Using ACEs in our everyday work:
Implications for clients and programs
Kristen Rector – Prevent Child Abuse Tennessee
Jennifer Drake-Croft – The Family Center
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
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
The Adverse Childhood Experiences (ACE) StudyA collaborative effort of Kaiser Permanente and the CDC
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
www.acestudy.org
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 violenceHousehold substance abuseHousehold mental illnessParental separation or divorceIncarcerated household member
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.
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); 1609-1613
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 Anxiety 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
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
www.acestudy.org
ACEs effect your brain development, hormone
production, cellular health, and even the expression of your DNA
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
http://www.developingchild.harvard.edu
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
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
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
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 www.acestoohigh.com
Implementing the tool – Prevent Child Abuse TN (PCAT)
Safety firstExtremely sensitive
informationUsing empathyProvide follow up/referralsACES are commonMake time to discuss
Results of ACEs Data Collection at The Family Center
94% Experienced Household Dysfunction
71% Separation / DivorceCompare to 23%
56% Domestic ViolenceCompare 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% EmotionalCompare to 11%
43% PhysicalCompare to 28%
37% SexualCompare to 21%
69% Experienced Child Neglect
65% Emotional
Compare to 15%
41% PhysicalCompare to 10%
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
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?
http://vimeo.com/75914128
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
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
The Amazing Brain
Booklet to help parents understand
the impact of trauma on early brain development
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