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November 5th, 2014 Preliminary Results Presented by the team at C.O.R.E. Lauren Broffman—Associate Research Scientist Aaron Scott—Research Assistant Fanny.

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Presentation on theme: "November 5th, 2014 Preliminary Results Presented by the team at C.O.R.E. Lauren Broffman—Associate Research Scientist Aaron Scott—Research Assistant Fanny."— Presentation transcript:

1 November 5th, 2014 Preliminary Results Presented by the team at C.O.R.E. Lauren Broffman—Associate Research Scientist Aaron Scott—Research Assistant Fanny Rodriguez—Research Assistant Natalie Royal—Research Assistant Amy Campbell—Research Assistant Jennifer Matson—Project Manager The LIFE Study

2 The Research Question ◆ What Happened to People? ◆ What Events in Life are Formative? ◆ How are Events Connected? Why the LIFE Study? ◆ There was significant anecdotal evidence about trauma ◆ The LIFE study was a response to what we were hearing from the field ◆ We wanted to incorporate our hypothesis about high utilizers and traumatic life experiences into our evaluation work The LIFE Study Overview

3 Arriving at the Methods, Part 1: Living and Learning WHAT WAS HARD? ◆ Survey too Structured ◆ Trauma Triggers ◆ Discrimination history ◆ Communication Barriers ◆ Interviewer Burnout WHAT WORKED? ◆ Flexibility ◆ Patience ◆ Hospitality ◆ Emphasis on respect ◆ Interviewer Self ­‐Care CORE’S Past Experience Collecting Data on Trauma

4 Arriving at the Methods, Part 2: Inventing the Wheel Evidence Based Research Methods: What had Others Done? ◆ We dug around in the literature to see if other researchers had done similar work -­‐ we didn’t want to reinvent the wheel ◆ There are not many other studies like LIFE -­‐ great news for a researcher trying to make a contributi on to a body of knowledge, but that means that there were no validated tools to leverage as we designed interview protocols ◆ We found one technique we liked: the Adapted Life History Calendar. It was used by someone who was researching school experiences with adolescents After hours of planning and deliberation, we came up with this…

5 UNDERSTANDING A LIFE: THINGS WE LEARNED TO ASK ◆ “What got you through the tough times?” ◆ “Do you have any hobbies or activities that mean a lot to you?” ◆ “What were some of the good things in your childhood?” ◆ “Who’s important to you and why? Reflecting on Our Experience Of Data Collection

6 90%90% 9% 1% Health Resilience New Directions and CHIPs Tri-County 911 Who Were Our 75 Interview Respondents? -­‐Another 35 were high-utilizers not associated with any grant program 10 were low-utilizers with similar disease profiles 30 were high-utilizers in an HC program that involves intensive management

7 40% Male 60% Female GenderRace/EthnicityAverage Age Demographics from the 30 Program Participants 47% AA 52% White 46 years old

8 What did we Learn about the Prevalence of Formative Experiences? 47% Suffered repeated physical, sexual or emotional abuse in childhood 23% Lived with an adult with a substance abuse issue 30% Were separated from parents 50% struggled in school 50% dropped out of school 33% Ran away or left home early 27% Became teen parents 37% Became homeless at some point 60% Became substance abusers 27% Were incarcerated at some point 90% Report job insecurity 30% Became unable to work at all 43% Were separated from their children 63% Struggle with mental health conditions 93% Describe struggling to get needed healthcare 33% Struggle to manage their medication 47% Describe being socially isolated In short: program participants have led extraordinarily difficult lives What the Numbers Tell Us

9 ✤ Almost a third of respondents reported some type of abuse in childhood ◆ A quarter of all respondents described abuse that was recurring ◆ A third of respondents lived in large, chaotic families ✤ A fifth of respondents described being very poor ◆ A quarter of respondents grew up in households where a parent was a substance abuser ◆ A quarter of respondents were separated from one or both parents Reported Events: Early Childhood 9 Between the ages of 0 and 5 Trauma CategoryType/CodeReported in interview Abuse Physical Abuse27% Emotional Abuse17% Neglect13% Sexual Abuse7% Insufficient Family Support Large chaotic family27% Separation from parents23% Poverty/ financial instability20% Mobility (multiple dislocations)13% Conflict with loved one7% Abandonment/Attachment Issues Parent / family member with Substance Use23% Separation from parents23% Parental Divorce13% Death of loved one7% Adoption3% Foster Care3%

10 Putting Numbers in Context: Stories from Early Childhood One woman spent her early childhood with her parents and 11 other siblings. She describes being “born into drugs and alcohol.” When she was 4 years old, her oldest brother died and then at 5 years old, her father passed away leaving her mother to raise 10 kids all alone.

