Children Living in Stressful Environments A Resource Kit June 2008.

Children Living in Stressful Environments

A Resource Kit

June 2008

“The health, productivity and creativity of a society are renewed each generation through its children. The society that understands and

acts on this will succeed; the society that does not is doomed to fail.”

– Bruce D. Perry, M.D., Ph.D., Senior Fellow, The Trauma Academy in “The Real Crisis of Katrina”

Children Living in Stressful Environments

– Children of Alcoholics/Addicts (COAs)– Children With Fetal Alcohol Spectrum Disorders (FASD)– Children in Families With Mental Health Disorders– Children in Families With Disabilities, HIV, or Chronic Illness– Children Who Have Been Abused/Witnessed Abuse– Children of Military Personnel/Veterans or Who Live

on/Close to Military Bases– Children of Divorced or Absent Parents/Orphaned or Foster

Children– Children of Immigrants or in Bicultural Families– Children Who Have Experienced Disasters– Children Who Are Homeless

Children Living in Stressful Environments

• What we are calling stressful environments are sometimes referred to as “adverse childhood experiences,” or ACEs.

• CDC and Kaiser Permanente partnered on an ACE study of 17,000+ Kaiser health plan subscribers from 1995 to 1997; analysis of the data is ongoing. Some findings will be included in this discussion.

Children Living in Stressful Environments

Children Living in Stressful Environments

• …are at increased risk for substance abuse, mental disorders, and other serious problems, including physical illness.

• Although many demonstrate resiliency, and gain valuable skills and lessons learned, many others may develop serious problems of their own.

• …may grow up to repeat similar patterns, carrying the cycle of addiction and other trouble to future generations.

• For example, children of alcoholics (COAs)…

Children Living in Stressful Environments

• “…are between 4 and 10 times more likely to become alcoholics themselves than are children who have no close relatives with alcoholism.

• “…are more likely to begin drinking at a young age and to progress to drinking problems more quickly.”

Source: NIAAA. (January 2006). Alcohol Alert No. 67. Underage drinking: Why do adolescents drink, what are the risks, and how can underage drinking be prevented?

Children of Alcoholics (COAs)

Early Drinking and Adolescent Development

“Given recent research indicating the negative impact of alcohol use on

neurodevelopment of adolescents, the relationship of ACEs (Adverse Childhood

Experiences) to early initiation of alcohol use is particularly worrisome.”

– Robert F. Anda, M.D., M.S., Co-Principal Investigator, CDC-Kaiser Permanente ACE survey

Childhood Trauma = Risks

• More than 35 percent of children exposed to a single traumatic event will develop mental health problems such as PTSD.

• They are at lifelong elevated risk for such physical problems as heart disease, diabetes, and hypertension.

• As adults, they have increased rates of divorce, unemployment and school failure, depression, PTSD, alcoholism, and drug abuse/dependence.

Source: Perry, B., M.D., The real crisis of Katrina. National Association to Protect Children. Child Trauma Academy.

Substance Abuse Links Many Problems

• Substance abuse is often a link between problems in the lives of parents and other caregivers.

• Substance abuse is often a factor in stressful environments affecting children and a link between such environments.

Co-Occurring Problems

• As serious problems may co-occur in an individual life, so may a child experience multiple stressful environments.

• Children who live in a stressful environment are more likely to experience additional adverse consequences in their lives… the more of these they experience, the more likely they will turn to alcohol, tobacco, and other drugs or develop mental health problems and/or other serious problems.

Adverse Childhood Experiences

The ACE study looked at:

• Childhood abuse– Emotional– Physical– Sexual

• Neglect– Emotional– Physical

…the rest of the ACE study list:• Growing up in a seriously dysfunctional household

as evidenced by:– Child witnessing domestic violence– Alcohol or other substance abuse in the home– Mentally ill or suicidal household member– Parental marital discord (as evidenced by

separation or divorce)– Crime in the home (as evidenced by having a

household member imprisoned).

Adverse Childhood Experiences

“The effects of ACEs are long-term, powerful, cumulative, and likely to be invisible to health care providers, educators, social service organizations, and policy makers because the linkage between

cause and effect is concealed by time, the inability to ‘see’ the process of neurodevelopment, and because

effects of the original traumatic insults may not become manifest until much later in life.”

Adverse Childhood Experiences

Key Findings of the ACE Study

• More than one in four respondents grew up with substance abuse.

• Two-thirds had at least one ACE, or “adverse childhood experience.”

• More than 1 in 10 reported 5 or more ACEs.• 81 percent reported at least one additional ACE.• ACEs are a major hidden “engine” underlying

preventable risk factors for HIV.• ACEs greatly increase the risk of adult alcohol abuse

or marriage to an alcoholic.

“Engine” Driving HIV Risk Factors

Risk factors for HIV/AIDS:

• Injected drug use

• Fifty or more lifetime intercourse partners

• Ever having an STD

“All increase dramatically as the ACE Score increases,” thus creating a “hidden engine” underlying HIV risks, according to the ACE study’s author.

