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ACES in WASHINGTON & Mental, Physical, Behavioral Health.

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1 ACES in WASHINGTON & Mental, Physical, Behavioral Health

2 WHAT ARE THE ADVERSE CHILDHOOD EXPERIENCES (ACEs)? 1.Child physical abuse 2.Child sexual abuse 3.Child emotional abuse 4.Neglect 5.Mentally ill, depressed or suicidal person in the home 6.Drug addicted or alcoholic family member 7.Witnessing domestic violence against the mother 8.Loss of a parent to death or abandonment, including abandonment by divorce 9.Incarceration of any family member

3 COUNTING ACEs The ACE Score is the number of categories of adverse childhood experience to which a person was exposed. The ACE Study found that the number of categories, not necessarily the frequency or severity of the experiences within a category, determine health outcomes across the population as a whole.

4  Alcoholism & alcohol abuse  Chronic obstructive pulmonary disease & ischemic heart disease  Depression  Fetal death  High risk sexual activity  Illicit drug use  Intimate partner violence  Liver disease  Obesity  Sexually transmitted disease  Smoking  Suicide attempts  Unintended pregnancy  Early Death The higher the ACE Score, the greater the incidence of co-occurring conditions from this list. LIFE LONG PHYSICAL, MENTAL & BEHAVIORAL OUTCOMES

5 ADVERSE CHILDHOOD EXPERIENCE DRAFT DO ACES CAUSE PROBLEMS? YES – Findings Meet All 9 Criteria A STRONG ASSOCIATION between the causative agent and the outcome CONSISTENCY of findings across research sites and methods SPECIFICITY “The ACE Score is associated with numerous outcomes, so specificity is lacking, but this in no way detracts from the argument of causation. ACEs would be expected to be associated with multiple outcomes because of their effects on a variety of brain structures and functions; and this is found to be true.” Anda, 2009 TEMPORAL SEQUENCE – ACEs occur before associated mental, physical, behavioral disorders BIOLOGICAL GRADIENT - The “dose-response” relationship between the number of ACEs and each of the outcomes (as well as the number of resulting health problems) is strong and graded.” Anda, 2009 BIOLOGICAL PLAUSIBILITY - strength of the convergence between epidemiology and neurobiology is most evident COHERENCE - The cause and effect interpretation for an association does not conflict with what is known about the natural history and biology of the disease) ANALOGOUS EVIDENCE - We all know the analogy for exposure causing multiple outcomes: smoking causes cardiovascular diseases, neoplasms, lung disease, and more. EXPERIMENTAL EVIDENCE - For ethical reasons randomized experiments depend on animal studies: Evidence in rodents & primates show that stressful exposures induce neurologic differences, aggression, drug seeking

6 ACEs in WASHINGTON WHAT’S THE POTENTIAL? 1.Bend the health care cost curve 2.Drastically reduce mental health disorders and disability driven by mental health disorders 3.Stop disastrous cycles of intergenerational poverty 4.Afford for all children optimal development, school completion, arrival at adulthood with full potential for employment success and a lifetime of well-being.

7 ACEs in WASHINGTON “Understanding Adverse Childhood Experiences isn’t to know one’s life path. It is to open doors for the future you would like for yourself and for future generations.” Dr. Ronald Voorhees, MD, PhD Chief Office of Epidemiology & Biostatistics Allegheny County Health Department

8 ACEs in WASHINGTON WHAT’S THE POTENTIAL? 1.Bend the health care cost curve 2.Drastically reduce mental health disorders and disability driven by mental health disorders 3.Stop disastrous cycles of intergenerational poverty 4.Afford for all children optimal development, school completion, arrival at adulthood with full potential for employment success and a lifetime of well-being.

9 ACEs in WASHINGTON CONTRIBUTING PARTNERS The Best Indicator of Healthy Collaboration Government 1.Family Policy Council 2.Mental Health Transformation Grant - Prevention Advisory Group 3.Children and Families of Incarcerated Parents Advisory Committee 4.Office of the Superintendent of Public Instruction 5.Department of Health 6.Department of Social and Health Services, Office of the Secretary 7.Department of Social and Health Services, Children’s Administration 8.Community Public Health & Safety Networks Research Institutions & Researchers 1.Dennis Culhane; University of Pennsylvania 2.Paula Nurius, University of Washington 3.David Takeuchi, University of Washington 4.Paul Flaspohler, Miami University, Ohio 5.Julie Grevstad, Tacoma Urban Network 6.Geof Morgan, Seattle University and 7.Joel Gaffney, Miami University, Ohio 8.Rob Anda 9.David Brown 10.Dr. Chris Blodgett and Dr. Roy Harrington, WSU Philanthropy 1.Bill and Melinda Gates Foundation 2.Sherwood Trust 3.Children’s Trust Foundation 4.Stuart Foundation

