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
2The ACE StudyUnaddressed Childhood Trauma
- Presented by Ann Jennings Ph.D.
- www.TheAnnaInstitute.Org
3Annas Story
4This is Anna at age one and a half
This is Anna years later in a mental institution
What happened?
5Anna Caroline Jennings 1960 - 1992
6Collaboration 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)
8What 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.
9ACE Study Findings
- Childhood experiences are powerful determinants
of who we become as adults
10Adverse 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
13Emotional Problems
14Childhood Experiences Underlie Chronic
Depression
15Childhood Experiences Underlie Suicide
4
3
2
1
0
16ACE 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
19Health Risk Behaviors
20Adverse Childhood Experiences and Current Smoking
21Childhood Experiences and Adult Alcoholism
4
3
2
1
0
22ACE 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
24Serious Social Problems
25Childhood Experiences Underlie Rape
4
3
2
1
0
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28Adverse Childhood Experiences andLikelihood of
gt 50 Sexual Partners
29ACE Score and Unintended Pregnancy or Elective
Abortion
30Sexual 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
31Frequency 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
32ACE Score and Indicators of Impaired Worker
Performance
Prevalence of Impaired Performance ()
33Adult Disease and Disability
34Adverse Childhood Experiences andHistory of STD
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38High Health and Mental Health Care Costs
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42Poor Life Expectancy
43Effect of ACEs on Mortality
Age Group
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45ACE 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
48Substance 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
49Serious 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 -
50Criminal 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
51Self-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
52Prevalence 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
53Yet 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
54The 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
55Sense of helplessness, paralysis,
captivity,inadequacy, powerlessness, danger, fear
Continues over the lifespan
56Sense of Shame, Guilt, Self-Blame, Being Bad
Continues over the lifespan
57Sense of defilement, contamination, spoiled,
degraded, debased, despicable, evil
Continues over the lifespan
58Sense 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
59In 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.
60There are Many Faces of Trauma
61The 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
621992 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.
63The 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
64Investing 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
65What 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.
66A 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
69Thank Youwww.TheAnnaInstitute.Org