Using ACEs in our everyday work: Implications for clients and programs JDC and KR 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 KR 2

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 KR 3

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 The Adverse Childhood Experiences (ACE) Study A collaborative effort of Kaiser Permanente and the CDC KR

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 JDC

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 KR

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 Mental health and well-being Depression, post-traumatic stress disorder (PTSD) Aggression Anxiety Somatic complaints Attempted suicide Social ostracism Academic achievement Re-victimization Unwanted pregnancy Job problems; lost time from work Disease and Injury STDs, including HIV Gynecological problems Heart disease Diabetes Stroke Cancer Suicide KR 8

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 KR Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, et al JS. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine. 1998;14:245-258. www.acestudy.org

JDC

JDC

ACEs effect your brain development, hormone production, cellular health, and even the expression of your DNA JDC

JDC http://communityresiliencecookbook.org/

The Power of Prevention JDC The Power of Parenting

Nurturing Relationships Make and Keep Us Well KR 15

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   KR 16

The Cost of ACEs JDC

ACEs are the LEADING determinant of health, social and economic wellbeing of our nation JDC

What was YOUR reaction when you learned about the ACE study? JDC

What are your reservations about administering the ACE questionnaire to your clients? JDC

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 JDC

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 JDC

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 JDC

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 JDC

Administering ACE at PCAT Normalize Guide conversation on change Inform of study KR

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 KR

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Results of ACEs Data Collection at The Family Center 94% Experienced Household Dysfunction 71% Separation / Divorce Compare to 23% 56% Domestic Violence Compare to 13% 55% Household Mental Illness Compare to 19% 55% Household Substance Abuse Compare to 27% 49% Incarcerated Family Member Compare to 5% 79% Experienced Child Abuse 74% Emotional Compare to 11% 43% Physical Compare to 28% 37% Sexual Compare to 21% 69% Experienced Child Neglect 65% Emotional Compare to 15% 41% Physical Compare to 10% JDC

Results of ACEs Data Collection at The Family Center 74% Have 4 or more ACEs Results in 5 – 10 years earlier death Compare to 13% from original ACE study 44% Have 7 or more ACEs Results in 20 years earlier death JDC

Anthony’s Story JDC

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 KR

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 KR

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 KR http://www.instituteforsafefamilies.org/materials/m/partnering-parents-apps-raising-happy-healthy-children

The Amazing Brain Booklet to help parents understand the impact of trauma on early brain development KR http://www.instituteforsafefamilies.org/materials/m/amazing-brain-0

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 KR