The Adverse Childhood Experience Study & the Buncombe County ACE Collaborative Dr. Adrienne Coopey, Pediatric Psychiatrist Mission Hospitals, Community Care of Western North Carolina Presentation on Behalf of the: Adverse Childhood Experiences Collaborative Innovative Approaches Grant Project Buncombe County Health and Human Services Presented at BC Health and Human Services Monday, April 13 th , 2015
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The Adverse Childhood Experience Study & the Buncombe County ACE Collaborative Dr. Adrienne Coopey, Pediatric Psychiatrist Mission Hospitals, Community.
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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
• 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
9
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.
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
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
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
25
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
30
Population Attributable Risk(PAR)
31
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.
34
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
• 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
Abstract Thought Problem solvingAffiliationAttachmentSexual BehaviorEmotional ReactivityMotor RegulationSleepDigestionBlood PressureHeart RateRespirationBody Temperature
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
• 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
• 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.
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