1. The Adverse Childhood Experiences (ACE) survey as a predictor for morbidity and mortality Childhood Adversity and Long-Term Negative Health Outcomes Aaron White

2. What is the Adverse Childhood Experiences (ACE) Survey? 10 questions related to childhood stress Completed in two waves, with 9,500 and 15,000 respondents, respectively Sent to members of the Kaiser Health Plan in San Diego, CA Comprehensive care Well-documented patient illness histories Demographics similar to the U.S. as a whole 80% white or Hispanic, 10% black, 10% Asian Half men, half women Mostly middle class in income Completed in collaboration with the CDC

3. The ACE Survey

4. Results: About 2/3 of the respondents scored at least 1 A score of “1” in any category gave a 87% change of responding “yes” in another category About 1/6 respondents scored a four or higher For all categories, adverse experiences correlated with health problems and in equal weight (p value less than 0.05)

5. Mental Health Incidence of DepressionIncidence of Suicide Attempts

6. Mental Health

8. Medical Disease Diseases Correlated with High ACE Scores Ischemic heart disease Cancer Chronic lung disease Skeletal fractures Liver disease General Conditions Associated with High ACE Scores Substance abuse Intimate partner violence Unintended pregnancies Suicide attempts Smoking Obesity Fetal death

9. Model of Stress and Disease Predecessor of the ACE study A Kaiser Health program was created to assist morbidly obese patients with losing weight Patients ranged from 100-600 lbs overweight Program drop-outs were almost exclusively amongst those actually losing weight When interviewing those who had dropped out, nearly all participants reported some sort of childhood abuse (Stevens, 2012)

10. A Patient-Centered Care Response Major Principles of Watson’s Theory of Caring Practice of loving-kindness and equanimity Authentic presence: enabling deep belief of other (patient, colleague, family, etc.) Cultivation of one’s own spiritual practice toward wholeness of mind/body/spirit—beyond ego “Being” the caring-healing environment Allowing miracles (openness to the unexpected and inexplicable life events) (Watson, 2008)

11. A Patient-Centered Care Response Patient Advocacy and Access to Care Addressing a Taboo Topic Often avoided by health care professionals Lowering barriers to a therapeutic relationship Openness and acceptance of the person Patient Engagement in Care Identifying needs and noting sources of childhood stress Imparting a sense of self care and forgiveness

12. A Patient-Centered Care Response Clinical Information Systems and Quality Improvement Identifying stressors and categorizing them Correlation of stressors with negative health outcomes Quality improvement by aligning problems with interventions Care Coordination Promoting a holistic understanding of health Recruiting team members with various specialties to address underlying problems

13. A Patient-Centered Care Response Comprehensive Team Care Holistic care and screening as a method to implement comprehensive team care Emphasizing the importance of comprehensive care for the patient Routine Patient Feedback to Healthcare Providers Assisting primary care providers in treating families as a whole Monitoring patient progress as a comprehensive team

14. Sources