Key Facts About COAs

• Approximately one in four children is exposed to family alcoholism or addiction or to alcohol abuse before age 18. Source: Grant B.F. (2000). Estimates of U.S. children exposed to alcohol abuse and dependence in the family.

• Research has documented that children with substance-abusing parents are more at risk than their peers for alcohol and drug use, delinquency and depression, as well as poor school performance. Source: SAMHSA Office of Applied Studies. (March 2006). Children of substance abusers; children at risk because of parental substance abuse.

Key Facts About COAs

• “Children of alcoholics (COAs) are between 4 and 10 times more likely to become alcoholics than children from families with no alcoholic adults.” Source: Office of the Surgeon General. (2007). The Surgeon General’s Call to Action To Prevent and Reduce Underage Drinking, 2007. U.S. Department of Health and Human Services.

Key Facts About Children With Fetal Alcohol Spectrum Disorder (FASD)

• FASD occurs in about 10 per 1,000 live births, or about 40,000 babies per year, according to estimates published in 2001.

Source: FASD Center for Excellence. (2004). The Language of Fetal Alcohol Spectrum Disorders. Substance Abuse and Mental Health Services Administration.

Key Facts About Children With FASD

• In these 2001 estimates, fetal alcohol syndrome (FAS), the most recognized condition in the spectrum, was estimated to occur in 0.5 to 2 per 1,000 live births.

Source: FASD Center for Excellence. (2004). The Language of Fetal Alcohol Spectrum Disorders. Substance Abuse and Mental Health Services Administration.

Key Facts About Children in Families With Mental Health Disorders

• About 31 percent of women and about 17 percent of men have a 12-month prevalence of at least one psychiatric disorder (not including substance abuse). Of women in this group, 65 percent are mothers; 52 percent of the men are fathers.Source: CMHS. (July 2001). Critical issues for parents with mental illness and their families summary. Substance Abuse and Mental Health Services Administration.

Key Facts About Children in Families With Mental Health Disorders

• Children of parents who are mentally ill are at increased risk for emotional, mental health, and behavioral problems and for alcohol and drug abuse.

Source: CMHS. (July 2001). Critical issues for parents with mental illness and their families summary. Substance Abuse and Mental Health Services Administration.

Key Facts About Children in Families With Disabilities, HIV, and Chronic Illness

• At least 8 million, or 11 percent, of families in the United States with children under 18 have one or more parents with a disability.Source: Olkin, R. (1999). What psychotherapists should know about disability.

• About 1.4 million children between the ages of 8 and 18 in about 906,000 households nationwide assist a disabled or ill family member. Source: National Alliance for Caregiving. (September 2005). Young caregivers in the U.S.: Findings from a national survey.

• After living with an ill parent, about 80,000 children in the United States have been orphaned by AIDS.

Source: Rotheram-Borus, et al, (2001). An intervention for parents with AIDS and their adolescent children. American Journal of Public Health.

Key Facts About Children in Families With Disabilities, HIV, and Chronic Illness

Key Facts About Children Who Have Been Abused/Witnessed Abuse

• Physical assault, physical neglect, contact sexual abuse, and supervision neglect before sixth grade are all linked with drug, cigarette, and alcohol use; violence; and depression.

Source: Dube, S.R., Anda, R.F., et al. (February 2002). Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: Implications for health and social services. Violence and Victims 17.

Key Facts About Children Who Have Been Abused/Witnessed Abuse

• Intimate partner violence is common; 9 in 10 children who live in homes where there is intimate partner violence see or hear it.

Source: CMHS. (December 2000). When parents need help first. Helping your children navigate their teenage years: A guide for parents. Substance Abuse and Mental Health Services Administration.

Key Facts About Children of Military Personnel/Veterans

• At any one time, over half a million children have one or more parents who are deployed on military assignment. Source: American Psychological Association’s Presidential Task Force on Military Deployment Services for Youth, Families and Service Members. (February 2007). The psychological needs of U.S. military service members and their families: A preliminary report.

• Youths who become emotionally distressed as a result of a parent’s military deployment are at increased risk for substance abuse. Source: Office of Applied Studies. (2007). Results from the 2006 National Survey on Drug Use and Health: National findings. Substance Abuse and Mental Health Services Administration.

Key Facts About Children of Military Personnel/Veterans

• Youths in military families and communities are exposed to a different substance use environment than that found in civilian life.

Source: Bray R.M., Hourani L.L., Rae Olmsted K.L., et al. (December 2006). 2005 Department of Defense survey of health related behaviors among active duty military personnel. RTI International prepared for the Assistant Secretary of Defense (Health Affairs).

Key Facts About Children of Divorced, Absent Parents/Orphans or Foster Children

• About 40 percent of children in the United States are children of divorced parents; 20 to 25 percent of them show signs that they are not dealing well with this change in family structure and are at risk for negative outcomes, including substance abuse.

Source: SAMHSA Family Guide. Divorce counseling may help prevent teen substance abuse.

