adverse childhood experiences and their relationship to adult well being n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Adverse Childhood Experiences and their Relationship to Adult Well Being PowerPoint Presentation
Download Presentation
Adverse Childhood Experiences and their Relationship to Adult Well Being

Loading in 2 Seconds...

play fullscreen
1 / 78

Adverse Childhood Experiences and their Relationship to Adult Well Being - PowerPoint PPT Presentation


  • 131 Views
  • Uploaded on

Adverse Childhood Experiences and their Relationship to Adult Well Being . How OB Nurses Can Help Prevent Turning Gold Into Lead!.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Adverse Childhood Experiences and their Relationship to Adult Well Being' - louvain


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
adverse childhood experiences and their relationship to adult well being

Adverse Childhood Experiences and their Relationship to Adult Well Being

How OB Nurses Can Help Prevent Turning Gold Into Lead!

slide3

“There is no trust more sacred than the one the world holds with children. There is no duty more important than ensuring that their rights are respected, that their welfare is protected, that their lives are free from fear and want and that they grow up in peace”

Kofi A. Annan

origin of the ace study
Origin of the ACE Study?

Dr. Vincent Filetti, head of the Department of Preventative Medicine in San Diego, wanted to understand the high dropout rate of his most successful patients in a weight loss study. Patients with the greatest success losing weight were most likely to drop out of his study.

WHY?

prevalence of adverse childhood experiences
Prevalence of Adverse Childhood Experiences

Abuse by Category

Psychological (by parents) 11%

Physical (by parents) 28%

Sexual Contact (by anyone) 22% (28% F, 16% M)

Neglect by Category

Emotional 15%

Physical 10%

Household Dysfunction by Category

Alcoholism or drug use in the Home 27%

Loss of biological parent at < 18 23%

Depression or Mental Illness in the Home 17%

Mother treated Violently 13%

Imprisoned household member 5%

what are the ace questions
What Are the ACE Questions?

When you were growing up, during your first 18 years of life:

  • Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
  • Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt.
  • Did an adult or person at least 5 years older than you ever Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
  • Did you often or very often feel that No one in your family loved you or thought you were important or special? or Your family didn’t look our for each other, feel close to each other, or support each other?
  • Did you often or very often feel that You didn’t have enough to eat, had to wear dirty clothes, or had no one to protect you? Or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
what are the ace questions1
What Are the ACE Questions?

When you were growing up, during your first 18 years of life:

  • Were your parents ever separated or divorced?
  • Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit at least a few minutes or threatened with a gun or knife?
  • Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
  • Was a household member depressed or mentally ill, or did a household member attempt suicide?
  • Did a household member go to prison?
importance of witnessing threats or assaults toward mother father or siblings
Importance of Witnessing Threats or Assaults toward Mother, Father, or Siblings

Percent Experiencing Symptoms

the ace study definitively finds
The ACE Study Definitively Finds
  • Adverse Childhood Experiences (ACES) are very common, but largely un-recognized.
  • ACES are strong predictors of adult DEATH, health risks, social functioning, well-being, and health care costs.
  • ACES are the major cause of much of adult medicine and many major public health and social problems.
  • ACES cluster. They are not isolated.
  • This combination makes Adverse Childhood Experiences the primedeterminant of the health, social, and economic well being of the nation.
investing in our children
Investing in Our Children

“The issue is not are we going to pay – it’s are we going to pay now, up front, or are we going to pay a whole lot more later on?”

Marian Wright Edelman

us financial savings from the infant primary vaccination series a yearly cohort group 2009
US Financial Savings from the Infant Primary Vaccination Series (A Yearly Cohort Group- 2009)
  • Total Direct Cost Savings (DtaP, Hib, IPV, MMR, Hep B, VZV, Hep A, PCV 7, Rotavirus) = 13.6 billion
  • Total Societal Costs of the Above = 68.9 billion
  • Total Direct and Indirect Cost Savings = 82.5 Billion
  • Total Direct and Societal Costs Savings for Rotavirus Immunization = “Despite a higher burden of serious rotavirus disease than estimated previously, routine rotavirus vaccination would unlikely be cost-saving in the United States at present”

Zhou et al, Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009, Pediatrics, 3/2014 online published

