What is ACEs and Why is it Important?

1. What is ACEs and
Why Is it Important?
Psychiatry & Behavioral Medicine Symposium
October 3, 2018

2. Plan for this Afternoon…
What are ACEs?
What is the research behind ACEs?
What is the impact of ACEs?
Why should we care?
What can we do about ACEs?
What?
So What?
Now What?

3. Let’s Start with WHAT

4. What are ACEs?
ACE = Adverse Childhood Experience
An adverse childhood experience is a
traumatic event that happens during
childhood (under the age of 18).

6. The Original ACE Study
Between 1995 and 1997, over 17,000 people receiving
physical exams completed confidential surveys prior
to their appointment (received by mail) containing
information about their childhood experiences and
current health status and behaviors.
Participants were members of the Kaiser Health Plan in
San Diego County, California
Study was retrospective – adults reported on things
they experienced in their childhood.

7. Who Were the Study Participants?

8. What did the study find?
Adverse childhood experiences are common,
but largely unrecognized

9. What Does This Mean?
Almost two-thirds of adults surveyed had at
least one adverse childhood experience.

10. 2016 Michigan Data

11. What did the study find?
Adverse childhood experiences rarely occur in isolation.

12. What did the study find?
ACEs are highly interrelated and tend to occur in clusters.

13. What Does This Mean?
If any one ACE is present, there is an 87%
chance of at least one other category of
ACE present, and 50% chance of 3 or more.

14. Cumulative Impact
ACEs have a
cumulative effect – the
higher the score, the
higher the likelihood of
health risk behaviors
and poor health
outcomes.
This is most likely due to
the increased allostatic
load – or “wear and
tear on the body”
which grows over time
when an individual is
exposed to repeated
or chronic stress.

15. What did the study find?
ACEs have a dose-response relationship
with many health problems.

16. ACE Score and Health Problems
SOURCE: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention

17. What did the study find?
ACEs are the nation’s most basic public health problem.

18. QUESTIONS?

19. So WHAT Does This Mean?

20. So What?
Health: obesity, diabetes, depression,
suicide attempts, STDs, heart disease,
cancer, stroke, COPD, broken bones
Behaviors: smoking, alcoholism, drug use
Life Potential: graduation rates,
academic achievement, lost time
from work
ACEs have been shown to have lasting effects on:

21. ACE Score & Chronic Disease1
Prevalence%
0
2
4
6
8
10
12
14
16
18
Ischemic Heart
Disease
Stroke COPD Diabetes Sexually
Transmitted
Disease
0 1 2 3 ≥ 4ACE Score
1 Felitti et al., (1998) American Journal of Preventive Medicine, 14:245-258.

22. ACE Score & Mental Health1
Prevalence%
0
10
20
30
40
50
60
70
80
Mood Disorders Anxiety Disorders Substance Abuse Impulse Control
Disorders
0 1 2 3 ≥ 4ACE Score
1 Data from the National Comorbidity Survey-Replication Sample (NCS-R): Putnam, Harris, Putnam, J Traumatic Stress, 26:435-442, 2013

23. 2016 Michigan Data

24. 2016 Michigan Data

25. ACE Score & Worker Performance1
PrevalenceofImpaired
Performance%)
0
5
10
15
20
25
Absenteeism Financial Problems Job Problems
0 1 2 3 ≥ 4ACE Score
1 Anda et al., (2004) The Permanente Journal/Winter 8:30-38.

