Adverse Childhood Experiences (ACEs)

Instructions

After completing the reading and watching the video( transcript for video is at the bottom of instructions), write a three- to four-page paper that addresses the following:*What is your response to the statistic in the article that 35 million (or about half of the U.S. population of children) have experienced at least one of the ten ACEs?*What do you think the implications are for these children and for the mental health of our society as these children grow up?*If you had the influence and ability to implement one major initiative on a national level to address this tragic trend of childhood ACEs, what would it be? Explain in detail.*Suggest one application of how you could be a positive influence to advocate for the safety and respectful treatment of children within the realms that you currently live.-Elaborate fully in your responses. Be sure to cite your sources in APA format in the text of your paper and in a reference page at the end.***Reading https://acestoohigh.com/2013/05/13/nearly-35-million-u-s-children-have-experienced-one-or-more-types-of-childhood-trauma/***Video Transcript "Citing if used" TedTalks: Nadine Burke Harris's how childhood trauma affects health across a lifetime [Video file]. (2015). Retrieved July 12, 2019, from https://0-fod-infobase-com.oak.indwes.edu/PortalPlaylists.aspx?wID=98671&xtid=114600[MUSIC PLAYING] [APPLAUSE] In the mid '90s, the CDC and Kaiser Permanente discovered an exposure that dramatically increased the risk for 7 out of 10 of the leading causes of death in the United States.00:00:27In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed.00:00:39Folks who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20-year difference in life expectancy, and yet doctors today are not trained in routine screening or treatment.00:00:58Now, the exposure I'm talking about is not a pesticide or a packaging chemical.00:01:03It's childhood trauma.00:01:07OK, what kind of trauma am I talking about here?00:01:09I'm not talking about failing a test or losing a basketball game.00:01:14I am talking about threats that are so severe or pervasive that they literally get under our skin and change our physiology, things like abuse or neglect or growing up with a parent who struggles with mental illness or substance dependence.00:01:32Now, for a long time, I viewed these things in the way I was trained to view them, either as a social problem, refer to social services, or as a mental health problem, refer to mental health services.00:01:46And then something happened to make me rethink my entire approach.00:01:52When I finished my residency, I wanted to go someplace where I felt really needed, some place where I could make a difference, so I came to work for California Pacific Medical Center, one of the best private hospitals in Northern California.00:02:07And together, we opened a clinic in Bayview-Hunters Point, one of the poorest, most under-served neighborhoods in San Francisco.00:02:16Now, prior to that point, there had been only one pediatrician in all of Bayview to serve more than 10,000 children.00:02:24So we hung a shingle, and we were able to provide top-quality care, regardless of ability to pay.00:02:31It was so cool.00:02:33We targeted the typical health disparities-- access to care, immunization rates, asthma hospitalization rates-- and we hit all of our numbers.00:02:42We felt very proud of ourselves, but then I started noticing a disturbing trend.00:02:48A lot of kids were being referred to me for ADHD, or Attention Deficit Hyperactivity Disorder, but when I actually did a thorough history and physical, what I found was that for most of my patients, I couldn't make a diagnosis of ADHD.00:03:07Most of the kids I was seeing had experienced such severe trauma that it felt like something else was going on.00:03:16Somehow, I was missing something important.00:03:21Now, before I did my residency, I did a master's degree in public health.00:03:25And one of the things that they teach you in public health school is that if you are a doctor, and you see 100 kids that all drink from the same well, and 98 of them develop diarrhea, you can go ahead and write that prescription for dose after dose after dose of antibiotics.00:03:44Or you can walk over and say, what the hell is in this well?00:03:49So I began reading everything that I could get my hands on about how exposure to adversity affects the developing brains and bodies of children, and then one day my colleague walked into my office.00:04:03And he said, Dr. Burke, have you seen this?00:04:09In his hand was a copy of a research study called The Adverse Childhood Experiences Study.00:04:16That day changed my clinical practice and ultimately my career.00:04:24The Adverse Childhood Experiences Study is something that everybody needs to know about.00:04:29It was done by Dr. Vince Felittie at Kaiser and Dr. Bob Anda at the CDC, and together they asked 17 and 1/2 thousand adults about their history of exposure to what they called Adverse Childhood Experiences, or ACEs.00:04:49Those include physical, emotional, or sexual abuse, physical or emotional neglect, parental mental illness, substance dependence, incarceration, parental separation, or divorce, or domestic violence.00:05:05For every yes, you would get a point on your ACE score, and then what they did was they correlated these ACE scores against health outcomes.00:05:17What they found was striking.00:05:20Two things, number one, ACEs are incredibly common.00:05:2567% of the population had at least one ACE, and 12.6%, 1 in 8, had 4 or more ACEs.00:05:39The second thing that they found was that there was a dose-response relationship between ACEs and health outcomes.00:05:49The higher your ACE score, the worse your health outcomes.00:05:53For a person with an ACE score of four or more, their relative risk of chronic obstructive pulmonary disease was 2 and 1/2 times that of someone with an ACE score of 0.00:06:05For hepatitis, it was also 2 and 1/2 times.00:06:08For depression, it was 4 and 1/2 times.00:06:11For suicidality, it was 12 times.00:06:15A person with an ACE score of 7 or more had triple the lifetime risk of lung cancer and 3 and 1/2 times the risk of ischemic heart disease, the number one killer in the United States of America.00:06:31Well, of course, this makes sense.00:06:33You know, some people looked at this data, and they said, come on.00:06:39You know, you have a rough childhood, you're more likely to drink and smoke and do all these things that are going to ruin your health.00:06:46This isn't science.00:06:47This is just bad behavior.00:06:50It turns out this is exactly where the science comes in.00:06:55We now understand better than we ever have before how exposure to early adversity affects the developing brains and bodies of children.00:07:06It affects areas like the nucleus accumbens, the pleasure and reward center