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The Adverse Childhood Experience Study
& the Buncombe County ACE Collaborative
Dr. Adrienne Coopey, Pediatric PsychiatristMission Hospitals, Community Care of Western North Carolina
Presentation on Behalf of the:Adverse Childhood Experiences Collaborative
Innovative Approaches Grant ProjectBuncombe County Health and Human Services
Presented at BC Health and Human ServicesMonday, April 13th, 2015
The Effects of Trauma and Chronic Stress: Lessons
Learned from the ACE Study and What That Means for
SchoolsAdrienne Coopey, DO
Pediatric Psychiatrist, Mission Children’s Hospital
2
Adverse Childhood Experiences (ACE) Study
• Dr Vincent Felitti• Chief of
Preventive Medicine at Kaiser Permanente
• Obesity Clinic 1985
• CDC• Short Video Introduc
tion to ACE Study 5
ACE Categories & Prevalence
Household Dysfunction:
Abuse:
- Substance Abuse 26.9%
- Psychological / Emotional
10.6%
- Parental separation/ divorce
23.3%
- Physical 28.3%
- Mental illness 19.4%
- Sexual 20.7%
- Domestic violence
12.7%
Neglect:
- Incarceration 4.7% - Emotional 14.8%
- Physical 9.9%
• 66% reported at least one ACE• 20% reported 3+ ACEs• Persons with 1 ACE are:
– 65% more likely to have 1 additional ACE
– 45% more likely to have 2 or more ACEs
Kaiser Major Findings
Intergenerational Transmission of ACEs
• Adults can transmit their biological experience to their children
• We need to address the ACE scores of parents for young children• The ‘passing’ of ACEs is a cyclical process
Intimate Partner Violence
• Men who experienced physical abuse, sexual abuse AND witnessed their mother being abused, are nearly four times more likely to batter women as those who didn’t experience those traumas.
• Women who were physically abused, sexually abused and saw their mothers being abused are three-and-a-half times more likely to become victims of family violence.
11
Levels of Stress
Stress responses that could affect brain architecture but generally occur for briefer periods which allow brain to recover and thereby reverse potentially harmful effects.
Moderate, short-lived stress responses that are normal part of life and healthy development. A child can learn to manage and control these experiences with support of caring adults in context of safe, warm, and positive relationships.
Strong, frequent or prolonged activation of body’s stress management system. Stressful events that are chronic, uncontrollable, and/or experienced without child having access to support from caring adults.
National Scientific Council on the Developing Child, 2009
Disrupted Neurodevelopment
• Harvard - Center on the Developing Child
• Children >3 ACEs are 32x more learning/behavior problems
14
Toxic Stress Derails Healthy Development
Harvard Center for the Developing Child (2 minute video)
Brain Research
Toxic Stress Derails Healthy Development
Harvard Center for the Developing
Child (2 minute video)
ACEs and School Performance
Students with 3 or more ACEs…Are 2 ½ times more likely to fail a gradeScore lower on standardized testsHave language difficultiesAre suspended or expelled moreAre designated to special education more
frequentlyHave poorer health
16
http://www.k12.wa.us/CompassionateSchools/Resources
ACE Score and Intravenous Drug Use
0
0.5
1
1.5
2
2.5
3
3.5
% H
ave
Inje
cted
Dru
gs
0 1 2 3 4 or more
ACE Score
N = 8,022 p<0.001
Childhood Experiences and Adult Alcoholism
0
2
4
6
8
10
12
14
16
18
% A
lcoh
olic
ACE Score
0
1
23
4+
Adverse Childhood Experiences and Current Smoking
0
2
4
6
8
10
12
14
16
18
20
0 1 2 3 4-5 6 or more
ACE Score
%
No ACE 1-2 3-80%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
16.4%
23.4%
34.0%
13.4%
20.4%
33.0%
Smoking Rates, by ACE Score Category, WNC v. Statewide, NC BRFSS, 2012
WNCStatewide
Perc
ent
Sm
okers
ACE score and Likelihood of > 50 Sexual Partners
0
1
2
3
4
Ad
just
ed O
dd
s R
atio
0 1 2 3 4 or more
ACE Score
Risk Factors for Adult Depression are Embedded in Adverse Childhood Experiences
Od
ds R
ati
o
ACEs Source: Chapman et al, 2004
0 1 2 3 4 5+
1
2
4
3
5
Risk Factors for Adult Heart Disease are Embedded in Adverse Childhood
Experiences
ACEs Source: Dong et al, 2004
Od
ds R
ati
o
0 1 2 3 4 5,6 7,8
0.5
1
1.5
2
2.5
3
3.5
Population Attributable Risk(PAR)
31
is the proportion of the disease incidence *in the population* (i.e. exposed and non-exposed) that is due to the exposure
Magellan Health Services, Inc./ACMHA: The College for
Behavioral Health Leadership 33
A CLASSIC CAUSAL RELATIONSHIPMORE ACEs = MORE HEALTH PROBLEMS
Dose gets bigger
Res
pons
e ge
ts b
igge
r Dose-response is a direct measure of cause & effect.
