1. State of Alaska Interagency Prevention Workgroup

2. Our Purpose The State Interagency Prevention Workgroup establishes a consistent time and forum where colleagues whose day to day work focuses on prevention programming meet to identify and strengthen efforts to work collaboratively towards the prevention of Alaska’s pervasive health and social challenges.

3. Focus of Our Work Connecting the dots among multiple prevention efforts to address suicide, domestic violence, sexual assault, child maltreatment and other adverse childhood experiences (ACESs), alcohol and substance abuse, unintentional injury deaths, fetal alcohol syndrome, and sexually transmitted diseases.

4. Alaska Statistics Youth: 9.3% of students have been physically forced to have sexual intercourse when they did not want to 13.5% of students have taken a prescription drug (such as OxyContin, Percocet, Vicodin, Codeine, Adderall, Ritalin, or Xanax) without a doctor’s prescription one or more times during their lifetime. 11% of students have experienced teen dating violence. 13.7 % of students had their first drink before the age of 13. 27.2% are reporting signs of depression Suicide is the second leading cause of death for adolescents and young adults.

5. Alaska Statistics Adults: 47.6% of adult women (or 117,685) experienced intimate partner violence in their lifetime. (AVS, statewide 2010) 37.1% of adult women (or 23,240) experienced sexual violence in their lifetime. (AVS, statewide 2010). 19.2% of Adults Aged 18-25 and 7.6% of Adults Aged 26+, Abused or were Dependent on Alcohol or Illicit Drugs in the Past Year(NSDUH2011-2012) 6.9% of Adults had been Diagnosed with Major Depression in Their Lifetimes (NSDUH 2011-2012) 2,242 Unique Adults Were Involved as Perpetrators of Child Maltreatment ( Child Maltreatment 2012)

6. Impact of Multiple Health and Social Challenges on Alaskan’s Short and long term consequences Physical Psychological Social Academic Economic Community well-being

7. Economic Burden In Alaska the Economic Costs of Alcohol and Other Drug Abuse total $1,191, 900,000 and include: $ 673,200,000 Productivity losses, $ 50,500,000 Traffic crash costs, $ 217,700,000 Criminal justice and protective services $ 237,300,000 Health care +$ 13,200,000 Public assistance and social services Total: $1,191,900,000 The Economic Costs of Alcohol and Other Drug Abuse in Alaska, 2012 Update

8. Economic Burden In the United States, victim costs associated with sexual violence are estimated at $126 billion annually, which includes medical costs, lost earnings, pain, suffering and lost quality of life (NIJ, 2002). Intimate Partner Violence has been estimated to cost employers in the U.S. up to $13 billion each year. (Bureau of National Affairs, Special Rep. 1990).

9. Opportunities: Collaboration on projects, grants and trainings; Identify shared risk and protective factors Clarify and maintain areas of prevention work that need unique and concentrated focus; Make focus area recommendations for state prevention policies and programming

10. Current Collaborations in Prevention Fourth R Strengthening Families ACEs

11. Some of the Organizations Supporting Fourth R

12. Some of the Organizations Supporting Strengthening Families:

13. Some of the Organizations Supporting the ACE Study in Alaska

14. Why Primary Prevention? Many of our health and social problems can be attributed to and even be predicted by our childhood experiences.

15. What the Research Tells Us Trauma and the Brain:

16. ACE’s Overview Abuse – Physical – Sexual – Verbal/Emotional Household Dysfunction – Mental Illness in the Household – Substance Abuse in the Household – Witnessing Domestic Violence – Separation/Divorce – Household Member in Prison Neglect – Physical – Emotional

17. Types of ACEs Abuse 1.Physical 2.Sexual 3.Verbal/Emotional Household Dysfunction 4.Mental Illness in the Household 5.Substance Abuse in the Household 6.Witnessing Domestic Violence 7.Separation/Divorce 8.Household Member in Prison Neglect 9.Physical 10.Emotional

