The Buffer Zone: What Adverse Childhood Experiences (ACE) Study Teaches about Maximizing Health and Wellbeing
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In an attempt to look at the association between childhood trauma and the risk for physical and mental illness in adulthood, Kaiser Permanente and the Centers for Disease Control and Prevention established the Adverse Childhood Experiences (ACE) Study which is one of the largest scientific research studies of its kind. This 90-minute webinar will provide participants with in-depth information on this study and its implications.
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The Buffer Zone: What Adverse Childhood Experiences (ACE) Study Teaches about Maximizing Health and Wellbeing
- 1. FD SMS icons 1 learn.extension.org/events/3027 This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Military Family Readiness Policy, U.S. Department of Defense under Award Number 2015-48770-24368. The Buffer Zone: What the Adverse Childhood Experiences (ACE) Study Teaches about Maximizing Health & Wellbeing
- 2. Connecting military family service providers and Cooperative Extension professionals to research and to each other through engaging online learning opportunities militaryfamilies.extension.org MFLN Intro Sign up for webinar email notifications at militaryfamilies.extension.org/webinars
- 3. Today’s Presenters 3 Melissa Merrick, PhD • Behavioral Scientist with the Surveillance Branch in the Division of Violence Prevention at CDC’s National Center for Injury Prevention and Control. • Serves as the Science Lead for the Adverse Childhood Experiences (ACE) Study. • Research interests focus on the etiology, surveillance, course, and prevention of child maltreatment.
- 4. National Center for Injury Prevention and Control The Buffer Zone: What the Adverse Childhood Experiences (ACE) Study Teaches about Maximizing Health & Wellbeing Melissa T. Merrick, PhD Behavioral Scientist Division of Violence Prevention
- 5. 5 the issue 1 BILLION CHILDREN EXPERIENCE VIOLENCE ANNUALLY https://static.pexels.com/photos/207653/pexels-photo-207653.jpeg
- 6. Child Abuse & Neglect 6 Physical Abuse Sexual Abuse Emotional Abuse Neglect children experienced child abuse and neglect in the last year. That is millions of kids. (self-report data) About 1 in 7 https://static.pexels.com/photos/262488/pexels-photo-262488.jpeg
- 8. Violence Compromises Early Brain Development 8
- 9. How Brains are Built 9 http://www.albertafamilywellness.org/resources/video/how-brains-are-built-core-story-of-brain-development
- 10. Picture This… When you think of child abuse and neglect, you likely picture this 10 https://www.flickr.com/photos/k9d/1414360666 https://pixabay.com/en/child-education-fear-terror-1439468/ https://commons.wikimedia.org/wiki/File:Fractured_ribs.jpg https://commons.wikimedia.org/wiki/File:Orthopedic_cast_Vincent%27s_Gips_Arm.jpg
- 11. Picture This… But probably not this 11 https://pixabay.com/en/diabetes-blood-finger-glucose-777001/https://commons.wikimedia.org/wiki/File:Asthma_inhaler_use.PNG https://pixabay.com/en/body-upper-body-hand-t-shirt-keep-116585/ https://www.flickr.com/photos/amboo213/4020584983
- 12. Risky Behaviors Alcohol & Drug Abuse Unsafe Sex Cancer Diabetes HIV STDs Unintended Pregnancy Pregnancy Complications Fetal death Depression Anxiety PTSD Traumatic Brain Injury Fractures Burns Violence Violence in the Public Health Context
- 13. Categories of ACEs 13 Abuse Neglect Family Challenges http://www.rwjf.org/en/library/infographics/the-truth-about-aces.html
- 14. How Common are ACEs? 14
- 16. 0 0.5 1 1.5 2 2.5 3 3.5 Dong, M et al. Circulation. 2004;110:1761–1766. AdjustedOddsRatio Number of ACEs 0 1 2 3 4 5,6 7,8 ACE Score and Cardiovascular Disease 16
- 17. 0 1 2 3 4 5 6 Number of ACEs AdjustedOddsRatio Chapman, DP et al. Journal of Affective Disorders. 2004;82:217–225 Gonzalez, O et al. MMWR. 2010;59(38):1229-1235 0 1 2 3 4 ≥5 ACE Score and Adult Depression 17
- 18. AdjustedOddsRatio Number of ACEs 0 2 4 6 8 10 12 0 1 2 3 ≥4 Number of ACEs Ever-injected drugs Had ≥50 intercourse partners Ever had an STD Felitti, VJ et al. American Journal of Preventive Medicine 1998;14:245–258 ACE Score and HIV Risk 18
- 19. AdjustedOddsRatio Number of ACEs Dube et al. JAMA. 2001;286:3089–3096. ACE Score and Suicide Attempts 19
- 20. AdjustedOddsRatio ACE Score and Life Potential 20
- 21. Leading Causes of Death in the U.S. in 2014 1. Heart disease 2. Cancer 3. Chronic lower respiratory diseases 4. Unintentional injuries (accidents) 5. Stroke 6. Alzheimer’s Disease 7. Diabetes 8. Influenza and Pneumonia 9. Nephritis, Nephrotic Syndrome, and Nephrosis (Kidney Disease) 10. Intentional Self-Harm (Suicide) 21The National Vital Statistics Report (NVSR) “Deaths: Final Data for 2014”
