Sonoma County ACEs Connection: Emerging ACEs Data Let’s take a moment to think deeply about ACEs and the scale of the problem as we know it. We’ll start at the macro-level with the data from the original study, then we’ll look at our County data – including one specific community, and then we’ll look at our ACEs Connection group. We’re going to spend 10-15 minutes look at some of the information we’ve collected to date so we can begin to ask ourselves more questions and develop an evolving picture of the state of ACEs in our community. This will be a “taste” and there will be more to come through the Mobilizing Action for Resilient Communities grant and other community initiatives. This group will identify, review, and even possibly develop new data sources in the years to come. We encourage your curiosity and participation. *Thanks to Karen Clemmer (Public Health), Meredith Kieschnick (Santa Rosa Health Center), and others for providing many of the slides in this set.

What do we know about ACE’s on a National Level?

Tracked health outcomes based on childhood ACEs “Conclusion: We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.” The first group who coined the term ACEs and used data to look at the prevalence of the problem were Felitti, Anda, and colleagues who published this seminal (strongly influential) study in 1998. 13,000 Kaiser HMO patients were surveyed for seven categories of abuse and household dysfunction. Tracked health outcomes based on childhood ACEs 75% Caucasian, 39% college graduates, 36% some college, living wage jobs with insurance; median age 57 yr. old Am J Prev Med 1998;14(4) ACEs on a National Level

Effects on 40+ Outcomes to Date In the 22 years since Felitti and Anda published their report, we’ve learned more about ACEs. The graded dose-response relationship with ACEs is no tied to more than 40 health outcomes. Another way to talk about the “graded dose-response” is the more ACEs someone experiences, the more health, behaviors, and life potential is impacted. Can folks share some of the 40 health outcomes impacted by ACEs? ACEs on a National Level

Prevalence Adverse Childhood Experiences (ACEs) Study Centers for Disease Control & Prevention (CDC) Household dysfunction Substance abuse 27% Parental separation/divorce 23% Mental illness 19% Battered mother 13% Incarcerated household member 5% Abuse Psychological 11% Physical 28% Sexual 21% Neglect Emotional 15% Physical 10% The ACE study is based on 10 questions which are broken up into 3 domains: household dysfunction, abuse, and neglect. The most common ACEs reported in the original study were: physical abuse, substance abuse, and parental separation/divorce. Source: Centers for Disease Control and Prevention ACEs on a National Level

What do we know about ACE’s in Sonoma County? We’ve reviewed the tremendous impact ACEs can have on life potential, behaviors, and health, now let’s look at the magnitude of the problem in Sonoma County. How concerned should Sonoma County be about ACEs?

Hidden Crisis Report on ACEs Results for Sonoma County/Napa: 22% have 4 or more ACEs In Sonoma County we know that 22% of our total population has an ACE score of 4 or more – and this is higher than the CA state average of 16.7%. A person with 4 or more ACEs is: • 5.13 times as likely to suffer from depression • 2.42 times as likely to have chronic obstructive pulmonary disease (COPD) • 2.93 times as likely to smoke • 3.23 times as likely to binge drink (Source: Demographics of the 2010 California adult population compared to California Behavioral Risk Factor Surveillance System (CA BRFSS) sample https://app.box.com/s/nf7lw36bjjr5kdfx4ct9) Knowing what we’ve reviewed about the dose-response effect, how does this data make you feel? Note: CA State agencies are adding ACE questions to other surveys and are compiling data from existing surveys. We may have more robust County-level data in the near future. Source: Demographics of the 2010 CA adult population compared to CA Behavioral Risk Factor Surveillance System (CA BRFSS) ACEs in Sonoma County

SRCHC Healthy Tomorrows Partnership for Children Technical Advisory Report May 25, 2016 Meredith Kieschnick, MD, of Santa Rosa Health Center introduced herself and her project to implement ACE screenings at two local health clinics – Elsie Allen Health Center and Roseland Pediatrics. ACEs in Sonoma County

2015 Screening/Referral Rates Goal: screen 80% of all new patients & well child exams ACE screenings: 1,246 New patients, well-child exams: 2,271 Screening rate: 54.9% Mental health referrals: 398 (all referrals) Rate of referral: 17% Roseland/Elsie Allen resource referrals: 111 4% ACEs in Sonoma County