The “response”—in this case the occurrence of the health condition—is caused directly by the size of the “dose”—in this case, the number of ACEs.
Economic Burden
• Annual Direct Costs: Hospitalization, Mental Health Care System, Child Welfare Service System and Law Enforcement = $33,101,302,133.00
• Annual Indirect Costs: Special Education, Juvenile Delinquency, Mental Health and Health Care, Adult Criminal Justice System, Lost productivity to Society = $70,652,715,359.00
• Total Annual Cost: $103,754,017,492.00
Economic Impact Study. (September, 2007). Prevent Child Abuse
Life Expectancy
“People with 6 or more ACEs died 20 years earlier on average than those without ACEs”
http://www.cdc.gov/violenceprevention/childmaltreatment/prevention.html
Local Evidence Based Programs
– Triple P (PPP)- Positive Parenting Program
– Nurse Family Partnership (NFP)– Cognitive Behavioral Therapy (CBT)– Community Resilience Training Model
(CRM)– Critical Incidence Treatment (CIT)– Buncombe County Health & Human
Services Resilient Workforce Movement- Compassionate Schools
37
Local Buncombe Efforts & Resources
• ACE Collaborative– Primary Care ACE Questionnaire Screening
Pilot – Primary Care Provider ACE Resource Guide – A County Wide Speakers Bureau – Website www.buncombeaces.org – ACEs Conference in Partnership with MAHEC– Buncombe County & Asheville City Schools-
1.2 million dollar grant from D.O.E for training on Compassionate School Curriculum
Buncombe County Assessment Center• Parents referred by Child Protective
Services• Adult Services referrals• Individuals on Pretrial Release
supervisionJail Diversion and Re-entry Services• Individuals in custody seeking
assistance with Substance Use &/or Mental Health Disorders
• Individuals in custody secondary to SPMI
Local ACE Questionnaire Screening Pilots
Further Information:
http://www.readynation.org/brainscience/#.UA2RMfoO6wk.gmail
http://developingchild.harvard.edu/
www.AceStudy.org
Medline/PubMed, Google - Anda/Felitti as authorwww.HumaneExprosures.com – 3 important books
http://acestoohigh.com/research/
Buncombe County Innovative Approaches ACE Collaborative
Learn More on our local Website:www.buncombeaces.org
Local Resource Portal:
“Not realizing that children exposed to inescapable, overwhelming stress may act
out their pain, that they may misbehave, not listen to us, or seek our attention in all the wrong ways, can lead us to punish these
children for their misbehavior…If only we knew what happened last night, or
this morning before she got to school, we would be shielding the same child we’re now
reprimanding.”
On Playing A Poor Hand Well by Mark Katz
Looking through the “trauma lens”…
44
Framework for Student Success: SEL Skills Instruction
Social &
Emotional
Learning
Self-awareness
Social awareness
Relationship Skills
Responsible decision-making
Self-management
Forming positive relationships,
working in teams, dealing effectively with
conflict
Making ethical, constructive choices
about personal and social behavior
Managing emotions andbehaviors to
achieve one’s goals
Showing understandin
g and empathy for
others
Recognizing one’s emotions and
values as well as one’s strengths and limitations
© 2007. CASEL
Toxic Stress Can Affect Brain Development
Healthy Child Severe Emotional Neglect
Centers for Disease Control and Prevention
Sequential Development of the Brain
Abstract Thought Problem solvingAffiliationAttachmentSexual BehaviorEmotional ReactivityMotor RegulationSleepDigestionBlood PressureHeart RateRespirationBody Temperature
Intervention programs that have shown to be effective in reducing the impact of Adverse Childhood Experiences and toxic stress:
– Triple P (PPP)- Positive Parenting Program– Nurse Family Partnership (NFP)– Cognitive Behavioral Therapy (CBT)– Community Resilience Training Model (CRM)– Critical Incidence Treatment (CIT)– What else?
