1. 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

2. 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

3. 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

4. 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
The Adverse Childhood Experiences (ACE) Study A collaborative effort of Kaiser Permanente and the CDC KR

5. 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

6. 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.

7. 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); KR

8. 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

9. 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 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:

10. JDC

11. JDC

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

13. JDC

14. The Power of Prevention
JDC
The Power of Parenting

15. Nurturing Relationships Make and Keep Us WellKR 15

16. 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   KR 16

17. The Cost of ACEs
JDC

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

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

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

21. 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

22. 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

23. 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

24. 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
JDC

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

26. 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

27. KR

28. KR

29. KR

30. 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

31. 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

32. Anthony’s Story
JDC

33. 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? KR

34. 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

35. 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

36. The Amazing Brain
Booklet to help parents understand the impact of trauma on early brain development KR

37. 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