adverse childhood experiences (ace) research: implications
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Adverse Childhood Experiences (ACE) Research: Implications. Heather Larkin, MSW, PhD Assistant Professor, University at Albany Thank you to Dr. Vincent Felitti for sharing the ACE slides at the beginning of this presentation. - PowerPoint PPT PresentationTRANSCRIPT
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Adverse Childhood Experiences (ACE) Research:
Implications
Heather Larkin, MSW, PhD
Assistant Professor, University at Albany
Thank you to Dr. Vincent Felitti for sharing the ACE slides at the beginning of this presentation.
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The Adverse Childhood Experiences Study
The largest study of its kind ever done to examine the health and social effects of adverse childhood experiences over the lifespan (Felitti & Anda)
• Experiences while growing up that deeply impact a young person and profoundly affect emotional and physical health later in life.
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Categories of Adverse Childhood Experiences
Abuse, by Category Category
Prevalence (%)• Psychological (by parents) 11%• Physical (by parents) 11%• Sexual (anyone) 22%
Household Dysfunction, by Category• Substance Abuse in family 26%• Mental Illness in family 19%• Domestic Violence 13%• Imprisoned Household Member 3%• Loss of parent 23%
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Adverse Childhood Experiences Score
Number of categories of childhood experiences are summed
ACE Score Prevalence
0 48%1 25%2 13%3 7%4 7%
• More than half have at least one ACE• Slightly more than one quarter have experienced
2 – 4 ACE categories
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The Adverse Childhood Experiences (ACE) Study
Summary of Findings:• Adverse Childhood Experiences (ACEs)
are very common • ACEs are strong predictors of adult
health risks and disease• ACEs are implicated in the 10 leading causes of death in the
U.S.!
• “I was actually stunned and I wept over what I saw.” ACEs researcher Rob Anda, M.D.
• Virtually every study shows that ACEs are strong predictors of homelessness (Burt, 2001)
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Adverse Childhood Experiences and Current Smoking
0
2
4
6
8
10
12
14
16
18
20
0 1 2 3 4-5 6 or more
ACE Score
%
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Childhood Experiences and Adult Alcoholism
0
2
4
6
8
10
12
14
16
18
% A
lco
ho
lic
ACE Score
0
1
23
4+
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Childhood Experiences Underlie Chronic Depression
0
10
20
30
40
50
60
70
80
% W
ith
a L
ife
tim
e H
isto
ry o
f D
ep
res
sio
n
0 1 2 3 >=4
ACE Score
Women
Men
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Childhood Experiences Underlie Suicide
0
5
10
15
20
25
% A
ttem
pti
ng
Su
icid
e
ACE Score
11
22
00
33
4+4+
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0
2
4
6
8
10
12
0 1 2 3 4 5 6 >=7
NoYes
ACE Score
Ever
Hallu
cin
ate
d*
(%) Abused
Alcohol or Drugs
*Adjusted for age, sex, race, and education.
ACE Score and Hallucinations
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ACE Score and Intravenous Drug Use
0
0.5
1
1.5
2
2.5
3
3.5
% H
ave
Inje
cted
Dru
gs
0 1 2 3 4 or more
ACE Score
N = 8,022 p<0.001N = 8,022 p<0.001
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ACE Score and Serious Job Problems
0
2
4
6
8
10
12
14
16
18
% w
ith
Jo
b P
rob
lem
s
0 1 2 3 4 or more
ACE Score
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A Connection with Homelessness
• Mental illness and substance abuse problems are more common among homeless people
• ACEs connection to substance abuse and mental illness
• Even non-homeless people with either substance abuse problems or mental illness are less likely to hold a job
• More than half of sample with ACE Score of 4 or higher
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University at Albany School of Social Welfare: ACE Response
• Enhance our understanding of ACEs
• Integrate with literature on resiliency and protective factors
• Prevention and Intervention for each ACE outcome
• Support systems transformation
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A complex interplay of risks and resources
ACE impact on Health Risk Behaviorsdeveloping self (substance abuse, sexual(overwhelming feelings, and other risk-taking, etc.)activation of defense Medical problems (bothmechanisms, etc.) short & long-term)
Changes in developing brainINDIVIDUAL
COLLECTIVE
Family meanings Family relational system/ACEsCultural values Social violenceSocial taboos Health, Mental health, & Substance abuse
servicesVictim blaming Social service , school, & criminal justice
systems“rugged individualism” Public health policy responses
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Development, behavior, health, culture, and systems
• Developmental theorists (Piaget, Kohlberg, Gilligan, Loevinger, Freud, and others)
• Impact of ACEs and health risk behaviors on development
• The role of culture and social systems
• Service interventions that prevent or effectively treat ACEs sooner might prevent homelessness (& other serious health and social outcomes) later in life
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Key Milestones
• Felitti and Anda visits – 2007, 2008, 2009
• Policy Lunch – May 2009
• Council on Children and Families – June 2009, September 2009
• ACE Think Tank and Action Teams– Rob Anda, Vincent Felitti, Fred Bolton
• ACE Steering Committee
• NYS Omnibus Survey
• Multi-state ACE Learning Community
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Planned NYS Omnibus Survey
• ACE Questions• 800 NYS residents over 18 years• demographic factors
– age, education, household income, gender, marital and family status, geographic region, partisan affiliation, race and ethnicity
• Move toward ongoing BRFSS ACE data collection as policy tool
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Implications
• ACE Response: Fostering resilience & mobilizing protective factors
• Workforce development
• Practice, programs, policies that take trauma into account
• The Healing Power of Social Networks
• Cross-system linkages/ service integration(TRANSFORMATION)