Promoting Early and Lifelong Health: From the
Challenge of Adverse Childhood Experiences (ACEs) to
the Promise of Resilience and Well-Being
(Visit Exhibit 427 to Participate)
Christina Bethell, PhD, MBA, MPH
Lisa Simpson, MB, MPH, FAAP
Pediatric Academic Societies
April 2015
“It is easier to build strong children than to repair broken men.”
Frederick Douglass
(1817–1895)
Outline
•
•
•
•
•
Project scope, phases and approach
Overview of ACES
Impact of ACES
Agenda setting and input
Questions for today
Project Goal
(Spring 2014-Spring 2015)
This goal of this project is to
1. optimize the role and
capacity of children’s
health services
2. to promote child and
family wellbeing
3. by further catalyzing
awareness, knowledge
and innovation
4. to prevent, recognize
and heal the impacts of
adverse childhood
experiences.
Funding for this project has come from The Child and Adolescent Health Measurement Initiative (CAHMI)
and the Robert Wood Johnson Foundation, with in-kind contributions from the California Endowment and
our many research, family, policy and practice partners.
Prevalence of
2+ (of 9) ACES:
16.3% (UT) –
32.9% (OK)
Four Pronged Project Scope
(Spring 2014-Spring 2016)
Agenda
• Build a coordinated child health
services and policy research and
action agenda
Build Shared
Knowledge
• Publish a set of applied research
papers to assess current
knowledge, practice and
translational research priorities
Four Pronged Project Scope
(Spring 2014-Spring 2016)
Capacity and
Resources
Participation and
Collective Action
• Assemble and develop resources to embed awareness
and support the development of capacity, advocacy and
innovation at three levels:
• – The clinician and family level
• – The healthcare organization level, including hospitals,
clinics, and health plans
• – The health policy level, including system financing,
organization, capacity and research support
• Promote the community-wide partnerships essential to
promote health and address ACEs by strengthening the
presence of children’s health services research, policy and
practice in these larger child well-being and ACEs collective
impact efforts
1. American Academy of Pediatrics (2014) Addressing Adverse Childhood Experiences and Other Types of Trauma in the Primary Care
Setting. Find: www.aap.org/en-us/Documents/ttb_addressing_aces.pdf.
2. Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. (2014)
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Health Affairs Dec; 33(12);210-2016
3. Short project meeting video: http://www.acesconnection.com/clip/we-are-the-medicine-5-min?reply=410425417487175152
4. Robert Wood Johnson Foundation: http://www.rwjf.org/en/about-rwjf/newsroom/features-and-articles/ACEs.html
Project Approach
Emphasizes
the inherent value of and the cross-cutting
importance of child well-being to population health
and well-being
Legitimizes
the known impact of embedded and chronic stress on
child development and well-being and adult health
Calls Out
the syndemic of adverse childhood experiences, links
to early & lifelong health and the possibility of healing
and prevention
Recognizes
Concludes
that child development depends on adult
development and the urgency to promote greater
research and policy action
that the health of children and our nation calls us to
squarely address trauma and promote positive
health—and the foundational role of safe, stable,
nurturing relationships and neuro-repair to healing
Overview of Adverse Childhood
Experiences (ACES)
8
Prevalence of ACEs Among
Adults in 18 States Assessing
ACEs Statewide
36.10%
26.00%
15.90%
9.50%
No ACEs 1 ACE
2 ACEs
12.50%
3 ACEs 4+ ACEs
http://acestoohigh.com/got-your-ace-score/
9
Prevalence Among US Children
(2011-12 National Survey of Children’s Health)
Prevalence of
2+ (of 9) ACES:
16.3% (UT) –
32.9% (OK)
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health
and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016
• Almost half of US children have had at least one of 9
key adverse childhood experiences – an estimated
34.8 million children nationwide
National
Prevalence
State Range
Child had ≥ 1 ACEs
47.9%
40.6% (CT) - 57.5% (AZ)s
Extreme economic hardship
25.7%
20.1% (MD) - 34.3% (AZ)
Family discord leading to divorce or separation
Has lived with someone who had an alcohol/drug
problem
Has been a victim or witness of neighborhood
violence
Has lived with someone who was mentally ill or
suicidal
Witnessed domestic violence in the home
20.1%
15.2% (DC) - 29.5% (OK)
10.7%
6.4% (NY) - 18.5% (MT)
8.6%
5.2% (NJ) - 16.6% (DC)
8.6%
5.4% (CA) - 14.1% (MT)
7.3%
5.0% (CT) - 11.1% (OK)
Parent served time in jail
6.9%
3.2% (NJ) - 13.2% (KY)
Treated or judged unfairly due to race/ethnicity
4.1%
1.8% (VT) - 6.5% (AZ)
Death of parent
3.1%
1.4% (CT) - 7.1% (DC)
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health
and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016
ACEs Data and Reports Available Online: www.childhealthdata.org
ACEs Impact Multiple Outcomes
Smoking
Alcoholism
Promiscuity
Relationship
Problems
High perceived
stress
Married to an
Alcoholic
Difficulty in job
performance
Poor SelfRated Health
Hallucinations
High Perceived
Depression
Obesity
General Health and
Sleep
Risk of HIV
Social Functioning
Disturbances
Risk Factors for
Mental
Common Diseases
Health
Memory
Disturbances
Poor Perceived
ACEs
Illicit Drugs
Anxiety
Health
IV Drugs
Panic Reactions
Prevalent
Sexual
Multiple Somatic
Poor Anger
Health
Diseases
Symptoms
Control
Cancer Liver Disease
Teen Paternity Fetal Death
Skeletal
Chronic Lung
Teen
Unintended
Fractures
Disease
Pregnancy
Pregnancy
Sexually
Early Age of
Ischemic Heart Disease
Sexual Dissatisfaction
Transmitted
First
Diseases
Intercourse
Multiple Impact Pathways
Graphic: Sandra Bloom
Impacts on chronic condition status appear early in life.
35.00%
31.60%
30.00%
25.00%
20.00%
15.00%
20.30%
AOR:
.44Scv
14.60%
14.60%
10.00%
AOR:
.68S
7.70%
4.80%
5.00%
0.00%
Chronic Condition Requiring Above Routine
Health Care
No ACEs
1 ACE
ADHD
2+ ACEs
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health
and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016
We Know Family Context Matters
Mother’s Health Substantially Lower Among Children and Adolescents
With ACEs
No ACEs
1 ACE
2+ ACEs
80.00%
70.00%
68.30%
60.00%
50.00%
40.00%
48.60%
35.80%
30.00%
20.00%
10.00%
0.00%
Mother in very good or excellent physical and mental health
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health
and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016
We Know School Success is Impacted
No ACEs
1 ACE
2+ ACEs
16.00%
15.00%
14.00%
12.00%
10.00%
9.10%
8.00%
6.00%
5.60%
4.00%
2.00%
0.00%
Repeated Grade(s) In School
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health
and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016
We Know Resilience Matters—And Can Be Learned!
School age children with chronic conditions/special needs with 2+
ACEs do better when they demonstrate even one aspect of resilience
100.00%
Never/Sometimes Resilient
80.00%
80.90%
Usually/Always Resilient
60.00%
52.00%
40.00%
19.80%
20.00%
11.00%
AOR:
1.66s
AOR: .26s
0.00%
Repated grade(s) in school
Usually/Always engaged in school
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health
and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016
We Know Resilience Matters—Need for Continuous Learning and
Relearning of Resilience (“every stress an ‘n of 1’ self- study”)
Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health
and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016