What is ACEs and Why is it Important?
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The document summarizes research on adverse childhood experiences (ACEs). It describes the original ACE study which found that two-thirds of participants reported at least one ACE. ACEs are interrelated and occur in clusters, with increased ACE scores correlated to higher risks of health problems, risky behaviors, and lower life potential. The document recommends promoting resilience and protective factors to reduce the prevalence and impact of ACEs.
What is ACEs and Why is it Important?
- 1. What is ACEs and Why Is it Important? Psychiatry & Behavioral Medicine Symposium October 3, 2018
- 2. Plan for this Afternoon… What are ACEs? What is the research behind ACEs? What is the impact of ACEs? Why should we care? What can we do about ACEs? What? So What? Now What?
- 3. Let’s Start with WHAT
- 4. What are ACEs? ACE = Adverse Childhood Experience An adverse childhood experience is a traumatic event that happens during childhood (under the age of 18).
- 6. The Original ACE Study Between 1995 and 1997, over 17,000 people receiving physical exams completed confidential surveys prior to their appointment (received by mail) containing information about their childhood experiences and current health status and behaviors. Participants were members of the Kaiser Health Plan in San Diego County, California Study was retrospective – adults reported on things they experienced in their childhood.
- 7. Who Were the Study Participants?
- 8. What did the study find? Adverse childhood experiences are common, but largely unrecognized
- 9. What Does This Mean? Almost two-thirds of adults surveyed had at least one adverse childhood experience.
- 11. What did the study find? Adverse childhood experiences rarely occur in isolation.
- 12. What did the study find? ACEs are highly interrelated and tend to occur in clusters.
- 13. What Does This Mean? If any one ACE is present, there is an 87% chance of at least one other category of ACE present, and 50% chance of 3 or more.
- 14. Cumulative Impact ACEs have a cumulative effect – the higher the score, the higher the likelihood of health risk behaviors and poor health outcomes. This is most likely due to the increased allostatic load – or “wear and tear on the body” which grows over time when an individual is exposed to repeated or chronic stress.
- 15. What did the study find? ACEs have a dose-response relationship with many health problems.
- 16. ACE Score and Health Problems SOURCE: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention
- 17. What did the study find? ACEs are the nation’s most basic public health problem.
- 18. QUESTIONS?
- 19. So WHAT Does This Mean?
- 20. So What? Health: obesity, diabetes, depression, suicide attempts, STDs, heart disease, cancer, stroke, COPD, broken bones Behaviors: smoking, alcoholism, drug use Life Potential: graduation rates, academic achievement, lost time from work ACEs have been shown to have lasting effects on:
- 21. ACE Score & Chronic Disease1 Prevalence% 0 2 4 6 8 10 12 14 16 18 Ischemic Heart Disease Stroke COPD Diabetes Sexually Transmitted Disease 0 1 2 3 ≥ 4ACE Score 1 Felitti et al., (1998) American Journal of Preventive Medicine, 14:245-258.
- 22. ACE Score & Mental Health1 Prevalence% 0 10 20 30 40 50 60 70 80 Mood Disorders Anxiety Disorders Substance Abuse Impulse Control Disorders 0 1 2 3 ≥ 4ACE Score 1 Data from the National Comorbidity Survey-Replication Sample (NCS-R): Putnam, Harris, Putnam, J Traumatic Stress, 26:435-442, 2013
- 25. ACE Score & Worker Performance1 PrevalenceofImpaired Performance%) 0 5 10 15 20 25 Absenteeism Financial Problems Job Problems 0 1 2 3 ≥ 4ACE Score 1 Anda et al., (2004) The Permanente Journal/Winter 8:30-38.
- 26. ACE Score & Suicide Attempts 1 of 100 people with 0 ACEs attempt suicide 10 of 100 people with 3 ACEs attempt suicide 20 of 100 people with 7 ACEs attempt suicide
- 27. ACEs Increase Health Risks
- 28. Exponentially! People with 4 or more ACEs, compared to those with 0 ACEs
- 29. ACEs Affect the Lifespan People with 6 or more ACEs died nearly 20 years earlier on average than those without ACEs.
