1. For Better or For Worse: Delaware Youth Data on Adverse and Protective Childhood Experiences
University of Delaware
Center for Drug and Health Studies
Delaware State Legislature Kids Caucus
May 16th, 2017

2. University of Delaware Center for Drug and Health Studies
Collect and identify data on attitudes, experiences, and behaviors
Analyze data
Share data with policy makers, community members, and others for strategic decision- making

3. If you’re not using our data, we’re not doing our job effectively.

4. Measuring Youth Behavior and Experiences:
Survey
Schedule
Who Participates
Delaware School Survey
Annually - Spring semester
Census of 5th, 8th, 11th grade students
Youth Risk Behavior Survey
Every other odd-numbered year – Spring semester
Random sample of classrooms within census of public middle and high schools
Youth Tobacco Survey
Every other eve-numbered year – Spring semester
School Health Profiles
Every other even-numbered year – Spring
Principals and lead health educators
College Risk Behavior Survey
Annually – Spring Semester
Random sample of college students

5. Modeling the Data Community/ Social Experiences Individual Factors
School Experiences
Individual Factors
Behavior (and self-perpetuating feedback loops)
Short Term Health
Well-being
Achievement
Long Term Health
Family Experiences
What the student experiences at home, at school, and in the community is perceived through the lens of individual factors, leading to specific behaviors that can be coping behaviors or behaviors to meet expectations (perceived or self) which determine the youth’s level of personal well-being and achievement.

6. Experience – Social, School, or Family – may be Adverse or Protective, each with lifelong consequences with regards to substance use and other risk behaviors.

7. ACES – Adverse Childhood Experiences
Survey
Time Frame
Sample
ACES Included
Kaiser/CDC
17,377 adults
10 ACES
Emotional, Physical, Sexual Abuse
Emotional and Physical Neglect
Divorce/Separation
Household Mental Illness
Household Substance Abuse
Incarceration DV
Delaware Household Health Survey (DHHS)
2015
2,609 adults
Original 10 ACES and ADDED:
Discrimination
Bullying
National Survey of Children’s Health (NSCH)
1,824 adults (responding on behalf of child)
Original ACES EXCEPT ABUSE or NEGLECT
ADDED:
Economic Hardship
Parental Death
Community Violence

8. WHAT ARE ACES?
ACES are Adverse Childhood Experiences that are traumatic, and, without intervention, can lead to lifelong negative health consequences, including shorter life expectancy. ACES include all types of abuse and neglect, living in a home with someone who has a mental illness or who abuses substances, and other conditions. Being bullied, living in poverty, and exposure to community violence have recently been added to the list of ACES in certain studies.

9. Why Are ACES Important? ACES are prevalent
Kaiser Study: Nearly 2 out of 3 reported having at least 1 ACE with more than 12.5% reporting 4 or more
Delaware Household Survey: Nearly a quarter of participants reported experiencing 1 ACE, nearly 1 in 5 reported experiencing 2 or 3, and 13.8% reported experiencing 4 or more
National Survey of Children’s Health: 48% of Delaware youth had experienced at least 1 ACE, most commonly: economic hardship (25%), divorce/separation (21%), and neighborhood violence (12%, > national norm)
ACES have lifelong consequences
Health risk behaviors
Chronic health problems
People with 6 or more ACES died on average 20 years earlier than people without ACES

10. Delaware Youth Risk Behavior Survey: Source of ACES Data for Delaware Students
For the most part, ACES data is collected retrospectively, and from adults. The Delaware Youth Risk Behavior Survey (YRBS) provides a tool for considering ACES as they impact our students, which provides insights for developing early intervention strategies.

11. Youth Risk Behavior Survey
ACES Data
from the Delaware
High School
Youth Risk Behavior Survey

12. Homelessness Where do you typically sleep at night? 2,750
Homelessness 
Trauma Indicator N
% of Total
% of Female
% of Male
Where do you typically sleep at night?
2,750
At home w/ parent/guardian 96
Other   97 3 96
  4
2015 DE HS YRBS

13. Homelessness and Substance Use
2015 DE HS YRBS

14. Homelessness and Mental Health
DE 2015 HS YRBS

15. Homelessness and Sexual Risk Behavior
DE 2015 HS YRBS

16. Parental Incarceration and Substance Use
2015 DE HS YRBS

17. Parental Incarceration and Mental Health
DE 2015 HS YRBS

18. Parental Incarceration and Sexual Risk Behavior
DE 2015 HS YRBS
2015 DE HS YRBS

19. Threatened with a Weapon
Violence Exposure –
Threatened with a Weapon
Trauma Indicator N
% of Total
% of Female
% of Male
During the past 12 months, how many times has someone threatened or injured you with a weapon such as a gun, knife, or club on school property?
2,739
0 times
1 or more
0 times
1 or more 4
0 times 92
1 or more 8
2015 DE HS YRBS

