Adverse Childhood Experiences (ACEs) are repeated, traumatic events in children’s lives that can affect their health and wellbeing into adulthood. ACEs involve episodes of physical or emotional abuse, neglect, witnessing domestic violence, and having family members who experience substance abuse, mental illness, or incarceration. Researchers believe that an understanding of ACEs is key to preventing a range of public health problems, including alcohol and drug abuse, high-risk sexual behavior, depression, and suicide.
To build awareness of ACEs research and its relevance to substance abuse prevention, the CAPT’s West Resource Team (RT) facilitated a two-day workshop in May entitled Adverse Childhood Experiences: Implications for Substance Abuse Prevention and Mental Health Promotion. The workshop featured an overview of ACEs as well as presentations that explored ways prevention practitioners can use ACEs data in their comprehensive planning. It was offered to prevention leaders including state epidemiology workgroup chairs.
“With the increased emphasis on partnering with other agencies, ACEs provides a common issue around which agencies can rally,” said Alyssa O’Hair, coordinator for the West RT. “ACEs are a shared risk factor for both substance abuse and mental health. Prevention practitioners are just beginning to look at the cumulative effects of these risk factors and how they might work together to address them.”
The CAPT workshop began with a presentation by Dr. Robert Anda, entitled Adverse Childhood Experiences: Connecting a Developmental Lens to the Health of Society. Anda is co-principal investigator of the ACE Study – an ongoing, joint project of the Centers for Disease Control and Kaiser Permamente Health Care in San Diego. The study draws on ACE data from 17,000 Kaiser members in the San Diego area.
In his presentation, Anda underscored the interrelationship of adverse childhood experiences. “Where there’s one ACE, there are others,” he explained. “Where there is alcohol abuse in the family, there’s more child abuse, domestic violence, emotional abuse and other adversities.” Children affected by ACEs are more likely to grow up and repeat these behavior patterns with their own offspring unless the cycle of abuse is interrupted. “If we can change the level of stress that children grow up with in our homes, in our communities and families, there’s a tremendous opportunity for prevention of many things, including substance abuse and mental illness.”
To help determine the prevalence of ACEs in their communities, Anda recommended that states collect their own ACEs data through existing health surveys, such as the Behavioral Risk Factor Surveillance System. Eighteen states are currently collecting their own ACE data; more are expected to do so. Anda cited Washington as a leading example of a state that has incorporated ACEs awareness into all aspects of its state services.
The other three workshop presenters expanded on the use of ACEs in prevention work. Dr. Heather Larkin, assistant professor at the University of Albany School of Social Welfare, delivered the presentation, Adverse Childhood Experiences: Implications for Substance Abuse Prevention and Planning. She offered a framework for using ACEs to inform prevention and treatment planning.
Laura Porter, director of the Washington State Family Policy Council, has worked extensively with Anda. Her presentation, entitled ACE Reduction and Resilience Promotion, focused on how Washington is using ACE data to support its substance abuse prevention and mental health promotion efforts.
Finally, Scott Waller, prevention integration lead for Washington’s Department of Social and Health Services, concluded with the presentation, Expanding the Use of ACEs in Washington: Getting Over the Wall, which focused on strategies for integrating ACES into SAMHSA’s five-step Strategic Prevention Framework.
Over the next several months, other states served by SAMHSA’s CAPT will determine their readiness to incorporate ACEs concepts into their prevention planning efforts. According to O’Hair, “They are all in different places. We plan to have a conference call with the states in our service area, to reflect on what they’ve been thinking since the workshop. Then the CAPT will offer more individualized technical assistance as needed.”
For more information, contact CAPT Epidemiologist Kristin Clements-Nolle: firstname.lastname@example.org
The Adverse Childhood Experiences Study This site offers an overview of the Adverse Childhood Experiences Study.
Adverse Childhood Experiences and Population Health in Washington: The Face of a Chronic Health Disaster This paper presents results from the 2009 Behavioral Risk Factor Surveillance System.
ACE Course This online course, developed by the Family Planning Council, covers brain science, the Adverse Childhood Experiences (ACE) Study, and resilience research. Participants will learn the prevalence and high-cost lifelong outcomes of ACEs, the vital role of culture and community to optimize well being, and how to use this emerging research to create transformative conversations.