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Using ACEs in our everyday work: Implications for clients and programs Kristen Rector – Prevent Child Abuse Tennessee Jennifer Drake-Croft – The Family.

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Presentation on theme: "Using ACEs in our everyday work: Implications for clients and programs Kristen Rector – Prevent Child Abuse Tennessee Jennifer Drake-Croft – The Family."— Presentation transcript:

1 Using ACEs in our everyday work: Implications for clients and programs Kristen Rector – Prevent Child Abuse Tennessee Jennifer Drake-Croft – The Family Center Kristen Rector – Prevent Child Abuse Tennessee Jennifer Drake-Croft – The Family Center

2 ACES in Childhood Can Make Us Sick Lifelong health and well being Brain health Educational achievement Mental, physical and intellectual development Workforce readiness and productivity

3 Public Health Burden  Children exposed to violence and other forms of adverse childhood experiences may exhibit :  a range of developmental problems and symptoms, both internal (depression or anxiety) and external (aggression or conduct problems)  Exposure to violence can :  Interfere with a child’s ability to think and learn  Disrupt the course of healthy physical, emotional, and intellectual development  Increase risk of:  health and mental health problems  use of health and mental health services  involvement with child welfare and juvenile justice systems

4 The Adverse Childhood Experiences (ACE) Study A collaborative effort of Kaiser Permanente and the CDC  Kaiser Permanente HMO population in San Diego  Over 17,000 participants - average age of 57  Study of the impact of adverse childhood experiences on health throughout the lifespan Felitti, VJ et al. American Journal of Preventive Medicine 1998;14:245–258  Kaiser Permanente HMO population in San Diego  Over 17,000 participants - average age of 57  Study of the impact of adverse childhood experiences on health throughout the lifespan Felitti, VJ et al. American Journal of Preventive Medicine 1998;14:245–258

5 What Are Adverse Childhood Experiences (ACEs)? Experiences that represent medical and social problems of national importance Childhood maltreatment (physical, sexual, emotional) Neglect (physical and emotional) Household dysfunction:  Growing up with intimate partner violence  Household substance abuse  Household mental illness  Parental separation or divorce  Incarcerated household member Experiences that represent medical and social problems of national importance Childhood maltreatment (physical, sexual, emotional) Neglect (physical and emotional) Household dysfunction:  Growing up with intimate partner violence  Household substance abuse  Household mental illness  Parental separation or divorce  Incarcerated household member

6 ACE Score Total number of categories of ACEs that each participant reported – Example: Experiencing physical abuse as a child is an ACE score of one – Experiencing physical abuse plus witnessing IPV is an ACE store of two More than half had at least one ACE If one category of ACE is present, there is an 84% likelihood of additional categories being present. Total number of categories of ACEs that each participant reported – Example: Experiencing physical abuse as a child is an ACE score of one – Experiencing physical abuse plus witnessing IPV is an ACE store of two More than half had at least one ACE If one category of ACE is present, there is an 84% likelihood of additional categories being present.

7 Adverse Childhood Experiences Reported by Adults Five States, 2009 First published report to document prevalence of ACEs in population-based representative sample from multiple states stratified by demographic characteristics, including sex, age, education, and race/ethnicity. Approximately 59% reported one or more ACEs CDC MMWR, December 17, 2010/59(49); First published report to document prevalence of ACEs in population-based representative sample from multiple states stratified by demographic characteristics, including sex, age, education, and race/ethnicity. Approximately 59% reported one or more ACEs CDC MMWR, December 17, 2010/59(49);

8 ACE STUDY FINDINGS As ACE score goes up, so does risk for: Health-risk Behaviors  Sexual promiscuity  Sexual perpetration  Alcohol abuse  Illicit/injected drug use  Smoking Mental health and well-being  Depression, post-traumatic stress disorder (PTSD)  Aggression  Anxiety  Somatic complaints  Attempted suicide  Social ostracism  Anxiety  Academic achievement  Re-victimization  Unwanted pregnancy  Job problems; lost time from work Disease and Injury  STDs, including HIV  Gynecological problems  Heart disease  Diabetes  Stroke  Cancer  Suicide

9 ACE STUDY FINDINGS  As ACE score goes up, so does risk for:  Smoking  Organic disease (pulmonary, heart & liver disease)  Adult alcoholism & drug use  Depression and suicide attempts  Multiple sexual partners  STD’s and Rape (from 5% to 33%)  Hallucinations  Risk for intimate partner violence  Addictions  Dying early  Job Problems and lost time from work   As ACE score goes up, so does risk for:  Smoking  Organic disease (pulmonary, heart & liver disease)  Adult alcoholism & drug use  Depression and suicide attempts  Multiple sexual partners  STD’s and Rape (from 5% to 33%)  Hallucinations  Risk for intimate partner violence  Addictions  Dying early  Job Problems and lost time from work 

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12 ACEs effect your brain development, hormone production, cellular health, and even the expression of your DNA

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14 The Power of Prevention The Power of Parenting

15 Nurturing Relationships Make and Keep Us Well

16 Importance of Early Experiences/Relationships Early experiences are built into our bodies and brains--- for better or for worse Healthy development in the early years provides the building blocks for future learning, behavior, and health: – educational achievement – economic productivity – responsible citizenship – lifelong health – strong communities – successful parenting of the next generation

