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

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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

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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

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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.

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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

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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

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http://www.k12.wa.us/CompassionateSchools/Resources

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Mind - Shift

• Addiction is a problem

• Addiction is a solution

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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

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ACE Score and Suicide

0

5

10

15

20

25%

Att

empt

ing

Sui

cide

ACE Score

1

2

0

3

4+

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

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Population Attributable Risk(PAR)

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is the proportion of the disease incidence *in the population* (i.e. exposed and non-exposed) that is due to the exposure

32https://acestoohigh.files

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.

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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

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How we teach

What we teach

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”…

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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

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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

How we teach

What we teach

The ACE Collaborative is working towards Building Resilience in the Community

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:Deanna.lamotte@buncombecounty.org

(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

marylynn.barrett@mahec.net Dr. Stephanie Citron, Independent Psychiatrist stephcitron@gmail.com

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 250-5094Marian.arledge@buncombecounty.org

BCHHS Resilient Workforce Movement

www.successequation.org828-259-9717

The Success Equation

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