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Adverse Childhood Experiences Data Links Trauma and Outcomes

Significant scientific documentation now shows a more complete picture of the far-reaching negative consequences of adverse childhood experiences (ACEs) on a person’s health. It also provides a strong case for groundbreaking, sustainable approaches to child abuse and neglect and chronic disease prevention.

In an effort to determine the association between childhood maltreatment and poor health outcomes faced throughout a person’s life, the health care organization Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) embarked on one of the largest studies ever conducted.

The study has found a strong correlation between ACEs and the likelihood of experiencing physical and mental health issues later in life. Comprehensive data demonstrates that traumatic childhood experiences are risk factors for unhealthy behaviors and illnesses, such as ischemic heart disease, liver disease, and depression.

The ACE study results are likely to play an integral role in efforts to curb some of the nation’s toughest health and social problems. It is a valuable tool in making the case for investments in strengthening families and child abuse and neglect prevention. The study shows that preventing abuse and neglect can yield long-term savings in health care costs associated with issues, such as depression, addiction, heart disease, and teen pregnancy.

“If we are truly committed to reducing the number of people living in poverty, improving health and well-being, and getting more people on the pathway toward education and employment success, we can’t do it without fully embracing the ACE science, and assuring its alignment into all practices and policies that that influence populations with high ACE scores,” says Susan Dreyfus, president and CEO of the Alliance for Children and Families. “For nonprofit human services, this data presents a comprehensive research-based, culturally adaptive understanding of what it takes to give people the best opportunities for healthy and productive lives.”

Data Proves the Correlation

The ACE study’s findings related to the health, social, and economic challenges that result from childhood trauma are striking.

The Kaiser Permanente and CDC ACE study tracked 17,000 people from 1995-1997 who offered detailed information on personal traumatic experiences, organized into 10 ACE categories. More than half of the participants in the original study reported having at least one ACE, and 27 percent reported having more than two.

The findings show clear association between these various traumatic childhood experiences and poor physical and mental health, work continuity, and relationships experienced later in life.

Dr. Robert Anda, the study’s co-principal investigator and co-founder, noted in a 2007 presentation, “The human and economic costs of the long-term effects of adverse childhood experiences in the workforce are likely major and merit attention by the business community in concert with the modern practice of medicine and public health.”(1)

He also indicated that close to 20 percent of people with an ACE score of four or more had “serious job problems,” compared to 6 percent of people with an ACE score of zero. In particular, 15 percent of people with an ACE score of four or more were absent from work more than two days a month, compared to 6 percent of people with an ACE score of zero.

ACE science needs to influence how professionals understand, assist, and work with adolescents and adults. “If we can help these community members understand why they are having the struggles they are having with work, relationships, substance abuse, or mental illness, we can give them understanding so they can create a path forward,” comments Dreyfus.

Dreyfus also points out how the science, if applied correctly, can improve health and reduce health care costs. “People may have understood the mental health consequences of a high ACE score, but not the physical health aspects,” she explains. “We can’t bend the cost curve of health care over time without embedding this groundbreaking science into health care policy and investing health care dollars.”

Washington State Provides Example

The budget facts are sobering; states faced a combined budget gap of $350 billion in 2010 and 2011. Already, 29 states have projected or have addressed shortfalls totaling $44 billion for fiscal year 2013, which begins July 1, 2012. Widespread intent to close budget gaps and diminished revenue are causing a paradigm shift at all levels of government.

“We know government is in a reset mode; we cannot afford to maintain the safety net as it once was,” says Dreyfus. “So, we have to get creative. We can move toward that goal by promoting a comprehensive community approach using this science.”

In Washington state, this community approach resulted in a true return on investment. Efforts included removing silos within the human services systems and implementing coordinated efforts that linked communities, existing human services systems, and ACEs information.

The Washington State ACE data was gathered as part of the state’s yearly Behavioral Risk Factor Surveillance Survey (BRFSS). Once analyzed, it was used to create a network of community-based collaborative groups to focus services on the areas most in need. This collaborative approach encompassed families; medical, social service, and education providers; and leaders within local government, courts, businesses, faith-based organizations, and neighborhoods.

