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Title: The%20Story%20of:%20A%20Childs%20Path%20to%20Mental%20Illness


1
There is no trust more sacred than the one the
world holds with children. There is no duty
more important than ensuring that their rights
are respected, that their welfare is protected,
that their lives are free from fear and want and
that they grow up in peace. Kofi A. Annan
2
The ACE StudyUnaddressed Childhood Trauma
  • Presented by Ann Jennings Ph.D.
  • www.TheAnnaInstitute.Org

3
Annas Story
4
This is Anna at age one and a half
This is Anna years later in a mental institution
What happened?
5
Anna Caroline Jennings 1960 - 1992
6
Collaboration between Kaiser Permanentes
Department of Preventive Medicine in San Diego
and the Center for Disease Control and Prevention
(CDC)
  • The Adverse Childhood Experiences Study
  • (ACE)

7
  • ACE Study slides are from
  • Robert F. Anda MD at the Center for Disease
    Control and Prevention (CDC)
  • September 2003 Presentation by Vincent Felitti MD
    Snowbird Conference of the Child Trauma
    Treatment Network of the Intermountain West
  • The Relationship of Adverse Childhood
    Experiences to Adult Medical Disease, Psychiatric
    Disorders, and Sexual Behavior Implications for
    Healthcare Book Chapter for The Hidden
    Epidemic The Impact of Early Life Trauma on
    Health and Disease Lanius Vermetten, Ed)

8
What is the Adverse Childhood Experiences (ACE)
Study?
  • Decade long. 17,000 people involved.
  • Looked at effects of adverse childhood
    experiences over the lifespan.
  • Largest study ever done on this subject.

9
ACE Study Findings
  • Childhood experiences are powerful determinants
    of who we become as adults

10
Adverse Childhood Experience Categories Abuse of Child Recurrent Severe Emotional abuse Recurrent Physical abuse Contact Sexual abuse Trauma in Childs Household Environment Substance abuse Parental separation or divorce - Chronically depressed, emotionally disturbed or suicidal household member Mother treated violently Imprisoned household member Loss of parent (by death, by suicide, - or by abandonment) Neglect of Child Abandonment Childs basic physical and/or emotional needs unmet Above types of ACEs are the heavy end of abuse. Impact of Trauma and Health Risk Behaviors to Ease the Pain Neurobiologic Effects of Trauma Disrupted neuro-development Difficulty controlling anger-rage Hallucinations Depression Panic reactions Anxiety Multiple (6) somatic problems Sleep problems Impaired memory Flashbacks Dissociation Health Risk Behaviors Smoking Severe obesity Physical inactivity Suicide attempts Alcoholism Drug abuse 50 sex partners Repetition of original trauma Self Injury Eating disorders Perpetrate interpersonal violence Long-Term Consequences of Unaddressed Trauma (ACEs) Disease and Disability Ischemic heart disease Cancer Chronic lung disease Chronic emphysema Asthma Liver disease Skeletal fractures Poor self rated health Sexually transmitted disease HIV/AIDS Serious Social Problems Homelessness Prostitution Delinquency, violence, criminal behavior Inability to sustain employment Re-victimization rape, DV compromised ability to parent Intergenerational transmission of abuse Long-term use of health, behavioral health, correctional, and social services

11
Adverse Childhood Experiences are Common
  • Of the 17,000 HMO Members
  • 1 in 4 exposed to 2 categories of ACEs
  • 1 in 16 was exposed to 4 categories.
  • 22 were sexually abused as children.
  • 66 of the women experienced abuse, violence or
    family strife in childhood.

