The

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The ACE StudyThe Tragic Consequences of
Unaddressed Childhood Trauma

• Presented by Ann Jennings Ph.D
• Federal Roundtable on Women and Trauma
• April 29, 2010

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Annas Story
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This is Anna at age one and a half
This is Anna years later in a mental institution
What happened?
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Anna Caroline Jennings 1960 - 1992
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• The Adverse Childhood Experiences Study
• (ACE Study)

In my beginning is my end. T.S. Eliot,
Four Quartets
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What is the Adverse Childhood Experiences (ACE)
Study?

• CDC and Kaiser Permanente Collaboration
• Over decade long. 17,000 people involved.
• Looked at effects of adverse childhood
  experiences over the lifespan.
• Largest study ever done on this subject.

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ACE Study Findings

• Childhood experiences are powerful determinants
  of who we become as adults

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Adverse Childhood Experience ACE Categories (Birth to 18) Abuse of Child Emotional abuse Physical abuse Contact Sexual abuse Trauma in Childs Household Environment Alcohol and/or Drug User Chronically depressed, emotionally disturbed or suicidal household member Mother treated violently Imprisoned household member Not raised by both biological parents (Loss of parent best by death unless suicide, - Worst by abandonment) Neglect of Child Physical neglect Emotional neglect Above types of ACEs are the heavy end of abuse. 1 type ACE score of 1 Impact of Trauma and Health Risk Behaviors to Ease the Pain Neurobiologic Effects of Trauma Disrupted neuro-development Difficulty controlling anger-rage Hallucinations Depression - other MH Disorders Panic reactions Anxiety Multiple (6) somatic problems Sleep problems Impaired memory Flashbacks Dissociation Health Risk Behaviors Smoking Severe obesity Physical inactivity Suicide attempts Alcoholism Drug abuse 50 sex partners Repetition of original trauma Self Injury Eating disorders Perpetrate interpersonal violence Long-Term Consequences of Unaddressed Trauma (ACEs) Disease and Disability Ischemic heart disease Cancer Chronic lung disease Chronic emphysema Asthma Liver disease Skeletal fractures Poor self rated health Sexually transmitted disease HIV/AIDS Serious Social Problems Homelessness Prostitution Delinquency, violence, criminal Inability to sustain employment Re-victimization rape, DV, bullying Compromised ability to parent Negative alterations in self percep- tions and relationships with others Altered systems of meaning Intergenerational trauma Long-term use of multiple human service systems

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HMO Members in ACE Study

• 80 White, including Hispanic
• 10 Black
• 10 Asian

• About 50 men, 50 women
• 74 had attended college
• 62 age 50 or older

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Adverse Childhood Experiences are Common

• Of the 17,000 HMO Members
• 1 in 4 exposed to 2 categories of ACEs
• 1 in 16 was exposed to 4 categories.
• 22 were sexually abused as children.
• 66 of the women experienced abuse, violence or
  family strife in childhood.
• Women were 50 more likely than men to have
  experienced 5 or more ACEs

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• The higher the ACE Score, the greater the
  likelihood of

• Severe and persistent emotional problems
• Health risk behaviors
• Serious social problems
• Adult disease and disability
• High health, behavioral health, correctional and
  social service costs
• Poor life expectancy
• For example

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Emotional Problems
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Childhood Experiences Underlie Chronic
Depression
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Childhood Experiences Underlie Suicide
4
3
2
1
0
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• 2/3rd (67) of all suicide attempts
• 64 of adult suicide attempts
• 80 of child/adolescent suicide attempts
• Are Attributable to
• Childhood Adverse Experiences

Women are 3 times as likely as men
to attempt suicide over the
lifespan.
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Childhood sexual abuse is strongest most
independent risk factor for suicidality

• As many as 42 of girls are sexually abused
  before age 18
• 79.8 of American Indian Alaskan Native (AIAN)
  girls experience sexual abuse in early
  childhood.
• Young AIAN women are over 3 ½ times more likely
  to commit suicide than females in the general
  population

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Childhood Experiences Underlie Serious and
Persistent Mental Health Problems
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Are We Misdiagnosing? ACE Score and
Hallucinations
Abused Alcohol or Drugs
Ever Hallucinated ()
ACE Score
Adjusted for age, sex, race, and education.
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Health Risk Behaviors
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Adverse Childhood Experiences and Current Smoking

