The ADVERSE CHILDHOOD EXPERIENCE study

1. THE ADVERSE CHILDHOOD EXPERIENCE STUDY Through the findings in the Adverse Childhood Experiences Study or ACE Study, we now know that toxic stress has a damaging impact on the developing brain and sets the stage for a lifetime of health, behavioral health, learning and social problems— problems that compromise long-term well-being and often result in the next generation repeating the vicious cycle. It’s a complex problem rooted in unhealthy relationships and environments. Many of the boys we work with at Hanna are struggling to overcome ACEs—the adversity and toxic stress caused by abuse, neglect, violence, family issues with substance abuse and mental illness, poverty, racism, immigration and so on. Preventing and treating it means influencing individual behaviors, relationships among families, neighbors and community involvement. If the stress stops and is replaced by practices that build resilience, the brain can slowly undo many of the stress-induced changes. There is well-documented research on how brains and bodies become healthier through mindfulness practices, exercise, good nutrition, adequate sleep and healthy social interactions. toxic At Hanna we focus on the practices of empowering change, building resilience and developing mastery, creating a safe, stable and nurturing environment for boys and their families. These elements are essential in assuring our boys are able reach their full potential, growing up to be healthy and productive citizens so that they, in turn, can build stronger and safer families and communities for their children. 17000 Arnold Drive, Sonoma, CA 95476-0100 Telephone: 707.996.6767 | Toll Free: 1.877.994.2662

2. WHAT IS THE ACE STUDY? The Adverse Childhood Experiences (ACE) Study is one of the largest studies ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego. The initial phase of the ACE Study was conducted at Kaiser Permanente from 1995 to 1997, and more than 17,000 Health Maintenance Organization (HMO) members under-went a standardized physical examination. Each willing participant completed a confidential survey that contained questions about childhood maltreatment and family dysfunction, as well as items detailing their current health status and behaviors. This information was combined with the results of their physical examination to form the baseline data for the study. 10 CATEGORIES WERE MEASURED IN THE ACE QUESTIONNAIRE:           Physical abuse Sexual abuse Verbal abuse Physical neglect Emotional neglect Having a family member with depression or diagnosed with a mental illness Having a family member with alcohol or substance addictions Having a family member in prison Witnessing a mother being abused Losing a parent to separation, divorce or other reason. There are many other types of childhood trauma—witnessing a sibling being abused, community violence, homelessness, food insecurity, being the victim of racism, or being bullied by a classmate or teacher—but only these 10 types, identified above, were measured. They provide a useful marker for the severity of trauma experienced. Other types of trauma may have a similar impact. MAJOR FINDINGS The ACE Study uses an ACE Score, which is a total count of the number of adversities experienced in childhood, from the above-listed 10 categories. Each type of adversity counts as one, no matter how many times it occurs. This score is then used to assess the total amount of stress during childhood and has demonstrated that as the number increases, the risk for the following health problems increases in a strong and graded fashion:     Alcoholism and alcohol abuse Chronic obstructive pulmonary disease (COPD) Multiple sexual partners Sexually transmitted diseases (STDs) 17000 Arnold Drive, Sonoma, CA 95476-0100 Telephone: 707.996.6767 | Toll Free: 1.877.994.2662

3.              Depression Fetal death Health-related quality of life Illicit drug use Ischemic heart disease (IHD) Liver disease Risk for intimate partner violence Smoking Suicide attempts Unintended pregnancies Early initiation of smoking Early initiation of sexual activity Adolescent pregnancy You can think of an ACE score as a cholesterol score for childhood trauma. For example, people with an ACE score of four are twice as likely to be smokers and seven times more likely to be alcoholic. Having an ACE score of four increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and suicide by 1200 percent. Most boys at Hanna have an ACE score of 4 or People with high ACE scores are more likely to be violent, have more accidents, sustain more broken bones, use more drug prescriptions, be more depressed and more likely to suffer with autoimmune People with an ACE score of six or higher are at risk of their lifespan being shortened by 20 years. more. diseases. WHY ARE ACES SUCH A BIG DEAL? The ACE Study revealed five significant findings:   ACEs are common: nearly two-thirds (64 percent) of adults have at least one. They are highly related to the adult onset of chronic disease, such as heart disease, diabetes, as well as mental illness, violence and being a victim of violence. ACEs don’t occur alone: if you have one, there’s an 87 percent chance that you have two or more. The more ACEs you have, the greater the risk for chronic disease, mental illness, violence and being a victim of violence. ACEs are responsible for a higher rate of workplace absenteeism, costs in health care, emergency response, mental health and criminal justice, and are a major contributor to most of our major chronic physical, mental, economic, and social health issues.    WHAT’S THE NEUROBIOLOGY OF TOXIC STRESS? Brain science shows that, in the absence of protective factors, toxic stress damages children’s developing Stress is the body’s normal response to challenging events or environments. Positive stress—the first day of school, a big exam, a game, a dance recital— is moderate and doesn't last long. It's brains. 17000 Arnold Drive, Sonoma, CA 95476-0100 Telephone: 707.996.6767 | Toll Free: 1.877.994.2662

4. part of growing up, and with support from parents or caregivers, children are prepared for and learn how to handle such stressors. Stress increases the heart rate and the amount of stress hormones in the body, but with positive stress, hormonal levels return to normal levels quickly. But when events or the environment are threatening or harmful—we come face-to-face with a bear in the woods or our house catches fire—then our brains instantly flip into fight, flight or freeze mode. Our thinking brains are bypassed, because we need action not analysis. Hopefully, for most of us, most of the time these episodes are few and far between. With help from caring adults, children can also recover from these intense but tolerable stressors. Stress becomes toxic howver when it is intense and persistent. The child’s brain and body will produce an overload of stress hormones, such as cortisol and adrenaline that harm the function and structure of the brain. This can be particularly devastating in children whose brains are developing at a rapid pace from Toxic stress is the kind of stress that can come in response to living for months or years with an alcoholic father, a severely depressed mother or parents who taks out life’s frustrations by hitting their child. conception until age three. RESILIENCE RESEARCH: A HIGH ACE SCORE IS NOT A LIFE SENTENCE The good news is that the brain is plastic and the body wants to heal. The brain is continually changing in response to the environment. If the toxic stress stops and is replaced by practices that build resilience, the brain can slowly undo many of the stress-induced changes. There is well-documented research on how individuals’ brains and bodies become healthier through mindfulness practices, exercise, good nutrition, adequate sleep, and healthy social interactions. To learn more about ACEs, The ACE Study, the impact of toxic stress and what some communities are doing to address these issues, visit acesconnection.com or acestoohigh.com 17000 Arnold Drive, Sonoma, CA 95476-0100 Telephone: 707.996.6767 | Toll Free: 1.877.994.2662