20. Threatened with Weapon at School and Substance Use 2015 DE HS YRBS

21. Threatened with Weapon at School and Mental Health 2015 DE HS YRBS

22. Threatened with a Weapon at School and Sexual Risk Behavior 2015 DE HS YRBS

23. Violence Exposure - Fighting
Violence Exposure - Fighting
Trauma Indicator N
% of Total
% of Female
% of Male
During the past 12 months, how many times were you in a physical fight?
2,714
0 times
1 or more 21
0 times
1 or more 16
0 times 75
1 or more 25
2015 DE HS YRBS

24. Fighting and Substance Use 2015 DE HS YRBS

25. Fighting and Mental Health 2015 DE HS YRBS

26. Fighting and Sexual Risk Behavior
2015 DE HS YRBS

27. Bullying
Trauma Indicator N
% of Total
% of Female
% of Male
During the past 12 months, have you ever been bullied on school property?
2,728
Yes No
Yes No
Yes No
2015 DE HS YRBS

28. Bullying and Substance Use
2015 DE HS YRBS

29. Bullying and Mental Health
2015 DE HS YRBS

30. Bullying and Sexual Risk Behavior
2015 DE HS YRBS

31. Emotional Dating Violence
Emotional Dating Violence
Trauma Indicator N
% of Total
% of Female
% of Male
During the past 12 months, how many times did someone you were dating or going out with say things to you or say things to other people about you to purposely hurt you?
2,732
Didn’t date 31
0 times
1 or more
Didn’t date 29
0 times
1 or more
Didn’t date
0 times
1 or more
2015 DE HS YRBS

32. Emotional TDV and Substance Use 2015 DE HS YRBS

33. Emotional TDV and Mental Health 2015 DE HS YRBS

34. Emotional TDV and Sexual Risk Behavior 2015 DE HS YRBS

35. Physical Dating Violence
Physical Dating Violence
Trauma Indicator N
% of Total
% of Female
% of Male
During the past 12 months, how many times did someone you were dating or going out with physically hurt you on purpose? (Count such things as being hit, slammed into something, or injured with an object or weapon.)
2,673
Didn’t date 30
0 times
1 or more
Didn’t date 28
0 times
1 or more
Didn’t date 33
0 times
1 or more
2015 DEHS YRBS

36. Physical TDV and Substance Use 2015 DE HS YRBS

37. Physical TDV and Mental Health 2015 DE HS YRBS

38. Physical TDV and Sexual Risk Behavior 2015 DE HS YRBS

39. Sexual Dating Violence
Sexual Dating Violence
Trauma Indicator N
% of Total
% of Female
% of Male
During the past 12 months, how many times did someone you were dating or going out with force you to do sexual things you did not want to do? (Count such things as kissing, touching or being physically forced to have sexual intercourse.)
2,670
Didn’t date 30
0 times
1 or more
Didn’t date 28
0 times
1 or more
Didn’t date
0 times
1 or more
2015 DE HS YRBS

40. Sexual TDV and Substance Use 2015 DE HS YRBS

41. Sexual TDV and Mental Health 2015 DE HS YRBS

42. Sexual TDV and Sexual Risk Behavior 2015 DE HS YRBS

43. Forced Sexual Intercourse
Forced Sexual Intercourse
Trauma Indicator N
% of Total
% of Female
% of Male
Have you ever been physically forced to have sexual intercourse when you did not want to?
2,734
Yes No
Yes No
Yes No
2015 DE HS YRBS

44. Forced Sexual Intercourse and Substance Use 2015 DE HS YRBS

45. Forced Sexual Intercourse and Mental Health 2015 DE HS YRBS

46. Forced Sexual Intercourse and Sexual Risk Behavior 2015 DE HS YRBS

47. Aggregated YRBS ACES Number of ACES Percent of Population 55% 1 24% 2
55% 1
24% 2
10% 3 6% 4 2% 5 1% 6 7 - 8 9
2015 DE HS YRBS

48. YRBS ACES Aggregated in Three Categories
Number of ACES
Percent of Population
0 ACES
55%
1 ACE
24%
2 or more ACES
21%
2015 DE HS YRBS

49. ACES and Substance Use
2015 DE HS YRBS

50. ACES and Mental Health
2015 DE HS YRBS

51. ACES and Sexual Risk-taking
2015 DE HS YRBS

52. Mental health concerns
The Take-Away…
Youth who experience adverse child experiences are also at much greater risk for
Substance use
Mental health concerns
Sexual risk behaviors