Pediatrics, 2007 April, 119(4): 684-97

so what are the financial costs of aces
So What Are the Financial Costs of ACES?
  • The estimated average lifetime cost per victim of nonfatal child maltreatment is 210,012 in 2010 dollars (this compares to the annual cost of obesity treatment starting at age 20 years of $5,600 to $30,770).
  • The estimated lifetime cost per death is $1,272,900.
  • The estimates of lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the U.S. for 2008 is approximately 124 billion annually at the NIS Harm Standard. The total burden is estimated to be as large as 585 billion annually based on the NIS Endangerment Standard.
  • The cost of Substance Abuse (tobacco, alcohol and drugs) in the United States is over 600 billion annually.
  • Child Maltreatment costs more on an Annual Basis then treating two Leading Health Concerns, Stroke and Type 2 Diabetes Combined.

The Economic Burden of Child Maltreatment in the United States and Implications for Prevention, Fang et al, Child Abuse and Neglect. 2012 February; 36 (2) 156-166

4th Annual National Incidence Study of Child Abuse and Neglect (NIS-4) Report to Congress 2010

National Institute on Drug Abuse.

Xiangming, Brown, Florence and Mercy: 2012, Child Abuse and Neglect 36(2), 156-165

vaccination is important to pediatrics but so is the prevention of aces saving lives and costs
Vaccination Is Important to Pediatrics But so Is the Prevention of ACES (Saving Lives and Costs)
us financial savings from the infant primary vaccination series a yearly cohort group 20091
US Financial Savings from the Infant Primary Vaccination Series (A Yearly Cohort Group- 2009)
  • Total Direct Cost Savings (DtaP, Hib, IPV, MMR, Hep B, VZV, Hep A, PCV 7, Rotavirus) = 13.6 billion
  • Total Societal Costs of the Above = 68.9 billion
  • Total Direct and Indirect Cost Savings = 82.5 Billion
  • Total Direct and Societal Costs Savings for Rotavirus Immunization = “Despite a higher burden of serious rotavirus disease than estimated previously, routine rotavirus vaccination would unlikely be cost-saving in the United States at present”

Zhou et al, Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009, Pediatrics, 3/2014 online published

Pediatrics, 2007 April, 119(4): 684-97

adverse childhood experiences score aces cluster
Adverse Childhood Experiences ScoreACEs Cluster

Ace Score Prevalence

0 33%

1 25%

2 15%

3 10%

4 6%

5-> 11%

If any one ACE category is present, there is an 87% chance of at least one other category of ACE and a 50% chance of 3->

further breakdown of the original teen pregnancy ace data published in pediatrics 2004
Further Breakdown of the Original Teen Pregnancy Ace Data Published in Pediatrics 2004

The Association Between Adverse Childhood Experiences and Adolescent Pregnancy, Long-Term Psychosocial Consequences, and Fetal Death

Susan Hillis, PhD, MS; Robert Anda, MD, MS; Shanta R. Dube, MPH; Vincent Felitti, MD; Polly Marchbanks, PhD; and James Marks, MD, MPH

Pediatrics Vol 113 No. 2 February 2004: 320-7.

odds adjusted ratio between teen pregnancy and multiple factors including increased fetal death
Odds Adjusted Ratio Between Teen Pregnancy and Multiple Factors Including Increased Fetal Death

The Negative Psychosocial Sequalae and Fetal Death Commonly Attributed to Adolescent Pregnancy seems to Result from Underlying ACEs rather than Adolescent Pregnancy

more recent publications with similar implications
More Recent Publications with Similar Implications:

Risk Factors for Unfavorable Pregnancy Outcome in Woman with Adverse Childhood Experiences

Journal of Perinatal Medicine. 2013 Dec 14: 1-8, Leeners B, Rath W, Block E, Gorres G, Tschudin S.

SUMMARY:

Woman with CSA, Physical Abuse, and Adverse Childhood Experiences present with a variety of abuse-associated obstetrical risk factors and an increased risk for premature delivery. Therefore, all types of abusive and other ACE should be considered in prenatal care.

depression
Depression:

Many physicians call depression a disease.

Maybe it’s genetic?

Maybe it’s a chemical imbalance?

