PROTECTIVE FACTORS AND RISK FACTORS (ADVERSE CHILDHOOD EXPERIENCES -ACE’s)

Judy Harrison, Executive DirectorLouisiana Children’s Trust Fund

November 2013

Principles of Brain Development-The outside world shapes the brains wiring.-The outside world is experienced through thesenses--seeing, hearing, smelling, touching,and tasting--enabling the brain to modifyconnections.-The brain operates on a “use it or lose it” principle-Relationships with other people early in life arethe major source of development of the emotionaland social parts of the brain.

I Am Your ChildReiner Foundation

“Discovery consists of looking at the same thing as everyone else and thinking something different.”

A.Szent-Gyorgyi

What are Protective Factors?

Parental Resilience Social Connections Knowledge of parenting and child

development Concrete supports in times of need Children social and emotional competence Nurturing and attachment

Risk Factors:Adverse Childhood Experiences Experiences that represent health or social

problems of national importance: Childhood abuse and neglect Growing up with domestic violence, substance

abuse or mental illness in the home Parental discord Crime

Adverse Childhood Experience (ACE) Study Largest study of its kind ever done to

examine the health and social effects of childhood experiences throughout the lifespan of participants (17,000)

Kaiser Permanente and CDC Retrospective study of an HMO population Average age 57 years

Categories of ACEs

ABUSE Abuse

Emotional Physical Sexual

Neglect Emotional Physical

HOUSEHOLD DYSFUNCTION Mother treated violently Household sustance abuse Parental separation or divorce Incarcerated household member

Adverse Childhood Experiences Are Very Common Percent reporting types of ACEs:

Alcohol abuse- 23.5% Mental illness- 18.8% Battered mother- 12.5% Drug abuse- 4.9% Criminal behavior- 3.4%

Childhood Abuse: Psychological- 11.0% Physical- 30.1% Sexual- 19.9%

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 score of two.

ACE Score PrevalenceNumber of individual adverse childhood experiences

0 47.9% 1 24.9% 2 13.1% 3 7.3% 4 or more 6.8%

More than half had at least one ACE More than one in four had 2 or more ACEs

Prevalence Maybe Underestimated

Sampling excludes persons in institutions, prisons, hospitals or who are homeless

Retrospective nature of ACE questions raises potential for recall error

Generational and socio-cultural influences- Older adults may have forgotten some of their

childhood experiences Different interpretations of experiences-

Corporal punishment interpreted differently between young and old participants

ACE Study Findings

As ACE score goes up, so does the risk for Organic disease (pulmonary, heart & liver) Adult alcoholism & drug abuse Depression and suicide attempts Multiple sexual partners STD’s and rape (5% to 33%) Hallucinations Risk for intimate partner violence Addictions Dying early Job problems and lost time from work

Summary of Findings

Adverse Childhood Experiences (ACE’s) are very common

ACE’s are strong predictors of health behaviors in adolescence and adult life

This combination of findings makes ACE’s one of the leading, if not the leading determinant of health and social well-being of our nation

ACE’s module administered in Louisiana in 2009 Percentage of adults participants (8147)

reporting ACE’s (by number of ACE’s reported) 0 ACE’s 43% 1 ACE’s 25% 2 ACE’s 13% 3 ACE’s 10% 4 ACE’s 12%

ACE CATEGORIES-Louisiana participants

AbusePhysical 11%

Sexual 10%

Emotional 21%

Household Dysfunction

Mental Illlness 17%

Substance Abuse 27%

Divorce/Separation 27%

Domestic Violence 15%

Incarceration 7%

What Does All This Mean?

•ACEs very common

•Strong predictor of later health and mortality risks

•Combination of ACEs increases risks

•Protective factors may buffer the effect of ACEs (•Journal of Adolescent Health October 2013

Supplement on Protective Factors interrupting cycle of maltreatment across generations)

•Importance of prevention!

Elements of Future Success in Child Health and Well-Being

-Recognizing that child abuse and neglect and other ACEsare like diseases that are self-replicating and interruptingthe cycle

-Fully documenting the long-term health, social, andeconomic costs of child abuse and neglect

-Educating our culture about the importance of childdevelopment via the schools (high schools and collegesmedical school and residency training)

-Multidisciplinary teamwork to develop new approachesto teaching child development, recognizing and treatingchild abuse and neglect and domestic violence, and treatingparents impaired by alcohol, illicit drug abuse, or mental illness

REFERENCES

http://wichildrenstrustfund.org/files/WisconsinACEs.pdf

http://www.pal-tech.com/web/NCCAN/files/Merrick%20ACES%20Webcast%20CLEARED.pdf

http://www.cdc.gov/ace/ http://friendsnrc.org/