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