12
  • The higher the ACE Score, the greater the
    likelihood of
  • Severe and persistent emotional problems
  • Health risk behaviors
  • Serious social problems
  • Adult disease and disability
  • High health and mental health care costs
  • Poor life expectancy
  • For example
  • The following information and slides are from
    September 2003 Presentation at Snowbird
    Conference of the Child Trauma Treatment Network
    of the Intermountain West, by Vincent J.
    Felitti, MD. And from Lanius/Vermetten Book
    Chapter 6/2007

13
Emotional Problems
14
Childhood Experiences Underlie Chronic
Depression
15
Childhood Experiences Underlie Suicide
4
3
2
1
0
16
ACE Score and Hallucinations
Abused Alcohol or Drugs
Ever Hallucinated ()
ACE Score
Adjusted for age, sex, race, and education.
17
Childhood Sexual Abuse and the Number of
Unexplained Symptoms
Percent Abused ()
Number of Symptoms
History of Childhood Sexual Abuse
18
ACE Score and Impaired Memory
of Childhood
Percent With Memory Impairment ()
ACE Score
1 2 3 4
5
ACE Score
19
Health Risk Behaviors
20
Adverse Childhood Experiences and Current Smoking

21
Childhood Experiences and Adult Alcoholism
4
3
2
1
0
22
ACE Score and Intravenous Drug Use
N 8,022 plt0.001
23
  • Basic cause of addiction is experience-dependent,
    not substance-dependent
  • Significant implications for medical practice and
    treatment programs

24
Serious Social Problems
25
Childhood Experiences Underlie Rape
4
3
2
1
0
26
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27
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28
Adverse Childhood Experiences andLikelihood of
gt 50 Sexual Partners
29
ACE Score and Unintended Pregnancy or Elective
Abortion
30
Sexual Abuse of Male Children and Their
Likelihood of Impregnating a Teenage Girl
1.8x
1.4x
1.3x
Percent who impregnated a teenage girl
1.0 ref
Not 16-18yrs 11-15
yrs lt10 yrs abused
Age when first abused
31
Frequency of Being Pushed, Grabbed, Slapped,
Shoved or Had Something Thrown at Oneself or
Ones Mother as a Girl and the Likelihood of Ever
Having a Teen Pregnancy
Pink self
Yellow mother
Percent who had a teen pregnancy
Never Once, Sometimes Often
Very Twice
often
32
ACE Score and Indicators of Impaired Worker
Performance
Prevalence of Impaired Performance ()
33
Adult Disease and Disability
34
Adverse Childhood Experiences andHistory of STD
35
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36
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38
High Health and Mental Health Care Costs
39
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40
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41
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42
Poor Life Expectancy
43
Effect of ACEs on Mortality
Age Group
44
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45
ACE Study
  • www.cdc.gov/nccdphp/ace
  • www.acestudy.org

46
  • Other Studies on Childhood Sexual and/or Physical
    Abuse

47
Sarah Joe, Anna
John Mary
  • Early Child Sexual Abuse (CSA) may especially
    impair resiliency

48
Substance Abuse and Unaddressed Childhood
Sexual/Physical Abuse
  • 2/3rds of men and women in SA treatment -
    physical and/or sexual abuse
  • 75 of the women - sexually abused.
    SAMHSA/CSAT, 2000 SAMHSA, 1994
  • Teenagers with alcohol and drug problems - 6 to
    12 times more likely physically abused ,
  • 18 to 21 times more likely sexually abused .
    Clark et al, 1997
  • Of AI/AN women in SA treatment 86 report
    physical abuse histories, 69 sexual abuse
    histories.
  • Of those with sexual abuse histories, 96.7
    physically abused . 96 of both (sa, pa)
    emotionally abused.
  • Saylors, 2003 2004

49
Serious Mental Illness and Unaddressed
Sexual/Physical Abuse
  • 51 98 of public mental health clients with
    severe mental health diagnoses

    Goodman et al, 1999, Mueser et al, 1998 Cusack
    et al, 2003
  • 93 of psychiatrically hospitalized adolescents
    Ipschitz et al, 1999

50
Criminal Justice Problems andUnaddressed
Sexual/Physical Abuse
  • More than 75 of girls in juvenile justice
    system Calhoun et al, 1993
  • 80 of women in prison and jails Smith, 1998
  • 100 of men on death row Freedman, Hemenway,
    2000
  • Boys who commit violence van der Kolk, 1998

51
Self-Injury and Suicide and Unaddressed Childhood
Sexual Abuse
  • Childhood sexual abuse is significantly related
    to adolescent and adult self-harm, including
    suicide attempts, cutting, and self-starving.
    Van der Kolk et al,
    1991
  • One study found childhood sexual abuse to be the
    single strongest predictor of suicidality
    Read et al, 2001

