Adverse Childhood Experiences Predictor s of Future Health In my end is my beginning T.S. Eliot Four quartets
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1 Adverse Childhood Experiences Predictor s of Future Health In my end is my beginning T.S. Eliot Four quartets Steve Wolfe, M.D. Professor Emeritus University of Iowa Department of Family Medicine
2 Learning Objectives: Understand and articulate the relationship between adverse childhood experiences and adult health risks/behaviors Understand the relationship between adverse childhood experiences and social outcomes Understand the ecobiodevelopmental model of health and the impact of ACEs and toxic stress on childhood brain development Use the ACEs screening tool in your practice to access future health risks/behaviors
3 Disclosure: Consultant, Iowa Medicaid Enterprise & Iowa Department of Public Health 1 st Five SPONSORED: IOWA MEDICAID ENTERPRISE AND CENTER FOR DISEASE AND DISABILITY UNIVERSITY OF IOWA
4 The ACEs Study Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. Vincent J. Felitti, FACP, Robert F. Anda, MD, MS, et al. Am J Prev Med 1998;14(4)
5 ACE Pyramid Concept for ACE Study
6 ACEs Study Design ACEs questionnaire completed by 17,421 of 26,000 HMO members of Kaiser Permanente, San Diego Department of Preventive Medicine
7 Iowa BRFSS Annual survey conducted by CDC and Iowa 2012 BRFSS include questions to assess for ACES Surveyed 6,361 Iowans Iowa ACES data consistent with original ACES study data
8 Adverse Childhood Experiences ACE = Events/Incidents which harm social, cognitive, and emotional functioning causing a dramatic upset in the safe, nurturing environments children require to thrive. ACEs are common stressful traumatic experiences which affect children s neurodevelopment. The Ecobiodevelopmental Model of Health. ACE score is a measure of the cumulative exposure to household dysfunction, abuse, and neglect.
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11 What Did We Learn ACEs Are Common
12 ACEs Are Interrelated
13 ACEs Are Cumulative: Co-occurrence and Cumulative Effect of ACES
14 ACEs --Strong Association With Alcohol Abuse
15 Relationship of ACE Score to Alcohol Use And Abuse
16 ACEs Are Common in Iowa
17 ACEs in Iowa Co-Occurrence
18 Iowans With ACEs Score 4 or Greater Experiencing Each ACE Category
19 ACEs Predict Future Health Risk Behaviors And Overall Quality of Life
20 Health Risk Behavior And Illness Burden Worse Case: childhood trauma as measured by ACE score can reduce life expectancy by 20 years
21 Depression and Suicide
22 Iowa ACEs/Depression
23 ACE Score and Teen Sexual Behaviors
24 ACEs and Population Attributable Risks
25 Iowa ACEs Study
26 ACEs Adversely Affects Many Health Outcomes RISK FACTOR % INCREASE Smoking 242% Obesity 22% Depression 357% Illicit drug use 443% Injected drug use 1133% STD 298% Attempted suicide 1525% Alcoholism 555%
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28 ACE National Issue Impact: Adolescent health, teen pregnancy and sexual behavior, risk of revictimization, stability of relationship, life performance at work and school. Impact: heart disease, liver disease, injuries, obesity, diabetes, arthritis
29 ACE Scores Among Parents in Iowa
30 Impact on Education And Future Work Place Problems
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32 Spokane Washington Students with 3 or more ACEs: 2 ½ times more likely to fail a grade Score lower on standardized tests Have language difficulties Suspended or expelled more Designated to special education more frequently Poorer health Courtesy of Chris Blodgett, PHD ~ Washington State University
33 Effect of ACEs on Educational Outcomes N.J. Burke et al/child Abuse And Neglect, 2011; 35(6):
34 New ACEs Pyramid Concept
35 IT IS EASIER TO BUILD STRONG CHILDREN THAN TO REPAIR BROKEN MEN. FREDERICK DOUGLAS
36 Nature Plus Nurture The Neurobiology of Development
37 Critical First 1000 Days
38 Synapse Development
39 Brain Architecture
40 Healthy Brain This PET scan of the brain of a normal child shows regions of high (red) and low (blue and black) activity. At birth, only primitive structures such as the brain stem (center) are fully functional: in regions like the temporal lobes (top), early childhood experiences wire the circuits.
41 Serve and Return
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43 Brain Architecture Persistent Stress Changes Brain Architecture
44 Toxic Stress
45 Still Face Experiment
46 An Abused Brain This PET scan of the brain of a Romanian orphan, who was institutionalized shortly after birth, shows the effect of extreme deprivation in infancy. The temporal lobes (top), which regulate emotions and receive input from the senses, are nearly quiescent. Such children suffer emotional and cognitive problems.
47 Epigenetics Process determines which genes are turned on/off synthesizer Environment/experience impacts how genotype is translated into phenotype Genes load the gun, the environment pulls the trigger
48 How Early Experiences Alter Gene Expression and Shape Development National Scientific Council on the Developing Child Working Paper 10: Early Experiences Can Alter the Gene Expression and Affect Long-Term Development
49 Eco-Bio-DevelopmentModel Experience (Ecology) Brain Development (Biology) Epigenetic Changes Behavior (Development)
50 Public Health Approach to ACEs 1) Identify protective factors: Encourage nurturing and positive relationships Provide knowledge of parenting and child development Assist in developing parental resilience Social connections Concrete support in times of need
51 Public Health Approach to ACEs 2) Build Strong Communities: Inform and Educate Enhance Skills Provide Support Enhance Access And Reduce Barriers Community Activities Modify/Change Policy
52 THE QUALITY OF LIFE FOR A CHILD BEGINS WITH THE BIRTH OF HIS OR HER PARENTS. ---UNKNOWN
53 References The Adverse Childhood Experiences Study: ACEs 360 Iowa: Health in Iowa, Annual Report from the Behavioral Risk Factor Surveillance System, Iowa 2012: Center of the Developing Child at Harvard University: National Scientific Council on the Developing Child (2005). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3 from: nd_working_papers/working_papers/wp3/ Nadine J. Burke et al. The impact of adverse childhood experiences on an urban pediatric population. Child Abuse and Neglect 35(2011)
54 Thank You QUESTIONS AND COMMENTS
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The ABC s of Trauma- Informed Care AGENDA What do we mean by trauma? How does trauma affect people? What can we learn from listening to the voices of people who have experienced trauma? Why is understanding