Data: Parent Positives Local parent data at these clinic shows our highest instance of ACEs is different than the original ACE study. Compare to original ACE study: Substance abuse 27% Parental separation/divorce 23% Physical 28% While the screening tool used by the Health Centers differs from the original 10 ACE study questions, a Sonoma County Epidemologist made a tracking tool to try and compare the results from the two tools. Meredith explained that these scores helped her staff identify what additional services to offer. Clearly divorce or separation groups rose to the top of the new service list! ACEs in Sonoma County

0-11yo Positives ACEs in Sonoma County

Teen Positives ACEs in Sonoma County

What do we know about the Sonoma County ACEs Connection? As part of the Mobilizing Action for Resilient Communities project, Robert Wood Johnson Foundation hired an evaluation firm, Westat, to measure the “strength” of our network at the start of the grant. Hopefully, with the 2 years of grant funding ($100K), we’ll effectively strengthen our network by increasing collaboration between sectors like Health and Justice and between partner agencies within and across sectors. Westat issued a survey in April 2016 and asked a sample of 27 agencies individuals to respond to a survey with questions aimed at measuring collaboration. Then they created some fun data visualizations or “maps” for us to look at:

All Levels of Interaction Map 1 ·         Org circle size is determined by the number of organizations represented in a given sector. ·         Line thickness is determined by the average level of collaboration among the pairs of organizations represented by the pairs of sectors. ·        Sectors that have lines going in a circle to themselves demonstrates that there are connections among organizations of the same sector. 27 individuals and organizations surveyed in April 2016 by Westat MARC grant evaluators, varying levels of participation in coalition, but commitment to ACEs. Let’s see if we can make sense of this together. Let’s look at Criminal Justice and Child Welfare. What does this thicker line mean? Which sectors show the highest level of participation? Which sectors often connect with agencies within their sector? All Levels of Interaction Sonoma County ACEs Connection by sector

All Levels of Interaction Map 2a All the organizations that were listed on the survey appear on this map. They are colored by their sector. In this map, you can see the connections of ANY level (share information, collaborate a little, collaborate some, collaborate a lot) and how the organizations are connected to each other. Sonoma County ACEs Connection interaction between partners

Collaborate a little, some, a lot Map 2b In this map, we see the three higher levels of collaboration: collaborate a little, collaborate some, collaborate a lot Sonoma County ACEs Connection interaction between partners

Collaborate some, a lot Map 2c Now, in this map, we see only relationships where the collaboration is “collaborate some” or “collaborate a lot” Sonoma County ACEs Connection interaction between partners

Collaborate a lot Map 2d Lastly, these are the members who said they collaborate a lot. Over time, you might be interested to see how additional organizations enter, how they strengthen their connections with more organizations, etc. We also have other data through the Westat Survey and the survey we shared more widely in June that we can analyze later to learn more about who is currently implementing Trauma Informed practices, who is trainng staff in ACEs and more. Sonoma County ACEs Connection interaction between partners

What do we know about interest in strengthening the network? Sonoma County ACEs interest in network

Paper Tigers Survey Data Event Date   # of Attendees Average understanding of ACES before film Average understanding of ACES after film Growth Want more learning opportunities Want a training at work-place 1/12/2016 Elsie Allen High School 74 2.47 4.31 1.84 47 85% 39 71% 1/14/2016 Santa Rosa High School 144 2.88 4.47 1.59 55 90% 45 74% 5/12/2016 Petaluma Boulevard Cinemas 221 2.62 4.30 1.68 69 83% 54% The scale of understanding of ACEs was 1 – 5 with 1=no knowledge and 5=high knowledge. The statistics of those who want a training at their work place are misleading – this is the percent of all respondents, but only some of those represent a workplace. In this case, the 54%-74% is still an enthusiastic showing of interest. # of Survey Responses Response Rate EAHS 55, 0.74 SRHS 61, 0.42 PBC 83, 0.38 Sonoma County ACEs interest in network

What are the Adverse Childhood Experiences? Child physical abuse Child sexual abuse Child emotional abuse Physical Neglect Emotional Neglect Mentally ill, depressed or suicidal person in the home Drug addicted or alcoholic family member Witnessing domestic violence against the mother Loss of a parent to death or abandonment, including abandonment by divorce Incarceration of any family member