Understanding Adverse Childhood Experiences. Building Self-Healing Communities
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1 Understanding Adverse Childhood Experiences Building Self-Healing Communities Robert Anda, MD, MS Co-Founder ACE Interface
2 Building Self-Healing Communities Health Care Child Childand Welfare Family Services System Education System Justice System 2013
3 The Biology of Adversity 2013
4 Stress (adrenaline, cortisol) Unpredictable Severe Predictable Moderate Number of Episodes Chronicity Neurodevelopment Epigenetics Vulnerability Resilience
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8 Integrity and Functioning of the Genome--Epigenetics 2013
9 epigenetics Methylation patterns ACEs Influence Gene expression Chromosomes tightly packed DNA Source: NIAA Alcohol Alert Number 86
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12 The Adverse Childhood Experiences (ACE) Study Examines the health and social effects of ACEs throughout the lifespan among 17,421 members of the Kaiser Health Plan in San Diego County A Primary Care Setting Educated Middle Class.. Predominantly White
13 Adverse Childhood Experiences Are Common 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%
14 Adverse Childhood Experiences Rarely Occur in Isolation They come in groups. 2013
15 ACEs tend to come in groups If you grew up with: Additional ACEs (%) or more Household Substance Abuse
16 Adverse Childhood Experiences Score Biologic Stress Dose ACE Score Prevalence 0 33% 1 26% 2 16% 3 10% 4 or more 16%
17 ACEs and Adolescent Health 2013
18 % early initiation 12 ACE Score and Early Initiation of Drug Use (by age 14) >5 ACE Score
19 Adverse Childhood Experiences and Teen Pregnancy ACE Score
20 Mental Health and Substance Abuse 2013
21 % addicted ACE Score and Ever Addicted to Drugs >5 ACE Score
22 Percent with alcohol related problem The ACE Score and Alcoholism ACE Score or more Alcoholic Married an Alcoholic
23 Percent atempted (%) The ACE Score and the Prevalence of Attempted Suicide >=4 ACE Score
24 Adverse Childhood Experiences A National Health Issue ACEs have a strong influence on: -adolescent health -reproductive health -smoking -obesity -alcohol abuse -illicit drug abuse -sexual behavior -mental health - risk of violence and revictimization -stability of relationships -performance in the workforce
25 ACEs are a Pathway to Disease 2013
26 Percent (%) The ACE Score and Liver Disease >=4 ACE Score
27 Percent (%) 6 The ACE Score and the Prevalence of Coronary Heart Disease >=4 ACE Score
28 ACEs and Leading Causes of Death Heart disease Chronic lung disease Stroke Diabetes Cancer Lung cancer Liver disease Suicide Injuries HIV and STDs -Autoimmune diseases -Premature mortality 2013
29 Being Trauma Informed It s not what s WRONG with you It s what HAPPENED to you a different narrative
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31 The Kiss Constantin Brancusi 1909
32 Rewriting the Narrative of Your Life The ACE Score provides a chance to see the story of your life And to create a different path for the future 2013
33 Rewriting the Narrative of Your Life From shame, confusion, and adaptations with a downside. To create a different path for the future with hope, meaning, and purpose 2013
34 Building Self-Healing Communities Health Care Child Childand Welfare Family Services System Education System Justice System 2013
35 Implications for the Health Care System 2013
36 Pharmacy and Polypharmacy 2013
37 Prescription rate (per 100 person-years) ACE Score and Rates of Antidepressant Prescriptions >=5 ACE Score
38 The Kaiser Formulary has 15 Classes of Drugs Anti-infectives Endocrine and Metabolic Cardiovascular Respiratory Gastrointestinal Genitourinary Neuromuscular Central Nervous System Analgesic and Anesthetic Antineoplastic Hematological Biologics Nutritional Topical Other 2013
39 ACEs and Polypharmacy Among Young Adults 8 or More Classes of Drugs* ACE Score >=5 *18-44 years
40 Unexplained Symptoms 2013
41 ACEs Predict Unexplained Symptoms >=5 ACE Score
42 Unexplained Symptoms Create High Service Utilization 2013
43 Unexplained Symptoms And 10 or more Doctor Office Visits/Year >=5 Number of Unexplained Symptoms
44 Significant care issues associated with high ACE patients include: -Comorbid conditions -Multiple somatic symptoms resulting in high levels of testing and referrals to different providers -Frequent visits, high use of the emergency room, and no shows -High pharmacy use and polypharmacy 2013
45 Implications for the Education System 2013
46 Students with 3 or more ACEs: Are 2 ½ times more likely to fail a grade Score lower on standardized tests Have language difficulties Are suspended or expelled more Are designated to special education more frequently -Have poorer health Courtesy of Chris Blodgett, PhD Washington State University
47 Population Average ACEs and High School Sophomores and Seniors
48 Implications for the Justice System The Prison Pipeline 2013
49 ACE Score and Repeated Suspension/Expulsion Youth on Probation, Pierce County, WA History of > 7 expulsions or suspensions since the first grade Prevalence (%) % (n=11) 25.5% (n=69) 35.3% (n=158) 35.7% (n=148) 38.6% (n=124) 39.4% (n=148) 1 aor (95% CI) ACE Score 0.1
50 ACE Score and Felony Re-offense Tacoma Urban Network Felony Re-offense Post Probation and ACE Score 40% 30% 20% 10% 16% 12% 10% 18% 16% 25% 11% 20% 19% 25% 23% 31% 0% ACE Score Within One Year Within Two Years
51 Large numbers of youth in the juvenile justice system are experiencing mental health disorders Prevalence of Mental Disorders- Findings From Recent Studies Positive Diagnosis NCMHJJ (2006) 70.4% Teplin et al. (2002) 69.0% Wasserman et al. (2002) 68.5% Wasserman, Ko, McReynolds (2004) 67.2% 51
52 Most have co-occurring substance abuse disorders % Without Co-Occurring Substance Use Disorders 28% % With Co-Occurring Substance Use Disorders 72% Source: The National GAINS Center,
53 ACEs are the Common Source Mental illness Addiction Domestic violence Poverty Homelessness Health disparities Violence Disrupted families/ relationships Suicide Crime/mass incarceration School failure Chronic Illnesses
54 ACEs and Population Attributable Risks 2013
55 Power of the ACE Study? -A Common Language -And Conceptual Framework ACEs are common ACEs are highly interrelated ACEs pile up and have a cumulative impact ACEs account for a large percentage of health and social problems Biologic Plausibility 2013
56 Building Self-Healing Communities Health Care Child Childand Welfare Family Services System Education System Justice System 2013
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