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Guest commentary / Adverse childhood experiences

Connections to adult problems clearer

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By Jim Teverbaugh and Michele Rastovich
Everyone knows that harsh, hurtful and negative emotional experiences in childhood make certain people more vulnerable to developing drug and alcohol problems as teens and adults. The Adverse Childhood Experiences (ACE) Study shows us that those same childhood experiences also make it much more likely that certain adults will have chronic debilitating diseases, employment problems and mental illness.
The ACE Study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente. It is perhaps the largest scientific research study of its kind, showing a direct, causal relationship between nine categories of adverse childhood experience (physical abuse; emotional abuse; sexual abuse; an alcohol and/or drug abuser in the household; an incarcerated household member; living with someone who is chronically depressed, mentally ill, institutionalized, or suicidal; witnessing domestic violence against the mother; parental discord indicated by divorce, separation, abandonment; emotional or physical neglect) and at least 18 physical, mental and behavioral health outcomes.
The more ACEs, the higher the rate of mental, physical, behavioral disease and disability in the population, including higher rates of chronic disease, low educational achievement and increased violence.
In the words of the Adverse Childhood Experiences Study authors: "The ACE Study reveals a powerful relationship between our emotional experiences as children and our physical and mental health as adults, as well as the major causes of adult mortality in the United States. It documents the conversion of traumatic emotional experiences in childhood into organic disease later in life. How does this happen, this reverse alchemy, turning the gold of a newborn infant into the lead of a depressed, diseased adult? The Study makes it clear that time does not heal some of the adverse experiences we found so common in the childhoods of a large population of middle-aged, middle class Americans. One does not 'just get over' some things, not even fifty years later."
In Washington, 26 percent of the adult population has three or more categories of ACE; 5 percent has six or more ACEs. It is a credible assumption that a community able to reduce ACEs will simultaneously reduce many factors known to influence health in the general population, and, in the long term, reduce the rates of cardiovascular disease, substance addiction, mental illness, obesity and community violence.
The Washington State Family Policy Council first introduced the ACEs research to Washington in 2003. With this new information, the Snohomish County Prevention Partners discovered a new lens by which to consider local prevention efforts and have been meeting with local leaders to discuss the implications of this research on public policy; how our systems work together; and how we deliver services in Snohomish County.
Increasing awareness and helping organizations understand how to incorporate ACE information and screening into care planning and service provision will result in improved health outcomes for individuals by insuring appropriate care is accessed, creating more appropriate care planning and increasing the likelihood that key causes of disease are addressed. Increasing awareness of ACEs in the general public will help reduce rates of ACEs in the community.
Adverse Childhood Experiences occur within the context of relationships -- specifically the relationships among people in the household of a child during his/her development. So, action to reduce ACEs must be broad enough to reach the adults and youth within those households and in trusted contact with household residents.
Additionally, professionals who are working with family members can, and should, have specific knowledge and competencies to address ACE-related risks and to help to mitigate ACE effects.
Greater community-based knowledge and understanding provides a larger context for service providers to integrate ACEs into their work, and offer support for the positive behavioral changes individuals need.

Jim Teverbaugh is executive director of the Snohomish County Federated Health and Safety Network. Michele Rastovich is coordinator of Snohomish County Community Mobilization Against Drugs and Violence.

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