Prevent, Screen and Heal: Addressing ACEs and Toxic Stress through Policy Jabeen Yusuf & Sara Silverio Marques Center for Youth Wellness October 3, 2017
Adverse Childhood Experiences Image courtesy of the Robert Wood Johnson Foundation 2
Additional ACEs being explored Foster care /Institutional care Bullying Severe illness Discrimination Parental death Parental separation Neighborhood violence Forced migration Center for Youth Wellness ACE-Q 2015, Finkelhor 2015, Wade 2006
What we know about ACEs Highly prevalent across the population Strong relationship to negative long term health outcomes Strong relationship to negative behavioral and mental health outcomes Accumulate over the course of childhood and adolescence In the absence of protective factors, ACEs may lead to a toxic stress response
Two-thirds of adults have at least one ACE 64% 9.5% 16% 12.5% 36% 0 ACEs 1 ACE 2 ACEs 3 ACEs 4 ACEs 26% Felitti 1998 5
34.8M children nationwide impacted by ACEs 2011/2012 National Survey of Children s Health 6
ACEs dramatically increase risk for 7 out of 10 leading causes of death Leading Causes of Death in US, 2013 Odds Ratio Associated with 4 ACEs 1 Heart Disease 2.1 2 Cancer 2.3 3 Chronic Lower Respiratory Diseses 3.0 4 Accidents 5 Stroke 2.4 6 Alzehimer s 11.2 7 Diabetes 1.5 8 Influenza and Pneumonia 9 Kidney Disease 10 Suicide 30.1 Odds Ratio associated with 4 ACEs CDC 2015, Feletti 1998, BRFSS 2013, Hughes 2017 7
Health and behavioral outcomes in adults Suicide Disability Anxiety Depression Drug abuse Alcoholism Incarceration Intimate Partner Violence Heart disease Cancer Respiratory diseases Stroke Alzheimer s Diabetes Obesity Premature death 8
Health and behavioral outcomes in children Internalizing behaviors Externalizing behaviors Learning difficulties Juvenile offending Substance abuse Suicidality Sexual risk behaviors Psychological disorders Asthma Atopic disease Viral Infection Pneumonia Somatic complaints Sleep disruption Failure to thrive Obesity Oh et al., in press, Matheson 2016, Kerker 2015, Shen 2016, Ryan 2015, Giordano 2014, Rhodes 2012, Thompson 2017, Bjorkenstam 2015 9
ACEs are a public health crisis.
Viewed through a public health lens, ACEs are widely prevalent; highly interrelated; and intergenerational Many conditions that public health seeks to prevent as if they were the primary problems are seen to be the diverse outcomes, or symptoms, of a common set of underlying determinants. Consequently, ACEs themselves are We the primary can mitigate problem, and the for impacts a truly preventive, of ACEs upstream approach, public health and social development policies and programs need to be explicitly aimed at ACE reduction. ADDRESSING ADVERSE CHILDHOOD EXPERIENCES TO IMPROVE PUBLIC HEALTH: EXPERT CONSULTATION, 4-5 MAY 2009 1 1X
Scale up programs and policies that prevent ACEs and mitigate the effects of toxic stress and raise awareness of ACEs as a public health crisis Ensure every child is screened for ACEs as part of the average well child exam so that all children can have the opportunity to reach their full potential Support children with toxic stress response with effective and most promising interventions to prevent long-term health outcomes 12
Center for Youth Wellness Approach Advance pediatric practice to achieve universal screening Enable and encourage social, cultural and policy change Educate pediatric clinicians on the connection of ACEs and toxic stress to physical health and support them with tools to ready their practices for ACEs screening. Engage and activate the public and policymakers to address ACEs & toxic stress, as a physical health issue and show the critical need for early identification and prompt intervention.
Learnings from insights research 1. There is an implicit bias that associates ACEs with certain socio-economic and racial groups. 2. Often only seen and addressed as a mental and behavioral health issue. We need to broaden to include a life course health perspective. 3. There is a clear need to debunk the myth that children under five do not hold or remember negative experiences. 4. While all parents may feel they know their kids best, they clearly need education to identify the impact of stress on their children. In this study, light bulbs went off in parents as they reinterpreted behavior in light of traumatic experiences endured by children. 5. Parents play a core role in building resilience in children. Tools are needed to help parents realize its importance and to learn skills to do it. 6. Once the physical health ramifications associated with toxic stress are understood, parents not only see a key role for pediatricians in prevention and treatment, they also understand the importance of ACEs screening.
Cross sector & public health approach Non government and governmental partnership Child serving professional and policymaker education Policy areas of interest: - Workforce development California Campaign to Counter Childhood Adversity www.4cakids.org - Systems change to enable early identification and intervention It fills me with an abundance of hope that we are transforming our systems to truly become cultures of care, hope and healing as we help individuals served by systems come out from shame and blame. Dana Brown, Southern California regional community facilitator for ACES Connection at 4CA Policymaker Education Day, Sacramento, CA, July 11, 2017
Learnings from policy efforts Issue needs champions that can convene stakeholders across sectors Data and local understanding of ACEs and toxic stress, and the community level factors that may moderate the impact of ACEs is critical to finding the right solution Child serving systems often disconnected, review to be sure they are trauma-informed Legislation has the potential to facilitate early detection of risk for toxic stress and prompt intervention Programs to address protective factors and to mitigate impact of ACEs need to be supportive to two generations Much still to learn. Continued research and evaluation of interventions necessary.
Addressing ACEs requires work on all fronts Enhance protective factors Prompt intervention Early identification Appropriate treatment 17
Resources Know your local data www.cahmi.org Get a feel for the field www.acesconnection.org Connect with colleagues from other states who are doing this work: Eg. California (Screening & EPSDT), Illinois (screening in school), New York (Screening & Medicaid), Vermont (Early Childhood, Workforce development), Wisconsin (TI across public agencies), Maine (comprehensive)
Thank You Center For Youth Wellness Twitter: @CYWSanFrancisco jyusuf@centerforyouthwellness.org smarques@centerforyouthwellness.org