18. ACE’s Major Findings – Alcoholism and alcohol abuse – Chronic obstructive pulmonary disease (COPD) – Depression – Fetal death – Health-related quality of life – Illicit drug use – Ischemic heart disease (IHD) – Liver disease  Risk for intimate partner violence  Multiple sexual partners  Sexually transmitted diseases (STDs)  Smoking  Suicide attempts  Unintended pregnancies  Early initiation of smoking  Early initiation of sexual activity  Adolescent pregnancy ACEs exposures are (sadly) common Short- and long-term outcomes of these childhood exposures include a multitude of health and social problems, such as:

19. ACE’s in Alaska ACE’s questions added to Alaska Behavioral Risk Factor Surveillance System (BRFSS) in 2013 One of many states collecting ACEs data in the U.S. Alaskan ACEs data just released in 9/2014. http://www.cdc.gov/brfss/about/about_brfss.htm

20. Alaska and Five States’ Combined ACE Data

21. Source: Alaska data from the 2013 Alaska Behavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion Source: Five States Study data from the Centers for Disease Control and Prevention, Adverse Childhood Experiences Reported by Adults --- Five States, 2009, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htm

22. Adverse Childhood Experience* AlaskaArkansasLouisianaNew MexicoTennesseeWashington Abuse%%% Emotional31.024.321.128.119.234.9 Physical19.114.110.519.512.918.1 Sexual14.810.99.912.912.713.5 Household Dysfunction%%% Mental Illness in the Home 21.917.016.619.417.124.3 Incarcerated Family Member 11.55.57.27.18.66.6 Substance Abuse in Home 33.825.526.629.928.332.7 Separation or Divorce31.723.327.124.429.126.0 Witnessed Domestic Violence 18.715.114.518.917.116.6

23. Source: Alaska data from the 2013 Alaska Behavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion

25. National Survey of Children’s Health 2011/2012 (1)socioeconomic hardship, (2)divorce/separation of parent, (3)death of parent, (4)parent served time in jail, (5)witness to domestic violence, (6)victim of neighborhood violence, (7)lived with someone who was mentally ill or suicidal, (8)lived with someone with alcohol/drug problem, (9)treated or judged unfairly due to race/ethnicity. Does not include Physical, Sexual and Emotional abuse.

26. National Survey of Children’s Health 2011/2012 - For Ages 0-18 Ace Question U.S.Alaska Statistically Significant Family's income hard to cover the basics like food or housing? Very often or Somewhat often. 25.7%25.0%No Did child ever live with a parent or guardian who got divorced or separated after he or she was born? Yes 20.1%23.8%Yes Did the child ever live with a parent or guardian who died? Yes3.1% No Did ever live with a parent or guardian who served time in jail or prison after he/she was born? Yes 6.9%9.6%Yes Did the child ever see or hear any parents, guardians, or any other adults in his/her home slap, hit, kick, punch, or beat each other up? Yes 7.3%8.6%No Was the child ever the victim of violence or witness any violence in his/her neighborhood? Yes 8.6%10.5%No Did the child ever live with anyone who was mentally ill or suicidal, or severely depressed for more than a couple of weeks? Yes 8.6%11.0%No Did the child ever live with anyone who had a problem with alcohol or drugs? Yes10.7%14.5%Yes Was the child ever treated or judged unfairly because of his/her race or ethnic group? Yes 4.1%4.9%No The Data Resource Center for Child and Adolescent Health is a project of the Child and Adolescent Health Measurement Initiative (CAHMI) supported by Cooperative Agreement 1-U59-MC06980-01 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). With funding and direction from MCHB, these surveys were conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics. CAHMI is responsible for the analyses, interpretations, presentations and conclusions included on this site. Additional analysis by Alaska Mental Health Board/Advisory Board on Alcoholism and Drug Abuse StaffCAHMIU.S. Department of Health and Human ServicesHealth Resources and Services Administration (HRSA)Maternal and Child Health Bureau (MCHB)National Center for Health Statistics

27. Age 0-5 by Number of ACES in Alaska Zero ACEs 59.8% One ACE 24.7% Two or More ACEs 15.5% Source: National Survey of Children’s Health 2011/2012, Graphic created by the Alaska Mental Health Board/Advisory Board on Alcoholism and Drug Abuse Staff.

