prevalence of aces among child service...
TRANSCRIPT
Prevalence of Adverse Childhood Prevalence of Adverse Childhood
Experiences (ACEs) among Experiences (ACEs) among
Child Service ProvidersChild Service Providers
Sanctuary Network DaysSanctuary Network Days
December 6December 6--7, 20127, 2012
Heather Larkin, Heather Larkin, PhDPhD, LCSW, LCSW--RR
TheThe UniversityUniversity at Albany at Albany
Nina Esaki, Nina Esaki, PhDPhD, MSW, MBA, MSW, MBA
ANDRUSANDRUS
OverviewOverview
�� Background leading to studyBackground leading to study
�� Research questionResearch question
�� Prior researchPrior research
�� Study designStudy design
�� ResultsResults
�� ConclusionConclusion
�� ImplicationsImplications
Background leading to studyBackground leading to study
�� ACEs and Sanctuary ModelACEs and Sanctuary Model
�� Informal ACEs surveys of Sanctuary Model Informal ACEs surveys of Sanctuary Model
training participantstraining participants
�� Increasing research on prevalence of ACEs in Increasing research on prevalence of ACEs in
general population general population (e.g., Behavioral Risk Factor Surveillance System)(e.g., Behavioral Risk Factor Surveillance System)
�� Increasing research on VT, STS and compassion Increasing research on VT, STS and compassion
fatigue among social workersfatigue among social workers
�� Importance of conducting formal exploratory Importance of conducting formal exploratory
studystudy
Research questionResearch question
�� What is the prevalence of ACEs among child What is the prevalence of ACEs among child
service providers?service providers?
�� Are there differences in ACEs by gender, type Are there differences in ACEs by gender, type
of position (direct/indirect), race or age?of position (direct/indirect), race or age?
Prior researchPrior research
�� ACEs study ACEs study (Dube et al., 2001)(Dube et al., 2001)
�� 63.9% of respondents have 1+ ACEs63.9% of respondents have 1+ ACEs
�� 14.5% have 4+ ACEs14.5% have 4+ ACEs
�� Social service providersSocial service providers
�� Primarily social work studentsPrimarily social work students
�� Link between early trauma and social work career Link between early trauma and social work career (Black, Jeffreys & Hartley, 1993; Rompf & Royse, 1994)(Black, Jeffreys & Hartley, 1993; Rompf & Royse, 1994)
�� Helping professionals can experience VT, STS Helping professionals can experience VT, STS
and compassion fatigue and compassion fatigue (Knight, 2010)(Knight, 2010)
Study designStudy design
�� Exploratory, crossExploratory, cross--sectional studysectional study
�� Voluntary child welfare agency in NortheastVoluntary child welfare agency in Northeast
�� Agency provides residential, day treatment and Agency provides residential, day treatment and
schooling for children with histories of schooling for children with histories of trauma, trauma,
and and mental health and community servicesmental health and community services
MeasuresMeasures�� ACE questionnaire ACE questionnaire (Dube et al., 2004)(Dube et al., 2004)
�� Depressed/Mentally Ill household member, Depressed/Mentally Ill household member, Humiliation/Physical Threat by household member, Substance Humiliation/Physical Threat by household member, Substance Abusing household member, Parental Loss through divorce or Abusing household member, Parental Loss through divorce or abandonment, Sexual Abuse, Physical Abuse, Lack of Support, abandonment, Sexual Abuse, Physical Abuse, Lack of Support, Domestic Violence, Incarceration, NeglectDomestic Violence, Incarceration, Neglect
�� The number of The number of ““yesyes”” responses to each category is added to responses to each category is added to create ACE score; 10 categoriescreate ACE score; 10 categories
�� Violence against the respondentViolence against the respondent’’s mother was s mother was changed to any parent figure to elicit domestic changed to any parent figure to elicit domestic
violence experience violence experience
Data collectionData collection
�� EE--mail introducing study from Executive mail introducing study from Executive
DirectorDirector
�� EE--mail with informed consent and link to mail with informed consent and link to