10 ACEs in WASHINGTON Will Help Washingtonians: 1. Derive More Meaning From Archival and Survey Data (e.g.: HYS) 2. Identify High-Risk Communities with Greater Precision 3. Understand Drivers of Mental, Behavioral, Physical Health 4. Invest More Wisely – Lower Costs 5. Leverage Resources & Partnerships - Achieve Greater Impacts WASHINGTON ADVERSE CHILDHOOD EXPERIENCE DATA

11 ACEs in WASHINGTON Population Average

12 ACEs in WASHINGTON PREVIEW OF BRFSS-ACE FINDINGS ACEs are common in Washington 1.17% of adults report physical abuse during childhood 2.17% of women and 7% of men report sexual abuse during childhood 3.One in four adults report parental separation or divorce during childhood 4.A third of adults grew up with substance abuse in the household 5.62% of adults have at least one ACE

13 ACEs in WASHINGTON One in four adults report three or more ACEs 5% of adults have six or more ACEs ACES ADD UP—MORE IS WORSE (As captured by the ACE Score)

14 ACEs in WASHINGTON ACES TEND TO CO-OCCUR / CLUSTER In the lives of Washingtonians Among adults exposed to physical abuse, 84% reported at least 2 additional ACEs Among adults exposed to sexual abuse, 72% reported at least 2 additional ACEs

15 ACEs in WASHINGTON Compared to adults without exposure to ACEs, the risk of smoking – a risk factor for many chronic diseases – was increased: 1.2 times for those with 1 ACE, * 1.5 times with 2 ACEs, * 1.9 times with 3 ACEs, * 2.8 times with 4 or 5 ACEs, * 4.6 times with 6 or more ACEs AS THE ACE SCORE INCREASES RISK OF NUMEROUS HEALTH & SOCIAL PROBLEMS INCREASE DRAMATICALLY SMOKING

16 ACEs in WASHINGTON The likelihood of life dissatisfaction – a risk factor for suicide – increased with increasing ACE score adults with 6 or more ACEs 9 times more likely to report life dissatisfaction compared to those with an ACE score of zero AS THE ACE SCORE INCREASES RISK OF NUMEROUS HEALTH AND SOCIAL PROBLEMS INCREASE DRAMATICALLY LIFE DISSATISFACTIONACTIVITY LIMITATION

17 ACEs in WASHINGTON HEALTH AND SOCIAL PROBLEMS SHOWN TO HAVE A GRADED RELATIONSHIP TO THE ACE SCORE IN THE 2009 WASHINGTON BRFSS Type of Problem Outcome Associated with Adverse Childhood Experience Prevalent Diseases Cardiovascular disease, cancer, asthma Risk Factors for Common Diseases/Poor Health Smoking, heavy drinking, binge drinking, obesity, high perceived risk of AIDS, taking painkillers to get high, marijuana use Poor Mental Health Sleep disturbances, frequent mental distress, nervousness, mental health or emotional problem requiring medication, emotional problems that restrict activities General Health and Social Problems Fair or poor health, life dissatisfaction, health-related quality of life Risk for Intergenerational Transmission Mental Illness: anxiety, emotional problems that restrict activities, medication for mental health conditions Drugs and Alcohol: Use of painkillers to get high, use of marijuana, smoking, heavy drinking, binge drinking Loss of a Parent: Divorced-widowed-separated

18 ACEs in WASHINGTON Consistent with Earlier FPC Research, Community Capacity Matters

19 ACEs in WASHINGTON Consistent with Earlier FPC Research, Community Capacity Matters

20 ACEs in WASHINGTON

21 “The Washington ACE data call for integrated approaches to prevent ACEs, and intervene early on children growing up being abused, neglected, witnessing domestic violence, or with substance abusing, mentally ill, or criminal household members. All of these childhood stressors are interrelated and usually co-occur. Prevention and treatment of one ACE frequently can mean that similar efforts are needed to treat multiple persons in affected households and other social systems. Better identification and treatment of the effects of ACEs among persons and systems interacting with children is necessary to minimize the impact of their intergenerational transmission.” Dr. Rob Anda, Dr. David Brown

22 ACE REDUCTION: A POWERFUL FRAMEWORK FOR THRIVING


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