ACE Bermuda Survey Development ACE Conference Tara Hines, Healthcare Data Analyst 11th October 2018

Overview Current Research Survey Development Preliminary Findings & Next steps

Purpose Review the existing literature and data available Discuss research process and development, in Bermuda Review preliminary findings from pilot

Data Available Transaction Level Data Census STEPS Survey 2018: Over 2.5 million claims, with 40 variables. Census STEPS Survey Independent Organizations SCARS

Filling the Gaps

Filling the Gaps Public Non-profit Government School QUANGO Church Physician QUANGO Clinic Charity Teacher Non-profit Government Church Leader Public School QUANGO Nurse Church Physician Legal System Hospital

Survey Tool Development Bermuda Context Census Internal Feedback WHO & BRFSS Validated Questions Refusals

Survey Tool Development Multiple Modalities Confidentiality & Autonomy Ethical Approval

Additional Considerations Unique RTC trauma Transient Population with High Immigration and Emigration Rates Parallelity in Timing

Domains & Considerations Demographics Sex vs Gender Race vs Ethnicity Education Work Status Bermudian Childhood Marital Status Relationship with Parents/ Guardians and Family Parents/ Guardians behavioral focus Food security, drug/ alcohol use, violence or neglect exposure

Domains & Considerations Relationship with Parents/ Guardians and Family “See or hear” phrasing VS “to YOU”

Domains & Considerations Childhood Experiences Child sexual abuse Peer & Community Experiences Bullying (with definition) “See or hear” language Current Lifestyle NCD (Non-communicable disease) Mental health Acute and chronic illness Risky behaviors

Deployment: Stakeholder Inclusion Pilot Survey Deployment National Survey Deployment Advertising via Multiple Avenues Online Social Media Facebook WhatsApp Radio Appearances Word of Mouth

Survey Tool Informed Consent This survey is the Adverse Childhood Experiences (ACE) Bermuda Questionnaire. This is designed to collect information from adults in Bermuda about events they experienced during the first 18 years of their lives and their lives now. The survey, as a part of the ACE study, is provided in partnership by Family Centre and the Bermuda Health Council. We will collect information from participants throughout Bermuda. This is a pilot, now, to test the survey and data analysis. The information will be gathered via print and electronic surveys. We will ask you questions about your age, education, employment, family background, community experiences, and your current lifestyle. The survey takes less than ten minutes. Please answer in one sitting, as your answers between pages will not be saved. It is your right, at any time to: - Decline to take part in the study - Withdraw your consent at any time - Decline to answer any questions in the interview that you do not wish to answer Your information will be kept confidential and at no time will be record your name. As this is a pilot, the results will be made public for limited review and inform the larger public survey distribution. If you would like more information about the questions in this questionnaire, a print copy of this survey, or for information about mental health or physical health services related to this questionnaire, please email stephanie@tfc.bm or tdhines@gov.bm.

Survey Follow Up Trigger warning Therapy links Explanation of “negative” values and definitions

Preliminary Findings (Analysis) Stratifying along race, Bermuda childhood, gender, education Chi squared analysis Odds ratio calculation

Preliminary Findings (Pilot) Current data demonstrates higher NCD burden, especially among highly educated (defined as post- graduate completion). Those who identified unaffordable care were more likely to have multiple co-morbidities

Preliminary Findings (Pilot) More than half of respondents experienced some form of child sexual abuse Those who have had an individual die from RTC are more likely to abide by safety recommendations Disease recognition, regardless of education and age is difficult

Next Steps Full survey deployment Publication Goal: Statistical Significance Publication Journal Deployment Screening tool development

Summary Current Research Survey Development Preliminary Findings & Next steps