aces and childhood trauma: social determinants of health
TRANSCRIPT
ACEs and Childhood Trauma: Social Determinants of Health
Approaches to Reduce Infant Mortality to Ensure Positive Birth Outcomes:
Causes and Solutions for Health Disparities and Inequalities
Altha J. Stewart, M.D.Associate Professor and Chief, Social and Community Psychiatry
Director, Center for Health in Justice Involved YouthUniversity of Tennessee Health Science Center
• Dr. Stewart is President-elect of the American Psychiatric Association Board of Trustees but the opinions expressed in her presentation today are her own and do not reflect the views or policies of the APA.
• She has no financial disclosures or conflicts of interest to report regarding the content in this presentation.
10th Annual Family Medicine / Psychiatry CME Conference
Social Determinants of Mental Health
Social/Physical
environment
Healthy child
development
Income and social status
Social support networks
Education/Employment
Health services
Trauma and Juvenile Justice
• Being abused or neglected as a child increases the likelihood of arrest as a juvenile by 59% (Widom, CS, 1995).
• 70% - 92% of incarcerated girls reported sexual, physical, or severe emotional abuse in childhood (DOC, 1998; Chesney & Shelden, 1992).
Academic-Community Partnership
Trauma and Adverse Childhood Experiences (ACEs)
National ACEs Study
More than 4 ACEs:
• 3.9 times as likely to have chronic bronchitis or emphysema
• 2.4 times as likely to have hepatitis or jaundice • 2.2 times as likely to have heart disease• 1.9 times as likely to have had cancer• 2.2 times as likely to have fair to poor self‐rated
health
Children with High ACEs:
• Appear guarded and anxious and are difficult to re-direct
• Are highly emotionally reactive and have difficulty “settling” after outbursts
• Control is external, not internalized• World is threatening, bewildering, punitive,
judgmental, humiliating and blaming
Impact of trauma on normal adolescent development
Shelby County Prevalence
of ACEs 48%
20%
21%
12%
0
1
2,3
4+
http://acestoohigh.com/2017/01/23/t
he-most-important-thing-i-didnt-
learn-in-medical-school-adverse-childhood-experiences/
To Help Youth with
Trauma Brain,
Treat
Entire FamilyBy Dr. Cathy Anthofer-Fialon | February 18, 2016
Trauma Among Youth in the Juvenile
Justice System:
Critical Issues and New DirectionsJulian D. Ford1, John F. Chapman2, Josephine
Hawke3, and David Albert
Screening and Assessment in Juvenile Justice Systems: Identifying Mental Health Needs and Risk of Reoffending Gina M. Vincent, Ph.D. Associate Professor Co-Director, National Youth Screening & Assessment Project Center for Mental Health Services Research Department of Psychiatry University of Massachusetts Medical School
January 2012
Juvenile Jails Adopting ACE- and
Trauma-
Informed PracticesBy Ed Finkel | May 27, 2015
Youth in Trauma Informed Care
• Spend more time in school
• Have improved grades
• Have fewer arrests
• Show reductions in disciplinary problems
• Have improved emotional health
• Have fewer suicide attempts
Caregivers of Children Served in Trauma Informed Care Report..
• Reduced strain associated with caring for a child who has a serious mental health condition
• Fewer missed days of work
• Improvement in overall family functioning
Studies have shown that when we address these ‘social’ issues we move the needle on:
• Reducing disparities in health and mental health care
• Improving overall health and wellness in the population
• Reducing impact of SDOH on individuals in the population
• Reducing morbidity associated with chronic medical and mental illnesses
• Improving academic and work performance
Trauma and ACEs: Community SolutionsINTERVENTIONS: trauma informed care by appropriately trained providers
– Range of trauma informed treatments made available (TFCBT, CPP, PCIT) – Incorporation of ACE interviews into parent and/or adolescent outreach and
education activities
POLICY: policy development and education about critical health/behavioral health issues– Universal trauma screening for all youth– Identify risk factors and create policies to address them
• Prevention – domestic and community violence; legal services; safe housing; community policing/DCS/MH - safe spaces for children to grow and thrive
• Parent and community education re: impact of ACEs and childhood trauma
PROFESSIONAL AND COMMUNITY TRAINING: consumer and community engagement, education and empowerment
– Trauma focused screening and treatment training– Community awareness/education– General Awareness campaigns/media blitz– Faith based health educators – community and family engagement
Risk factors are not predictive factors due to
protective factors
Certified Family Support Specialist
This Medicaid reimbursable service under the direction of the TN Department of Mental Health and Substance Abuse Services:
a) Provide family-based services (e.g. wraparound) b) Assist caregivers in obtaining services that are responsive to each family’s individual needs and culturec) Assist caregivers in developing problem-solving skills to respond effectively to child and/or family crises d) Assist providers in identifying programs that support resiliency and are family-driven and youth-guided in nature
The Science of ACES and Resilience goes ‘Hollywood’
