With A.C.E., You Need Heart

Aloha Colleagues,

As nurses, we are familiar with childhood trauma – and adult survivors. I recently read something I want to share with you. Last month, the Center for Disease Control (CDC) released the first-ever comprehensive estimates of how much Adverse Childhood Experiences (A.C.E.s )affect adults’ long-term health. Adverse Childhood Experiences include such things as experiencing or witnessing abuse or violence, surviving a war or natural disaster, or growing up in a family with alcohol or substance abuse. The accumulation of A.C.E.s can lead to health and social problems throughout childhood and into adulthood. Multiple different types of A.C.E.s together can produce toxic stress, a chronic activation of the stress response system that results in negative effects on brain development, behavior, and well -being. A.C.E.s are linked to health problems in adulthood.  At least five of the top ten leading causes of death: heart disease, cancer, respiratory diseases, diabetes, and suicide are all associated with A.C.E.s. We have long been aware that Adverse Childhood Experiences are correlated with depression and substance misuse. Considering the fall-out from toxic stress, it should not be surprising to read about the physical consequences of ACE’s – but I have to say I found the report disturbing. Working with Kaiser Permanente, CDC learned that more than half of adults have experienced at least one type of adverse childhood experience or A.C.E., and one in six people have experienced four or more types of A.C.E.s. The effects of A.C.E.s are cumulative: The more types of A.C.E.s a person has, the higher their risk for negative outcomes which can limit their opportunities their whole lives.  

It is majorly significant to note that there are proven ways to prevent A.C.E.s and to lessen the impact they have on individuals. It is important for our collective and individual health that families and communities work to create safe, stable, and nurturing relationships and environments for children. While it is not likely that we can avoid every A.C.E., there are opportunities to prevent A.C.E ‘s and to help those who have experienced them. The CDC has provided the first ever U.S. estimates of how much preventing adverse childhood experiences could reduce future chronic diseases, risky healthy behaviors, and socio-economic challenges like unemployment and not finishing high school. They analyzed behavior, the behavior risk factor surveillance system – or BRFSS – data that came from 25 states that included A.C.E. questions for the years 2015 to 2017, with data from 140,000 adults. Findings demonstrated that women, American Indian or Alaska Native, and African-americans had a higher risk of experiencing four or more types of A.C.E.s than other groups. The analysis suggested that preventing A.C.E.s could potentially reduce the number of people with coronary heart disease, the leading cause of death in Hawaii and across the US, by as much as 13%. If the same results were applied to national disease estimates in 2017, preventing A.C.E.s could have potentially resulted in up to 1.9 million avoided cases of coronary heart disease, 2.5 million avoided cases of overweight or obesity, and 21 million cases of avoided depression! Besides their impact on health, A.C.E.s also negatively affect life-opportunities like finishing high school or future employment. This makes sense, too, since adolescents who quit school are often depressed. Using the same 2017 national estimates, preventing A.C.E.s could have kept up to 1.5 million students from dropping out of school. Preventing A.C.E.s can help children and adults thrive and have the potential to substantially lower the risk for conditions like asthma, cancer, depressive disorder, and diabetes. Preventing A.C.E.s could reduce health risk behaviors like smoking, heavy drinking, and substance abuse, as well as improve education and job potential.  While A.C.E.s are strongly associated with a host of negative outcomes, not everyone who experiences A.C.E.s will go on to have poor outcomes. Children’s positive experiences, relationships, or other protective factors and interventions can strengthen resilience and reduce behavioral and health consequences even after A.C.E.s have occurred. It will take all of us working together to change environments and behaviors to stop A.C.E.s from happening in the first place and to lessen the harms for those who have experienced A.C.E.s. There’s a role for everyone: parents, families, neighborhoods, schools, spiritual communities, businesses, and government. CDC has recently released a new resource called preventing adverse childhood experiences: leveraging the best available evidence. The report describes six strategies for prevention:  Intervening to lessen harms of A.C.E.s with treatment, services and support; Connecting youth to caring adults and activities through mentoring and after-school programs;  Improving youth and parent skills like communication and problem-solving to manage stress and everyday challenges;  Providing high-quality, affordable childcare and early education to assure a strong start;Promoting social norms that protect against violence and adversity; Strengthening families’ economic stability to reduce family stress and conflict. 

This new resource for states and communities describes each strategy and provides specific approaches with examples of programs, practices, and policies. The resource also provides a brief summary of the evidence base for preventing A.C.E.s or the associated risk factors for A.C.E.s. Some prevention approaches like enrichment programs that provide expanded services to children and their families have had long-term studies. For example, evaluation of child-parent centers found not only substantially lower levels of child abuse and neglect, but also sustained benefits on a range of outcomes into young adulthood for children who participated. Long-term benefits included better academic success, lower arrest rates, lower levels of depression, and lower rates of disabilities.  Preventing A.C.E.s is a priority for the CDC. They are still building the evidence base related to programs that work to prevent A.C.E.s, we also know some strategies to prevent A.C.E.s that can be used now by various sectors to stop A.C.E.s before they occur and mitigate the immediate and long-term harms of A.C.E.s. States and communities can help parents and youth grow their skills to manage stress, reduce violence, and tackle everyday challenges by using relationship skill-building programs as well as parenting skills and family relationship approaches.  Employers can adopt and support family-friendly policies such as paid family leave and flexible work schedules. Health care providers can recognize current risks in children and A.C.E.s history in adults and refer patients to effective family services and support.  States and communities can use effective social and economic policies to address financial hardships and other conditions that put families at risk for A.C.E.s. Everyone can participate in A.C.E.s prevention by recognizing the challenges that families face and offering support and encouragement to reduce stress. Bottom line is this: adverse childhood experiences produce toxic stress that can impact people all their lives. A.C.E.s are potentially preventable by creating safe, stable, nurturing relationships and environments for all children, families, and communities.
For more information, visit
https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html
Join us March 10/11, 2020 for our conference,Nursing: Body, Mind, Spirit.