17 The Cost of ACEs

18 ACEs are the LEADING determinant of health, social and economic wellbeing of our nation

19 What was YOUR reaction when you learned about the ACE study?

20 What are your reservations about administering the ACE questionnaire to your clients?

21 How assessing ACEs benefits your organization?  Helps you understand if you are reaching your target population  You can tailor interventions to address past traumas that might impact parenting  You can better help the public, donors, and funders better understand the impact of trauma on your population  Helps staff operate in a more trauma-informed manner  Helps you understand if you are reaching your target population  You can tailor interventions to address past traumas that might impact parenting  You can better help the public, donors, and funders better understand the impact of trauma on your population  Helps staff operate in a more trauma-informed manner

22 How assessing ACEs benefits your CLIENT  Creates an “aha moment” and buy-in to the urgency of adopting healthy parenting practices  Motivation to change by knowing their own story  Allows parent to receive more tailored services that meet their needs  Empowers parent to reframe from thinking from believing they are “bad” to understanding they are hurt  Discover and build resilience  Creates an “aha moment” and buy-in to the urgency of adopting healthy parenting practices  Motivation to change by knowing their own story  Allows parent to receive more tailored services that meet their needs  Empowers parent to reframe from thinking from believing they are “bad” to understanding they are hurt  Discover and build resilience

23 ACE Scores at The Family Center  Initial reservations of staff  Triggering clients  Discomfort with asking questions  Fear of stigmatization by talking directly about abuse  Fear of turning psychoeducation into therapy  Fear of inducing guilt and shame  Initial reservations of staff  Triggering clients  Discomfort with asking questions  Fear of stigmatization by talking directly about abuse  Fear of turning psychoeducation into therapy  Fear of inducing guilt and shame

24 Administering ACE at The Family Center  Preparation to administer assessment  Staff watched a webinar from the FRIENDS website on ACE administration with clients  Identifying how to share ACE information in a way that ties in with current education  Use of empowering language along with strategies to decrease ACEs for their children  Transparency about WHY we collect ACEs and how we use the information  Emphasize the healing power of safe, stable, nurturing relationships if ACEs have already accumulated for the child  Create a handout where they can record their ACE score and learn more at  Preparation to administer assessment  Staff watched a webinar from the FRIENDS website on ACE administration with clients  Identifying how to share ACE information in a way that ties in with current education  Use of empowering language along with strategies to decrease ACEs for their children  Transparency about WHY we collect ACEs and how we use the information  Emphasize the healing power of safe, stable, nurturing relationships if ACEs have already accumulated for the child  Create a handout where they can record their ACE score and learn more at

25 Administering ACE at PCAT  Normalize  Guide conversation on change  Inform of study  Normalize  Guide conversation on change  Inform of study

26 Implementing the tool – Prevent Child Abuse TN (PCAT)  Safety first  Extremely sensitive information  Using empathy  Provide follow up/referrals  ACES are common  Make time to discuss  Safety first  Extremely sensitive information  Using empathy  Provide follow up/referrals  ACES are common  Make time to discuss

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30 Results of ACEs Data Collection at The Family Center 94% Experienced Household Dysfunction 71% Separation / Divorce Compare to 23% 56% Domestic Violence Compare to 13% 55% Household Mental Illness Compare to 19% 55% Household Substance Abuse Compare to 27% 49% Incarcerated Family Member Compare to 5% 79% Experienced Child Abuse 74% Emotional Compare to 11% 43% Physical Compare to 28% 37% Sexual Compare to 21% 69% Experienced Child Neglect 65% Emotional Compare to 15% 41% Physical Compare to 10%

31 Results of ACEs Data Collection at The Family Center 74% Have 4 or more ACEs Results in 5 – 10 years earlier death Compare to 13% from original ACE study 44% Have 7 or more ACEs Results in 20 years earlier death

32 Anthony’s Story

33 Lacey’s Story  Both parents alcoholics  Mother depressed  Father frequently absent, left several times between the ages of 5-12 and then finally “for good” at 12.  What will happen to her as an adult?   Both parents alcoholics  Mother depressed  Father frequently absent, left several times between the ages of 5-12 and then finally “for good” at 12.  What will happen to her as an adult? 

34 Teaching Lacey about ACES  New ways of coping: safe coping strategies  Understanding triggers  Relating the cycle of addiction  Renewed relationship with her own parents through understanding her parent’s ACES  Family awareness of the importance of togetherness  Learning to deal with stress in a healthier way  New ways of coping: safe coping strategies  Understanding triggers  Relating the cycle of addiction  Renewed relationship with her own parents through understanding her parent’s ACES  Family awareness of the importance of togetherness  Learning to deal with stress in a healthier way

35 Partnering with Parents to Prevent ACES  Institute for Safe Families  Educational resource  Booklet that looks like an app with QR codes  Co branded by Prevent Child Abuse America and the Academy of Pediatrics

36 The Amazing Brain Booklet to help parents understand the impact of trauma on early brain development

37 Understanding a parent’s adverse childhood experience takes nothing away from understanding her resilience It puts into perspective how spectacularly resilient she may be, the strengths she is building on for the next phase of her life, and opens the space to talk about the life she wants for her family and her new baby


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