- 22. Leading Causes of Death in the U.S. in 2014 1. Heart disease 2. Cancer 3. Chronic lower respiratory diseases 4. Unintentional injuries (accidents) 5. Stroke 6. Alzheimer’s Disease 7. Diabetes 8. Influenza and Pneumonia 9. Nephritis, Nephrotic Syndrome, and Nephrosis (Kidney Disease) 10. Intentional Self-Harm (Suicide) 22The National Vital Statistics Report ( NCSR) “Deaths: Final Data for 2014”
- 23. ACEs in Children and Adolescents 23 https://pixabay.com/en/children-silhouette-cheers-1499274/
- 24. ACEs in Children & Adolescents 24 ACE Constructs NatSCEV NSCAW II LONGSCAN Physical Abuse • • • Sexual Abuse • • • Physical Neglect • • • Emotional Neglect • • Psychological / Emotional Abuse • • • Caregiver Treated Violently • • • Household Substance Abuse • • • (caregiver only) Household Mental Illness • • • (caregiver depression only) Parent Separation or Divorce • • Incarcerated Household Member • • •
- 25. ACE Score 25 Total Number of ACEs %ofsamplereportingACEs
- 26. NSCAW II: ACEs by Age Group 26
- 27. Economic Consequences of Violence ➢ Child Maltreatment • $124 billion total lifetime cost associated with one year of confirmed cases of maltreatment ➢ Intimate Partner Violence • $8.3 billion (1995 estimate adjusted to 2003) ➢ Sexual Violence • $6.5 billion dollars in 1996 for a single state (Michigan) • $126 billion annually in US for victim costs 27CDC (2003); Fang, Brown, Florence, & Mercy (2012); National Institutes of Justice (1996); Post et al., (2002)
- 28. The Public Health Impact of Violence 28
- 29. Violence Across the Lifespan 29
- 30. Role of Public Health Violence Prevention 30 Role of Criminal Justice, Child Welfare, Social Services
- 31. Preventing child maltreatment requires understanding WHY some children and families are at greater risk 31
- 32. CDC’s Strategic Focus on Child Maltreatment • Prevent violence through surveillance, research and development, and capacity building • Emphasis on primary prevention • Commitment to developing rigorous science base • A cross-cutting perspective • A population approach 32 https://pixabay.com/en/family-uncle-familia-nephew-child-1804701/
- 33. 33 Safe Stable Nurturing Assuring safe, stable, nurturing relationships and environments for all children CDC’s Essentials for Childhood Framework
- 34. CDC’s Essentials for Childhood ➢ CDC’s Essentials for Childhood Framework • Raise Awareness and Commitment to Support Safe, Stable, Nurturing Relationships and Environments • Use Data to Inform Action • Create the Context for Healthy Children and Families through Norms Change and Programs • Create the Context for Healthy Children and Families through Policies 34 http://www.cdc.gov/violenceprevention/childmaltreatment/essentials.html
- 35. CDC’s Essentials for Childhood CDC Funding 5 State Health Departments • California • Colorado • Massachusetts • North Carolina • Washington 31 Self Supported States- participating in initiative in some way • Training/technical assistance and meetings also available to self supported states 35
- 36. GOAL 1: Raise Awareness and Commitment 36 https://www.flickr.com/photos/sydneytreasuresphotography/16046410082
- 37. The Raising of America 37 ➢ Raising explores how a strong start for all our kids can lead to a healthier, stronger, and more equitable America ➢ Components: ▪ Six-part documentary series ▪ National public engagement campaign ▪ Companion website http://www.raisingofamerica.org/
- 38. GOAL 2: Use Data to Inform Prevention Action 38
- 39. 39+ States Have Included the ACE Module on their BRFSS 39
- 43. Using Data to Inform Solutions: State Examples ➢ Wisconsin • Examining ACE “Hotspots” • Added Poverty and Neglect Items to BRFSS • Hosted Midwest Regional ACEs Summit in 2014 ➢ Washington • Legislators changed the definition of work participation for TANF recipients • Juvenile offenders needed additional support to mitigate future adverse outcomes 43
- 44. GOAL 3: Create the Context for Healthy Children & Families through Norms Change & Programs 44 https://www.flickr.com/photos/armymedicine/13584554804
- 45. Essentials for Parenting: Toddlers and Preschoolers ➢ Online interactive resource developed for parents with toddlers and preschoolers ➢ Based upon best available science ➢ Includes a variety of content, including • Written content, videos, and interactive activities 45 https://www.cdc.gov/parents/essentials/index.html
- 46. GOAL 4: Create the Context for Healthy Children and Families through Policies 46 http://www.buckley.af.mil/News/Photos/igphoto/2000272288/