of the brain that is implicated in substance dependence.00:07:14It inhibits the prefrontal cortex, which is necessary for impulse control and executive function, a critical area for learning, and on MRI scans, we've seen measurable differences in the amygdala, the brain's fear response center.00:07:32So there are real neurologic reasons why folks exposed to high doses of adversity are more likely to engage in high risk behavior, and that's important to know.00:07:44But it turns out that even if you don't engage in any high risk behavior, you're still more likely to develop heart disease or cancer.00:07:56The reason for this has to do with the hypothalamic pituitary adrenal axis, the brain's and body's stress response system that governs our fight-or-flight response.00:08:09How does it work?00:08:11Well, imagine you're walking in a forest, and you see a bear.00:08:15Immediately, your hypothalamus sends a signal to your pituitary, which sends a signal to your adrenal gland, that says, release stress hormones-- adrenaline, cortisol.00:08:25And so your heart starts to pound.00:08:27Your pupils dilate.00:08:29Your airways open up, and you are ready to either fight that bear or run from the bear.00:08:36And that is wonderful if you're in a forest, and there's a bear.00:08:44But the problem is what happens when the bear comes home every night, and this system is activated over and over and over again.00:08:56And it goes from being adaptive or lifesaving to maladaptive or health damaging.00:09:04Children are especially sensitive to this repeated stress activation because their brains and bodies are just developing.00:09:13High doses of adversity not only affect brain structure and function.00:09:20They affect the developing immune system, developing hormonal systems, and even the way our DNA is read and transcribed.00:09:32So for me, this information threw my old training out the window because when we understand the mechanism of a disease, when we know not only which pathways are disrupted but how, then as doctors it is our job to use this science for prevention and treatment.00:09:53That's what we do.00:09:54So in San Francisco, we created the Center for Youth Wellness to prevent, screen, and heal the impacts of ACEs and toxic stress.00:10:04We started simply with routine screening of every one of our kids at their regular physical because I know that if my patient has an ACE score of 4, she's 2 and 1/2 times as likely to develop hepatitis or COPD.00:10:19She's 4 and 1/2 times as likely to become depressed, and she's 12 times as likely to attempt to take her own life as my patient with zero ACEs.00:10:28I know that when she's in my exam room.00:10:32For our patients who do screen positive, we have a multi-disciplinary treatment team that works to reduce the dose of adversity and treat symptoms using best practices including home visits, care coordination, mental health care, nutrition, holistic interventions, and, yes, medication when necessary.00:10:54But we also educate parents about the impact of ACEs and toxic stress the same way you would for covering electrical outlets or lead poisoning, and we tailor the care of our asthmatics and our diabetics in a way that recognizes that they may need more aggressive treatment given the changes to their hormonal and immune systems.00:11:18So the other thing that happens when you understand this science is that you want to shout it from the rooftops because this isn't just an issue for kids in Bayview.00:11:29I figured the minute that everybody else heard about this, it would be routine screening, multi-disciplinary treatment teams, and it would be a race to the most effective clinical treatment protocols.00:11:41Yeah, that did not happen, and that was a huge learning for me.00:11:47What I had thought of as simply best clinical practice I now understand to be a movement.00:11:57In the words of Dr. Robert Block, the former president of the American Academy of Pediatrics, adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today, and for a lot of people, that's a terrifying prospect.00:12:17The scope and scale of the problem seems so large that it feels overwhelming to think about how we might approach it.00:12:26But for me, that's actually where the hope lies because when we have the right framework, when we recognize this to be a public health crisis, then we can begin to use the right toolkit to come up with solutions.00:12:44From tobacco to lead poisoning to HIV/AIDS, the United States actually has quite a strong track record with addressing public health problems, but replicating those successes with ACEs and toxic stress is going to take determination and commitment.00:13:05And when I look at what our nation's response has been so far, I wonder.00:13:12Why haven't we taken this more seriously?00:13:15You know, at first, I thought that we marginalized the issue because it doesn't apply to us, right?00:13:21That's an issue for those kids in those neighborhoods, which is weird because the data doesn't bear that out.00:13:28The original ACEs study was done in a population that was 70% Caucasian, 70% college educated, but then the more I talk to folks, I'm beginning to think that maybe I had it completely backwards.00:13:47If I were to ask how many people in this room grew up with a family member who suffered from mental illness, I bet a few hands would go up.00:14:00And then if I were to ask how many folks had a parent who maybe drank too much, or who really believed that if you spare the rod, you spoil the child, I bet a few more hands would go up.00:14:14Even in this room, this is an issue that touches many of us, and I'm beginning to believe that we marginalize the issue because it does apply to us.00:14:25Maybe it's easier to see in other zip codes because we don't want to look at it.00:14:30We'd rather be sick.00:14:33Fortunately, scientific advances and, frankly, economic realities make that option less viable every day.00:14:45The science is clear.00:14:48Early adversity dramatically affects health across a lifetime.00:14:53Today, we are beginning to understand how to interrupt the progression from early adversity to disease and early death, and 30 years from now, the child who has a high ACE score and whose behavioral symptoms go unrecognized, whose asthma management is not connected, and who goes on to develop high blood pressure and early heart disease or cancer, will be just as anomalous as a six-month mortality from HIV/AIDS.00:15:25People will look at that situation and say, what the heck happened there?00:15:30This is treatable.00:15:32This is beatable.00:15:35The single most important thing that we need today is the courage to look this problem in the face and say, this is real.00:15:44And this is all of us.00:15:48I believe that we are the movement.00:15:53Thank you.00:15:54[APPLAUSE] [MUSIC PLAYING]

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