52
Prevalence of Child Sexual Abuse
  • 1/4th to 1/3rd of all children and as many as 42
    of girls are sexually abused before age 18 with
    9 experiencing persistent, genital assault.
    Males are underreported.
  • Saunders et al, 1992 Randall 1995 Epstein,
    1998
  • 79.8 of American Indian girls experience sexual
    abuse . This abuse starts early.
  • National Center on Child Abuse and Neglect,
    1999
  • One fifth of all sexually abused children
    develop serious psychological disturbances as
    adults . Giller, 2007

53
Yet the Silence Continues
They do not want to hear what their children
suffer. Theyve made the telling of the
suffering itself taboo From Possessing
the Secret of Joy, Alice Walker
From ACE Study Slides Vincent Felitti
54
The sexual and physical violation of children
results in alterations in self-perception which
are immediate, last throughout the life-span, and
contribute to suicidality as a way to cope.
Judith Herman, 1992
Lasting Alterations in Self Perception

55
Sense of helplessness, paralysis,
captivity,inadequacy, powerlessness, danger, fear
Continues over the lifespan
56
Sense of Shame, Guilt, Self-Blame, Being Bad
Continues over the lifespan
57
Sense of defilement, contamination, spoiled,
degraded, debased, despicable, evil
Continues over the lifespan
58
Sense of complete difference from others,
deviance, utter aloneness, isolation, non-human,
specialness, unseen, unheard, belief no other
person can ever understand
Continues over the lifespan
59
In Summary
  • Childhood abuse and trauma
  • Impacts brain and nervous system, perception of
    self and others
  • Causes serious and chronic health, behavioral
    health and social problems
  • Epidemic proportions. Major public health issue
  • Often unrecognized , ignored or denied.

60
There are Many Faces of Trauma
61
The Costs Are High1992 Analysis of Cost of
Annas Care
  • Over 17 years, Anna was hospitalized a total of
    4,124 days. At 648 a day the cost was
    2,639,360.
  • Other costs entitlements, residential
    treatment, case management, legal, medical were
    estimated to be over 1,000,000, bringing total
    cost to nearly 4,000,000.
  • Adjusted for inflation (2005) total cost
    5,417,032

62
1992 Analysis of Cost of Annas Care
  • Intensive trauma based psychotherapy, figured at
    150 a session, 2 sessions a week, for 17 years,
    would have cost a total of 265,200 - (compared
    to 2,639,360)
  • Had trauma been recognized and treated at age 3,
    costs would have been significantly less.
  • If parents had been trauma-informed, the abuse
    may not have occurred.

63
The financial burden to society of childhood
abuse and trauma is staggering.
  • Annual Direct Costs Hospitalization, Mental
    Health Care System, Child Welfare Service System
    and Law Enforcement 33,101,302,133.00
  • Annual Indirect Costs Special Education,
    Juvenile Delinquency, Mental Health and Health
    Care, Adult Criminal Justice System, Lost
    productivity to Society 70,652,715,359.00
  • Total Annual Cost 103,754,017,492.00
  • Economic Impact Study. (September,
    2007). Prevent Child Abuse America

64
Investing in Our Children
  • The issue is not are we going to pay - - - its
    are we going to pay now, up front, or are we
    going to pay a whole lot more later on.
  • Marian Wright Edelman

65
What Can We Do as Individuals?
  • Break societal silence and end the isolation of
    the child.
  • Ask what happened vs whats wrong with you.
  • Listen. Pay attention. Believe. Respond with
    compassion. Be a safe place for the child.

66
A Public Health Approach
  • I. Prevention
  • II. Detection and Early Intervention
  • III. Safe, Strengthening and Healing
    Environments and Responses

67
  • If you think youre too small to make a
    difference, try sleeping in a room with a
    mosquito.
  • African Proverb

68
  • The solution of adult problems tomorrow depends
    in large measure upon the way our children grow
    up today.
  • Margaret Mead

69
Thank Youwww.TheAnnaInstitute.Org
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