Adverse Childhood Experiences a presentation for SEPs

1. Adverse Childhood Experiences a presentation for SEPs Based on a presentation by Kaiser Permanente and The Centers for Disease Control Original Vincent J. Felitti, M.D. Robert F. Anda, M.D. Modification John Records, J.D.

2. Introduction toAdverse Childhood Experiences(ACEs)

3. What do we mean by Adverse Childhood Experiences? Experiences while growing up that deeply impact a young person and profoundly affect emotional and physical health later in life.

4. How Important are ACEs? • Compare Louis Pasteur and his radical theory: • Germs cause infectious disease • Initial resistance • Generally accepted now

5. Adverse Childhood Experience (ACEs) compared with Pasteur’s theory • Underlying cause of noninfectious disease, implicated in 10 leading causes of death in the U.S. • Initial skepticism • Emerging acceptance (Kaiser, CDC)

6. ACEs Study (overview)

7. The Adverse Childhood Experiences (ACEs) Study • The largest study of its kind ever done to examine the health and social effects of adverse childhood experiences over the lifespan (17,000+ participants)

8. The ACEs Questions

9. The Adverse Childhood Experiences (ACE) Study • Summary of Findings: • Adverse Childhood Experiences (ACEs) are very common • ACEs are strong predictors of adulthealth risks and disease • ACEs are implicated in the 10 leading causes of death in the U.S.! • “I was actually stunned and I wept over what I saw.” ACEs researcher Rob Anda, M.D. • Virtually every study shows that ACEs are strong predictors of homelessness

10. Adverse Childhood Experiences Score Number of categories adverse childhood experiences are summed … ACE score Prevalence 0 48% 1 25% 2 13% 3 7% 4 or more 7% • More than half have at least one ACE • If one ACE is present, the ACE Score is likely to range from 2.4 to 4

11. ACEs Impact

12. Adverse Childhood Experiences vs. Current Smoking %

13. ACE Score vs. Smoking and COPD

14. Childhood Experiences vs. Adult Alcoholism 4+ 3 2 1 0

15. Childhood Experiences Underlie Chronic Depression

16. Childhood Experiences Underlie Suicide 4+ 3 2 1 0

17. Adverse Childhood Experiences vs.Likelihood of > 50 Sexual Partners

18. Adverse Childhood Experiences vs.History of STD

19. ChildhoodExperiences Underlie Rape 4+ 3 2 1 0

20. ACE Score and Hallucinations Abused Alcohol or Drugs Ever Hallucinated* (%) ACE Score *Adjusted for age, sex, race, and education.

21. ACE Score vs. Intravenous Drug Use N = 8,022 p<0.001

22. ACE Score vs. Serious Job Problems

23. ACEs Discussion

24. Evidence from ACE Study Suggests:Many chronic diseases in adults are determined decades earlier, by the experiences of childhood. Affective Response

25. Evidence from ACE Study Suggests:Risk factors for these diseases are initiated during childhood or adolescence . . . Seeking to Cope

26. Evidence from ACE Study Suggests:. . . and continue into adult life. Outcome: social and biomedical damage

27. Evidence from ACE Study Suggests:Adverse childhood experiences are the most basiccause of health risk behaviors, morbidity, disability, mortality, and healthcare costs.

28. Embodied Trauma

30. Early Early Death Death Death Birth Disease, Disability Adoption of Health-risk Behaviors Social, Emotional, & Cognitive Impairment Adverse Childhood Experiences Adverse Childhood Experiences The Influence of AdverseChildhood Experiences Throughout Life

31. “The truth about childhood is stored up in our bodies and lives in the depths of our souls. Our intellect can be deceived, our feelings can be numbed and manipulated, our perceptions shamed and confused, our bodies tricked with medication, but our soul never forgets. And because we are one, one whole soul in one body, someday our body will present its bill.” Alice Miller

32. Doing our best to cope

33. The risk factors underlyingthese adult diseases areadaptive, coping devices. (Smoking, severe obesity, physical inactivity, depression, suicide attempt, alcoholism, illicit drug use, injected drug use, 50+ sexual partners, history of STD (sexually transmitted disease)).

34. Dismissing them as “bad habits” or“self-destructive behavior” totallymisses their function.

35. What is conventionallyviewed as a problem is actually a solution to an unrecognized prior adversity.

36. Application to Homelessness

37. What’s the real problemwe’re addressing? • Addiction? Mental illness? Poor health? Inability to find and keep a job? • Homeless people most often are the walking wounded, because of neglect and repeated trauma that began with numerous ACEs and that frequently continue in adult life.

38. What’s the real problem we’re addressing (con’t)? • Homeless shelters and facilities are in fact trauma wards. • Should the fact that we are working with trauma survivors be given primacy in our programs and in our efforts to educate the community?

39. Trauma Treatment • There are exciting new developments in treating trauma, such as Somatic Experiencing. • A pilot Somatic Experiencing Clinic has been established at COTS, a homeless program in California.

40. A Ray of Hope: Resiliency • Some people suffer terrible abuse, yet “make it.” • A high ACEs score isn’t a death sentence, it just worsens the odds. • Resiliency Theory is one powerful response and “vaccination” for children.

41. Explicatory Narrative • The ACEs explicatory narrative can powerfully help people to understand their behavior and problems, to realize that they are not alone, to have less shame. • ACEs give us a new way to put together our life stories, a new way to understand from where we come and where it may be possible for us to go.

42. ACEs and Advocacy • ACEs are a very powerful way to help the community at large understand sometimes troubling behavior. • Understanding ACEs helps us all to move past shame and blame to the productive next steps.

43. An Integral Response • Integral Theory provides an unexcelled framework both for understanding all of the causes of homelessness, including ACEs, and for developing comprehensive, cost-effective responses that are supported by the community. • Integral Restorative Processes (IRP) are an example of such responses.

44. Program Design • Teach parents about ACEs so they know about their own problems and are less likely to inflict ACEs on their own children • Teach about ACEs to other adults, so they will know more about the origins of their present problems and can build this into their explicatory narrative. • Offer Integral Restorative Process and Integral Support, including trauma treatment

45. Conclusion

46. In a way, to accept the import of ACEs is just so mind-boggling that it may be impossible for some people. To be blunt, how much of the way we behave as a culture, how much of the pain and confusion and sickness, comes from our continuing rape, abuse and neglect of our children?

47. We have the power to intervene and to lead our community and society in a healthy response.

48. What about our ACEs? • Without your wounds where would your power be? The very angels themselves cannot persuade the wretched and blundering children on earth as can one human being broken in the wheels of living. In love's service, only the wounded soldiers can serve. --Thornton Wilder (quoted by Joan Borysenko, Guilt is the Teacher, Love is the Lesson)

49. Our ACEs… • Some of the healthiest people I know are those who have had to heal from the most challenging situations, and in the process, have gained insight and wisdom far beyond what a "comfortable" life would ordinarily provoke. --Joan Borysenko, Fire in the Soul • Thanks to Deborah Boyar for quotes!