BUT

slide36

Incest is thought to occur in approximately 1 out of 1.1 million women. There is little agreement about the role of father-daughter incest as a source of serious subsequent psychopathology. The father-daughter liaison satisfies instinctual drives in a setting where mutual alliance with an omnipotent adult condones the transgression… The ego’s capacity for sublimation is favored by the pleasure afforded by incest…such incestuous activity diminishes the subject’s chance of psychosis and allows for a better adjustment to the external world. There is often found little deleterious influence on the subsequent personality of the incestuous daughter...one study found that the vast majority of them were none the worse for the experience.Freedman and Kaplan, Comprehensive Textbook of Psychiatry, 1972

self injury and suicide and unaddressed childhood sexual abuse
Self-Injury and Suicide and Unaddressed Childhood Sexual Abuse

“The sexual and physical violation of children results in alterations in self-perception which are immediate, last throughout the life-span, and contribute to suicidalityas a way to cope.”

Judith Herman, MD (Harvard), 1992

“Childhood sexual abuse is significantly related to adolescent and adult self-harm, including suicide attempts, cutting, and self-starving.”

Bessel Van der Kolk, MD (Harvard), 1991

slide38
Childhood Sexual Abuse and the Number of Unexplained Somatic SymptomsHorizontal Axis Number of SymptomsVertical Axis Percent Abused
slide39
ACE Score and % Experiencing Hallucinations (adjusted for age, sex, race, and education). Blue No OH/Drug Abuse - Red OH/Drug Abuse
addiction the traditional concept
Addiction the Traditional Concept

“Addiction is due to the characteristics intrinsic in the molecular structure in some substance.”

HOWEVER

the ace study challenges that by showing
The ACE Study Challenges that by Showing:

“Addiction highly correlates with characteristics intrinsic to that individual’s childhood experiences.”

estimates of population attributable risk of aces for selected outcomes in women
Estimates of Population Attributable Risk of ACES for Selected Outcomes in Women

Drug Abuse:

  • Alcoholism 65%
  • Drug Abuse 50%
  • IV Drug Abuse 80%

Mental Health:

  • Current Depression 54%
  • Suicide Attempt 60%

Crime Victim:

  • Sexual Assault 62%
  • Domestic Violence 52%
the probability of sample outcomes given 100 american adults
The Probability of Sample Outcomes Given 100 American Adults

33 w/ No ACES51 w/ 1-3 ACES16 w/4-8 ACES

  • 1/16 smokes 1/9 1/6
  • 1/69 alcoholics 1/9 1/6
  • 1/480 use IV drugs 1/43 1/30
  • 1/15 has heart disease 1/7 1/6
  • 1/96 attempts suicide 1/10 1/5
simple
SIMPLE

Because ACES (Childhood Abuse and Neglect) Drastically Affect a Child’s Developing Brain and Immune System.

brain regions affected by abuse and neglect
Brain Regions Affected by Abuse and Neglect

CORPUS COLLOSUM

Integrates the hemispheres and facilitates

  • Language Development
  • Proficiency in Math
  • Processing of Social cues like Facial Expressions

HIPPOCAMPUS – THE CENTER FOR

  • Controlling Emotional Reactions
  • Constructing Verbal Memory
  • Constructing Spatial Memory

SUPERIOR TEMPORAL GYRUS – The Center for Spoken Language

brain regions affected by abuse and neglect1
Brain Regions Affected by Abuse and Neglect

CEREBELLAR VERMIS – CENTER FOR

  • Regulating Mental Health
  • Regulating Movement through the Physical Environment
  • Reacting to Peripheral Details in the World around Us

CEREBRAL CORTEX – CENTER FOR

  • Thinking and Judgment
  • Executive Functioning
  • Long Term Memory
  • Vision
the results
The Results

Cognitive

  • Slowed Language Development
  • Attention Problems (ADHD)
  • Speech Delay
  • Poor Verbal Memory/Recall
  • Loss of Brain Matter/IQ

Social

  • Aggression and Violent Outbursts
  • Poor Self-Control of Emotions
  • Can’t Modify Behavior in Response to Social Cues
  • Social Isolation – Can’t Navigate Friendships

Mental Health

  • Poor Social/Emotional Development
  • Alcohol, Tobacco, and other Drug Abuse – Vulnerable to Early Use
  • Adolescent and Adult Mental Health Disorders – Especially Anxiety, Depression, Suicide, Psychosis, Dissociative Disorders, Borderline Personality Disorder, PTSD
a fast tract to poverty
A Fast Tract To Poverty

Special Education Low Wage Jobs

School Failure Unemployment

Dropping Out Public Assistance

Teen Pregnancy Prison

Suspension Chronic Disease

Expulsion Substance Abuse

Delinquency Poor Mental Health

WHAT WORKS???

