PROTECTIVE FACTORS AND RISK FACTORS (ADVERSE CHILDHOOD EXPERIENCES -ACE’s)

2. PROTECTIVE FACTORS AND RISK FACTORS (ADVERSE CHILDHOOD EXPERIENCES -ACE’s) Judy Harrison, Executive Director Louisiana Children’s Trust Fund November 2013

3. Principles of Brain Development -The outside world shapes the brains wiring. -The outside world is experienced through the senses--seeing, hearing, smelling, touching, and tasting--enabling the brain to modify connections. -The brain operates on a “use it or lose it” principle -Relationships with other people early in life are the major source of development of the emotional and social parts of the brain. I Am Your Child Reiner Foundation

4. “Discovery consists of looking at the same thing as everyone else and thinking something different.” A.Szent-Gyorgyi

5. What are Protective Factors? • Parental Resilience • Social Connections • Knowledge of parenting and child development • Concrete supports in times of need • Children social and emotional competence • Nurturing and attachment

6. Risk Factors:Adverse Childhood Experiences • Experiences that represent health or social problems of national importance: • Childhood abuse and neglect • Growing up with domestic violence, substance abuse or mental illness in the home • Parental discord • Crime

7. Adverse Childhood Experience (ACE) Study • Largest study of its kind ever done to examine the health and social effects of childhood experiences throughout the lifespan of participants (17,000) • Kaiser Permanente and CDC • Retrospective study of an HMO population • Average age 57 years

8. Categories of ACEs • ABUSE • Abuse • Emotional • Physical • Sexual • Neglect • Emotional • Physical

9. HOUSEHOLD DYSFUNCTION • Mother treated violently • Household sustance abuse • Parental separation or divorce • Incarcerated household member

10. Adverse Childhood Experiences Are Very Common • Percent reporting types of ACEs: • Alcohol abuse- 23.5% • Mental illness- 18.8% • Battered mother- 12.5% • Drug abuse- 4.9% • Criminal behavior- 3.4% • Childhood Abuse: • Psychological- 11.0% • Physical- 30.1% • Sexual- 19.9% • Total number of categories of ACEs that each participant reported •Example: Experiencing physical abuse as a child is an ACE score of one. Experiencing physical abuse plus witnessing IPV is an ACE score of two.

11. ACE Score PrevalenceNumber of individual adverse childhood experiences • 0 47.9% • 1 24.9% • 2 13.1% • 3 7.3% • 4 or more 6.8% • More than half had at least one ACE • More than one in four had 2 or more ACEs

12. Prevalence Maybe Underestimated • Sampling excludes persons in institutions, prisons, hospitals or who are homeless • Retrospective nature of ACE questions raises potential for recall error • Generational and socio-cultural influences- • Older adults may have forgotten some of their childhood experiences • Different interpretations of experiences- • Corporal punishment interpreted differently between young and old participants

13. ACE Study Findings • As ACE score goes up, so does the risk for • Organic disease (pulmonary, heart & liver) • Adult alcoholism & drug abuse • Depression and suicide attempts • Multiple sexual partners • STD’s and rape (5% to 33%) • Hallucinations • Risk for intimate partner violence • Addictions • Dying early • Job problems and lost time from work

15. Summary of Findings • Adverse Childhood Experiences (ACE’s) are very common • ACE’s are strong predictors of health behaviors in adolescence and adult life • This combination of findings makes ACE’s one of the leading, if not the leading determinant of health and social well-being of our nation

17. ACE’s module administered in Louisiana in 2009 • Percentage of adults participants (8147) reporting ACE’s (by number of ACE’s reported) • 0 ACE’s 43% • 1 ACE’s 25% • 2 ACE’s 13% • 3 ACE’s 10% • 4 ACE’s 12%

18. ACE CATEGORIES-Louisiana participants Abuse Physical 11% Sexual 10% Emotional 21% Household Dysfunction Mental Illlness 17% Substance Abuse 27% Divorce/Separation 27% Domestic Violence 15% Incarceration 7%

19. What Does All This Mean? •ACEs very common •Strong predictor of later health and mortality risks •Combination of ACEs increases risks •Protective factors may buffer the effect of ACEs (•Journal of Adolescent Health October 2013 Supplement on Protective Factors interrupting cycle of maltreatment across generations) •Importance of prevention!

20. Elements of Future Success in Child Health and Well-Being -Recognizing that child abuse and neglect and other ACEs are like diseases that are self-replicating and interrupting the cycle -Fully documenting the long-term health, social, and economic costs of child abuse and neglect -Educating our culture about the importance of child development via the schools (high schools and colleges medical school and residency training) -Multidisciplinary teamwork to develop new approaches to teaching child development, recognizing and treating child abuse and neglect and domestic violence, and treating parents impaired by alcohol, illicit drug abuse, or mental illness

22. REFERENCES • http://wichildrenstrustfund.org/files/WisconsinACEs.pdf • http://www.pal-tech.com/web/NCCAN/files/Merrick%20ACES%20Webcast%20CLEARED.pdf • http://www.cdc.gov/ace/ • http://friendsnrc.org/