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Opportunities for Early Childhood Systems Building
Using the ACEs Study: Iowa’s Experience (so far)
ACE Study Provides a Paradigm Shift on Addictions & Unhealthy Behaviors
“What’s wrong
with you?”
“What
happened to
you?”
• Decade long study involving 17,000 people.
• Examines the health and social effects of ACEs throughout the lifespan.
• Largest study ever done on this subject.
• General Findings: Childhood experiences are powerful determinants of who we become as adults.
Adverse Childhood Experiences (ACE) Study
Dr. Vincent Felitti Dr. Rob Anda
Physical abuse
Emotional abuse
Sexual abuse
An alcohol and/or drug abuser in the household
An incarcerated household member
Someone who is chronically depressed, mentally ill, institutionalized, or suicidal
Mother is treated violently
One or no parents
Emotional or physical neglect
ACEs Questionnaire
Of the 17,000 HMO Members ~ Household Dysfunction:
Substance abuse 27%Parental sep/divorce 23%Mental illness 17%Battered mother 13%Criminal behavior 6%
Abuse: Psychological 11% Physical 28% Sexual 21% Neglect: Emotional 15% Physical 10%
Adverse Childhood Experiences are
Common
PopulationAverage
Most frequently asked question in Iowa
“Now what?”
after learning about the ACEs study is:
Central Iowa’s Process
Established Central Iowa ACEs Steering Committee
Started with “a small group of thoughtful, committed citizens…” inspired by the ACEs study with an understanding that there is a responsibility that
comes with now knowing this information.
1)Created the Central Iowa ACEs Steering Committee
2) Developed public/private co-investment partnership to fund ACEs module in state BRFSS
3) Statewide ACEs Summit
4) Created Iowa ACEs 360 Website http://www.iowaaces360.org/
5) Developed a Visioning and Strategic Planning Timeline
Top 5 Game Changers to Getting Traction in
Iowa
Scope of ACEs Work
To enhance the individual and community capacity to prevent and respond to adverse childhood experiences and toxic traumas
To engage as many partners as possible across a
variety of disciplines, at both a state and local level about the impact of ACEs
• Broad-based • Recognize no cookie cutter approach to this
work across sectors and communities• Focus on education & awareness• Use current and continually evolving research to
ground policy and practice recommendations
Source: Behavioral Risk Factor Surveillance System, CDC.
States Collecting ACE Data2009-2012
No data 20102009 2011
2009-201219
States
2012
Possible Policy & Practice Implications
Improve effectiveness of public health campaigns by refining messages grounded in ACEs findings
Integrate trauma-informed professional development across state departments and family-serving systems
Increase policymaker understanding of the prevalence of ACEs to inform policy decisions, such as Iowa’s Mental Health Redesign, the Healthiest State Initiative, and Education Reform efforts.
Promote early identification and intervention efforts through universal screening and assessment within family-serving systems.
• ACEs are common• ACEs are interrelated• ACEs are associated with:
– Mental Health Outcomes – Health Risk Behaviors– Physical Health Outcomes– Socioeconomic Status– Medicaid/Badger Care
Enrollment– Quality of Life
16
17
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19
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• Increase public awareness of ACEs and their impact on health and well-being
• Increase assessment of and response to ACEs in health and other human service settings
• Enhance the capacity of communities to prevent and respond to ACEs
• Continue to collect Wisconsin-specific data on the relationship between ACEs and health outcomes 23
Iowa ACEs Summit Participant Survey Results
1) Close to 90% of respondents found the ACEs study findings to be relevant or very relevant to their field of work.
2) Respondents anticipate making changes in their field of work based on what they learned from the summit. • The most common plan was to educate colleagues and employees
about ACEs. Other responses included:
• Sharing what they learned at the summit with parents and clients they work with. • Incorporating what they learned at the summit directly into their
work with children and clients• Screening clients for ACEs
3) Participants see themselves getting involved in Iowa’s next steps • Most respondents expressed an interest in spreading awareness
about ACEs or learning more themselves. • Others would like to serve on committees or take other leadership
roles. Many were unaware of existing community initiatives working to infuse ACEs at the time and would like to learn about opportunities to get involved as they come up.
Iowa ACEs Summit Participant Survey Results, continued…
Recommended Key Stakeholders
• Department of Education• Health Care Professionals (including mental
health) • Department of Public Health. • Legislators • Department of Human Services and social
workers • Non-profits and community action agencies • Law enforcement and the justice system • Businesses • Faith-based organizations • Parents
Iowa ACEs Summit Participant Survey Results, continued…
Recommended Next Steps for Iowa ACEs Steering Committee
1) Close to one third of respondents indicated interest in participating on the Central Iowa ACEs Steering Committee.
2) The Central Iowa ACEs Steering Committee can support local and state planning efforts by:
• Educating the public and increase awareness around ACEs in a variety of ways including conferences, meetings, and trainings.
• Building connections and relationships throughout the community.
• Developing models and frameworks•Lobbying for policy change
• Providing resources to people affected by ACEs and the agencies that serve them.
Challenges to Moving Ahead1)No full time dedicated staff
2) Waiting for Iowa data when interest in high
3) Speaker capacity on ACEs (The more public speaking on ACEs, the higher the demand for speakers across the state to continue spreading the word)
4) Shift in how services can/should be delivered will require multiple level strategies
5) Stay focused on strategic plan, and yet flexible enough to incorporate innovations
6) Long term commitment to changing intergenerational transmission of ACEs
Recommended Resources
Family Policy Council of Washington:http://www.fpc.wa.gov/
Frameworks Institute:http://www.frameworksinstitute.org/
Harvard Center on the Developing Child:http://developingchild.harvard.edu/
Iowa ACEs 360:http://www.iowaaces360.org/
National Child Traumatic Stress Network:http://www.nctsn.org/
Wisconsin Children’s Trust Fund:http://wichildrenstrustfund.org
Sonni VierlingState Coordinator
1st Five Healthy Mental Development Initiative
Iowa Department of Public Health
[email protected](515) 281-8284