WHAT CAN NURSING DO???

awhonn policy statement on access to health care
AWHONN POLICY STATEMENT ON ACCESS TO HEALTH CARE

PREVENTION AND EARLY DETECTION AND TREATMENT ARE COST-EFFECTIVE MEASURES THAT ENSURE A HEALTHIER POPULATION.

BECAUSE AWHONN MEMBERS PROVIDE CARE PRIMARILY TO WOMAN AND INFANTS ….. AWHONN SUPPORTS MEASURES TO INCREASE TIMELY ACCESS TO HIGH QUALITY PRENATAL CARE, PARTICULARILY FOR AT-RISK POPULATIONS.

acog and intimate partner violence
ACOG and Intimate Partner Violence
  • ACOG recommends that physicians screen ALL patients for Intimate Partner Violence.
  • For Woman who are not pregnant, screening should occur: At routine ob-gyn visits, family planning visits and preconception visits.
  • For woman who are pregnant, screening should occur at various times over the course of the pregnancy because some women do not disclose abuse the first time they are asked and abuse may begin later in pregnancy. Screening should occur: At the first prenatal visit, at least once per trimester and at the postpartum checkup.
acog and intimate partner violence1
ACOG and Intimate Partner Violence

Domestic violence screening can be conducted by making the following statement and asking these three questions.

“Because violence is so common in many women’s lives and because there is help available for woman being abused, I now ask every patient about domestic violence”

acog and intimate partner violence2
ACOG and Intimate Partner Violence
  • Within the past year – or since you have been pregnant – have you been hit, slapped, kicked, or otherwise physically hurt by someone?
  • Are you in a relationship with a person who threatens or physically hurts you?
  • Has anyone forced you to have sexual activities that made you feel uncomfortable?
acog and adult manifestations of childhood sexual abuse
ACOG and Adult Manifestations of Childhood Sexual Abuse

Committee Opinion August 2011, Reaffirmed 2013;

The American College of Obstetricians and Gynecologists (Committee on Health Care for Underserved Woman).

acog and adult manifestations of childhood sexual abuse1
ACOG and Adult Manifestations of Childhood Sexual Abuse
  • ACOG recommends that all women be screened for a history of sexual abuse.
  • Patients overwhelmingly favor universal inquiry about sexual assault because they report a reluctance to initiate this discussion.
acog and adult manifestations of childhood sexual abuse2
ACOG and Adult Manifestations of Childhood Sexual Abuse

The primary aftereffects of childhood Sexual abuse include:

  • Emotional reactions: Fear, shame, humiliation, guilt, and self-blame are common and lead to depression, anxiety. Patients may be diagnosed with bipolar/borderline.
  • Survivors can experience intrusive or recurring thoughts of the abuse as well as nightmares or flashbacks.
  • Distorted self-perception: Including the expected belief that they caused the sexual abuse and they deserved it. These beliefs can result in self-destructive behaviors and relationships.
  • These women are often less skilled at self-protection. They are more likely to be victimized by others repeatedly. This can lead to the normal mistrust of others.
acog and adult manifestations of childhood sexual abuse how to ask
ACOG and Adult Manifestations of Childhood Sexual Abuse (How to Ask)
  • Make the question “natural.” Asking over and over makes the physician proficient.
  • Physicians can offer a normalizing response “About 1/5 woman have been sexually abused as a child. Science shows these experiences can affect health so I ask all my patients about unwanted sexual experiences during childhood.”
  • Let the patient decide what they will disclose.
  • If the patient discloses sexual abuse, ask if she has disclosed this previously or sought help. Listen attentively and compassionately.
  • The exam may be postponed until another visit. Once the patient is ready for the exam, ? about whether any parts of the breast or pelvic exam cause emotional or physical discomfort.