Opportunities for Early Childhood Systems Building Using the ACEs Study: Iowa’s Experience (so far)

ACE Study Provides a Paradigm Shift on Addictions & Unhealthy Behaviors “What’s wrong with you?” “What happened to you?”

Decade long study involving 17,000 people. Examines the health and social effects of ACEs throughout the lifespan. Largest study ever done on this subject. General Findings: Childhood experiences are powerful determinants of who we become as adults. Adverse Childhood Experiences (ACE) Study Dr. Vincent Felitti Dr. Rob Anda

Physical abuse Emotional abuse Sexual abuse An alcohol and/or drug abuser in the household An incarcerated household member Someone who is chronically depressed, mentally ill, institutionalized, or suicidal Mother is treated violently One or no parents Emotional or physical neglect ACEs Questionnaire

Of the 17,000 HMO Members ~ Household Dysfunction: Substance abuse 27% Parental sep/divorce 23% Mental illness 17% Battered mother 13% Criminal behavior 6% Abuse: Psychological 11% Physical 28% Sexual 21% Neglect: Emotional 15% Physical 10% Adverse Childhood Experiences are Common

Population Average

Most frequently asked question in Iowa “Now what?” after learning about the ACEs study is:

Central Iowa’s Process Established Central Iowa ACEs Steering Committee Started with “a small group of thoughtful, committed citizens…” inspired by the ACEs study with an understanding that there is a responsibility that comes with now knowing this information.

1)Created the Central Iowa ACEs Steering Committee 2) Developed public/private co-investment partnership to fund ACEs module in state BRFSS 3) Statewide ACEs Summit 4) Created Iowa ACEs 360 Website 5) Developed a Visioning and Strategic Planning Timeline Top 5 Game Changers to Getting Traction in Iowa

Scope of ACEs Work To enhance the individual and community capacity to prevent and respond to adverse childhood experiences and toxic traumas To engage as many partners as possible across a variety of disciplines, at both a state and local level about the impact of ACEs Broad-based Recognize no cookie cutter approach to this work across sectors and communities Focus on education & awareness Use current and continually evolving research to ground policy and practice recommendations

Source: Behavioral Risk Factor Surveillance System, CDC. States Collecting ACE Data No data States 2012

Possible Policy & Practice Implications Improve effectiveness of public health campaigns by refining messages grounded in ACEs findings Integrate trauma-informed professional development across state departments and family-serving systems Increase policymaker understanding of the prevalence of ACEs to inform policy decisions, such as Iowa’s Mental Health Redesign, the Healthiest State Initiative, and Education Reform efforts. Promote early identification and intervention efforts through universal screening and assessment within family-serving systems.

ACEs are common ACEs are interrelated ACEs are associated with: –Mental Health Outcomes –Health Risk Behaviors –Physical Health Outcomes –Socioeconomic Status –Medicaid/Badger Care Enrollment –Quality of Life 16

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Increase public awareness of ACEs and their impact on health and well-being Increase assessment of and response to ACEs in health and other human service settings Enhance the capacity of communities to prevent and respond to ACEs Continue to collect Wisconsin-specific data on the relationship between ACEs and health outcomes 23

Iowa ACEs Summit Participant Survey Results 1) Close to 90% of respondents found the ACEs study findings to be relevant or very relevant to their field of work. 2) Respondents anticipate making changes in their field of work based on what they learned from the summit. The most common plan was to educate colleagues and employees about ACEs. Other responses included: Sharing what they learned at the summit with parents and clients they work with. Incorporating what they learned at the summit directly into their work with children and clients Screening clients for ACEs 3) Participants see themselves getting involved in Iowa’s next steps Most respondents expressed an interest in spreading awareness about ACEs or learning more themselves. Others would like to serve on committees or take other leadership roles. Many were unaware of existing community initiatives working to infuse ACEs at the time and would like to learn about opportunities to get involved as they come up.

Iowa ACEs Summit Participant Survey Results, continued… Recommended Key Stakeholders Department of Education Health Care Professionals (including mental health) Department of Public Health. Legislators Department of Human Services and social workers Non-profits and community action agencies Law enforcement and the justice system Businesses Faith-based organizations Parents

Iowa ACEs Summit Participant Survey Results, continued… Recommended Next Steps for Iowa ACEs Steering Committee 1) Close to one third of respondents indicated interest in participating on the Central Iowa ACEs Steering Committee. 2) The Central Iowa ACEs Steering Committee can support local and state planning efforts by: Educating the public and increase awareness around ACEs in a variety of ways including conferences, meetings, and trainings. Building connections and relationships throughout the community. Developing models and frameworks Lobbying for policy change Providing resources to people affected by ACEs and the agencies that serve them.

Challenges to Moving Ahead 1)No full time dedicated staff 2) Waiting for Iowa data when interest in high 3) Speaker capacity on ACEs (The more public speaking on ACEs, the higher the demand for speakers across the state to continue spreading the word) 4) Shift in how services can/should be delivered will require multiple level strategies 5) Stay focused on strategic plan, and yet flexible enough to incorporate innovations 6) Long term commitment to changing intergenerational transmission of ACEs

Recommended Resources Family Policy Council of Washington: Frameworks Institute: Harvard Center on the Developing Child: Iowa ACEs 360: National Child Traumatic Stress Network: Wisconsin Children’s Trust Fund:

Sonni Vierling State Coordinator 1st Five Healthy Mental Development Initiative Iowa Department of Public Health (515)