and WellBeing 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 ID: 759148
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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, MPHLisa Simpson, MB, MPH, FAAPPediatric Academic Societies April 2015
“It is easier to build strong children than to repair broken men.”
Frederick Douglass
(
1817–1895)
Slide2Outline
Project scope, phases and approach
Overview of ACES
Impact of ACES
Agenda setting and input
Questions for today
Slide3Project Goal(Spring 2014-Spring 2015)
This goal of this project is to optimize the role and capacity of children’s health services to promote child and family wellbeing by further catalyzing awareness, knowledge and innovation to prevent, recognize and heal the impacts of adverse childhood experiences.
Prevalence of
2
+ (of 9) ACES: 16.3% (UT) – 32.9% (OK)
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.
Slide4Four Pronged Project Scope(Spring 2014-Spring 2016)
Slide5Four Pronged Project Scope(Spring 2014-Spring 2016)
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
Slide6Project Approach
EmphasizesLegitimizes Calls OutRecognizesConcludes
the inherent value of and the cross-cutting importance of child well-being to population health and well-being
the known impact of embedded and chronic stress on child development and well-being and adult health
the syndemic of adverse childhood experiences, links to early & lifelong health and the possibility of healing and prevention
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
Slide7Overview of Adverse Childhood Experiences (ACES)
Slide88
Slide99
http://acestoohigh.com/got-your-ace-score/
Slide10Prevalence 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
Slide11Almost half of US children have had at least one of 9 key adverse childhood experiences – an estimated 34.8 million children nationwide
National PrevalenceState RangeChild had ≥ 1 ACEs47.9%40.6% (CT) - 57.5% (AZ)s Extreme economic hardship25.7%20.1% (MD) - 34.3% (AZ) Family discord leading to divorce or separation20.1%15.2% (DC) - 29.5% (OK) Has lived with someone who had an alcohol/drug problem10.7%6.4% (NY) - 18.5% (MT) Has been a victim or witness of neighborhood violence8.6%5.2% (NJ) - 16.6% (DC)Has lived with someone who was mentally ill or suicidal8.6%5.4% (CA) - 14.1% (MT) Witnessed domestic violence in the home7.3%5.0% (CT) - 11.1% (OK) Parent served time in jail6.9%3.2% (NJ) - 13.2% (KY)Treated or judged unfairly due to race/ethnicity4.1%1.8% (VT) - 6.5% (AZ) Death of parent3.1%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
Slide12ACEs Data and Reports Available Online: www.childhealthdata.org
Slide13ACEs
Skeletal Fractures
Relationship Problems
Smoking
General Health and Social Functioning
Prevalent Diseases
Sexual Health
Risk Factors for
Common Diseases
Hallucinations
Mental Health
ACEs
Impact Multiple Outcomes
Difficulty in job performance
Married to an Alcoholic
High perceived stress
Alcoholism
Promiscuity
Illicit Drugs
Obesity
Multiple Somatic Symptoms
IV Drugs
High Perceived Risk of HIV
Poor Perceived Health
Ischemic Heart Disease
Sexually Transmitted Diseases
Cancer
Liver Disease
Chronic Lung Disease
Early Age of First Intercourse
Sexual Dissatisfaction
Unintended Pregnancy
Teen Pregnancy
Teen Paternity
Fetal Death
Depression
Anxiety
Panic Reactions
Sleep Disturbances
Memory Disturbances
Poor Anger Control
Poor Self-Rated Health
Slide14Graphic: Sandra Bloom
Multiple Impact Pathways
Slide15Impacts on chronic condition status appear early in life.
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
Slide16Bethell, 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
Slide17Bethell, 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
Slide18AOR: .26
s
AOR: 1.66s
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
Slide19We 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