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Understanding the Impact of ACEs

Learn about ACEs, protective factors, and addressing ACEs in a pediatric practice. Explore the relationship between childhood trauma and adult health risks, along with strategies for trauma-informed care. Resource list included.

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Understanding the Impact of ACEs

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  1. Understanding the Impact of ACEs Kalpana Miriyala, MD Zero to Three Fellow, Assoc. Professor Child and Adolescent Psychiatry Marshall University, Huntington, WV 25701

  2. Objectives • Describe ACEs • Describe the ACEs pyramid • Describe protective factors • Discuss ways to address ACEs in a pediatric practice

  3. Childhood Trauma Oprah Winfrey

  4. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults Vincent J Felitti, Robert F Anda, Dale Nordenberg, David F Williamson, Alison M Spitz, Valerie Edwards, Mary P Koss, James S Marks American Journal of Preventive Medicine Volume 14, Issue 4, Pages 245-258 (May 1998) DOI: 10.1016/S0749-3797(98)00017-8

  5. www.cdc.gov

  6. www.cdc.gov

  7. www.cdc.gov

  8. Brains are built over time Use it or Lose it Experience-Expectant and Experience-Dependent

  9. Dopamine Endorphins Oxytocin Cortisol

  10. Toxic Stress Derails Healthy Development Maternal HPA axis trains Infant HPA Excess cortisol: neurotoxic Lower levels of cortisol: Induce neurons

  11. Social, Emotional and Cognitive Impairment Self Control Working Memory Mental Flexibility

  12. Is it ADHD or Trauma? Children ages 3-5 with > 2 ACEs: more likely to have trouble calming themselves, be easily distracted, have a hard time making and keeping friends. More than ¾ of those who are expelled from preschool have > 2 ACEs. (Finding from CAHMI data analysis) (NCTSN: Is it ADHD or trauma – A guide for clinicians Aug 2016)

  13. Health-Risk Behaviors

  14. Health-Risk Behaviors

  15. Chronic Medical Problems

  16. Chronic Medical Problems

  17. Parental Adverse Childhood Experiences (P-ACES)/ Intergenerational Trauma/ Epigenetics

  18. Protective factors

  19. SSNRE: Stable Supportive Nurturing Relationships and Environments

  20. Protective Factors • Parental Resilience • Social connections • Knowledge of parenting and child development • Concrete support in times of need • Social and emotional competence of the children

  21. The Process • Why are we looking at this issue? • What are we looking for? – Who should be assessed, when, how often, parents? • How do we find it? – How will questions be asked, questionnaire/interview, documentation, follow up. • What do we do once we have found it? Resource list, possible care co-ordinator, ask parents.

  22. Trauma informed care is Quality Improvement • Set the tone. • Use other modalities to open the topic : Posters, Did you know • Encourage developmental promotion. • Create a parent advisory group. • Shift of attitude – the family is the patient.

  23. Trauma informed care is Quality Improvement • Review and evaluate the process of asking questions. • Understand that listening can be therapeutic – “don’t just do something, stand there” • Encourage parents to come up with their own solutions. • Self-care is so important. Reflective supervision is helpful. • Find community partners.

  24. Responding to Adversity with HOPE (Health Outcomes from Positive Experiences) • Being in nurturing, supportive relationships. • Living, developing, playing, and learning in safe, stable, protective, and equitable environments • Having opportunities for constructive social engagement and to develop a sense of connectedness • Learning social and emotional competencies

  25. “You are not alone, it is not your fault and we will help”

  26. Resources • https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/journal.html • WV Department of Health and Human Resources, Health Statistics Center. (2018). West Virginia Behavioral Risk Factor Surveillance System Report, 2016 • https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Trauma-Guide.aspx • WV Infant Toddler mental health association • Healthysteps.org • Attachment and Biobehavioral Catchup • Child parent Psychotherapy

  27. - Nurse Family Partnership • - Healthy Families America • - www.wvaces.org • - https://teamwv.org/ • - http://healthygrandfamilies.com/ • - Stumbling blocks or stepping stones- Findings on ACEs in WV January 2018 • www.strengtheningfamilies.net Center for Study of Social Policy • www.zerotothree.org • - Center on the Developing Child At Harvard University • - Responding to ACEs With HOPE: Health Outcomes From Positive Experiences • Sege, Robert D. et al. Academic Pediatrics , Volume 17 , Issue 7 , S79 - S85

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