11 ✤ Abuse continued into middle childhood for many of those who experienced it early on. For some, this is when abuse started. ✤ School was challenging for almost half of our respondents. 10% dropped out during this period. ✤ A quarter of respondents described having parents with substance abuse issues during this time ◆ 10% of respondents became substance abusers themselves during these years Reported Events: Middle Childhood 11 Between the ages of 6 and 12 Trauma CategoryType/CodeReported in interview School Failure School struggles43% School drop out10% Abuse Sexual30% Physical27% Emotional27% Bullying17% Neglect17% Discrimination7% Abandonment Parent / family member with substance use23% Parental divorce13% Adoption7% Separation from parents / sibs7% Death of loved one7% Social isolation3% Risk Behaviors Substance use10%

12 Putting Numbers in Context: Stories from Middle Childhood This man described a good experience at school until age 12. When he was 12 years old, the he suffered a major traumatic event: he found his mother murdered by her boyfriend in their home. He tells us, “I wouldn’t talk about it to anybody. To this day I haven’t gone to therapy. I just crammed up.”

13 ✤ Close to half of respondents drop out of school ◆ The prevalence of abuse lessens during this period, in part because many leave home. 3% describe becoming abusers themselves during this time. ✤ More than 10% become socially isolated; 3% become homeless ◆ Close to half start to abuse substances ✤ Health problems emerge: A quarter report mental health issues, and a fifth describe not getting necessary health care Reported Events: Adolescence 13 Between the ages of 12 and 19 Trauma CategoryType/CodeReported in interview School Failure School struggles27% School drop out40% Abuse Emotional23% Physical20% Neglect17% Sexual10% Bullying7% Abuser3% Abandonment Parent with substance abuse problem17% Conflict with loved one13% Death of loved one13% Social isolation13% Parental divorce7% Homelessness3% Risk Behavior Substance use40% Run away/ left home early30% Teen pregnancy/parenthood27% Criminality13% Health Conditions Mental health conditions23% Lack of care/ unmet health needs20% Forced hospitalizations / Institutionalization7%

14 Putting Numbers in Context: Stories from Adolescence One woman, despite a difficult early childhood, described having a lot of friends and being popular once she got to high school. When she was 16 or 17 she met someone with whom she had a child. This relationship was extremely abusive. This relationship also caused her to become an alcoholic, which led her to drop out of college.

15 ✤ One fifth report becoming abusers ◆ Respondents become marginalized in many ways -­‐ a third are separated from their children, a quarter report social isolation ◆ Almost everyone describes the inability to maintain employment ◆ One third report being homeless ◆ One fifth have been arrested ◆ Half are substance abusers ✤ Health problems continue: The majority can’t get the help they need, and half are struggling with mental health Lorem Ipusm Reported Events: Young Adult 15 Between the ages of 19 and 30 Trauma CategoryType/CodeReported in interview Abuse Physical20% Perpetrator of abuse17% Discrimination10% Emotional7% Physical assault7% Sexual3% Personal Marginalization Separation from children33% Social isolation23% Divorce17% Death of loved on10% Social support3% Social Marginalization Job insecurity83% Homelessness30% Arrest20% Incarceration20% Disability / can't work17% Risk Behavior Substance use50% Criminality20% Sex work10% Health Conditions Lack of care/ unmet health needs60% Mental health conditions47% Forced hospitalizations / Institutionalization13%

16 Putting Numbers in Context: Stories from Young Adulthood One woman described her assault, resulting in serious injuries; as a result she had to drop out of college. The case against the man who assaulted her was dismissed because it was what she called “black on black crime,” and because she had a history of sex crimes from her time as a sex worker. She developed PTSD as a result of the attack.

