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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) Study
A 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 violence
Household substance abuse
Household mental illness
Parental separation or divorce
Incarcerated 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 Relationships
Make 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
Normalize
Guide conversation
on change
Inform of study
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
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
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