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ACE and Trauma-Informed Care

Adverse Childhood Experiences and Trauma Informed Care: the future of health care.
Oral R, Peek-Asa C. et. al.
Pediatr Res. 2016 Jan;79(1-2):227-33. Full Article: Download ACE & Trauma Informed Care

Abstract: Adverse childhood experiences (ACEs) are related to short- and long-term negative physical and mental health consequences among children and adults. Studies of the last three decades on ACEs and traumatic stress have emphasized their impact and the importance of preventing and addressing trauma across all service systems utilizing universal systemic approaches. Current developments on the implementation of trauma informed care (TIC) in a variety of service systems call for the surveillance of trauma, resiliency, functional capacity, and health impact of ACEs. Despite such efforts in adult medical care, early identification of childhood trauma in children still remains a significant public health need. This article reviews childhood adversity and traumatic toxic stress, presents epidemiologic data on the prevalence of ACEs and their physical and mental health impacts, and discusses intervention modalities for prevention.

Being Bullied Is Bad for Your Health

by Nicholas Bakalar
New York Times, May 13, 2014

[This is an important piece.  It is likely that bullying has similar effects to adverse childhood experiences (ACE). The latter is more common, but it may turn out that bullying has the some of the same longterm effects. DJE]

Victims of bullying may develop long-term physical and mental health problems, and now researchers have found one possible reason: Being bullied raises the blood’s level of C-reactive protein, or CRP, a marker of systemic inflammation and a risk factor for cardiovascular and other diseases.

Scientists followed 1,420 boys and girls ages 9 to 21, interviewing bullies, victims and their parents. They assessed CRP levels with periodic blood tests.

After controlling for initial levels of CRP and for many factors that affect it — sex, age, race and various health and socioeconomic issues — the researchers found that CRP levels in victims increased in direct proportion to the number of bullying incidents they experienced.

Bullies, in contrast, had low increases in CRP, even lower than those in children not involved in bullying at all. The finding suggested that a bully’s increased social status might have biological advantages, the scientists said. Their study was published online on Monday in The Proceedings of the National Academy of Sciences.

“The only other kind of social adversity where we see this kind of long-term effect is in children who are physically abused or neglected,” said the lead author, William E. Copeland, an associate professor of psychiatry at Duke. “We don’t think about bullying the same way, but I’m moving toward the position that we should. This kind of social defeat is more potent and long-lasting than we previously thought.”

The article about which this Times piece was written is available full text in the Proceedings of the National Academy of Sciences: Childhood bullying involvement predicts low-grade systemic inflammation into adulthood, by William E. Copeland and others.

Related articles

ACE and Resilience Questionnaires

ACE and Resilience Questionnaires

ACE Score Questionnaire  Download ACE Score Questionnaire

What’s Your ACE Score? (and, at the end, What’s Your Resilience Score?)

Background

There are 10 types of childhood trauma measured in the ACE Study. Five are personal — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma counts as one. So a person who’s been physically abused, with one alcoholic parent, and a mother who was beaten up has an ACE score of three.

 

What’s Your Resilience Score?  Download Rersilience Questionnaire

This questionnaire was developed by the early childhood service providers, pediatricians, psychologists, and health advocates of Southern Kennebec Healthy Start, Augusta, Maine, in 2006, and updated in February 2013. Two psychologists in the group, Mark Rains and Kate McClinn, came up with the 14 statements with editing suggestions by the other members of the group. The scoring system was modeled after the ACE Study questions. The content of the questions was based on a number of research studies from the literature over the past 40 years including that of Emmy Werner and others. Its purpose is limited to parenting education. It was not developed for research.

ACE Background

Adverse childhood experiences (ACEs) cause kids to have a hard time learning, making friends and trusting adults. They can’t keep up in school, so they shut down or get in fights. They’re the “problem” kids. Schools suspend them. There’s lots of ways for kids to cope with their trauma.  Alcohol. Drugs. Smoking. Food. Kids become daredevils and break their bones. Sleep around and get STDs. Grow up too fast and become workaholics.  ACEs can cause health problems later in life, too. Vincent Felitti and colleagues found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.

For background information on ACEs, please see the website: ACEstoohigh.com.

You can check your ACE Score if you wish.

Printable ACE Questionnaire.

A good article on ACEs is Paul Tough's "The Poverty Clinic" which appeared originally in the New Yorker.