1. Cyndie Meyer, R.D. Program Manager for Chronic Disease Prevention Clark County Public Health From Adversity to Resilience

2. The ACE study Drs. Filetti and Anda Began in 1985 at Kaiser Permanente San Diego More than 17,000 participants… and growing All insured 54% female 78% Caucasian 75% college educated Identified link between childhood trauma and risk factors, chronic disease, mental illness, suicide and early death

3. ACE study factors ABUSE Physical Emotional Mental ABUSE Physical Emotional Mental NEGLECT Physical Emotional NEGLECT Physical Emotional FAMILY DYSFUNCTION Mental illness, depression, suicide Substance abuse/addiction Parental discord – divorce, separation, abandonment Observing domestic violence Incarceration of any family member FAMILY DYSFUNCTION Mental illness, depression, suicide Substance abuse/addiction Parental discord – divorce, separation, abandonment Observing domestic violence Incarceration of any family member Poverty, Homelessness, Racism ACE Score = Number of categories to which a person is exposed

4. ACEs Prevalence 87% of people with one ACE have another 62% of adults have more than one ACE 27% have three or more ACEs Parents with two or more ACEs are eight times more likely to have two or more conditions that create ACEs for their kids In Washington State… 12% of elementary children have three or more ACEs 42 % of high school students have three or more ACEs In an average Washington state high school classroom: Seven students will have four to five ACEs Three students will have six or more ACEs

5. ACE Score Comparison Kaiser Study v. Clark County Truants Researchers: Clayton Mosher, WSU Vancouver Jodi Martin, Clark County Juvenile Court

6. Zero ACEs 1 in 16 smokes 1 in 69 is alcoholic 1 in 480 uses IV drugs 1 in 14 has heart disease 1 in 96 attempts suicide With Three ACEs 1 in 9 smokes 1 in 9 is alcoholic 1 in 49 uses IV drugs 1 in 7 has heart disease 1 in 10 attempts suicide With Seven or More ACEs 1 in 6 smokes 1 in 6 is alcoholic 1 in 30 uses IV drugs 1 in 6 has heart disease 1 in 5 attempts suicide 0 37+ As ACEs increase…

8. Risk Factors: Smoking Substance abuse/addiction Alcohol use Early sexual activity Over-eating Chronic Disease: Asthma Lung disease Heart disease Liver disease Diabetes Cancer Auto-immune disorders Chronic Disease: Asthma Lung disease Heart disease Liver disease Diabetes Cancer Auto-immune disorders Mental Illness: Depression Anxiety Suicidal ideation Nervousness Hallucinations Impaired executive function

9. The ACE paradigm

10. The brain under stress Immediate, Intermediate, Long-term consequences

11. The brain under stress

12. All good if you are in the forest, being chased by a bear…

13. But, what if the bear lives in your home?

14. Policies and practices can compound trauma

15. Childhood trauma interrupts healthy brain development

16. The impact of childhood trauma is inheritable (epigenetics)

17. Economic consequence of ACEs “Approximately 579,000 new substantiated cases of nonfatal child maltreatment (CM) and 1,740 cases of fatal CM per year in the United States result in a total economic burden of $124 billion/year. This estimate is based on discounted lifetime costs of $210,012 per victim of nonfatal CM and $1,272,900 per victim of fatal CM. These estimates are based on an incidence-based approach, which facilitates economic analysis for public health interventions. Compared with other health problems, the burden of CM is substantial, even after conservative assumptions are used, indicating the importance of preventing and treating CM. “ − Fang, et al., 2012

18. Estimated impact of ACEs Annual economic costs of Adverse Childhood Experiences in Alaska - 2015 http://dhss.alaska.gov/abada/ace-ak/Pages/default.aspx Unduplicated $91,936,300/year

21. Keys to Resilience CAPABILITY ATTACHMENT AND BELONGING COMMUNITY CULTURE FAITH Skills Knowledge Self-regulation Mindfulness Focus Discipline Family bonds Caring adults Relationships Inclusion Intrinsic and extrinsic value Faith Hope Meaning Traditions Network of services Belonging

22. 1.Awareness 2.Support for children and families 3.By applying a cross-sector trauma- informed lens to organizational policies and practices How can a community move from adversity to resilience?

23. Early childhood support = Excellent return on investment

24. Aligning community efforts to promote resilience in Clark County, Washington ACEs Action Alliance Action Teams: Assessment and Evaluation Team Education and Awareness Team Trauma-Informed Organizations Team Cross-Sector Collaboration Team Interested? Please email Cyndie.Meyer@Clark.wa.gov