The Delaware ACE’s Story Dana Thompson, MPH Iman Sharif, MD, MPH Aileen Fink, PhD

Adverse Childhood Experiences (ACEs) Stressful or traumatic experiences that occur before the age of 18 Cumulative ACE exposure is related to health, social, and behavioral problems later on in life obesity chronic health conditions premature death

Goals Describe the intergenerational impact of ACEs exposure in Delaware. Identify disparities in exposure to ACEs in Delaware. Describe the relationship between child and parent ACEs exposure and the child’s ability to thrive in our communities.

Objectives Determine the prevalence of ACEs exposure amongst children in Delaware Test the hypotheses that: Children of racial/ethnic minority background and children with disabilities have a greater exposure to ACEs Children who live in a household with someone who has a mental illness are at higher risk of exposure to additional ACEs. Children’s ability to function in the community is hindered by ACEs exposure, but improved by positive parental health and neighborhood supports.

Methods Secondary Data Analysis 2011-2012 National Survey of Children’s Health (NSCH) National telephone survey conducted by National Center for Health Statistics Includes topics on child’s health and well-being physical, emotional, and behavioral child health indicators child’s family context child’s neighborhood environment Study Population: Delaware children, ages 0-17 years old (n=1,824) Statistical Analysis: Logistic Regression (adjusted for age, race, income) SAS 9.3 (SAS Institute, Cary NC)

Measures- ACEs exposure

Measures Flourishing (Thriving) Indicators in children 0-5 years old Child is affectionate and tender with parent Child bounces back quickly when things don’t go his/her way Child shows interest in learning new things Child smiles and laughs a lot Indicators in children 6-17 years old Child finishes tasks and follows through with plans Child stays calm and in control when faced with a challenge Child shows interest and curiosity in learning new things

Predictors Secondary Predictors Primary Predictor Demographics Number of ACEs (0-1 vs. 2 or more) Secondary Predictors Parental Factors Overall Parental Health Parental Stress Neighborhood Factors Support Amenities Safety Risks (Detracting Elements) Demographics Age Race/Ethnicity Special Health Care Needs Federal Poverty Level (FPL)

Results

Study Population (n=1824) 497 (27%) 1278 (70%) 1053 (58%) 275 (15%) Total n(%) Age (years) 0-5 497 (27%) 6-17 1278 (70%) Race/Ethnicity White, NH 1053 (58%) Black, NH 275 (15%) Hispanic 198 (11%) Other 204 (11%) % Federal Poverty Level (FPL) Below 200% FPL 525 (29%) At or above 200% FPL 1250 (68%)

Prevalence of ACEs

Racial Disparities

Disparities for children with disabilities

Results: Children who live with an adult with mental illness have a greater odds of exposure to other ACEs

Results: Factors that diminish a child’s ability to flourish AOR (95% CI) p-value 2 or more ACEs 0.65 (0.48 – 0.86) 0.003 Black, non-Hispanic 0.61 (0.44 – 0.84) 0.012 School-aged children (6-17 years old) 0.27 (0.21 – 0.36) <0.001

Results: factors that promote child’s flourishing AOR (95% CI) p-value More neighborhood safety 1.72 (1.17 – 2.52) 0.005 Decreased parental stress 4.44 (2.90 – 6.81) <0.001 Excellent parent health 1.68 (1.31 – 2.16)

Conclusions Exposure to ACEs has an intergenerational impact. Disparities exist Black children and children with special health care needs are at greater risk of ACEs exposure. It only takes 2 adverse childhood experience to have a significant impact on a child’s ability to flourish Parental well-being and neighborhood safety play an important role in determining whether children flourish.

Implications A holistic approach is needed to identify at-risk families and communities Integrated systems of trauma informed care are needed across sectors- Health Care Education Public Health Criminal Justice

Acknowledgments Work supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Binder-Macleod).  Additional generous support comes from the State of Delaware, the University of Delaware, Christiana Care Health System, Nemours, and the Medical University of South Carolina.