What are we doing in our community?
Positive Parenting Program
Is a public health approach to parenting support Is a whole system of interventions
Universal prevention levels AND intensive higher “treatment” levels
Does NOT tell parents what to do Buncombe County Health & Human Services received a 3 year
grant from NC DHHS through May 2016 Focus on families of children 0-6 120 trained practitioners so far
Program Coordinator Deanna LaMotte:[email protected]
(828) 250-5110
Nurse-Family Partnership is…
• An evidence-based, community health program
• Transforming lives of vulnerable first-time mothers living in poverty
• Improving prenatal care, quality of parenting and life prospects for mothers by partnering them with a registered nurse
Nurse-Family PartnershipBuncombe County
• 10 Staff Members including 8 Nurse Home Visitors
• Program Capacity: 200 Clients
• Currently Serving: 163 Clients and 112 Infant/Toddlers
• 437 Families Served since Program Initiation in 2009
Nurse Family Partnership
http://www.nursefamilypartnership.org/(828) 250-5072
• Cognitive behavioral therapy (CBT) is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors.
• By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with mental illness can modify their patterns of thinking to improve coping.
Cognitive Behavioral Therapy (CBT)
Dr. Adrienne CoopeyPediatric Psychiatrist
Community Resiliency Model (CRM)
Key Concepts for the Community Resiliency Model: Set of 6 wellness skills that anyone can learn People respond to stress in similar ways. People are resilient by nature. People can learn skills that will mitigate the impact
of stress.
Master Community Resiliency Model Trainers in Buncombe County MaryLynn Barrett, Director of Behavioral Health, MAHEC
[email protected] Dr. Stephanie Citron, Independent Psychiatrist [email protected]
The goal of CIT training is to promote safety by:
• Educating law enforcement on mental illnesses;• Having officers learn about the characteristics
associated with untreated mental illnesses, and• Practicing skills designed to de-escalate certain
behaviorsLisa Astin, Training CoordinatorSmoky Mountain (828) 225-2785 X 5129
Critical Incidence Treatment (CIT)
• BCHHS Resilient Workforce Movement• First 2000 Days Campaign
Smart Start of Buncombe County• The Success Equation/Children
FIRST/CIS Compassionate Schools Initiative Under Six Initiative/Buncombe County
Health & Human Services Trauma Informed Practice Movement
Other Important Community Movements
• Result: An HHS workforce where all staff have the capacity to manage adversity and the stress associated with it. – Increasing workforce resiliency by improving
communication and relationships across all levels of agency, resulting in improved staff sense of status, certainty, autonomy, relatedness and fairness.
– Marian Arledge [email protected]
BCHHS Resilient Workforce Movement
http://www.first2000days.org 828-407-2057
The First 2000 Days Campaign
Buncombe County Innovative Approaches ACE Collaborative
Learn More on our local Website:www.buncombeaces.org
Local Resource Portal:
Final 16 Minute Video Clip
Nadine Burke on Adverse Childhood Experiences
Any Questions? Your Thoughts? Thank you!
ACE Study
• www.buncombeaces.org• http://acestudy.org/ • http://acestoohigh.com/ • http://www.cdc.gov/violencepreventi
on/acestudy/
• http://www.nasmhpd.org/TA/nctic.aspx
Thank you!
Important Links
Thank you! Community Agencies involved in the ACE Collaborative
Allison Development Group ABC Pediatrics Asheville City Schools Asheville Medicine & Pediatrics Asheville Pediatric Associates Blue Sky Pediatrics Brandi Nichole Family Enrichment Center Buncombe County Health & Human
Services Buncombe County Schools CarePartners Children’s Developmental Services
Agency Community Care of WNC Early Intervention Program for Children
who are Deaf/Hard of Hearing Families Together, Inc./NC Mentor Family Preservation Services Family Support Network of WNC FIRST
Head Start MAHEC MAHEC Family Medicine Residency
Program Mission Fullerton Genetics Mission Children’s Hospital Mission Health System Mountain Area Pediatric Associates North Carolina Department of
Public Health, Children & Youth Branch
NC Infant Mental Health Association
Olson Huff Development Center RHA Health Services Smart Start of Buncombe County Smoky Mountain LME/MCO WNC Healthy Kids Sparrow Research, Inc. Searchlight Consulting, Inc. Verner Center for Early Learning
Parent Volunteers: Fred Lashley Lee Kube Jim Johnston