1. Adverse Childhood experiences (ACE)

2. Adverse Childhood Experiences (ACE) Study
acestudy.org
Collective effort of Kaiser Permanente and Centers for Disease Control and Prevention (CDC)
The largest study of its kind to examine the health, social and economic effects of ACEs over the lifespan (over 17,000 participants)
Examined past history of abuse, family dysfunction and current health status
Retrospective cohort study of an HMO population with average of 57 years
Some additional information about the original study
50/50 split between male and female
75% were white
46% were over the age of 60
39% were college graduates
ALL were working privately insured people

3. ACEs Questionnaire Physical abuse Emotional abuse Sexual abuse
An alcohol and/or drug abuser in the household
An incarcerated household member
Someone who is chronically depressed, mentally ill, institutionalized or suicidal
Mother is treated violently
One or no parents
Emotional or physical neglect
The ACE Study used a simple scoring method to determine the extent of each participant's exposure to childhood trauma.  Exposure to one category (not #s of incidents) of ACE, qualifies as one point.  When the points are added up, the ACE Score is achieved.   (read ACE categories above)
An ACE Score of 0 (zero) would mean that the person reported no exposure to any of the categories of trauma listed as ACEs.  An ACE Score of 9 would mean that the person reported exposure to all of the categories of trauma listed above.
Important to acknowledge other forms of trauma or adverse experiences that are not listed in this study – historical trauma, combat experiences, bullying, racism…

4. 3 Types of ACEs
These were the 10 areas that were included in the initial study, with the three categories of Abuse, Neglect, and Household Dysfunction. Studies since then have added domestic violence and bullying

5. ACE Study Participants Experienced
17,000 ACE Study participants had the following:
0 ACE
12.4%
4+ ACEs
36% experienced
64% have
at least 1 ACE

6. How Prevalent are ACEs?
The ACE Study revealed the following estimates:
Highest area of abuse was physical abuse
Highest area in neglect was emotional neglect
Highest in household dysfunction was substance abuse followed by parental separation or divorce
More recent studies have shown that if domestic violence is in the home, the prevalence of ACE events increases. And in adults their risk of illicit drugs, self reported alcoholism, iv drug use, and depression increased by approximately 2 to 6 times higher rate if witnessed domestic violence

7. The Impact of ACEs
Discuss how these things lead to low worker productivity, absenteeism, etc.

8. The Impact of ACEs, continued
As the number of ACEs increase, so do the risk for negative health outcomes.
People with 4 or more adverse childhood experiences were more likely:
to begin risky behavior at an earlier age ie: having sex at an earlier age, leading to an increased chance of teen pregnancy
Increased likelihood of no physical activity leads to higher risk of obesity, diabetes, heart disease, etc
Trying smoking at an earlier age (teen or pre-teen) leads to higher risk of COPD, etc
Ultimately if ACE’s are not addressed or prevented it can lead to early death

9. Lifetime Influence of ACEs
Death
Birth
Adverse Childhood Experiences
Social, emotional & cognitive impairments
Adoption of
health-risk behaviors
Disease, injury & disability
Early

10. How do ACEs Affect our Society?

11. Washington School Classroom: ACEs
30 students; high school sophomores & seniors

12. 3 Systems for Promoting Resilience
Intellectual & employable skills
Self-regulation—self-control, executive function, flexible thinking
Ability to direct & control attention, emotion, behavior
Positive self-view, efficacy
Bonds with parents &/or caregivers
Positive relationships with competent & nurturing adults
Friends or romantic partners who provide a sense of security & belonging, help with emotion coaching
Faith, hope, sense of meaning
Engagement with effective organizations—schools, work, pro-social groups
Network of supports/services & opportunity to help others
Cultures providing positive standards, expectation, rituals, relationships & supports

13. What does Abuse Cost Us?
Non-fatal Child Maltreatment has an average lifetime
cost of $210,012 per victim (CDC 2012). Compare to the lifetime costs of Type II Diabetes at $181,000.
Work Productivity Losses
Childhood Health Care
Adult Health Care
Special Education
Child Welfare
Criminal Justice

14. Resources to Learn More…
cdc.gov/violenceprevention/ acestudy
cdc.gov/violenceprevention/ childmaltreatment
preventchildabuse.org
kansaspowerofthepositive.org

15. Thank you!