26. ACE Score & Suicide Attempts
1 of 100 people with 0 ACEs attempt suicide
10 of 100 people with 3 ACEs attempt suicide
20 of 100 people with 7 ACEs attempt suicide

27. ACEs Increase Health Risks

28. Exponentially!
People with 4
or more ACEs,
compared to
those with
0 ACEs

29. ACEs Affect the Lifespan
People with 6 or more ACEs died nearly
20 years earlier on average than those
without ACEs.

30. Trauma
Trauma
Trauma
ACE Pyramid

31. Short, stressful events like
meeting new people or
starting the first day of
school. These are healthy
for brain development.
They prepare the brain and
body for stressful situations
later in life.
Tragic, unavoidable events
like a natural disaster or
losing a loved one aren’t good
for us. But if supportive
caregivers are around to
buffer the stress response,
these events won’t do lasting
damage to the brain & body.
Ongoing, repeated exposure to
abuse or neglect is bad for brain
development. If no supportive adults
are present to help buffer the stress
response, stress hormones will
damage developing structures in the
child’s brain. The result is an
increased vulnterability to lifelong
problems.

32. Body’s Response to Stress

33. Impact on Developing Brain

35. Important to Note…
ACEs is an emerging topic in the public
health arena – especially as it relates to
adult health and wellness.
It doesn’t matter what the ACE is.
Begin to shift thinking from
“What’s wrong with you?” to
“What happened to you?”

36. QUESTIONS?

37. So NOW WHAT?

39. Resilience Factors That Make a Difference
Feeling social/emotional support and hope.
Having 2 or more people who help (giving
concrete help when needed).
Community reciprocity: watching out for children,
intervening when they are in trouble, doing favors
for others (social connectedness).
Social Bridging: reaching outside your social
circle to get help for family and friends.
is a set of capacities!

49. Resilience is NOT a Superpower
ANYONE can learn and develop

50. AND….It’s Never TOO Late
can be built over time
with practice and
positive experiences.

51. Actionable Next Steps
Attend/Offer Screening of RESILIENCE
http://bit.ly/MichiganACE
Share information/training with others
Nadine Burke Harris TED Talk

52. Actionable Next Steps
Know Your Number!
This is a history taking tool – looking at your
history of childhood trauma and adversity
helps “explain” its impact on your health.
It’s not “what’s wrong with you,” but rather
“what happened to you.”
Promote the idea that “what is predictable is
preventable.”

53. Actionable Next Steps
Promote Resilience and Protective Factors
Protective factors are attributes in individuals
and families that, when present, alleviate or
eliminate risk in families and increase their health
and well being.
What Makes Your Family Strong?

55. Actionable Next Steps
Share user-friendly information tools (UFIT)
https://www.futureswithoutviolence.org/connected-parents-connected-kids/

56. The Story of ACEs in Michigan
Michigan ACEs Data
2013: ACEs questions added to BRFSS and 2015
Surveillance Brief released
2016: ACEs questions added (again) along with
questions about protective factors
Data currently being analyzed
2019: ACEs questions asked of the entire state
Will provide county level data

57. Michigan ACE Initiative
To date, 75 people have been trained as
Master Trainers.
These trainers represent all parts of the state
and are available to conduct presentations
and/or facilitate screenings of the film
RESILIENCE.
The Michigan ACE Initiative has
trained over 3200 individuals on ACEs
reached/created awareness to over 3300
people through screenings of RESILIENCE, the
documentary on ACE’s (with the help of
community partners)
Developed a legislative ask – proposing both
funding and policy changes to reduce the
prevalence and impact of ACEs in Michigan.
Learn more at http://www.miace.org

59. Washington State Family Policy Council
A large portion of many health, safety and prosperity
conditions is attributable to Adverse Childhood Experiences.

60. Resources
Original ACE Study
Relationship of Childhood Abuse and Household
Dysfunction to Many of the Leading Causes of
Death in Adults published in the American Journal of
Preventive Medicine in 1998, Volume 14, pages 245-
258.
CDC ACEs Information
https://www.cdc.gov/ace
ACEs Primer
https://vimeo.com/139998006
End It Now
http://bit.ly/EndItNowACES
Adverse Community Experiences and Resilience
http://bit.ly/AdverseCommunityExperiences

61. Jodi L. Spicer, MA
Adverse Childhood Experiences (ACEs) Consultant
Division of Chronic Disease and Injury Control
Michigan Department of Health and Human Services
Phone: (517) 373-9295
Email: spicerj1@michigan.gov
Contact Information