Key Facts About Children of Divorced, Absent Parents/Orphans or Foster Children

• In 2005, an estimated 680,000 youths (2.7 percent) aged 12 to 17 had ever been in foster care and had higher rates of need for substance abuse treatment than youths who have never been in foster care.

Source: SAMHSA Office of Applied Studies. (February 18, 2005). The NSDUH Report. Substance use and need for treatment among youths who have been in foster care.

Key Facts About Children of Immigrants or in Bicultural Families

• While new immigrants are less likely to engage in substance use than the U.S.-born population, those who had been here for 10 years or longer reported similar drug use to native-born residents.

Source: SAMHSA. (February 2003). Acculturation increases risk for substance use by foreign-born youth. SAMHSA News.

Key Facts About Children of Immigrants or in Bicultural Families

• Children of immigrants are the fastest-growing segment of the U.S. population under age 18.Source: Migration Policy Institute. (December 2003). Poverty grows among children of immigrants in the U.S.

• 68 percent of children in immigrant families live with parents who have been in the United States for 10 or more years.Source: Foundation for Child Development. (April 2007). Children in immigrant families—The U.S. and 50 states: National origins, language, and early education.

Key Facts About Children Who Have Experienced Disasters

• Disaster is likely to worsen problems in children and their families.Source: SAMHSA/CMHS/American Academy of Pediatrics. Psychological issues for children and families in disasters: A guide for the primary care physician.

• Children who experience disaster and develop PTSD are at greater risk for developing substance abuse problems.Source: NIDA. (February 2006). NIDA Community Drug Alert Bulletin—Stress & Substance Abuse.

Key Facts About Children Who Have Experienced Disasters

• Two years after Hurricane Katrina, 46,600 children along the gulf coast still have mental health and behavioral problems.

Source: Columbia University Mailman School of Public Health/Children’s Health Fund. (December 2007). The legacy of Katrina’s children.

Key Facts About Children Who Are Homeless

• An estimated 1.6 million youths are homeless each year, some for brief periods; approximately 200,000 youths each year live permanently on the street.Source: SAMHSA OAS. (July 2, 2004.) The NSDUH Report. Substance use among youths who had run away from home.

• “…rates of substance use among runaway youth have been shown to be nearly double that of housed youths attending school…”Source: Bender, K.A. and Thompson, S. (January 14, 2006.) Alcohol use among a national sample of runaway/homeless youth.

Key Facts About Children Who Are Homeless

• 48 percent of homeless youths reported significant alcohol use vs.19 percent of other youths, and 26 percent of homeless youths reported injection drug use; about one-fifth reported that drug use contributed to their leaving home.

Source: Health Resources Services Administration. (2001). The health center program: Program assistance letter: Understanding the health care needs of homeless youth.

The Good News…

“…children of substance abusing parents can and often do overcome the effects of these [family substance abuse] potentially

damaging environmental and genetic factors.”

Source: SAMHSA. 2003. Children’s program kit: Supportive education for children of addicted parents.

Many Children Overcome

“Even COAs in high-risk environments with other chronic sources of stress—including

poverty, racism, disrupted marriages, serious emotional problems, and histories of

abuse and neglect—are often able to overcome these painful beginnings and

create healthy, fulfilling lives for themselves.”

Source: SAMHSA/CSAP. (1992). The fact is…alcoholism tends to run in families.

Resilient Children of Alcoholics (COAs)

• …may have increased resilience when they benefit from the efforts of supportive adults.

Source: SAMHSA/CSAP. (2003). Children’s program kit: Supportive education for children of addicted parents; COAs: Important facts, 2–9.

• …benefit tremendously from adult efforts to help and encourage them. Children who cope best…often trace their sense of well-being to support from a nonalcoholic parent, family member, teacher, or other significant adult in their lives.

Source: SAMHSA/CSAT. Hot topics: Children and addiction. DHHS Publication No. (SMA) 01-3544.

Helping COAs

• Group programs facilitated by nurturing adults can reduce feelings of isolation, shame, and guilt among COAs and encourage positive peer influence and mutual support.

• Helping such children develop competencies like forming and sustaining close relationships, expressing their feelings, and problem-solving can increase their resilience.

Strategies Should Help Children To

• Develop autonomy and independence. • Develop a strong social orientation and social skills. • Engage in acts of “required helpfulness.” • Develop a close bond with a caregiver. • Cope successfully with emotionally hazardous

experiences. • Perceive their experiences constructively, even if

those experiences cause pain or suffering, and gain, early in life, other people’s positive attention.

• Develop day-to-day coping strategies.

Selected SAMHSA Resources

From http://ncadi.samhsa.gov:• SAMHSA’s Children’s Program Kit (w/videos on

DVD). • SAMHSA’s Native American Children’s Program Kit

(w/videos on DVD).

Plus…• SAMHSA’s Family Guide to Keeping Youth Mentally

Healthy and Drug Freehttp://www.family.samhsa.gov/

Key Prevention Resources

• http://preventionpathways.samhsa.gov • http://www.nrepp.samhsa.gov/ • http://preventionplatform.samhsa.gov/

…and your State’s National Prevention Network membership.

And remember our good news…