Shasta County Adverse Childhood Experiences Efforts Andrew Deckert, MD, MPH Health Officer Public Health Branch Shasta County - HHSA
KIXE ACEs Commercial
The Impact: Chronic Illness, early mortality
The risk of delay: ACEs accumulate over time Most children accumulate ACEs over the course of childhood. A multi-site study of children exposed to or at risk for maltreatment found that ACEs accumulate over time.
Who is the National Pediatric Practice Community on ACES for? Pediatric-focused primary care medical providers (physicians, nurses, and medical assistants) and their teams Medical practices at any stage of implementation of ACEs screening and intervention
What does the National Pediatric Practice Community offer? www.nppcaces.org Virtual offerings Peer exchange Resources for practice Co-designed Community of Practice Shared lessons learned from experienced practitioners Opportunities for deeper engagement Latest relevant scientific information
Trauma and Social Location Adverse Childhood Experiences Historical Trauma Embodiment
Number of ACEs 3 Average number of ACEs by race/ethnicity (range 0-8) 2.5 2.6 2 1.8 1.7 1.6 1.5 1 0.9 0.5 0 American Indian Asian/Pacific Islander Black Hispanic White
Educating people about ACEs. Engages people you serve by helping them understand their own lives and behavior Empowers people Changes their understanding of others behavior Opens a channel for them to tell you what they need
2004-2011 2004 2007: 40 Developmental Assets community effort 2008: HO pitching the science of original ACE study internally to Public Health staff in meetings 2009 2011: HO giving ACE PowerPoint presentations to the Shasta County Public Health Advisory Board, Mental Health Alcohol and Drug Advisory Board, Federally Qualified Health Centers, and all Public Health Branch staff etc
2011-12 Vision A connected community for strong, safe families. Mission Strengthen families and reduce Adverse Childhood Experiences (ACEs) by increasing protective factors, coordinating service systems and engaging the community. http://www.shastastrongfamilies.org/
Parental Resilience Strengthening Families Framework Social and emotional competence of children Concrete support in times of need Social Connections Knowledge of parenting and child development
ACE Prevalence Surveys, Shasta vs CA, 2012 California Shasta County 4 or more ACEs 16.7% 39.7% 2-3 ACEs 23.3% 32.2% 1 ACE 12.1% 21.7% 0 ACEs 16.1% 38.3% 0 5 10 15 20 25 30 35 40 45
The most common reported ACES, Shasta vs CA, 2012 Incarcerated Family Member 6.6% 17.1% SexualAbuse 11.4% 21.2% California ShastaCounty Witnessed Domestic Violence 17.6% 29.7% PhysicalAbuse 19.9% 34.8% Household Mental Illness 15.1% 43.8% Parental Separation or Divorce 26.7% 44.3% VerbalAbuse 35.0% 54.5% Family Substance Abuse 26.2% 57.7% 0 10 20 30 40 50 60 70
Prevalence of Household Substance Abuse by Education Level, Shasta County ACE Survey, 2012 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% High School or Less Some College/Associate's Degree Bachelor's or Higher
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Prevalence of 4+ ACEs by Educational Attainment, Shasta County 2012 0% High School or Less Some College/Associate's Degree Bachelor's or Higher
100% Prevalence of Childhood Sexual Abuse Shasta County, ACE Survey 2012 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Male Female
Prevalence of ACEs by Race/Ethnicity, Shasta County 2012 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Household Mental Illness Sexual Abuse Latinx White, non-hispanic People of Color, non-hispanic
An ACEs Story
ACE presentation to Women s Fund 2012
Dr. Felitti Grand Rounds at Mercy Medical Center Redding, 2014
Dr. Petterson Training Event September 2015
Shasta County Community Health Assessment
www.rwjf.org/content/dam/farm/reports/reports/2016/rwjf430225 2016
2017
2016-18 ACE Screening Identify screening tools Support with training and technical assistance Public Health to help coordinate referrals Parent Cafes and Parenting Classes Incentives for families Thanks to Partnership Health Plan for awarding HHSA - Public Health Branch $50,000 Social Determinants of Health Planning Grant to support this effort.
