Last week, at the California Home Visiting Summit, about 500 amazing front-line caregivers gathered to share their experiences and learn about the latest research and practice.
I was invited to give a presentation about "the unified science of ACEs", which includes the epidemiology of adverse childhood experiences (the original CDC-Kaiser Permanente ACE Study and all the other subsequent ACE surveys), the neurobiology of toxic stress, the long-term biomedical and epigenetic consequences of toxic stress, and resilience research, across the lifespan.
In other words, who's affected by ACEs, how toxic stress affects the brain and the body, how it's transmitted from generation to generation, and how we're preventing and healing the damage at all ages.
I call it ACEs science. (If you're interested, my presentation is attached.)
As I often do during presentations, I offered those who wanted to do so, to participate in an anonymous survey that would show us instantly the ACE scores in the room (and to talk with anyone afterwards if they wanted to). We've posted the results from other meetings previously. (Sonoma County Blue Ribbon Training, International Attachment Conference)
What wasn't surprising is that, for most questions, the percentage of people answering "yes" to the ACE questions was higher than the original ACE Study.
But what was -- and should be -- of concern to California's home visiting program is how many people had an ACE score of 4 or more. It's at an ACE score of four or higher that you start to see very significant health effects. That's something that I hadn't asked in other presentations, because either that multiple choice wasn't available, or I didn't know about it. (I use PollEverywhere.com.)
The image at the top of this blog shows the results -- 63% -- for the afternoon session during which 23 people responded. For the morning session, where 56 people responded, the result was 51 percent -- more than four times the percentage in the original ACE Study, which was 12.5%. According to the latest California data (2011 and 2013), 16% of the state's residents have an ACE score of 4 or more.
Of course, this is a relatively small sample, but the results are significant enough that it's probably useful to do an anonymous ACE survey of all home visitors -- combined with education about ACEs science and self-care. (A good toolkit for this is the NEAR@Home toolkit for home visitors. It's being used by other related professions, as well. And here's some research in which home visitors participated that looked at how self-care, specifically mindfulness, helped them be physically and mentally healthier, no matter what their ACE scores.)
These results show that, as for any caring profession -- people who work in child welfare, domestic violence shelters, homeless shelters, substance abuse clinics, medical clinics, in education, and, yes, even in law enforcement and criminal justice -- it's likely that ACE scores are high for more people than we realize. And it's important for people to learn what their ACE scores are so that they understand how important self-care is, not only for themselves, but for those they serve.
Below are the results from the conference morning and afternoon sessions for the 10 questions of the original ACE Study:
1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you?
ACE Study -- 10.6% "Yes"
CA home visitors (morning session - 56 people) -- 46%
CA home visitors (afternoon session - 23 people) -- 45%
2. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way?
ACE Study -- 20.7% "Yes"
CA home visitors (morning session - 56 people) -- 59% "Yes"
CA home visitors (afternoon session - 23 people) -- 43% "Yes"
3. Did you often or very often feel that … No one in your family loved you or thought you were important or special?
ACE Study -- 14.8% "Yes"
CA home visitors (morning session - 56 people) -- 36% "Yes"
CA home visitors (afternoon session - 23 people) -- 26% "Yes"
4. Did you often or very often feel that … You didn't have enough to eat, had to wear dirty clothes, and had no one to protect you?
ACE Study -- 9.9% "Yes"
CA home visitors (morning session - 56 people) -- 15% "Yes"
CA home visitors (afternoon session - 23 people) -- 13% "Yes"
5. Was a biological parent ever lost to you through divorce, abandonment, or other reason?
ACE Study -- 23.3% "Yes"
CA home visitors (morning session - 56 people) -- 53% "Yes"
CA home visitors (afternoon session - 23 people) -- 36% "Yes"
6. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
ACE Study -- 12.7% "Yes"
CA home visitors (morning session - 56 people) -- 13% "Yes"
CA home visitors (afternoon session - 23 people) -- 22% "Yes"
7. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
ACE Study -- 26.9% "Yes"
CA home visitors (morning session - 56 people) -- 52% "Yes"
CA home visitors (afternoon session - 23 people) -- 43% "Yes"
8. Was a household member depressed or mentally ill, or did a household member attempt suicide?
ACE Study -- 19.4% "Yes"
CA home visitors (morning session - 56 people) -- 47% "Yes"
CA home visitors (afternoon session - 23 people) -- 33% "Yes"
9. Did a household member go to prison?
ACE Study -- 4.7% "Yes"
CA home visitors (morning session - 56 people) -- 17% "Yes"
CA home visitors (afternoon session - 23 people) -- 14% "Yes"
10. Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you?
ACE Study -- 28.3% "Yes"
CA home visitors (morning session - 56 people) -- 27% "Yes"
CA home visitors (afternoon session - 23 people) -- 27% "Yes"
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