1. Adverse Childhood Experiences: ACEs across the lifecourse
Karen Clemmer, RN, MN, PHN.
Sonoma County
Maternal Child Adolescent Health Program

2. “Never before in the history of medicine have we had better insight into the factors that determine the health of an individual from infancy to adulthood, which is part of the life course perspective—a way of looking at life not as disconnected stages but as integrated across time.”

3. Adverse Childhood Experiences
(ACE) Study
Centers for Disease Control and Kaiser Permanente in San Diego,
17,300 Adults
Tracked health outcomes based on childhood ACEs
75% Caucasian, 39% college graduates, 36% some college,
living wage jobs with insurance; median age 57 yr. old

4. What are the Adverse Childhood Experiences?
Child physical abuse
Child sexual abuse
Child emotional abuse
Physical Neglect
Emotional Neglect
Mentally ill, depressed or suicidal person in the home
Drug addicted or alcoholic family member
Witnessing domestic violence against the mother
Loss of a parent to death or abandonment, including abandonment by divorce
Incarceration of any family member

5. Prevalence Adverse Childhood Experiences (ACEs) Study Centers for Disease Control & Prevention (CDC)
Household dysfunction
Substance abuse 27%
Parental separation/divorce 23%
Mental illness 19%
Battered mother 13%
Incarcerated household member 5%
Abuse
Psychological %
Physical 28%
Sexual 21%
Neglect
Emotional %
Physical %
Centers for Disease Control and Prevention

6. A “Trauma Lens” helps us understand behavior
A shift in perspective from: “What is wrong with this person?” to “What has this person been through?”
Isabel 6

8. Hidden Crisis Report on ACEs
Results for Sonoma County
22% have 4 or more ACEs
Increased risk for
depression
suicide attempt
drug & alcohol use
heart disease, stroke, COPD
diabetes
Alzheimer‘s

10. LOCAL HELPERS (BLUE RIBBON EVENT May 2015)
Abuse
Psychological % 53%
Physical % 23%
Sexual 21% 28%
Neglect
Emotional 15% 25%
Physical 10% 12%
Household Dysfunction
Substance Abuse 27% 51%
Parent Absent % 46%
Mental Illness % 47%
Domestic Violence 13% 16%
Criminal Behavior % 9%

12. IMPACT OF TOXIC STRESS
Humans are designed to deal with intermittent stress, not chronic stress.
We were not designed to fight the tiger all day long!
In children, stress becomes toxic when it is not buffered by the comfort of a supportive adult.
Trauma and Toxic Stress cause
Changes in physiology
Changes in brain architecture
Changes in skills, abilities and behavior
Changes in health and mental health

13. Impact of Structural Brain Changes STRESS
Dysregulation of the Hypothalamic-Pituitary-Adrenocortical Axis leads to increased secretion of adrenaline and cortisol by the adrenal gland.
Inflammatory cytokines are also over-produced, leading to accelerated wear and tear on the heart, brain, immune system and elsewhere throughout the body.
The end result? Toxic stress in childhood can lead to lifelong, multi-system disease.

15. In California, the Department of Health Care Services issued a slightly more conservative summary for a presentation coordinated by the California HealthCare Foundation, which publishes California Healthline. DHCS officials said the top 5% account for 51% of Medi-Cal spending.

17. How ACES Cross Generations

18. Trigger Alert!

21. Quick Review -

22. Quick Review -

23. Quick Review -

28. Traumatized Children
Appear guarded and anxious Difficult to re-direct, reject support Highly emotionally reactive Difficulty settling after outbursts Hold on to grievances May not take responsibility for behavior Make the same mistakes over and over

29. wash schools

30. LOCAL data: Children 0-11yo

31. LOCAL data: Teens

32. ACE & School Performance
Traumatized children are:
2.5x more likely to fail a grade in school
score lower on standardized achievement tests
more likely to struggle with receptive & expressive language
suspended & expelled more often
more frequently placed in special education

33. Promote Sense of Safety
Highly structured environment
Predictable schedule
Predictable routines
Predictable consequences
Predictable rewards
Zero tolerance for bullying
Alert children to loud noises before they occur
Adults are respectful, calm and confident
“Peace corner” in the classroom

34. The most common factor for children who develop resilience is
Building Resilience
KEY SLIDE!
The most common factor for children who develop resilience is
at least one stable & committed relationship with an adult
This can be a teacher, coach or other school personnel
Nurturing and positive relationship with an adult who sees their strengths
A relationship as brief as one school year can make a dramatic lasting impact

38. Learn More!

39. National Happenings
The National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC)
National Association of State Mental Health Program Directors
Trauma-Informed Organizational Toolkit – The National Center on Family Homelessness
National Center for Domestic Violence, Trauma & Mental Health
National Child Traumatic Stress Network
National Council for Community Behavioral Healthcare- Trauma Informed BHC
The National Institute for Trauma and Loss in Children
The National Association of States Directors of Developmental Disabilities Services
National Center for Social Work Trauma Education and Workforce Development
Chadwick Center for Children and Families
ACES Too High
Mandy

40. THANK YOU! Karen Clemmer, RN, MN, PHN Karen.Clemmer@Sonoma-county.org
Department of Health Services, Public Health Division
Maternal, Child, Adolescent Health
LEARN MORE!
JOIN - Sonoma County ACES Connection!
(Just Google “Sonoma County ACES Connections”)
An on-line group
Monthly meetings:
4th Wed of each month
12:30 – 2:00
625 Fifth Street, Santa Rosa