53. Protective Childhood Experiences
Family has clear rules and consequences
Child gets along well with parents
Parents show they are proud of child
Child can count on parents
Friends feel it is wrong to use alcohol/drugs

54. Strongly Disagree/Disagree
Protective Factors
Factor
Never/Almost Never
Always/Almost Always
How often can you count on your parents? 7%
67%
How often your parents show they are proud of you 9%
63%
How often do you get along well with your parents 4%
Strongly Agree/Agree
Strongly Disagree/Disagree
Your parents have clear rules and consequences
79%
2015 DE HS YRBS

55. How often can you count on your parents?
2015 DE HS YRBS

56. How often can you count on your parents?
2015 DE HS YRBS

57. How often can you count on your parents?
2015 DE HS YRBS

58. How often do your parents show they are proud of you?
2015 DE HS YRBS

59. How often do your parents show they are proud of you?
2015 DE HS YRBS

60. How often do your parents show they are proud of you?
2015 DE HS YRBS

61. How often do you get along well with your parents?
2015 DE HS YRBS

62. How often do you get along well with your parents?
2015 DE HS YRBS

63. How often do you get along well with your parents?
2015 DE HS YRBS

64. Family has clear rules and consequences
2015 DE HS YRBS

65. Family has clear rules and consequences
2015 DE HS YRBS

66. Family has clear rules and consequences
2015 DE HS YRBS

67. In 2012,House Bill 268 made a number of changes to the state’s bullying law:
Required schools report all incidents of bullying to the state DOE and required DOE to randomly audit schools each year to ensure reports to the state and to parents were being made
Required more prominent placement of contact information for the AG’s ombudsman who assists parents and students unsatisfied with their school’s resolution of bullying issues including on school websites
Required schools to report to the state if a bullying incident was the result of a student being targeted for an identifiable reason, including but not limited to race, religion, and sexual orientation to determine if particular groups of students were disproportionately subject to bullying, so steps could be taken to intervene.

68. Percentage of High School Students Who Were Bullied on School Property,* 2009-2015†
Data for this slide are from the 2015 Delaware Youth Risk Behavior Survey. This slide shows percentages from 2009 through 2015 for high school students who were bullied on school property (during the 12 months before the survey). These are results from the Delaware Youth Risk Behavior Surveys,
The percentage for 2009 is The percentage for 2011 is The percentage for 2013 is The percentage for 2015 is 16.4.
For this behavior, based on linear trend analyses using logistic regression models controlling for sex, race/ethnicity, and grade (p < 0.05), the prevalence did not change from 2009 to 2015.
*During the 12 months before the survey
†No change [Based on linear trend analyses using logistic regression models controlling for sex, race/ethnicity, and grade (p < 0.05).]
Note: This graph contains weighted results.
Delaware - YRBS,

69. Percentage of High School Students Who Were Threatened or Injured with a Weapon on School Property,* †
Data for this slide are from the 2015 Delaware Youth Risk Behavior Survey. This slide shows percentages from 1999 through 2015 for high school students who were threatened or injured with a weapon on school property (such as a gun, knife, or club one or more times during the 12 months before the survey). These are results from the Delaware Youth Risk Behavior Surveys,
The percentage for 1999 is The percentage for 2001 is The percentage for 2003 is The percentage for 2005 is The percentage for 2007 is The percentage for 2009 is The percentage for 2011 is The percentage for 2013 is The percentage for 2015 is 6.2.
Significant linear trends (if present) across all available years are described first followed by linear changes in each segment of significant quadratic trends (if present). For this behavior, based on linear and quadratic trend analyses using logistic regression models controlling for sex, race/ethnicity, and grade (p < 0.05), the prevalence decreased from 1999 to 2015.
*Such as a gun, knife, or club one or more times during the 12 months before the survey
†Decreased [Based on linear and quadratic trend analyses using logistic regression models controlling for sex, race/ethnicity, and grade (p < 0.05). Significant linear trends (if present) across all available years are described first followed by linear changes in each segment of significant quadratic trends (if present).]
Note: This graph contains weighted results.
Delaware - YRBS,