SurveyMonkeySurveyMonkey survey April 2011survey April 2011
�� One reminder eOne reminder e--mailmail
�� 3 weeks3 weeks
Sample characteristicsSample characteristics
�� 94 out of 360 employees (26%)94 out of 360 employees (26%)
�� 79.1% female, 20.9% male79.1% female, 20.9% male
�� 59.8% direct care, 40.2% indirect care59.8% direct care, 40.2% indirect care
�� 65.9% white (not 65.9% white (not HispHisp), 17.6% Hispanic, 7.7% ), 17.6% Hispanic, 7.7%
Black (not Black (not HispHisp), 5.5% Asian/PI, 3.3% Mixed), 5.5% Asian/PI, 3.3% Mixed
�� Age range: 22 to 68 with average of 39Age range: 22 to 68 with average of 39
AnalysisAnalysis
�� DescriptiveDescriptive
�� ACE ScoreACE Score
�� Prevalence of each ACE categoryPrevalence of each ACE category
�� Correlational analysisCorrelational analysis
�� Age and ACE ScoreAge and ACE Score
�� Independent samples Independent samples tt--testtest
�� ACE Score and gender, position, race (White/Non)ACE Score and gender, position, race (White/Non)
Results Results –– ACE ScoreACE Score
0
5
10
15
20
25
30
35
40
None One Two Three Four +
Pe
rce
nta
ge
Agency Kaiser Permanente
Results Results –– ACE CategoryACE Category
0
10
20
30
40
Pe
rce
nta
ge
Agency Kaiser Permanente
ResultsResults
�� CorrelationalCorrelational analysisanalysis
�� No significant association between age and ACE No significant association between age and ACE score; r = score; r = --.001, .001, p p =. 991=. 991
�� IndependentIndependent--samples samples tt--teststests
�� No differences in ACE score by type of position No differences in ACE score by type of position held held tt(84) = .32, (84) = .32, pp =.75, as was the case with gender =.75, as was the case with gender tt(48.49) = (48.49) = --1.34, 1.34, pp =.19, and race =.19, and race tt(84) = 1.07, (84) = 1.07, p p =.29=.29
FindingsFindings
�� Suggests high prevalence of ACEs among Suggests high prevalence of ACEs among
workers in an agency serving children with workers in an agency serving children with
histories of traumahistories of trauma
�� ~70% of employees had at least one ACE; ~70% of employees had at least one ACE;
nearly 16% reported 4+nearly 16% reported 4+
�� ACEs more prevalent in this sample than ACEs more prevalent in this sample than
original ACE study original ACE study ((DubeDube et al., 2001)et al., 2001)
�� Higher prevalence of family mental illness and Higher prevalence of family mental illness and
emotional abuse among agency staff emotional abuse among agency staff (Dong et al., (Dong et al.,
2004)2004)
LimitationsLimitations
�� CrossCross--sectional, retrospective designsectional, retrospective design
�� Single agencySingle agency
�� Reliance on selfReliance on self--reportreport
�� Somewhat low response rate (26%)Somewhat low response rate (26%)
ConclusionConclusion
�� Study helps us understand ACE characteristics among Study helps us understand ACE characteristics among child service providerschild service providers
�� Future research could explore ACE prevalence among Future research could explore ACE prevalence among other types of social service providersother types of social service providers
�� Integrating knowledge about resilience suggests Integrating knowledge about resilience suggests opportunity to create restorative organizational culturesopportunity to create restorative organizational cultures
�� Qualitative research could explore provider Qualitative research could explore provider perspectives on elements of restorative cultures that perspectives on elements of restorative cultures that reduce STS, VT and compassion fatiguereduce STS, VT and compassion fatigue
�� Article to be published in Article to be published in Families in SocietyFamilies in Society
Policy & Program ImplicationsPolicy & Program Implications
�� ACE research as a policy advocacy toolACE research as a policy advocacy tool
�� Behavioral Risk Factor Surveillance Survey Behavioral Risk Factor Surveillance Survey
(BRFSS)(BRFSS)
�� Fragmented service silos vs. comprehensive, Fragmented service silos vs. comprehensive,
integrated servicesintegrated services
Restorative Integral SupportRestorative Integral Support
•Support strengths
•Mobilize resilience & recovery
•Enhance coping skills