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Childhood Experiences and Adult Alcoholism
4
3
2
1
0
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ACE Score and Intravenous Drug Use
N 8,022 plt0.001
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Adverse Childhood Experiences andLikelihood of
gt 50 Sexual Partners
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Serious Social Problems
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Childhood Experiences Underlie Rape
4
3
2
1
0
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(No Transcript)
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ACE Score and Unintended Pregnancy or Elective
Abortion
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ACE Score and Indicators of Impaired Worker
Performance
Prevalence of Impaired Performance ()
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Adult Disease and Disability
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Higher ACE Score significant rise in chronic
health conditions

• Sexually Transmitted Disease
• Liver Disease
• COPD
• Ischemic Heart Disease
• Autoimmune Disease
• Lung Cancer

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Poor Life Expectancy
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Effect of ACEs on Mortality
Age Group
0 ACE 60 live to 65 4 ACE less than 3 live
to 65
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(No Transcript)
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The Many Faces of Women and Trauma
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The Costs Are High1992 Analysis of Cost of
Annas Care

• Over 17 years, Anna was hospitalized a total of
  4,124 days. At 648 a day the cost was
  2,639,360.
• Other costs entitlements, residential
  treatment, case management, legal, medical were
  estimated to be over 1,000,000, bringing total
  cost to nearly 4,000,000.
• Adjusted for inflation (2005) total cost
  5,417,032

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1992 Analysis of Cost of Annas Care

• Intensive trauma based psychotherapy, figured at
  150 a session, 2 sessions a week, for 17 years,
  would have cost a total of 265,200 - (compared
  to 2,639,360)
• Had trauma been recognized and treated at age 3,
  costs would have been significantly less.
• If parents had been trauma-informed, the abuse
  may not have occurred.

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The financial burden to society of childhood
abuse and trauma is staggering.

• 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
• Total Annual Cost 103,754,017,492.00 (Over
  184 million dollars a day)
• Economic Impact Study. (September,
  2007). Prevent Child Abuse America

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• The solution of adult problems tomorrow depends
  in large measure upon the way our children grow
  up today.
• Margaret Mead

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Thank Youwww.TheAnnaInstitute.Org
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Handouts

• Chart of Adverse Childhood Experiences Study
• Finding Your ACE Score A Questionnaire
• ACE Publications on Major findings by Health
  Outcomes
• The Hidden Epidemic The Impact of Early Life
  Trauma on Health and Disease

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Sources

• ACE Publications For comprehensive list see CDC
  ACE Study website Publications on Major Findings
  By Health Outcomes This site was updated (March
  1, 2010) and links to related articles on all
  subjects.
• http//www.cdc.gov/nccdphp/ACE/outcomes.htm
• The Damaging Consequences of Violence and Trauma
  See Trauma-Informed Resources
• www.TheAnnaInstitute.Org
• Documents and articles on women and trauma
  Presentation Bibliography in preparation.
  Available upon request Ann Jennings,
  afj_at_gwi.net

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• ACE Study slides are from
• Robert F. Anda MD at the Center for Disease
  Control and Prevention (CDC)
• September 2003 Presentation by Vincent Felitti MD
  Snowbird Conference of the Child Trauma
  Treatment Network of the Intermountain West
• The Relationship of Adverse Childhood
  Experiences to Adult Medical Disease, Psychiatric
  Disorders, and Sexual Behavior Implications for
  Healthcare Book Chapter for The Hidden
  Epidemic The Impact of Early Life Trauma on
  Health and Disease Lanius Vermetten, Ed)

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Presentation Artwork

• All artwork in this presentation was created by
  Anna Caroline Jennings. Although she had no
  formal training, her work is stark, sophisticated
  and haunting. It has been exhibited at
  conferences across the country.
• Through her paintings and drawings she vividly
  and poignantly expresses her abuse at the hands
  of perpetrators and within the mental health
  system.
• Her work and story are displayed on the website
  www.TheAnnaInstitute.org.

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Trauma Informed Resources

• http//mentalhealth.samhsa.gov/nctic/default.asp
• SAMHSA National Center for Trauma-Informed
  Care
• www.TheAnnaInstitute.org The Anna Institute
  Inc
• ACE Study Section Powerpoint presentation
  slides and notes 41 full downloadable ACE Study
  articles related materials collection of ACE
  Study powerpoint slides
• Annotated list of Trauma Websites
• Models for Developing Trauma-Informed Behavioral
  Health Systems and Trauma-Specific Services, 2008
• Downloadable trauma-informed articles,
  powerpoints, educational materials links
  Annas story and art exhibit.