17 ✤ A third are socially isolated ✤ The majority have no stable employment, with a fifth of those being unable to work at all ✤ Almost everyone describes the inability to maintain employment ◆ One fifth have been arrested Half are substance abusers ◆ Health problems continue: The majority can’t get the help they need, and half are struggling with mental health issues 17 Reported Events: Adulthood The ages of 30 and older Trauma CategoryType/CodeReported in interview Personal Marginalization & Loss Social isolation33% Separation from children23% Death of a loved one17% Social Marginalization Job insecurity43% Disability / can't work20% Arrest13% Incarceration13% Homelessness13% Risk Behavior Substance use20% Criminality10% Health Conditions Lack of care/ unmet health needs70% Mental health issues40% Medication management issues30% Forced hospitalizations / Institutionalization13%

18 Putting Numbers in Context: Stories from Adulthood One woman told us that she doesn’t have too many friends right now and finds that this is due to financial and physical health constraints (she can’t afford to go to coffee or help people move). She keeps really busy to stay out of her apartment complex as much as possible. She read a poem she wrote called “Old Age is Hell.”

19 How Events Connect We analyzed a subset of interviews to help us understand what events are related. We looked for commanlities in life trajectories of respondents who described suffering from extended childhood abuse between the ages of 0-12: WHAT HAPPENS IF There was extended abuse in early childhood? 19 Extended, chronic childhood abuse (n=11) Though they might have escaped abuse at home, life remains fraught with difficulty. Half become homeless. All become estranged from their own children as adults Most report struggles in school in middle childhood Most enter into abusive relationships as young adults All start to struggle with mental health issues as young adults All become substance abusers and struggle maintain employment as adults. Their health problems are apparent; most aren’t getting care needs met. Most are engaged in risk behaviors -­‐sexual activity and substance abuse -­‐in high school. More than half run away or leave home early.

20 How Events Connect Much of the extended abuse that was reported was physical and emotional. While this was also true of some of the sexual abuse, some of the experiences were single incidents. We tracked what happened to the 5 women and 3 men who reported this type of trauma: WHAT HAPPENS IF Sexual abuse occurs before age 19? 20 Described experiencing sexual abuse (n=8) All report struggling in school after the incident(s). For some, this is a complete 180; they had been doing well prior Almost half drop out of school, most leave home. Three become homeless. All become substance abusers Half become engaged in criminal activity; three spend time in prison Most struggle with mental health conditions All report having unmet care needs; half describe struggling to manage their medication All are isolated in some way, either in general or separated from their children

21 How Events Connect Substance abuse was a prominent experience in our sample. The trajectories connect the experience of early abuse and later substance use, but we also isolated narratives of respondents who described growing up with a substance user in a non abusive environment: WHAT HAPPENS IF Parents were substance users? 21 This group has substance user in the house, but no abuse (n=3) All of parents separate or divorce at some point All report feeling neglected as children All struggle in and eventually drop out of school. Two become teenage parents. All become isolated in young adulthood and struggle to find work Only one has mental health problems (in contrast with those who report abuse). Further, only one becomes a substance abuser However, all report a struggle with physical health conditions and describe unmet care needs Social isolation and job insecurity continue into adulthood

22 How Events Connect Though high healthcare utilization is known to be correlated with Adverse Childhood Events, our data demonstrates that childhood trauma is not a necessary factor in determining whether someone becomes program eligible: WHAT HAPPENS IF Childhood was happy? 22 Relatively happy childhoods (n=10). Of these, the majority (7) are black Most start engaging in risk behaviors in high school, including substance abuse. Half drop out. Half report struggles in school in middle childhood or high school. Discrimination plays a role Health issues emerge. Most report unmet needs and struggles with mental health For this group, the major trauma occurs in early adulthood. Many suffer abuse, become abusive, or engage in criminal behavior Substance abuse issues and run-ins with the law continue into adulthood. Respondents have multiple romantic relationships. Some become abusive Respondents become isolated, separated from children, and continue to struggle with health All struggle to maintain employment; several report being homeless

23 Concluding Thoughts ◆ We confirmed our hypothesis: not a single respondent in the high-utilizer category had a life unscathed by trauma ◆ We can’t determine causality, but we can assert that those treating high- utilizers need to be aware that their life story likely includes trauma ◆ We can use these stories to nuance the national conversation on high-utilizers ◆ We can think more broadly about upstream interventions In Closing… The Next Steps ◆ More analysis! We want to look at more “trajectories,” include the other 35 high-utilizers in the dataset, and compare and contrast the “control group” ◆ Dissemination: We want to share these results with the larger community ◆ Survey design and fielding: prevalence in best assessed using a larger sample, so we are going to conduct a survey for a more accurate scan

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