70. Percentage of High School Students Who Were Bullied on School Property,* by Sex,† Grade, and Race/Ethnicity,† 2015 (percents)
Data for this slide are from the 2015 Delaware Youth Risk Behavior Survey. This slide shows the percentage of high school students who were bullied on school property (during the 12 months before the survey).
The percentage for all students is The percentage for Male students is The percentage for Female students is The percentage for 9th grade students is The percentage for 10th grade students is The percentage for 11th grade students is The percentage for 12th grade students is The percentage for Black students is The percentage for Hispanic students is The percentage for White students is All Hispanic students are included in the Hispanic category. All other races are non-Hispanic. Note: This graph contains weighted results.
For this behavior, the prevalence for female students is higher than for male students. The prevalence for White students is higher than for Black students. (Based on t-test analysis, p < 0.05.)
*During the 12 months before the survey
†F > M; W > B (Based on t-test analysis, p < 0.05.)
All Hispanic students are included in the Hispanic category. All other races are non-Hispanic.
Note: This graph contains weighted results.
Delaware - YRBS, 2015

71. Delaware High School Students Reporting They’ve Been Bullied in School in the Past 12 Months
2015 DE HS YRBS

72. 16% of Delaware High School Students Report They’ve Been Bullied in the Past Year; 12% of Those Students Report They Have No Supportive Adult
2015 DE HS YRBS

73. 16% of Delaware High School Students Report They’ve Been Bullied in the Past Year; 12% of Those Students Report They Have No Supportive Adult
2015 DE HS YRBS

74. 16% of Delaware High School Students Report They’ve Been Bullied in the Past Year; 12% of Those Students Report They Have No Supportive Adult
2015 DE HS YRBS

75. Prevention and Intervention Strategies
Trauma Informed Approaches to education, health care, service delivery
Parenting programs, including programs for teen parents, and parenting social supports
High quality daycare and early childhood education programs
Home visiting programs for new families
Mental health and substance use counseling services across the lifespan
Anti-bullying programs
Gay-Straight Alliances and other clubs that foster inclusiveness
Programs that address poverty, joblessness, etc.

76. Trauma Matters Delaware
The mission of the Delaware ACEs Action group is to advance trauma-informed initiatives in Delaware, including trauma-informed approaches in any and all settings where people are served.

77. Applying the Data

78. ? ? ?
What data do YOU need to enhance your work? Seek funding? Measure your impact?

79. SEOW Data Products and Dissemination Vehicles
DDATAGrams – Highlighting one noteworthy fact
Fact Sheets – Conversation starters for community events
Gap reports – Analyses of specific areas of need
Delaware Epidemiological (State and Substate) Profiles
Special Briefs – By request
Presentations – By request
Social Media
SEOW Networks – Data, Dissemination, other

80. Applying the Data: Identifying Needs
Developing and Implementing Programming
Supporting Grant Applications
Statements of Need
Letters of Support
Logic Model, SMART Objectives

81. Applying the Data: Measuring Impact
DSAMH Strategic Prevention Framework – Partnerships for Success
DOE DASH HIV Prevention Grant
NIJ MEASURING TEEN DATING VIOLENCE (proposed)
Kids Count in Delaware
Impact Tobacco
DPH Prep Grant
Drug Free Communities Grant
DELTA Grant for the Delaware Coalition Against Domestic Violence

82. What does the data leverage?
At a minimum…
By 2015, data collected had supported
the generation of over
$37 million
in grant funding and program evaluation throughout Delaware.

83. Ultimate Goal of Data Driven Planning, Decision-Making, and Evaluation…
Evidence-based practices
Effective policy and legislation
Avoidance of economic losses related to mortality, morbidity, and adverse events prevented

84. …the adoption of practices and behaviors that
And above all…
…the adoption of practices and behaviors that
lead to the improved health and social well-being
of individuals, families, and communities
in Delaware.

85. University of Delaware Center for Drug and Health Studies
On behalf of the Delaware Division of Substance Abuse and Mental Health Services Strategies for Prevention – Partnerships for Success Grant (SPF-PFS), CDHS convenes the State Epidemiological Outcomes Workgroup (SEOW) whose mission is to “bring data to the forefront of the prevention planning process” by:
Identifying and analyzing data from State and local sources
Providing current benchmarks, trends and patterns of use and consequences
Providing data products to inform planning and policy development
Training agencies and communities in effective use of data
its precursors and its consequences to inform prevention policy, practice and programming in the State.

86. SOURCES and RESOURCES
Adverse Childhood Experiences (ACEs) – Centers for Disease Control and Prevention, US Department of Health and Human Services Adverse Childhood Experiences – Looking at How ACES Affect Our Lives and Society – Center for Disease Control and Prevention, US Department of Health and Human Services Delaware Household Health Survey, Public Health Management Corporation (PHMC) Delaware Youth Risk Behavior Survey Trauma-informed Practices and Compassionate Schools Model Information – Delaware Department of Education

87. Twitter: @CDHSDelaware
For More Information
Sharon Merriman-Nai
Roberta Gealt