The short answer is EVERYONE needs to pay attention to the Adverse Childhood Experience (ACE) Study that began in 1995! Some of you may be thinking, “What’s the big deal – if it’s so important, why isn’t everyone already paying attention?” After all, it started 20 years ago. The average length of time it takes from what we know from research to putting it into practice is about 17 years. Therefore, starting to pay attention now to the ACE study and its implications is not too far off from the average. Now some of you may also be thinking “as long as social workers, mental health clinicians, psychologists, and physicians are paying attention to addressing the adverse childhood experiences, what does it matter if others even know about the study?”
Dr. Robert Block, the former President of the American Academy of Pediatrics, said “adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today.” Many public health issues require a broader response from policy makers, decision makers and even the general population in addition to the helping professionals, to successfully address the issues of concern.
Okay, so some of you may also be thinking that it’s a stretch to put this issue of adverse childhood experiences, i.e. “trauma,” at the top of the list when we have other issues that seem more important. Maybe it’s time to say a little more about the study, what it revealed, and why it is so important for a comprehensive public health approach.
Between 1995 and 1997, the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego conducted the initial phase of the study with over 17,000 adult patients by using a confidential survey during a physical examination visit that contained 10 questions about childhood maltreatment and family situations (before age 18) as well as questions about current health status and behaviors.
The 10 questions covered abuse, neglect, whether they had witnessed their mother being abused, whether their parents were separated or divorced and whether anyone in the family had mental illness, abused substances, or was incarcerated. A “yes” response to each of those 10 questions scored a “1” so the possible range for the ACE score was from “0” to “10.”
What the researchers found was that adverse childhood experiences are common – over 2/3 of this group of mostly white, mostly middle and upper class college educated adults with health insurance had an ACE score of at least 1 and 12% had a score of 4 or more. Below is a chart from the original study listing the percentages of individuals who responded yes to the 10 specific questions. More information can be found on the CDC website.
As they followed these patients through time they discovered the higher the ACE score, the greater the health risk. The health risks were not only for mental health or substance abuse issues but also for cancer and heart disease and other physical health problems. The chart to the right shows clearly how suicide attempts increase as the ACE score gets higher.
Individuals with a score of 6 or higher had a 20 year difference in life expectancy from individuals with a score of 0.
The chart to the left helps to explain the trajectory from early adverse childhood experiences through disrupted brain development that leads to social, emotional and cognitive impairment that can lead to adoption of health risk behaviors, disease, obesity, and social problems and eventually an early death.
Dr. Nadine Burke-Harris did a brilliant TED talk getting this message out about the implications of the ACE study to a broader group of people to help change this trajectory by intervening early. The interventions not only include a recommendation for screening in pediatric offices but also educating parents to understand the long term impact of early adverse experiences in an attempt to prevent some preventable trauma. Click the image to watch the video.
So, even though you may see this early intervention as something valuable that could help to make life better for those who are now children, you may be wondering about implications for those who are now adults and who have gone through their whole lives without ever addressing or possibly even disclosing their adverse childhood experiences.
National Public Radio aired a segment this week about the ACE study and implications for how these 10 questions from the ACE study can be used in a therapeutic way even with adult patients for those physicians who have the courage to ask: 10 Questions Some Doctors Are Afraid To Ask. This segment was part of a larger series called “What Shapes Health” that includes several other segments related to ACE study as well as an opportunity to find your ACE score.
Now you may be wondering about cost. If we are going to think about a comprehensive public health approach, won’t that be too expensive? Australia recently released a report showing that as a nation, Australia could save a minimum of $6.8 billion annually by addressing the impacts of unresolved child abuse in adults and a minimum of $9.1 billion annually by addressing the impacts of childhood trauma more broadly. Click here to read details of this report.
So now that you’re paying attention, you may want to join folks in exploring how you can get involved in this movement to address adverse childhood experiences as a public health issue by visiting our new trauma tool, “Trauma Informed Care: Perspectives and Resources,” a collaborative project between Georgetown University National Technical Assistance Center for Children’s Mental Health and JBS International. Individuals in over 80 countries have viewed our trauma tool and it’s received over 90,000 hits.
For questions, please contact
Sherry Peters, MSW, ACSW
Senior Policy Associate
Georgetown University National Technical Assistance Center for
Children’s Mental Health