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

http://communityresiliencecookbook.org/

The Power of Prevention

The Power of Parenting

Nurturing RelationshipsMake and Keep Us Well

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  

The Cost of ACEs

ACEs are the LEADING determinant of health, social and economic wellbeing

of our nation

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

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

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

Administering ACE at PCAT

NormalizeGuide conversation

on changeInform of study

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

Anthony’s Story

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