Mercy Maternity Clinic Survey offered at first prenatal visit 300+ surveys collected to date Referred to our Healthy Babies Program
Mercy Family Health Clinic Screening with OB patients and in behavioral health counseling clinic Trained residents on ACE screening; want annual refresher Referrals starting to be made
Hill Country Community Clinic ACE screening patients for fit for an addiction program (Suboxone) ACE embedded in EHR Supporting them as needed
Hill Country ACEs Screening Tool
Shasta Community Health Center Attended Center for Youth Wellness Conference Screening parents at the 4- month well baby check-up Starting to screen in their family practice program
Shasta Community Health Center Pediatric ACE Questionnaire
One SAFE Place Received California Endowment funding Screening residents and some children Training and screening tool support from staff
Shasta County Women s Refuge (aka One SAFE Place) ACEs Data Report July 1, 2016 June 30, 2017 Household Substance Abuse Witnessed Domestic Violence 50% 44% 54% 26% 56% 49% Physical Abuse 68% 42% 54% 43% Sexual Abuse Emotional Neglect n=161 clients Parent Separation/Divorce Physical Neglect
Shasta County ACEs Referral Guide
ACE Referral Card - one phone # for clinicians
An ACEs Story
What can we do about ACE: Evidence Informed Approaches
Shasta County Community Health Improvement Plan
Nurse Family Partnership Success Story February 2017 In court, the nurse testified that Jennifer was severely impacted by Adverse Childhood Experiences (ACEs), and she required guidance, patience, structure and routine to succeed success that she had seen Jennifer* achieve during her time with NFP. The nurse also testified that separating the new baby from her mother would likely continue the cycle of ACEs for another generation. The judge was moved by the research presented about childhood trauma and its connection with addiction, and recognized significant improvement in Jennifer since her last court appearance. *Client s name has been changed
ACEs Town Hall Forum, April 2017 ACEs Town Hall Forum April 2017
ACEs Town Hall Forum, April 2017 Shasta Strengthening Families Rack Card
Dr. Robert Anda training Shasta County community leaders ACE Community Leader Luncheon May 19, 2017
Parent Cafes May 2017
ACE Champions Training June 2017
Shasta Strengthening Families website Request an ACEs presentation http://www.shastastrongfamilies.org/
Shasta County ACE Dashboard Indicators October 2017
Shasta Strengthening Families Community ACE Prevention Framework 2017
Shasta County HHSA Public Health Branch New Social Emotional Resiliency Unit 2017
Shasta County Provider News Publication of Shasta County Public Health Branch
Shasta County Public Health Branch Strategic Plan
Other Community Efforts Training in schools on the neurological model developed by Bruce Perry, MD at the Child Trauma Academy Triple P: Positive Parenting Program Help Me Grow: a project of First 5 Shasta
An ACEs Story
2018 WHAT HOW WHY? WHY We believe Adverse Childhood Experiences can be prevented and healed in the individuals and collective communities of Shasta County.
WHAT HOW HOW? Tell everyone you know Grassroots/Grass top community ownership of ACE Create institutional change WHY We believe Adverse Childhood Experiences can be prevented and healed in the individuals and collective communities of Shasta County. Build trust with the community Research & data driven Educate with trauma informed care Support families with protective factors
WHAT? Strengthening Families Collaborative (SFC) Learning Community educate with Commercial, Intro, Core ACE Interface Presentations Find inside Champion ACE Interface Workshop presentations Trainers working within sphere of influence Strengthening Families Collaborative PSAs/Town Hall/website/social media Tell everyone you know Fidelity to ACE Interface Grassroots/Grass top community ownership of ACE Create institutional change WHAT HOW WHY We believe Adverse Childhood Experiences can be prevented and healed in the individuals and collective communities of Shasta County. Build trust with the community Share success stories/social media Educate om historical trauma Research & data driven Educate with trauma informed care Brain Breaks Support families with protective factors Screen for ACEs Asset Map 5 Protective Factors SFC Date Committee creates Data Dashboard Success Stories/research from other communities SFC Parent Cafes SFC Table Host Trainings 40 Developmental Assets Local Family Resources
ACEs Town Hall Forum, April 2017 ACEs Town Hall Forum May 2018
Whole Child Assessment in Spanish
Partnering with ACE Interface Community ACEs Prevention Plan Data Dashboard to track outcomes ACE Interface Master Training and licensed materials Ongoing technical support and follow up sessions
Future Possible ACE Efforts We are long overdue for a national awareness campaign similar to public health initiatives on how seat belts save lives, smoking causes cancer, and hand washing prevents flu to educate physicians and families on how childhood trauma begets adult illness. Donna Jackson Nakagawa
Future Possible ACE Efforts
The solution of all adult problems tomorrow depends in large measure upon the way our children grow up today. - Margaret Mead, Anthropologist Regional Child Abuse Prevention Councils 2011
Resources for ACEs CDC website https://www.cdc.gov/violenceprevention/acestudy/ ACEs Policy https://www.chcs.org/welcome-upswing-state-federalsupport-trauma-informed-practices-policies/ Data and Resources about the health of children www.kidsdata.org/ ACEs Connection http://www.acesconnection.com/ To do your own ACEs test http://acestoohigh.com/got-your-ace-score/ For more information contact: Andrew Deckert, MD, MPH Health Officer Shasta County Health & Human Services Agency Public Health Branch (530) 225-5591 adeckert@co.shasta.ca.us