that we are working with
trauma survivors be given primacy in our
programs and in our efforts to educate the
community?
Trauma Treatment
 There are exciting new developments in
treating trauma, such as Somatic
Experiencing.
 A pilot Somatic Experiencing Clinic has
been established at COTS, a homeless
program in California.
A Ray of Hope: Resiliency
 Some people suffer terrible abuse, yet “make
it.”
 A high ACEs score isn’t a death sentence, it
just worsens the odds.
 Resiliency Theory is one powerful response
and “vaccination” for children.
Explicatory Narrative
 The ACEs explicatory narrative can
powerfully help people to understand their
behavior and problems, to realize that they
are not alone, to have less shame.
 ACEs give us a new way to put together our
life stories, a new way to understand from
where we come and where it may be possible
for us to go.
ACEs and Advocacy
 ACEs are a very powerful way to help the
community at large understand
sometimes troubling behavior.
 Understanding ACEs helps us all to move
past shame and blame to the productive
next steps.
An Integral Response
 Integral Theory provides an unexcelled
framework both for understanding all of the
causes of homelessness, including ACEs,
and for developing comprehensive, costeffective responses that are supported by the
community.
 Integral Restorative Processes (IRP) are an
example of such responses.
Program Design
 Teach parents about ACEs so they know
about their own problems and are less likely
to inflict ACEs on their own children
 Teach about ACEs to other adults, so they
will know more about the origins of their
present problems and can build this into their
explicatory narrative.
 Offer Integral Restorative Process and
Integral Support, including trauma treatment
Conclusion
• In a way, to accept the import of ACEs is just
so mind-boggling that it may be impossible
for some people. To be blunt, how much of
the way we behave as a culture, how much of
the pain and confusion and sickness, comes
from our continuing rape, abuse and neglect
of our children?
We have the power to intervene and
to lead our community and society
in a healthy response.
What about our ACEs?
 Without your wounds where would your power
be? The very angels themselves cannot persuade
the wretched and blundering children on earth as
can one human being broken in the wheels of
living. In love's service, only the wounded
soldiers can serve.
--Thornton Wilder (quoted by Joan Borysenko,
Guilt is the Teacher, Love is the Lesson)
Our ACEs…
 Some of the healthiest people I know are those who
have had to heal from the most challenging
situations, and in the process, have gained insight
and wisdom far beyond what a "comfortable" life
would ordinarily provoke.
--Joan Borysenko, Fire in the Soul
 Thanks to Deborah Boyar for quotes!