ACEs ADVERSE CHILDHOOD EXPERIENCES Objectives of this Presentation

ACEs: ADVERSE CHILDHOOD EXPERIENCES

Objectives of this Presentation • Raise awareness and understanding about Adverse Childhood Experiences research and application. • Raise awareness and understanding of the CDC framework being implemented to prevent Adverse Childhood Experiences: Essentials for Childhood, Safe, Stable and Nurturing Relationships and Environments. • Inform about how Kansas and other states are moving forward with this work using collective impact approach.

Introduction What are the Adverse Childhood Experiences? What is their impact? • Childhood experiences of abuse, neglect & family dysfunction • These incidents harm social, cognitive & emotional functioning of children; • Dramatically upset the safe, nurturing environments children need to thrive.

The ACE Study One of the largest studies to assess associations between childhood maltreatment health & well-being later in life Collaboration the Centers of Disease Control & Kaiser Permanente’s Health Appraisal Clinic in San Diego, CA Initial phase 1995 - 1997

Adverse Childhood Experiences (ACE) Study acestudy. org • Collective effort of Kaiser Permanente and Centers for Disease Control and Prevention (CDC) • The largest study of its kind to examine the health, social and economic effects of ACEs over the lifespan (over 17, 000 participants) • Examined past history of abuse, family dysfunction and current health status • Retrospective cohort study of an HMO population with average of 57 years

ACE STUDY PROVIDES A PARADIGM SHIFT ON ADDICTIONS & UNHEALTHY BEHAVIORS. FROM ‘what’s wrong with you’ TO ‘what happened to you’

ACEs Questionnaire • • • Physical abuse Emotional abuse Sexual abuse An alcohol and/or drug abuser in the household An incarcerated household member Someone who is chronically depressed, mentally ill, institutionalized or suicidal Mother is treated violently One or no parents Emotional or physical neglect

3 Types of ACEs

The Impact of ACEs

Washington School Classroom: ACEs 30 Students: high school sophomores & seniors

Significant Adversity Impairs Development in the First Three Years Kansas Children's Service 11

The Impact of ACEs, continued As the number of ACEs increase, so do the risk for negative health outcomes.

Healthy Development…DERAILED

Exposure to Violence During Childhood Associated with Telomere Erosion • Telomeres are the ends of DNA strands, which are shortened with each cellular division and contribute to aging. • Same children examined for telomere erosion between 5 and 10 years of age. • Physical abuse in childhood caused advanced erosion of telomeres. • Combination of physical abuse, exposure to domestic violence or bullying caused the most erosion. • Children at increased risk for decreased life span, earlier diseases. Shalley I, Moffet TE, Sugden K, Williams B, Houts RM, Danese A, Mill J, Arseneault I, Caspi A. Molecular Psychiatry 2012. Doi: 10. 1038/mp/2012. 3

Lifetime Influence of ACEs Death Early Death Disease, injury & disability Adoption of health-risk behaviors Social, emotional & cognitive impairments Adverse Childhood Experiences Birth

How do ACEs Affect our Society?

What does Abuse Cost Us? Non-fatal Child Maltreatment has an average lifetime cost of $210, 012 per victim (CDC 2012). Compare to the lifetime costs of Type II Diabetes at $181, 000. $160, 000 $140, 000 $120, 000 $100, 000 $80, 000 $60, 000 $40, 000 $20, 000 $0 e e n re re ity ar tic o a a v i s C f i t C t u a el l. J lth uc uc lth a W a d s e n o i E ild He Pr osse d. H im al h t i r l o k C c L C u e or ho Ad Sp W ld i Ch

Child Maltreatment Prevention: a public health issue • Magnitude of the problem • Significant Public Health burden • Potential contribution to solutions

NATIONAL vs. KANSAS ACE DATA

Kansas BRFSS • Random, digit dial telephone (landline and cell phone) survey of non-institutionalized adults 18 years & older: – – health-related risk behaviors chronic health conditions use of preventive services conducted annually since 1992 • Sample size: – 10, 000+ in even years – 20, 000+ in odd years • Core section & state added section

ACE Module for KS BRFSS CDC developed a standardized ACE Module in 2008 KS BRFSS included ACE Module in 2014 and 2015 Survey Module comprised of 11 questions 8 categories of ACEs are assessed by the module Categories reflect childhood abuse or household dysfunction

ACE Study Participants Kansas data compared to National study # of ACEs % in Kansas % in Nation 0 45. 2% 41% 1 22. 3% 2 11. 5% 13% 3 7. 4% 8% 4+ 13. 5% 15%

Prevalence of ACEs Kansas data compared to National study

Prevalence of ACEs Kansas data compared to National study, cont.

Summary of Kansas Results ACEs are prevalent… 1 in 2 KS adults experience at least one ACE. HIGH ACE SCORES (3+) ARE SEEN AMONG: women compared with men those with lower annual household income those with lower educational attainment non-Hispanic other and multiracial adults non-heterosexual adults those less than 65 years old

Summary of Kansas Results, continued When compared to adults with no ACEs, the adults with high ACE scores (3+) have higher prevalence of: Kansas data mirror findings in other states.

Public Health Implications KS DATA HIGHLIGHT need to increase awareness of ACEs as a public health issue. ACE PREVENTION MAY HAVE beneficial effects on long-term health of Kansans. COLLABORATION BETWEEN STATEWIDE PARTNERS WILL BE REQUIRED to address this complex issue.