•Resolve trauma
•Restore development
•Build other life skills
•“Evidence-based behavioral practices” (i.e. CBT)•Medical model•Body-oriented interventions•Physical exercise
Individual
Collective
•Social networks
•Therapeutic milieu
•Peer supports
•Culture of Recovery and
Transformation
•Policies and procedures
•Infrastructure
•Recovery-oriented systems of
care
•Systems Transformation
RIS & CoalitionsRIS & Coalitions
�� New York example: New York example:
The HEARTS InitiativeThe HEARTS Initiative
�� a coalition of wella coalition of well--established Capital Region established Capital Region service providersservice providers
�� strengthening social networks strengthening social networks
within and across agencieswithin and across agencies
�� Includes & supports Sanctuary Includes & supports Sanctuary
as well as other approachesas well as other approaches
RIS: Key elementsRIS: Key elements
•• Raise staff awareness of ACEs Raise staff awareness of ACEs
•• Integrate resilience and recovery knowledge Integrate resilience and recovery knowledge
•• Engage staff in organizational development Engage staff in organizational development
–– Best practices, values, culture, systemsBest practices, values, culture, systems
•• Support Support staff selfstaff self--carecare
•• Policy advocacyPolicy advocacy
•• TeamTeam--based research partnerships based research partnerships
•• Leadership as keyLeadership as key
Recovery & TransformationRecovery & Transformation
�� ““Some of the healthiest Some of the healthiest people I know are those who people I know are those who have had to heal from the have had to heal from the most challenging situations, most challenging situations, and in the process, have and in the process, have gained insight and wisdom gained insight and wisdom far beyond what a far beyond what a ‘‘comfortablecomfortable’’ life would life would ordinarily provoke.ordinarily provoke.””
-- Joan Borysenko, Fire in the SoulJoan Borysenko, Fire in the Soul
ReferencesReferences
�� Black, P. N., Jeffreys, D., & Hartley, E. K. (1993). Personal History of Black, P. N., Jeffreys, D., & Hartley, E. K. (1993). Personal History of
Psychosocial Trauma in the Early Life of Social Work and Business Students. Psychosocial Trauma in the Early Life of Social Work and Business Students.
Journal of Social Work Education, 29(2), 171. Journal of Social Work Education, 29(2), 171.
�� Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F.,
Thompson, T. J., . . . Giles, W. H. (2004). The interrelatedness of multiple Thompson, T. J., . . . Giles, W. H. (2004). The interrelatedness of multiple
forms of childhood abuse, neglect, and household dysfunction. forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Child Abuse &
Neglect, 28(7), 771Neglect, 28(7), 771--784. doi: 10.1016/j.chiabu.2004.01.008784. doi: 10.1016/j.chiabu.2004.01.008
�� Dube, S. R., Anda, R. F., Croft, J. B., Edwards, V. J., Giles, W. H., & Felitti, Dube, S. R., Anda, R. F., Croft, J. B., Edwards, V. J., Giles, W. H., & Felitti,
V. J. (2001). Growing up with parental alcohol abuse: exposure to childhood V. J. (2001). Growing up with parental alcohol abuse: exposure to childhood
abuse, neglect, and household dysfunction. abuse, neglect, and household dysfunction. Child Abuse & Neglect, 25(12), Child Abuse & Neglect, 25(12),
16271627--1640. 1640.
References contReferences cont’’’’’’’’dd
�� Knight, C. (2010). Indirect Trauma in the Field Practicum: Secondary Knight, C. (2010). Indirect Trauma in the Field Practicum: Secondary
Traumatic Stress, Vicarious Trauma, and Compassion Fatigue Among Social Traumatic Stress, Vicarious Trauma, and Compassion Fatigue Among Social
Work Students and Their Field Instructors. Work Students and Their Field Instructors. Journal of Baccalaureate Social Work, Journal of Baccalaureate Social Work,
15(1), 3115(1), 31--52. 52.
�� RompfRompf, E. L., & Royse, D. (1994). Choice of Social Work as a Career: , E. L., & Royse, D. (1994). Choice of Social Work as a Career:
Possible influences. Possible influences. Journal of Social Work Education, 30(2), 163Journal of Social Work Education, 30(2), 163--171. 171.
Thank you and Questions?
914.965.3700 x1084