1. Addressing Childhood Trauma: Optimizing Use of the National Survey of Children’s Health January 25, 2017 PM 2:30-4:00PM ET Christina Bethell, PhD, MBA, MPH Johns Hopkins Bloomberg School of Public Health Child and Adolescent Health Measurement Initiative Department of Population, Family and Reproductive Health

2. For Child & Family Health (using family centered data and tools)
Identify Shared Transformative Goals
For Child & Family Health
Promote Early and Lifelong Health of Children, Youth and Families
(using family centered data and tools)
Transformational Partnerships
Actionable Data & Data-Driven Tools
Inspire and Inform
Bethell, C 2016

3. Promoting early and lifelong health leveraging prevention and human development sciences.
A Critical Goal:
Optimize the capacity of Medicaid to drive and ensure efforts at the individual, family, community and systems levels to effectively address social and emotional determinants of health, like ACEs, to promote positive health resilience and well-being among children, youth and families.
….and catalyze and epidemic of health for generations to come!

4. Hard Science Reveals Requirements for Healthy Development and Well-Being
Positive Health, Resilience, Protective Factors and Risks
Social and Emotional Development
Safe, Stable, Nurturing Relationships
If regulation requires connection—what does “self-regulation” mean?
Source: Bethell, C 2016

5. ACEs Impact Multiple Outcomes General Health and Social Functioning
Relationship Problems
Married to an Alcoholic
Poor Self-Rated Health
Smoking
Alcoholism
High perceived stress
Difficulty in job performance
Hallucinations
Promiscuity
High Perceived Risk of HIV
Depression
Obesity
General Health and Social Functioning
Sleep Disturbances
Risk Factors for
Common Diseases
Mental Health
Memory Disturbances
Poor Perceived Health
ACEs
Illicit Drugs
Anxiety
IV Drugs
Panic Reactions
5 categories are…
Examples of these categories are…
But wait, there’s more…
It is easy to look at this slide and to be overwhelmed, but I see potential because if all of these diverse outcomes are associated with ACEs, there’s at least the potential to impact upon all of these public health crises by preventing and addressing childhood toxic stress.
Another way to breakdown this slide is to look at these 6 risk factors, which are essentially unhealthy lifestyles that are known to be maladaptive stress reduction techniques. THEY ARE ALL WAYS TO ESCAPE, even if only temporarily, THE STRESS OF LIFE. And most of the rest of these adverse outcomes can be attributed, at least in part, to these unhealthy lifestyles.
So, this forces us to look at adolescent and adult health in a completely different manner. Are we going to continue treating all of these unhealthy lifestyles and symptoms of unmanaged stress, or are we going to pro-actively address the childhood antecedents – the root or distal causes?
Which reminds me of the following public health parable…
Prevalent Diseases
Sexual Health
Multiple Somatic Symptoms
Poor Anger Control
Cancer
Liver Disease
Teen Paternity
Fetal Death
Skeletal Fractures
Chronic Lung Disease
Teen Pregnancy
Unintended Pregnancy
Sexually Transmitted Diseases
Early Age of First Intercourse
Ischemic Heart Disease
Sexual Dissatisfaction 5

6. Data Resource Center

7. Prevalence Among US Children (2011-12 National Survey of Children’s Health)
Prevalence of
2+ (of 9) ACES:
16.3% (UT) –
32.9% (OK)
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);
Source: Bethell, C 2016

10. Source: Bethell, C 2016

11. Impacts on chronic condition status appear early in life.
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);
Source: Bethell, C 2016

12. Prevalence and Adjusted Odds Ratio of EMB Conditions, by ACEs Status and Age,
Data: NSCH

13. Equally Unequal: Similarities of Impact Across Income Groups Prevalence of Emotional, Behavioral of Developmental Problems Among Children with 4+ ACEs: By Household Income
Rich or poor
The withholding of love
Pierces
May you be led to the mysterious transfiguration this piercing can allow
And open to the truth from within like the nautilus closing off all former layers
And slowly, patiently rising up into the love that always was
Mirrored or not
Always was
Always will be
Excerpt from “Breaking Ground” Christina Bethell
Bethell, C 2016

14. Nearly 2/3 of children with public sector insurance coverage carry ACEs, such as physical and emotional abuse and neglect, substance abuse or mental illness in the home, justice-involved family members, exposure to violence, and extreme poverty.
63.8% Public. 36.6% Private % Uninsured

15. Maternal Health and Child Health

16. School Engagement Rate Among Children With Special Health Care Needs Exposed to 2+ Adverse Childhood Experiences: By Demonstration of Resilience
“You can go good places with your mind if you can’t go good places with your body. “
Stephen Porges, PhD
Professor Emeritus, University of Illinois at Chicago. Director, Brain Body Center in the Department of Psychiatry. Author: The Polyvagal Theory
Bethell, C 2016

17. Child Protective Factors
Prevalence of School Success Factors Among US Children Age 6 to 17 with EMB Conditions and 2 + ACEs by Resilience Status. Data: NSCH

18. Flourishing and Adverse Childhood Experiences (US Children Age 6-17)

19. Flourishing and ACEs (2+) Among School Age Chidlren 44% CA to 25
Flourishing and ACEs (2+) Among School Age Chidlren 44% CA to 25.8 NY Zero ACEs: 62.9% ND to 44.7% DC

20. Public vs. Privately Insured Children Higher ACEs, Similar Across State Variation (

22. Relationship and Family Level Protective Factors
Prevalence of Resilience Among Children with EMB Conditions and 2+ ACEs Exposures by Key Protective Factors. Data: NSCH

23. Data: 2007 NHIS and NHIS-Child CAM Supplement and 2008 MEPS
Use of Mind–Body Approaches and Mean of Total Conventional Medical Care Expenditures: Children with EMB Conditions and ADD/ADHD.
Data: 2007 NHIS and NHIS-Child CAM Supplement and 2008 MEPS
Percent estimates and estimated mean of total health care expenditures among mind–body users and nonusers statistically significant at p≤05.