- 47. Policies with impacts on risk factors for child abuse and neglect ➢ Increased minimum wage ➢ Earned Income Tax Credit ➢ Child Tax Credit ➢ Housing Vouchers ➢ Head Start ➢ Bans on corporal punishment ➢ Family-friendly work 47 https://pixabay.com/en/list-hook-check-mark-ticked-off-1030596/
- 48. Technical Packages Select group of strategies with a focus on PREVENTING child abuse & neglect from happening in the first place as well as approaches to LESSEN the immediate and long-term harms of child abuse & neglect. 48 http://www.cdc.gov/violenceprevention/pdf/can-prevention-technical-package.pdf
- 50. CDC’s Technical Package to Prevent Child Abuse and Neglect 50 Strengthen economic supports for families Change social norms to support parents and positive parenting Provide quality care and education early in life Enhance parenting skills to promote healthy child development Intervene to lessen harms and prevent future risk http://www.cdc.gov/violenceprevention/pdf/can-prevention-technical-package.pdf
- 51. Strengthen Economic Supports to Families Strengthen household financial security ➢ Child support payments ➢ Tax credits ➢ State nutrition assistance programs ➢ Assisted housing mobility ➢ Subsidized child care Family friendly work policies ➢ Livable wages ➢ Paid leave ➢ Flexible and consistent schedules 51 http://www.59mdw.af.mil/News/Art/igphoto/2000485858/
- 52. Change Social Norms to Support Parents & Positive Parenting Public engagement and education campaigns ➢ Breaking the Cycle Legislative approaches to reduce corporal punishment ➢ Bans pertaining to home, school, & other settings 52 https://pixabay.com/en/girl-boy-family-together-love-603511/
- 53. Provide Quality Care & Education Early in Life Preschool enrichment with family engagement ➢ Child Parent Centers ➢ Early Head Start Improved quality of child care through licensing and accreditation 53 http://www.seymourjohnson.af.mil/News/Photos/igphoto/2000153166/
- 54. Enhance Parenting Skills to Promote Healthy Child Development Early childhood home visitation ➢ Nurse Family Partnership ➢ Durham Connects Parenting skill and family relationship approaches ➢ Adults and Children Together Against Violence: Parents Raising Safe Kids (ACT) ➢ Incredible Years ➢ SafeCare 54 http://archive.defense.gov/News/NewsArticle.aspx?ID=120984
- 55. Intervene to Lessen Harms & Prevent Future Risk Enhanced primary care ➢ Safe Environment for Every Kid (SEEK) Behavioral parent training programs ➢ Parent-Child Interaction Therapy ➢ SafeCare ➢ Incredible Years 55 http://www.travis.af.mil/News/Photos/igphoto/2000266887/
- 56. Intervene to Lessen Harms & Prevent Future Risk Treatment to lessen harms of abuse & neglect exposure ➢ Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Treatment to prevent problem behavior and later involvement in violence ➢ Children with Problematic Sexual Behavior Cognitive- Behavioral Treatment Program: School- age Program ➢ Multisystemic Therapy (MST) 56 https://www.pexels.com/photo/blond-haired-girl-wearing-pink-knitted-cap-48789/
- 57. Violence Prevention is Strategic Developing New Partnerships and Working Across Sectors Including: Public Health, Government, Health Care Services, Social Services, Education, Business, Justice, Housing, Non-Governmental Organizations, Foundations 57
- 58. Thank you! Melissa T. Merrick, PhD mmerrick@cdc.gov www.cdc.gov/violenceprevention/acestudy For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov 58 The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
- 59. Connect with MFLN Family Development Online! MFLN Family Development MFLN Family Development @mflnfd MFLN Family Development To subscribe to our MFLN Family Development newsletter send an email to: MFLNfamilydevelopment@gmail.com with the Subject: Subscribe FD SMS icons 59
- 60. MFLN Intro 60 We invite MFLN Service Provider Partners to our private LinkedIn Group! https://www.linkedin.com/groups/8409844 DoD Branch Services Reserve Guard Cooperative Extension
- 61. Evaluation and Continuing Education Credits/Certificate MFLN Family Development is offering 1.5 CEUs from the University of Texas at Austin School of Social Work or certificate of completion for today’s webinar. Please complete the evaluation and post-test at: https://vte.co1.qualtrics.com/jfe/form/SV_0BqtGIkfg2ogGDX Must pass post-test with an 80% or higher to receive certificate. 61
- 63. MFLN Virtual Conference For session info and to register, visit militaryfamilies.extension.org/2017virtualconference For more information on MFLN Family Development, go to: militaryfamilies.extension.org/family-development 63
- 64. militaryfamilies.extension.org/webinars 64This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Military Family Readiness Policy, U.S. Department of Defense under Award Number 2015-48770-24368.