Understanding the Performance Implications of Buffer to Buffer
The Buffer Zone: What Adverse Childhood Experiences (ACE) Study Teaches about Maximizing Health and...
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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
Connecting military family service providers
and Cooperative Extension professionals to research
and to each other through engaging online learning opportunities
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MFLN Intro
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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.
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
the issue
1 BILLION CHILDREN EXPERIENCE VIOLENCE
ANNUALLYhttps://static.pexels.com/photos/207653/pexels-photo-207653.jpeg
Child Abuse & Neglect
6
Physical
Abuse
Sexual
Abuse
Emotional
AbuseNeglect
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
Building Brain Architecture
7
https://pixabay.com/en/brain-electrical-knowledge-migraine-1845962/https://pixabay.com/en/construction-worker-building-job-642631/
Violence Compromises Early Brain
Development
8
How Brains are Built
9
http://www.albertafamilywellness.org/resources/video/how-brains-are-built-core-story-of-brain-development
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
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
Risky Behaviors Alcohol & DrugAbuse
Unsafe Sex
CancerDiabetes
HIVSTDs
Unintended Pregnancy
PregnancyComplicationsFetal death
DepressionAnxiety
PTSD
Traumatic Brain Injury
FracturesBurns
Violence
Violence in the
Public Health Context
Categories of ACEs
13
Abuse Neglect Family Challenges
http://www.rwjf.org/en/library/infographics/the-truth-about-aces.html
How Common are ACEs?
14
Lasting Effects
15
0
0.5
1
1.5
2
2.5
3
3.5
Dong, M et al. Circulation. 2004;110:1761–1766.
Ad
just
ed O
dd
s R
atio
Number of ACEs
0 1 2 3 4 5,6 7,8
ACE Score and Cardiovascular Disease
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0
1
2
3
4
5
6
Number of ACEs
Ad
just
ed
Od
ds
Rat
io
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
Ad
just
ed
Od
ds
Rat
io
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
Ad
just
ed
Od
ds
Rat
io
Number of ACEs
Dube et al. JAMA. 2001;286:3089–3096.
ACE Score and Suicide Attempts
19
Ad
just
ed O
dd
s R
atio
ACE Score and Life Potential
20
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”
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”
ACEs in Children and Adolescents
23
https://pixabay.com/en/children-silhouette-cheers-1499274/
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 • • •
ACE Score
25
Total Number of ACEs
% o
f sam
ple
rep
ort
ing A
CE
s
NSCAW II: ACEs by Age Group
26
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)
The Public Health Impact of Violence
28
Violence Across the Lifespan
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Role of Public Health Violence Prevention
30
Role of Criminal Justice, Child Welfare, Social Services
Preventing child maltreatment
requires understanding
WHYsome children and families
are at greater risk
31
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
Safe Stable Nurturing
Assuring safe, stable, nurturing relationships and
environments for all children
CDC’s Essentials for Childhood Framework
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
34http://www.cdc.gov/violenceprevention/childmaltreatment/essentials.html
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
GOAL 1: Raise Awareness and Commitment
36
https://www.flickr.com/photos/sydneytreasuresphotography/16046410082
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/
GOAL 2:
Use Data to Inform Prevention Action
38
39+ States Have Included the ACE
Module on their BRFSS
39
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http://www.health.state.mn.us/divs/cfh/program/ace/content/document/pdf/acereport.pdf
ACE Online Resources
41
http://vetoviolence.cdc.gov/apps/phl/images/ACE_Accessible.pdf
https://vetoviolence.cdc.gov/apps/aces/
http://www.cdc.gov/violenceprevention/acestudy/index.html
42
https://preventionboard.wi.gov/Pages/OurWork/ACE.aspx
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
GOAL 3: Create the Context for Healthy
Children & Families through Norms Change &
Programs
44
https://www.flickr.com/photos/armymedicine/13584554804
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
GOAL 4: Create the Context for Healthy
Children and Families through Policies
46
http://www.buckley.af.mil/News/Photos/igphoto/2000272288/
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/
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.
48http://www.cdc.gov/violenceprevention/pdf/can-prevention-technical-package.pdf
Technical Package Development
49
CDC’s Technical Package to Prevent Child
Abuse and Neglect
50
Strengthen economicsupports 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
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/
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/
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/
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
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/
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/
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
Thank you!
Melissa T. Merrick, PhD
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.
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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.