28. Age 6-11 by Number of ACES in Alaska Zero ACEs 48.1% One ACE 24.9% Two or More ACEs 27.0% Source: National Survey of Children’s Health 2011/2012, Graphic created by the Alaska Mental Health Board/Advisory Board on Alcoholism and Drug Abuse Staff.

30. ACEs Linked to Health Alaskans 2020 1.Reduce Alaskan Deaths from Cancer 2.Increase the Proportion of Alaskans who Are Tobacco-Free 3.Reduce the Proportion of Alaskans who are Overweight and Obese 4.Increase the Proportion of Alaskans who are Physically Active 5.Reduce the Deaths from Suicide 6.Reduce the Number of Alaskans Experiencing Poor Mental Health 7.Increase the Proportion of Alaskan Youth with Family and/or Social Support 8.Reduce the Number of Alaskans Experiencing Domestic Violence and Sexual Assault 9.Reduce the Number of Alaskans Experiencing Alcohol and Other Drug Dependence and Abuse 10.Reduce Alaskans Deaths from Unintentional Injury 11.Reduce the Proportion of Alaskans Experiencing Infectious Disease 12.Reduce the Proportion of Alaskans Without Access to High Quality and Affordable Healthcare 13.Increase the Economic and Educational Status of Alaskans

31. Using Research to Plan and Implement Prevention Programming

32. Population Attributable Risks in Alaska Source: Alaska data from the 2013 Alaska Behavioral Risk Factor Surveillance System, Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion, Graphic: AMHB/ABADA

33. Why Focus on Shared Risk and Protective Factors? Prevent multiple forms of violence simultaneously Develop new partnerships Leverage resources/funding streams Consider a larger pool of strategies Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014). Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute.

34. Societal Risk Factors CMTDVIPVSVYV Bullying Suicide Elder Abuse Norms supporting aggression* XXXXXX Media ViolenceXXXX Societal income inequality XXXX Weak health, educational, economic, and social policies/laws XXXX Harmful gender norms*XXXXXX *Norms are generally measured at the individual level Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014). Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute. NOTE: CM (Child Maltreatment), TDV (Teen Dating Violence), IPV (Intimate Partner Violence), SV (Sexual Violence), YV (Youth Violence)

35. Relationship/Individual Level Protective Factors CMTDVIPVSVYVBullyingSuicide Elder Abuse Family support/ connectedness XXXXXX Connection to a caring adult XXX Association w/ prosocial peers XXX Connection/ commitment to school XXXXX Skills solving problems non-violently XXXX Source: Wilkins, N., Tsao, B., Hertz, M., Davis, R., Klevens, J. (2014). Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Oakland, CA: Prevention Institute. NOTE: CM (Child Maltreatment), TDV (Teen Dating Violence), IPV (Intimate Partner Violence), SV (Sexual Violence), YV (Youth Violence)

36. Examples of Potential Strategies for Addressing Multiple Forms of Violence and Related Social Conditions  Community/Societal level  Norms change strategies  Strategies/activities that enhance community support & connectedness  Coordinated services  Relationship level  Strategies that support families under stress  Strategies that connect youth with supportive adults, pro-social peers, and their schools  Individual level  Strategies that build youth and families’ skills in solving problems non- violently  Substance abuse prevention strategies

38. James Heckman James J. Heckman, The Productivity Argument for Investing in Young Children, October 4, 2004

39. Group recommendations: Support Quality Early Childhood Programs – Embed the Strengthening Families Protective Factors Framework in existing programs Ensure access to health care including mental health care Strengthen capacity for Social Emotional Learning throughout Alaska’s schools Continue collaborative prevention programming when addressing common risk and protective factors.

40. I'm an Elder (Minto, Alaska) - YouTube