According to a Washington State Family Policy Council report, “This overarching approach aligns resources for collective impact, uses research to inform system and service innovation, builds each community’s own problem-solving capacity, and fosters common accountability for the quality of child, family, and community life—all with a relatively small investment.”

The results were profound. According to a 2010 report from the Family Policy Council, there was a decrease in youth alcohol and drug use, high school dropout rate, children in out-of-home placement due to abuse or neglect, teen suicide attempts, teen pregnancy, teen violent crime, and domestic violence. The projected case reduction in out-of-home placements from 2009-2011 represented a projected savings of $6.8 million. 

In total, the communities funded by this network represent an estimated $55.9 million savings for the state each biennium.

Gathering the Data

Even though ACE data has been available and recognized for a number of years, most states are neither gathering the state-specific data nor using it to inform policy and practice as was done in Washington.

The Wisconsin Children’s Trust Fund set out to gather the data with its BRFSS to gain a better understanding of the prevalence of ACEs among Wisconsin residents.

It partnered with the Child Abuse Prevention Fund of Children’s Hospital and Health System to develop the comprehensive report. Funding partners for the ACE module in the full publication were the Department of Health Services, Department of Children and Families, and the Child Abuse Prevention Fund. 

“This Wisconsin-specific data can help inform our efforts to prevent child abuse and neglect and other adverse childhood experiences,” explains Jennifer Jones, associate director of the Wisconsin Children’s Trust Fund. “Similar to the work of Washington state, our goal is to gather county-level ACE data and then infuse prevention services and supports into counties with high ACE clusters. Ultimately, we hope to show a reduction in the number of adverse experiences in the lives of Wisconsin children.”

In its findings, the Wisconsin Children’s Trust Fund identified four policy recommendations to improve the health, functioning, and productivity of Wisconsin residents:

  • increase awareness of ACEs and their impact on health and well-being,
  • increase assessment of and response to ACEs in health care settings,
  • enhance the capacity of communities to prevent and respond to ACEs, and
  • continue to collect Wisconsin-specific data on the relationship between ACEs and health outcomes.

Nonprofit human service organizations can partner with other community stakeholders and inform lawmakers and the public of the potential for return on investment and social change.

“The well-being of America’s children and the presence of adverse experiences in their lives is a major public health issue that demands not just our attention, but our action,” explains Dreyfus. “In short, it is a public health imperative.”

ENDNOTES:

1. The presentation, The Health and Social Impact of Growing up with Adverse Childhood Experiences: The Human and Economic Costs of the Status Quo, was given in 2007 at the Guest House Institute Summer Leadership Conference.

Assessing Presence of ACEs

  • To assess the occurrence of traumatic childhood experiences, adults are asked if they experienced any of the following prior to the age of 18:
  • Psychological abuse
  • Recurrent physical abuse
  • Sexual abuse
  • Alcohol and/or drug abuser in the household
  • Household mental illness (chronically depressed, mentally ill, institutionalized, or suicidal)
  • Incarcerated household member
  • Violence between adults in the home
  • Parental separation or divorce*
*Some studies do not include this category.

ACE Issue Brief

The Alliance Severson Center has begun developing a collection of issue briefs as part of the Scanning the Horizons family of knowledge products. The first brief in the collection addresses the impact of ACEs on health.

This guide is valuable for sharing with partners, funders, and other stakeholders because it provides concise information about the study’s background and findings. In addition, it articulates why human service organizations are critical partners in efforts to use ACE data to strengthen families and communities.

Pre-Conference Session

Members are encouraged to attend a special workshop that will precede the 2012 Alliance National Conference, to be held Oct. 17-19 in Orlando, Fla. Applying Adverse Childhood Experiences Research to Policy and Practice will feature the ACE study’s co-principal investigator and co-founder Dr. Robert F. Anda, senior scientific consultant at the CDC.

Anda and additional presenters will equip participants with the critical knowledge to position themselves as critical partners in the effort to communicate the link between trauma and mental and physical health outcomes to policymakers. In addition, they will learn how to use the ACE study data to inform practices.

 

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