Bridging Research & Practice

Caregivers are One Answer FIVE PROTECTIVE FACTORS Resilience to Stress Social Connections Child Development Knowledge Concrete Supports in Crisis Parent/Child Attachment

3 Systems for Promoting Resilience • • Intellectual & employable skills Self-regulation—selfcontrol, executive function, flexible thinking Ability to direct & control attention, emotion, behavior Positive self-view, efficacy • • • Bonds with parents &/or caregivers Positive relationships with competent & nurturing adults Friends or romantic partners who provide a sense of security & belonging, help with emotion coaching • • Faith, hope, sense of meaning Engagement with effective organizations— schools, work, pro-social groups Network of supports/services & opportunity to help others Cultures providing positive standards, expectation, rituals, relationships & supports

Capability What helps individuals self-regulate? – Massage – Mindfulness, Reflection – Pleasure – Biofeedback – Movement and Music – Exercise and Play – Physical Activities – Practicing Connection

Attachment & Belonging What helps to generate belonging? – Developing ceremonies or rituals – Including others in therapeutic and health promoting activities – Engaging in multiple family or whole community dialogues – Setting up mutual support or helping systems – Creating art, movement, rhythm, music – Learning together

Community Capacity What builds community capacity for well-being? – Opportunities for Everyone to Lead – Rhythm & Ritual of Coming Together: focus on matters of importance – Reciprocity: learning, helping, generating – Shared Identity: acting in concert for desired future

3 Core Concepts in Early Development • Experiences build brain architecture/brain health. • “Serve and Return” interactions shapes brain circuitry. • Toxic stress derails healthy development. developingchild. harvard. edu

Essentials for Childhood (Ef. C) • Ef. C is the broad umbrella & strategic direction for all child maltreatment work through the CDC. • THEIR VISION: VISION all children live in safe, stable & nurturing relationships and environments to prevent child maltreatment & to assure that children reach their full potential. • However, safe, stable & nurturing relationships and environments are important for adults as well.

Essentials for Childhood (Ef. C), continued • SAFETY: SAFETY the extent to which a child is free from fear & secure from physical or psychological harm within their social & physical environment. • STABILITY: STABILITY the degree of predictability & consistency in a child’s social, emotional & physical environment. • NURTURING: NURTURING the extent to which a parent or caregiver is available & able to sensitively respond to & meet the needs of their child. CDC’s strategic direction for CM prevention.

Moving from Isolated Impact… Countless nonprofit, business & government organizations each work to address social problems independently.

…to Collective Impact! Fundamentally different, Collective Impact is a more disciplined, highly structured & higher performing approach to large-scale social impact than other types of collaboration.

Essentials for Childhood GOALS 1. Raise awareness & commitment to support safe, stable & nurturing relationships and environments & prevent child maltreatment. 2. Use data to inform solutions. 3. Create the context for healthy children and families through norms change & programs. 4. Create the context for healthy children & families through policies.

5 Elements of Collective Impact Achieving Large-Scale Change through Collective Impact Involves Five Key Elements Common Agenda • Common understanding of the problem • Shared vision for change Shared Measurement • Collecting data and measuring results • Focus on performance management • Shared accountability Mutually Reinforcing Activities • Differentiated approaches • Willingness to adapt individual activities • Coordination through joint plan of action Continuous Communication Backbone Support • Consistent and open communication • Focus on building trust • Separate organization(s) with staff • Resources and skills to convene and coordinate participating organizations © 2014 FSG, fsg. org

Strategies that Address the Needs of Children & their Families

Level One Commitment States 2014 -2018 • Coordinate and manage existing and new partnerships with other child maltreatment prevention organizations and non-traditional partners. • Work with partners to identify strategies across sectors. • Identify, coordinate, monitor and report on the strategies implemented by multi-sector partners. • Coordinate improvement processes (e. g. continuous quality improvement for multi-sector partners to refine strategies and document state-level impact of the efforts.

Kansas Collective Impact Team • Business Alliance for Childhood Education • Kansas City Coalition for Child Abuse Prevention • Children’s Alliance of Kansas • Kansas Court Appointed Special Advocates • Children’s Mercy Hospital • Kansas Coalition Against Sexual & Domestic Violence • Courts • Kansas Department on Aging & Disability Services • Episcopal Diocese of Kansas • Kansas Department for Children & Families • Family Conservancy • Kansas Department of Corrections • Health Care Foundation of Greater KC • Kansas Department of Health &Environment • Innovative Leadership Strategies • Kansas Head Start Association • KU Center for Public Partnerships & Research • Kansas Health Institute • KU Department of Social Welfare • Kansas State Department of Education • KU School of Medicine • Kansas Statewide Parent Leadership Advisory Council • Kansas Action for Children • Morris Family Foundation • Kansas Alliance of Children’s Trust Funds • Prevent Child Abuse America • Kansas Attorney General’s Office • Reaching Out From Within • Kansas Chapter of Academy of Pediatrics • Washburn University School of Social Welfare • Kansas Chapter of Circle of Parents • Wesley Hospital • Kansas Chapter of Prevent Child Abuse America • Westar Energy • Kansas Child Advocacy Centers • Wichita Coalition for Child Abuse Prevention • Kansas Children’s Cabinet and Trust Fund • WSU Center for Community Support & Research • Kansas Children’s Service League

Resources to Learn More… • cdc. gov/violenceprevention/ acestudy • cdc. gov/violenceprevention/ childmaltreatment • preventchildabuse. org • kansaspowerofthepositive. org

THANK YOU! Vicky Roper, Prevent Child Abuse Kansas Director (316) 942. 4261 vroper@kcsl. org