- 31. Short, stressful events like meeting new people or starting the first day of school. These are healthy for brain development. They prepare the brain and body for stressful situations later in life. Tragic, unavoidable events like a natural disaster or losing a loved one aren’t good for us. But if supportive caregivers are around to buffer the stress response, these events won’t do lasting damage to the brain & body. Ongoing, repeated exposure to abuse or neglect is bad for brain development. If no supportive adults are present to help buffer the stress response, stress hormones will damage developing structures in the child’s brain. The result is an increased vulnterability to lifelong problems.
- 32. Body’s Response to Stress
- 33. Impact on Developing Brain
- 35. Important to Note… ACEs is an emerging topic in the public health arena – especially as it relates to adult health and wellness. It doesn’t matter what the ACE is. Begin to shift thinking from “What’s wrong with you?” to “What happened to you?”
- 36. QUESTIONS?
- 37. So NOW WHAT?
- 39. Resilience Factors That Make a Difference Feeling social/emotional support and hope. Having 2 or more people who help (giving concrete help when needed). Community reciprocity: watching out for children, intervening when they are in trouble, doing favors for others (social connectedness). Social Bridging: reaching outside your social circle to get help for family and friends. is a set of capacities!
- 49. Resilience is NOT a Superpower ANYONE can learn and develop
- 50. AND….It’s Never TOO Late can be built over time with practice and positive experiences.
- 51. Actionable Next Steps Attend/Offer Screening of RESILIENCE http://bit.ly/MichiganACE Share information/training with others Nadine Burke Harris TED Talk
- 52. Actionable Next Steps Know Your Number! This is a history taking tool – looking at your history of childhood trauma and adversity helps “explain” its impact on your health. It’s not “what’s wrong with you,” but rather “what happened to you.” Promote the idea that “what is predictable is preventable.”
- 53. Actionable Next Steps Promote Resilience and Protective Factors Protective factors are attributes in individuals and families that, when present, alleviate or eliminate risk in families and increase their health and well being. What Makes Your Family Strong?
- 55. Actionable Next Steps Share user-friendly information tools (UFIT) https://www.futureswithoutviolence.org/connected-parents-connected-kids/
- 56. The Story of ACEs in Michigan Michigan ACEs Data 2013: ACEs questions added to BRFSS and 2015 Surveillance Brief released 2016: ACEs questions added (again) along with questions about protective factors Data currently being analyzed 2019: ACEs questions asked of the entire state Will provide county level data
- 57. Michigan ACE Initiative To date, 75 people have been trained as Master Trainers. These trainers represent all parts of the state and are available to conduct presentations and/or facilitate screenings of the film RESILIENCE. The Michigan ACE Initiative has trained over 3200 individuals on ACEs reached/created awareness to over 3300 people through screenings of RESILIENCE, the documentary on ACE’s (with the help of community partners) Developed a legislative ask – proposing both funding and policy changes to reduce the prevalence and impact of ACEs in Michigan. Learn more at http://www.miace.org
- 59. Washington State Family Policy Council A large portion of many health, safety and prosperity conditions is attributable to Adverse Childhood Experiences.
- 60. Resources Original ACE Study Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults published in the American Journal of Preventive Medicine in 1998, Volume 14, pages 245- 258. CDC ACEs Information https://www.cdc.gov/ace ACEs Primer https://vimeo.com/139998006 End It Now http://bit.ly/EndItNowACES Adverse Community Experiences and Resilience http://bit.ly/AdverseCommunityExperiences
- 61. Jodi L. Spicer, MA Adverse Childhood Experiences (ACEs) Consultant Division of Chronic Disease and Injury Control Michigan Department of Health and Human Services Phone: (517) 373-9295 Email: spicerj1@michigan.gov Contact Information